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Title: Treatment of Alopecia with cation-liposomes, by prof. Giovanni Brotzu.
Presenter:
Now we'll talk about drugs and therapies. We have professor Brotzu and his "treatment of alopecia with positively charged (cation) liposomes".
Brotzu:
Good morning everyone. After listening to Ms Cella and Ms Manunza discussing what alopecia is, for me it is difficult to talk because I am a vascular surgeon who has always dealt with blood circulation and who came through this topic only by chance. I will now say why and how I encountered it.
My work stems from the fact we were studying the effect of the prostaglandin E1 in the treatment of the micro-circulatory pathologies of diabates.
Many suppose that alopecia derives from microcirculation and hormonal alterations. This however is data I had never taken care of.
(Shows a drawing of the circulatory system)
A 90 kg person has 90000 KM long capillaries. Capillaries have pericytes as last blocks. The flux of blood in capillaries is regulated by the phisiology of endothelial cells, which separate blood from tissues.
You can see this schema that starts from the heart and gets to the small capillary.
Capillaries can be very different based on the organ they land on. If the capillary is linked to the skin, it will be very different when on a kidney or muscles.
(Shows the drawing of a capillary): this is a capillary. A capillary is made up of endothelial cells and at the beginning there is the pericyte cell.
Pericytes are the locus of action of a drug called minodixil. The drug cannot act anywhere else.
(Shows "continuous" capillaries): Continuous capillaries are those that arrive next to all hair bulbs.
(Shows a capillary on the microscope. Shows a red globule): Through this region, there is the passage of both oxygen and the nutrients for the different tissues.
Capillaries run to next to all the loci of the body. For instance, the brain has 500 KMs of capillaries.
(Shows some studies related to the stress factors of capillaries, among which the liberation of adrenaline and noradrenaline and hypoxia in the pericyte cells contrasted by minoxidil.)
I will underline this work of 2008 (shows a work by Nickoloff and Griffiths related to abherrant intercellular adhesion molecule-1 (ICAM-1) expression by hair-follicle epithelial cells and Endothelial Leukocyte Adhesion Molecule-1 (ELAM-1) by vascular cells are important Adhesion-molecule alterarions in alopecia areata).
This work of 2008 says that in AA there is an interaction at endothelial cell level, with the liberation of these two molecules, which are very well known because they activate immune-type systems.
These two molecules block blood flow in capillaries.
All the engineers who tried to present data on microcirculation had to stop churning numbers because these two molecules "enjoy" the modification of microcirculation and prevent blood from flowing.
We studied Prostaglandin PGE1, which is today in commerce for other pathologies. PGE1 favors the elasticity of capillaries, their permeability, and stimulates the multiplication of endothelial cells, improving vascularization.
I have to underline this has been shown also for other pathologies.
We saw that PGE1 is formed starting from linoleic acid and through a linoleic (?) with 20 atoms of carbon. This is the precursor of Prostaglandin.
Another important factor that was observed is that gamma-linoleic acts on the formation of keratocytes, that is the say the material that forms hair. Keratocytes also facilitate the transmigration of nutrients via endothelial cells.
(Shows a slide with the functioning of testosterone): Testosterone becomes DHT, which is toxic for endothelial cells and all what is behind them, that is to say also for hair bulbs.
What did we do? We prepared liposomes. What are liposomes? They are like "little balls" containing drug. They have a very limited diameter. We charged liposomes so that they have a positive charge. The positive charge allows these liposomes to attach to the skin and penetrate it.
(A little excursus: it must have happened to you to unwrap a candy and not be able to throw away the wrapping. When this happened, the wrap had a positive charge.)
(Shows pictures of endothelial cells and liposomes): this is a liposome attached to the membrane of an endothelial cell, magnified 60 thousand times.
(Shows another study of 2008 that shows how positively charged liposomes allow for the treatment of a series of pathologies with a facilitated transfer of drugs.)
(Shows a drawing of the blood vessel that arrives to the hair bulb allowing the latter to be fed). We saw that PGE1 improves the blood flow by blocking the two mono-nuclear substances that, as affirmed by the doctor before me, create peripheral damage.
(Shows the hair cycle): you all know the hair cycle, let us go on.
(Shows a list of substances used in diabetic vascular problems: DGLA, Equol, Carnitine)
We administered these substances while working on another problem, that of diabetic micro-angiopathies. We passed these substances around diabetic ulcers. We saw that diabetic ulcers indeed healed. However, in addition, all hair around diabetic ulcers grew as well.
We were astonished. I am talking of something happened 7-8 years ago. This is when we wanted to test this substance.
A lot of people wanted to try it out. These people suffered from Androgenetic Alopecia, not AA. What we saw is that these people stopped losing hair.
Only then did we treat a little girl with AA. At that time we were still using prostaglandin rather than DGLA, which is its precursor. This little girl regained her hair.
We stopped here with these results: people with Androgenetic Alopecia stopped losing hair, a little girl with AA regrew them. This is when the news spread around.
We weren't looking for any publicity, as this is not our specialty.
However, we examined:
- 5 kids younger than 10 years of age
- 6 people older than 20 (three with AA from less than 8 years, three with AA from more than 8 years).
(Shows pictures of one of the kids)
This is before the treatment of the little boy
This is his hair after two months
This is after four months.
I have to underline I am NOT treating alopecia. I do not know about its causes.
I will make a comparison. Let us imagine hair bulbs are balls on a billiard. Balls are hair bulbs.
The stick hits the balls. The balls go into the holes. Every one of these balls is a hair bulb that disappears.
I act on the stick. I do not know who moves the stick and why. I just stop the stick.
(Shows the last little girl they treated, bald at first and with some - maybe a lot - of hair after one year): I did not want to treat this girl in the beginning. We were trying out DGLA rather than PGE1, because DGLA is not a drug, it is a precursor of a drug. However, I started treating her on April 22, 2015. On April 22, 2016, this was the result (shows a girl that is no more bald).
I did nothing particular. I just moved something and found something else. I agree with what my dermatologist colleagues said before. We need to find the cause of the pathology. This can be a cure. However, to avoid flu, we get flu vaccine shots. Anti-flu drugs, instead, just help with the symptoms.
We have to tackle the base of the pathology. On this, I cannot say anything as I am a surgeon and this is not my field...