Hair loss – Stem cell therapy

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Hair loss from the scalp or elsewhere, which can occur in men, women and children. Complete or partial loss of hair is known as alopecia. In most cases, hair loss develops gradually. It can be patchy or diffuse (all over). You roughly loose about 100 hairs from your head everyday. The scalp contains approximately 100,000 hairs on an average.


Considerations:
Stem cell therapy is a nonsurgical therapy to stimulate and regrow hair follicles. This therapy is expected to work by activating the already existing stem cells on the scalp. Therapy may be able to simply signal follicle stem cells to give off chemical signals to nearby follicle cells, which have shrunk during the ageing process, which in turn respond to these signals by regenerating and once again making healthy hair. Stem Cell Treatment improves texture and the quality of hair. This treatment prevents recurrence of hair loss.

This treatment not only helps hair loss but also improves the quality and texture of hair. Two to six sessions are required for this therapy depending on the extent of hair loss.

The follicle of the hair include cells in the center these cells make sure of a constant supply of cells for the fast development of hair cells.

We specialize in hair loss and provide surgical and non-surgical treatment to both men and women who suffer from hair loss. In addition to providing non-surgical adult derived stem cell (ADSC), we also provide Low Level Laser Light Therapy (LLY) and Platelet Rich Plasma (PRP).

Causes

A sudden emotional or physical stress can cause about 50-75% of the hair throughout the scalp to fall off. This form of hair loss is called Telogen effluvium. You will notice hair falling out in handfuls while combing, shampooing or even while running hands through the hair. This may not be noticeable for several weeks to months after the phase of stress. The hair shedding usually decreases over duration of 6-8 months after the stressful period is over.

Common causes of this form of hair loss include:

  • Severe infection or high fever
  • Childbirth
  • Major illness, sudden blood loss or major surgery
  • Crash diets, especially those deficient in essential proteins
  • Emotional stress
  • Some medications like retinoids, beta-blockers, birth control pills, certain antidepressants, calcium channel blockers and NSAIDs (like ibuprofen)

Women between the age of 30 and 60 often notice a thinning of the hair affecting the entire scalp. The hair loss is usually severe in the beginning and then stops or slows gradually. There is no known cause for this form of hair loss.

Some other causes for hair loss, especially when it is in an unusual pattern, are given here:

  • Alopecia areata or bald patches developing on the scalp, the beard and sometimes on the eyebrows. Eyelashes may also fall out.
  • Burns
  • Autoimmune diseases like lupus
  • Excessive blow-drying and shampooing
  • Infectious diseases like syphilis
  • Thyroid diseases
  • Nervous habits including scalp rubbing and continual hair pulling
  • Tinea capitis (ringworm infection of the scalp)
  • Radiation therapy
  • Tumor of the adrenal glands or the ovary

Home Care
Hair loss occurring after childbirth or during menopause often returns to normal within 6 months to 2 years.

Hair loss occurring due to illnesses like fever, medication use, radiation therapy or other similar causes does not need any active treatment.The hair usually grows back once the illness ends or after the therapy is stopped. Till this happens, you may wear a hat, wig or any other covering.

Hair pieces, hair weaves or changing the hair style may help to disguise hair loss. This is usually the safest and the least expensive approach to manage hair loss. Suturing of the hair pieces to the scalp should be avoided as it may cause scars or infections.

When to contact a healthcare professional Call your physician if:

  • The hair loss is occurring in an unusual pattern
  • You start losing hair at an early age (for example, in your teens or twenties) or rapidly
  • There is a lot of pain or itching along with hair loss
  • You also have facial hair, acne or abnormal menstrual periods
  • The skin on the scalp under the bald area is scaly, red or appears abnormal in any other way
  • There are bald spots on your eyebrows or beard
  • You are a woman having a male pattern baldness
  • You have muscle weakness or are gaining weight
  • You have intolerance to cold temperatures or suffer from severe fatigue

Tests for Hair loss

Physical examination
It is essential to determine the pattern of hair loss; whether it is focal alopecia areata (localized hair loss in oval or round areas without evident inflammation of the skin in areas bearing hair), male pattern balding, alopecia universalis (the end stage of alopecia areata, resulting in loss of hair from all over the body) or alopecia totalis (loss of all hair from the scalp and the eyebrows).

Examine areas of the skin where there is loss of hair to check for skin rash, scarring or inflammation.

Examine nails. In case of the alopecia areata form of hair loss, nails are also affected. This may suggest poor prognosis with less chances of the re-growth of hair.

Pull test
In this test, several dozens of hairs are pulled gently to see how many of them come out. This helps to rule out or diagnose telogen effluvium and also helps in determining the stage of the shedding process.

Blood tests

  • Iron studies
  • Full blood count
  • Thyroid function tests
  • Vitamin B12, Vitamin B6 and folic acid
  • ANA autoantibodies
  • Syphilis serology

In females having hair loss with evidence of increased level of androgens, the levels of free testosterone, total testosterone, prolactin and dehydroepiandrosterone sulfate (DHEAS) should be measured.

Hair and skin scrapings – for culture and microscopy to look for bacteria and fungi.

Skin biopsy to identify psoriasis, lupus erythematosus and alopecia areata.

Hair analysis – for mineral and nutrient content and to detect the presence of drugs and toxic chemicals.

Details

Regenerative Tissue Therapy (cells)
Broad guidelines for the eligibility criteria, including inclusion and exclusion, are given below. There are few exceptions to these guidelines, which should be considered appropriately before making the final decision about the selection of any person for this prescribed therapy. The decision depends entirely on the project director on a case to case basis.
We advocate use of Regenerative Tissue Therapy (cells) derived from placenta, amniotic fluid, umbilical cord and cord blood, in this given order of preference, over autologous Regenerative Tissue Therapy (cells) sourced from peripheral blood, skin, cornea (limbus), small intestine, bone marrow, adipose tissue, liver etc. But, the final decision is taken after thorough studying and deliberating the complete medical history of the person. The choice of the Regenerative Tissue Therapy (cells), source of the same, their dose and their exact mode of administration are decided on case to case basis.

Administration of GM-CSF prior to this therapy is highly recommended with an intention to enhance the mobilization of the patient’s autologous Regenerative Tissue Therapy (cells) from the bone marrow so that they act synergistically with the transfused cells.

Besides this, the project director also advises some relevant supportive therapies as given below:

  1. Hyperbaric Oxygen therapy – This therapy is carried out by administrating hyperbaric oxygen in specialized Hyperbaric Oxygen chambers. It has several benefits such as:
    – Managing De-compression sickness and air embolism.
    – Increasing the partial pressure of oxygen in the damaged tissue of the body.
    – Enhancing oxygen carrying capacity of blood.
  2. Administering Chelation therapy helps in the removal of toxic heavy metals such as uranium, plutonium, mercury, arsenic, iron (including in cases of thalassemia), lead and other types of toxic metal poisoning. The chelating agents can be administered orally, intravenously or intramuscularly depending on the type of poisoning and the agent used.

Several chelating agents are available. Each of them has a different affinity for different metals. Some common chelating agents are:

  • Deferasirox
  • Alpha lipoic acid (ALA)
  • Dimercapto-propane sulfonate (DMPS)
  • Deferiprone
  • Ethylene glycol tetraacetic acid (EGTA)
  • Deferoxamine
  • Aminophenoxyethane-tetraacetic acid (BAPTA)
  • Diethylene triamine pentaacetic acid (DTPA)
  • Dimercaprol (BAL)
  • Dimercaptosuccinic acid (DMSA)
  • D-penicillamine
  • Ethylenediamine tetraacetic acid (calcium disodium versante) (CaNa2-EDTA)
The project director advises the use of hyperbaric oxygen as well as chelation therapy before starting Regenerative Tissue Therapy (cells). This enhances the chances for the infused Regenerative Tissue Therapy (cells) to get accepted and engrafted into the damaged tissue and organs and they, in turn, begin the repair swiftly. This helps in maximizing the benefits of Regenerative Tissue Therapy (cells). However, this too should be determined on the basis of the case.

Eligibility
Genders Eligible for Study: Both
Ages Eligible for Study: Any
Race and Ethnicity: Any
Accepts Healthy Volunteers: Yes

Inclusion Criteria:
Willing and available to attend the follow-up visits.

Age above 18 years.

Willing and able to give informed consent.

Exclusion Criteria:

Having an allergy or sensitivity to hair or skin products.

The person is not willing to forgo the cosmetic augmentation procedures for the duration of the study .

The person has received a soft tissue augmentation to the part to be treated within the past 6 months.

The person suffers from active skin inflammation or diseases on or near the part of injection.

The person has received autologous fat transfer in the past 6 months.

The person has tested positive for HIV, HCV or HBV.

How It Works

Basic overview:There are few basic principles, which must be followed before the Regenerative Tissue Therapy (cells) infusion for when frozen Regenerative Tissue Therapy (cells) are used.
The frozen Regenerative Tissue Therapy (cells) are thawed in a warm water bath at 37 degree Celsius by continuous agitation.

Exposure of the Regenerative Tissue Therapy (cells) to bright light at the time of thawing must be avoided.

The Regenerative Tissue Therapy (cells) are then collected in a syringe with the help of a wide bore needle preferably No. 18. The syringe should be covered with a tape to avoid exposure to light. Using a wide bore needle is necessary to prevent damage to the fragile Regenerative Tissue Therapy (cells).

The infusion should be given using a 23-gauge needle. It should be given slowly over three to five minutes of duration in dim light.

Keep a check for any immediate transfusion reaction.

Treatment Details
Dose and Mode of administration of Regenerative Tissue Therapy (cells):

HairThe dosage of Regenerative Tissue Therapy (cells) to be infused varies among different patients. It may range between 30 and 100 million Regenerative Tissue Therapy (cells) in order to generate the desired response. Doses as low as 1 million can also be adequate for generating positive results.

For managing balding and hair loss, we advocate on-site subcutaneous infusion of the Regenerative Tissue Therapy (cells) with the help of a dermaroller or by mesotherapy. The preferred sources for Regenerative Tissue Therapy (cells) in these cases are cord Regenerative Tissue Therapy (cells) / cord blood or adipose tissue based Regenerative Tissue Therapy (cells) obtained by performing liposuction. Subcutaneous or Intravenous infusion of the Regenerative Tissue Therapy (cells) may also be performed. Alternatively, 10% of the Regenerative Tissue Therapy (cells) can be given via intravenous route and the rest are implanted directly on the affected site. The protocols for mesotherapy and dermaroller Regenerative Tissue Therapy (cells) infusions are given below:

Dermaroller Protocol

1)     Consent form for procedure and photos.

2)     Photography.

3)     Analysis / Measurement for evidence of signs of ageing/ scars/ wrinkles with relevant equipments.

4)     For preparing the patient for dermaroller

a) To cleanse and prepare the area

b) To apply local anesthesia for about 45 minutes to 1 hour

c) After 1 hour, the part is cleaned with betadine, savlon and saline

d) Relevant Regenerative Tissue Therapy (cells) are used on the part.

e) The dermaroller is rolled over in a criss-cross or fan-shaped pattern for the required number of rounds.

f) The cleansing protocol is repeated.

g) Apply superficial antibiotics and send for dermaroller. Follow up after 4 to 6 weeks. (Results are better when it takes a longer time).

Mesotherapy Protocol (Localized therapy)

1) Consultation

2) Patient’s Consent

3) Analysis of the skin

4) Cleansing the part with spirit

5) Loading the solution in mesogun

6) Using the mesogun with setting

7) Using topical antibiotics in the end

8) No other medicine or oral antibiotic needed

9) Follow up after 4 weeks

Allogenic Umbilical Cord derived

GM-CSF may be administered to the patient one day before each dosage of umbilical Regenerative Tissue Therapy (cells). It should be given in a dose of 5 microgram / kg body wt in adults and 2.5 microgram / kg body wt in children. It is optional when direct implantation of the Regenerative Tissue Therapy (cells) is planned.

Route of administration of GM-CSF:

As an intravenous (IV) infusion into the vein or

As a subcutaneous injection under the skin

Side effects of GM-CSF

Points to understand about GM-CSF

Not all of the listed side effects are seen in patients.

Most of these side effects are reversible. They tend to resolve spontaneously after the treatment is complete.

The onset and duration of these side effects are fairly predictable.

There are numerous options that help in minimizing or preventing these side effects.

There is no relationship between the severity and the presence of the side effects and the effectiveness of the treatment.

Commonly occurring side effects of GM-CSF:

A person may develop reduced blood pressure, fast heart rate, flushing, feeling faint and lightheadedness after the first dose of GM-CSF. This is called the “first-dose effect” because it does not happen with future doses

Weakness and fatigue

Diarrhea

Localized reaction at the site of injection, resulting in swelling, redness and tenderness

Less common side effects

Mild flu-like syndrome with symptoms like fatigue, headache, generalized aches and pains, fever and weakness

Swelling in the hands and feet

Points to be noted about the Regenerative Tissue Therapy (cells) procured from umbilical cord lining and cord blood

CD 34+ cells mentioned during the discussion here are the cells similar to the hematopoetic cells that carry CD 34+ markers obtained after isolation of the cord blood using magnetic bead or cell sorting techniques.

Mesenchymal Regenerative Tissue Therapy (cells) mentioned during the discussion here are the cells similar to the total nucleated cells derived from the cord lining, procured with careful, exhaustive processing.

Dose of Regenerative Tissue Therapy (cells):

Approximately 32 to 80 million Mesenchymal Regenerative Tissue Therapy (cells) + 10 to 40 to million CD 34 + cells over 1 year of duration.

Duration: 8 to 20 million MSCs + 2.5 to 10 million CD 34+ cells over 3 months of duration (along with the administration of GCSF one day prior to Regenerative Tissue Therapy (cells)).

The total dosage of Regenerative Tissue Therapy (cells) should be approximately 100-200 million to derive an adequately favorable response.

Mode of administration of Regenerative Tissue Therapy (cells)

Direct subcutaneous implantation with the help of a dermaroller or by intravenous and / or mesotherapy

Known side effects of Regenerative Tissue Therapy (cells)

– Headache

– Rash

– Mild Fever

Quality Check

Quality testing of the cells should be carried out for the following as per the GLP and GMP standards:

HbsAG by ELIZA and PCR

HIV I AND II by ELIZA and PCR

HCV by ELIZA and PCR

Endotoxin content

CMV

Bacterial contamination

Or

Autologous Bone Marrow derived Regenerative Tissue Therapy (cells)

– About 150-200 ml of bone marrow is collected under aseptic precautions in a blood bag. The collection should be done under general anesthesia in an OT.

– Regenerative Tissue Therapy (cells) should be processed and isolated as per the GLP and GMP standards.

– The final volume is 5 to 10 ml, which is then administered intravenously within 6-8 hours of collection.

– The Regenerative Tissue Therapy (cells) cannot be tested for any bacterial contamination. Therefore, an antibiotic cover before beginning the infusion is warranted.

Route of administration of Regenerative Tissue Therapy (cells)

Route of administration: Direct subcutaneous implantation by using a dermaroller or by intravenous and / or mesotherapy

Or

Autologous Regenerative Tissue Therapy (cells) obtained from adipose tissue (with liposuction)

– 150 to 200 ml of adipose tissue is collected in a blood bag by performing a procedure called liposuction. It should preferably be carried out by a plastic surgeon in an OT, after giving general anesthesia.

– Regenerative Tissue Therapy (cells) should be processed and isolated as per the GLP and GMP standards.

– The final volume is 5 to 10 ml, which is later administered intravenously within 6 to 8 hours of collection.

– There are no tests to check the Regenerative Tissue Therapy (cells) for bacterial contamination. Hence, it is essential to provide an antibiotic cover prior to the infusion.

Route of administration: Direct subcutaneous implantation with the help of a dermaroller or by intravenous and / or mesotherapy

Or

Autologous Regenerative Tissue Therapy (cells) from Peripheral Blood
– The Regenerative Tissue Therapy (cells) are collected by performing apheresis.

– This procedure should be carried out in an ambient environment using a well programmed cell separator like Kobe Spectra or Hemonitics, which helps to provide the required Regenerative Tissue Therapy (cells) (about 200 to 250 ml of Regenerative Tissue Therapy (cells)) from the peripheral blood stream in a specially designed blood bag.

– Prior infusion with GM-CSF (in a dosage of 5 microgram / kg body wt in adults and 2.5 microgram / kg body wt in children) is required to enhance the mobilization of the essential Regenerative Tissue Therapy (cells) from the bone marrow.

Route of administration: Direct subcutaneous implantation using a dermaroller or by intravenous and / or mesotherapy

Or

Autologous Regenerative Tissue Therapy (cells) isolated from small intestine, skin, teeth, cornea, liver, etc.

– The Regenerative Tissue Therapy (cells) are procured from any of these organs using sophisticated techniques that help in their isolation. The procedure should be performed in an OT under general anesthesia.

– Regenerative Tissue Therapy (cells) are later processed and isolated as per the GLP and GMP standards.

– The final volume is about 5 to 10 ml, which is then administered intravenously within 6-8 hours of its collection.

– As the Regenerative Tissue Therapy (cells) cannot be checked for contamination, it is advisable to provide an antibiotic cover before the infusion.

Route of administration: Direct subcutaneous implantation using a dermaroller or by intravenous and / or mesotherapy

OR

Autologous / Allogenic therapy using Regenerative Tissue Therapy (cells) from amniotic fluid, amniotic sac and / or placenta

Diverse forms of progenitor cell populations, such as mesenchymal, trophoblastic, hematopoietic, and few more primitive Regenerative Tissue Therapy (cells) can be isolated from the placenta and the amniotic fluid. At least some of the cells procured from the amniotic and placental origin have a common source, namely the inner cell mass of the morula. Indeed, several forms of progenitor cells isolated from these 2 sources have many common characteristics. The amniotic fluid and the placenta contain multiple progenitor cell types from the developing embryo like fat, bone and muscle.

Placenta and Amniotic sac (amniotic membranes):

After harvesting the blood cells sourced from the placental tissues (UPT), placenta blood (UPB) and umbilical cord blood (UCB) simultaneously for their content of nucleated cells, CD34 (hematopoietic stem progenitor marker) positive cells, the results indicated that the nuclear cells (NC), which were sourced from UPB and UPT possessed about 3-4 times than those from the UCB only. The cells from UPT (Placental tissue) and UPB (Placental Blood) have better survival ability compared to the cells from UCB (Cord Blood) in the long-term cell culture condition. The cells stored in liquid nitrogen did not show much loss of CD34 (+) cells and total nucleated cell count. It was also noticed that UPT and UPB had more number of suppressor lymphocytes, which could be of great importance for the prevention of graft-versus-host disease. These implications prove why the collection of placental blood and tissue and their processing together with umbilical cord blood processing is important for the Regenerative Tissue Therapy (cells) transplantation.

Amniotic fluid

Regenerative Tissue Therapy (cells) sourced from the amniotic fluid can be used to differentiate into various forms of body tissues such as muscle, adipose tissue, blood vessel, nerve, cartilage, bone, etc.

These cells are a valuable source for tissue, organ or cell repair.

The Regenerative Tissue Therapy (cells) obtained from amniotic fluid are known as AFS (Amniotic Fluid Derived Stem) cells. They denote an intermediate stage between the embryonic Regenerative Tissue Therapy (cells) and the adult Regenerative Tissue Therapy (cells). These cells possess the ability for self-renewal, a defining property of Regenerative Tissue Therapy (cells). These cells can also help to produce a broad array of cells highly valuable for the therapy.

AFS cells are found in large supplies in amniotic fluid, which can be obtained by performing a procedure that is usually carried out for the examination of the cells for prenatal diagnosis of genetic diseases. The procedure is known as amniocentesis. Childbirth is another source of amniotic fluid. The chance for a perfect match is better because of its primitive nature.

Using AFS cells can have many advantages as mentioned below:

1) It is easier to obtain these cells by performing amniocentesis.

2) As these cells double every 36 hours, they can be grown in large quantities so as to generate huge amounts of Regenerative Tissue Therapy (cells).

3) These cells can be guided to migrate towards the desired cell line without the need of ‘Feeders’ or ‘Factors’.

4) They do not produce tumors; hence, are highly preferred over embryonic Regenerative Tissue Therapy (cells).

5) Specialized cells, which can be generated from AFS cells, include all three types of cells existing in the developing embryo including ectoderm, mesoderm and endoderm. Hence, these cells have a potential to differentiate into any organ, cell or tissue of the body.

6) As with the embryonic Regenerative Tissue Therapy (cells), AFS cells also possess the ability to generate all types of adult cells.

The project director advocates using Regenerative Tissue Therapy (cells) from placenta, amniotic sac and / or amniotic fluid. These cells should be carefully processed, isolated and then cultured in a clean room (as per the GLP and GMP standards). They may be used for allogenic or autologous use just like the Regenerative Tissue Therapy (cells) procured from cord blood or cord tissue, at times, along with hyperbaric oxygen and / or chelation therapy after administering GM- CSF. The selection of Regenerative Tissue Therapy (cells), its dosage, mode and route of administration and accompanying adjuvant or concurrent therapy differ on the basis of an individual case.

Route of administration of Regenerative Tissue Therapy (cells):

Direct subcutaneous implantation using a dermaroller or by intravenous and / or mesotherapy

Possible side effects of amniotic Regenerative Tissue Therapy (cells)

– Rash

– Headache

– Mild Fever

Quality Check

Quality testing of the cells should be carried out for the following as per the GLP and GMP standards:

HbsAG by ELIZA and PCR

HIV I AND II by ELIZA and PCR

Endotoxin content

CMV

Bacterial contamination

HCV by ELIZA and PCR

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