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  1. #21
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    It's good to hear both sides of the conversation. I think we should sit back and wait for more results from Doctors Cooley and Hitzig. In addition lets see how the studies that Doctors Bernstein and Rassman are entering into go. I had a consult with Dr. Bernstein once and he seemed to be a very pragmatic individual so I'm pretty sure if he sees promise in the procedure he will say so.
    Until then I will keep on my meds.

  2. #22
    Senior Member gmonasco's Avatar
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    Realistically, this scenario is exactly what you want to see when it comes to medical breakthroughs: researchers who are testing out a new treatment to see if it has potential, and skeptics who are asking the tough questions about whether (and how well) that treatment is actually working.

  3. #23
    IAHRS Recommended Hair Transplant Surgeon Jerry Cooley, MD's Avatar
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    I thank Dr Cole for his interest in our work. As I’ve stressed repeatedly, my work consists of preliminary ‘anecdotal’ observations about the use of ACell in hair restoration surgery. Of course it would be nice to have large clinical studies with control groups which would provide a higher level of proof. Any physician who has participated in formal clinical studies knows the difficulty and complexity involved in such work. These are especially difficult with hair restoration surgery, and there are almost no such studies done in our field. The bulk of what we do has developed over time based on the ‘anecdotal’ observations of forward thinking surgeons who went on to share these results with their peers.

    With a product like ACell that is entirely new to our field, most physicians would be lost as to where to begin looking at possible applications within the spectrum of hair restoration procedures. Hopefully our work will provide a starting point for others to do controlled studies. I’m glad Dr. Cole is now working with ACell and is able to share his anecdotal observations with us. That is how progress occurs in our field.

    In reference to “autocloning”, our work continues. As each new patient comes in for followup with positive results, I become more excited about the future of this procedure. None of our patients have complained of thinning in the areas that were plucked, and none of my test sites with plucked hair without ACell subsequently grew hair. Dr. Cole is right that occasionally Dr. Hitzig had success with plucking alone, but the fact that he saw a big difference after he began using ACell and only does it this way now is rather convincing to me that ACell is making a difference. The hair diameter certainly appears normal but I have not scientifically tested that.

    In reference to the many points raised by Dr. Cole, I can sum up my answer by saying, 'time will tell'. I know he has faced similar criticisms over the years in regards to body hair transplants; nevertheless he has tenaciously carried on. That is our intention too.
    Jerry Cooley, MD
    Member, International Alliance of Hair Restoration Surgeons
    View my IAHRS Profile

  4. #24
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    Default Skepticism is healthy

    I too thank Dr. Cole for his detailed skepticism. When analyzing his extensive report, one should not miss that he too saw impressive results with ACell in some of his body hair patients. I think Dr. Cooley's message is on target.
    It is very important that ACell be used correctly to achieve optimal (and even satisfactory) results. Suspending ACell powder in saline is not optimal. One of the advantages of PRP and related mediums is that they have high concentrations of Adult Stem Cells. These are the cells that ACell, when in direct contact, converts back to the Active Progenitor Cells and are instrumental in taking over the healing process by duplication instead of scarring. ACell is unique in that it is the only ECM (Extracellular Matrix) that is Bi-Modal and incorporates the recruitment of both Epithelial and Endothelial Cells needed for skin and hair duplication. It also provides a scaffold for the process to occur which is temporary and then disappears allowing the newly recruited cells to do their work.
    ACell also contains a multitude of Growth Factors as well as proteins needed to support Hair Growth-this is most likely why it has dramatically increased plucked hair survival. Plucked hairs do not grow thinner-at least not in my experience of over 10 years with them.
    Let me also make it clear that my original and still use of plucked hairs has been for repair of old transplants with depleted donor areas or small areas of transplant fill-ins. It is a tedious procedure although improving as our techniques do.
    My greatest fear has been the worry that judgements will be made of a discovery based on improper employment of it. Sometimes it is easier to shoot the product than the surgeon.
    I applaud Dr. Cole for his intense scrutiny, but the "empirical" results, as Dr. Jerry Cooley has said, are very real and multiplying daily.

  5. #25
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    Quote Originally Posted by Jerry Cooley, MD View Post
    I thank Dr Cole for his interest in our work. As I’ve stressed repeatedly, my work consists of preliminary ‘anecdotal’ observations about the use of ACell in hair restoration surgery. Of course it would be nice to have large clinical studies with control groups which would provide a higher level of proof. Any physician who has participated in formal clinical studies knows the difficulty and complexity involved in such work. These are especially difficult with hair restoration surgery, and there are almost no such studies done in our field. The bulk of what we do has developed over time based on the ‘anecdotal’ observations of forward thinking surgeons who went on to share these results with their peers.

    With a product like ACell that is entirely new to our field, most physicians would be lost as to where to begin looking at possible applications within the spectrum of hair restoration procedures. Hopefully our work will provide a starting point for others to do controlled studies. I’m glad Dr. Cole is now working with ACell and is able to share his anecdotal observations with us. That is how progress occurs in our field.

    In reference to “autocloning”, our work continues. As each new patient comes in for followup with positive results, I become more excited about the future of this procedure. None of our patients have complained of thinning in the areas that were plucked, and none of my test sites with plucked hair without ACell subsequently grew hair. Dr. Cole is right that occasionally Dr. Hitzig had success with plucking alone, but the fact that he saw a big difference after he began using ACell and only does it this way now is rather convincing to me that ACell is making a difference. The hair diameter certainly appears normal but I have not scientifically tested that.

    In reference to the many points raised by Dr. Cole, I can sum up my answer by saying, 'time will tell'. I know he has faced similar criticisms over the years in regards to body hair transplants; nevertheless he has tenaciously carried on. That is our intention too.
    Dr. Cooley why not add WNT proteins to the mix of Acell/PRP. Its been shown by Dr. Cotsarelis and Histogen and Angela Cristiano and others that injury+WNT proteins cause new hair growth.

  6. #26
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    Quote Originally Posted by Westonci View Post
    Dr. Cooley why not add WNT proteins to the mix of Acell/PRP. Its been shown by Dr. Cotsarelis and Histogen and Angela Cristiano and others that injury+WNT proteins cause new hair growth.
    And wherefrom should he get Wnt proteins? In a supermarket?

    http://en.wikipedia.org/wiki/Wnt_signaling_pathway

  7. #27
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    Quote Originally Posted by HairRobinHood View Post
    And wherefrom should he get Wnt proteins? In a supermarket?

    http://en.wikipedia.org/wiki/Wnt_signaling_pathway
    http://www.genwaybio.com/all_protein...77386bc323cca2

    Scroll to the bottom to see the WNT proteins. I think doctors would have access to such material.

  8. #28
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    Quote Originally Posted by Westonci View Post
    http://www.genwaybio.com/all_protein...77386bc323cca2

    Scroll to the bottom to see the WNT proteins. I think doctors would have access to such material.
    Ok. And which one should he choose and add? All availabel Wnt proteins? Or just a specific combination/mix thereof?

    Concerning "Wnt proteins" - basically you're right; Dr. George Cotsarelis (Follica) brought this subject up in this field, followed by Dr. Gail Naughton (Histogen) and so on. BUT none of them ever discussed "adding" of any "Wnt proteins" to mammals for any therapeutical purpose. It's just all about "Wnt SIGNALING" and not about adding any "Wnt proteins". But feel free to read it yourself:

    http://www.wipo.int/pctdb/en/wo.jsp?...DISPLAY=CLAIMS
    -------------------------
    EXCERPT
    "79. A method for producing pigmented hair on a subject, said method comprising comprising (i) generating a hair follicle on said subject according to the method of any of claims 47-78; and (ii) suppressing an expression of a Wnt protein in said hair follicle.

    80. The method of claim 79, wherein the step of suppressing an expression of a Wnt protein comprises inducing an expression of a Dkkl protein.
    -------------------------

    So as you can see, they do not mention something of "adding" of any Wnt proteins. They just talk about "suppressing" an expression of a [specific) Wnt protein.

  9. #29
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    Default Wnt vs. growth factors

    @Westonci – My previous post (yesterday) about the “Wnt” subject, was just a quick response out of my memory. I just read it again and checked what I wrote. But besides some grammar mistakes (I guess), everything I mentioned is basically – correct:

    Nilofer Farjo, MBChB Manchester, England
    Wnt signaling: a review
    One of the current buzz words in the literature, in meetings, and on the Internet is “wint”; but, what exactly is wnt and how does it fit into our understanding of hair follicle physiology? And, more significantly, will it lead to a new generation of treatments for alopecia?
    When we talk of “wint,” we are in fact referring to two different things: the wnt gene family and wnt proteins. Wnt genes are structurally similar genes (19 wnt genes in humans have been identified on different chromosomes) that produce signalling proteins also referred to as wnt. These signaling molecules regulate cell-to-cell interactions during embryogenesis and control normal physiological processes in adults; some of these wnt proteins are specific to certain cells and tissues.
    Histogen Inc. has been conducting studies using the concepts of increasing wnt signaling to promote hair growth in clinical trials. Below I interview their founder and CEO, Dr. Gail Naughton, on these recently completed trials.

    Source: Hair Transplant Forum International, Jul/Aug 2009, page 120
    Dr. Gail Naughton (Histogen Inc) mentioned in this interview, that they “produce” specific types of Wnt proteins (e.g. Wnt 7a) in their own labs, as well as “other hair-regeneration-related proteins” (e.g. follistatin) under specific and controlled conditions. Thereby specific cell types (fibroblasts) INCREASE their production of specific Wnt proteins, and during the production of these Wnt proteins, the cells also “secret a variety of wound healing growth factors” (e.g. KGF, VEGF etc). All in all results in a special medium which they simply call “Hair Stimulating Complex” (HSC). That’s all – isn’t it?

    Concerning “abnormalities in Wnt signaling” or formations of tumors/cancer, particularly related to Wnt 5a proteins, Dr. Gail Naugthon mentioned in this interview, that they have to adapt the growth conditions to down-regulate Wnt 5a proteins and to up-regulate Wnt 7a proteins and so on.

    So I ask you once again: Which Wnt protein type should Dr. Jerry Cooley “add” to the mix of Acell/PRP, and finally, for what reason? Wnt 7a proteins? Down-regulated proteins or up-regulated proteins? How much should they be “up-regulated”? Is it possible that too much “up-regulated” Wnt 7a proteins “signal” other proteins in your body to be e.g. Wnt 5a proteins or to be any other (“risky”) protein type, simply with the intention “just for fun”?

    How about just adding of the mentioned “growth factors” ?

  10. #30
    IAHRS Recommended Hair Transplant Surgeon Jerry Cooley, MD's Avatar
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    Default Role of WNT

    Westonci and HairRobinHood

    Thank you for the lively discussion of WNT. Doubtlessly the WNT pathway is critical in the formation of hair follicles. In fact, I wouldn't be surprised if the WNT pathway is activated when ACell coated plucked hair is implanted in the skin. However, I would be very cautious about adding exogenous WNT proteins as this may disturb the delicate balance of stimulatory/inhibitory factors present in this context. For example, it is well known that activation of WNT/beta-catenin is associated with tumor formation, which is why Cotsarelis' approach is requiring such careful animal studies and will be subjected to close regulatory scrutiny. In the past, some thought that Sonic Hedgehog stimulation had potential for hair loss treatment, but I believe that tumor formation occurred which shut down any further work on this. It may be that the Histogen approach, which uses a mix of embryonic proteins secreted by neonatal fibroblasts, is more desirable because that stimulatory/inhibitory system is already built in.

    Regardless, use of either approach would require FDA supervised studies and should not be done by the surgeon at this time just to 'see what happens'. ACell is already FDA approved for wound healing and can be safely used as an adjunct to transplanting plucked hairs.

    Thanks again for the thought provoking discussion.
    Jerry Cooley, MD
    Member, International Alliance of Hair Restoration Surgeons
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