Med. praxi. 2025;22(2):141-146 | DOI: 10.36290/med.2025.030
Systemic enzyme therapy: current view on the treatment of inflammatory diseases with proteolytic enzymes
- dp medic, s. r. o., ordinace praktického lékaře
The article discusses systemic enzyme therapy (SET) to place it in the context of treating inflammatory diseases, clinical evidence of the preparation Phlogenzym, and the possibilities of its use. SET is a therapeutic modality based on the administration of proteolytic enzymes necessary for the optimal course of the inflammatory reaction. It therefore finds its place in the treatment of diseases caused or accompanied by both infectious and non-infectious inflammation. The two basic mechanisms of action include a direct proteolytic action and an immunomodulatory effect. Unlike anti-inflammatory drugs, SET does not affect the physiological extent of inflammation but accelerates its course, shortens recovery time, and reduces the frequency of recidivism. The clinical effectiveness of SET is documented by randomized controlled trials in different groups of patients.
Keywords: systemic enzyme therapy, proteolytic enzymes, inflammation, Phlogenzym.
Received: March 11, 2025; Revised: April 22, 2025; Accepted: April 22, 2025; Published: April 30, 2025 Show citation
References
- Masinovský Z a kol. (Ne)skutečný příběh enzymů. 1. vydání. Praha: WALD Press; 2021.
- Souhrn údajů o přípravku Phlogenzym [Internet]. SÚKL [cit.2025-02-02]: www.sukl.cz.
- Nouza K a kol. Systémová enzymoterapie - od historie po současnost. 1. vydání. Havlíčkův Brod: HYPERTENZE.EU; 2018.
- Lorkowski G. Gastrointestinal absorption and biological activities of serine and cysteine proteases of animal and plant origin: review on absorption of serine and cysteine proteases. Int J Physiol Pathophysiol Pharmacol. 2012;4(1):10-27.
- Donath F, Roots I, Mai I, et al. Dose‑related bioavailability of bromelain and trypsin after repeated oral administration. Eur J Clin Pharmacol. 1997;52(S):146.
- Ernst E. Oral therapy with proteolytic enzymes: Effects on hemorheological parameters. Perfusion. 1994;12:440-441.
- Hale LP, Greer PK, Sempowski GD. Bromelain treatment alters leukocyte expression of cell surface molecules involved in cellular adhesion and activation. Clin Immunol. 2002 Aug;104(2):183-90. doi: 10.1006/clim.2002.5254. PMID: 12165279.
Go to original source... 
Go to PubMed... - Desser L, et al. Concentrations of soluble tumor necrosis factor receptors, β2-microglobulin, IL-6 and TNF in serum of multiple myeloma patients after chemotherapy and after combined enzyme + chemotherapy. Int J Immunotherap. 1997;13(3/4):121-130.
- Rose B, Herder C, Löffler H, et al. Dose‑dependent induction of IL-6 by plant‑derived proteases in vitro. Clin Exp Immunol. 2006 Jan;143(1):85-92. doi: 10.1111/j.1365-2249.2005.02970.x. PMID: 16367938; PMCID: PMC1809566. Go to original source... Go to PubMed...
- Emancipator SN, et al. Effects of oral enzymes in collagen II induced ar thritis in mice. Int J Immunotherap. 1997;13(3/4):67-74.
- Honzíková M, et al. Systémová enzymoterapie v komplexní léčbě recidivujících zánětů dýchacích cest u dětí - postregistrační retrospektivní multicentrické hodnocení. Čes‑slov Pediatr. 2004;59(10):513-521.
- Luerti M, Vignali ML. Influence of bromelain on penetration of antibiotics in uterus, salpinx and ovary. Drugs Exptl Clin Res. 1978;4(1):45-48.
- National Library of Medicine [Internet]. Phlogenzym [cit.2025-04-12]. Available from: https://pubmed.ncbi.nlm.nih.gov/?term=phlogenzym.
- Baumüller M. Therapie der Distorsion des oberen Sprunggelenks mit hydrolytischen Enzymen. Praktische Sport‑Traumatologie und Sportmedizin. 1994;10(4):171-178.
- Vosáhlo J, et al. Oral enzyme combination with bromelain, trypsin and the flavonoid rutoside reduces systemic inflammation and pain when used pre- and post‑operatively in elective total hip replacement: a randomized exploratory placebo‑controlled trial [Internet]. Ther Adv Musculoskelet. 2023; 15. https://doi.org/10.1177/1759720X231186875. Go to original source... Go to PubMed...
- Kameníček V, et al. Systémová enzymoterapie v léčbě a profylaxi poúrazových a pooperačních otoků. Acta Chir Orthoped et Traum Čechosl. 2001;68:45-49.
- Kleine MW. Evidence of the efficacy of an enzyme combination preparation using the method of artificial hematomas in combination with a pressure meter: A placebo controlled, randomised, prospective, double blind study. J Clin Res. 1998;1:87-102.
- Bauműller M, Rau S. Efficacy and tolerance of systemic enzyme therapy in the treatment of acute thrombophlebitis-a randomised double‑blind controlled trial. J Phlebol Lymphol. 2018;11(1):7-12. Go to original source...
- Koshkin VM, Kirienko AI. Systemic Enzyme Therapy in the Treatment of Acute Thrombosis of Superficial Veins in the Lower Extremities and Postthromboflebitis Disease. Int J Immunotherap. 2001;17:121-124.
- Schlüter P, Stauder G. Harnwegsinfektionen - Behandlung mit hydrolytischen Enzymen. TW Urol Nephrol. 1996;8:276-279.
- Bolten WW, et al. The safety and efficacy of an enzyme combination in managing knee osteoarthritis pain in adults: a randomized, double‑blind, placebo‑controlled trial [Internet]. Arthritis 2015. http://dx.doi.org/10.1155/2015/251521. Go to original source... Go to PubMed...
- Ueberall MA, et al. Efficacy, tolerability, and safety of an oral enzyme combination vs diclofenac in osteoarthritis of the knee: results of an individual patient level pooled reanalysis of data from six randomized controlled trials. J Pain Res. 2016;9:941-961. Go to original source... Go to PubMed...
- Pavelka K, et al. Léčba RA proteolytickými enzymy: dvojslepá, randomizovaná studie proti sulfasalazinu [Abstract book]. 42. congress of Czech and Slovak rheumatologists; Brno: May 27-30; 1998.
- Szczurko O, Cooley K, Mills EJ, et al. Naturopathic treatment of rotator cuff tendinitis among Canadian postal workers: a randomized controlled trial. Arthritis Rheum. 2009 Aug 15;61(8):1037-45. doi: 10.1002/art.24675. PMID: 19644905. Go to original source... Go to PubMed...