Potential role of systemic enzyme therapy with trypsin, bromelain and rutoside combination in burns

Suhas Vidyadhar Abhyankar, Arvind Madhusudan Vartak, Gautam Vinod Daftary


Burns is a global public health problem, with a higher prevalence rate in the Southeast Asia region, including India. The therapeutic interventions mainly target the control of complications following burn injury and assisting in physiological recovery. However, the excessive inflammatory changes and loss of immunological integrity, seen in burns patients, interfere with the healing process. An orally applied formulation composed of hydrolytic enzymes (bromelain, trypsin) and the flavonoid rutoside has a long history of use as natural anti-inflammatory agents. This combination has been found to exert anti-inflammatory, anti-thrombotic and antioxidant effects through myriad mechanisms that include favorable modulation of inflammatory mediators, enhancement of plasmin levels, reduced leukocyte migration to injury site and suppression of the formation of reactive oxygen species. These actions have been demonstrated in multiple in vitro and animal models. Further, the beneficial effects of the combination on inflammatory markers have been reported from multiple clinical studies. This review provides a discussion of the current understanding of cellular mechanisms and pathways involved in burn injury and the evidence highlighting the beneficial role of systemic enzyme therapy with trypsin-bromelain-rutoside combination in the management of burn injury patients.  


Hydrolytic enzymes, Proteolytic, Cytokines, Anti-inflammatory, Anti-oxidant

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