When my daughter was in elementary school she had a classmate with just a few patches of hair on an otherwise bald scalp. The effect was undeniably startling. I came to learn that the child had alopecia areata, an autoimmune disorder that causes hair loss when immune cells attack the hair follicles. About 2 percent of Americans suffer from some form of the disorder, which can unfortunately be difficult to treat.
Recently Stanford dermatologist Anthony Oro, MD, PhD, along with dermatology resident Milene Crispin, MD, and dermatologist Justin Ko, MD, collaborated with researchers in the laboratory of Brett King, MD, PhD, at Yale University to research new treatments for the condition. They published their findings today in the Journal of Clinical Investigation Insight.
Oro, who directs the Stanford Hair Loss Clinic, explained in an email to me:
Over 10,000 hairs on your head grow continuously like flowers in a garden. Normally the body’s immune system allows the hair follicles to peacefully elongate. However, in patients with the common alopecia areata, the body’s immune system attacks mature hair follicles, often results in irreversible and total hair loss, called alopecia universalis. Living with alopecia is emotionally traumatic, especially for women and young girls, and there are no currently FDA approved treatments.
In contrast to male pattern baldness, in which the stem cells are damaged and unable to grow, the immune system leaves the stem cells intact in alopecia and damages only the mature hair follicle. Blocking the immune interaction with the hair follicle allows the hair to grow back fully. But it’s been challenging to identify a safe and effective immune suppressant.
Recent animal studies, however, have suggested that blocking an immune pathway called JAK might be effective in treating alopecia. So the researchers teamed up to test an oral medication called tofacitinib in a group of people.
As Oro described:
We tested this new class of medications, designed to treat other inflammatory conditions, in 70 patients with alopecia. We found that treatment can safely lead to total hair regrowth even in patients with severe, decades-long alopecia. Sixty-eight percent of our subjects responded to the drug, and 36 percent experienced robust and nearly complete hair regrowth.
The authors then used changes in genome-wide expression profiles to predict which patients were likely to respond to treatment. They developed a scale to classify patients based on their genomes, which they plan to test further in future clinical studies.
The researchers found that most patients reported only mild side effects. Unfortunately, however, the response to treatment stopped within a few weeks after the drug was discontinued. But the researchers are hopeful that their findings, together with a corroborating independent study from the lab of Angela Christiano, PhD, at Columbia University might lead to new therapies for the disorder. As Oro said:
Severe alopecia can have devastating effects on patients’ overall quality of life. This work illustrates the excellence of our emerging Stanford hair clinic research group and this new class of drugs for patients that previously had no options. We are in the process of testing additional therapeutics we hope will have efficacy for hair growth.
Previously: The secret life of hair follicles, revealed by Stanford researchers, Examining the role of genetics in hair loss and ‘Pacemaker’ channels in hair follicles offer clues to tissue regeneration, say Stanford researchers
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