新藥可能讓斑禿患者毛髮再生
The first thing Brian H. noticed was that he could grow a real beard. It had been years since that had been possible, years he spent bedeviled by hair loss on his head, face, arms and legs.
布萊恩·H(Brian H.)注意到的第一件事情是，他可以長出真正的鬍鬚來。在這件事成爲可能之前，他已經被頭上、臉上以及四肢上毛髮的脫落困擾了很多年。
Brian, 34, who asked that his last name be withheld to protect his privacy, suffers from alopecia areata, an autoimmune disease afflicting about 1 percent of men and women, causing hair to fall out, often all over the body. He believes that the “mangy patches” of baldness that have plagued him since his 20s have cost him jobs and relationships.
34歲的布萊恩患有斑禿，爲保護隱私起見，他要求隱去姓氏。斑禿是一種自身免疫性疾病，在人羣中的發病率約爲1%，通常會造成全身各處毛髮的脫落。從20多歲開始，布萊恩一直被那些“癩癩巴巴的禿斑”折磨着。他認爲它們嚴重影響了他的工作和人際關係。
After trying various treatments, Brian enrolled this year in a study at Columbia University Medical Center testing whether a drug approved for a bone marrow disorder could help people with alopecia. One of the study’s leaders, Angela Christiano, is a dermatology professor and geneticist who herself has alopecia areata.
今年，曾嘗試過各種療法的布萊恩，在哥倫比亞大學醫療中心(Columbia University Medical Center)報名參加了一項旨在測試一種獲批治療骨髓疾病的藥物能否幫人擺脫斑禿的研究。該研究的負責人之一安吉拉·克里斯蒂雅諾(Angela Christiano)是皮膚科教授和遺傳學專家，同時也是一名斑禿患者。
After successfully testing on mice two drugs from a new class of medicines called JAK inhibitors, which suppress immune system activity by blocking certain enzymes, the researchers began testing one of the drugs, ruxolitinib, on seven women and five men. Some of their findings were published Sunday in the journal Nature Medicine.
研究人員先拿兩種新型JAK抑制劑類藥物在老鼠身上做了測試——JAK抑制劑可以通過阻斷特定種類的酶來抑制免疫系統的活動——隨後讓參與人體測試的7位女性和5位男性使用了其中一種名叫魯索利替尼(Ruxolitinib)的藥物。週日，他們的部分研究成果被髮表在了《自然醫學》(Nature Medicine)雜誌上。
The results for Brian and several other participants have been significant.
布萊恩和其他幾個參與者的病情有了很大的起色。
“Pretty quickly, there were sort of fringes,” Brian said. Then “three or four large areas started to show hair growth,” and by five months, he had plenty of hair on his head, arms, and even his back. “I was blown away,” he said.
“很快就看到了絲須狀的東西，”布萊恩說。接着“有三四個地方開始長出毛髮”，到五個月的時候，他的頭上、胳膊上甚至後背上都有了大量毛髮。“我當時覺得難以置信，”他說。
The disease differs from other types of hair loss, including male pattern baldness, and there is no evidence the drug will work for those conditions. Experts caution that even for alopecia areata, it is too early to know if the treatment will work for most patients and if there are significant side effects or safety concerns.
斑禿不同於包括男性型禿髮在內的其他類型的脫髮，沒有證據證明這種藥物對後者也有療效。專家們提醒說，即便就斑禿而言，目前也遠遠不能確定該療法是否適用於大多數患者，以及是否存在較大的副作用或安全隱患。
The study is continuing, but so far a few participants did not regrow hair, said Dr. Julian Mackay-Wiggan, director of Columbia’s dermatology clinical research unit and an author of the study.
這項研究的發起者之一、哥倫比亞大學皮膚病學專業臨牀研究部主任朱利安·麥凱-維根(Julian Mackay-Wiggan)博士表示，研究仍在繼續，但到目前爲止，還有幾個參與者並沒重新長出毛髮。
“It appears to work — not in everyone, but in the majority,” she said. “We need a lot more data on the long-term risks in healthy individuals. But it’s certainly very exciting in terms of hair growth. It was surprising how quickly and impressively the growth occurred.”
“它似乎對大部分人有效，但並非在每個人身上都能起作用，”她說。“我們還需要獲得更多與健康人羣長期使用該藥物的風險有關的數據。但在促進毛髮生長方面，其效果確實令人振奮。這種生長來得如此快速和明顯，簡直出人意料。”
Dr. Luis Garza, a dermatologist at Johns Hopkins Hospital who was not involved in the research, said the results were encouraging enough that he would consider prescribing ruxolitinib to patients who could not be treated with other methods and who understood potential side effects.
約翰·霍普金斯醫院(Johns Hopkins Hospital)的皮膚科醫生路易斯·加爾薩(Luis Garza)說，魯索利替尼療效可喜，他會考慮給那些不能用其他方法治療，且對其潛在副作用有所瞭解的病人開魯索利替尼。加爾薩未參與該項研究。
Cortisone injections often work for patients with isolated patches of baldness, but they must be done regularly and are painful. For patients with severe baldness, “it’s impossible to inject their whole scalp,” he said.
對單純性斑禿而言，注射可的鬆(Cortisone )通常是有效的，但注射必須定期進行，而且會給患者帶來痛苦。他說，有的患者禿得厲害，“總不可能給整張頭皮都注射藥物”。
“There’s a major need for improving the treatment,” he added. “It’s not ludicrous to try on a patient.”
“這項療法的改進是有巨大需求的，”他補充道，“在患者身上進行試驗並不過分。”But Dr. George Cotsarelis, a dermatologist at the University of Pennsylvania, urged caution until further research is conducted. He said it makes sense that drugs suppressing immune system activity would work for a disorder caused by an overly active immune reaction.
不過，賓夕法尼亞大學(Pennsylvania)的皮膚病專家喬治·柯薩萊利斯(George Cotsarelis)博士，極力主張在進行更深入的研究之前保持謹慎。他表示，抑制免疫系統活動的藥物對因免疫反應過度靈敏而引發的疾病有效，這不出奇。
But because patients in the study received twice-daily pills that circulated ruxolitinib throughout their bodies, rather than topical cream, he said they were “treated systemically with a very toxic drug” that can cause liver and blood problems, infections and other ailments.
但由於參與這項研究的患者每天兩次服用魯索利替尼片劑——而不是塗抹膏劑——藥物成分會在整個身體內循環，他認爲他們在接受以毒性很強的藥物爲手段的全身性治療，該藥物有可能讓肝臟和血液出問題，還有可能引發感染以及其他疾病。
Although the patients have experienced few side effects, the study is small and not a randomized trial comparing ruxolitinib to other treatments.
儘管患者幾乎還沒感受到什麼副作用，但這項研究規模很小，也並非一次拿魯索利替尼和其他治療手段作對比的隨機試驗。
If ruxolitinib could be applied topically, Dr. Cotsarelis said, “this would be an amazing breakthrough.” Until then, “patients are going to rush in demanding this treatment, and I would not give it.”
柯薩萊利斯博士說，假如可以局部應用魯索利替尼，“那將是驚人的突破”。在此之前，“要求用該療法治療的患者未免顯得草率，我是不會給他們開處方的”。
Dr. Raphael Clynes, a co-leader of the research while he was a Columbia professor (he now works for Bristol-Myers Squibb), said the team tested cream and pills on mice, and planned to test a cream on people.
必治妥施貴寶公司(Bristol-Myers Squibb)的拉斐爾·克萊因 (Raphael Clyne)博士在哥倫比亞大學當教授期間是這項研究的負責人之一，他表示，研究團隊拿老鼠做測試時用過膏劑和片劑，並且打算進行膏劑的人體測試。
So far, he considered ruxolitinib “an expensive therapy that’s probably effective based on the small number of patients that we’ve treated, and it’s likely to have a reasonable safety profile. But there’s no way that I can endorse it fully unless we do larger trial.”
他認爲魯索利替尼迄今爲止還是“一種價格高昂的治療手段。就我們治療的爲數不多的患者而言，它或許是有效的，在安全性方面的表現似乎也說得過去。但除非進行更大規模的測試，否則我絕不會完全認可這種療法”。
The team also plans to test on people another JAK inhibitor, tofacitinib, which is approved for rheumatoid arthritis and grew hair on mice. In June, Dr. Brett King, a dermatologist at Yale, reported that tofacitinib caused full hair growth and no negative effects for a man with alopecia universalis, a variant involving almost total hair loss.
研究團隊還打算對另外一種JAK抑制劑——託法替尼(Tofacitinib)——進行人體測試。這是一種獲批治療類風溼關節炎的藥物，能讓老鼠長出毛髮。今年6月，耶魯大學(Yale)皮膚病專家布萊特·金(Brett King)博士宣稱，託法替尼(Tofacitinib)能促進男性普禿患者的毛髮生長，且沒有任何副作用。普禿是一種幾乎可以造成全身毛髮全部脫落的疾病。
For Brian, five months on the drug yielded a full head of hair. For unknown reasons, the new hair is white instead of black, its original color.
對布萊恩而言，服用魯索利替尼五個月換來了滿頭的髮絲。他原先的頭髮是黑色的，不知道爲什麼，新長出來的頭髮卻是白色的。
Still, “It’s a lot easier to shrug that off than to pass the silent judgment of people” who he said he felt were staring at his bald splotches. He said side effects, including slight anemia, were minor.
但他說，“相比面對人們無聲的成見，這樣要好受多了”——他以前總感覺人們在打量他的禿斑。他還表示，包括輕微貧血在內的副作用是非常小的。
