Androgenetic alopecia is the medical term for pattern baldness. Pattern baldness can manifest in several ways such as a receding hairline, a bald spot in the crown of the head, and/or generalized thinning hair. Pattern baldness is the most common form of hair loss. Approximately 4 out of 5 men will experience some degree of androgenetic alopecia by the time they reach age 70. Androgenetic alopecia affects a substantial number of women as well. Pattern baldness is not lethal, but it can create substantial amounts of psychological suffering and greatly diminishes the quality of life for both men and women.
The two first-line treatments for androgenetic alopecia in men are finasteride or minoxidil. Finasteride is an oral medication, while minoxidil is topical, i.e. it is placed on this directly on the scalp. These baldness treatments are modestly effective in a certain percentage of men. Patients may also be treated with dutasteride, light therapy, platelet-rich therapy, or surgery. Minoxidil is the main form of treatment for women with androgenetic alopecia. If minoxidil fails to help regrow hair or stop the balding process, women may alternate treatments including spironolactone, finasteride, cyproterone acetate, or flutamide. As with male pattern baldness, female pattern baldness is somewhat resistant to treatment, leaving most women to cover their baldness with wigs or concealers.
One important observation about androgenetic alopecia is that while the number of hair follicle stem cells remains the same in people who are balding, the number of more actively proliferating progenitor cells drops dramatically. In other words, it is theoretically possible to treat androgenetic alopecia with hair follicle stem cells that contain actively proliferating progenitor cells.
Indeed, researchers recently tested this hypothesis in a group of 11 patients with androgenetic alopecia. The researchers collected a bit of tissue from each patient and then purified the sample to collect hair follicle stem cells with actively proliferating progenitor cells. The doctors then injected those stem cells into balding areas on the patients’ scalps. For comparison, some were treated with a placebo injection, i.e. saltwater.
Patients treated with hair follicle stem cells enjoyed a 29% increase in hair density over the treated area. by contrast. Patients treated with placebo had less than a 1% increase in her density over the same time period. The researchers also noticed that they were substantially more stem cells in and around hair follicles in balding areas.
The authors of this research concluded that isolated cells are capable of improving hair density in patients with androgenetic alopecia. While additional, larger studies are needed to confirm these results, the current study provides strong evidence that bald and balding patients may benefit from autologous stem cell treatment.
Reference: Gentile P. et al. (2017). Stem cells from human hair follicles: first mechanical isolation for immediate autologous clinical use in androgenetic alopecia and hair loss. Stem Cell Investigation. 2017 Jun 27;4:58.
Frailty is a syndrome of weight-loss, exhaustion, weakness, slowness, and decreased physical activity. These features combine to make frail individuals more susceptible to physical, psychosocial, and cognitive impairments. Unfortunately, frailty is rather common among elderly individuals. In one study of over 44,000 elderly adults living in the community estimated the overall prevalence of frailty was 10.7%. While the risk of becoming frail increases with old age, frailty is not a normal part of aging. Instead, the syndrome of frailty is driven by biological processes such as inflammation and stem cell dysfunction.
No specific treatment can prevent or reverse frailty. Indeed, the goal of treatment is to maximize the patient’s functional capacity and overall health. The most widely accepted way to manage frailty is a multimodal and multidisciplinary approach. Frail individuals or those at risk for becoming frail are encouraged to participate in strength training and aerobic exercise to build up a cardiovascular reserve and physical fitness. At the same time, substantial efforts are devoted to helping patients consume enough calories to maintain lean muscle and support their immune function. As appetite diminishes, malnutrition can become an issue, so supplemental nutrition may be needed. Physicians can help patients by optimizing medical treatments and reducing the total number of medications prescribed (i.e. avoiding polypharmacy).
Despite these multimodal treatments, most frail patients tend to get worse over time. One hope of treatment is to slow the rate of decline; however, this is not always possible.
Since frailty is driven by stem cell dysfunction, a reasonable way to prevent or treat frailty could be to provide patients with healthy stem cells. Researchers recently conducted a randomized, double-blind, clinical trial in 30 elderly patients with frailty. Frail patients received an IV infusion of either human mesenchymal stem cells or placebo. The researchers then followed the patients for 6 months to assess the safety and efficacy of the stem cell treatment.
Stem cell treatment resulted in a rather remarkable set of benefits for frail patients. Compared to placebo, patients treated with stem cells performed significantly better on tests of physical strength and stamina. Stem cell-treated patients used calories more efficiently, which is a sign that they were more physically fit than those in the placebo group. Moreover, patients who received stem cells had better lung function at the end of the trial than those in the control group. Interestingly, women who received stem cell treatment reported a substantial increase in sexual quality of life compared to those in the placebo group. Lastly, no patients experienced any treatment-related serious adverse events.
When one considers how difficult it is to treat frailty or even alter its progressive decline, these results are remarkable. Stem cell treatment not only stopped the progression of frailty, but patients actually improved in several important measures including physical strength, physical endurance, lung function, and sexual quality of life. We anxiously await a pivotal clinical trial to confirm these results.
Reference: Tompkins, BA. (2017). Allogeneic Mesenchymal Stem Cells Ameliorate Aging Frailty: A Phase II Randomized, Double-Blind, Placebo-Controlled Clinical Trial. The Journals of Gerontology, Series A, Biological Sciences and Medical Sciences. 2017 Oct 12;72(11):1513-1522.
Progressive supranuclear palsy, also known as PSP, is a disorder of the brain that gets worse over time (progressive neurodegenerative disorder). Many progressive supranuclear palsy symptoms are similar to Parkinson’s disease. These include rigidity, slowness of movement, cognitive (thinking) problems, difficulty speaking, and difficulty swallowing. While people with Parkinson’s disease can have an unsteady gait and “freeze,” these symptoms are much more prominent in people with progressive supranuclear palsy. Likewise, people with PSP have a particular eye problem called supranuclear gaze palsy, which causes PSP patients to have difficulty moving their eyes in certain directions.
Despite the similarities between PSP and Parkinson’s disease, there are no treatments for progressive supranuclear palsy as they are for Parkinson’s disease. Drugs like levodopa help reduce tremors and rigidity in people with Parkinson’s, but they have been largely ineffective in people with PSP. Some PSP patients may benefit from drugs like levodopa, but most experience severe visual hallucinations or other side effects, which causes them to stop the medication. Because there are so few treatments, patients with progressive supranuclear palsy rely on supportive care measures such as occupational and physical therapy, nutritional support, and palliative care.
To address this critical need, researchers are testing mesenchymal stem cells for their ability to treat progressive supranuclear palsy. Dr. Margherita Canesi and her colleagues selected five patients with progressive supranuclear palsy. Her research team used bone marrow from healthy volunteers to select healthy mesenchymal stem cells. The researchers then infused the mesenchymal stem cells into patients in a single infusion.
While patients with PSP normally deteriorate rapidly, the patients who received a single stem cell treatment remained stable for at least six months after treatment. Some patients still maintained function at the end of the study (12 months). All patients tolerated the treatment well, there were no major side effects. While the study was small, it suggests that stem cell treatment was able to change the natural course of the disease. Based on these encouraging results, the authors have set their sights on a randomized, placebo-controlled phase 2 study to further test mesenchymal stem cell treatments in patients with progressive supranuclear palsy. We look forward to their results with great enthusiasm.
Reference: Canesi, M. et al. (2016). Finding a new therapeutic approach for no-option Parkinsonisms: mesenchymal stromal cells for progressive supranuclear palsy. Journal of Translational Medicine. 14, Article number: 127 (2016).
A new study has shown that a protocol for treating Multiple Sclerosis with stem cells is safe. According to the researchers, the potential for using stem cells in Multiple Sclerosis therapy warrants further investigation. The results of the study were published in the Journal of Translational Medicine.
Stem cells – and specifically, mesenchymal stem cells, have been increasingly used in the treatment of immune and inflammatory conditions. Based on the success that has been seen in these areas, scientists reasoned that mesenchymal stem cells may also represent a useful approach to treat Multiple Sclerosis, a neurological disease that involves the abnormal attack by the immune system on the myelin sheath that insulates nerves and allows nerve cells to communicate effectively and efficiently with one another.
To test this idea, the scientists used umbilical cord mesenchymal stem cells in 20 Multiple Sclerosis patients. The patients were given intravenous injections of the stem cells each day for seven days. The researchers evaluated the patients – with both neurological testing and nervous system imaging – at baseline, one month after treatment, and one year after treatment. The researchers found that the stem cell treatment improved neurological scores in patients and that lesions in the brain and cervical spinal cord were inactive one year after the stem cell injections. There were no serious adverse side effects associated with the treatment.
Based on these findings, it is possible that stem cells will provide a useful treatment option for those with Multiple Sclerosis. With more research, we will better understand exactly how stem cells can be used to help this population of patients.
Reference: Riordan, N.H. et al. (2018). Clinical feasibility of umbilical cord tissue-derived mesenchymal stem cells in the treatment of multiple sclerosis. Journal of Translational Medicine, 16(57), 1-12.
Erectile dysfunction is the most common sexual disorder among men. During an erection, blood enters the tissues within the penis and is temporarily trapped there. In erectile dysfunction, however, this process does not occur. A man who suffers from this condition is unable to achieve a penile erection sufficient for sexual intercourse.
Erectile dysfunction has many causes ranging from neurological conditions to vascular (blood vessel) conditions to psychological conditions. In most men, erectile dysfunction is caused by a problem in blood flow and nitric oxide production, which is why drugs like the Viagra and Cialis are effective for some men because they temporarily reverse these problems.
Results from a review of 54 research studies showed that stem cell-based therapies may be able to reverse these effects on a more permanent basis. For example, mesenchymal stem cells were able to increase the number of enzymes that produce nitric oxide. Likewise, mesenchymal stem cells increased the size of penile tissue in older rats. Indeed, stem cell injections were able to restore erectile function in rats with diabetes.
Based on these laboratory results, researchers have conducted clinical trials using stem cells to treat men with erectile dysfunction. In one such trial, researchers used a person’s own fatty tissue (adipose) to generate stem cells. They then injected those cells into men with erectile dysfunction. Eight out of 11 men treated with stem cells regained erectile function. In another small study, eight men with profound erectile dysfunction in whom oral ED treatments failed received placenta-derived stem cells. Two of the patients were able to achieve and sustain erections six weeks after treatment while an additional patient was able to do so after three months.
Laboratory studies of stem cells in the treatment of erectile dysfunction are extremely promising. The clinical studies in this area are limited, and the results are somewhat less impressive. Nonetheless, as improvements and refinements are made to stem cell technology, this approach could offer hope to men with erectile dysfunction, especially those men who have not been helped by ED drugs.
Reference: Albersen, M. et al. (2013). Stem-cell therapy for erectile dysfunction. Arab Journal of Urology. 2013 Sep; 11(3): 237–244.
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