Enzyme therapy in combination with hardware techniques

Natalya Sachuk, head of the Farmosa medical center, dermatovenerologist, trichologist, dermato-oncologist, cosmetologist, member of the All-Ukrainian Academy of Dermatovenerology, Association of Psoriasis, Association of Preventive and Anti-Aging Medicine, Society of Trichologists of Ukraine, All-Ukrainian Association of Dermatovenerologists and Cosmetologists (Ukraine)

Enzymes are a special type of proteins, which by nature play the role of catalysts for chemical processes, especially necessary in medicine and cosmetology. Enzyme therapy is safe and effective in all areas of aesthetic medicine

From the history of discovery

"Enzyme" translated from Greek means "leaven". Humanity owes the discovery of this substance to the Dutchman Jan Baptist Van Helmont, who lived in the 16th century, who became interested in alcoholic fermentation and, during his research, found an unknown substance that accelerates this process. He called it fermentum, which means “fermentation.” Then, almost three centuries later, the Frenchman Louis Pasteur, also in the process of observing fermentation processes, came to the conclusion that enzymes are nothing more than substances of a living cell. And after some time, the German Eduard Buchner isolated an enzyme from yeast and determined that this substance was not a living organism. He also gave it his name - “zimaza”. A few years later, another German, Willi Kühne, proposed that all protein catalysts be divided into two groups: enzymes and enzymes. It was only in 1897 that it was decided to use both terms as absolute synonyms.

Nature of enzymes

All enzymes are proteins and are made up of amino acids. A huge number of reactions occur in nature with the participation of enzymes, and all of them can be divided into several categories:

• oxidation and reduction. The enzymes involved in these reactions are called oxidoreductases. As an example, we can recall the process of converting a primary alcohol into an aldehyde by alcohol dehydrogenases;
• group transfer reaction. The enzymes that enable these reactions to occur are called transferases. They have the ability to move functional groups from one molecule to another. This occurs, for example, when alanine aminotransferases transfer alpha amino groups between alanine and aspartate. Transferases also move phosphate groups between ATP and other compounds, and create disaccharides from glucose residues;
• hydrolysis. The hydrolases involved in the reaction are able to break single bonds by adding water elements;
• creating or removing a double bond. This type of reaction occurs non-hydrolytically with the participation of lyase;
• isomerization of functional groups. This type of transformation is possible under the influence of isomerase enzymes;
• formation of a single bond with the elimination of the element water. Hydrolases break the bond by adding water elements to the molecule. Lyases carry out the reverse reaction, removing the aqueous part from the functional groups.

Enzymes accelerate almost all chemical reactions, but each of them is capable of accelerating only a certain reaction according to the “key-lock” principle. They are able to increase the speed of reactions by 1010 times. There are more than three thousand enzymes in the human body, each of which stimulates one or another process in tissues and organs. However, there are a number of factors that determine the speed of the reaction:

• substrate concentration. The more molecules of the active substance, the faster the reaction occurs, since more active centers are involved;
• temperature. Typically, an increase in temperature leads to an acceleration of reactions, but only until the temperature rises above 40 ° C, then the reaction rate begins to decrease sharply;
• acidity. Each enzyme has its own optimal acidity level at which the reaction occurs most adequately. Changing the pH level affects the activity of the enzyme, and therefore the speed of the reaction. If the changes are too great, the substrate loses its ability to bind to the active nucleus and the enzyme can no longer catalyze the reaction. With the restoration of the required pH level, enzyme activity increases.

In industry, enzymes are obtained from plants, animals and, more recently, actively from microorganisms, which makes it possible to produce enzymes in large volumes using standard fermentation techniques, and it is easier to increase the productivity of microorganisms than plants or animals. The use of recombinant DNA technology makes it possible to synthesize enzymes and use them in various fields - in medicine, pharmaceuticals, food industry and other related fields.

An interesting fact is the existence of enzymes in foods. Avocado can serve as a natural source of lipase. In the body, this substance is produced by the pancreas. Banana supplies the body with amylase and maltase. Amylase is also found in bread, potatoes, and cereals. Maltase helps break down maltose, the so-called malt sugar. Pineapple contains many enzymes, including bromelain.

Enzyme therapy

Enzymes are found in the skin in significant quantities. These are nuclease, lipase, proteolytic enzymes - in particular protease, hyaluronidase, phosphatase, keratinase. The activity of enzymes is largely related to the metabolism of minerals, especially trace elements, the pH state of the skin, the level of hormones and vitamins. Age-related changes in skin elasticity, a tendency to swelling, ptosis, and an increase in fat packets are also associated with a decrease in the activity of enzymes that affect the state of the extracellular matrix and trigger the processes of physiological skin remodeling.

The use of a combination of enzymes is one of the actively developing areas in cosmetology, since the substances comprehensively cover all links of influence on the dermis and skin, such as stimulation, acceleration of metabolic processes and regeneration at the cellular level, restoration of its energy balance and protective forces, transport of active components

Collagenase

Collagenase (Collagenasum) is an enzyme preparation that has proteolytic activity with a highly specific focus on the breakdown of collagen with the release of the free amino acid hydroxyproline. Collagenase is a protein with an amino acid composition close to that of collagen, containing about 1% hydroxyproline and 7.5% proline.

The activity of the drug is expressed in units of action. 1 unit is taken to be the amount of enzyme that, under certain conditions, releases at least 40% of the hydroxyproline contained in collagen from collagen. The collagenolytic activity of the drug determines its use as a means of stimulating the resorption of tissues containing collagen (in particular, scar tissue).

Collagenase is used to accelerate the rejection of scabs and necrotic tissue after burns and frostbite, to cleanse trophic ulcers and flaccid granulating wounds from purulent-necrotic plaques, to correct scars, post-acne, stretch marks, to correct ptosis of the face and neck, body skin.

The drug is used topically in the form of solutions, which are prepared immediately before use by adding a sterile isotonic sodium chloride solution to the bottles with the dry drug. Side effects - pain, burning, hyperemia at the injection site.

A contraindication to the use of the drug is hypersensitivity to collagenase.

Special instructions: antiseptics, heavy metals, detergents, soaps weaken the activity of the drug. If infection is present, antibiotic therapy must be administered. The drug should not be combined with tyrothricin, gramicidin, or tetracyclines. The introduction of collagenase preparations into the tissue of pathological skin scars leads to the destruction of excess collagen and a change in the ratio of proteins and glycosaminoglycans, which is manifested by an increase in the proportion of structured (bound) water in the tissues.

This dynamics of moisture content can be explained by the fact that as a result of the action of collagenase, hydrolysis of collagen in the extracellular matrix occurs with the release of water. This property is important for its unique moisturizing effect during the treatment of pathological scarring and wound healing.

Simultaneously with the breakdown of collagen, microcirculation normalizes. A decrease in the volume fraction of the extracellular matrix in the scar is accompanied by an increase in the number of epithelial and connective tissue cells, and the moisture saturation of the intercellular matrix of the scar tissue of the skin increases, which is a sign of a favorable outcome of the resolution of the scar process.

Laser + enzyme

The most promising and effective in my practice for solving such a problem as pathological scars (hypertrophic and atrophic) is the use of physiotherapeutic methods based on the use of fractional laser radiation, which can remove richly vascularized fibrillar protein and coarse collagen in the scar or at the bottom of the scar (with atrophy). This technology, using a wavelength of 1550 nm and a radiation power of 6–40 mJ, is called fractional photothermolysis (FPT).

The laser beam, unlike other lasers, does not cause tissue ablation, but forms microscopic zones in the skin in the form of columns with a width of 50–150 microns and a depth of 382 to 1,359 microns (the depth and diameter are determined by the energy of the laser beam, controlled by the doctor during treatment ). Thus, FFT is a technology for focal destruction of tissue under the influence of laser energy in strictly defined areas of the skin, subsequently forming a reliable framework and foci of growth of a new epidermis. It was revealed that, in addition to already known facts, PFT is also able to influence the processes of cellular regeneration, changing the ratio of the structural elements of the skin after damage. The fractional photothermolysis technique has a destructive, coagulating and defibrosing effect on scar tissue

At the same time, to correct collagenogenesis in scars, collagenase is used in parallel, destroying excess collagen and glycosaminoglycans. The amino acids formed as a result of proteolysis serve as building materials for the newly formed skin structures at the site of coagulation. The induction of intracellular stress provokes the proliferation and division of these cells, resulting in the appearance of a sufficient number of young fibrocytes and keratinocytes involved in the remodeling of the damaged area.

In particular, the use of laser technology in combination with collagenase causes a decrease in the intensity of color, consistency and size of scars, as well as subjective sensations of burning, itching and tension of the scar.

Lipase

Lipase is a unique enzyme that works directly with subcutaneous fatty tissue and fatty tissues. It acts like a key with a lock, including the mechanism of physiological lipolysis - the division of triglycerides into di- and monoforms of fatty acids, which are excreted through the blood and lymphatic channels. In this way, the fat cell is reduced in volume, but its integrity is not damaged, which allows us to work safely and effectively. This is an indirect lipolytic, and there is no classic swelling and pain with its use. In most cases, lipase is used in a triad with hyaluronidase and collagenase for an immediate anti-inflammatory and lifting effect. The mechanism of action of hyaluronidase itself is very diverse: it improves microcirculation, corrects swelling, tissue pastiness, improves tissue metabolism, and participates in the regulation of tissue permeability. It complements the action of lipase. Using drugs that contain several enzymes, such as lipase, collagenase and hyaluronidase, we are able to correct various patient problems. First of all, this is the correction of the volume of fat packets in the face area or body fat deposits. In this case, collagenase works ideally in tandem with lipase: lipase reduces volume, and collagenase eliminates sagging skin

To obtain maximum results, 4-5 procedures are recommended with an interval of 1-2 weeks. It all depends on how quickly the patient wants to get results.

Patients of our clinic always get results after the first enzyme therapy procedure, and with each session it becomes more and more noticeable to others. The cycle of procedures must be completed no more than once a year. The most striking example is the correction of the lower third with pronounced lipolysis and lifting in this area. Complete safety and absence of visible side effects have made the triad of enzymes the favorite procedure among our patients.

First published in "Les Nouvelles Esthétiques Ukraine" No. 1 (113) 2019