At this year’s IMCAS Paris congress, collagen was firmly back on the agenda as start-up company EternoGen LLC unveiled its Advanced Collagen Replenishment portfolio, comprising Rapid Polymerizing Collagen (RPC) and Gold Nanoparticle Collagen (CG Nanomatrix).

While not officially launched as yet, EternoGen believes that it is on track for CE approval later this year following some positive findings in pre-clinical trials.

‘We’ve just started the clinical work, which Mr Christopher Inglefield is leading, but the pre-clinical degradation trials indicate that we’re looking at a longevity of approximately 12 months or more,’ said Charles Weatherstone, Marketing Director of EternoGen.

‘We’re pretty confident that it’s safe,’ agreed Mr Inglefield, Plastic Surgeon at London Bridge Plastic Surgery, UK. ‘But we have to document the safety before we can go on to a multicentre study looking at the outcomes and results that can be achieved.’

The study has received both IRB and ethics committee approval, and will focus on injections to the forearm in women and the lower back in men. Following a biopsy at 4 weeks to assess immunological response, treatment will focus on the nasolabial folds to assess tolerability and safety.

Why a return to collagen?

Collagen dermal fillers were the first to be introduced as an aesthetic treatment during the 1980s, and became popular owing to their skin-friendly, safe and efficacious track-record.

However, as it was from a bovine source, it required a pre-treatment skin test and only lasted for approximately 4 months, meaning frequent treatments were required.

Naturally, with the emergence of the longer-lasting hyaluronic acid (HA) fillers, collagen was pushed out of the market, and following the brief appearance of a cross-linked collagen in 2004 (Evolence), there haven’t been any similar products since. But according to many physicians, this has been to the detriment of the aesthetic market.

‘We’ve always recognised that collagen is the holy grail of skin repair,’ said Mr Inglefield. ‘If you’re repairing your house, you wouldn’t use tiles to fix the walls, which is what we’ve been doing with HAs — we’re using them to do everything within the skin.

‘We’ve always said that collagen is really the true building material to provide real skin remodelling and rejuvenation. So EternoGen, with its science and what it has been able to develop, has produced a product that is very close to the ideal situation for a collagen product: collagen building blocks that, when injected into the tissue, produce natural collagen.’

Indeed, it is this unique aspect of EternoGen’s product — the ability to produce natural collagen once injected into the dermis — that has the industry eagerly anticipating its approval.

Currently known as Rapid Polymerizing Collagen (RPC), EternoGen’s offering is purified collagen from a porcine source, which is a slightly viscous liquid requiring only 7N of pressure for injection (compared with 25–30N pressure for HA products).

As it is a liquid, RPC can percolate through the dermis, can be massaged or sculpted, and then within several minutes it polymerises to form a mesh-like tissue that is contour-stable. According to Charles Weatherstone, the results are immediate and the chances of tissue migration low.

That notwithstanding, in pre-clinical studies EternoGen found that at 2 weeks after injection in a rabbit ear, it was possible to see blood vessels growing into the injected collagen. Furthermore, after 53 days, that injected collagen had become almost indistinguishable from the host tissue.

Treating the dermis

The dermis of the skin is approximately 80% collagen, and as we age, collagen production naturally decreases as a result of extrinsic ageing. In women, this is further compounded be a decrease in oestrogen production during menopause. In fact, approximately 30% of one’s collagen is lost during menopause.

‘Hyaluronic acids are typically injected sub-dermally; they lift the skin very well, are safe, but they stay as a defined bolus and don’t necessarily do anything for the dermis,’ said Charles.

‘We use collagen injected into the dermis, which integrates with the tissue and forms an open porous mesh that allows the body’s own cells to migrate through and populate the mesh. After around 50 days, it becomes an integral part of the tissue and that’s why we call it ‘tissue in a syringe’.’

Indeed, RPC is an advanced collagen designed to provide this matrix for cell integration and regeneration, while protecting against collagenase degradation.

Further in EternoGen’s pipeline is Gold Nanoparticle Collagen, which combines collagen with gold nanoparticles to add enhanced duration without compromising its natural biocompatibility and stability. This is based on research carried out at the University of Missouri, suggesting that the duration of treatment could last for a further 12 months (to 2 years).

Essentially, the product could be ideal to treat thin, delicate skin, as well as the lips, where age has resulted in the appearance of fine lines and wrinkles, as well as a more transparent appearance.

‘The absence of collagen from the physician’s armamentarium has been keenly felt in recent years,’ said Mr Inglefield.

‘The real future for this product is that you can inject it right into the dermis, in areas where HA could never go. And by that token, rebuild the collagen in the dermis, which gets us into the realm of true skin rejuvenation.’