Ascorbic acid 500mg/2ml / Nicotinamide 160mg/2ml solution for injection ampoules

BackgroundCellular senescence, characterized by irreversible cell cycle arrest, plays a pivotal role in ageing and the development of age-related pathologies. Mitigating oxidative stress, a primary contributor to cellular ageing, is crucial for inhibiting the senescence-associated secretory phenotype (SASP). A comparative analysis of synthetic and natural antioxidants is necessary to evaluate the efficacy of synthetic and natural antioxidants in this context.MethodA systematic review encompassed studies published up to July 2023, utilizing prominent databases such as PubMed, Google Scholar, Scopus, and Web of Science. To enhance the efficiency of data screening and selection, we employed Rayyan. ai, an advanced tool designed for systematic reviews.ResultThe review encompassed 33 studies examining the impact of diverse antioxidants on cellular senescence. Findings indicated that synthetic antioxidants, such as N-acetylcysteine, and natural alternatives, like Vitamin C, demonstrated efficacy in attenuating oxidative stress and senescence markers. Notably, natural antioxidants frequently exhibited comparable or superior efficacy to their synthetic counterparts in most studies. Furthermore, the synergistic effects of antioxidant combinations sometimes yield enhanced benefits. It is worth noting that certain recently developed synthetic compounds, such as MHY2233, have shown promising results, exhibiting greater potency than established antioxidants in mitigating senescence markers.ConclusionDietary practices and the aging process can influence these intricate processes and how they interact, serving as potential primary and secondary preventative strategies. The Mediterranean diet, dietary antioxidants, and limiting calorie intake are promising nutritional strategies. Better insight into the molecular mechanisms of aging may facilitate the development of efficient biomarkers and antioxidants for diagnosis or treatment.Systematic review registrationhttps://osf.io/b67wm/.

Abstract licence: CC BY

Melasma is a common skin disorder characterized by facial hyperpigmentation, often aggravated by sun exposure. Antioxidants are being studied as a treatment option for their potential to reduce oxidative stress and improve skin pigmentation. A comprehensive literature search was conducted in PubMed for articles published over the past decade, up to January 31, 2024, on the use of antioxidants in melasma treatment. The systematic review, conducted by two independent investigators, included 30 studies on antioxidants in melasma, covering vitamin C, cysteamine, silymarin, PLE, tomato extract/lycopene, zinc sulfate, melatonin, and other antioxidants. Findings indicated that combining vitamin C with physical therapies, such as peels and lasers, yielded better results. Cysteamine, a naturally occurring aminothiol, showed efficacy comparable to hydroquinone with fewer side effects. Silymarin was effective in reducing melasma severity with minimal adverse effects. PLE showed mixed results but potential as an effective antioxidant when combined with other treatments. Lycopene from tomato extract demonstrated significant improvements in melasma when used as an adjuvant therapy. Zinc sulfate showed some effectiveness but was less potent than hydroquinone. Melatonin had antioxidant capabilities but showed no statistically significant improvement. Glutathione is emerging as a new antioxidant therapy showing efficacy in melasma in combination with other topicals and microneedling. Other antioxidants, including combinations of vitamins C, E, and ferulic acid, showed potential as adjuncts in melasma treatment. These findings highlight the diverse efficacy of antioxidants in managing melasma, suggesting their potential as safe and effective treatments.

Abstract licence: CC BY-NC-SA

BackgroundWith the rise of regenerative medicine and geroscience, translational research has shifted focus from lifespan to healthspan-years lived in good health. Applied to aesthetic medicine, the authors introduce the concept of "skinspan," to both describe the period during which skin maintains a youthful, healthy appearance, and additionally to serve as a tool for the cosmetic consult.AimsThe aim of this comprehensive review is to illuminate "skinspan" as a framework for guiding long-term skin health. The authors review the molecular drivers of skin aging along with appraise current evidence-based interventions and synthesize evidence into an algorithm to expand skin span.MethodsA comprehensive literature review was conducted to examine the molecular hallmarks of skin aging: genomic instability, mitochondrial dysfunction, cellular senescence, and proteostasis decline, and how they are targeted by lifestyle modifications, pharmacologic agents, and aesthetic procedures. Each intervention discussed in this paper is categorized based on the strength of the available evidence for augmenting skinspan.ResultsProactive interventions, including lifestyle interventions, topical agents, systemic therapies, and noninvasive procedures, show promise in mitigating aging mechanisms and preserving skin health. We recommend a first-line strategy of sun protection, topical retinoids, and antioxidants. Second-line interventions include laser and energy-based devices. Clinicians may also consider emerging therapies-including stem cell-based treatments, sirtuins, nicotinamide, and natural SIRT activators-as adjunctive third-line add-ons, while continuing to monitor the evolving evidence base.ConclusionThe skinspan framework offers a holistic, evidence-based approach to skin longevity, promoting prevention, continuity of care, and patient education beyond isolated aesthetic interventions. To expand skinspan based on current evidence, we recommend a first-line approach of sun protection, topical retinoids, and antioxidants. Second-line interventions include procedures such as laser and energy-based devices. Clinicians may also consider emerging therapies-including stem cell-based treatments, sirtuins, nicotinamide, and natural SIRT activators-as adjunctive third-line add-ons, while continuing to monitor the evolving evidence base. A need exists for more randomized controlled trial studies to strengthen the evidence base.

Abstract licence: CC BY

BackgroundAscorbic acid is a strong antioxidant that prevents postoperative delirium by inhibiting reactive oxygen species production. This pilot study was designed to investigate the prevalence of postoperative delirium among older patients undergoing cardiovascular surgery, who received perioperative ascorbic acid administration, to estimate an appropriate sample size for further randomized controlled trials.MethodsThis single-arm prospective interventional study enrolled patients aged > 70 years scheduled to undergo elective cardiovascular surgery using cardiopulmonary bypass. Ascorbic acid (500 mg) was administered intravenously every 6 h for a total of eight times following the induction of general anesthesia. The incidence of postoperative delirium was evaluated until discharge using the Confusion Assessment Method for the Intensive Care Unit.ResultsData from 48 patients were analyzed. Of the 48 patients, 16 developed postoperative delirium (33.3%). Patients in the delirium group had more severe heart failure (New York Heart Association Classification), higher European System for Cardiac Operative Risk Evaluation scores, lower intraoperative Bispectral Index, longer duration of cardiopulmonary bypass and surgery, incidence of postoperative cerebral infarction, longer intubation time, and length of intensive care unit stay.ConclusionsThe incidence of postoperative delirium among older patients undergoing cardiovascular surgery who received ascorbic acid perioperatively (2 g/day for 2 days) was 33%. This incidence was comparable to that observed in a previous observational study, suggesting that ascorbic acid administration may not be effective in preventing the incidence of postoperative delirium.

Abstract licence: CC BY-NC

BackgroundNicotinamide has demonstrated efficacy in the treatment of melasma. Topical antioxidants and humectants may enhance its performance. Currently, there is no controlled trial on the combination of 10% nicotinamide, 5% magnesium ascorbyl phosphate, and 5% hyaluronic acid, a dermo-cosmetic compound, in comparison to 4% hydroquinone for the treatment of melasma. This study aimed to explore the tolerability and efficacy of the association of the combined product versus hydroquinone.MethodsA randomized, double-blind trial involving women with facial melasma was conducted. Participants were instructed to apply the combined product (NIC group) twice daily or 4% hydroquinone for 60 days (HQ group) at night and placebo in the morning. Evaluations were performed at inclusion, after 14 and 60 days of treatment, measuring the modified Melasma Area and Severity Index (mMASI), Melasma Quality of Life Scale (MELASQoL), and colorimetric luminosity. The Global Aesthetic Improvement Scale (GAIS) was assessed by a blinded evaluator.ResultsBoth interventions led to a progressive improvement in mMASI, MELASQoL, and GAIS, without a difference between them on D14 and D60 (p>0.2). For NIC, the mean reduction (95% CI) in mMASI was 16% (8-24%) on D14 and 32% (23-41%) on D60, while for HQ, it was 10% (7-24%) on D14 and 43% (34-52%) on D60. Reduction in colorimetric luminosity was greater in the HQ group at D60 (p=0.01). No serious side effects were identified. Of the initially included 50 patients, one was lost to follow-up in the HQ group on D60, and one withdrew consent from the NIC group, both unrelated to treatment.ConclusionThe association of 10% nicotinamide, 5% magnesium ascorbyl phosphate, and 5% hyaluronic acid was safe and well-tolerated, although its overall clinical efficacy was numerically inferior to 4% hydroquinone. This regimen can be considered for patients with poor tolerability to hydroquinone.Clinical trial registration#RBR-4mkfmr8.

Abstract licence: CC BY-NC

BackgroundGlaucoma is a progressive optic neuropathy marked by retinal ganglion cells (RGCs), apoptosis, vascular insufficiency, oxidative stress, mitochondrial dysfunction, excitotoxicity, and neuroinflammation. While intraocular pressure (IOP) reduction remains the primary intervention, many patients continue to lose vision despite adequate pressure control. Emerging neuroprotective agents-citicoline, coenzyme Q10 (CoQ10), pyruvate, nicotinamide, pyrroloquinoline quinone (PQQ), homotaurine, berberine, and gamma-aminobutyric acid (GABA)-target complementary pathogenic pathways in experimental and clinical settings.MethodsThis literature review synthesizes current evidence on glaucoma neuroprotection, specifically drawing on the most relevant and recent studies identified via PubMed.ResultsCiticoline enhances phospholipid synthesis, stabilizes mitochondrial membranes, modulates neurotransmitters, and improves electrophysiological and visual field outcomes. CoQ10 preserves mitochondrial bioenergetics, scavenges reactive oxygen species, and mitigates glutamate-induced excitotoxicity. Pyruvate supports energy metabolism, scavenges reactive oxygen species, and restores metabolic transporter expression. Nicotinamide and its precursor nicotinamide riboside boost NAD+ levels, protect against early mitochondrial dysfunction, and enhance photopic negative response amplitudes. PQQ reduces systemic inflammation and enhances mitochondrial metabolites, while homotaurine modulates GABAergic signaling and inhibits β-amyloid aggregation. Berberine attenuates excitotoxicity, inflammation, and apoptosis via the P2X7 and GABA-PKC-α pathways. Preclinical models demonstrate synergy when agents are combined to address multiple targets. Clinical trials of fixed-dose combinations-such as citicoline + CoQ10 ± vitamin B3, citicoline + homotaurine ± vitamin E or PQQ, and nicotinamide + pyruvate-show additive improvements in RGCs' electrophysiology, visual function, contrast sensitivity, and quality of life without altering IOP.ConclusionsA multi-targeted approach is suitable for glaucoma's complex neurobiology and may slow progression more effectively than monotherapies. Ongoing randomized controlled trials are essential to establish optimal compound ratios, dosages, long-term safety, and structural outcomes. However, current evidence remains limited by small sample sizes, heterogeneous study designs, and a lack of long-term real-world data. Integrating combination neuroprotection into standard care holds promise for preserving vision and reducing the global burden of irreversible glaucoma-related blindness.

Abstract licence: CC BY