Inflammation and wound healing are attended by interactions of numerous cell types, mediators, cytokines, and the vascular system. Any imbalance in these interactions can set off a cascade of processes, often working in different directions, and which continue till homeostasis is restored. Systemic enzyme therapy with trypsin-bromelain-rutoside combination has long been used as dietary supplements or pharmaceuticals commercially to counter various inflammatory conditions. The clinical benefits are believed to be due to the multipronged action of the combination, which include anti-kinin, antioxidant, antiplatelet, anti-chemokine, pro-fibrinolytic, and pro-fibrotic activities; with more recent evidence indicating inhibition of pro-inflammatory signal transduction. The primary modes of action of the individual agents on different components and processes involved in inflammation have been evaluated and elucidated, using various in vitro, animal model, and clinical studies. A narrative review of the evidence collected over the years has been provided.
Key words: Inflammation; Enzymes; Trypsin; Bromelain; Rutin
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