Turkiye Klinikleri Journal of Health Sciences

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Bromelain ve Kanser
Bromelain and Cancer
Tuğba GÜNDOĞDUa, Gamze AKBULUTb
aBeslenme ve Diyet Bölümü, Sağlık Bilimleri Üniversitesi, Antalya Eğitim ve Araştırma Hastanesi, Antalya, TÜRKİYE
bBeslenme ve Diyetetik Bölümü, Gazi Üniversitesi Sağlık Bilimleri Fakültesi, Ankara, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2019;4(1):79-84
doi: 10.5336/healthsci.2018-60225
Article Language: TR
Full Text
ÖZET
 Kanser, dünya çapında önemli bir halk sağlığı sorunudur ve günümüzde en yaygın ölüm nedenlerinden biridir. Kanserden korunmada ve kanser tedavisinde beslenme büyük bir öneme sahiptir. Günümüzde kanser tedavisinde besinsel desteklere ilgi giderek artmaktadır. Besinsel destekler arasında ananastan elde edilen ve ham sulu bir özüt olan bromelain ön plana çıkmaktadır. Bromelain, güvenli kullanım geçmişine sahiptir ve uzun süre tüketildiğinde insan vücudunda ciddi düzeyde yan etkilere neden olmamaktadır. Bromelainin yapısında endopeptidazlar, fosfatazlar, glukozidazlar, peroksidazlar, selülazlar, glikoproteinler, proteinaz inhibitörleri, kalsiyum ve karbonhidrat bulunmaktadır. Bromelainin anti-kanser aktivitesi proteolitik aktivitesinden kaynaklanmaktadır. Bromelain antikanser aktivitesini; büyüme/invaziv kapasite, apoptoz/hücre sağkalımı, inflamasyon, immünomodülatör, hemostatik sistem üzerine etkileri ile göstermektedir. Farelerde yürütülen çalışmalarda; bromelainin Bax ekspresyonunu artırdığı, Akt ve Erk gibi hücre sağkalım düzenleyicilerinin aktivitesini azalttığı ve tümörlerde apoptotik hücre ölümünü teşvik ettiği bildirilmiştir. Bromelain; inflamatuar yolaklar aracılığı ile kanserli hücreler üzerinde nükleer faktör kappa-B, siklooksijenaz-2 ve prostaglandin E2 aktivitesinin inhibisyonunu sağlamaktadır. Ayrıca, bromelainin dolaşımdaki CD44 birikimini engellediği, dönüştürücü büyüme faktörü beta ekspresyonunu azalttığı ve tümörlü hücrelerde reaktif oksijen türleri üretimini artırdığı rapor edilmiştir. Kanser hastalarında bromelain süplemantasyonu ile yapılan çalışmaların yetersiz olmasından dolayı, aktif kanser tedavisi sırasında süplemantasyon kullanımının uygunluğu ve dozu hakkında net bir öneri verilememekte, ancak bromelainin birlikte kullanılan kemoterapik ilaçlar ile kanserli hücrelere karşı sinerjik etkiler gösterdiği ve ilaçların sitotoksik aktivitesini artırdığı vurgulanmaktadır. Sonuç olarak, bromelain proteolitik aktivitesinden dolayı anti-kanser aktivite göstermektedir ve gelecekte kanser tedavisi için etkin bir besinsel destek olabileceği düşünülmektedir. Ancak, bu konu hakkında yürütülecek daha fazla çalışmaya gereksinim duyulmaktadır.

Anahtar Kelimeler: Kanser; bromelain; beslenme; süplementasyon
ABSTRACT
 Cancer is a major public health problem worldwide and is one of the most common causes of death today. Nutrition has a great importance in prevention and treatment of cancer. At present, interest in nutritional supplements in cancer treatment is increasing. Among the nutritional supplements, bromelain, which is obtained from ananas (ananas cosmosus) and is a raw juice extract, is the foreground. Bromelain has a history of safe use and does not cause serious side effects in the human body when consumed for a long time. Bromelain structure includes endopeptidases, phosphatases, glucosidases, peroxidases, cellulases, glycoproteins, proteinase inhibitors, calcium and carbohydrates. Anti-cancer activity of bromelain is due to its proteolytic activity. Bromelain shows anticancer activity via its effects on growth/invasive capacity, apoptosis/cell survival, inflammation, immunomodulator, hemostatic system. Studies conducted in mice have reported that bromelain increases Bax expression, decreases the activity of cell survival regulators such as Akt and Erk, and induces apoptotic cell death in tumors. Bromelain provides inhibition of nuclear factor kappa-B, cyclooxygenase-2 and prostaglandin E2 activity on cancer cells via inflammatory pathways. It has also been reported that bromelain inhibits circulating CD44 accumulation, decreases the expression of transforming growth factor beta, and increases the production of reactive oxygen species in tumor cells. Since studies with bromelain supplementation in cancer patients are inadequate, there is no clear recommendation on the suitability and dosage of supplementation during active cancer treatment. Finally, it has been emphasized that bromelain has synergistic effects on cancerous cells, when it is used in combination with chemotherapeutic drugs, and increases the cytotoxic activity of the drugs. As a result, bromelain shows anti-cancer activity due to its proteolytic activity and it is considered that there may be an effective nutritional supplement for cancer treatment in the future. However, there is a need to study more about this issue.

Keywords: Cancer; bromelain; nutrition; supplementation
REFERENCES:
  1. Bhui K, Prasad S, George J, Shukla Y. Bromelain inhibits COX-2 expression by blocking the activation of MAPK regulated NF-kappa B against skin tumor-initiation triggering mito- chondrial death pathway. Cancer Lett. 2009;282(2):167-76. [Crossref] [PubMed]
  2. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-86. [Crossref][PubMed]
  3. Mohamed SIA, Jantan I, Haque MA. Naturally occurring immunomodulators with antitumor activity: an insight on their mechanisms of action. Int Immunopharmacol. 2017;50:291-304. [Crossref][PubMed]
  4. Pavan R, Jain S, Shraddha, Kumar A. Properties and therapeutic application of bromelain: a review. Biotechnol Res Int. 2012;2012:976203. [Crossref][PubMed][PMC]
  5. Amini A, Ehteda A, Masoumi Moghaddam S, Akhter J, Pillai K, Morris DL. Cytotoxic effects of bromelain in human gastrointestinal carcinoma cell lines (MKN45, KATO-III, HT29- 5F12, and HT29-5M21). Onco Targets Ther. 2013;6:403-9. [PubMed][PMC]
  6. Muhammad ZA, Ahmad T. Therapeutic uses of pineapple-extracted bromelain in surgical care-a review. J Pak Med Assoc. 2017;67(1):121-5. [PubMed]
  7. Ramli AN, Aznan TN, Illias RM. Bromelain: from production to commercialisation. J Sci Food Agric. 2017;97(5):1386-95. [Crossref][PubMed]
  8. Rathnavelu V, Alitheen NB, Sohila S, Kanagesan S, Ramesh R. Potential role of bromelain in clinical and therapeutic applications. Biomed Rep. 2016;5(3):283-8. [Crossref][PubMed][PMC]
  9. Báez R, Lopes MT, Salas CE, Hernández M. In vivo antitumoral activity of stem pineapple (Ananas comosus) bromelain. Planta Med. 2007;73(13):1377-83. [Crossref][PubMed]
  10. Taussig SJ, Szekerczes J, Batkin S. Inhibition of tumour growth in vitro by bromelain, an extract of the pineapple plant (Ananas comosus). Planta Med. 1985;51(6):538-9. [Crossref][PubMed]
  11. Tysnes BB, Maurer HR, Porwol T, Probst B, Bjerkvig R, Hoover F. Bromelain reversibly inhibits invasive properties of glioma cells. Neoplasia. 2001;3(6):469-79. [Crossref][PubMed][PMC]
  12. Batkin S, Taussig SJ, Szekerezes J. Antimetastatic effect of bromelain with or without its proteolytic and anticoagulant activity. J Cancer Res Clin Oncol. 1988;114(5):507-8. [Crossref][PubMed]
  13. Beuth J, Braun JM. Modulation of murine tumor growth and colonization by bromelaine, an extract of the pineapple plant (Ananas comosum L.). In Vivo. 2005;19(2):483-5. [PubMed]
  14. Chobotova K, Vernallis AB, Majid FA. Bromelain?s activity and potential as an anti-cancer agent: current evidence and perspectives. Cancer Lett. 2010;290(2):148-56. [Crossref][PubMed]
  15. Bhui K, Tyagi S, Prakash B, Shukla Y. Pineapple bromelain induces autophagy, facilitating apoptotic response in mammary carcinoma cells. Biofactors. 2010;36(6):474-82. [Crossref][PubMed]
  16. Dhandayuthapani S, Perez HD, Paroulek A, Chinnakkannu P, Kandalam U, Jaffe M, et al. Bromelain-induced apoptosis in GI-101A breast cancer cells. J Med Food. 2012;15(4):344-9. [Crossref][PubMed]
  17. Paroulek AF, Jaffe M, Rathinavelu A. The effects of the herbal enzyme bromelain against breast cancer cell line GI101A. FASEB J. 2009;23:LB18.
  18. Romano B, Fasolino I, Pagano E, Capasso R, Pace S, De Rosa G, et al. The chemo- preventive action of bromelain, from pineapple stem (Ananas comosus L.), on colon carcinogenesis is related to antiproliferative and proapoptotic effects. Mol Nutr Food Res. 2014;58(3):457-65. [Crossref][PubMed]
  19. Bhui K, Tyagi S, Srivastava AK, Singh M, Roy P, Singh R, et al. Bromelain inhibits nuclear factor kappa-B translocation, driving human epidermoid carcinoma A431 and melanoma A375 cells through G(2)/M arrest to apoptosis. Mol Carcinog. 2012;51(3):231-43. [Crossref][PubMed]
  20. Kalra N, Bhui K, Roy P, Srivastava S, George J, Prasad S, et al. Regulation of p53, nuclear factor kappaB and cyclooxygenase-2 expression by bromelain through targeting mitogen- activated protein kinase pathway in Mouse skin. Toxicol Appl Pharmacol. 2008;226(1):30-7. [Crossref][PubMed]
  21. Eckert K, Grabowska E, Stange R, Schneider U, Eschmann K, Maurer HR. Effects of oral bromelain administration on the impaired immunocytotoxicity of mononuclear cells from mammary tumor patients. Oncol Rep. 1999;6(6):1191-9. [Crossref]
  22. Harrach T, Gebauer F, Eckert K, Kunze R, Maurer H. Bromelain proteinases modulate the cd44 expression on human molt-4/8 leukemia and sk-mel-28 melanoma-cells in- vitro. Int J Oncol. 1994;5(3):485-8. [PubMed]
  23. Desser L, Holomanova D, Zavadova E, Pavelka K, Mohr T, Herbacek I. Oral therapy with proteolytic enzymes decreases excessive TGF-beta levels in human blood. Cancer Chemother Pharmacol. 2001;47 Suppl:S10-5. [Crossref][PubMed]
  24. Zavadova E, Desser L, Mohr T. Stimulation of reactive oxygen species production and cyto- toxicity in human neutrophils in vitro and after oral administration of a polyenzyme prepara- tion. Cancer Biother. 1995;10(2):147-52. [Crossref][PubMed]
  25. Pillai K, Akhter J, Chua TC, Morris DL. Anticancer property of bromelain with therapeutic potential in malignant peritoneal mesothelioma. Cancer Invest. 2013;31(4): 241-50. [Crossref][PubMed]
  26. Maurer HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci. 2001;58(9):1234-45. [Crossref][PubMed]
  27. Taussig SJ, Batkin S. Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application. An update. J Ethnopharmacol. 1988;22(2):191-203. [Crossref]
  28. Sak K. Chemotherapy and dietary phytochemical agents. Chemother Res Pract. 2012;2012:282570. [Crossref]
  29. Pauzi AZ, Yeap SK, Abu N, Lim KL, Omar AR, Aziz SA, et al. Combination of cisplatin and bromelain exerts synergistic cytotoxic effects against breast cancer cell line MDA-MB-231 in vitro. Chin Med. 2016;11:46. [Crossref][PubMed][PMC]
  30. Pillai K, Ehteda A, Akhter J, Chua TC, Morris DL. Anticancer effect of bromelain with and without cisplatin or 5-FU on malignant peritoneal mesothelioma cells. Anticancer Drugs.2014;25(2):150-60. [Crossref][PubMed]

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30.03.2014

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