STEM CELL THERAPY IN HAIR TRANSPLANT - TOP 5 MYTHS

We keep hearing about stem cell treatment in all spheres  and of special interest for those on this website are reports of stem cell treatment for hair restoration.

Recently, a company from New Delhi has been promoting their ‘stem cell treatment’ very heavily in the North East, which according to them can solve every disease known to human kind from cancer to heart disease, and also restore hair. I was approached by the company also which promised me heavy paybacks if I advised this for my patients. They were apparently unaware of my strong views against any form of unscientific treatments. A few pertinent questions from me and they  were left tongue tied as they could not explain anything in depth and their fraud  was exposed.

However it is clear that this company will now try to spread their wings in the North East hoping to sweep some money from gullible people. They have already tied up with a well known Beauty Saloon chain for their hair restoration treatment and are trying to tie up with hospitals and individual doctors to promote their treatments for various other diseases.

This set me thinking as to how to  ensure that people are well informed enough not to go in for this sort of treatment. Hence I am writing again about stem cells and the true facts of their curative powers.

What are stem cells? Most people in fact are not aware of this even when they are actually receiving so called ‘stem cell treatments’.

Stem cells are cells that are pluripotent, ie, they can go on to form different types of specialized cells. All organs of our body are formed by specialized cells. Skin is formed by skin cells, liver is formed by liver cells, brain is formed by brain cells or neurons and so on. Each of these cells are specialized, i.e, skin cells are specialized for the function of skin and they are completely  different from say brain cells, which are specialized for brain functions. Stem cells are a form of root cell which themselves are not specialized, but can form other specialized cells such as cells of the eye, liver, brain, skin, etc.

Stem cells are not a single entity but there are six very different types of stem cells which have different characteristics.

Embryonic Stem cells:  These are the most powerful stem cells. They are found in the earliest stages of embryos. The first stage of the embryo within 4-5 days contains a bunch of about 100 cells which are capable of forming every other type of cell in the human body. It is from this batch of stem cells that all the structures of the human body are formed. They are hence the most versatile of cells in the human body at any stage of its development.

Adult stem cells: These are cells which are already specialized to some extent and which can form cells of a particular type. Thus fat stem cells can form other fat cells, brain stem cells can form other brain cells and so on. Of great importance are blood or Hemopoietic stem cells in adult bone marrow which can form different types of blood  cells.

Induced Pluripotent Stem cells:  In 2006 scientists discovered how to reprogram skin stem cells so that they become despecialized and act like Embryonic Stem Cells. This was an important discovery. However the IPC’s are not exactly like Embryonic Stem cells and differ in many aspects.

Cord Blood Stem cells: The blood in the umbilical cord of a newly delivered baby contains a lot of stem cells. These however are similar to Blood Adult Stem cells and are programmed to form blood cells.

Fetal cells: Cells taken from the fetus (after 10 weeks of gestation) are called fetal stem cells. These also are already specialized to some extent.

Cancer cells: Cancer cells also become deprogrammed and become stem cells. Such cells are being used for research to see if they can provide any useful function.

 

Of these different types of stem cells, it is the Embryonic Stem cells and Adult Stem cells which are the most promising. Various research projects are going on to  see how these stem cells can eventually be used to treat human diseases. The hope is that these stem cells will  be able to regenerate the tissues which have been affected by diseases or injury and thus provide a novel cure for many diseases which at present are incurable.

Embryonic Stem Cells are generated from a surprising source – the embryos left behind in IVF procedures. In IVF which is a form of fertility treatment, embryos are generated outside the body using eggs from the mother and sperm from the father which are allowed to fertilize. They are then cultured for 4-5 days till embryos are formed. These embryos are then implanted into the mother’s uterus. However the process frequently generates extra embryos which are never implanted. It is these extra embryos which are donated for research and used to produce Embryonic Stem cells.

HESC or Human Embryonic Stem cells are currently being studied in Phase 1 clinical trials in three eye diseases, Stargardt’s Macular Dystrophy, Age Related Macular Degeneration and Acute Wet Macular Degeneration.

Adult Stem Cells are the most frequently studied for their role in various diseases. Stem cells from different tissues are being studied for their effectiveness in repair of those tissues. Different types of Adult Stem Cells that are being used for research are Bone Marrow Stem cells, Human Central nervous System Stem Cells, Human Spinal Cord Stem Cells, Human Mesenchymal Stem Cells and Eye Stem cells.

Bone Marrow Stem cells are till date the only successful treatment based on stem cells. In fact bone marrow stem cells have been used for several decades to treat a wide variety of blood cancers. In these cancers, the patient is subjected to strong radiation which kills off all cells in the marrow and fresh Bone Marrow Stem cells from healthy individuals are injected into the blood so that they can form normal blood cells. This treatment is very successful and is widely used.

Human Central Nervous System Stem cells or HuCNS-SCs are being studied for their use in the same eye disease, Age Related Macular Degeneration.

Human Spinal Cord cells are being studied for their use in a nerve disease called ALS or Amyotrophic Lateral Sclerosis.

Human Mesenchymal Stem Cells are being studied with Phase 2 trials by one company for their use in three conditions, Type 1 Diabetes Mellitus, repair of heart tissue following heart attack and repair of lung tissue  in COPD. The same company  is conducting Phase 3 trials for  acute graft vs host disease and Crohn’s disease.

Eye Stem Cells from the cornea are being studied for their ability to repair the cornea in corneal damage.

Besides Embryonic and Adult stem cells, Induced Pluripotent cells or IPC’s are also being studied in Japan for their use in Age Related Macular Degeneration.

 

This is a more or less exhaustive list of all the ways  in which stem cells are being studied for various diseases by established research  companies.

As we can see, the diseases being studied are mainly serious  diseases like eye diseases and nerve diseases, because these are far more important than hair therapy,  and also because they offer more potential for cure.

No serious research   agency or government or  University is willing to spend time and effort on using  stem cell research for hair restoration. Instead they  would rather concentrate on more serious diseases which are more important for humankind.

That is why there is no mention of hair restoration research in the official list of authorized clinical trials being conducted around the world.

Some research is going on in the field of hair restoration. But this is by two commercial companies which do not have much academic authority, and the research also is at a very early stage.

One by a Vancouver company called Replicel duplicates Dermal Sheath Cup cells in the millions and then hopes to inject them and have hair growth. This is however not strictly stem cell research as no stem cells are used. Instead this is more like cloning. The company hopes to clone the dermal sheath cup cells and then use them for hair growth. No clinical trials have been held  till now but one trial is being planned in Germany.

Another Japanese company called Aderans has had some success in growing dermal papillae cells from stem cells.

University of Pennysylvania researcher Mr. Xu has been able to convert adult human stem cells into epithelial stem cells which are needed both for skin and hair follicles. The research here is for the purpose of growing skin cells which can hopefully be used in burn patients. The growth of hair follicles is an added bonus and is not the focus of the research.

But hair follicles need two types of cells – epithelial cells and dermal papillae cells. These two types of cells need to be combined in a specific pattern and shape to give rise to a hair. At present it is impossible to see how this can be achieved.

Research in stem cells till date is confined to trying to grow a particular type of cell such as retinal cells of the eye, brain cells or heart cells so that they can replace the damaged cells of these organs. We are still very far from growing two different types of cells and then combining them to form a single organ as would be needed to form a complete hair follicle. Hence we will still have to wait for quite some time before stem cells begin to restore hair.

One particular stem cell treatment in this line received wide publicity in the US a few years back. It used AAA or Autologus Adipose Adult stem cells – these are fat stem cells which are found inside fatty tissues. A company collected  fat by Liposuction from the stomach, separated the AAA stem cells and then injected them into the scalp hoping they would form hair. As we can see from our knowledge of stem cells, the whole system is very haphazard and there are too many problems for this to achieve any success. No clinical trials were ever conducted and it was soon found not to work. The treatment became widely discredited and is not used anymore.

But this is a typical example of the kind of treatments being offered as stem cell treatment. Stem cells are gathered from any source possible and injected into the scalp promising the patient it will grow hair. Similar claims of cure are made for all possible diseases as if stem cells will automatically grow and repair any tissue into which it is injected.

Not  just stem cell therapy but many other similar therapies are being heavily advertized among the public, and they are quite profitable judging from the amounts spent on publicity. These include mesotherapy,Hijima (a type of cupping therapy) and many other similar treatments. The question is –how to tell a fraudulent therapy from a genuine one? Another question is - how do these spurious therapies survive and why do people go for them if they do not work?

There are three important red flags or warning signs which we must look for in all doubtful cases.

No Scientific studies – this is the most important. Any new therapy must be proven by scientific studies. No medical therapy is ever approved without a lot of scientific studies which are published in peer reviewed medical journals. Peer reviewed journals are those authorized journals in which any paper which is published is first screened for its authencity by a committee of experts in that field. Studies published in in-house journals or magazines are of no value.

One Cure for All – this is another very important sign. Most spurious therapies will offer cures not just in one field but will promise to cure all kinds of diseases. In case of the stem cell company that I mentioned in the beginning of this article, they promised not only hair restoration with their treatment but also told me they had a cure for almost all diseases known, and mentioned cancer, diabetes, heart diseases, stroke and a host of other diseases. This is a sure sign of a fraudulent treatment. All these diseases are so different that it is impossible that a single form of treatment will cure all of them. Scientists and doctors have been struggling for centuries to find cure for these individual diseases, and when one company claims to have a treatment which will help in all of these diseases, it is a big warning sign for me.

Testimonials only – these companies always come with effusive testimonials from their said clients. All these patients will talk in glowing terms about how the treatment has helped them. However we do not know whether these patients are indeed genuine patients or simply made up by the company. But the most important point is – it is clinical trials  which tell us whether a treatment works and not testimonials. People can be fooled for various reasons into thinking that a treatment works. Only a scientific case-control study published in a peer reviewed journal will prove definitely that a treatment is successful. When a company offers testimonials only in place of case-control studies, it is a sure sign of deceptiveness.

Besides these three main signs, there are a number of other signs which warn us against a particular treatment:

• Being backed by non-medical persons instead of doctors. Even where doctors are mentioned, it is not a medical doctor but a homeopath, etc.
• The treatment being done not in a hospital but in a non-medical facility
• Lots of advertisement in media like newspapers and radio/television
• Being associated with beauty saloons, spas, etc and not medical establishments
• Typically comes with offers and discounts and guarantees – no genuine medical treatment will ever offer a guarantee or money back scheme
• The company will often speak derisively of medical treatments and say they are ignoring the genuine findings of the treatment

The other question that arises is – why do people actually say that the treatment has worked for them? There are various reasons for this.

In the first place, we do not hear the testimonies of all the patients. Only a select few are picked out. There is no doubt that if we could interview a good sample of their patients, we would have a very different picture.

A few individuals will always report success with a treatment, no matter how spurious it is. This has various reasons.

Placebo effect – when any new treatment is given to a person, the conscious desire of the person to be cured often causes some improvement in the disease. This is called the placebo effect. That is why to test whether a treatment is genuinely effective, case-control studies are a must. In case-control studies, the ‘cases’ are given the actual treatment and the ‘controls’ are given placebos, or non-effective treatments. For example, in testing a new pill, the cases would be given the actual pill while the controls would be given a sugar pill. It is always seen in any study that even in the control group, about 20% of the patients have some genuine improvement in their symptoms. This is the placebo effect. For a treatment to be considered effective, it must cause more improvement than what we see in the control group.

Because of this placebo effect, even a spurious treatment will cause improvement in some people. It is from these individuals that positive testimonials can be reported.

Changes in the history of the disease – all diseases and conditions have periods of fluctuation and aggravation. For example, even in hair loss, there will be periods when there is excessive hair loss and other periods when the hair loss seems to improve. These periods of improvement may coincide with the treatment and thus give a false sense of improvement.

Accompanying treatments – often such treatments are accompanied by advise to take nutritious diets or combined with actual medical treatments like vitamins, etc. This also can cause improvement in the condition and this is reported as a successful treatment.

Because of these factors, even a spurious treatment is able to find some positive testimonials. That is why testimonials have no value and we must look for genuine data on the success of the treatment.

I hope this finally rests all doubts on stem cell therapy for hair restoration. This will probably be a success some day in the future, but for now if any company says that it can give you a cure, just do not believe it. When stem cells do work, hair transplant doctors will be the first to use this treatment as it will free us from having to work with limited available hairs and give us the chance to offer a full crop of hair to everyone.