CONSENSUS ON THE APPLICATION AND CARE OF BROMELAIN-BASED ENZYMATIC DEBRIDEMENT ON BURNS.

Treatment of burned patients involves early excision of the burn. The approach to this excision has changed since bromelain-based enzymatic debridement was introduced. This treatment option reduces complications from the surgical procedure and improves scar quality. It is indicated for partial and full thickness burns. It is important to agree on the nursing care before, during and after enzymatic debridement treatment to ensure an optimal preparation and maintenance of the wound bed for later treatment to be most successful. A multi-centre Delphi study was conducted with enzymatic debridement nursing care on burned patient experts. A coordinating group developed a 29-item questionnaire based on clinical guidelines and experience. Two question rounds were asked, reaching consensus on answers > 70%. Nine panellists from nine leading burns centres in Spain participated. The aim was to develop a national consensus on enzymatic debridement treatment based on clinical practice and evidence from almost 1500 cases. The experts reached 29 agreements on different aspects of treatment and patient condition: general considerations about the treatment, burned patient admission, treatment prior to enzymatic debridement, applying debridement, removing enzymatic debridement and the post-enzymatic debridement phase. The expert consensus on nursing care of the burn patient and application of bromelain-based enzymatic debridement includes general recommendations for the patient before, during and after application and the planning of localised care after debridement. This consensus document supports knowledge on enzymatic debridement technique, increasing safety in clinical nursing practice and ensuring successful treatment for the patient.

L'excision précoce est la référence dans le traitement des brûlures. Sa technique a été transformée par le débridement enzymatique à la bromélaïne. Cette technique, indiquée dans les brûlures intermédiaires et profondes, réduit les complications chirurgicales et améliore la qualité cicatricielle. La qualité des soins locaux, avant, pendant et après l'application de bromélaïne, est un paramètre important d'efficacité. Nous avons organisé une étude basée sur la méthode Delphi auprès de 9 experts de 9 CTB espagnols. Le groupe de coordination a réalisé un questionnaire à 29 items à partir des recommandations et de leur expérience (quasiment 1 500 cas au total). Deux séances ont été organisées, dans le but d'obtenir les agréments de plus de 70% des participants. Un consensus a été obtenu sur les 29 questions posées, se rapportant aux généralités, aux critères d'admission, au traitement avant bromélaïne, à son application, à son retrait et aux soins ultérieurs. Les recommandations de soins locaux consécutives recouvrent les phases avant, pendant et après utilisation. Elles permettent une amélioration de l'efficacité et de la sécurité du débridement enzymatique.

Use of 3D printing technology for custom bolus fabrication in the management of palmar or plantar fibromatosis with radiotherapy: A retrospective case series.

PURPOSE: Palmar or plantar fibromatosis is a benign fibroproliferative disorder affecting the fascia of the hands or feet. Management involves surgery, typically reserved for cases where progression limits function. Retrospective series demonstrate that radiation therapy (RT) can stabilize the disease course in many patients and improve symptoms in some cases. RT techniques vary between the use of electrons and superficial or orthovoltage photons and often require lead cutouts or custom boluses. We present a new approach demonstrating the implementation and effectiveness of three-dimensional (3D)-printed bolus material in patients receiving RT for fibromatosis. MATERIALS AND METHODS: A total of 3 patients, one with plantar and two with palmar fibromatosis, were treated with radiation using 3D-printed boluses over the past year. Bolus's design was based on computed tomography (CT) imaging data. Palmar patients were treated with a single en-face electron field, with a two-part accessory as a bolus and an immobilization device encasing the hand. The plantar case required 6MV photons delivered with a Volumetric Modulated Arc Therapy (VMAT) technique to cover the deeper target volume adequately. Dose and fractionation were based on guidelines from the Royal College of Radiologists in the United Kingdom. CT was used to assess printed shape and density accuracy. RESULTS: The mean deviations in shape between the printed bolus pieces and their designs were all less than 0.4 mm. The differences in mean Hounsefield units (HU) between the printed boluses and their expected values were between 7 and 44 HU. No significant issues were encountered when applying the bolus to patients. The thermoluminescent dosimeters (TLD) used demonstrated dose accuracy to within TLD precision (5 %). CONCLUSIONS: 3D printing bolus technology represents a novel approach to treating fibromatosis with radiation. It offers superior dosimetry through the reduction of air gaps and by permitting custom bolus thickness. Also, it simplifies clinical set-up by acting as an immobilization device and a visual aid for daily field placement.

Phytochemicals in vital tooth bleaching: Spectrophotometric evaluation of efficacy with papaya, pineapple, or kiwi extracts and 30% hydrogen peroxide.

Context: Dental bleaching, a common cosmetic treatment, typically uses hydrogen peroxide (H2O2). Yet, the search for natural options has prompted an investigation into fruit extract efficacies such as papain, bromelain, and actinidin for tooth whitening. Aim: The aim of this study was to evaluate the efficacy of 30% hydrogen peroxide and fruit extracts (papaya, pineapple, and kiwi) on human enamel using a spectrophotometer at different time intervals. Study Design: Eighty maxillary anterior teeth were stained with tea solution and evaluated for baseline color. They were then divided into four groups: hydrogen peroxide alone and hydrogen peroxide combined with papaya, pineapple, or kiwi extracts. Each group was further divided based on bleaching duration: 10 or 20 min. Materials and Methods: The color value of the bleached teeth was measured using a reflectance spectrophotometer. In order to analyze the data, one-way ANOVA, post hoc Tukey, and paired t-tests were used. The significance level was established at α =0.05. Results: Combining hydrogen peroxide with pineapple extract showed the highest efficacy, followed by papaya and kiwi extracts. Hydrogen peroxide alone also demonstrated significant bleaching efficacy, albeit lower than the combinations with fruit extracts. Conclusion: Combining hydrogen peroxide with pineapple and papaya extracts notably improves dental bleaching efficacy, as shown by reduced color difference (ΔE) values. This underscores the potential of natural enzymes in tooth whitening.

Evaluation of the physical properties of bromelain-modified biodentine for direct pulp capping.

BACKGROUND: This study aims to evaluate the compressive strength, solubility, radiopacity, and flow of Bromelain (BR)-modified Biodentine (BD) for direct pulp capping (DPC). This is suggested to determine the impact of BR on the physical properties of BD. METHODS: Eighty samples were prepared according to the ISO and ADA specifications and evaluated for compressive strength, solubility, radiopacity, and flow. The compressive strength was evaluated at 24 h and 21 days via a universal testing machine. The solubility was determined by weight loss after 24-hours immersion in deionized water. Radiopacity was assessed via X-ray with aluminum step-wedges, and flow was measured by the diameter of the discs under a standard weight. Independent sample t-tests were used to statistically assess the data. A significance level of 5% was considered. RESULTS: The compressive strength was 41.08 ± 1.84 MPa for BD and 40.92 ± 1.80 MPa for BR + BD after 24 h, and 88.93 ± 3.39 MPa for BD and 87.92 ± 3.76 MPa for BR + BD after 21 days, with no significant differences. Solubility was slightly greater in the BR + BD (2.75 ± 0.10%) compared to BD (2.62 ± 0.25%), but not significantly different. The radiopacity was similar between BD (2.82 ± 0.11 mm) and BR + BD (2.73 ± 0.10 mm). BR + BD resulted in significantly greater flow (9.99 ± 0.18 mm) than did BD (9.65 ± 0.27 mm) (p ≤ 0.05). CONCLUSION: BR-modified BD maintains BD's physical properties, with improved flow, making it a promising DPC agent that warrants further study.

Bromelain-Based Enzymatic Debridement Versus Standard of Care in Deep Burn Injuries: A Systematic Review and Meta-Analysis.

Deep burn injuries necessitate effective debridement to promote healing and reduce complications. Traditional surgical debridement is the standard of care; however, it can lead to significant tissue loss, excessive bleeding and delayed healing. Bromelain-based enzymatic debridement offers a potential less invasive alternative that aims to selectively remove necrotic tissue while preserving viable ones. Therefore, this systematic review and meta-analysis comprehensively compares bromelain debridement versus standard care in the management of partial and full-thickness burns. Cochrane Library, Embase, and Medline were searched until May 30th, 2024 for studies comparing bromelain debridement versus standard care. R version 4.4.0 was used to pooled risk ratio and mean difference in a random-effects model. We included seven studies, comprising 484 participants, of whom 238 (49%) were treated with enzymatic debridement. Bromelain significantly reduced time to eschar removal (MD - 7.60 days 95% CI [-9.76, -5.44]; I² = 70%) in comparison with standard care. Additionally, bromelain group presented a significant reduction in the risk of surgical excision (RR 0.17; 95% CI [0.06, 0.47]; I² = 79%) and need for autografts (RR 0.40; 95% CI [0.18, 0.93]; I² = 76%) in comparison with standard group. No differences were found in behalf of time to wound closure (MD -7.64; 95% CI [-18.46]-[3.18]; I2 = 86%), nor in Modified Vancouver Scar Scale (MD -0.36; 95% CI [-0.96]-[0.23]; I2 = 0%). Bromelain-based enzymatic debridement may accelerate eschar removal and reduce the need for surgical excision and autografts, without adversely affecting wound closure time or long-term scar quality.

Anticancer Potential of Pineapple and its Bioactive Compound Bromelain.

Various ailments have been treated with pineapple [Ananas comosus (L.) Merr.] throughout medicinal history. Pineapple and its bioactive compound bromelain possess health-promoting benefits. Detailed information on the chemotherapeutic activities of pineapple and its bioactive compound bromelain is provided in this review, which analyses the current literature regarding their therapeutic potential in cancer. Research on disease models in cell cultures is the focus of much of the existing research. Several studies have demonstrated the benefits of pineapple extract and bromelain for in vitro and in vivo cancer models. Preliminary animal model results show promise, but they must be translated into the clinical setting. Research on these compounds represents a promising future direction and may be well-tolerated.

Does NexoBrid® have antimicrobial properties?

We previously published the microbial profile of burn wounds managed with NexoBrid® in Pinderfields Regional Burns Centre, Wakefield, UK. Our results showed no significant changes in bacterial colonisation in burn wounds debrided with NexoBrid®. Previous studies described the antimicrobial properties of bromelain enzyme. To date, the effects of NexoBrid® on microorganisms have not been reported. In this study, a series of lab experiments were conducted to investigate the antimicrobial properties of NexoBrid®. Mueller-Hinton agar plates were pre-treated with NexoBrid® and inoculated with common pathogens after serial dilution. Our results revealed that the pre-treated plates showed reduction in the growth of E. faecalis and S. aureus. No zones of inhibition were observed around NexoBrid® after 18 h of incubation. Where a combination of controls and test solutions were added, no zones of inhibition were seen around the NexoBrid® wells in any of fifty tested organisms. The slightly lower infection rates observed in patients treated with NexoBrid® are more likely to be due to efficient selective debridement of necrotic skin rather than direct antimicrobial action.

Effect of Experimental Bleaching Gels With Enzymes on Composite and Enamel.

INTRODUCTION AND AIMS: Potential secondary or toxic effects of peroxide-based whitening gels have driven the search for alternative methods that use natural compounds with gentle action on tooth enamel that provide remineralizing benefits. METHODS: This study introduces four innovative experimental whitening gels (GC, G1, G3, G4) formulated with enzymes (Bromelaine and Papaine) and natural extracts, along with SiO2. The efficacy of these gels was tested on nanohybrid dental composite (EsCOM100, Spident Company) and dental enamel stained with coffee and natural juice (Tedi) over 10 days. The structural changes in samples before and after bleaching were examined using scanning electron microscopy and atomic force microscopy. Additionally, cytotoxicity tests were conducted on the gels using mesenchymal stem cells from human dental pulp (dMSC) and human keratinocytes (HaCaT). Antibacterial activity was assessed on five strains (Streptococcus mutans. Porphyromonas gingivalis; Enterococcus faecalis; Escherichia coli; Staphylococcus aureus). RESULTS: Coffee and natural juice stains significantly increase the roughness of composite and enamel surfaces by forming deposits. The enzymatic action of bromelain and papain effectively disorganizes and removes these clusters, significantly reducing surface roughness. CONCLUSION: Notably, the gel containing papain and nanostructured SiO2 proved to be the most effective in removing coffee stains from both composite surfaces and enamel. On the other hand, the gel with bromelain and nanostructured SiO2 was the most efficient in removing natural juice stains. The absence of SiO2 in the experimental gels slightly decreased the enzymes' effectiveness in stain removal. The antibacterial activity observed in the experimental gels is attributed solely to the enzymatic compounds.

The Combination of Natural Compounds Escin-Bromelain-Ginkgo Biloba-Sage Miltiorrhiza (EBGS) Reduces Platelet Adhesion to TNFα-Activated Vascular Endothelium through FAK Signaling.

Thrombosis is a key process that determines acute coronary syndrome and ischemic stroke and is the leading cause of morbidity and mortality in the world, together with cancer. Platelet adhesion and subsequent activation and aggregation are critical processes that cause thrombus formation after endothelial damage. To date, high hopes are associated with compounds of natural origin, which show anticoagulant action without undesirable effects and can be proposed as supportive therapies. We investigated the effect of the new combination of four natural compounds, escin-bromelain-ginkgo biloba-sage miltiorrhiza (EBGS), on the initial process of the coagulation cascade, which is the adhesion of platelets to activated vascular endothelium. Our results demonstrated that EBGS pretreatment of endothelial cells reduces platelet adhesion even in the presence of the monocyte-lymphocyte population. Our data indicate that EBGS exerts its effects by inhibiting the transcription of adhesion molecules, including P-selectin, platelet membrane glycoprotein GP1b, integrins αV and ß3, and reducing the secretion of the pro-inflammatory cytokines interleukin 6, interleukin 8, and the metalloproteinases MMP-2 and MMP-9. Furthermore, we demonstrated that EBGS inhibited the expression of focal adhesion kinase (FAK), strictly involved in platelet adhesion, and whose activity is correlated with that of integrin ß3. The results shown in this manuscript suggest a possible inhibitory role of the new combination EBGS in the reduction in platelet adhesion to activated endothelium, thus possibly preventing coagulation cascade initiation.

Efficacy of Percutaneous Laser Disc Decompression (PLDD) Combined with an Oral Food Supplement for Lumbar Disc Herniation.

Background: In recent years, minimally invasive treatment options for lumbar disc herniation, such as percutaneous laser disc decompression (PLDD), have been introduced to avoid more invasive surgical methods. Combining these minimally invasive approaches with nutraceuticals that are effective in neuroprotection and pain management may lead to better long-term outcomes. Methods: The present study evaluated the beneficial effects of a new oral food supplement composed of acetyl-L-carnitine, α-lipoic acid, quercetin, bromelain, pantothenic acid, and vitamins C, B1, B2, B6, and B12 in patients with neuropathic pain due to herniated lumbar discs treated with PLDD. Patients were divided into two groups of 26 patients each: group A underwent PLDD alone, while group B underwent PLDD followed by a dietary supplement for two months after surgery. Preoperative VAS scores for leg pain were recorded for both groups and no significant difference was observed (8.7 for Group A and 8.6 for Group B). Results: In Group A, the mean postoperative VAS score for leg pain at a 1-month follow-up was 2.5, which remained stable at 3 months. In Group B, the mean postoperative VAS score was 2.0 at 1-month and improved to 1.6 at the 3-month follow-up. According to self-reported leg pain assessments, 66.5% of the patients using the dietary supplement reported a significantly better pain condition, and 43.5% reported a somewhat better situation. In contrast, 7.7% of the patients who underwent PLDD alone reported no changes in leg pain at the final follow-up. Conclusions: The results of our study indicate that the oral food supplement could provide a safe and effective treatment in patients with painful radiculopathy, enhancing the recovery of sensory fiber function in lumbar nerve roots after surgical lumbar disc decompression.

Impact of Nebulized BromAc® on Mucus Plug Clearance in a Mechanically Ventilated Ex Vivo Ovine Lung Model of Obstructive Respiratory Conditions.

Mucus plugging of the respiratory tract occurs in airway diseases, including asthma, chronic obstructive pulmonary disease, and cystic fibrosis. It can cause blockage of the airways, leading to breathlessness and lung failure. Here, we used a ventilatory setup to demonstrate the effect of BromAc® in dissolving mucus plugs in a novel ex vivo ovine obstructive lung model. Mucus simulant was filled into the trachea of freshly slaughtered ovine lungs and ventilated via an endotracheal tube (ETT) using Continuous Mandatory Ventilation. Predetermined single or repeated doses of Bromelain, Acetylcysteine (Ac), BromAc®, and saline control were administered via an Aerogen® vibrating nebulizer and ventilated for 30 or 60 min. Ventilatory recording of resistance, compliance, and tidal volume was conducted, and rheology pre- and post-treatment were measured. A significant decline in airway resistance (p < 0.0001) compared to the saline control was observed when treated with Bromelain, Ac, and BromAc®, with the latter showing a stronger mucolytic effect than single agents. The decline in resistance was also effective in shorter time points (p < 0.05) at lower doses of the drugs. Changes in compliance, peak pressure, and tidal volume were not observed after administration of the drugs. Rheology measurements revealed that BromAc®TM significantly reduced the viscosity of the mucin at the end of 30 min and 60 min time points (p < 0.001) compared to the saline control. BromAc® showed complete dissolution of the respiratory mucus simulant and improved ventilatory airflow parameters in the ex vivo ovine model.

Bromelain decreases oxidative stress and Neuroinflammation and improves motor function in adult male rats with cerebellar Ataxia induced by 3-acetylpyridine.

Bromelain is a plant-based molecule with antioxidant, antithrombotic, anticancer, and anti-inflammatory properties. Bromelain has been shown to reduce the release of inflammatory cytokines. This study aimed to determine whether bromelain can prevent ataxia in rats caused by 3-acetylpyridine (3-AP). Thirty-six albino rats were divided into the control, 3-AP, and 3-AP + Brom groups. In the 3-AP + Brom group, bromelain was injected intraperitoneally at 40 mg/kg daily for 30 days. Various techniques such as rotarod, electromyography (EMG), elevated plus maze, IHC, and Sholl analysis were used to evaluate the possible effects of bromelain on cerebellar neurons and glial cells. The results demonstrated significant improvements in most of the 3-AP + Brom, including motor coordination, neuromuscular response, anxiety, oxidative capacity, microgliosis, astrogliosis, cell death, and morphological variables compared to the 3-AP group. The mechanism of action of bromelain in restoring cerebellar ataxia needs further investigation, but it may be a candidate to help restore degeneration in animals with ataxia.

Adhesive Performance of Pit and Fissure Sealants on Deproteinized Enamel with Different Proteolytic Agents: In Vitro Study.

The objective of this work was to assess the efficacy of different proteolytic agents on the bond strength of pit and fissure sealants to bovine enamel. Eighty-four bovine enamel specimens were randomly assigned in groups according to the pit and fissure sealant applied (HelioSeal F or Dyad Flow). Then, the specimens were subdivided according to the proteolytic agent used (n = 7): Group 1, distilled water (control); Group 2, 10 wt.% Tergazyme®; Group 3, 10 wt.% ZYME®; Group 4, 10% papain gel; Group 5, 10% bromelain gel; and Group 6, 5.25 wt.% sodium hypochlorite. The cell viability of the proteolytic solutions was assessed through the MTT assay. The proteolytic agents were applied on the enamel surface prior to the acid-etching procedure; then, the pit and fissure sealants were placed. The micro-shear bond strength was evaluated after 24 h or 6 months of water storing at 37 °C. Representative SEM images were taken for each experimental group. The bond strength data were statistically analyzed by a three-way ANOVA test using a significance level of α = 0.05. Bromelain and papain proteolytic solutions did not exert any cytotoxic effect on the human dental pulp cells. After 24 h and 6 months of aging, for both pit and fissure sealants, sodium hypochlorite, papain, bromelain, and Tergazyme® achieved statistically significant higher bond strength values (p < 0.05). Irrespective of the deproteinizing agent used, Dyad Flow resulted in a better bond strength after 6 months of aging. The type 1 etching pattern was identified for sodium hypochlorite, papain, and bromelain. Tergazyme®, papain, and bromelain demonstrated efficacy in deproteinizing enamel surfaces prior to acid etching, leading to the improved bond strength of pit and fissure sealants. Clinically, this suggests that these proteolytic agents can be considered viable alternatives to traditional methods for enhancing sealant retention and longevity. Utilizing these agents in dental practice could potentially reduce sealant failures.

Tracking heterogenous protein aggregation at nanoscale through fluorescence correlation spectroscopy.

Various biophysical techniques have been extensively employed to study protein aggregation due to its significance. Traditionally, these methods detect aggregation at micrometer length scales and micromolar concentrations. However, unlike in vitro, protein aggregation typically occurs at nanomolar concentrations in vivo. Here, using fluorescence correlation spectroscopy (FCS), we captured bromelain aggregation at concentrations as low as ~20 nM, surpassing the detection limit of traditional methods like thioflavin T fluorescence, scattering, and fluorescence microscopy by more than one order of magnitude. Moreover, using thioflavin T fluorescence-based FCS, we have detected larger aggregates at higher bromelain concentrations, which is undetectable in FCS otherwise. Importantly, our study reveals inherent heterogeneity in bromelain aggregation, inaccessible to ensemble-averaged techniques. The presented report may provide a platform for the characterization of premature aggregates at very low protein concentrations, which are thought to be functionally significant species in protein aggregation-induced diseases.

Bromelain Immobilized onto Clay-Carboxymethylcellulose Composites for Improving Nutritive Value of Soybean Meal.

Improvement of nutritional value and reduction of antinutritional factors (ANFs) of soybean meal (SBM) for animal feed applications could be achieved by using bromelain immobilized onto bentonite (Bt)-carboxymethylcellulose (CMC) composites. The composite with mass ratio between CMC to calcium ion (Ca2+) at 1:20 provided the highest enzyme activity, immobilization yield higher than 95%, with superior thermal and storage stabilities. Performance of the immobilized bromelain for soybean protein hydrolysis was further studied. The results showed that at 60 °C, the immobilized bromelain exhibited the highest efficiency in enzymatic hydrolysis to release free alpha amino nitrogen (FAN) as a product with high selectivity and to effectively reduce SBM allergenic proteins within 30 min. In conclusion, immobilization of bromelain onto Bt-CMC composites leads to stability enhancement of the enzyme, enabling effective improvement in SBM quality in a short treatment time and showing great potential for application in animal feed industries.

ECONOMIC ANALYSIS OF ENZYMATIC DEBRIDEMENT VERSUS STANDARD BURN CARE: A RETROSPECTIVE ANALYSIS.

When compared to standard surgical management, rapid enzymatic debridement of deep burns reduces the need for surgery while achieving similar long-term results. However, few studies have directly compared the costs of standard surgical and enzymatic burn care. We conducted a study comparing the care costs of 44 adult burn patients treated before (n=22) and after (n=22) introducing rapid bromelain-based enzymatic debridement (BED) of deep burns. Mean age was 59 years, 54% were male, and mean total body surface area (TBSA) was 23.5%. Burn etiology included flame and scalding burns (8). Groups treated with standard of care and enzymatic debridement were comparable in terms of age, sex and TBSA. Burn management with BED significantly reduced total debridement costs as well as grand total costs when compared with traditional surgical care. Such reduction was mostly related to lower costs associated with reduced surgical care and less facilities and resources consumption in the BED group.

Comparativement au traitement standard, l'excision enzymatique précoce (EEP) réduit la nécessité de chirurgie, à résultats égaux à long termes. Très peu d'études ont comparé les coûts de ces deux stratégies. Nous avons comparé 2 groupes de 22 patients profondément brûlés ayant pour l'un été pris en charge conventionnellement, l'autre ayant bénéficié d'une EEP. L'âge moyen était de 59 ans, 54% étaient des hommes, la surface brûlée moyenne de 23,5% (les 2 groupes étaient comparables). Seuls 8 patients avaient été ébouillantés, les autres étant brûlés par flamme. L'utilisation d'EEP réduisait significativement le coût de la prise en charge, en rapport avec la réduction de l'utilisation de locaux et de matériel consécutifs à la chirurgie.

Exploring the Therapeutic Potential of Bromelain: Applications, Benefits, and Mechanisms.

Bromelain is a mixture of proteolytic enzymes primarily extracted from the fruit and stem of the pineapple plant (Ananas comosus). It has a long history of traditional medicinal use in various cultures, particularly in Central and South America, where pineapple is native. This systematic review will delve into the history, structure, chemical properties, and medical indications of bromelain. Bromelain was first isolated and described in the late 19th century by researchers in Europe, who identified its proteolytic properties. Since then, bromelain has gained recognition in both traditional and modern medicine for its potential therapeutic effects.

Synergic Role of Dietary Bioactive Compounds in Breast Cancer Chemoprevention and Combination Therapies.

Breast cancer is the most common tumor in women. Chemotherapy is the gold standard for cancer treatment; however, severe side effects and tumor resistance are the major obstacles to chemotherapy success. Numerous dietary components and phytochemicals have been found to inhibit the molecular and signaling pathways associated with different stages of breast cancer development. In particular, this review is focused on the antitumor effects of PUFAs, dietary enzymes, and glucosinolates against breast cancer. The major databases were consulted to search in vitro and preclinical studies; only those with solid scientific evidence and reporting protective effects on breast cancer treatment were included. A consistent number of studies highlighted that dietary components and phytochemicals can have remarkable therapeutic effects as single agents or in combination with other anticancer agents, administered at different concentrations and via different routes of administration. These provide a natural strategy for chemoprevention, reduce the risk of breast cancer recurrence, impair cell proliferation and viability, and induce apoptosis. Some of these bioactive compounds of dietary origin, however, show poor solubility and low bioavailability; hence, encapsulation in nanoformulations are promising tools able to increase clinical efficiency.

Effects of a Dietary Supplement Composed of Baicalin, Bromelain and Escin for Venous Chronic Insufficiency Treatment: Insights from a Retrospective Observational Study.

Chronic venous insufficiency (CVI) represents a risk factor for cardiovascular events. The first-line treatment includes the use of compression stockings and lifestyle changes. Natural products, such as flavonoids, could be used to improve the effects of compression therapy due to their anti-inflammatory and anti-oxidant properties. This study aims to evaluate the effects of a dietary supplement containing baicalin, bromeline and escin in CVI patients. A retrospective cohort study was performed by using the medical records of CVI affected outpatients. Patients treated with the dietary supplement were defined as "users". A modified Venous Clinical Severity Score (VCSS) was calculated, including pain, inflammation, vessels induration and skin pigmentation. All clinical variables were evaluated at baseline (T0), after 30 (T1) and 90(T2) days in "users" and "non-users". Out of 62 patients, 30 (48.4%) were "users". No difference was observed between groups at baseline. A lower VCSS value was recorded in "users" than that observed in "non-users" at T2 (7.0 (4.0-9.0) vs. 9.0 (5.0-10.0); p = 0.025). Vessels' induration and pain significantly reduced in 53.3% and 43.3% of "users" and in 18.8% and 9.4% of "non-users". Only "users" (33.3%) showed a reduction of the inflammatory signs as well as a decrease in malleolar circumference, from 29.0 (26.5-30.0) to 27.5 (26.0-28.5) (p < 000.1). A reduction of C-reactive Protein levels was found in "users" compared to "non-users" at T2 (1.0 (0.9-1.2) vs. 1.3 (1.0-1.5); p = 0.006). These findings suggest that implementation of a dietary supplement could improve the clinical outcomes of CVI patients.

A review on the immobilization of bromelain.

This review shows the endeavors performed to prepare immobilized formulations of bromelain extract, usually from pineapple, and their use in diverse applications. This extract has a potent proteolytic component that is based on thiol proteases, which differ depending on the location on the fruit. Stem and fruit are the areas where higher activity is found. The edible origin of this enzyme is one of the features that determines the applications of the immobilized bromelain to a more significant degree. The enzyme has been immobilized on a wide diversity of supports via different strategies (covalent bonds, ion exchange), and also forming ex novo solids (nanoflowers, CLEAs, trapping in alginate beads, etc.). The use of preexisting nanoparticles as immobilization supports is relevant, as this facilitates one of the main applications of the immobilized enzyme, in therapeutic applications (as wound dressing and healing components, antibacterial or anticancer, mucus mobility control, etc.). A curiosity is the immobilization of this enzyme on spores of probiotic microorganisms via adsorption, in order to have a perfect in vivo compatibility. Other outstanding applications of the immobilized enzyme are in the stabilization of wine versus haze during storage, mainly when immobilized on chitosan. Curiously, the immobilized bromelain has been scarcely applied in the production of bioactive peptides.