Doctors have spent decades searching for a way to reverse hair loss. Why haven’t we found the ultimate remedy? Jeremy Laurance reports.
It ought to be simple. We grow babies in test tubes, so why not hair? A sheet of cells cultivated in the laboratory would be stitched onto a polished scalp to produce a good, thick crop. It could rescue hundreds of thousands of men and women from the misery of baldness and for the company that cracked the problem, riches would flow.
Odd, then, that baldness has so far defied the best efforts of the hair technologists, considering the size of the potential market. Thirty-five million Americans spend $1.5 billion ($A2.6 billion) a year on hairrestoration products, drugs and transplant surgery.
While similar figures are not available here, it’s estimated that about 45 per cent of Australian adult men and about 19 per cent of women suffer hair loss.
Baldness has always been a hot topic in boardrooms, bedrooms, laboratories. As Melbourne dermatologist Dr Rodney Sinclair points out, it has been a prime matter of conversation “for about 1000 years”.
Hippocrates noted that castration saved the eunuchs in the Persian army from baldness but stopped short of recommending it as a treatment. The belief that a hairless scalp is a sign of manliness has persisted, however.
In business, baldies do well, and the fashion for aggressively shaved heads looks like an attempt by men to reassert their dwindling authority.
But where baldies lose out is with the opposite sex. Women don’t like a slap head at least one with a worn-out, threadbare look (as opposed to the deliberate, close-cropped kind).
The yearning for a luxuriant head of hair is about preserving youth, looks and attractiveness and men are prepared to spend to achieve it.
Companies are now waking up to the potential and are investing in research to meet the challenge. Aderans, the world’s largest manufacturer of wigs, is pouring funds into the science of follicular neogenesis.
Based in Japan, Aderans bought the company Bosley International, America’s largest hair-transplantation company, in 2001, and has established the world’s largest hair-regeneration laboratory.
There is nothing new about hair transplantation, which has been practised for 50 years. Early efforts involved lifting hair “plugs” from the back and sides of the head and replanting them on the top. Each plug contained 15 or 20 hairs, creating the much-derided bottlebrush effect.
Today, surgeons are able to harvest and replant as few as two hairs at a time, creating a more natural look. But no matter how skilful the surgeon, the success of transplantation is limited by the quantity of available hair. There is rarely enough on the back and sides to cover the top.
It is a supply-and-demand problem and one that Ken Washenik, head of research at Bosley’s hair-regeneration lab, is determined to solve.
Instead of removing a chunk of scalp, the scientists in the Bosley lab are extracting single hair cells and attempting to get them to replicate in the laboratory. These “dermal papilla” cells mature into hair follicles in the process known as follicular neogenesis. If they can be stimulated to multiply there should be no limit to the number that could be grown in the laboratory and then transplanted back to the head from which they originated.
“It’s the Holy Grail of hair technology and we are going to be the first to get it,” says the ebullient Washenik, who invites visitors to his Beverly Hills office to inspect his own hair transplant, carried out to conceal a receding hairline, with hair grown in the traditional way.
Washenik has a mountain to climb. It is 14 years since the technique of stimulating hair cells to regenerate was first demonstrated by a British researcher, Colin Jahoda, at the University of Durham in 1990. He took follicle cells from his own head, cultured them in the laboratory and implanted them between the pale hairs on his wife’s arm. Out grew a thick, dark hair with male DNA. He carried out a similar experiment with mice and proved that hair cells could be induced to grow anywhere on the body.
Since then, researchers around the world have been trying to find ways to make the dermal papilla cells multiply. They will grow strongly when placed in a petri dish in the lab but in doing so they lose the capacity to develop into hair follicles. The researchers ended up with a lot of generic cells that would not grow anything.
In America, Japan, Holland and Britain, researchers are looking for the magic ingredient that will trigger multiplication of the dermal papilla cells without loss of the genetic signature that tells them to grow hair. But some scientists wonder if they will ever find it.
Terence Kealey, a biochemist and vice chancellor of the University of Buckingham, says it is every researcher’s dream to extend the work begun by Jahoda but the prospect of success is diminishing as the years go by.
“Any scientist is sceptical about a technique that has been around for a long time when nothing has come out of it,” he says. This is not a criticism of the science, but it does suggest that the routinisation of the technique may have very real problems.
There are also safety concerns. “If you grow things in the laboratory you have got to add things to the medium growth factors, which may be obtained from other people. Nothing is risk-free in science and there is always a concern that you might activate disease.”
Jahoda, who still works at the University of Durham, acknowledges the difficulties in bringing his work to fruition, but remains convinced that it will be achieved one day.
He, however, has returned to basic research on the mechanisms of cell multiplication, leaving the field of hair growth to the commercial interests with the resources to exploit his discovery.
“The rewards would be phenomenal if you could get it to work,” he says. “I believe it should be possible, but I don’t want to spend the rest of my research days working it out.
“Theoretically, it should be possible to grow the dermal papilla cells in culture, multiply them up and transplant them into the scalp, where they will instruct neighbouring cells to organise into new hair follicles. But it is not easy to get funds for this work in the non-commercial sector.”
Kealey believes there is greater potential in developing drug treatments such as the hair tonic Minoxidil. He runs Cambridge Biotechnical, specialising in the development of products for the skin and hair. The company has been retained to investigate Minoxidil, marketed in Australia under the brand name Rogaine, which was hailed as the first effective treatment for baldness when it was launched, but turned out to significantly help fewer people than hoped just one in 100.
“Minoxidil was discovered by accident,” says Kealey. “It genuinely does cause hairs to grow better, but it only works in 1 per cent of people. That is too few. We are one of the companies trying to see if we can engage in rational drug design. We are looking at switching a nitrogen group here or an oxygen group there to produce a better drug.”
However, Dr Rodney Sinclair, an associate professor at Monash University’s department of medicine and a senior lecturer in dermatology at the University of Melbourne, says that while just 1 per cent may get a fantastic result from Rogaine, about 75 per cent of Rogaine users get some benefit.
Investigation of the genetics of baldness may also yield novel treatments but none are on the horizon yet. In the meantime, hair transplantation still offers the best hope for most men.
At Bosley International in the US, Washenik remains upbeat and hopes to start human trials of cultured hair cells within the next two years. His researchers have experimented with different combinations of growth catalysts and he claims that 80 per cent of his laboratory-grown cells now produce hair when implanted in mice.
Even if the trials are successful, Washenik admits it will be at least five years before the US Food and Drug Administration approves the process, opening the way for it to be marketed to the public. Nor would it come cheap, at an estimated cost of $US10,000 a head.
In Australia, current research includes an investigation by the Department of Physiology at the University of Melbourne looking at identifying genes that cause hair loss.Hair is a very complex organ, says Sinclair, and unlocking the secrets of the hair follicle is very important to science.
“Once the key to regrowing hair is found then we will understand a lot more about biology.”
Regardless of a momentous leap forward, the prospect of a solution to hair loss has provoked fevered speculation among potential customers. There is talk of hair banks to which people could donate cells for use by others and suggestions that women who want highlights could apply to a bank for a different colour.
Hair-loss message boards are crammed with requests for help and offers of assistance, and websites which deal with these issues, such as www.clonemyhair.com, have sprung up.
One message captures the desperation of the follically challenged, whose hopes have been raised and dashed by bad toupees, botched transplants and restoratives that promise more than they deliver: “If 10 million balding people each give $100 it will be $1billion we can offer to a research institute, provided that they find the solution good and fast,” it says.
– The Independent, with Victoria Gurvich