Brief Items of Interest, January 2017

Hair loss news first:

— Replicel’s CEO provided a detailed 2017 forecast, and this was followed up by the release of an important PowerPoint presentation in which the company summarized final 5-year safety and efficacy data for their RCH-01 product. Key finding: “mean change in total hair density at 6-months = 6.1% vs 5.0% target“. 70 percent of responders saw a 14.3% average increase in density at 6-months. While they did not mention 12-month RCH-01 results, they do point out 12-month results from Finasteride (7-14% increase in hair density) and Minoxidil (8-16% increase in hair density) for comparison. Also of note, Replicel partner Shiseido’s Japanese clinical research findings are expected in 2018 along with a potential product launch in the same year.

— Aclaris Therapeutics made yet another presentation (pdf downloadable from their press releases page — I did not listen to the webcast), this time at the 35th Annual JP Morgan Healthcare Conference. At the end of the report they mention that pre-clincial development is now underway for their topical ATI-50003 selective covalently binding JAK 3 inhibitor to treat androgenetic alopecia. However, nothing in the report mentions when they aim to start phase 1 clinical trials. I hope it will be before the end of 2017.

— Follicum announced patent approvals in Russia and in Japan. The company had earlier also announced that they were scheduled to complete the multiple dose part of their clinical phase I/IIa study in January 2017 at the prestigious Charité University Hospital in Berlin.

— Judging from the latest update from Fidia Farmaceutici (Italy), The Dr. Brotzu lotion will not come out as early as some people expected, and a lot of people on the forums got mad (but a few took it as a positive sign that Fidia is finally releasing dates even if ambiguous i.e., “development of the potential product candidate being completed by 2018“). Ever since I first wrote about Dr. Brotzu, I have not paid much attention to this product, but if you are inclined, go through the last 50 or so pages of this record breaking HLT thread and check out the various Italian hair loss forums out there.

— Also from Italy, some kind of PRP plus insulin type of treatment (hard to tell for sure after translation).

— Researchers identify how skin cells become hairy or sweaty during the embryonic stage of development. Actual study.

This guy got a hairpiece and over 2 million youtube views in the process. He is probably someone famous, but I did not feel like doing any background research or even watching most of the video.

And now on to medical items of interest:

— From a team led by the most famous hair loss researcher in the world Dr. George Cotsarelis (who has been at it for at least 20 years), comes a new study on how to heal wounds without leaving any residual scars. Key quote from Dr. Cotsarelis: “Essentially, we can manipulate wound healing so that it leads to skin regeneration rather than scarring. The secret is to regenerate hair follicles first. After that, the fat will regenerate in response to the signals from those follicles”. I have discussed the link between fat cells and hair cells many times on this blog, including in the last post on the arrector pili muscle. These latest findings were widely covered by the global media, with headlines such as “The End of Scars“. The Reddit thread on this blew up. However, as with all things Cotsarelis, headline grabbing findings, but one always gets the feeling that practical use will be at least a decade away unless other labs get in on the action.

Babies born without mothers (via embryos made from male skin cells) will come sooner than expected warn scientists. Surreal.

Designer babies: an ethical horror waiting to happen? I am all for it even if it turns out horrific.

Alzheimer’s drug “tideglusib” helps rotten teeth regenerate, reducing the need for fillings.

— Chinese company implants 3D prints blood vessels into monkeys.

The Arrector Pili Muscle (aka the Goosebump Muscle)

Several weeks ago, the arrector pili muscle got significant coverage in a few newspapers around the world. Famed Australian dermatologist Dr. Rodney Sinclair co-authored an important paper titled “The arrector pili muscle, the bridge between the follicular stem cell niche and the interfollicular epidermis” that was just published this month. Dr. Sinclair has been involved in this area of hair loss research for a few years and already published similar findings several times in the past decade. Nevertheless, Australian newspapers were especially interested in this latest study and its findings as evidenced by articles such as this one and this one.

The Arrector Pili Muscle

Arrector pili muscles are small muscles attached to individual human hair follicles on both the scalp as well as body (so we have millions of these muscles throughout our bodies). Contraction of these muscles causes hairs to stand up, a phenomenon that is known as goosebumps. Therefore, the arrector pili muscle is often referred to as the goosebump muscle.

The Arrector Pili Muscle Degeneration and Hair Loss

In recent years, a few studies have come out that suggest a possible connection between the arrector pili muscle degenerating (where it gets replaced by fat) and hair loss due to the subsequent disconnection between various hair follicle stem cell populations. It is possible that an intact arrector pili muscle plays a crucial role in the maintenance of follicular integrity and stability.

However, there are many uncertainties about this theory that I discuss in the next section. It seems that while in alopecia areata (AA) patients the arrector pili muscle remains intact, this is not true in androgenetic alopecia (AGA) patients (and unfortunately over 95 percent of balding men suffer from AGA). So this could be why it is much easier to grow back hair for people with AA compared to people with AGA. However, the rate at which the arrector pili muscle degenerates and gets replaced by fat varies substantially between patients and between individual hairs on the same scalp. Some miniaturized vellus hairs in balding regions might even never lose most of their arrector pili muscle connection.

Points of Contention

  • According to Dr. Sinclair’s own quote from a past paper, “It remains unclear whether arrector pili muscle regression is a cause or effect of permanent follicle miniaturization“. I think this is the crux of the issue surrounding this theory/hypothesis.
  • It seems like hair that is transplanted from the back of a person’s scalp to the front of that same person’s scalp regenerates the arrector pili muscle. A very important related study from 2012  comes to us from Japan. So it might be very possible to regenerate this muscle.
  • There are 100s of anecdotal reports on the internet of people regrowing long-lost hair. On the internet, you can find many reports of old men who recently started taking Dutasteride for enlarged prostate issues and have subsequently noticed hair regrowth on areas of their scalps that have been totally devoid of any visible hair for decades. Maybe they regenerated their arrector pili muscles; or maybe their arrector pili muscles always remained intact in spite of severe AGA; or maybe one can regenerate hair without the need for having any intact arrector pili muscles?
  • It is unclear when exactly we have a point of no return where the arrector pili muscle is largely or entirely replaced by fat and hair stops growing (either as a cause or effect — see first bullet point above). It seems like there is significant variation depending on person and hair follicle. In many cases, the arrector pili might not be entirely degenerated and replaced by adipose tissue even in areas of the scalp where one has been bald for several decades. In such cases, subsequent hair and muscle regeneration could perhaps even be possible via something like Dutasteride or Finasteride?

It would seems that just as with out bodies, muscle beats fat yet again. However, as is always the case in the world of hair, nothing is ever straightforward! Even fat has significant hair growth benefits in the correct circumstances.

A Hair Loss Blog