Finding a cure for baldness is proving a real head-scratcher.
FINDING A CURE FOR BALDNESS IS PROVING A REAL HEAD-SCRATCHER
Why do we care so much about hair? If we’re not trying to wax it, pluck it, shave it, dye it or otherwise forcibly remove it, we’re desperately trying to put it back, popping pills, parting what’s left, paying for surgery or brazenly painting it on. Anything rather than admit it’s gone, lost, departed.
Baldness has an insidious power. “It has a massive psychological effect,” says Mike Marsh, not someone who generally crumples at the first challenge. He served for almost two decades in an elite branch of the British Armed Forces. Yet his thinning hair sent him running for cover. “Some of the guys in my unit were fine with it, they would just shave their heads. But I felt very self-conscious. It has that emotional effect. People like me, we will do anything.”
From now, that includes freezing follicles in hair banks, rather as some women might choose to preserve their eggs. The biotechnology firm Hairclone, based in Manchester, England has just been approved by the Human Tissue Authority to store follicular units ( FU). The idea is that 50-100 such units will be taken from patients and used to clone dermal papilla cells ( DPCS) found in abundance in the roots of healthy, thick hair. It is an experimental treatment, which will ultimately involve ( pending approval from the Medicines and Healthcare products Regulatory Agency) making the clones into a solution and injecting that into the scalp, repopulating the roots of thinning hair follicles.
There is no guarantee it will work. Even if it does, Dr. Bessam Farjo, Hairclone’s medical director, concedes that it will require repeating every few years to top up DPCS. And yet, Marsh is willing to take a bet. Like others, he will do anything to restore his mane.
“The procedure to harvest the follicle sample will cost around $3,500,” he says. “Then it is around $ 175 per year to preserve it. After that it will be about $10,000 every three to five years to culture and replace the cells. It is a gamble because it is experimental, but if the theory matches the experimental results, it will be a complete game-changer.”
The global hair loss market is currently worth about $4 billion, with sufferers like Mike willing to pay many thousands for the prospect of a renewed, lush mop. According to estimates from the International Society of Hair Restoration, there were more than 600,000 surgical hair restoration procedures performed worldwide in 2016 — almost triple the figure of a decade before.
The British Association of Dermatologists ( BAD) says that, aged 50, about half of men have male pattern hair loss ( also known as androgenetic alopecia). And it’s not just men going under the knife. Combined, female pattern hair loss and associated conditions related to a group of hormones known as androgens leave 40 per cent of women with some visible hair loss by the same age.
The problem, as BAD gloomily points out, is that “there is no cure.” Rather, it lists treatments including “licensed topical and oral treatments” — basically shampoos. But these can be expensive — and there are other costs. “Decreased libido and erectile problems are recognized side-effects of this treatment,” it notes, which seems a high price to pay if a sense of manliness is what you are striving to regain.
Other options on its list include wigs and what it euphemistically calls “skin camouflage.” There are downsides here, too: “These preparations may wash away if the hair gets wet in rain.”
Such lack of progress seems incredible. We live in an age in which the cost of sequencing an individual’s entire genome has fallen to hundreds of dollars. In which organs are routinely implanted. A paralyzed Polish man recovered movement after his severed spine was patched up with cells from his nose! And we can’t cure baldness? How hard can it be?
Very hard, it turns out. “Hair is far, far more complicated than it appears,” says Dr. Farjo. “Every week, someone publishes another research paper that describes a compound or chemical that is supposed to play a role in hair growth and loss.”
From stress to genes and hormones and inflammatory conditions, the causes are many and interwoven. “Hair is a whole system within the body,” says Dr. Farjo. “It’s very complicated.”
So while the money and the motivation has long been there, much of the hair replacement industry has remained more or less the same for 70 years, since surgical transplants were first offered in Fifties America.
Techniques then were unpalatable, and are testament to the desperation of patients. Surgeons used four to five millimetre borers to extract FUS from the back and side of the head to re-implant on top. To allow the skin to heal, the tiny discs of hair couldn’t be placed too close together, so a colander effect was produced. Two or three repeat visits were required to fill in the grid. And even then, it hardly had the feathery feel of the original follicles. “Aesthetically, it didn’t look good,” says Dr. Farjo.
More recently, surgeons started removing strips of scalp to harvest FUS. The average human has 100,000 such units, and the most such procedures could transplant without leaving livid scars was 4,000. Even with several ops, the results were never perfect.
Now there is follicle freezing. Yet Dr. Farjo admits that technologically isn’t as sexy as it sounds, freezing can only hope to rejuvenate existing, if thinning, hair.
“We’re not close to growing hair from scratch,” he laments. “We don’t have the full answer about the interaction between hormones and enzymes and proteins to create hair, and even if we do, mechanically it can be hard to deposit in the tiny space and keep it there. We’re years away. It’s like nature has a protection to stop us from curing baldness.”
Not everyone is so downcast. In the U.S., the Stemson Therapeutics company is trying to clone not just dermal papilla but also hair follicles. Implanting such follicles is hard, as hair risks sprouting in all directions. Stemson hopes to overcome this by using a “scaffold” for cloned follicles. And in December last year another researcher, Angela Christiano, a professor of genetics and dermatology at Columbia University, described using 3D printed follicle moulds. These were implanted in mice, which proceeded to sprout human hair.
She imagines hair farms, in which cloned DPCS “seed” thousands of 3D- printed moulds, with the follicles created implanted into the scalp.
Finally, we might all have access to an infinite supply of thick youthful hair, cloned from our own cells. “Use of this new technology by hair researchers, hair restoration surgeons and the pharmaceutical and cosmetic industries will have overwhelming implications in the maintenance and regeneration of this complex human tissue,” she wrote in Nature magazine.
To Mike Marsh that sounds like a dream. He is all for being “baldness positive.” He has long tried to reconcile himself to losing his hair. But he just can’t. He knows that failing to do so has exposed him to charlatans. “There is a lot of smoke and mirrors out there,” he says. “People get exploited. But I started losing my hair aged 25. Now I’m 39. And I know now that it is a mental health thing. It’s linked to that.”
HAIR IS FAR, FAR MORE COMPLICATED THAN IT APPEARS.