By Meghana Keshavan @megkesh
August 12, 2016
Christiano, a researcher at Columbia University, has a condition known as alopecia areata, which leads to sudden and substantial hair loss. And she’s not satisfied with the treatments on the market: There are just two approved drugs for hair loss, and both are more than 20 years old.
So she’s trying a radically new approach — turning a patient’s own stem cells, which in theory can convert into any type of cell in the body, into hair that could then be transplanted to cover bald patches.
Christiano’s work — she’s also got a second startup, taking an entirely different tack — reflects a burgeoning interest in the biotech community in treating hair loss as a medical condition. The problem has traditionally been treated as a cosmetic issue, so it’s drawn less attention than dire diseases like cancer. But scientists are now tackling the problem in several novel ways — though experts caution that false starts are inevitable and it’ll be a while before new products hit the market.
“Hair is hot right now,” said Dr. Melissa Piliang, a dermatologist at Cleveland Clinic. “But it’s hard to grow hair.”
Several forms of hair loss impact both men and women. The most immediately devastating kind is alopecia areata — a rare condition in which the immune system attacks hair follicles, causing huge swaths of hair to fall out en masse. Another is androgenetic alopecia — a genetic form of hair loss seen in both men and women, often starting at a relatively young age.
Then there’s run-of-the-mill hair loss due to aging, which also affects both genders. Half of all women experience some form of hair loss, especially after menopause, and it can cause great turmoil. “Women feel they shouldn’t lose their hair, and have an enormous amount of emotional anxiety about it,” Piliang said.
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The two hair loss drugs on the market now are Propecia and Rogaine, or minoxidil, which is the only approved treatment for women, and which now comes in purple-and-teal packaging marketed for female patients. (Propecia alters hormonal levels so powerfully that pregnant women are advised to not even touch the pills.) Given that Americans spend $3.5 billion a year on hair loss products — most of which don’t work at all — there’s huge financial incentive to develop something new.
Samumed, a San Diego startup that shot to the spotlight this year with ambitious claims that it’s inventing drugs to reverse aging, is working on baldness as well as diseases such as osteoarthritis and pancreatic cancer. Samumed’s approach targets a molecular signaling channel known as the WNT pathway, which plays an important role in hair growth. The company says it does not interfere with hormones — a major concern in developing hair growth products for women.
The company has already conducted two Phase 2 trials for male pattern baldness. In one trial with more than 300 patients, participants who took a low dose of the drug showed a nearly 10 percent increase in hair count over 135 days. Those taking placebos continued to lose hair. The study has not been published or peer-reviewed; the company presented the results this spring at a meeting of the American Academy of Dermatology.
So far, the drug has been tested only in men; testing the drug in women is part of Samumed’s “long-term plan,” but the company has to discuss it first with the Food and Drug Administration, said Dr. Yusuf Yazici, chief medical officer of Samumed. “Androgenetic alopecia is a bigger disease in men — more patients are affected by it,” he said.
Christiano is taking a different approach — or, actually, two different approaches.
Her startup Vixen Pharmaceuticals worked to develop a hair loss drug from so-called JAK inhibitors, which tamp down the activity of a class of enzymes called janus kinase. Two JAK inhibitors have been approved by the FDA — not for baldness, but for rheumatoid arthritis, psoriasis, and a type of skin cancer called myelofibrosis. Both are used off-label for other autoimmune conditions — including hair loss.
Vixen was acquired a few months ago by Pennsylvania-based Aclaris Therapeutics; the company intends to develop JAK inhibitors to treat hair loss. (Regarding that name: “Vixen,” of course, is the term for female fox — and, as Christiano noted, the word “alopecia” means “mangy fox” in Greek.)
With her second startup, Rapunzel, Christiano aims to solve a big problem in hair transplant surgery: It requires removing hair from one part of the body to transplant it elsewhere. But there’s only a finite amount of hair to harvest from one’s own body.
That’s why she wants to grow hair in the lab.
The challenge, to date, has been getting scalp stem cells to turn into actual hair follicles — for years, scientists could only get them to morph into standard fibroblasts, which are cells that create generic connective tissue. Christiano’s lab has now found that it can grow actual hair on a 3-D scaffold of tissue culture medium doused with a mix of growth factors.
“Rat hair, that is — we can grow rat hair like it’s no tomorrow,” Christiano said. “But we think we can do it with human hair, too.”
Hair restoration surgeon Dr. Joseph Greco thinks Christiano is headed in the right direction.
“The race to the moon is the multiplication of hair,” Greco said. “To be able to have an inexhaustable supply. … That’s coming in the next five to 10 years.”
On top of standard hair transplantation surgery, Greco offers a technique called “platelet rich plasma,” or PRP, which is meant to stimulate growth in lazy hair follicles. Seven out of 10 of his hair loss customers are women.
Greco’s team draws a patient’s blood, spins it in a centrifuge to extract the plasma, isolates growth factors from the platelets, adds nutrients, then re-injects the mixture into patients’ scalps. It costs about $1,600 for the first treatment, then a bit less for follow-on visits — recommended every six months to a year.
Greco participated in a 2014 pilot study of 64 women that found PRP showed promise in treating androgenetic hair loss, but the procedure has not been formally tested in a randomized clinical trial.
Not waiting for a miracle cure
For all the excitement around the new approaches, scientists also raise a note of caution. They remember the enthusiasm more than a decade ago when a new gene controlling what’s called the “sonic hedgehog” pathway was discovered — and showed promise in treating hair loss. New companies began to spring up around the hedgehog approach — until it hit an important snag.
“They found that the ‘Sonic The Hedgehog’ pathway was also involved in skin cancer — so that kind of dampened a lot of the enthusiasm of using drugs for hair growth,” Christiano said.
Lauren Engle, a Dallas mother of two, isn’t waiting around for a miracle cure. When she was pregnant with her first child, Engle “lost a ton of hair,” she said. She’s tried Rogaine and spironolactone, which is used off-label for hair loss, but came off the drugs because of their potential harm during her childbearing years.
Engle writes a blog, “Corner of Hope and Mane,” and sends out a regular newsletter to some 3,500 women, providing tips on how to “wear hair,” and cope with the stigma and depression associated with women’s hair loss.
“It’s devastating for a lot of people,” Engle said. “Hair can be the crowning jewel of women’s appearance — of their female identity.”
Meghana Keshavan can be reached at Meghana.Keshavan@statnews.com
Follow Meghana on Twitter @megkesh
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