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Walt asked: "Hello Doc. Which cure looks the
most realistic in the soonest timeframe? Gene therapy? Stem
Cell therapy? Hair Multiplication? What we want is an end
of all the drugs that just produce peach fuzz on a few lucky
chaps and to move on to something that means that real hairs
are growing out of our own repaired follicles. As you look
at the advances in the various fields, which one looks like
it will be available first. We're all tired of waiting. Thanks.
Walt"
Dr. Animesh A. Sinha, MD, Ph.D answered: "Hi Walt,
therapy in the future may incorporate all of the above approaches
that you have mentioned, perhaps in synthesis with each other.
at this point, we are still in need of acquiring more basic
information about the genetics and physiology of hair growth
and loss before we can devise specific therapies with emerging
technologies. nevertheless, modern molecular tools are providing
us with a promise to accelerate this process. this all may
seem very tedious at times, but unfortunately no one can predict
or dictate the rate of progress."
Andreas
Lutz asked: "Dear Dr. Sinha, I heard, that you think
about a cooperation with the NHI to get the needed biopsies.
This sounds very interesting, as a hair transplant clinic
should have a lot of the needed biopsies every day. So you
could get the needed biopsies in a very short period of time.
So are there already any concrete agreements with the NHI?
Thank you Andreas"
Dr.
Animesh A. Sinha, MD, Ph.D answered: "Hi Andreas, for
our pilot studies we need 6-10 eligible study subjects. there
are several criteria to meet eligibligy. in addition to recruiting
through our own clinic, we are working with a couple dermatologic
surgeons on a professional and collaborative basis to help
identify suitable and aggreeable individuals."
Bill
asked: "Hi Doctor, I have spoken with Hadley King
about joining your study. I'm thinking I could be a good candidate,
but I have a question regarding the use of non-propecia treatments
and your study. Currently I am using propecia, rogaine and
NANO shampoo. When I talked with Hadley she stated that I
would have to stop all treatments for 1 month prior to the
test. Then after the biopsies were taken I would only be able
to use propecia for the next 6 months. I'm thinking that I
don't want to give up my treatments, but I would like to participate
in the study. In fact, if it came down to giving up the treatments
and joining the study or vice-versa, I would probably skip
the study. I'm just scared of losing what I've been maintaining
with my regimen. Could you tell me why is it that the subjects
can only use propecia? I'm pretty sure that the study is being
sponsored by Merck and I think that's the reason, but I'd
like to hear it from you. Thanks for your time. Bill"
Dr.
Animesh A. Sinha, MD, Ph.D answered: "hi bill, although
Merck is sponsoring some of the costs associated with the
study, the study design was set prior to this and adheres
to strict scientific principles. the resaon that participants
in the study are to use only propecia is that in this pilot
study we would like to test the effects of a single treatment
in isolation. if more that one treatment was being used by
some patients and not others, it would make it difficult to
compare results between patients - too many variables. in
a later phase of the study however, we may want to include
more categories of patients undergoing different forms of
treatments and even combinations of treatments. your participation
in the study is entirely voluntary. if you do not wish to
enroll now, you may fit into our study at a later time point
as it expands. -AAS."
Kevin
Davis asked: "Hi Dr. Sinha, In your estimation
of what we know right now, how many genes determine whether
a person will suffer from male pattern baldness - one, several,
lots? Also, in your opinion, do you think gene therapy holds
the potential of *reversing* hair loss, even in those individuals
who have been balding for a number of years? Lastly, how challenging
do you think it will be to introduce genes to human hair follicles,
and have these genes express themselves for a long period
of time? Thanks, Kevin Davis"
Dr.
Animesh A. Sinha, MD, Ph.D answered: "Hi Kevin, all
you questions are very on point in terms of the issues that
we face to understand the genetic basis of hair loss. it is
not at all clear how many genes are associated with the initiation
and progression of male pattern baldness. however, it seems
very likely that this is not a single gene defect. it more
likely to involve a few to several genes. moreover, the relative
effects of each gene and their interactions with other genes
as well as environmental and/or hormonal factors are likely
to be variable, making the mapping of genetic elements difficult.
we hope that by suding the expression of thousands of genes
at once, directly in tissue, we will begin to take some significant
steps to unravel the genetic mysteries. once we (the scientific
community as a whole) have identified the key genetic elements,
our challenge will be to understand how they orchestrate the
development of male pattern baldness. it may be possible at
some point in the future to even reverse hairloss. therapy
and prevention may or may not involve the actual introduction
of genes into tissue (although this is a possibility). it
may be that therapy will be aimed at disrupting, enhancing,
or modifying specific physiologic effects and processes of
hair loss related genes."
Greg
asked: "Dr.-- quick question. I am 26 and MPB
gene is very prominent in my family - onset is usually in
early teens, and expresses itself in most men. I have been
on Proscar for 4 yrs, and have had 5 transplant ops starting
at 18yrs old. Can I be of any help in your study??"
Dr.
Animesh A. Sinha, MD, Ph.D answered: "Hi Greg, thank
you for your interest in our study. we can only begin to understand
hairloss mechanisms with the help of dedicated volunteers
such as yourself. our current study is a limied pilot project
in which we wish to recruit 6-10 male patients with mild to
moderate androgentic alopecia. the severity of your condition
and previous longterm use of propecia may preclude you from
the study. but i will refer you to our study coordinator,
hadley king (1-212-746-6554). she will be able to review the
details of the protocol with you over the phone. at the very
least we would keep you on file for the future as we are likely
to expand the study groups in the next wave of the project."
Mike
asked: "Dr Sinha Ive noticed a recent surge in the
genetic approach to conquering Hairloss. Between the discovery
of important proteins by the German scientists and your process
of defining the actual genes what is a reasonable timeframe
for fruition of these projects? Is it possibly that an unexpected
breakthrough could occur or are we ultimately at the mercy
of a tedious process? Personally I am feeling quite optimistic
these days by taking into account the frenetic pace of genome
discoveries and stem cell therapies. Is it unreasonable to
hope for an effective treatment within a year or 2? With all
the amazing things science has given us why is hair growth
such an enigma?"
Dr.
Animesh A. Sinha, MD, Ph.D answered: "Hi Mike, it would
be very difficult (and not very wise!) for me to predict when
we may be able to untangle the genetic mechanisms of hair
loss. however, you are right to be enthusiatic about the propects
for the future. we are entering an era of large scale, high-throughput
genetic technologies that are allowing us to gather information
at a remarkably accelerated pace not have been imagined even
a few years ago. the key will be to process the torrent of
genetic information we are now in the phase of acquiring and
to begin to synthesize the data into coherent biological maps
regarding hair growth and differentiation. no doubt this process
will be at times tedious as well as exhilarating. "
Paul
Proshan MD asked: "Everyones focus seems to be
on the blocking of type 1 & type 2 DHT production. My
point Id like to raise: If this was the main culprit - then
how could we explain the fact that one follicle that produces
a sideburn or beard hair located perhaps less than a miilimeter
apartthrives while the terminal hair atop the head meets its
demise in the very same biochemical milleau? Obviously the
current appraches are myopic in view at best? Thoughts appreciated?"
Dr.
Animesh A. Sinha, MD, Ph.D answered: "Hi Paul, you
have posed an astute question. this issue remains a confunding
matter. it is not yet known why androgens inhibit hair growth
on the scalp but stimulate growth elsewhere. it may be that
there are local differences (perhaps related to sebaceous
glands) in the amounts of steroid metabolizing enzymes that
convert weak androgens to more potent androgens in hair-bearing
versus nonhair-bearing sites. there are no doubt several other
differences related to tissue differentiation that are still
unknown. one of the goals of the genome-wide expression studies
that we are undertaking is to identify gene sequences differentially
expressed in various anatomic sites that may provide a clue
to understanding local differneces in hair growth and hair
loss."
Chris
asked: "Your team is working to identify the gene
that causes hair loss. When/if you find this gene(s) I was
wondering how that will develop into a treatment. In other
words, if you find the gene will the treatment be a one-time
treatment to change the gene(some type of injection), or will
it be in a pill form that a person takes forever. I'm just
trying to understand how gene therapy treatments work."
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Dr.
Animesh A. Sinha, MD, Ph.D answered: "Hi Chris, your
question is an excellent one. let me answer it by first saying
that at this stage of our work we are hoping to first identify
genes that are involved in the initiation, progression and
response to treatment (e.g. propecia) in androgenetic alopecia.
this will likely require a synthesis of a lot of varied approaches
from many research groups. the approach that my laboratory
is taking is to utilize a technology capable of monitoring
thousands of genes at once directly in scalp tissue. sequences
that are hairloss associated may then possibly be disrupted,
enhanced, or manipulated depending on their mechanism of action
(which may or may not be readily evident). the exact form
that a potential therapy based on this type of information
may take is unclear at this point. there are several possiblities,
including oral, injectable or topical preparations."
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Dr.
Animesh A. Sinha, MD, Ph.D. an Assistant Professor at the
Department of Dermatology at Weill Medical College of Cornell
University is heading up a study to try find the genes associated
with hair loss.