Bromelain-Based Enzymatic Debridement: Mechanism of Action in the Wound Environment. A Literature Review

Chronic hard-to-heal wounds, such as diabetic foot ulcers, venous leg ulcers, and pressure ulcers, present significant safety concerns, patient burdens, and challenges to health care systems globally. To review the mechanism of action and clinical function of bromelain-based enzymatic debridement (BBD) in the context of wound care, focusing on the mechanism of action of BBD and its formulation for chronic wounds in particular. A literature review was conducted to assess both bromelain's mechanism of action as well as clinical and preclinical studies on the use of BBD, searching the PubMed and Google Scholar databases for articles published between November 1992 and July 2024. The literature review shows that BBD, a mixture of proteolytic enzymes derived from the pineapple plant, demonstrates multifaceted actions beneficial to wound healing. It selectively targets devitalized tissue, inhibits bacterial biofilm formation, promotes granulation tissue formation, and maintains moisture balance, thus facilitating a conducive wound microenvironment. Clinical studies and in vivo experiments support the efficacy of BBD in expediting wound debridement, in the formation of granulation tissue, and in reducing bioburden. The mechanistic insights presented in this review underscore the potential of BBD as a novel standard in chronic wound care that warrants further exploration and clinical validation across diverse wound classifications.