German Enzyme Research Yields Joint Pain Breakthrough

by Lane Lenard, Ph.D.
Anyone who has played ice hockey or even just watched a game knows how rough it can be. Flying across the ice at breakneck speeds, players routinely flatten each other against the boards. They may be pummeled by a swinging hockey stick or stung by a rock-hard puck sailing through the air at speeds in excess of 100 miles per hour, not to mention bloodied by their opponent's ungloved fists.

If you come out of a hockey game without at least a few bruises, you probably spent it sitting on the bench. Bruises, contusions, torn muscles, and ruptured ligaments are pretty much the norm for serious hockey players. The swelling, pain, and immobility that follow such traumatic injuries not only leave the individual player feeling uncomfortable, they can diminish his performance or keep him out of action altogether.

So it was in an attempt to shorten the recovery time from common injuries that the German National Hockey Team began experimenting in the early 1990s with a substance known as Wobenzym. In addition to their usual treatments, the players took Wobenzym capsules either immediately after an injury or prophylactically before games. Each of 100 injuries the athletes suffered was well-documented, and the healing process carefully and systematically monitored with regard to several criteria. The first use of Wobenzym in athletics was by the German Olympic team competing in Los Angeles. The coaches and athletes found that those who were hampered by painful bruises and swelling seemed to get back into action faster if they were taking Wobenzym.

The apparent ability of Wobenzym to reduce bruising, swelling, and pain while improving mobility and healing was also suggested by two studies on hockey players and skiers. Those who used the product preventatively were able to return to their sport significantly faster after an injury than those who used conventional and potentially dangerous nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen.

Both the physicians and the players of the German National Hockey Team were pleased with their results. Bruises and hematomas shrank in size faster, swelling was less severe and resolved faster, spontaneous pain, pain on mobility, and pain on pressure were all lower than expected, and full mobility returned quicker. Moreover, they found that taking Wobenzym prophylactically worked better than taking it right after an injury.

Proteolytic Enzyme Combinations
It is actually not a single substance but rather a unique, synergistic combination of various proteolytic (protein-destroying) enzymes, or proteases. It was developed during the 1950s by Professor Max Wolf, a Vienna-born scientist, and his American collaborator, Dr. Helen Benitez. (The name "Wobenzym" is simply a combination of their names and the word enzyme.) The precise formulation has evolved over the years, but its basic ingredients remain the same. The ingredients include the enzymes, bromelain and papain, which are derived from plant sources; pancreatin, trypsin, and chymotrypsin, which are extracted from animal sources; and the flavonoid rutin, which also comes from a plant.

Although systemic enzymatic combinations, such as those developed by Wolf and Benitez are of fairly recent origin, their healing roots reach far back into antiquity. The leaves and fruit of the papaya tree (the source of papain) and the fruit of the pineapple (the source of bromelain), for example, were used therapeutically by the ancient peoples of Central and South America. The use of an enzyme (ficin, derived from the fig) to treat a form of cancer is described in the Bible (Second Book of Kings, Chapter 20, Verse 7). In Europe during the Middle Ages, early forms of enzyme therapy were used topically to heal such conditions as decubitus ulcers and warts. Beginning in the 1900s, proteolytic enzyme extracts of pancreas (pancreatin) were used systemically with some success for treating certain cancers.

The Modern Age of Enzymes
The modern age of proteolytic enzyme therapy began with the work of Max Wolf, who is also credited with writing the first textbook on the young science of endocrinology. The work of Wolf and Benitez with various enzyme combinations, from the 1930s until the 1970s, was largely empiric in nature and lacked the rigorous controls common to modern-day research. Nevertheless, they observed positive effects of enzyme therapy in people with vascular diseases, lymphedema, certain viral infections, and in the healing of injuries and inflammations. This convinced them that a deficiency of proteolytic enzymes was a primary factor in premature aging.

In his 1970 book Enzymtherapie, Dr. Wolf proposed that a disturbance of important physiologic regulatory and feedback mechanisms lay at the heart of most geriatric diseases-including the loss of immune function-and that the essential equilibrium within these systems depended on the actions of various proteolytic enzymes. When certain specific protease enzymes, derived from both vegetable and animal sources, are administered systemically by oral, rectal or by intravenous injection, in the proper proportions, Wolf, Benitez, and their colleagues found they could produce extraordinary healing related to:

• Reduced swelling and inflammation
• Enhanced immune function
• Improved circulation
• Less pain
• More rapid recovery from traumatic injury
• Minimal scar formation
• Prevention of serious consequences of injury
• Management of rheumatic diseases, such as rheumatoid arthritis, soft tissue rheumatism and ankylosing spondylitis

Proteolytic enzymes can also be helpful in cases of infection. For example, both papain and trypsin have been shown to inhibit the growth or multiplication of bacteria; bromelain, trypsin, and chymotrypsin can serve a "vehicular" function when combined with many antibiotic drugs, bringing more drug to the site of an infection. This combination has proved particularly useful for treating urinary tract infections.

Clinical investigations carried out in Europe show that systemic proteolytic enzymes combined with antibiotic drugs like ampicillin, tetracyclines, and trimethoprim leads to a substantially higher antibiotic concentration at the site of the infection and a more rapid cure. In addition, enzymes reduce the pain, support the development of better circulation and hinder the spread of the infection.

Enzymes, Inflammation and Immunity
While we hear a lot about the value of hormones, vitamins, and antioxidants for optimizing health and prolonging life, hardly anyone pays any attention to enzymes. In fact, enzymes are the unsung heroes of bodily function. Life without them would be impossible. It has been estimated that the human body contains at least 50,000 different enzymes. These vital chemicals help orchestrate the countless biochemical reactions that control the function of everything from large organs like the heart, lungs, liver and brain, to individual chemical bonds in molecules of proteins and lipids.

Enzymes also play an essential role in inflammation and other functions of the immune system. Inflammation is one of the body's most important mechanisms for protecting itself against dangers both animate and inanimate. If you've ever had an insect bite, a sprained ankle, a sore throat, or a bad sunburn, you know what an inflammation is. Inflammation is the body's way of imposing a measured, temporary discomfort in the interests of long-term health. The five cardinal symptoms of inflammation are:

1. Redness,
2. Heat,
3. Swelling,
4. Pain, and
5. Restriction of movement.

These signs indicate that the body is bringing in more blood and immune resources, like white blood cells and macrophages, to remove microorganisms and other foreign matter. Redness is a sign that vasodilation is allowing more blood and other fluids to reach the affected area; local heat reflects the increased flow of warm blood from deep within the body; swelling (edema) is caused by the local accumulation of fluids; pain and restricted mobility arise from the added pressure due to the swelling.

Essential Regulators of Inflammatory Response
Proteolytic enzymes are essential regulators and modulators of the inflammatory response. Among their important actions is a 7- to 10-fold increase in the "appetite" of macrophages and in the potency of natural killer (NK) cells. Proteolytic enzymes also degrade pathogenic immune complexes which can inhibit normal immune function. These immune complexes, which consist of an antigen bound to an antibody, are a normal part of the immune response. But when immune complexes occur in excess, they are a principal cause of certain kidney diseases (eg, glomerulonephritis), nerve inflammations, and a number of rheumatologic diseases, including rheumatoid arthritis. Evidence suggests that trypsin, papain, and other proteolytic enzymes can break up existing pathogenic immune complexes and even prevent their formation in the first place, enhancing lymphatic drainage. The bottom line of these actions is a regulatory or stimulatory effect on the immune system.

Proteolytic enzymes modulate the inflammatory process by a variety of mechanisms, including reducing the swelling of mucous membranes, decreasing capillary permeability, and dissolving blood clot-forming fibrin deposits and microthrombi. By reducing the viscosity (thickness) of the blood, enzymes improve circulation. This consequently increases the supply of oxygen and nutrients to and the transport of harmful waste products away from traumatized tissue. Proteolytic enzymes also help break down plasma proteins and cellular debris at the site of an injury into smaller fragments. This greatly facilitates their passage through the lymphatic system, resulting in more rapid resolution of swelling, with the consequent relief of pain and discomfort.

Enzymes vs. Anti-Inflammatory Drugs
In an Italian study the relative ability of the enzymes trypsin, chymotrypsin and bromelain to prevent edema was compared with that of four powerful steroidal and nonsteroidal anti-inflammatory drugs-phenylbutazone, hydrocortisone, indomethacin, and acetylsalicylic acid (aspirin).

Utilizing a standard laboratory animal model of edema, rat paw edema, investigators inject rat paws with a small amount of a substance known to cause an inflammatory response. Prior to injecting the rat paws with the edematogenic agent, however, they gave the animals oral doses of either one of the enzymes or one of the drugs. The scientists then evaluated the extent of the resulting edema.

Figure 1. Comparison of the ability of proteolytic enzymes (a trypsin/chymotrypsin mixture or bromelain) and each of fourc different anti-inflammatory drugs to prevent edema. Following administration of one of these agents, experimental edema was induced in rat paws using either serotonin (A), brewer's yeast (B), or carrageenan (C). (Source: Netti et al, 1972).

The results (Fig. 1) showed that the proteolytic enzymes were generally equal or superior to the drugs in their ability to reduce swelling. Bromelain consistently reduced swelling by 40 to 45%, as did the trypsin/chymotrypsin combination (although bromelain was ineffective against swelling induced by brewer's yeast). Interestingly, in this study papain showed absolutely no ability to prevent edema, although other research has shown it to be quite effective when applied to a pre-existing inflammation.

In a randomized, double-blind, placebo-controlled study of edema and pain following episiotomy, women received either bromelain, the anti-inflammatory drug oxyphenbutazone, or placebo. The results showed bromelain and oxyphenbutazone to be equally effective and significantly superior to placebo in reducing post-episiotomy edema (Fig. 2 below) and associated pain. The placebo group also used substantially more analgesic drugs than the two treated groups.

Figure 2. Reduction in edema following treatment with either bromelain or the anti-inflammatory drug oxyphenbutazone in women following episiotomy.

Although rutin is classified as a quercetin glycoside flavonoid and not a proteolytic enzyme, it also has important anti-inflammatory properties. Key among these are its ability to inhibit enzymes like hyaluronidase and the phospholipases, cyclooxygenases, and lipoxygenases.

Although individual proteolytic enzymes are useful, the extraordinary combination of these enzymes yields a combination greater than the sum of its parts. Systemic multi-enzyme therapy has proved helpful in cases of arthritis and related diseases, offering a wide range of benefits relative to anti-inflammatory, vasculoprotective, and immunomodulatory effects.

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