Question for Roger

mm12 · April 1, 2014, 2:23am

Question for Roger and other knowledgeable members
I have met a doctor at the vitamin shop. I have told her about my PRP procedure which didn’t work. She told me in order for PRP to work you have add calcium in it. Calcium activates the PRP she said. I’m not sure if this is true. She showed me pictures on her phone which looked amazing if true.

baldlatino34 · April 2, 2014, 1:51am

that photo mm12?

roger_that · April 2, 2014, 2:30am

Calcium is essential for binding to and activating clotting factors like the thrombin/prothrombin cycle, which are mediated by platelets (PRP = platelet rich plasma).

But my opinion is that PRP is only good for promoting better healing of wounds (like at donor site), so that there’s no scar formation.

Some doctors, like Dr. Hitzig, IMPLY that PRP can promote new hair growth, but I don’t think there’s any real evidence of that whatsoever. I think it’s just a convenient thing for Dr. Hitzig and others to promote (Dr. Nigam uses PRP, too). I think they use it and make a lot of money from it, because it’s so hard to prove that there’s no new hair growth, since it’s usually used in conjunction with other therapies, so you can’t separate out what is doing what.

But if the PRP is being used to promote tissue/wound healing, then yes, I think that adding Calcium would help.

drnigam · April 2, 2014, 8:18am

Hi roger,
Long time…
In my experience, i can say, approx. only 3 to 5% patients get some visible results after prp injections.
But yes i have also seen at least 1 or 2% patients,who see some good visible thickness of their existing hair.
But there is no real evidence to claim prp… for hair growth

Roger is right,prp may play some role in wound healing as it has some growth factors and negligible bone marrow derived, mesenchymal stemcells.

Traditionally prp kits ,or centrifugation, at the clinic to separate platelet rich plasma…patients 20ml,40 ml blood is drawn and processed.With this small volume of blood, a very low cell count of bone marrow stemcells, growth factors etc. is available.
To counter this problem,we draw 250 ml blood and send it to the lab, from this volume after centrifugation in big centrufugers…approx, 10 times concentrated platelet rich plasma is available…

Normal 30 ml blood derived prp is given free with HT to every patient, for
wound healing at the donor and or supporting the newly implanted grafts,so that they can get serum… for may be better survival of implanted grafts…
as in first few days ,newly implanted grafts, survive with the help of serous fluid (specially to get access to oxygen).
Dr mwamba,is using my ecm, provided to him and with traditional prp kit for donor fue scar reduction,i asked him to shift to 250 ml blood derived prp.

[quote][postedby]Originally Posted by roger_that[/postedby]
Calcium is essential for binding to and activating clotting factors like the thrombin/prothrombin cycle, which are mediated by platelets (PRP = platelet rich plasma).

But my opinion is that PRP is only good for promoting better healing of wounds (like at donor site), so that there’s no scar formation.

Some doctors, like Dr. Hitzig, IMPLY that PRP can promote new hair growth, but I don’t think there’s any real evidence of that whatsoever. I think it’s just a convenient thing for Dr. Hitzig and others to promote (Dr. Nigam uses PRP, too). I think they use it and make a lot of money from it, because it’s so hard to prove that there’s no new hair growth, since it’s usually used in conjunction with other therapies, so you can’t separate out what is doing what.

But if the PRP is being used to promote tissue/wound healing, then yes, I think that adding Calcium would help.[/quote]

roger_that · April 2, 2014, 12:44pm

[quote]Hi roger,
Long time…
In my experience, i can say, approx. only 3 to 5% patients get some visible results after prp injections.
But yes i have also seen at least 1 or 2% patients,who see some good visible thickness of their existing hair.
But there is no real evidence to claim prp… for hair growth [/quote]

Thank you, Dr. Nigam.

So, I have some questions about that. If you say 3-5% of patients get some visible results after PRP injections, are those patients who are not being treated with any other therapy concurrently with the PRP?

Are we to understand from this that these are patients receiving HT, cell injections or any drugs at the same time as PRP? Or is PRP ever being used as a “stand alone” treatment?

Another question, are these figures based on actual hair counts, or just on a subjective visual evaluation of the appearance of the hair?

Either way, 3-5% with “some visible results” and 1-2% with “good visible thickness” are negligible figures, and not statistically significant. Especially if the figures are based on subjective evaluations of appearance of the hair, it can be said that these numbers should not encourage anyone to spend money on PRP injections, unless it is ONLY to aid healing at the donor site.

Hypothetical question for Dr. Nigam: Let’s say a young man, 22 years old with some temporal recession and crown thinning, comes to your office and says, “I am not ready for a hair transplant. I only have a little thinning. I don’t want to take any drugs right now because I am concerned with side effects. But I heard about this new treatment, PRP, and I would like some PRP injections in my scalp to possibly promote regrowth, to gain what I’ve already lost.”

This patient ONLY wants PRP injections. No HT, no cell injections, no drugs.

He says he heard something that PRP injections alone might regrow hair.

Would you provide the PRP injections for him? What would you tell him?

NeverAgain · April 2, 2014, 6:10pm

[quote][postedby]Originally Posted by mm12[/postedby]
Question for Roger and other knowledgeable members
I have met a doctor at the vitamin shop. I have told her about my PRP procedure which didn’t work. She told me in order for PRP to work you have add calcium in it. Calcium activates the PRP she said. I’m not sure if this is true. She showed me pictures on her phone which looked amazing if true.[/quote]

Are the pics she showed you men or women? There is a chance women may respond better.

mm12 · April 3, 2014, 1:18am

The guy was a 21 year kid and the lady was 60 year old. The guy had amazing regrowth. She had the pictures in her phone. She told me that’s her third case and she’s following it closely. The lady had decent growth

hair101 · April 3, 2014, 1:34am

[quote][postedby]Originally Posted by mm12[/postedby]
Question for Roger and other knowledgeable members
I have met a doctor at the vitamin shop. I have told her about my PRP procedure which didn’t work. She told me in order for PRP to work you have add calcium in it. Calcium activates the PRP she said. I’m not sure if this is true. She showed me pictures on her phone which looked amazing if true.[/quote]

What kind of doctor is she? a dermatologist? hair transplant doctor? is she a hair specialist?

mm12 · April 3, 2014, 6:21am

She’s a skin doctor

cal · April 4, 2014, 6:49am

The limitation of PRP is not so much that it does nothing for MPB (besides wound healing help), but it does nothing for MPB that lasts. Everyone is back to baseline within a year.

Aran_Linvail · April 10, 2014, 12:46am

I hope you are well dr nigam. I have heard from Boldy that you have experimented with multiplying Beard DP cells, because they benefit from androgens. How is that work progressing, if I may ask?

drnigam · April 12, 2014, 2:33pm

Roger,

Hi roger,

Yes, those 2/3 percent patients are of pure PRP prepared from 250ml( as against usual 40 ml blood derived prp) blood and sent to blood bank for preparing, appox.pure 40ml prp,
Yes the male patients are simultaneously started on Finasteride 1mg,but the female patients are not on any concomitant medications.In my practice ,it is the female patients with thinning hair, who ask for non surgical options. finasteride and minoxidil will work better at lesser cost and without repeat visits to the doctor.
Patients keep reading different stuff on net,like dermaroller, prp…and themselves ask for the same.I have never enrolled anyone for prp alone, yes my clinic does enroll,if their budget is low,and they do not want anything except prp,i do make sure , i add ecm,fresh trichogenic dp cells, wherever possible for their benefit.
These data was just by subjective analysis during follow up visit, as prp is not my major interest to follow .

Regards your hypothetical question
22 years old with some temporal recession and crown thinning comes to me…i will not claim with prp alone any improvement in hair thinning and or growth.

Normally i would convince them to use dermaroller, add some medications with blood bank processed prp,and give them a prescription to follow,still without any claims.

Yes , i will use prp for donor and recipient scalp for wound healing and better graft survival respectively.
I tell patients that if they do not want to go for my BIOFUE,the next best option is give me grafts for stemcell hair multiplication, give me few grafts for isolating fresh trichogenic dp cells, ecm and blood bank processed prp and follow the medical prescription and or dermaroller with topical medications.

roger/arun
to let you all know what has been happening off late at my end…

1)Mr. Joshi the nw7 started his procedure, when his stem cells got ready. stcase will complete his 3rd session tommorrow , that is total 4000 grafts with HM and denovo doubling tmr. I can share his pictures in may, in personal emails whosever wants it.

2)I am seeing some improvement in donor regen after biofue,after approx.6 months since i started 3d spheroidal cultured dp cells injection at donor and recipient.I have seen some improvement after injecting the same at recipient site.Did not get time yet to quantify.Will do so in july/august.

3)Uptill now at 45 days, i used to have only 4-5 million Dermal Papilla cells from 80-90 grafts,as we were using T-75 flask, in which the culturing area was 75sqcm.
since 20 days we have started using hyper flask which has a culturing area 1720 sqcm. theoretically we should get 20-25 million cells after 2 months with similar with 4-5 passages. after the 1st 45 days the 5 million cells are ready, repeat injections definitely showing some improvement, as i c 2013 patients in 2014. i have approx 50 more pictures with pure HM which i can send on mail to my friends on forum, but not very keen to post in the forum for the review and feedback. Roger most researchers say that at least by 3rd passage of DP cells in-vetro lab they start loosing their partial trycogeniticty and by 5 th passage total trycogenity. I am not sure how much efficacy of activating villious hair will remove, even if Dp cells are classified as tryconogenic, which VERCIAN, alk 4 posphate markers etc. Hope so efficacy improves by how much percent… don’t know. Because the interaction of follicle bulge cells and DP cells in 3 dimension in-vivio need to be achieved. Also I wish to inject cultured DP cells with tricogentic potential retention till probably 3-4 passages( After which they loose their tricogeniticityj).That means the patient will have to give 75 grafts and repeat injections in 45days this will confirm, whterer even if we have tricogentic DP cells, what is the efficacy of tricogentic DP cells to convert the Cells.

4)I hope after 8th world congress, new ideas will be exchanged improving dp culture trycogenty as well as how to delive active ct200 hair follicle to hair follicle bulge wherein the stem cell which might be domainat(proably by nano delivery) how to make cultured dp cells reach exactly the dormaint dp(by nano technology or direct visualization through movable microscope). 1st we need proof of concept with every protocol, once tested we need to look solutions for large volume of cells with minimum time and cost. 2 guys from Japan Lab, 2 directors visited my lab, who are not into research in hair bt other medical conditions wanted to set up, bioreacter unit for culturing meschan cells. i hope in nxt 6 mnths, are lab may have biometer unit, for 3d DP culture in next 6 months requires investment of US dollar 1.5 million dollar and movable photon microscope will cost .5 million dollar. w e are pvt ltd company, but 6-8 mnths will go public. 1 of my patient has taken 5% of my share with some funding after he got results with HM. it is unfortunate that i don’t have everything in my lab to do research. hopefully after election in India v have form grp of 10 companies who will push for proposal which i presented and to the fda commsrn, that is setting of a biotech park, which will be under special regulation of FDA wherein govt will put most hitech equipments required for R&D for finding solution of various ailments. it will have small training coll of biotechnology for manpower sourcing and leading dr from germany, europe, us, india and japan will be invited to be part of this biotech zone. there will be special sec on patent production and 1 window clearance for expimental therapies, mini hospital and opd where, braindead patients, cancer, patients who hav no cure for medical science can acess these treatment with their connsent and fda guidlines. also to let u know the final draft of stemcell therapy is 3 ministry but its not yet law, but will take proably 6 mnths to become a law. we will lobby with the new govt to have relaexd autologus, adult stem cells. here in India its possi to start stem cell therapy. all the phases of clinical trialwith al the trials may be possible within 4-5 years i. i have alrdy got insitutional/ ethics clearance. will be registering, in clinical trial website by may and would start the clinical trials on different protocols from june 2014.uptil now the law allows to exprimental therapies from institutional/ ethics clearance which we already have. till will take us 6 months to comply are to analyse and prepare 2 yr 4 months data on exprimental HM therapy. we alrdy have safety animal rs (mouse)study report without any adverse effect for every new protcol since last 2 yrs and 4 months. simultaneity in august we are in the process of proof of concept with animal study which will be started in august 2014.
5) i did 1 small experiment on my left forearm wherein i did, bood grp cross matching with 1 donor, v both are o positive and also HLA typing and took 2 grafts and implanted on my scalp on 2014, I see 1 thick terminal hair comming on my forearm, will send u the pic by moro.

6)will share as n when i get more time. i will; b in Korea in 14-18may and in brusselles in june for EHRS workshop. hope to c some of u, if u reside in these locations.

Dear Arun, i prefer using beard grafts since last 6 months to those patients who are willing to send their grafts to the lab for HM injections. Few give grafts from the beard but few give from donor scalp, worried if there would be any white dots.

[quote][postedby]Originally Posted by Roger_that[/postedby]