Hair Cloning — the ultimate cure for baldness?

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Rembrandt van Rijn, Stone Operation (Allegory of Touch), 1624-25).

Could hair cloning be the ultimate cure for baldness? Hair cloning, aka hair multiplication, holds the promise of unlimited hair. In principle, even someone who is completely bald could restore a full head of hair via injections of regenerative hair follicle stem cells. But, hair loss has been a persistently tough nut to crack and there is no shortage of snake oil that over-promises and under-delivers.

Dr. Bessam Farjo believes that hair cloning could offer a viable alternative to hair transplant surgery, a market expected to reach $24 billion by 2023: “One of the shortcomings of hair transplantation is that there’s a particular amount of hair available from the back and sides of the head. So, if someone was to lose enough hair, at some point you may run out of hair you can keep transplanting and therefore, you can’t promise somebody they’re going to have all the hair they want over their lifetime.”

Not so when it comes to hair cloning, according to leading UK hair transplant surgeon, Dr. Bessam Farjo who posits that the procedure could be available to patients as early as the end of 2022/beginning of 2023.

Board Certified hair transplant surgeon, Dr. Sara Wasserbauer, is also bullish on the technology, placing its availability a bit further into the future – more like 2025/2026, barring any further Covid-related delays.

But, not so fast cautions world-renowned expert in hair disorders, Dr. Antonella Tosti. When it comes to stem cells, it’s important to distinguish between hair rejuvenation and hair restoration, with the latter being at least a decade away. In the meantime, there are multiple ways of optimizing hair health.

So, what is hair cloning and how does it work? A single, hardy hair strand is produced by thousands of stem cells called dermal papillae, located at the base, i.e. in the bulb, of each hair follicle. We are born with all the hair follicles we’ll ever have – around 100,000. But their life spans are limited. Aging, genetics, testosterone, cancer, even Covid-19 can kill the stem cells that make the hair. As dermal papillae disappear over time, follicles “miniaturize” and become dormant. Once a hair follicle goes dormant, it cannot be restored.

Enter hair cloning. What hair cloning refers to is the replication in the lab of the dermal papillae, explains Dr. Farjo. “What you do is isolate these cells from someone’s hair and then you culture them in a particular medium that allows for these hairs to multiply into thousands.”

Hair anatomy.

The process of hair miniaturization.

Hair cloning is not a new concept. In the past, attempts have been made to simply grow these cells in the lab and then inject them back into the head of the person from whom the cells originated. These efforts, however, have failed over the last 20 years or so.

Dr. Sara Wasserbauer: “Banking at the earliest opportunity ‘stops the clock’ on the banked follicles ageing so the cells will be the most active when the treatment system is available and you need treatment.” As for when the procedure will be available, “exciting and rapid progress in developmental biology will provide the scientific basis for this ground-breaking new treatment and we expect that this could be in the clinic within the next few years although it will take several years before it is fully licensed around the world.”

What gives Dr. Farjo cause for optimism is that the last few years have seen a resurgence of research in this field. A number of companies worldwide, including HairClone, with which both Drs. Farjo and Wasserbauer are affiliated, have picked up the pace of research because hair biology has advanced considerably.

“We now have new ways of culturing these cells in the lab that improve their chance of stimulating hair growth,” says Dr. Farjo.

Here’s where the all-important distinction between hair rejuvenation and hair regeneration comes in. There’s a difference between cloning the follicle itself, i.e. making a brand new follicle that regenerates its own hair, explains Dr. Wasserbauer. That is probably 10 or 20 years away. What is imminent is the cloning of dermal papillae cells, which serves to thicken existing thinning hair.

So, rather than attempt to make a hair grow from nothing in completely bald skin, these cells are introduced into hairs that are on their way out. In this way, the hair thinning is reversed. “Instead of looking like a thinning, dying hair, it could be revived to a mature, good quality hair,” explains Dr. Farjo.

The way it works is this: up to 100 hair follicles are removed from the back of the patient’s head in a similar manner to a hair transplant – with a follicular unit extraction or FUE. Those hairs then get cryo-preserved in a tissue bank. This stops the aging process of the hair. When the time comes to introduce treatment to the patient, 5 or 6 of those follicles are thawed and the basic cells in the root are isolated. Those cells are then cultured in a lab and multiplied. The multiplied cells are then injected into the areas of the patient’s head where the hairs are thinning.

Hair cloning procedure. Illustration: SureHair International.

“The concept is that we inject these cells close to the roots of the existing hairs and we rely on these cells finding their way to re-enter the roots that belong to the thinner hairs and re-populate the root,” elaborates Dr. Farjo.

“So now, not only do you have more cells inside the root, but you have cells that come from this original hair that came from the back of the head that is a better quality hair and that should contribute towards building a better quality hair instead of the one that was miniaturizing.”

Manchester-based HairClone is the world’s first hair bank. Photo: HairClone

The only tissue bank in the word that is specifically geared towards the cryopreservation of hair follicles — Hair Clone — is in the United Kingdom. Patients in the US can undergo the extraction procedure and although the cryopreservation process is started here, the tissue samples are sent to the UK for banking.

Because this procedure is not FDA approved, injections of stem cells will also have to take place in the UK. “We are hoping the FDA will grant approval to store tissue at US storage facilities sometime this year,” says Dr. Wasserbauer, who, to date, has performed extractions in close to 100 patients since she began offering the procedure in 2020.

Dr. Antonella Tosti: Hair loss is due to many different conditions, so the most important thing is to have a correct diagnosis and understand if the hair growing back is of the right thickness or not, because this is the beginning of a treatment plan. I believe it’s wrong to treat yourself without seeing a dermatologist. Transplant doctors are very good … but they are not experts in medical treatment. And many diseases require medical treatment. Other diseases require both medical and surgical treatment.”

Some experts, however, doubt the imminence of this technology. “The idea is there — to introduce stem cells into the follicle to increase the population of dermal papillae in order to grow thicker hair — but this is not happening right now,” says Dr. Tosti. “The published papers didn’t show that. It’s far from being close in clinical studies.”

The closest we are to hair cloning at the moment and what some transplant doctors are doing is dissecting the bulb of one follicle and implanting the resulting two half bulbs to create two follicles. “That’s the maximum that has ever been obtained,” says Dr. Tosti.

While hair thinning and baldness have many causes, one factor that should not be overlooked when it comes to hair strength is the health of the scalp. “We know now that the scalp is very, very important. It’s not just the follicles,” says Dr. Tosti, explaining that the hair makes a three-week journey from the follicle to the scalp surface. The hair is thick before it reaches the scalp. But, if the scalp is unhealthy, the emerging hair is damaged.

Very good hygiene is crucial to maintaining a healthy scalp, relieving inflammatory conditions such as itchy, flaky seborrheic dermatitis (dandruff is its mild cousin) caused by yeast overgrowth.

In general, advises Dr. Tosti, “it is very important to avoid scalp inflammation because that is a very important trigger for hair loss and also worsens different types of hair problems.” What consists of good scalp hygiene? For Dr. Tosti, it’s frequent shampooing (at least 3 times per week for Caucasian and Asian hair and less so for more delicate African American hair) with a shampoo that is appropriate for the hair type.

Moreover, having a healthy diet is also very important, according to Dr. Tosti. Ditto for avoiding sun exposure and pollution. In addition, advises Dr. Tosti, “try to eliminate endocrine disruptors [like flame retardants, pesticides and BPA from plastics] from the environment and from the diet. Try to eat organic – that’s what I always tell my patients – and be very careful about the chemicals you put on your scalp because some of those chemical can have a negative effect on hair growth.”

A healthy scalp is crucial to healthy hair. Illustration: Advanced Hair Clinic

So, let’s say you’ve gathered the facts and decided to bank on banking your hair follicles. Are you a good candidate for hair cloning? If you are a man who has not gone completely bald, but whose hair is in the process of thinning, the answer is yes. And not surprisingly, the younger the better for “we know from our own studies that young tissue and young hair follicles grow better in culture,” says Dr. Farjo.

Women with thinning hair are prime candidates too as they do not normally go bald and there are not many treatments to treat hair thinning in women, according to Dr. Farjo.

One thing to keep in mind is that at the beginning this treatment is unlikely to be a one-off process. The procedure may have to be repeated up to three times over the course of a 10-year period because male pattern hair loss and female pattern hair loss are progressive conditions.

“Although you’re injecting cells into an existing root and rejuvenating it, the existing cells in that root want to continue to miniaturize,” explains Dr. Farjo. “So, you may get a little bit more miniaturization over the following two or three years and then you have to treat them again, until you get to the point where the entire hair is being stimulated by these new cells and that’s when it should stop miniaturizing.”

Costs for banking, storage and injection are on par with those of a hair transplant. To bank or not to bank? That is the question. Dr. Wasserbauer has already banked her husband’s hair follicles and said she would bank her children’s too if they were old enough. “Many may see this as an insurance policy for later life,” says Dr. Farjo.

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