This should finally made Cole slink away from all his jealous naysaying (although I hear he's desperately trying to team up with Cooley to study Acell, which is ironic given that he initially intimated that Cooley was being 'misleading' and fueling 'irrational exuberance.'
I'd suggest you skip the Hitzig PRP/Acell section, as I think it's all a bit tenuous at this point anyway. The good part starts when Cole tries to smackdown autocloning (although he has toned down his 'this is all bull' rhetoric and now leaves a bit of wiggle room), and then Cooley responds:
I understand why Dr. Cole is confused. In fact, I was quite
confused for a long time about the plucked graft technique
developed by Dr. Gary Hitzig. When I wrote in my 2006 Co-
Editors’ Message that Dr. Hitzig was able to pluck intact follicles,
I was wrong. It only appeared that way to me using the
stereomicroscope. The key to understanding this controversy is
the dermal sheath.
I have now plucked many thousands of hairs in the course of
refining and developing this technique. I have examined them
not only with the stereomicroscope but also histologically and
microscopically with special stains (1% Dimethylaminocinnamaldehyde).
The following has become very clear: The plucked
hair follicle contains the inner and outer root sheath (epithelial
cells) and sometimes the dermal papilla (mesenchymal origin)
but never, in my experience, the dermal sheath. The dermal
sheath is a practically invisible layer of mesenchmal cells that
envelops the hair follicle, and in its lower section is thought to be
a reservoir of mesenchymal stem cells that supplies the dermal
papilla in much the same way that the “bulge” is the source of
stem cells for matrix keratinocytes. The dermal sheath is always
left behind after plucking. What is thought to occur is that, after a
hair is plucked, the dermal sheath reconstitutes the dermal papilla
and the bulge stem cells reconstitute all the epithelial layers of
the follicle, thus allowing hair to regrow.
Ever since humans developed self-awareness and opposable
thumbs, they have likely been plucking hair from their bodies.
Much to their consternation, the hair regrows. If I had a special
plucking technique that completely removed the hair follicle, I
would be redirecting much of my practice toward permanent hair
removal, which would likely be very lucrative for me judging
by the insatiable desire people have to get rid of unwanted hair.
Sadly, or fortunately, depending on how you look at it, this is
not the case. Neither I, nor Dr. Hitzig, have ever seen permanent
thinning in areas that were plucked. Since the dermal sheath
and some epithelial stem cells are left behind after plucking,
the hair follicle regenerates and hair regrows. Trichotillomania
is a biological model for repeated plucking so we can see what
happens over time. Many children have this common behavior
disorder and never develop permanent hair loss. It is only after
years of repeated plucking that permanent alopecia develops,
probably from depletion of epithelial stem cells. The autocloning
technique does not promise unlimited donor hair, but it does hold
the possibility of a greatly expanded donor supply.
What interests me is that Dr. Cole says there is no evidence
for hair duplication yet he doesn’t really explain the histologic
data I presented. Looking at the rather coarse hair growing in
isolation on a bald crown, and seeing the vertical histologic section
of this hair with its apparent normal follicular architecture
is indeed a piece of evidence. There are only three possible
explanations: 1) it’s a fraud (I grafted a whisker harvested by
FUE and am saying it was plucked); 2) it’s from a plucked intact
follicle (which is impossible because as discussed above, the
dermal sheath cannot be “plucked”); or 3) it’s what I say it is,
a regenerated follicle from a plucked partial hair follicle. The
dermal sheath and sebaceous gland is present and must have been
regenerated in situ. This data is supported by a second biopsy
where a 4-hair unit is seen with horizontal sectioning. Considering
that this was created by implanting four beard whiskers
into a site in the balding crown, where only highly miniaturized
1- and 2-hair units were present, it’s a rather remarkable result.
Again, all the normal components of follicular architecture are
present. If this isn’t evidence, what is it? Yes, of course, large
blinded studies would be nice. But these are very difficult for the
unfunded solo doctors to carry out in their private practices, and
they are especially difficult in the field of surgical hair restoration.
In fact, I’m not aware of any “evidence based medicine” study
that has had any significant effect on the day-to-day practice of
the hair surgeon. We change and evolve through hearing case
presentations and technique descriptions from our colleagues,
and then trying these out in our own practices. This is the milieu
in which the autocloning technique will live or die and this, of
course, takes time.
Regarding the name—autocloning—there is no double entendre
here, only one entendre. Webster’s Dictionary defines a
“clone” as one that appears to be a copy of an original form; duplicate
is a synonym of clone. It is derived from the Greek word
klōn, meaning twig. The word arose in the horticulture world,
where the creation of a new plant from a twig of the original
was called cloning. This is very similar to the hair autocloning
technique, where auto (self) cloning (copying) occurs by plucking
a “twig” of hair from the mother follicle to create daughter
follicles. Cloning in scientific usage may also be applied to
disparate laboratory techniques involving DNA, cells, or whole
organisms. In scientific circles, it is not generally used to refer
to somatic cell therapy. Implanting cultured dermal papilla to
regenerate follicles is not “cloning,” as has been explained many
times in the past.
The actual clinical significance of the autocloning technique
remains to be determined. How successful, how durable, etc., are
important questions that must be answered before a consensus is
reached. But as far as I am concerned, these preliminary clinical
and histologic observations have weathered their first round of
criticism quite nicely.