Bromelain is a protein digestive enzyme extracted from pineapple fruit or stem. The preparation methods of pineapple enzyme and pineapple enzyme are different, and the components of the enzyme are also different. "Bromelain" usually refers to "stem bromelain". "Pineapple enzyme is a mixture of different mercaptoendopeptidases and other components such as phosphatase, glycosidase, peroxidase, cellulase, pectinase and several protease inhibitors. In vitro and in vivo studies show that bromelain has a variety of fibrinolytic, anti-edema, antithrombotic and anti-inflammatory activities. Bromelain is easily absorbed in the body, and it will not lose its proteolytic activity, nor will it produce any major side effects. Bromelain has many therapeutic effects, such as treating angina pectoris, bronchitis, sinusitis, surgical trauma, thrombophlebitis, wound debridement and enhancing drug absorption, especially antibiotic absorption. It can also relieve osteoarthritis, diarrhea and various cardiovascular diseases. Bromelain also has certain anti-cancer activity and promotes cell apoptosis.
The therapeutic effect of bromelain involves many biological processes, such as anti-inflammation, anti-edema, analgesia, anti-thrombosis, exfoliation and so on. It is mediated by kinin-kinin and arachidonic acid, which has an effect on cellular immunity. It is suggested that more clinical trials should be conducted to determine its clinical efficacy and safety.
Bromelain can selectively remove dead skin for new skin transplantation as soon as possible. In Europe, it is approved for oral and external use, mainly used for debridement of surgical wounds, trauma and inflammation and deep burns caused by surgery. Animal experiments have proved that bromelain has no adverse effect on adjacent normal skin. Local use of antibiotics does not affect the role of bromelain. Yan Longfei and others used its bromelain scabbing preparation to treat deep second-degree and third-degree burns, and scabbing could be completed in 3 ~ 4 hours. No anesthesia is needed in the whole process, and the scab is completely removed, which is more important for the burn treatment of functional parts [1].
Tian Ying and others carried out a "wound bed preparation" plan for diabetic foot patients, and adopted different external treatments in the black stage and yellow stage. The experimental group was given bromelain combined with Shengji ointment to promote the early healing of wounds and shorten the hospitalization time of patients [2].
At present, non-steroidal anti-inflammatory drugs are the first-line drugs to treat osteoarthritis, but their gastrointestinal side effects are great. Bromelain has been proved to have therapeutic effect on a variety of arthritis, and patients are well tolerated. Klein and others compared the effects of bromelain and non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis through double-blind experiments, and found that there was no significant difference between the two drugs. During the experiment, none of the patients in bromelain group quit because of drugs. On the contrary, many patients in NSAIDs group stopped taking drugs because of gastrointestinal reaction. Klein et al. determined pepsin A and C (which can reflect the functional and morphological changes of gastrointestinal mucosa) when diclofenac and bromelain were used to treat shoulder arthritis, indicating that the latter had good gastrointestinal tolerance when taken orally. It is believed that bromelain may play its role through the following mechanisms: releasing inflammatory regulators, regulating intercellular adhesion factors, reducing immune complexes and enhancing fibrinolysis. Treating osteoarthritis with bromelain takes a short time, and the intervention drug contains not only bromelain but also other enzymes. In order to further study the therapeutic effect of bromelain on patients with osteoarthritis when the course of treatment is long enough and it is used alone, Bfien et al. conducted a double-blind clinical trial for 12 weeks. Patients in the intervention group took orally 800mg of bromelain every day, while patients in the control group only took placebo. Finally, it was found that bromelain had no obvious therapeutic effect compared with placebo group. Therefore, it can be seen that bromelain needs further research in the treatment of osteoarthritis. [3]
The study of oral bromelain in the treatment of various cancers began in the 1970s. In vitro studies have proved that bromelain has certain cytotoxicity. 1990, Desser et al. found that bromelain stimulated the production of α tumor necrosis factor in blood mononuclear cells cultured in vitro. Immunoregulation, especially the release of cytokines, is considered to be the reason why bromelain has therapeutic potential. Some patents mention the application of bromelain in cancer treatment. US5223406 thinks bromelain can induce tumor necrosis factor (TNF), while DE4302060 thinks bromelain can prevent metastasis by modifying the structure of tumor surface protein CD44. WO-A-9600082 discloses that crude bromelain can interfere with signal transduction pathways that play an important role in growth, especially those produced by growth factors such as interleukin -2(IL-2), platelet-derived growth factor (PDGF) and insulin-like growth factor (IGF). According to this patent, bromelain's ability to block signal transduction makes it an anticancer agent. The anti-cancer effect of bromelain needs more experimental evidence to be further confirmed. [ 1]
As a proteolytic enzyme, bromelain is beneficial to the prevention and treatment of cardiovascular diseases. It can inhibit heart attack and stroke caused by platelet aggregation, relieve angina symptoms, relieve arterial contraction and accelerate the decomposition of fibrinogen. Experiments show that bromelain can reduce the aggregation of human platelets in vitro, the adsorption of platelets by bovine endothelial cells and the formation of thrombosis in rats. These results explain the clinical effect of bromelain on thrombosis and related diseases [1]. The research on bromelain and cardiovascular diseases is extremely limited. This may be a field worth exploring in the future research of cardiovascular diseases. [4]
Fu Youding reported the curative effect of compound bromelain combined with Baiqian Biyan tablets on asthmatic bronchitis in children. On the basis of giving full play to the antibacterial and antiviral effects, compound bromelain combined with Baiqianbiyan tablets was used to treat asthmatic bronchitis, aiming at strengthening allergic reaction, eliminating congestion and edema of bronchial mucosa and relieving bronchospasm. The effect is quick and good, and it is worth popularizing [5].
Li Weihua et al. observed the efficacy and side effects of bromelain combined with tin in the treatment of pneumonia in children. The combination of bromelain and tin can enhance the antibacterial effect of tin, improve the cure rate and shorten the treatment time [6].
The combination of bromelain and various antibiotics (such as tetracycline and amoxicillin) can improve its curative effect. Relevant research results show that it can promote the spread of antibiotics in infected areas, thus reducing the dosage of antibiotics. In addition, bromelain can promote the absorption of nutrients [7].
A large number of research results show that. The effect of using antibiotics and bromelain enteric-coated tablets in the treatment of chronic prostatitis is obviously better than using antibiotics alone [8].
The results of animal experiments show that bromelain can promote the penetration of different drugs into tissues and organs and improve the level of antibiotics in blood and urine. Its enhancement of antibiotic drugs is mainly attributed to bromelain promoting absorption, enhancing the permeability of diseased tissues and making antibiotics reach the infected site easily [7].
Semen liquefaction is one of the common reasons that affect male fertility. From 2002 to 2004, 227 cases of semen non-liquefaction were diagnosed and treated in Xinhui District Maternal and Child Health Hospital, Jiangmen City, Guangdong Province, and the curative effect of compound bromelain enteric-coated tablets on semen non-liquefaction was systematically observed. The results show that bromelain tablets can achieve satisfactory results in the treatment of semen liquefaction [9].
The application of bromelain has a long history, and its safety has passed the test of time. It has shown its application potential in respiratory diseases such as debridement, asthma, pneumonia, rheumatoid arthritis, cardiovascular diseases, tumors and semen liquefaction. However, at present, the number of clinical studies in various disease fields is extremely limited. It is suggested that more clinical trials should be conducted to determine its clinical efficacy and safety.
refer to
Zhang Peifen, Guo Yong, Luo Huanmin. Research and application progress of bromelain [J]. Huaxi Journal of Pharmacy, 2002, volume deficiency (2): 128- 129.
Tian Ying, Zhang Chaohui, Ma Jing, et al. Application of bromelain combined with Shengji ointment in the preparation of diabetic foot wound bed [J]. China Journal of Chinese Medicine Information, 20 12, 19(7): 69-70.
Zhu, Zhao Mingshan. Clinical application and mechanism of bromelain [J]. Shandong Medicine, 2008,48 (46):114-15.
Lai Chitomoy, Chiami Amalia, Ni Qing, et al. Systematic evaluation of bromelain in treating cardiovascular diseases [J]. China Journal of Integrated Traditional Chinese and Western Medicine, 20 1 1, 9 (7): 702-7 10.
Fu youding. Observation on the therapeutic effect of compound bromelain combined with Baiqian Biyan tablets on asthmatic bronchitis in children [J]. Clinical collection, 2002, volume missing (7): 404.
Li Weihua, Wang Xuejie, Jing Cheng. Bromelain combined with Steining in the treatment of 60 cases of pneumonia in children [J]. Harbin Medicine, 2005, volume deficiency (1): 30-3 1.
Li, a man. Extraction of bromelain and its application in medicine [J]. Guangzhou Chemical Industry, 2009,37 (2): 52-53,57.
[8] Giant. Bromelain enteric-coated tablets combined with antibiotics in the treatment of chronic prostatitis [J]. Modern Medicine and Health, 2004, lack of volume (9): 753.
Tan Zhongrong, Liang Guifang. Clinical analysis of compound bromelain tablets in the treatment of semen non-liquefaction 1 12 cases [J]. national journal of andrology, 2006, lack of volume (12): 56-57.