Search JIM Advanced Search

Journal of Chinese Integrative Medicine ›› 2011, Vol. 9 ›› Issue (7): 702-710.doi: 10.3736/jcim20110702

• Systematic Review • Previous Articles     Next Articles

A review of the use of bromelain in cardiovascular diseases

Chit Moy Ley1, Amalia Tsiami1, Qing Ni2Nicola Robinson3()   

  1. 1. Social Care and Human Sciences, School of Psychology, University of West London, Middlesex, TW8 9GA, UK
    2. Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
    3. Faculty of Health and Social Care, London South Bank University, London SE1 0AA, UK
  • Received:2011-03-05 Accepted:2011-05-05 Online:2011-07-20 Published:2011-06-15

Background: In 2004 an estimated 17.1 million people died from cardiovascular diseases (CVDs) worldwide, representing 29% of all global deaths. According to the American Heart Association, heart disease and stroke are the main cause of death and disability among people with type 2 diabetes. Additional safe and effective approaches are needed for the prevention and management of CVDs which may include nutritional supplements.
Objective: To identify the potential of bromelain (a food supplement) on the risk factors associated with CVDs.
Search strategy: An electronic and manual search was conducted during November 2009 to March 2010. The databases searched included: Ovid MEDLINE; All EBM Reviews — Cochrane Database of Systematic Reviews (Cochrane DSR), American College of Physicians (ACP) Journal Club, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CCTR), Cochrane Methodology Register (CMR), Health Technology Assessment (HTA) and National Health Service Economic Evaluation Database (NHSEED); Allied and Complementary Medicine (AMED); British Nursing Index and Archive; EMBASE; Health Management Information Consortium (HMIC); ScienceDirect and Electronic Thesis Online Services (ETHOS). Only papers in the English language were included.
Inclusion criteria: Randomised controlled trials (RCTs), human studies, animal studies and experimental studies related to bromelain for CVDs.
Data extraction and analysis: The quality assessment of all the selected studies was conducted by the authors. Data from 3 animal trials and 3 human trials were included in the review. Data collected included: type of trial, drug dosage, duration, outcome measures, characteristics of bromelain used, significance of results and conclusion.
Results: Out of 223 papers retrieved, 6 papers met the inclusion criteria and could be included in the review. These comprised of 3 animal and 3 human trials, each of which investigated the use of bromelain for CVDs. Results suggested that bromelain could be used for treating acute thrombophlebitis, as it decreases aggregation of blood platelets, has a cardio-protective effect, ameliorates rejection-induced arterial wall remodelling, prevents thrombin-induced human platelet aggregation as well as reduces thrombus formation.
Conclusion: No substantive study of bromelain and clinical CVDs has been carried out in human populations. Only a few studies on bromelain and CVDs were published from 1948 to 2010. This may be an area worthy to be explored in future CVDs research.

Key words: cardiovascular diseases, bromelains, review

Figure 1

Review flow diagram"

[1] World Health Organization. Cardiovascular diseases. ( 2011)[ 2011-02-03]. 2011) [2011-02-03].
[2] World Health Organization. Cardiovascular diseases (CVDs). (2011-01)[ 2011-02-03]. Cardiovascular diseases (CVDs). (2011-01) [2011-02-03].
[3] British Heart Foundation , 1999-2009: a decade of achievements. ( 2010)[ 2011-02-03]. 2010) [2011-02-03]. .
[4] American Heart Association. Diabetes and cardiovascular disease. (2010-09-08)[ 2011-02-03]. Diabetes and cardiovascular disease. (2010-09-08) [2011-02-03]. .
[5] Jackson PPR, Aarabi M, Wallis E .Aspirin for primary prevention of coronary heart disease[J].Cochrane Database Syst Rev, 2004,(1):CD004586
doi: 10.1002/14651858.CD004586
[6] Lip GY, Felmeden DC .Antiplatelet agents and anticoagulants for hypertension[J].Cochrane Database Syst Rev, 2004,( 3):CD003186
doi: 10.1002/14651858.CD003186.pub3 pmid: 22161375
[7] Perez MI, Musini VM, Wright JM .Effect of early treatment with anti-hypertensive drugs on short and long-term mortality in patients with an acute cardiovascular event[J].Cochrane Database Syst Rev, 2009,( 4):CD006743
[8] Taylor F, Ward K, Moore TH, Burke M, Davey Smith G, Casas JP , Ebrahim S.Statins for the primary prevention of cardiovascular disease[J].Cochrane Database Syst Rev, 2011,( 1):CD004816
[9] King DE, Ellis TM, Everett CJ, Mainous AG3rd .Medication use for diabetes, hypertension, and hypercholesterolemia from 1988-1994 to 2001-2006[J]. South Med J, 2009,102(11):1127-1132
doi: 10.1097/SMJ.0b013e3181bc74c8 pmid: 19864974
[10] Heinicke RM, Gortner WA . Stem bromelain — a new protease preparation from pineapple plants[J]. Econ Bot, 1957,11(3):225-234
doi: 10.1007/BF02860437
[11] Kelly GS . Bromelain: a literature review and discussion of its therapeutic applications[J]. Alt Med Rev, 1996,1(4):243-257
[12] Guimarães-Ferreira CA, Rodrigues EG, Mortara RA, Cabral H, Serrano FA, Ribeiro-dos-Santos R, Travassos LR . Antitumor effects in vitro and in vivo and mechanisms of protection against melanoma B16F10-Nex2 cells by fastuosain, a cysteine proteinase from Bromelia fastuosa[J]. Neoplasia, 2007,9(9):723-733
doi: 10.1593/neo.07427
[13] Heinicke RM, van der Wal L, Yokoyama M . Effect of bromelain(Ananase) on human platelet aggregation[J]. Experientia, 1972,28(7):844-845
doi: 10.1007/BF01923166 pmid: 4658882
[14] Metzig C, Grabowska E, Eckert K, Rehse K, Maurer HR . Bromelain proteases reduce human platelet aggregation in vitro, adhesion to bovine endothelial cells and thrombus formation in rat vessels in vivo[J]. In Vivo, 1999,13(1):7-12
[15] Felton GE . Fibrinolytic and antithrombotic action of bromelain may eliminate thrombosis in heart patients[J]. Med Hypotheses, 1980,6(11):1123-1133
doi: 10.1016/0306-9877(80)90134-6 pmid: 6256612
[16] Pirotta F, De Giuli-Morghen C .Bromelain — a deeper pharmacological study. NoteⅠ. Antiinflammatory and serum fibrinolytic activity after oral administration in the rat[J]. Drugs Exp Clin Res, 1978,4:1-20
[17] Brien S, Lewith G, Walker A, Hicks SM, Middleton D . Bromelain as a treatment for osteoarthritis: a review of clinical studies[J]. Evid Based Complement Alternat Med, 2004,1(3):251-257
doi: 10.1093/ecam/neh035 pmid: 538506
[18] Brien S, Lewith G, Walker AF, Middleton R, Prescott P, Bundy R . Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study[J]. QJM, 2006,99(12):841-850
doi: 10.1093/qjmed/hcl118
[19] Rosenberg L, Lapid O, Bogdanov-Berezovsky A, Glesinger R, Krieger Y, Silberstein E, Sagi A, Judkins K, Singer AJ . Safety and efficacy of a proteolytic enzyme for enzymatic burn debridement: a preliminary report[J]. Burns, 2004,30(8):843-850
doi: 10.1016/j.burns.2004.04.010
[20] Neumayer C, Fügl A, Nanobashvili J, Blumer R, Punz A, Gruber H, Polterauer P, Huk I . Combined enzymatic and antioxidative treatment reduces ischemia-reperfusion injury in rabbit skeletal muscle[J]. J Surg Res, 2006,133(2):150-158
doi: 10.1016/j.jss.2005.12.005
[21] Bahde R, Palmes D, Minin E, Stratmann U, Diller R, Haier J, Spiegel HU . Bromelain ameliorates hepatic microcirculation after warm ischemia[J]. J Surg Res, 2007,139(1):88-96
doi: 10.1016/j.jss.2006.10.004 pmid: 17292418
[22] Gutfreund AE, Taussig SJ, Morris AK . Effect of oral bromelain on blood pressure and heart rate of hypertensive patients[J]. Hawaii Med J, 1978,37(5):143-146
pmid: 659096
[23] Taussig SJ . The mechanism of the physiological action of bromelain[J]. Med Hypotheses, 1980,6(1):99-104
doi: 10.1016/0306-9877(80)90038-9 pmid: 7382892
[24] Tochi BN, Wang Z, Xu SY, Zhang WB . Therapeutic application of pineapple protease(bromelain): a review[J]. Pakistan J Nutr, 2008,7(4):513-520
doi: 10.3923/pjn.2008.513.520
[25] Joanna Briggs Institute . JBI comprehensive systematic review training program: Module 3 — The appraisal, extraction and pooling of quantitative Data. 2010.
[26] Stevinson C, Lawlor DA . Searching multiple databases for systematic reviews: added value or diminishing returns?[J]. Complement Ther Med, 2004,12(4):228-232
doi: 10.1016/j.ctim.2004.09.003 pmid: 15649836
[27] Juhasz B, Thirunavukkarasu M, Pant R, Zhan L, Penumathsa SV, Secor ER Jr, Srivastava S, Raychaudhuri U, Menon VP, Otani H, Thrall RS, Maulik N . Bromelain induces cardioprotection against ischemia-reperfusion injury through Akt/FOXO pathway in rat myocardium[J]. Am J Physiol Heart Circ Physiol, 2008,294(3):H1365-H1370
doi: 10.1152/ajpheart.01005.2007
[28] Gaciong Z, Paczek L, Bojakowski K, Socha K, Wisniewski M, Heidland A . Beneficial effect of proteases on allograft arteriosclerosis in a rat aortic model[J]. Nephrol Dial Transplant, 1996,11(6):987-989
doi: 10.1093/oxfordjournals.ndt.a027521 pmid: 8671957
[29] Nieper HA . Effect of bromelain on coronary heart disease and angina pectoris[J]. Acta Med Empirica, 1978,5:274-278
[30] Seligman B . Oral bromelains as adjuncts in the treatment of acute thrombophlebitis[J]. Angiology, 1969,20(1):22-26
doi: 10.1177/000331976902000103 pmid: 4885019
[31] Maurer HR . Bromelain: biochemistry, pharmacology and medical use[J]. Cell Mol Life Sci, 2001,58(9):1234-1245
doi: 10.1007/PL00000936 pmid: 11577981
[32] Malezieux E . Global network for pineapple research[J]. Acta Hortic, 2000,529:35-47
doi: 10.17660/ActaHortic.2000.529.2
[1] Dona Nirmani Ann Wijewickrama Samarakoon, Deepthi Inoka Uluwaduge, Malith Aravinda Siriwardhene. Mechanisms of action of Sri Lankan herbal medicines used in the treatment of diabetes: A review. Journal of Integrative Medicine, 2020, 18(1): 13-20.
[2] Lena Grönblom Lundström, Ulrika Aasa, Yan Zhang, Tobias Sundberg. Health care in light of different theories of health—A proposed framework for integrating a social humanistic perspective into health care. Journal of Integrative Medicine, 2019, 17(5): 321-327.
[3] Jia Xu, Fu-qing Zhang, Jian Pei, Jun Ji . Acupuncture for migraine without aura: A systematic review and meta-analysis. Journal of Integrative Medicine, 2018, 16(5): 312-321.
[4] Wen-jie Xu, Ling-tai Wang, Zhi-ping Zhao, Li-ming Zhu, Liang-hua Zu, Qi Zhang, Dan-bo Dou. Prospects of a comprehensive evaluation system for traditional Chinese medicine services. Journal of Integrative Medicine, 2017, 15(6): 426-432.
[5] Naseem Akhtar Qureshi, Gazzaffi Ibrahim Ali, Tamer Shaban Abushanab, Ahmed Tawfik El-Olemy, Meshari Saleh Alqaed, Ibrahim S. El-Subai, Abdullah M.N. Al-Bedah. History of cupping (Hijama): A narrative review of literature. Journal of Integrative Medicine, 2017, 15(3): 172-181.
[6] Tom Fleischer, Tung-Ti Chang, Hung-Rong Yen. Post-hematopoietic stem cell transplantation in patients with hematologic disorders: Chinese herbal medicine for an unmet need. Journal of Integrative Medicine, 2016, 14(5): 322-335.
[7] Eric Wei Chiang Chan, Siu Kuin Wong, Hung Tuck Chan. Apocynaceae species with antiproliferative and/or antiplasmodial properties: A review of ten genera. Journal of Integrative Medicine, 2016, 14(4): 269-284.
[8] JiaXia, Li-qunHe, XiaoSu. Interventional mechanisms of herbs or herbal extracts on renal interstitial fibrosis. Journal of Integrative Medicine, 2016, 14(3): 165-173.
[9] Yu-fangLin, Zhi-danLiu, WenMa, Wei-dongShen. Hazards of insomnia and the effects of acupuncture treatment on insomnia. Journal of Integrative Medicine, 2016, 14(3): 174-186.
[10] Jason Yamaki, Kalyan C. Nagulapalli Venkata, Animesh Mandal, Piyali Bhattacharyya, Anupam Bishayee. Health-promoting and disease-preventive potential of Trianthema portulacastrum Linn. (Gadabani)—An Indian medicinal and dietary plant. Journal of Integrative Medicine, 2016, 14(2): 84-99.
[11] Qing Ji, Yun-quan Luo, Wen-hai Wang, Xuan Liu, Qi Li, Shi-bing Su. Research advances in traditional Chinese medicine syndromes in cancer patients. Journal of Integrative Medicine, 2016, 14(1): 12-21.
[12] Wei Chiang Chan Eric, Kuin Wong Siu. Phytochemistry and pharmacology of ornamental gingers, Hedychium coronarium and Alpinia purpurata: A review. Journal of Integrative Medicine, 2015, 13(6): 368-379.
[13] Jessica Stanhope, Philip Weinstein, Angus Cook. Health effects of natural spring waters: A protocol for systematic reviews with a regional case example. Journal of Integrative Medicine, 2015, 13(6): 416-420.
[14] Xiao-ping Huang, Huang Ding, Jin-dong Lu, Ying-hong Tang, Bing-xiang Deng, Chang-qing Deng . Autophagy in cerebral ischemia and the effects of traditional Chinese medicine. Journal of Integrative Medicine, 2015, 13(5): 289-296.
[15] Amal Bakr Shori. Screening of antidiabetic and antioxidant activities of medicinal plants. Journal of Integrative Medicine, 2015, 13(5): 297-305.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] Dong Yang, Yong-ping Du, Qing Shen, Wei Chen, Yan Yu, Guang-lei Chen. Expression of alpha-smooth muscle actin in renal tubulointerstitium in patients with kidney collateral stasis. Journal of Chinese Integrative Medicine, 2008, 6(1): 41-44
[2] SUN Ming-yu, ZUO Jian, DUAN Ji-feng, HAN Jun, FAN Shi-ming, ZHANG Wei, ZHU Li-fang, YAO Ming-hui. Antitumor activities of kushen flavonoids in vivo and in vitro. Journal of Chinese Integrative Medicine, 2008, 6(1): 51-59
[3] Daniel Weber, Janelle M Wheat, Geoffrey M Currie. Inflammation and cancer: Tumor initiation, progression and metastasis,and Chinese botanical medicines. Journal of Chinese Integrative Medicine, 2010, 8(11): 1006-1013
[4] Yan-bo Zhu , Qi Wang, Cheng-yu Wu, Guo-ming Pang, Jian-xiong Zhao, Shi-lin Shen, Zhong-yuan Xia , Xue Yan . Logistic regression analysis on relationships between traditional Chinese medicine constitutional types and overweight or obesity. Journal of Chinese Integrative Medicine, 2010, 8(11): 1023-1035
[5] Wei Xu, Meng Shi, Jian-gang Liu, Cheng-long Wang . Collagen protein expressions in ischemic myocardium of rats with acute myocardial infarction and effects of qi-tonifying, yin-tonifying and blood-activating herbs and detoxifying and blood-activating herbs. Journal of Chinese Integrative Medicine, 2010, 8(11): 1041-1047
[6] Ya-hui Liang , Ping Li, Jing-xia Zhao, Xin Liu, Qi-fu Huang. Acetyl-11-keto-beta-boswellic acid and arsenic trioxide regulate the productions and activities of matrix metalloproteinases in human skin fibroblasts and human leukemia cell line THP-1. Journal of Chinese Integrative Medicine, 2010, 8(11): 1060-1069
[7] Chan Chen, Yong-mei Meng , Peng Zhang, Juan Wang, Hui-hui Zhao, Shu-zhen Guo , Wei Wang. Diagnosis and treatment rule of traditional Chinese medicine for syndrome factors of chronic congestive heart failure: a study based on Shannon entropy method. Journal of Chinese Integrative Medicine, 2010, 8(11): 1080-1084
[8] Zhi-mei Wang, Bin Zhang. A study on translation of ellipses in Huangdi Neijing from perspective of hermeneutic theory. Journal of Chinese Integrative Medicine, 2010, 8(11): 1097-1100
[9] Gui Yu, Jie Wang. Thinking on building the network cardiovasology of Chinese medicine. Journal of Chinese Integrative Medicine, 2012, 10(11): 1206-1210
[10] Ming-qing Wei , Jin-zhou Tian , Jing Shi , Fu-yun Ma , Ying-chun Miao , Yong-yan Wang. Effects of Chinese medicine for promoting blood circulation and removing blood stasis in treating patients with mild to moderate vascular dementia: a randomized, double-blind and parallel-controlled trial. Journal of Chinese Integrative Medicine, 2012, 10(11): 1240-1246