Decoding Cell Based Therapies (Stem cell treatments)
Dr Sandeep Sattur
MS, M Ch (Plastic Surgery)
Hair Transplant Surgeon.
Member ISHRS (International Society of Hair Restoration Surgery)
Founder Member AHRS- India (Association Of Hair Restoration Surgeons – India)
Hair loss is a problem faced by practically everyone at some time in their life. Though by itself it is not a disease, it has significant effect on the psychosocial wellbeing of the person. Man has sought to treat hair loss since ancient times.
Hair transplantation is one of the methods of hair restoration. Hair transplantation means transfer of hair follicles from androgen resistant area to androgen sensitive area with the transferred follicles retaining their native property of androgen resistance. The most significant limitation is the finite donor area. It has been the hope of hair restoration surgeons and patients alike, to have a modality of treatment which would not have any limitations and an endless supply of hair would be available for restoring lost hair in bald individuals. Converting hundreds of follicles from a single follicle was one such mechanism. This method was incorrectly addressed as hair cloning. The mechanism where one follicle is converted to hundreds of follicles is more accurately acknowledged as laboratory engineered cell growth or cell based therapy
In the last decade, the advances in stem cell biology and tissue engineering techniques have raised the hope of possible cell based therapies which could overcome the donor area limitation.
The seeds for cell therapy have their roots in the research dealing with normal hair growth in mammals. This demonstrated follicle induction by use of follicular stem cells. Since then the hope for a possible treatments by use of follicular stem cells has gone up.
Current research basically involves
1) Dermal papilla cells (DPC)
2) Epithelial stem cells from the bulge area
3) Dermal Cup Sheath cells (DSC)
The methodology is more or less same for all the cell types. A punch is used to harvest tissue from the permanent donor zone. In lab the cell types are isolated and cultured (multiplied). The collection of cell culture is then injected into the bald area.
The various hypotheses on how these stem cells will work have been proposed and these are:
- These cells may create new hair follicles
- They may stimulate the existing follicles converting the vellus follicles into thicker terminal follicles.
Till date there is no published report which has demonstrated formation of new follicles in the bald skin in humans. Most of the clinical trials in humans have shown that injection of stem cells into the scalp led to some thickening of existing vellus hairs. This result is similar to that achieved with conventional treatment (topical minoxidil and oral finasteride). The exact mechanism which leads to this thickening is not known. As the duration of the benefits is also not known it is difficult to predict whether a single treatment is required or multiple treatments on an ongoing basis are required. So at this point in time the expense of these cell based therapies may not justify its temporary benefits.
Moreover the hype associated with cell based therapies is such that many clinics/centres have fraudulently started using preliminary data obtained from studies in mice as final results. This has led to patients actually believing that the cure for baldness has arrived. Unfortunately, this not true. The researches in mice have demonstrated that new hair formation can be achieved but the same results could not be translated in humans. True hair multiplication has proved to be far more complicated than previously thought.
Another aspect that needs looking into is the safety of such treatments. The cells that are implanted are cultured in the laboratory and the behaviour of these cells may not be predictable after implantation. The biggest worry is the possibility of tumor formation. Review of existing human trials however has not shown any such incident. For these treatments to be a part of mainstream hair restoration practice, they mandate approval of statutory bodies like the FDA.
Advertisements alluding to stem cell usage in hair restoration are seen in newspapers, websites etc. These claim to replace hair transplantation as method of hair restoration. But unfortunately that is not true.
“As per the National Guidelines for Stem Cell Research – 2017, at present, there are no approved indications for stem cell therapy other than Haematopoietic Stem Cell Transplantation (HSCT) for haematological disorders. Accordingly, all stem cell therapies other than the above shall be treated as investigational and may be conducted only in the form of clinical trials after obtaining necessary regulatory approvals. Use of stem cells for any other purpose outside the domain of clinical trials will be considered unethical and hence not permissible.”
As things stand today cell based therapies seem to be the next big thing in treating hair loss but true hair multiplication is far away from being used as routine hair loss treatments.