DAVID FOLK THOMAS: Welcome to our webcast. I'm David Folk Thomas. In 1996, a lamb named Dolly was cloned from the genetic material of another sheep, and if they can clone a lamb, why not some hair for balding heads? Cloning for hair loss is not an option yet, but current research is moving in that direction. How would hair cloning work, and how soon might it be an option for hair loss patients? Join us as we take an in-depth look at what the future of hair treatment might look like.
Joining me to take that in-depth look, on my left is Dr. Angela Christiano. She is an Associate Professor of Dermatology and Genetics at Columbia University, and to Angela's left is Dr. Animesh Sinha. He's an Assistant Professor in the Department of Dermatology at Weill Medical College of Cornell University and New York Hospital. Thank you both for joining us.
Now, Ani, let me start with you. What is the current state of the art in hair transplantation?
ANIMESH SINHA, MD, PhD: David, I think what's been exciting for dermatologists and their patients alike are the tremendous advances that have occurred over the last couple decades in hair transplantation surgery. You may all remember some strangers on the street or friends of our who had the old-fashioned plugs that were the horror stories from two or three decades ago. The science and the surgical techniques have evolved tremendously to single-graft transplants and micrografts that have allowed for much more natural redefinition of the hairline. So there is a tremendous advance, and with new biology and science coming about that Angela's going to come to, I think there is even more potential in the near future.
DAVID FOLK THOMAS: Angela, what exactly? We mentioned cloning of sheep, and now cloning of hair, so explain what that's all about.
ANGELA CHRISTIANO, PhD: Let's talk about definitions a little first. When we talk about cloning a sheep, we're not talking here about trying to recreate a whole person from a single hair follicle, so the challenge isn't nearly as great as it was to make an entire organism from one cell. Really, what we want to be able to do is nothing more than use your body's own cells to regenerate structures that have begun to atrophy or die. The technology, more broadly called tissue regeneration or cell engineering is being widely applied through many areas of medicine -- people trying to recreate vessels or to recreate cartilage or to get your body to do what it knows how to do, but which somehow over time has either been injured or lost the ability to do.
So the theory of hair follicle cloning, if you will, is very simple and elegant. It's simply to take a few hair follicle cells from your own scalp -- usually in the back -- or a donor area, and the theory would be to grow or cultivate large populations of cells in a laboratory, your own cells, and then to surgically reimplant those cells into the scalp into the front of the head.
DAVID FOLK THOMAS: Now, those cells, that's before they start growing the hair, or are you growing the hair in the lab?
ANGELA CHRISTIANO, PhD: One of the great limitations of hair biology is that we don't yet know how to grow a hair in a dish, and if we did we'd be in a lot better shape. But right now we have no good way to do that, so what we're really just hoping to do is to culture the important cells, the germinative cells, and then use those to reimplant into the scalp, and then to let nature take its course, to basically allow those cells to induce a brand-new hair follicle.
In theory, it's already been done. Last year, a paper was published in Nature which showed that between a different donor and a different recipient, those particular cells could be implanted in the forearm of the recipient, and even in an area where no hair usually grows, those cells were powerful enough to induce a new hair follicle. The technical challenges are many at this point, and no one has successfully done it large scale. If you use your own cells, of course the hair should be the same color, but there's still the question of direction, angling, and the most important question with the new hair is the cycle, and those are technical aspects that haven't been worked out yet. But that would be, in theory, the goal.
DAVID FOLK THOMAS: By cycle, you mean once it grew and then fell out, if it would grow again?
ANGELA CHRISTIANO, PhD: Right. Exactly.
DAVID FOLK THOMAS: I guess at that point maybe you'd go through the procedure again. Now, is this something new? Why couldn't this have been tried 20 years ago, or could it have been, but people just decided, "Let's go this direction right now?"
ANGELA CHRISTIANO, PhD: I think the whole field of tissue engineering is just coming into its own, and the technology to grow cells and propagate them, keep them alive in the lab, is something that's relatively new. More important about these particular types of cells is keeping them in what we call a primitive state. We don't want them to differentiate or grow up into mature skin or hair cells. We want to keep them immature, because we think that in their immature state is when they have the instructions that dictate how to make a hair.So the techniques, the laboratory techniques, are just coming of age.
In addition, the surgical techniques for learning how to reimplant cells in a given direction in a uniform way is something that will bring us back to the clinic. Eventually it will be medical practitioners who probably implant these cells into recipient patients, but one of the key principles in hair transplant is that the current technology simply takes hair from the back of your head and moves them to the front of your head, so you're working with a finite number of hair follicles. The beauty of cloning would be that you could actually increase the overall number of follicles, because you wouldn't need to harvest too many from the back, yet you could build more in the areas where you need it.
DAVID FOLK THOMAS: Is it necessary to use your own hair follicles, or could you use hair follicles from somebody else, who ostensibly had a lot of hair who never went through hair loss, in a patient who is balding?
ANGELA CHRISTIANO, PhD: One of the nicest things about male pattern hair loss is that the area in the back of the head, the fringe is preserved. In most cases, it's actually protected from male pattern baldness for reasons we don't understand. One of the most important lessons from hair transplantation has been the concept of donor dominance. That is, when you move good hairs from the back of the head to the front, they maintain the character from the back of the head and they don't usually fall out once you move them to the front. So I think the concept of using a different donor is probably not even necessary, although the experiment that was published last year was between a male and a female, very different donors and recipients.
ANIMESH SINHA, MD, PhD: Angela, in that case, when the donor and recipients are different individuals, is there a risk or a problem with rejection?
ANGELA CHRISTIANO, PhD: In this particular case, that was one of the most important questions -- would the new hair be rejected from the recipient? They were not immunologically matched. They had been tested and they weren't compatible. In the first three hairs that were grown, there was no evidence for an overt immune response, so it didn't seem as though the body was rejecting the new hair. The concept of immune privilege is something that's been speculated for the hair, but at least initially, in the first experiments, it wasn't a problem.
ANIMESH SINHA, MD, PhD: That might open up a whole new source, a bigger source of potential donors, and you might even have designer choices of color and texture at some point.
DAVID FOLK THOMAS: Are there any obstacles that are in front of you as you go down this cloning road?
ANGELA CHRISTIANO, PhD: Sure. There are several groups around the world that are trying to do this, and I think right now the biggest obstacle is learning how to keep the cells alive, and then once you put them back in, getting them to make new hair. So the technical aspects are still being worked out, but in theory I think it's certainly something approachable. It's something we should see probably sooner than we see a cure for male pattern hair loss.
DAVID FOLK THOMAS: Now, Angela, this webcast stands on its own, but you know the question that's coming next, right? So why don't you tell our audience what that question is and then answer it.
ANGELA CHRISTIANO, PhD: The question is, how long until you can go to a dermatologic surgeon and have this done? Right now, the answer is not within the next few years. It certainly needs to be perfected and then has to go through clinical trials to be sure that it's safe, because it is tissue manipulation. I think a conservative guess would be that within five years we might be at the point of clinical trials, and then maybe within 10 years to the point where this is a commonplace surgical procedure. But that's, again, best-case.
DAVID FOLK THOMAS: That sounds very promising. A lot of great things happening out there in the world of hair loss. Angela and Ani, I want to thank you for joining me. My name is David Folk Thomas, and we'll see you next time.