Peyronie’s Disease and Vitamin E – Interview with Gianni Paulis, M.D.

Post on January 13, 2014 by André Broussard, D.C.

Gianni Paulis, MD
Service of Andrology, Regina Apostolorum Hospital
Via San Francesco, 50 – CAP 00041
Albano Laziale, Rome, Italy
+39 06932989 / +39 069321138 (FAX)
paulisg@libero.it

“Efficacy of Vitamin E in the Conservative Treatment of Peyronie’s Disease: Legend or Reality? A Controlled Study of 70 Cases,”
Andrology. 2013 Jan;1(1):120-8. 50257 (11/2013)

Kirk Hamilton: Can you please share with us your educational background and current position?

Gianni Paulis: I received a degree in Medicine and Surgery at the University (La Sapienza) of Rome, Italy and I completed postgraduate courses specializing in Urology (Rome) in 1985 and in Endocrinologyfield of Andrology (Pisa) in 2002. I have also completed University Masterclasses in Andrology and clinical Sexology (Rome) and Andrological Ultrasonography (Pisa). I was Medical Director (First Level) in Complex Operative Unit of Urology (Regina Apostolorum Hospital-Albano L., ROME, ITALY) and Director of Service of Andrology until June 2013. Currently I am an Andrologist Consultant at Regina Apostolorum Hospital where I direct the Center of Andrology. I also head the “Center for the Treatment of Peyronie’s Disease” (Castefidardo Medical Team, ROME, ITALY), and the “Center for the Treatment of Prostatitis” (Scialoja18 Medical Team, ROME, ITALY).

My current scientific positions:

  • Scientific Coordinator of “Italian Society of Andrology” (macro-region Lazio-Abruzzo-Molise and Sardinia)
  • Member of Scientific Committee of the “Italian Society of Male Genital Surgery”.

KH: What got you interested in studying the role of vitamin E and Peyronie’s disease (PD)?

GP: Vitamin E was the first oral therapy proposed for the treatment of PD, but mainly because this vitamin has antioxidant properties.

KH: What is the biochemistry of vitamin E that might alter the pathophysiology of PD? Do we know the pathophysiology PD? What are the lifestyle risk factors if any?

GP: Vitamin E interacts with hydroxide (the more damaging ROS) donating a hydrogen atom to restore the molecule to its normal inert state. Vitamin E and its metabolites also have an anti-inflammatory and anti-COX2 property.  The pathophysiology of PD is known almost completely, and its mechanisms are very similar to other chronic inflammatory processes where oxidative stress is mainly present.  All lifestyles that promote oxidative stress (competitive sports, smoking, stronger sexual intercourse, high-fat diets, etc….) can facilitate the occurrence of Peyronie’s disease.

KH: What was your daily dose of vitamin E? How was it taken? With meals or away from meals? In a single dose or divided dose?

GP: The vitamin E dosage was 600 mg in divided dose (300 mg twice daily) orally and after meals.

KH: Why were blueberries used as a component of the treatment? Why propolis?

GP: Because both substances have a powerful antioxidant actions. Blueberry flavonoids inhibit iNOS, COX-2 expression, NF-kB activation and they protect endothelial cells against peroxynitrite- induced apoptosis. The various components of propolis (flavonoids etc.) inhibit NF-kB activity, production of proinflammatory cytokines, the release of nitric oxide and the expressions of cyclooxygenase-2 (COX-2) and inducible iNOS.

KH: Were blood levels of vitamin E or other biochemical markers taken before, during or after the intervention? If so did they correlate with symptoms and supplementation with vitamin E?

GP: Many of the patients were assessed for oxidative stress using the d-ROMs test and it was shown that oxidative stress was reduced after therapy.

KH: Can you tell us about your study and the basic results?

GP: Although in the scientific literature regarding vitamin E monotherapy showed no effects as compared to placebo, my (and others) studies reported better results when vitamin E was administered in combination with another substance in the treatment of PD. In my studies the results show that vitamin E with the above therapeutic dose, in combination with other substances is very effective in treating PD, whereas lower therapeutic responses were obtained in the groups without vitamin E.

References:

  • Pryor JP & Farrell CF. Controlled clinical trial of vitamin E in Peyronie’s disease. Prog Reprod Biol.
  • 1983, 9, 41-45.
  • Hashimoto K, Hisasue S, Kato R, Kobayashi K, Shimizu T & Tsukamoto T. Outcome analysis for
  • conservative management of Peyronie’s disease. Int J Urol. 2006, 13, 244-247.
  • Hauck EW, Diemer T, Schmelz HU & Weidner W. A critical analysis of nonsurgical treatment of
  • Peyronie’s disease. Eur Urol. 2006, 49, 987-997.
  • Paulis G, D’Ascenzo R, Nupieri P, De Giorgio G, Orsolini G, Brancato T et al. Effectiveness of
  • antioxidants (propolis, blueberry, vitamin E) associated with verapamil in the medical management of
  • Peyronie’s disease: a study of 151 cases. Int J Androl. 2012, 35, 521–527.
  • Paulis G, Brancato T, D’Ascenzo R, De Giorgio G, Nupieri P, Orsolini G, Alvaro R. Efficacy of vitamin E
  • in the conservative treatment of Peyronie’s disease: legend or reality? A controlled study of 70 cases.
  • Andrology. 2013, 1, 120-128.
  • Prieto Castro RM, Leva Vallejo ME, Regueiro Lopez JC, Anglada Curado FJ, Alvarez Kindelan J &
  • Requena Tapia MJ. Combined treatment with vitamin E and colchicine in the early stages of Peyronie’s
  • disease. BJU Int. 2003, 91, 522-524.
  • Safarinejad MR, Hosseini SY & Kolahi AA. Comparison of vitamin E and propionyl-L-carnitine,
  • separately or in combination, in patients with early chronic Peyronie’s disease: a double-blind, placebo
  • controlled, randomized study. J Urol. 2007, 178, 1398-1403.

KH: Were there any side effects with the vitamin E therapy? How was the patient compliance?

GP: There were no major side effects after treatment with vitamin E. In some cases (5 %) there were only mild digestive complaints that have never caused patients to discontinue treatment.

KH: Who is a candidate for vitamin E therapy? All subjects with PD?

GP: All patients with PD in active phase (not stabilized) should be treated with vitamin E.

KH: How can the public or health professionals use this information?

GP: The public should consult only the websites of specialized physicians or scientific associations as well as yours. I believe that PD patients should be addressed and treated in highly specialized Centers of Andrology.

KH: Do you have any further comments on this very interesting subject?

GP: I think it would be better to study the “natural history of Peyronie’s disease” according to new scientific knowledge and especially with the new diagnostic technologies. On this issue, I share with you my recent scientific work: Paulis G, Cavallini G. Clinical Evaluation of Natural History of Peyronie’s Disease: Our Experience, Old Myths and New Certainties. Inflamm Allergy Drug Targets. 2013 Oct;12(5):341-348.

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