Updates on Hair Duplication (AutoCloning) and ACell: Hope For a Hair Loss Cure – By Dr. Jerry Cooley

Whether or not hair duplication (formerly known as “autocloning”) may become a true cure for hair loss in the near future has been a hot topic of discussion since the topic was introduced by Coalition member Dr. Jerry Cooley at the 2010 Annual Scientific International Society of Hair Restoration Surgery (ISHRS) Scientific Meeting.  Dr. Cooley recently presented a brief presentation at last year’s 2012 ISHRS Meeting.  To view the highlights of his findings, visit the 2012 Annual Scientific ISHRS Meeting.

Hair Duplication (autocloning) works on the principle that a hair, when plucked properly, will emerge with its epithelial cells and follicular stem cells intact.  According to Dr. Cooley, applying ACell (a natural agent regularly used in optimal wound healing) to the plucked hair and implanting it into the scalp stimulates the body’s natural regenerative potential to create new hair follicles.  Since plucked hairs also regrow in the original site, a potentially limitless donor supply is created, providing hair loss sufferers with the possibility of restoring a full head of hair.

Below, world renowned hair transplant surgeon Dr. Cooley  presents his ongoing research on the use of ACell MatriStem for wound healing and the promising hair duplication technique.   While the below, preliminary data gives hope to hair loss sufferers waiting for hair multiplication technology to provide a cure for baldness, much more research and testing is required.

To view the entire power point presentation, click here.

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What is ACell?

ACell MatriStem™ is one type of extracellular matrix, available in both a powder and sheet form. It is made of porcine urinary bladder and contains the following:

• Collagen
  • Types: I, II, III, IV, V, VI, VII
• Bioactive Components
  • GAGs
  • Proteoglycans
• Growth Factors
  • VEGF, BMP4, PDGF-BB, KGF, TGFbeta1, IGF, bFGF, EGF, TGFalpha
• Glycoproteins
  • Laminin, Elastin, Fibronectin
• Anti-Infective Peptides
  • 18 AMP’s have been identified in porcine tissue
    • Porcine defensi  n pBD-1

Benefits of ACell

• Stimulates angiogenesis (the physiological process through which new blood vessels form from pre-existing vessels)
• Inhibits fibrosis (the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process)
• Recruits progenitor-stem cells

Applications for Hair Restoration Surgery

• Powder and sheet form (I use both)
• Clinical experience
  • Follicular unit extraction (FUE)/punch sites
  • Donor strip healing
  • FU grafting
  • Hair duplication (‘autocloning’)- plucked grafts

ACell & Punch Harvest Scars

ACell MatriStem in Donor Strip Healing

• Can use sheet or powder, but sheet is easier & more convenient.
• I use 3 x 7cm sheets, cut 2-3 mm wide

Very important: sheet is implanted BELOW skin, in SQ bed, and skin is sutured together which buries sheet in SQ space

Possible benefits: softer feel, patient less aware of scar, easier re-excision in future? Better regeneration of blood vessels and nerves after strip removal.

 ACell and Scar Revision

• ACell can be one component of successful scar revision
• By itself, ACell use improves only feel and vascularity of final scar, not scar width
• May create better skin quality for FUE grafting

ACell & Follicular Unit Grafting

• ACell MatriStem™ powder
  • Our current technique:
    • use 200mg FINE particles
  • Mixed with saline
    • 50mg/0.5cc = 1000 grafts
  • Applied to grafts just prior to implantation
  • Goal: get ACell particles on to graft, not in the holding solution. ACell does not go into solution!

• Personal experience
  • Better consistency
  • Grafts appear more robust
  • Better preservation of recipient bed

Is ACell Necessary for Hair Transplant Surgery?

• Is like asking, ‘is microscopic dissection necessary?’
• We believe ACell is one element of achieving consistent, optimal results
• Is part of overall strategy to reduce stressors and augment natural processes that allow grafts to take and grow.

ACell + Platelet Rich Plasma (PRP)

• Growth factors known to stimulate hair growth
  • Platelet derived growth factor
  • Fibroblast growth factor
  • Keratinocyte growth factor
  • Vascular endothelial growth factor
  • Insulin like growth factor

• Considerations:
  • Different systems = different platelet (growth factor) concentrations
  • Different techniques
  • Frequency & treatment intervals: unknown
  • Duration of benefit: unknown

Hair Duplication (Autocloning)

• History
  • 2000 Use of plucked beard whiskers as grafts (Hitzig)
  • 2008 combined with use of ACell
  • 2009 use of plucked scalp hair (Cooley & Hitzig)
  • Plucked hair:  Epithelial cells & epithelial stem cells
• Gho CG et al.  Human follicular stem cells: their presence in plucked hair and follicular cell culture. Br J Dermatol. 2004 May;150(5):860-8.

Plucked Grafts in Scar

Because of the LOW success of hair duplication in bald scalp and scar, we tried combining standard FUE/FUT grafts placed close together and in the same site as plucked grafts, with some early success.

Theory of Regeneration

Plucked hairs need healthy follicles nearby to donate mesenchymal stem cells. Mesenchymal stem cells from surrounding healthy follicles migrate to plucked graft to assist in regenerating dermal sheath and dermal papilla.

Mesenchymal stem cells from dermal sheath of surrounding healthy follicles migrate to plucked graft to assist in regenerating dermal sheath and dermal papilla, possibly encouraged by ACell.

Plucked Beard Grafts – Success

Complications of Plucked Grafting

• Folliculitis
• Persistence of plucked hairs in recipient zone
• Telogen effluvium- uncommon
• Time for plucked donor to grow back

Summary

• Enhances punch (FUE) & strip (FUT) healing
  • Results in “Soft” tissue with better blood supply
  • (vs fibrotic scarring without ACell)
• Enhances results of FU grafting
• Facilitates follicle regeneration from implanted plucked hair (hair duplication/autocloning)
  • Better results in patients with previous transplants
  • Variable results indicates that more work is needed before this can be ready for widespread use

For more information, view the entire presentation here.

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
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