Dicembre Vol.3 N° 3 - 2007 - Salute per tutti

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Multicenter study for the evaluationof tolerance and efficacy of a newintegrated aminoacidic treatmenton the aging faceAdele Sparavigna 1Riccardo Forte 2Francesco Saverio Dioguardi 3SU M M A R YMulticenter study for the evaluationof tolerance and efficacy of a newintegrated aminoacidic treatmenton the aging faceAge-related changes in the dermis mainly consist of reduced thickness and flatteningof the dermo-epidermal junction. In aging skin less efficient biosynthetic activitiesmake the newly formed collagen more easily attacked by collagenases and metalloproteinases.We have evaluated the activity of a specific treatment based on aninjectable aminoacid mixture plus low molecular weight hyaluronic acid along withfood and cosmetic supplementation of the same aminoacids. In the used mixture theaminoacids glycine, proline, leucine and e lysine are in a stechiometric ratio specificallystudied to improve collagen neo-synthesis. The aminoacidic treatment produceda very statistically significant reduction of skin roughness evaluated both clinicallyand instrumentally; in particular, profilometric parameters were significantlydecreased after 1 month and dramatically decreased after 4 months. Our resultsdemonstrate that specific aminoacid formulations as substrates to collagen syntheticpathways may have a positive role in improving the ageing signs of the skin.KE Y W O R D S: Aminoacidic treatment, Aging face1Derming, Clinical Researchand Bioengineering Institute2Italian Society of Aesthetical Medicine3Department of Internal Medicine, University of MilanI ntroductionA g e - related changes in the dermismainly consist of reduced thickness and flatteningof the dermo-epidermal junction (1). Thisis particularly true for sun-exposed skin andduring menopause in women (2, 3). The alterationsof the dermal connective tissue, correspondingmainly to a reduction of the extracellularmatrix, are highly responsible for thewrinkling and sagging of the skin, since theydetermine deep modifications in the mechanicalproperties of ageing skin. Several studieshave demonstrated that ageing unbalances theenzymatic activities related to the synthesis,remodelling and catabolism of the extracellularmatrix components in the dermis: collagen, elastinand glycoaminoglycans. As a result, notonly do ageing processes induce a reduction ofthe extracellular matrix, but its quality is alsoaffected. Moreover, in aging skin less efficientbiosynthetic activities make the newly formedcollagen more easily attacked by collagenasesand metalloproteinases. Nowadays, skin can bestimulated to improve quali-quantitative ageingalterations by the intradermal injection of biologicalsubstances able to induce a revitalizationof the dermis. The most frequently used substanceis natural, not cross-linked, low molecularweight hyaluronic acid. In fact, with ageingthere is a decrease in the content of glycoaminoglycansin the dermis, in particular of hyaluronicacid, the major non-sulphated glycoaminoglycanof connective tissue ground substance.The reduction in hydrophilic glycoaminoglycansleads to a direct reduction in water contentand skin turgor. Interestingly, not only canthe injected simple hyaluronic acid moleculesJournal of Plastic Dermatology 2007; 3, 3 19
A. Sparavigna A, R. Forte, F.S. Dioguardiprovide ground substance enrichment and deephydration of the skin, but they also strongly stimulatefibroblasts to sinthetize new groundsubstance (4). Moreover, recent publicationshave suggested the possible positive role of thecurrent greater availability of specific aminoacidmixtures as substrates to collagen syntheticpathways in human organs (5-7). Collagen hasa complex molecular structure, due to its particularlyregular aminoacidic content. Althoughthere are several different collagen types, ineach type every third aminoacid one is glycine,the smallest of all aminoacids. The quite monotonouscomposition of collagen peptides is notonly limited to the highly regular recurrence ofthe glycine residue, but is also present in thefollowing two positions, called positions X andY, where position Y is hydroxyproline (OHpro)in 50% of the cases, and hydroxylisine (OHlys)in most of the remaining sequences. These aminoacidsare very rarely found in proteins otherthan collagen. They are fundamental in a cascadeof events allowing a reaction forming interandintra- molecular bonds strongly entanglingthree peptides into fibrils and firmly tighteningthem into the complex collagen units. Havingone glycine every third aminoacid allows peptidesto bend regularly and form a left-handedhelical structure, entwined with two other peptidesin a super-helical structure twisted to theright, greatly similar to the structure of a rope.This gives extraordinary tensile strength andflexibility to collagen fibers. Based on theabove, a new integrated treatment was prepared,consisting of a specific “aminoacidic functionalcluster” assembled in order to physiologicallypromote local collagen synthesis throughchemotactic stimulus (see Table 1 for the composition)and which includes intradermal injections(injectable aminoacidic mixtures plus lowmolecular weight hyaluronic acid), cosmetictreatment and food supplementation. The presentstudy was performed in order to evaluatethe activity of this integrated treatment on theaging face.aterials and methodsMFive dermatological centers participatedin the study. Investigations were carried outin 103 healthy female volunteers, aged 35 to 60(average age: 47). All the enrolled subjects hadlow to moderate skin ageing/photo-ageing,a c c o rding to a re f e rence photographic scale, andhad given their informed consent. Exclusion criteriawere: pregnancy or lactation, use of permanentfillers in the past, presence of other systemicpathologies, like autoimmune disease, diabetes,liver and renal insuff i c i e n c y, heart failure .Subjects who for any reason had taken drugslike aspirin or other NSAID’s, or systemic cortico s t e roids during the three month preceding thep resent study, were also excluded.The objective of the study was to evaluate thetolerance and efficacy of an intradermal injectableproduct associated to cosmetic treatmentand food supplementation (J a l u p ro ® a n dP ro g l y m e ® , Professional Dietetics s.r.l., Milan,Italy) over a treatment period of twenty-twoweeks. The study was performed according to amulticenter open study protocol, and the treatmentunder investigation was administered asfollows:4 intradermal injections - done directly by participatingdermatologists using the injectableproduct (Jalupro ® ); injections were done once aweek, and the first one was done two weeksafter the basal visits (subjects had already startedto take cosmetic and food supplements twoweeks before).Food supplement - one ampoule/day of aminoacidfood supplement (Proglyme ® , in water orin any other drink) was taken by the subjectsfrom week T-2 to the last intradermal implant,for a total of six weeks.Cosmetic treatment - from T0 to T4: aminoacidcream, applied on the face twice a day (morningand evening) and liquid patch applied twice aweek (30 minutes of setting).T h ree evaluation visits were performed duringthe study: at baseline (T0), 1 month after the lastL-Proline L-Glycine L-Lisine L-LeucineInjectable vials 37,6 50 5,4 7Oral solution 43,8 50 5,2 -Cream 37,6 50 5,4 7Liquid patch 37,6 50 5,4 7Table 1. Aminoacidic composition (%) delivered by tested products.20Journal of Plastic Dermatology 2007; 3, 3
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Page 4: L’istopatologia ed il foto-invecc
Page 10: P. Filecciaammesso nelle formulazio
Page 15 and 16: A. Sparavigna A, R. Forte, F.S. Dio
Page 17 and 18: A. Sparavigna A, R. Forte, F.S. Dio
Page 20 and 21: M. Cavallini, M. Papagnitaining lon
Page 22 and 23: M. Cavallini, M. PapagniSkin hydrat
Page 24 and 25: M. Cavallini, M. Papagni5. Altman D
Page 26 and 27: G. Menchini, C. ComacchiM ethodsO b
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Page 30 and 31: Impiego di lamine autoadesivedi pol
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Page 36 and 37: Efficacia, tollerabilità ed accett
Page 42 and 43: D. AnconaGli studi sulla citotossic
Page 44 and 45: D. AnconaPRIMADOPOFigura 2. Pazient
Page 46 and 47: L.Scuderi, L. Francesconi, F. Dinot
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Irsutismo: trattamento con eflornit
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Una molecola classicain una nuova v
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Microcircolo, cute e antocianosidiA
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Microcircolo, cute e antocianosidiL
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Microcircolo, cute e antocianosidiG
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Microcircolo, cute e antocianosidiC
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struzioni agli AutoriIObiettivo del
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Dicembre Vol.3 N° 3 - 2007 - Salute per tutti

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