Future hair loss treatments will exceed the barriers of many cosmetic, medical and surgical methods used nowadays. Some new treatment methods including hair cloning and gene therapy are able to cure hereditary patterned baldness permanently.
However, it is logical to ask: why is the scientific society making huge efforts on medical research and paying big funds on hair loss treatment, while other fatal diseases such as AIDS, cancer, diabetes and heart diseases wait for solutions? In fact, human hair follicles are a rich scientific models to better understand important fields of human cell biology, tissue evolutionary biology, immunity, cell divisions and differentiation and of course human genome. When talking about hair growth cycle, hair follicles usually vanish totally after shedding phase, and probably new follicles develop and start growing in the next phase.
Creation of brand new hair follicles at the start of every growing phase gives more opportunities to apply new developed molecular-biological techniques like cloning and gene therapy. When we discover the function of one part of the body, surely it will have relation with something else, it means what we learn in one medical field will surely be applied in other fields.
Nowadays, many hair loss medications have very limited effectiveness. Also, we don’t have enough information why several diseases lead to hair loss. In many cases, we treat the symptoms not the causes of the disease, usually treatment of these diseases are not effective enough. In fact, medications prescribed these days for androgenetic alopecia, require continuous use to guarantee its results, these medications usually have limited effect on some patients. Also, they need to carry the cost of these medications for long periods to have the wanted results. In the future, scientists and physicians will have a better understanding of how to control normal hair growth cycle, and how other conditions affect it.
Also, they will develop new effective treatments to target hair loss causes and lower its side effects.
Dutestride is one of the promising future treatments. Currently, it is prescribed for treating benign prostate hyperplasia. It is produced by GSK (GlaxoSmithCline) under the commercial name Avodart. Like Fenestride, Dutestride is 5α-reductase inhibitor, taken in form of pills. It is shown that it inhibits chemical reactions that transform testosterone to dehydrotestosteron(DHT). High levels of this molecule cause prostate hyperplasia over years. In addition, it send signals to reduce hair growth causing baldness in those who are genetically qualified with hair bulbs sensitive to dehydrotestosteron.
Lowering DHT levels weakens these signals and reduce their effect on hair. The trick is to use a medication to inhibit 5α-reductase from converting testosterone to dehydrotestosteron, consequently, hair will grow again.
There are two forms of 5α-reductase inhibitor that converts testosterone to dehydrotstosterone. While Fenistride can be effective inhibiting 5α-reductase inhibitor type 2, dusteride inhibits type Fenestide lowers DHT with 65-70%, while dutestride affect can reach 90% or more. It is expected that Dutestride will be better for women who have hereditary hair loss more than any other medication currently available, as well for men who did not benefit from Fenestride. Dutestride side effects are similar to Fenestride. Anyway, doses prescribed for hair loss treatment are not determined yet, and side effects appearance depends on the dose.
Specific targeting of cells causing hair loss is the way to increase the effectiveness of hair loss medications, and reduce side effects at the same time. In the future, we will have topical lotions applied to the scalp that will block the DHT signals from getting to hair bulbs cells more effectively. Medications in pill form such as Fenestride and Dutasteride affect DHT blood levels, which in turn affects the amount of DHT in scalp tissue; it means it affects DHT concentrations at the cellular level in hair bulbs.
In the future, we will be able to better affect the DHT levels in the cells in the hair bulbs, and as a result better control hair loss, and reduce its side effects. Future medications may be combined with shampoos or hair conditioners, and these products will become a common way to keep hair from shedding, just as fluoride in toothpaste used now to help prevent from tooth decay.
There will also be development in medications to treat hair loss conditions other than genetic pattern baldness. In the future we will develop new drugs that will emit more powerfully signals to cells in the hair bulbs to start or remain in the anagen (growing) phase and continue producing hair, even when they receive other inhibitory signals, such as from sudden stressful events. And we will make advances in medications to cure diseases causing both permanent and temporary hair loss.
Doctors call diseases and conditions that cause temporary hair loss “non-scarring alopecia” because hair follicles are not harmed or damaged. The hair is lost, but it either regrows all by itself, or with the right chemical signals. Alopecia aerate is a non-scarring alopecia. Some alopecia aerate patients have been able to regrow hair even after years of constant hair loss. Hair loss resulting from chemotherapy, and moderate doses of radiation treatment, are also non-scarring. Hair shafts that are pulled out of hair bulbs, do not permanently damage them. After being plucked, the follicle rests and recovers, and a new hair bulb is grown, and it then produces a new hair.
Non-scarring alopecia’s affect the “bulb” which is a part of the hair follicle, located at its base deep in the skin. The specialized cells in the bulb grow hair shaft for 4 to 6 years during each hair growth cycle, but at the end, they seem to deteriorate as the hair follicle shrinks in size and enters the rest stage of the normal growth cycle. New hair bulb cells are then produced at the beginning of the following growth cycle. Future medications that effectively targets or protects bulb cells, may result more effective treatment for alopecia aerate, as well as less hair loss from stressful events and cancer treatments.
Doctors call diseases that cause permanent hair loss “scarring alopecia’s”, because the disease alters or scars the hair follicle in such a way that it loses the ability to grow new hairs again. Some scarring alopecia’s, such as lupus erythematosus and lichen planopilaris, trigger an inflammatory immune response where white blood cells attack cells in the “bulge” area of the hair follicle. The bulge area is located near the middle of the hair bulb, below the sebaceous (oil) gland and near the attachment point of arrector pili muscle (the tiny muscle that allows hairs to “stand on end”).
Androgenetic alopecia (genetic pattern hair loss) is also considered a scarring alopecia, as it decreases hair bulb production over time until no new hairs are able to grow. New researched suggested the inflammation area in these permanent hair loss diseases is the “bulge” portion of the hair follicle, and certain cells in the bulge area are believed to be responsible for re-growing the hair bulbs at the beginning of each new growth stage. It is believed that many cells in the bulge produce the bulb cells at the start of each growing phase, these new cells form new hair. When the cells in the bulge area are sufficiently injured, the hair follicle is not able to grow a new bulb, and no new hair is produced. In the future, medications that protect the cells in the bulge area will treat permanent hair loss diseases more effectively, including genetic pattern hair loss.
Surgical treatments available nowadays are limited in effectiveness because no new hair is added. Current surgical methods simply cannot produce a full head of thicker hair. The essential key to improve surgical treatment is cloning hair follicles. Successfully cloning multiple hair follicles from a donor area follicle that is already programmed to continue to grow new hairs for a lifetime will give in a limitless supply of hair grafts, which means having limitless hair thickness, just like the normal one. It will be possible to indirectly inject cloned follicles into the scalp, eliminating surgery altogether.
So, if scientists have already clone an entire sheep, why isn’t human hair follicle cloning a possible reality? The answer is somehow complicated, and requires some explanation of cell biology, genetics, cell replication, and then a review of some different types of cloning that may apply in the future to duplicate of human hair follicles.
Cells are the basic units of all living organisms. Cells in a multi-celled organism have specialized characteristics that allow them to most efficiently do their particular functions. Individual cells in an organism work together with other similar cells in tissue, or they work together with different types of cells in specialized cell structures called organs. For example, in a hair follicle, which is a miniature organ, there are several different types of cells working together to grow a hair.
Inside every mature cell is a structure called a nucleus that contains chromosomes composed of double strands of twisted DNA molecules? DNA molecules contain information about creating particular types of proteins, and the cell uses that information to make the proteins that allow it to perform its particular function. Some proteins are structural, such as keratin protein in hair, while others have the function of sending messages, such as the hormone DHT, and some proteins such as the enzyme 5-alpha-reductase, help convert proteins from one form to another.
Parts of DNA molecules that contain the codes for particular types of proteins are called genes. That is all genes are instructions for making specific proteins. There are no genes for particular body characteristics, such as “pattern baldness” or “green eyes” or “curly hair”. Only instructions for making proteins. But the particular types of proteins that genes instruct cells to make, determine characteristics such as inherited hair loss and eye color and hair curling. Usually many different genes, and many different proteins, together determine particular inherited body characteristics.
A remarkable characteristic of cells in multi-celled organisms is that each one contains in its chromosomes a complete DNA blueprint of all the genes for all the proteins of the entire organism. However, individual cells use only the protein-making information that they need to do their particular work, even though they contain the protein-making information for the entire organism. For example, cells in the iris of the eye may make the proteins that express the characteristics for green eyes, but not the proteins that could cause pattern baldness or curly hair, or any other of thousands genetic traits of the organism. But all the information to make these proteins is contained in the iris cells but they are inactive; just as the information for making proteins that result in green eyes is contained in hair follicle cells. Unlocking the DNA information in mature specialized cells is an important aspect of some cloning techniques.’
In a rapidly growing embryo, cells replicate by splitting in half and then grow to full size again. This process is called cell mitosis, and each half of a cell that splits contains a complete and exact set of the organism’s DNA. When the embryo grows into a fully functioning organism, its cells start to specialize, and begin to divide less. As cells become more specialized, cell replication shifts to special precursor cells called stem cells.
Specialized and differentiated cells do not replicate easily, maybe as a defense line against cancers, which is characterized by uncontrolled cell replicating. But all cells die by time, and new ones must replace them. Some cells live for days, others for years, others for decades, but at the end, they all die. The inability of differentiated cells to replicate themselves limit the body ability to repair itself and heal wounds and replace aging cells, as it makes cloning difficult.
In mature organisms there are undifferentiated cells called stem cells responsible of replacing old or harmed specialized cells. Stem cells are located in every self-repairing tissue, but most of them are hard to be discovered in a mature organism. Stem cells in mature organisms are similar to the embryonic ones, they can differentiate to any type of specialized cells. When stem cells are not actively making new cells, they devise infrequently which reduces the risk of undesirable DNA mutations. But when they are directed to make new cells of a particular type, they produce typically short-lived intermediate cells called transient amplifying cells, which in turn engage in rapid cell mitosis and create the specialized cells that the organism needs.
Well, for a quick review, we have learned that cells make up tissue and organs, which make organisms. The DNA in cells contains genes that are instructions for making proteins, and these proteins determine specialized cell characteristics and functions. Specialized cells in turn, determine characteristics of an organism, including inherited characteristics, like resistance to DHT, for example. Specialized cells do not replicate themselves easily. When an organism needs new specialized cells, stem cells are signaled to create transient amplifying cells, which in turn make the needed specialized cells.
There is an even more advanced technique for curing inherited hair loss in the future which is gene therapy. Gene therapy consists of changing genes of existing cells in the body, and thereby altering cell function. It is a medical treatment still at its first steps, and there have been only a few recent examples of gene therapy working. But it is a potential future baldness treatment method worth exploring.
Gene therapy requires learning how inherited medical conditions occur at the DNA molecule level, and then detecting and fixing it. With gene therapy, the hair follicles with DHT-sensitive cells could be changed into follicles with resistant cells, and the hair follicles would keep growing new hairs for a lifetime. But gene therapy involves several steps difficult to achieve. The first step is figuring out which of the tens of thousands of genes on strands of DNA are involved in the characteristic to be changed, and the second step is figuring out how exactly change these genes, so that they give instructions for making different proteins that will achieve the desired effect. The third step is getting the target cells in the living organism to incorporate the new and improved genes as alternatives for the old undesirable genes.
Figuring out which genes are involved in the genetic condition to be changed is not an easy task. Despite all the progress in mapping genes in recent years, we are still very far away from knowing the function of all these genes. We certainly do not have a good understanding of all of the genes that affect hair growth cycle, especially which genes are responsible for inherited hair loss. It is most likely that several genes are responsible for making proteins that cause certain hair follicles to be DHT-sensitive.
It is possible that future studies will involve comparing the genes and resulting proteins in different bulbs from the same person. In a given individual with androgenetic alopecia, some hair bulb cells will express the characteristic of DHT-resistance (the bulbs at the back of the scalp), while other hair bulbs on the same person will express the characteristic of DHT-sensitivity (at the hairline, for example). Both follicles contain cells with identical DNA, but they express different characteristics. So identifying the responsible genes will be hard. And even after we identify these genes, we have to figure out how to change them so they will make proteins that create DHT-resistant hair bulbs. Scientists have been making progress in gene identification.
The third challenge of gene therapy is delivering the new-and-improved genes to the target cells, after that, these cells must use the new genes to make new proteins so at the end altered cells express the desired characteristic.
Choosing the right targeted cells is the key point for gene therapy success. If the specialized cells were edited, the benefits of gene therapy will fade after the death of these cells and replacing them with new cells containing the original DNA. To have a long-term effect, we must target stem cells. When successful, the altered stem cells will make altered transient amplifying cells, which in turn will make altered specialized cells that will express the desired characteristics.
The most common altered gene-delivery method involves using weakened viruses to insert desired genes into the target cells. Outside of the laboratory, viruses are tiny organisms that infect cells by replacing some of the cell’s DNA with virus DNA. After infection by a virus, a cell begin to make the proteins expressed by the virus DNA, causing the expression of various diseases. Scientists use the virus infection mechanism to deliver desirable DNA.
First, they cripple the virus DNA so that it cannot reproduce or cause harmful effects, but is still able to insert new DNA into target cells. The desired genes are spliced onto to the virus DNA, and the viruses insert the new DNA into the target cells. The viruses can be injected directly to the location of stem cells, or the stem cells may be cultured in a laboratory, altered by viruses containing the new DNA, and then the altered stem cells can be placed back into the organism.
There are many fields of gene therapy that need more search. Identifying genes, determining exactly how to change them to code for the desired proteins, avoiding an immune response when the viruses are injected directly into the organism, getting an enough quantity of target cells to take the altered DNA regardless of how it is delivered, and getting the cells that express the characteristics coded by the altered genes, once the new DNA is inserted, all this need more work and research. But progress is being made in this field.
In summary, the future of hair loss treatment shows great promise, starting from new medications such as dutasteride to advances in cloning and gene therapy. But many of these treatments need years, and maybe decades to be at commercial use. Current treatment methods, including cosmetic products, drugs such as Fenistride, and surgical procedures such as follicular unit micrografts are available right now, if you really want to do something about your hair loss. Your first step should be scheduling an examination with a dermatologist knowledgeable about hair loss treatment.