Web site: "Information
About Herbs, Botanicals and Other Products"
URL: http://www.mskcc.org/aboutherbs
© 2003 Memorial Sloar-Kettering Cancer Center
(Monograph)
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Full Text |
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Barrie Cassileth
and K. Simon Yeung
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Bromelain
(Sulphydryl proteolytic enzyme, cysteine-proteinase)
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| Clinical Summary |
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Enzyme
obtained from the stem of the pineapple. Bromelain belongs to a group of
plant-derived proteolytic enzymes that also includes papain, and has a
wide range of applications. In-vitro and some in-vivo studies demonstrate
its ability to prevent edema formation and reduce existing edema.
Bromelain can reduce blood levels of fibrinogen and support fibrinolysis.
It activates plasmin and prolongs prothrombin and partial thromboplastin
times.
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| Scientific Name |
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Sulphydryl
proteolytic enzyme, cysteine-proteinase
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| Food Sources |
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Pineapple
(Ananas comosus)
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| Purported Uses |
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• Arthritis
• Bruises
• Burns
• Cancer
prevention
• Cancer
treatment
• Circulatory
disorders
• Edema
• Indigestion
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| Mechanism Of Action [1], [2], [6], [7] |
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Studies
show that bromelain prevents platelet aggregation and the adhesion of
platelets to blood vessel endothelial cells. It can act as an
anti-inflammatory agent via its ability to reduce levels of prostaglandin
E2 and thromboxane A2. Bromelain promotes the absorption of antibiotic
drugs and, topically, supports the skin debridement of burns. The
mechanism of action of bromelain is thought due to its proteolytic
activity. Oral enzymes such as bromelain have been proposed as additive
agents for cancer therapy. Proposed anti-cancer mechanisms include
down-regulation of the immunosuppressive cytokine TGF-beta, direct
inhibition of tumor cell growth, modulation of immune cell function,
modulation of cell adhesion molecules (CAMs), and the effects on platelet
aggregation and thrombosis mentioned above.
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Pharmacokinetics
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Absorption
Orally administered bromelain is absorbed intact from
the intestine. Because of its proteolytic activity, about 50% of bromelain
is rapidly complexed with an antiproteinase, namely alpha-2-macroglobulin
(AMG). Proteolytic activity is maintained within this protective molecule,
but reduced. In a recent human study, plasma half-life was determined to
be 6-9 h. Orally administered bromelain is absorbed at a rate of 40% in
animal studies.
Distribution
Bromelain
is distributed in the blood and plasma.
Metabolism/Excretion
The
pathways of metabolism and excretion are not fully known
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Adverse Reactions
[1], [4] |
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Reported:
Diarrhea, GI disturbance, allergic reactions.
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Drug Interactions
[4] |
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Antibiotics/Tetracyclines:
Bromelain may increase blood and urine levels.
Anticoagulants: Bromelain may increase bleeding
risk due to its antithrombotic effects.
Chemotherapy: Bromelain may increase the efficacy
of drugs such as 5-flouroacil and vincristine.
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| Literature Summary And Critique |
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Desser
L, et al. Oral
therapy with proteolytic enzymes decreases excessive TGF-beta levels in
human blood. Cancer
Chemother Pharmacol
2001;47suppl:S10-S15.
The effect of a combination of oral proteolytic enzymes (OET) containing
papain, bromelain, trysin and chymotrypsin on the levels of cytokin-transforming
growth factor-beta (TGF-beta) was studied. Overproduction of TGF-beta is
involved in chronic inflammation and delayed wound healing and is
associated with adverse effects from chemo- and radiationtherapy. 52
patients with rheumatoid arthritis, osteomyelofibrosis or herpes zoster
were recruited. 78 healthy volunteers served as controls. OET were
shown to reduce TGF-beta1 only in patients with elevated TGF-beta1
concentration (> 50 ng/ml serum). This study was well designed and has
a relatively high level of statistical significance. However, it included
other OET in addition to bromelain, leaving the possibility that the
outcome was due to a synergy of all the OET. The effect of bromelain
alone was not identified.
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| References |
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[1] Maurer
HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol
Life Sci 2001;58:1234-45.
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[2] Klasen
HJ. A review on the non-operative removal of necrotic tissue from burn
wounds. Burns 2000;26:207-22.
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[3] Petry
JJ. Surgically significant nutritional supplements. Plast Reconstr
Surg 1996;97:233-40.
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[4] Herr SM. Herb-Drug Interaction handbook, 2nd ed. Nassau
(NY): Church Street Books; 2002
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[5]
Castell
JV, et al. Intestinal absorption of undegraded proteins in men: presence
of bromelain in plasma after oral intake. Am J Physiol
1997;273:G139-46.
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[6]
Desser
L, et al. Oral
enzymes as additive cancer therapy. Int J Immunotherapy
2001;17:153-61.
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[7]
Desser
L,et al. Oral therapy with proteolytic enzyes decreases excessive TGF-beta
levels in human blood. Cancer Chemother Pharmacol 2001;47:S10-5.
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| Written |
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08/28/2002 |
| Updated |
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11/07/2002
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Disclaimer: http://www.mskcc.org/mskcc/print/11790.cfm |
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Source:
http://www.mskcc.org/mskcc/print/11571.cfm?RecordID=540 |
