On the first visit (TO), the subjects were examined by a trained technician to confirm the inclusion and exclusion criteria. 在首次访问(TO)时,受试者由经过培训的技术人员检查,以确认纳入和排除标准。
Before product use (T0) and in the visits after 4 (T4w) and 12 (T12w) weeks of product use, the technician conducted a clinical assessment, verification of compliance with the requirements of the study, verification of possible adverse events, discomfort sensations and confirmation of the correct use of the products. Subjects were instructed to contact the study coordinator at any time, in case they presented any complaints. 在产品使用前(T0)以及产品使用后 4 周(T4w)和 12 周(T12w)的访问中,技术人员进行了临床评估,验证了研究要求的遵守情况,验证了可能的不良事件、不适感觉,并确认了产品的正确使用。受试者被告知在任何时候如有任何投诉,应联系研究协调员。
The subjects acclimated in a standard environment of 20--22^(@)C20--22^{\circ} \mathrm{C} temperature and humidity of 40%-60%40 \%-60 \% for 15--20min3915--20 \min ^{39} and then the following measurements were obtained at T0, T4w, and T12w time points. 受试者在 20--22^(@)C20--22^{\circ} \mathrm{C} 温度和 40%-60%40 \%-60 \% 湿度标准环境中适应 15--20min3915--20 \min ^{39} ,然后在 T0、T4w 和 T12w 时间点进行了以下测量。
Measurements of transepidermal water loss was performed by trained technicians using the Vapometer (Delfin Technologies Vapometer model SWL5, Kuopio, Finland). Measurements were obtained by applying the probe to the test area and resting it on the skin. The measurement indicated trans epidermal water loss (TEWL) in G/M ^(2){ }^{2} /hour where higher values indicate greater evaporation and hence a worse skin barrier. 使用 Vapometer(Delfin Technologies Vapometer 型号 SWL5,库奥皮奥,芬兰)由经过培训的技术人员进行了经皮水分流失的测量。通过将探头应用于测试区域并放置在皮肤上获得测量值。测量值表示经皮水分流失(TEWL)为 G/M ^(2){ }^{2} /小时,数值越高表示蒸发越严重,因此皮肤屏障越差。
D-Squame a 22 mm diameter, crystal-clear adhesive-coated disc was used to remove layers of the stratum corneum to simulate barrier disruption. ^(40){ }^{40} It has a homogenous layer of a medical-grade adhesive that safely removes superficial corneocytes and provides optimum visibility of adhering skin cells. A D-Squame Pressure Instrument was used to apply standardized pressure on the tape. The D-Squame discs were applied to the skin and the soft padded end of D-Squame Pressure Instrument was placed on the D-Squame and pressed downward for 2 s , then released. The D-squames were gently peeled off to remove loose layers of the stratum corneum. 使用直径 22 毫米的 D-Squame,一种无色透明的粘合剂涂层圆盘,用于去除角质层以模拟屏障破坏。 ^(40){ }^{40} 它具有一层均匀的医疗级粘合剂,可以安全地去除表层的角质细胞,并提供最佳的粘附皮肤细胞可见性。使用 D-Squame 压力仪施加标准压力在胶带上。将 D-Squame 圆盘应用于皮肤,并将 D-Squame 压力仪柔软的垫子端放在 D-Squame 上向下按压 2 秒,然后释放。轻轻撕下 D-squames 以去除松散的角质层。
TEWL measurements were obtained again after three consecutive strippings with D-squames. Strippings and TEWL measurements were continued until the skin barrier was disrupted as indicated by a value of TEWL of 18G//M^(2)//18 \mathrm{G} / \mathrm{M}^{2} / hour or more. TEWL was plotted against number of strippings and using the linear equation the exact number of strippings to obtain a TEWL of 18G/M²/hour was calculated for each subject. Barrier repair was determined by measurement of TEWL, 3 h after the final stripping. 使用 D- Squames 连续剥离三次后,再次获得了 TEWL 测量值。剥离和 TEWL 测量一直持续到皮肤屏障被破坏,表现为 TEWL 值达到 18G//M^(2)//18 \mathrm{G} / \mathrm{M}^{2} / 小时或更长时间。将 TEWL 值与剥离次数进行线性回归,计算出每个受试者获得 TEWL 值为 18G/M²/hour 所需的精确剥离次数。屏障修复通过测量最终剥离后 3 小时的 TEWL 来确定。
The same measurements were performed on the left and right malar areas of the face at baseline and after 4 and 12 weeks of product use. 在基线以及产品使用后 4 周和 12 周,对脸部左右颧部区域进行了相同的测量。
3.4 | Cutometer 3.4 | 切割仪
Cutometer® (dual MPA 5802 mm probe by Courage and Khazaka Cologn, Germany) was employed to study the viscoelasticity of skin. 使用了 Cutometer®(德国 Courage 和 Khazaka Cologn 的双 MPA 5802 mm 探头)来研究皮肤的粘弹性。
The Cutometer measures the vertical deformation of the surface of the skin as it is pulled by a vacuum suction ( 500 mm Hg ) through a small probe aperture. From the resulting curve, several variables can be extrapolated including immediate, delayed, and final distention and immediate retraction. ^(41,42){ }^{41,42} These variables estimate the elastic, viscoelastic, and purely viscous behavior of the skin. ^(42){ }^{42} 切割计测量皮肤表面在真空吸力(500 毫米汞柱)作用下通过小探头孔径的垂直变形。从得到的曲线中,可以外推出包括即时、延迟和最终膨胀以及即时回缩等几个变量。 ^(41,42){ }^{41,42} 这些变量估计了皮肤的弹性、粘弹性和纯粘性行为。 ^(42){ }^{42}
The measurements were obtained under standard conditions of temperature and humidity ( T=20--22^(@)C\mathrm{T}=20--22^{\circ} \mathrm{C}, humidity 40%--60%40 \%--60 \% ) and after a rest period of 15–20 min for each subject tested. ^(39){ }^{39} 测量是在标准温度和湿度条件下( T=20--22^(@)C\mathrm{T}=20--22^{\circ} \mathrm{C} ,湿度 40%--60%40 \%--60 \% )以及每个受试者在休息 15-20 分钟后进行的。 ^(39){ }^{39}
Measurements were automatically produced in triplicate. One Cutometer measurement was obtained from the randomized cheek at each designated time point. The following parameters were observed: 测量自动进行三次。在每个指定的时间点,从随机选取的面颊处获得一次切割计测量。观察以下参数:
RO: Distensibility (Uf) This parameter looks at the maximum amplitude and represents the passive behavior of the skin to force. Decrease in this parameter indicates improvement in firmness. ^(43-44){ }^{43-44} RO:扩张性(Uf)该参数查看最大振幅,代表皮肤对力的被动行为。该参数的降低表示皮肤紧实度的改善。 ^(43-44){ }^{43-44}
R1: The ability to return to the original form (Uf-Ua) (minimum amplitude after relaxation). The older the skin, the higher the number, thus decrease in this parameter indicates improvement in elasticity. ^(43-44){ }^{43-44} R1:恢复到原始形态的能力(Uf-Ua)(放松后的最小振幅)。皮肤越老,这个数字越高,因此该参数的降低表明弹性的改善。 ^(43-44){ }^{43-44}
R3: (Last max amplitude): Tiring effect (Fatigue) visible for repeated suction/relaxation. Repeated suction and release with the Cutometer provoke skin fatigue, resulting in decreased elasticity and increased maintenance of the deformed position. Tiring effects of the skin are visible, as the amplitude increases with each new suction. The last curve, compared to the maximum amplitude of the first curve is correlated with skin fatigue (laxity). Decrease in this parameter indicates improvement. ^(43-44){ }^{43-44} R3:(最大振幅):重复吸/放松的疲劳效应(疲劳)。使用 Cutometer 重复吸/放松会引发皮肤疲劳,导致弹性降低和变形位置的维持增加。随着每次新的吸力,皮肤的疲劳效应(松弛)变得可见,振幅随之增加。与第一次曲线的最大振幅相比,最后一条曲线与皮肤疲劳(松弛)相关。该参数的降低表明改善。 ^(43-44){ }^{43-44}
3.5 | Statistical considerations 3.5 | 统计考虑
Using Excel package statistical package, descriptive statistical analysis was performed on all parameters pertaining to the primary and secondary objectives. 使用 Excel 统计软件包,对与主要和次要目标相关的所有参数进行了描述性统计分析。
Comparisons were made between Baseline and 4 and 12-weeks use. Descriptive statistics (frequencies and percentages) summarized responses from the Study Product. A Students tt test was conducted to determine statistical significance. 对基线与 4 周和 12 周使用进行了比较。对研究产品的响应进行了描述性统计(频数和百分比)总结。进行了 Student's t 检验以确定统计显著性。
3.6 | Ethical considerations 3.6 | 伦理考量
The investigational test products, study protocol, Informed Consent Form, subject recruitment materials, and written study instructions were reviewed and approved by the Institutional Review Board prior to study initiation in accordance with Title 21 of the Code of Federal Regulations (CFR), Parts 50 and 56.This study was performed in accordance with the ethical principles based in the Declaration of Helsinki and its subsequent amendments, and in accordance with the International Council for Harmonization (ICH) Good Clinical Practice (GCP) guideline (ICH E6(R2), 2016), and applicable regulatory requirements. 在研究启动前,研究测试产品、研究方案、知情同意书、受试者招募材料和书面研究说明已由机构审查委员会审查并批准,符合《联邦法规》第 21 篇第 50 部分和第 56 部分的规定。本研究遵循赫尔辛基宣言及其后续修订的伦理原则,以及国际协调会议(ICH)的良好临床实践(GCP)指南(ICH E6(R2),2016 年),以及适用的监管要求。
Trans epidermal water loss (TEWL) measures barrier integrity and a reduction in TEWL indicates barrier improvement. As observed in Figure 2(A) there was a slight reduction in TEWL by about 6% after 4 weeks and a significant ( p < 0.05p<0.05 ) 6.9%6.9 \% after 12 -week use of the sup- 经皮水分丢失(TEWL)衡量屏障完整性,TEWL 减少表示屏障改善。如图 2(A)所示,4 周后 TEWL 略有下降,约为 6%,12 周使用补充剂后出现显著( p < 0.05p<0.05 ) 6.9%6.9 \% 。
Barrier strength as measured by the calculated number of strippings to disrupt skin barrier is presented in Figure 2(B). An increase in the number of strippings indicates that the barrier strength increased. 通过计算剥离次数来测量的屏障强度如图 2(B)所示。剥离次数的增加表明屏障强度增加。
As observed, initially the placebo group appeared to exhibit a 15%15 \% improvement in 4 weeks (possibly due to temporary effect of glycerin in the placebo). This further increased to 29.23%29.23 \% after 12 weeks of use. The group that used Lumenato did not show a change after 4 weeks; however, after 12 weeks of use, this group exhibited a significant ( p < 0.05p<0.05 ) improvement of 59.9% in barrier strength. In this study barrier structure required more than 4 weeks to strengthen. 如观察所示,安慰剂组在 4 周内似乎表现出 15%15 \% 的改善(可能由于安慰剂中甘油暂时性作用)。使用 12 周后,这种改善进一步增加到 29.23%29.23 \% 。使用 Lumenato 的组在 4 周内没有变化;然而,使用 12 周后,该组在屏障强度方面表现出显著的( p < 0.05p<0.05 )改善,改善率为 59.9%。在本研究中,屏障结构需要超过 4 周才能加强。
RO looks at the maximum amplitude and represents the passive behavior of the skin to force (firmness). As observed in Figure 3(A) Skin firmness improved by 5.61%5.61 \% after 4 weeks and a significant ( p < 0.05p<0.05 ) 9.34%9.34 \% after 12 weeks of using Lumenato. The placebo also showed a slight improvement of 2.55%2.55 \% and 4.44%4.44 \% (non-significant) after 4 and 12 weeks of use, respectively. RO 观察最大振幅并代表皮肤对力的被动行为(硬度)。如图 3(A)所示,使用 Lumenato 后 4 周皮肤硬度提高了 5.61%5.61 \% ,12 周后显著提高了 p < 0.05p<0.059.34%9.34 \% 。安慰剂在 4 周和 12 周使用后也显示出轻微的改善 2.55%2.55 \% 和 4.44%4.44 \% (非显著)。
R1 measurement indicates an inverse of elasticity (the ability to return to the original form). Older the skin has been reported to exhibit a higher R1. ^(55,56){ }^{55,56} As observed in Figure 3(B), skin elasticity improved by 5.8%5.8 \% and a significant 11.6%(p < 0.05)11.6 \%(p<0.05) after 4 and 12 weeks of using the Lumenato supplement. The placebo exhibited a slight effect of 3.76% and 7.78%7.78 \% after 4 - and 12-week use, respectively. R1 测量表示弹性的倒数(恢复原状的能力)。据报道,皮肤越老,R1 值越高。如图 3(B)所示,使用 Lumenato 补充剂后 4 周和 12 周皮肤弹性分别提高了 5.8%5.8 \% 和显著提高了 11.6%(p < 0.05)11.6 \%(p<0.05) 。安慰剂在 4 周和 12 周使用后分别显示出轻微的效果 3.76%和 7.78%7.78 \% 。
Carotenoid ingestion in food has been reported to significantly increase serum as well as skin levels of carotenoids. Such an increase has been linked to protection from photodamage. ^(45){ }^{45} Skin epidermal barrier is a dynamic process of cell differentiation and turnover which is known to be strengthened with oral supplementation with nutrients such as tomato extract. Skin barrier, commonly measured in terms of TEWL was on average 16G//M^(2)16 \mathrm{G} / \mathrm{M}^{2} /hour which is slightly higher than normal facial skin and consistent with sensitive skin. TEWL dropped significantly from Lumenato use, but also to some extent in the placebo 已有报道表明,食物中的类胡萝卜素摄入可以显著增加血清和皮肤中的类胡萝卜素水平。这种增加与防止光损伤有关。 ^(45){ }^{45} 皮肤表皮屏障是细胞分化和更新的动态过程,已知口服补充如番茄提取物等营养素可以增强皮肤屏障。皮肤屏障通常以 TEWL(经皮水分流失)来衡量,平均每小时 16G//M^(2)16 \mathrm{G} / \mathrm{M}^{2} ,略高于正常面部皮肤,与敏感皮肤一致。使用 Lumenato 后,TEWL 显著下降,但在一定程度上也出现在安慰剂组。
group, which contains glycerin. Orally administration of glycerol has been shown to improve skin elasticity and barrier recovery. ^(46){ }^{46} Pathways for endogenous delivery of glycerol and metabolism in the skin involve the aquaporin-3 transport channel and lipid metabolism in the pilosebaceous unit. ^(47){ }^{47} It is possible that the initial boost in skin barrier observed in this study could be from the glycerin in the placebo. The placebo effect did not appear to maintain for the course of the study. 该组含有甘油。口服甘油的摄入已被证明可以提高皮肤弹性和屏障恢复。 ^(46){ }^{46} 甘油在皮肤中的内源性递送途径和代谢涉及水通道蛋白-3 转运通道和毛囊皮脂单位的脂质代谢。 ^(47){ }^{47} 可能性在于,本研究中观察到的皮肤屏障初始提升可能来自安慰剂中的甘油。安慰剂效应似乎在整个研究过程中并未维持。
While TEWL in damaged skin is high, it does not increase with age, ^(48-50){ }^{48-50} however, the aged barrier is perturbed more readily versus young subjects ^(50){ }^{50} and barrier recovery is slower in aged than in young subjects. ^(50,51){ }^{50,51} In this study, sensitive skin individuals showed a significant improvement in barrier strength after consuming carotenoids from Lumenato supplement. Dietary carotenoids accumulate in the skin and regulate ceremide levels ^(52,53){ }^{52,53} which strengthen the adhesion between the corneocytes of the stratum corneum, thus improving the strength of the skin barrier structure. In addition, the antioxidant properties of carotenoids such as those in Lumenato protect the stratum corneum from further damage. 当受损皮肤的 TEWL 较高时,它不会随着年龄的增长而增加,然而,与年轻受试者相比,老年人的屏障更容易受到干扰,并且老年人的屏障恢复速度比年轻人慢。在本研究中,敏感皮肤个体在摄入 Lumenato 补充剂中的类胡萝卜素后,屏障强度显著提高。膳食类胡萝卜素在皮肤中积累并调节神经酰胺水平,从而增强角质层细胞之间的粘附,从而提高皮肤屏障结构的强度。此外,类胡萝卜素(如 Lumenato 中的类胡萝卜素)的抗氧化特性可保护角质层免受进一步损伤。
This study indicates that skin barrier repair was faster with Lumenato supplementation. When the barrier function is damaged, a series of homeostatic systems is accelerated to recover it to its original level. ^(54){ }^{54} Lamellar bodies are immediately extruded into the intercellular domain between the stratum granulosum and stratum corneum to form a water-impermeable membrane. ^(54,55){ }^{54,55} This is followed by an increase in the activity of enzymes involved in the biosynthesis of the lipids, cholesterol, ceramides, and free fatty acids of the stratum corneum lipid bilayer. Carotenoids in Lumenato may affect ceremide levels in skin thereby enhancing this repair process. In addition, oral administration of carotenoids elevates the levels of skin filaggrin protein which is instrumental in improving skin barrier. ^(31){ }^{31} A strengthened barrier further improves skin hydration, smoothness, firmness elasticity as well as reduce fine lines and wrinkles. ^(36,37){ }^{36,37} Skin hydration is an important parameter responsible for skin homeostasis and all deviations from normal hydration levels can result in significant changes in skin properties and functions. It is well known that lower hydration levels result in a lower elasticity of the skin ^(56){ }^{56} as well as faster skin aging and wrinkle creation. ^(57){ }^{57} Dry skin is more prone to mechanical failure, flakiness, irritation, and other problems. ^(58,59){ }^{58,59} In this study there was a significant improvement in skin elasticity and frictional parameters after using Lumenato for 12 weeks. 这项研究表明,在 Lumenato 补充下,皮肤屏障修复更快。当屏障功能受损时,一系列稳态系统加速以恢复到原始水平。 ^(54){ }^{54} 鳞状小体立即被挤出颗粒层和角质层之间的细胞间隙,形成一层防水膜。 ^(54,55){ }^{54,55} 随后,参与角质层脂质、胆固醇、神经酰胺和游离脂肪酸生物合成的酶的活性增加。Lumenato 中的类胡萝卜素可能影响皮肤中神经酰胺的水平,从而增强这一修复过程。此外,口服类胡萝卜素可提高皮肤丝聚蛋白蛋白的水平,这对于改善皮肤屏障至关重要。 ^(31){ }^{31} 加强的屏障进一步改善皮肤的水分、光滑度、紧致度和弹性,以及减少细纹和皱纹。 ^(36,37){ }^{36,37} 皮肤水分是负责皮肤稳态的重要参数,所有偏离正常水分水平的变化都可能导致皮肤性质和功能的显著变化。 众所周知,较低的含水量会导致皮肤弹性降低 ^(56){ }^{56} ,以及皮肤老化加快和皱纹的产生。 ^(57){ }^{57} 干性皮肤更容易出现机械损伤、脱屑、刺激和其他问题。 ^(58,59){ }^{58,59} 在这项研究中,使用 Lumenato 12 周后,皮肤弹性和摩擦参数有显著改善。
Older individuals are more vulnerable to environmental insults and their cellular turnover and repair are much slower ^(60){ }^{60}; however, as observed in this study, supplementation with Lumenato could reverse some of these effects associated with ageing. A healthy lifestyle is known to influence the extrinsic aging process, which is related to visible signs of aging. Healthy diet, containing significant fruits and vegetables, as well dietary enhancement with antioxidant rich supplements such as Lumenato can lead to a higher concentration of carotenoids in skin manifested as a slower rate of skin aging. ^(61,62){ }^{61,62} 老年人更容易受到环境侵害,他们的细胞更新和修复速度也较慢 ^(60){ }^{60} ;然而,正如本研究观察到的,补充 Lumenato 可以逆转一些与衰老相关的这些效果。健康的生活方式被认为会影响外在老化过程,这与衰老的可见迹象有关。健康的饮食,包括大量的水果和蔬菜,以及使用富含抗氧化剂的补充剂如 Lumenato,可以使皮肤中的类胡萝卜素浓度更高,表现为皮肤老化速度减慢。 ^(61,62){ }^{61,62}
ACKNOWLEDGMENTS 致谢
This study was completely funded by Lycored Ltd, Beer Shiva, Israel. 本研究完全由 Lycored Ltd,以色列比尔谢瓦资助。