The transplanted hairs are attached to the
hair root which we call follicle or graft commonly. The graft is of the size of
the rice grain and when we transplant them in your skin a major part remains
under the skin and a very small part remains projected outside the skin surface
as shown in the figure. Immediately after and for first 24 to 48 hours there
may be some oozing of blood from around the graft and if that blood is not washed away by spraying in
the early period that may form a dry
black brown scab which becomes hard
( as shown in the photo) and is difficult to remove for 10 to 20 days at times.
Usually
the skin heals in one week’s time. The overlying scab which is attached to the
graft if tried to remove forcibly before 1o days the graft may be pulled out
and that hair may not grow and more over there may be some bleeding from that
site. It takes 10 days for the graft to be secure in the skin and even by
removing scab it now does not come out and all that come out is the hair
attached to the dry scab and some sticky white material under the scab. It does
not bleed.The
hair will grow from this graft. The majority of
transplanted hairs will first fall between 10 to 30 days time after
transplant and they start growing form the already incorporated roots in 3-5
months time. This happens to every patient of hair transplant and this is not
abonormal.
For the first two days, pulling on a hair
always resulted in a lost graft, but the chance of the graft being removed
started to decrease by the third day. By the sixth day pulling on a hair would
no longer dislodge the graft. Pulling on an adherent scab always resulted in a
lost graft through day five. At nine days post-op, grafts were no longer at
risk of being dislodged.
The presence of crusting extends the interval that grafts are at risk of being
dislodged in the post-op period. If one can prevent crust formation by early
and regular washing following a hair transplant, this would both shorten the
time patients are at risk of losing their grafts and enable them to return to
their normal hair care routines more quickly.
At the outset it is important to know that cloning as it sounds fascinating is not only clinicallybut even experimentally successful in human beings. There are mainly 2 companies Aderans of America ( Japanese owned) and the UK based
Intercytex are into these experiments and world is looking for any positive that comes out from their efforts. Although it appears form recent evidence that it may not be less that 10 years away before it ic available clinically. Following information is compiled to give idea about developing and related topics.
It was known to the scientists that the Embryonic stem cells have pluripotent characteristics i.e. they can
develop in to any body tissue given proper environment.
There is a big ethical issue involved in the use of
Embryonic Stem cells due to possible loss of life.
The following
experiment made it clear that even some adult tissues cells have Pluripotent
characteristics they are called Adult
Stem Cells. The significance of Adult stem cells is not having such a
potential loss of life.
What is cloning?
Cloning technically means the production of genetically
identical organisms. The first clone of animal was Dolly, the famous Edinburgh
sheep. Although technically not an exact replica of her mother (and therefore
not a true clone), the revolutionary part
of the experiment was that it overturned
the long-held view that non-sex cells of an adult (somatic cells e.g. of liver, lungs. Brain, skin etc.) were
differentiated to such a degree that they lost
any potential to develop into a new adult organism or in other words other
genes in the cell became permanently inactive. The other major challenge was to
be able to initiate the multiplication
of the genetically altered cell and then to provide the proper environment in which the growth
of the new organism could take place.
Transgender Induction of Follicles: (1999)
From the idea of producing genetically identical organism it
was natural to come to the idea of genetically identical organ or for that sake
hair follicle (which is no less than an organ with multiple tissues and
complexity of an organ). Earliest successful work done in this field is that of
Colon Jahoda of England. In their
paper Transgender Induction of hair
Follicles, the researchers have
shown that dermal sheath cells (essentially
a fibroblast- an Adult
stem cells) , found in the lower part of the human follicle, was isolated
from one person ( a male) and then injected into the fore arm skin of genetically
unrelated another person (a female) to promote the formation of new intact
hair. The implanted cells interacted locally to stimulate the creation of full
terminal (i.e. normal) hair follicles. Although this is not actually cloning
the dermal sheath cells can potentially
be multiplied in a Petri dish and then injected in great numbers to produce a
full head of hair. The word potentially is highlighted, as this multiplication
has not yet been accomplished. It seems, however, that this hair “induction”
processes is the model most likely to work. It is well known that fibroblasts,
unlike many other tissue cells, are relatively easy to culture. Theoretically,
a patient's fibroblasts could be removed from the sheaths of just a few
follicles and then cultured to produce thousands of follicles. These
fibroblasts could then be injected back into the scalp to induce thousands of
new hair follicles to grow. So far this
important single study has not been reproduced.
Another interesting aspect of their experiment is that the
donor cells came from a male but the recipient, who actually grew the hair, was
a female. The importance of this is that donor cells can be transferred from
one person to another without being rejected. Since repeat implantations did
not provoke the typical rejection responses, even though the donor was of the
opposite sex and had a significantly different genetic profile, this indicates
that the dermal sheath cells have a special immune status and that the lower
hair follicle is one of the bodies “immune
privileged” sites.
Unlike, Follicular Unit Transplantation (FUT), in which an
intact follicular units are planted into the scalp in the exact direction the
surgeon wants the hair to grow, with cell implantation there is no guarantee
that the induced hair will grow in the right
direction or have the color, hair
thickness or texture to look natural. However, it is not even certain that
the induced follicles will actually grow
long enough to produce cosmetically significant hair. And once that hair is
shed in the normal hair cycle, there
are no assurances that it will grow and cycle again. A major technical problem
to cloning hair is that cells in culture
(unlike the Cloning of the whole organism in the uterus - a proper
environment) begin to de-differentiate
as they multiply and revert to acting like fibroblasts again, rather than hair.
In another experiment(2009)
The study —
conducted by Marwa Fawzi, a dermatologist at the University of Cairo Faculty of
Medicine, and reported on Bloomberg.com — used stem cells from the scalps of
eight children with alopecia areata to regenerate their own hair: The Cairo researcher
took small amounts of skin from the scalps of the children, isolated the hair
follicle stem cells that stimulate hair production, and grew them in the lab,
increasing the number of cells. After one month, she put the cells back into
the scalps of the children, with numerous injections across the bald areas of
their heads. Six months after the hair cloning
treatment, an evaluation showed a 50% increase in hair in more than half of the
subjects. Dr. Fawzi took new skin samples and examined the hair follicles
themselves and could see that the injected stem cells had migrated into the
follicles. There, the stem cells
stimulated the follicles to transition from a dormant phase to a
hair-generating phase. (Posted on
Bloomberg.com, July 10, 2009)
In the recent study published in Nature it is repored that in mice large skin wounds can regenerate new hair follicles.Report
by Dr. George Cotsarelis, a dermatology
professor at the University of Pennsylvania School of Medicine in Philadelphia
underlines that in regenerating woulds skin undergoes processes similar to
these during embryonic development which results in formation of new hair
follicles. This process happens in wounds of adult animals. This fact shows
that mammals and humans have better regenerative abilities than commonly
believed.
These new findings could provide basis for developing new treatment strategy
for male-pattern baldness and other types of hair loss. It is shown that hair
follicles newly formed from wounds functioned normally, cycle through the
normal stages of hair cycle. More
importantly, hair fibers that they produce are indistinguishable from
pre-existing hairs with one exception - lack of pigmentation.
Finding details:
In the reported experiments scientists
produced relatively large wounds on the backs of adult mice. When wounds reached
a certain size new hair follicles developed at the center of wounds. This
developmental process closely resembled normal embryonic development of hair
follicles.
It appears that as the part of this hair neogenesis non-hair skin stem
cells were able to transform into hair cell types. It was shown that the stem cells that gave rise to de novo hair
follicles were not stem cells usually associated with hair follicle development
(i.e. bulge stem cells). Dr. Cotsarelis comments: "...They're actually
coming from epidermal cells that don't normally make hair follicles. So they're
somehow reprogrammed and told to make a follicle..."
Dr. Cotsarelis is affiliated with with Follica Inc., that has a license for the
patent on this process of hair regeneration from wounds . He predicts that it
will be more than 5 years before a baldness treatment will be available.
These experiments have shown that Inducer role of Fibroblasts of Dermal Papilla, DP (and or
Dermal Sheath Cell ,DSC) [DP cells (fibroblasts) can be grown and multiplied in
culture so that a small number can produce enough hair follicles to cover an
entire bald scalp.] to induce Hair Follicle formation esp. in presence of Pluripotent
Progenitor Stem cells -Epithelial cells of Matrix keratinocytes.
Methods of cloning:
While considerable work remains on turning hair cloning
methods into a viable treatment for hair loss, there are four experimental
techniques described in a 2008 paper in Hair Transplant Forum International —
the primary medical journal in the field of hair transplantation — that shed
some light on how cloning could become a viable treatment in hair restoration.
* Teumer J. Strategies for follicular cell implantation. Hair Transplant Forum
International 2008.
1. Implant Dermal Papillae
Cells Alone
Implant DP cells into the
dermis
Cause the overlying skin
cells (keratinocytes) to be transformed into hair follicles
Referred to as “Follicular
neo-genesis” since new hair is formed on previously bald scalp
2. Implant Cloned
Dermal Papillae Cells Next to Miniaturized Follicles [ a model used by
Intercytex for research-called Follicular cell
regeneration]
DP cells induce the
keratinocytes of the miniaturized follicles to grow into terminal hairs
Advantage: existing
miniaturized follicles already have the proper structure and orientation
to produce a natural look
3. Implant Dermal
Papillae Cells with Keratinocytes (“Proto-Hairs”)-[ A model followed by Aderans
company of US- called follicular Neogenesis]
Keratinocytes and DP cells
are cultured together until partial hair formation takes place
These culture-grown hairs
(“proto-hairs”) are implanted in the skin
Advantage: better hair
direction because of the orientation of the proto-hair
4. Implant Cells Using a
Matrix
DP cells alone or in
combination with keratinocytes are placed in a matrix of collagen or
synthetic materials
Matrix acts like a scaffold
to help cells organize to form a follicle and direct its growth
Problem is that the
cultured cells (or Cloning) :
1. May lose their
ability to differentiate into hair follicles with multiple passages
2. Hair direction may
be uncontrolled. With mouse experiments, the hairs grow at all different
directions instead of in the right direction.
3. Hair, may not be
of a quality that is cosmetically acceptable and matches the patient
existing hair.
4. And the hair may
not grow in follicular units. Individual hairs will not give the fullness
or natural look of follicular units.
5. Issue of safety: Are we sure that cultured cells may not
turn into something else – such as malignancy
cells with uncontrolled growth?
6. Finally, FDA approval
would be required and this takes few years time
What is Hair Multiplication? (HM)
HM is a wider term that also includes other methods besides cloning. In hair multiplication, hairs are simply plucked from the
scalp or beard and then implanted into the bald part of the scalp. The idea is
that some germinative cells at the base
of the hair follicle will be pulled out along with the hair. Once the hair is
re-implanted, these cells would be able to regenerate a new follicle. In
theory, microscopic examination of the plucked hair could help the doctor
determine which hairs have the most stem cells attached and thus which are most
likely to regrow. The procedure is called “hair multiplication” since the
plucked follicles would regrow a new hair, potentially
giving an unlimited supply. In a modification of
this procedure, the bulbs of the hair
are separated from the shafts and then their cells (matrix keratinocytes and Mesodermal sheath or papilla
cells) cultivated in vitro (outside the
body). After the cells are multiplied, they are injected into the pores of
local, dormant hair follicles in the balding area. The problem with either technique is that matrix keratinocytes (the plucked
cells) are only transient amplifiers, and the stem cells around the bulge
region of the follicle, the ones most important for hair growth, are not
harvested in any significant numbers and can’t be readily activated to produce
a hair.
Genetic Engineering
In contrast to
replicating whole organisms, in genetic engineering, one alters the DNA of a
particular cell so that it can manufacture proteins to correct genetic defects
or produce other beneficial changes in an organism.
The initial step in genetic
engineering is to isolate the gene that is responsible for the problem. The next step is to clone (multiply) the
gene. The last step is to insert the
gene inside the cell so that it can work to alter bodily function. The focus of such work is to identify the defect that causes the problem we wish to fix and then
to develop a drug, enzyme blocker, or another approach to address the problem.
There are many baby steps taking us to that cure and Dr. Markus M Nothen of the
University of Bonn
in Germany
identified an androgen receptor gene on
the ‘X’ Chromosome which is contributed by the mother in setting a person
up for balding. The androgen receptor gene helps
govern the workings of male sex hormones (androgens), such as testosterone.
Though these hormones promote the growth of body and facial
hair, on the scalp excess androgens may cause hair loss. Dr. Nothen believes
that this is only one of possibly many
genes that trigger the balding process
Some websites about hair follicle
cloning or which follow it closely are…
1. Aderans
Research Institute: “dedicated to developing state-of-the-art cell
engineering solutions for hair loss.”
2. Intercytex:
It promotes “an autologous hair regeneration therapy, a suspension of human
dermal papilla (DP) cells, for the treatment of male pattern baldness and
female diffuse alopecia.” According to latest news the company has gone bust and has closed down the research operation in January 2010.
3. Follica: “Developing
novel therapies for conditions and disorders of the hair follicle, the
epicenter for the development and replenishment of human hair and skin.”
4. Histogen:
It is marketing “a proprietary liquid formula created by the culturing of
newborn fibroblasts in an embryonic-like environment and then harvesting the
naturally secreted growth factors, anitoxidants and other synergistic
bioproducts that are produced” that, it claims, may have “significant
applications” as “an injectable for hair growth.”
5. Luna
Innovations: It is use “nanomedicine” to stimulate new hair growth.
6. Hair
Science Institute: Dr. Coen Gho’s clinic that claims a superior
method for individual follicle transplantation.
7. Phoenix
Bio: A Japanese biotech company that “propagates hair papillar cells
which are the key element in hair growth and develops therapies that enable the
implantation of these cells on patients thus regenerating the ability of the
patient’s scalp to produce hair naturally.”
8. Shisheido
Research: Another Japanese company that is doing research into hair
multiplication technologies.
9. Bernstein Medical Center
for Hair Restoration: An advanced hair transplantation clinic, the
Bernstein Center also follows closely developments in hair cloning technologies
and is a good source for a
“hands on” reality check on what is realistic at the moment.
10.Doctors of St Vincent’s Hospital in Melbourne and Melbourne University in Australia with the leadership of Professor Sinclair are also in to stem cell research according to latest report
