Sometimes, the smallest of developments can alter the course of a life. For Angela Christiano, a geneticist studying skin diseases at Columbia University, that development was a small bald patch at the back of her scalp, discovered by her hairstylist in 1995.
Christiano, then 30, was diagnosed with a form of alopecia, an autoimmune disease in which the immune system attacks the hair follicles, causing sporadic to complete, body-wide hair loss.
The diagnosis was fraught with irony. Christiano, who grew up in Nutley and now lives in Mahwah, was a Jersey girl, with piles of hair to prove it. Her mother was a beautician, her grandfather a barber. When she learned that the only treatment for her condition was the injection of steroids into the scalp, she took what she calls “a short leap” and switched the focus of her research to alopecia. In doing so, she not only changed her own life, but could potentially change the lives of others suffering from a disease that has both physical and psychological effects. Studies have linked alopecia with depression and thoughts of suicide. For many sufferers, Christiano says, “alopecia becomes the wallpaper of their existence—it’s something they worry about from morning till night.”
Still, when she applied for grants to study the disease, she was often turned down with the explanation that alopecia was merely a cosmetic problem. She persevered, adding to a nationwide registry of patients with her specific form of the disease, alopecia areata (AA), which causes patchy baldness.
In 2010, Christiano and her research team identified a gene or group of genes in AA sufferers that drew killer immune cells, which destroy unwanted invaders, to the hair follicle. In 2014, she and an immunologist colleague, Raphael Clynes, published a paper describing another discovery: that a class of drugs known as Janus kinase (JAK) inhibitors, mainly used to treat rheumatoid arthritis, was potentially effective against AA.
Today, thanks to that discovery, half a dozen pharmaceutical companies—including Pfizer and Eli Lilly—are in phase III of drug development for a JAK inhibitor against AA, testing it in some 700-plus patients worldwide. If the data they glean is positive, the next step will be registration for FDA approval.
Christiano’s work has the potential to touch lives beyond those of alopecia sufferers. In 1998, she was the first person to discover a gene for hair loss. She’s since partnered with cell biologist Colin Jahoda, of Durham University in England, to develop a technique that could revolutionize the treatment of male-pattern baldness. It consists of removing hair-follicle stem cells, culturing them in the lab and implanting the resulting hairs back into the scalp. Theoretically, the process could produce a limitless number of implantable hairs.
“Limitless” might also describe the offshoots of Christiano’s research, which has led to a discovery that could conceivably change the treatment for melanoma by triggering those AA genes to draw killer immune cells to the malignancy.
Christiano’s AA research has changed not just medicine, but minds. “I think we’ve managed to shift the science to where alopecia is now considered as significant as any other autoimmune disease,” she says.
Her own bald patch has never recurred, though she has a slice of eyebrow that regularly disappears and reappears. She calls it “a little reminder” that the disease is lurking inside her—waiting, perhaps, for someone with the insight and determination to vanquish it, once and for all.