The "substrate to energy"
The importance of the diet and nutritional supplements in metabolic process of the hair bulb before and after transplant

Dr Rinaldi F., Dr Bezzola P. and Dr Sorbellini E.
(Italy)

The biology of hair bulb is complex and undergoes specific biochemical controls. The normal life of a bulb depends on hormonal an nutritional mechanisms regulated by complicated feed-back systems.

It is well known the role played by DHT in the miniaturization of hair and the positive effect of finasteride in improving androgenetic alopecia.

We know also other molecules that have similar effect on 5 alfa reductasi
enzyme, as liposterolic extract of Serenoa Repens, that seems to be effective in treating androgenetic alopecia without any risk of side effects.

Many studies have provided evidence that apoptosis is a central element in androgenetic alopecia and that the efficacy of finasteride is also linked to its ability to reduce apoptosis.
Recent theories report the beginning of apoptosis at a "catagen cascade", during that TGF-beta promotes activation of caspasi, the enzymes able to induce cellular death.

It is well known that transplant is a biological shock for hair and scalp: the transplant produces some modifications in the life of a hair bulb that must get through the stress of the explant and the adaptation after the implant, The "biological shock" may inhibit proliferation and may induce apoptosis in dermal papilla cells.

Usually the anagen phase can stop and the bulb can pass, in a precocious catagen phase and, consequently, in telogen.

We have valued in our patients underwent to hair transplantation, the efficacy of some natural scavengers and the importance of a correct diet because there is evidence that elevated availability of aminoacids may promote hair growth and prolong the anagen phase.

There is a convincing bulk of evidence that in the hierarchical scale of human body the highest quantity of amino acids of the diet is utilized by noble organs such as liver, brain, kidney, heart and muscles and only a dietary supplement is able to satisfy the need of hair, particularly all what bulbs need to get over the transplant stress.

It's also well known that cellular ageing provides a global reduction but not changes in composition of aminoacids in the bulb.

We well know also the effectiveness of polyamines in controlling hair growth, Polyamines, like spermidin, are molecules synthesized from aminoacids by ornitin-decarbossylase enzyme (ODC) strongly represented in anagen bulbs.

Aminoacids concentrations in:	skin	nails	hair
Lisine	4.2	3.1	2.5
Istidine	1.5	1.0	0.9
Arginine	3.8	6.4	6.5
Aspartic Acid	7.9	7.0	5.4
Treonine	3.0	6.1	7.6
Serine	13.6	11.3	12.2
Glutaminic Acid	12.6	13.6	12.2
Proline	3.0	5.9	8.4
Glicine	24.5	7.9	5.8
Alanine	4.4	5.5	4.3
Valine	3.0	4.2	5.5
Metionine	1.1	0.7	0.5
Isoleucine	2.7	2.7	2.3
Leucine	6.9	8.3	6.1
Tirosine	3.4	3.2	2.2
Fenialanine	3.2	2.5	1.7
Cistine	1.1	10.6	15.9
Sulfur	1.4%	3.2%	4.5%

When "catagen" cascade begins the ODC level dramatically decreases and consequently polyamines synthesis too.

ODC is mainly expressed on dermal papilla but also in some cells of external root sheath nearest to the bulge. This confirm that bulge steam cells are conditioned (directly? indirectly?) from syntheses, differentiation and proliferation of polyamine.

The direct supply of polyamine bypasses the action of the ODC and causes a direct stimulation of bulb cells. We prescribe the patients a daily pill at the dosage of 0,05 mg starting from one month before the transplant.

We usually prescribe a dietary supplement of aminoacid pool at the dose of 4/8 gr daily for 2 months starting 6 month after transplant. We prescribe Taurine tablets 400 mg daily for 3 months starting 1 month after the hair transplant. Implementation of taurine, a sulfur aminoacid, improve hair growth, via activation of glycine receptor and ion channel in external root sheaths.

We also prescribe tocotrienols tablets of 300 mg daily for 4 months. Tocotrienols have greater antioxidant activities in preventing lipid peroxidation than tocopherols and no side effects.

As a consequence of the supply of aminoacids and antioxidants pools we can point out the dramatic reduction of post-transplant telogen effluvium and, at the same time, a faster transplanted hair growth rate.

L - Leucine	1250 mg
L - Lisine	650
L - Isoleucine	625
L - Valine	625
L - Treonine	350
L - Cistine	150
L-Istidine	150
L - Fenialanine	100
L - Metionine	50
L - Tirosine	30
L - Triptofan	20
TOTAL AMINOACIDS	4000 mg

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