Gentlemen,
I’ve been a lurker on this forum and I wanted to share some details from a medical textbook that I was going through last day in preparation for my upcoming exams. I’m an M.D. student at the University of Toronto in Ontario, Canada. My area of intended specialization is in Dermatology.
Coincidentally, I happened to come upon a section on Genetics and IGF-1 in my exam review readings. The primary author of the textbook is Dr. Jerry Shapiro , co-author is Nina Otenberg.
[Author/Physician/ Researcher Introduction:]
By way of background, Dr. Shapiro is a renowned hair restoration surgeon and a hair loss researcher. He is one of the few doctors who happens to be affiliated with the public hair research and skin institute at the University of British Columbia’s medical school, one of Canada’s pre-eminent medical institutions. In addition to being a practicing hair restoration surgeon and doctor, he serves at the NYU – Langone Clinical Center and UBC- Vancouver. Dr. Shapiro mixes teaching, research and diagnosis all in one.
Dr. Shapiro’s research is heavily “lab based” and he is constantly researching at UBC on hair follicle biology. Upon closer research, it appears he is the advising physician for Replicel and their RCH-01 trials. Moreover, he is conducting double-blind placebo controlled clinical trials (the first of their kind) on PRP to “validate” if the hype around PRP growth factors is true or not. (Note: No double-blind , placebo controlled studies on PRP and Androgenic Alopecia exists to date)
To date, Dr. Shapiro’s stance has been tailored to traditional FDA approved drugs minoxidil and finasteride to treat male pattern baldness. At the last consult, he discouraged use of PRP until further scientific evidence accumulates via double-blind, placebo controlled studies.
IGF-1 is a key part of PRP and one of many growth factors released by PRP, it is a key area of Dr. Shapiro’s research.
http://www.doctorjerryshapiro.com/ (Dr. Shapiro’s Biography)
https://clinicaltrials.gov/ct2/show/NCT02074943 (PRP Trial - Clinical Trials.gov)
Dr. Nina Otberg is a hair loss restoration surgeon and also teaches, researches and authors textbooks on hair loss. Dr. Otberg has worked in research labs at the University of Berlin (Germany) and currently is stationed out of the University of British Columbia. Her specialization is in the niche of “female pattern baldness.”
http://www.hlcp.de/en/personnel
Both Dr. Shapiro and Otberg have authored numerous articles on hair loss in the renowned peer-review journal NATURE which has high standards of review unlike some other smaller “peer-reviewed” articles
In the research world, Nature has a high “Impact Factor” compared to many journals because of its strict academic reputation and many researchers and publication cite its research. It is not easy and fairly hard for the average researcher to get published in Nature. Moreover, many researchers have tried to replicate findings of many Nature research articles (aside)
The textbook authored by Dr. Shapiro and Nina Otberg entitled “Hair Loss and Restoration” has to say this about IGF-1 and hair follicle biology (meat of the matter):
[Textbook Excerpt]
The expression of Insulin like growth factor (IGF-1) in the dermal papilla is discussed to play an “important” role in the development of pattern balding. Older men with vertex balding showed higher levels of IGF-1 and lower circulation levels of IGF-1 binding protein 3. A decreased expression of IGF-1 was found in in the scalp tissue.
Source:
(Genetics in Hair Loss and Restoration, Dr. Jerry Shapiro and Nine Otenberg, pg 28)
https://books.google.ca/books?id=bJG...hapiro&f=false
Analysis:
It appears to me in my academic study of IGF-1 that this growth factor certainly plays a role in hair growth – no question about that. IGF-1 contributes to hair thinning and it is important! That being said, it can be speculated that the dermal papilla senesce in balding men/women impacted by androgenic alopecia is due to two things:
1) Lower circulation of the IGF-1 binding protein results in lack of IGF-1 in the scalp and thus, the regular hair follicle cycle is disrupted resulting in thinner and thinner hair until the follicle miniaturizes or goes dormant. The IGF1 binding protein 3 receptors for the dermal papilla are functional
2) Abnormality or inability of proper uptake of the IGF1-1 binding protein 3 at the dermal papilla receptors which results in the protein not being used properly even if IGF1 levels are higher and thus progressive miniaturization
As a medical student, I have to say that Follicept’s “science is strong” and they are going after the right target. However, the probability of failure is there, and it is high.
Thus I am cautiously watching and observing here. Who said science was simple?
This can obviously fail too, the complexity of the hair follicle has evaded a cure for so long. We have to wait and see the results.
The Challenge:
If Point # 1 holds true, then Follicept is likely to work. If Point # 2 holds true then, Follicept will fail.
The challenge or onus is on Follicept to show their trials one-man and multiple specimen experiments and publish results from double-blind placebo controlled fashion.
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