Bromelain

Bromelain is a protein extract derived from the stems of pineapples, although it exists in all parts of the fresh plant and fruit. The extract has a history of folk medicine use. As a culinary ingredient, it may be used as a meat tenderizer.

The term "bromelain" may refer to either of two protease enzymes extracted from the plants of the family Bromeliaceae, or it may refer to a combination of those enzymes along with other compounds produced in an extract.

Although tested in a variety of research models for its possible efficacy against diseases, bromelain has no established research evidence as a nutraceutical or drug. Limited evidence exists for possible effectiveness of a product used to reduce pain from osteoarthritis that combines bromelain with trypsin and rutin.

Extract components

Bromelain extract is a mixture of protein-digesting (proteolytic) enzymes and several other substances in smaller quantities. The proteolytic enzymes are sulfhydryl proteases; a free sulfhydryl group of a cysteine amino acid side chain is required for function. The two main enzymes are:

Bromelain (pharmacology)

A concentrate of proteolytic enzymes from the pineapple plant enriched in bromelain is approved in Europe for the debridement (removal of eschar, that is dead and damaged tissue) of severe burn wounds under the trade name NexoBrid. In the US, it has completed Phase III clinical trials and has the tentative trade name Debrase. It was developed by MediWound, Germany; and Teva is responsible for development and marketing in the US.

The medicine has been granted orphan drug status by the European Medicines Agency (EMA).

Medical uses

The medication is approved for burns of degrees IIb, i.e. deep partial skin thickness burns, to III, i.e. full thickness burns, and has been shown to significantly reduce the necessity of surgical debridement (15% versus 63% under standard treatment) and skin transplants (18% versus 34%) in a randomized controlled trial.

The concentrate is solved in a sterile gel basis, applied onto the burn wound, covered with a wound dressing, and removed after four hours. The healthy surrounding skin has to be protected with a sterile paraffin ointment. The EMA recommends that the treatment should only be used in hospitals with specialised burns centres.