“I think it’s a realistic vision,” says Maria Kasper, associate professor of cell and molecular biology at the Karolinska Institute in Sweden. However, she emphasizes that it’s too early to say whether Plikus’ findings will lead to a new treatment for hair loss and notes that alternative therapeutic approaches are being developed as well.
Turn Biotechnologies, for instance, is developing a treatment that uses messenger RNA (mRNA), following the same basic principles as the Pfizer and Moderna Covid vaccines—delivering genetic instructions to our cells to have them build useful substances. According to cofounder Vittorio Sebastiano, an associate professor of obstetrics and gynecology at Stanford University in the US, Turn’s goal is to deliver mRNA encoding for a cocktail of proteins that can turn back the clock on hair follicles. Their treatment, TRN-001, would be delivered to follicles inside liquid nanoparticles and help reset stem cells there, making the follicles functionally younger. “I would be happy to get my hair back to when I was 30,” Sebastiano jokes, “so that would be 15 years of rejuvenation.”
Sebastiano is hoping to start clinical trials in humans by the end of next year or early 2024, envisioning a future in which TRN-001 is applied topically with microinjections, much like Plikus imagines for SCUBE3. But while an mRNA-based approach might be more potent, since it forces cells to make relevant proteins themselves, Sebastiano recognizes that this technology’s newness makes the cost and periodicity of treatment difficult to predict and the regulatory landscape more challenging.
In fact, Kevin McElwee, associate professor of dermatology at the University of British Columbia in Canada and chief scientific officer of hair biotech company RepliCel, says that’s why his team isn’t going down the mRNA route: “the regulatory issues with the FDA are huge.” Instead, RepliCel—and a competitor, HairClone—are working on a cell-based approach to baldness, where hair cells from one part of the scalp are moved to another in order to kickstart growth. First, hair follicles are harvested from the back of a person’s scalp, then the relevant cells (dermal papilla cells for HairClone, dermal sheath cup cells for RepliCel) are dissected out and cultured, and finally these multiplied cells are microinjected into a person’s balding head. Some of these cells are also cryopreserved for future injections.
“The problem with hair transplantation is that it’s one for one; you still have the same number of hairs, just spread out,” says HairClone CEO Paul Kemp. With these multiplying techniques, you can instead increase the volume of hair. However, Kemp and McElwee both estimate that for the patient, the process might take one to two months from start to finish and, at least initially, cost more than hair transplants, given the manual labor involved. But this treatment might also be more successful, Kemp says, because “it’s a personalized cell therapy, unlike Plikus’ approach, which is a one-size-fits-all.” RepliCel’s therapy has begun to be tested in patients in Japan, while HairClone hopes to start human trials in the UK by early 2023; both countries have more flexible clinical trial requirements than the US.