For Patients & Caregivers
Bromelain is a digestive aid. It has not been shown to treat or prevent cancer or other serious medical conditions.
Bromelain, obtained from the stem of the pineapple, is an enzyme that breaks down protein molecules. In laboratory experiments, bromelain prevented several steps of blood clotting and decreased some substances that cause inflammation. Bromelain increases the absorption of antibiotics and when used topically, helps remove dead and damaged tissue from burns. Bromelain can help digestion and absorption in patients with digestive tract cancers. Anticancer activity has not been studied in humans.
- To treat arthritis
Laboratory studies show that bromelain reduces the levels of some substances that cause inflammation, but results from clinical trials are mixed. - To treat burns of the skin
Laboratory evidence supports this use, but clinical trails have not been conducted to show that bromelain can treat burns. - To prevent and treat cancer
Laboratory studies suggested bromelain has anticancer activities. But these effects have not been confirmed in humans. - To treat circulatory disorders
Laboratory studies show that bromelain can prevent the formation of blood clots, but there is no proof from clinical trials that it can treat circulatory disorders. - To reduce swelling and edema
Laboratory studies show that bromelain reduces the levels of substances in the body that cause inflammation. Clinical trials have yet to be conducted.
For Healthcare Professionals
An enzyme obtained from the stem of 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 anti-inflammatory (15) (16) properties. Bromelain reduces serum fibrinogen levels, supports fibrinolysis and has been investigated for its debriding effects on burn wounds (1). In addition, it may be useful for treating some skin conditions (2). Bromelain reduces mild, acute knee pain in a dose-dependent fashion (3). It was also shown to reduce post-operative pain and swelling, and improve quality of life (27). Studies of bromelain’s pain relieving effect on patients with arthritis yielded mix results (4) (5) (6).
Studies done in vitro and in mice have shown that bromelain has chemopreventive (19) (25) and antitumorigenic effects (20) (26). Bromelain and other proteolytic enzymes were used as adjuvants in cancer treatments (7) (8) (9). It also increased the survival indices of animals bearing leukemia, sarcoma, lung, breast, and ascetic tumors (10); however, the anticancer effects of bromelain have not been evaluated in clinical trials.
Theoretically, bromelain may interfere with anticoagulation therapy and increase bleeding risk due to its antithrombotic effects. Bromelain also inhibits cytochrome P450 (CYP) 2C9 activity (12).
Proteolytic removal of cell surface molecules by bromelain may account for some of its activities. Studies show that bromelain prevents platelet aggregation and adhesion of platelets to blood vessel endothelial cells as well as improves ischemia-reperfusion injury (13). It can act as an anti-inflammatory agent by reducing levels of prostaglandin E2 and thromboxane A2 (9). In addition, bromelain inhibits neutrophil migration in response to IL-8 during inflammation (14) and decreases pro-inflammatory chemokine and cytokine secretion (15) (16). Topical application of bromelain may be used for the skin debridement of burns (1).
Oral enzymes such as bromelain have been proposed as additive agents for cancer therapy (8). Proposed mechanisms include down-regulation of the immunosuppressive cytokine, TGF-beta (7), 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 (8) (9). Studies does in mice showed that bromelain induced apoptosis-related proteins along with inhibition of NF-kappaB-driven Cox-2 expression by blocking the MAPK and Akt/protein kinase B signaling in DMBA-TPA-induced skin tumors (20). Bromelain also induces the expression of autophagy-related proteins, light chain 3 protein B II (LC3BII), and beclin-1 thereby facilitating apoptosis in mammary carcinoma cells (26).