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Background. Recent experimental and clinical stu­dies have confirmed the effectiveness and safety of serratiopeptidase (SRP) as a powerful anti-inflammatory agent, highlighting its potential benefits across various fields of medicine. The ­purpose was to analyze current literature on the mechanisms of action of SRP as a means of systemic enzyme therapy for low-intensity chronic inflammation and pain syndromes, its clinical applications, and prospects for implementation in general medical practice. ­Materials and methods. To identify relevant literature sources, a comprehensive search was conducted in electronic databases, inclu­ding PubMed, Scopus, Web of Science, and the Cochrane Library. ­Results. According to modern literature data, SRP demonstrates quite powerful anti-inflammatory, analgesic, reparative, fibrinoly­tic, and mucolytic properties, and exhibits a certain antimicrobial activity, especially against biofilm-forming bacteria. The combination of this enzyme with traditional antibiotics provides a more effective treatment of infectious processes. SRP has significant potential in the treatment of conditions and diseases associated with the development of low-intensity chronic inflammation and pain syndromes (especially in comorbid ones) due to its anti-inflammatory, anti-edematous, antithrombotic, and analgesic properties associated with the inhibition of cyclooxygenase 1 and 2, 5-lipoxygenase activity, myeloperoxidase and elastase, suppression of the formation and/or release of bradykinin, biogenic amines, pro-inflammatory cytokines, cell adhesion molecules, cleavage of bradykinin-related peptides, limitation of oxidative-nitrosative stress. The effectiveness of the enzyme notably increases when it is combined with some prebiotics and/or probiotics. Conclusions. The development of new dosage forms of SRP, along with further preclinical and clinical trials, could lead to new strategies for the prevention and treatment of inflamatory diseases.

Background. Vulvovaginal infections are the most common, studied, and still causing many questions. It has been established that the disturbance of the ratio of the vaginal microbiota components does not always lead to a disorder since the development and outcome of the disorder largely depend on the state of the macroorganism, including the state of its immune system. To date, the only method for assessing the state of local immunity is smear microscopy with counting leukocytes. An alternative to leukocyte counting is the assessment of immunological parameters (e.g., the transcriptional profile of cytokine genes). An integrated approach to assessing the state of microbiocenosis (the ratio of lactobacilli and opportunistic pathogens) and local mucosal immunity, considering the individual genetic characteristics of patients and microorganisms, makes it possible to optimize treatment methods for vaginitis. One of the ways to increase the effectiveness of treatment and prevention of the recurrence of infectious and inflammatory diseases in gynecology is systemic enzyme therapy based on the complex effect of a specially selected combination of plant and animal origin enzymes on key physiological and pathophysiological processes in the body. Aim. To study the clinical effect and the effect of combined therapy with an antibiotic and a medicinal product, including a complex of enzymes of plant and animal origin (Wobenzym) on the state of the vaginal microbiota, the expression of cytokine genes, and the recurrence rate in patients with bacterial vulvovaginitis. Materials and methods. An open-label, single-center, prospective, comparative, randomized study enrolled 88 patients according to inclusion criteria. After randomization of patients into 2 groups, the main group received combination therapy (clindamycin vaginal cream 2% and Wobenzym), and patients of the comparison group received standard therapy only (clindamycin vaginal cream 2%). Short-term and long-term endpoints were defined. The primary endpoints included the assessment of symptoms, the change over time of the number of leukocytes in Gram-stained smears, and the recurrence rate; the secondary endpoints were the study of the change over time of the inflammation index, the results of the assessment of the state of the vaginal microbiota by real-time quantitative polymerase chain reaction using the Femoflor 16 reagent kit and a microbiological study. Results. When used in combination, Wobenzym potentiates the antibacterial properties of clindamycin, reduces the inflammation index, promotes the growth of the normal microbiota of the vagina (Lactobacillus spp.), prevents the growth of opportunistic microorganisms and, as a result, prevents the recurrence of vulvovaginitis. Conclusion. The results support the use of combination therapy (antibiotic + Wobenzym) to improve the effectiveness of therapy and maintain normocenosis.

Background. Recent experimental and clinical studies have confirmed the effectiveness and safety of serratiopeptidase (SRP) as a powerful anti-inflammatory agent, highlighting its potential benefits across various fields of medicine. The purpose was to analyze current literature on the mechanisms of action of SRP as a means of systemic enzyme therapy for low-intensity chronic inflammation and pain syndromes, its clinical applications, and prospects for implementation in general medical practice. Materials and methods. To identify relevant literature sources, a comprehensive search was conducted in electronic databases, including PubMed, Scopus, Web of Science, and the Cochrane Library. Results. According to modern literature data, SRP demonstrates quite powerful anti-inflammatory, analgesic, reparative, fibrinolytic, and mucolytic properties, and exhibits a certain antimicrobial activity, especially against biofilm-forming bacteria. The combination of this enzyme with traditional antibiotics provides a more effective treatment of infectious processes. SRP has significant potential in the treatment of conditions and diseases associated with the development of low-intensity chronic inflammation and pain syndromes (especially in comorbid ones) due to its anti-inflammatory, anti-edematous, antithrombotic, and analgesic properties associated with the inhibition of cyclooxygenase 1 and 2, 5-lipoxygenase activity, myeloperoxidase and elastase, suppression of the formation and/or release of bradykinin, biogenic amines, pro-inflammatory cytokines, cell adhesion molecules, cleavage of bradykinin- related peptides, limitation of oxidative-nitrosative stress. The effectiveness of the enzyme notably increases when it is combined with some prebiotics and/or probiotics. Conclusions. The development of new dosage forms of SRP, along with further preclinical and clinical trials, could lead to new strategies for the prevention and treatment of inflamatory diseases. [ABSTRACT FROM AUTHOR]

Introduction. The most advanced and effective method of surgical treatment for benign prostatic hyperplasia (BPH) is transurethral laser enucleation of the prostate (tLEP). Recently, there has been a growing interest in exploring new approaches to reduce the risk of complications following tLEP.Objective. To evaluate the efficacy of using Phlogenzym® as part of a comprehensive treatment plan for patients following tLEP to reduce dysuria (urinary discomfort), leukocyturia (white blood cells in urine), and prevent infectious and fibrosis-related complications.Materials & methods. An open-label, randomized trial enrolled 105 patients undergoing tLEP. The patients were randomly assigned to two groups: the study group (n=50) received standard postoperative care in combination with Phlogenzym® for 30 days, while the control group (n=55) received standard care (α1-adrenergic blocker for 28 days) only. uring the follow-up period, which lasted for 1, 3, and 6 months postoperatively, complaints were evaluated using the IPSS-QoL, and IIEF-5 questionnaires, as well as indicators of urinalysis and urine culture, prostate volume measurements, residual urine volume, and uroflowmetry data.Results. Among all patients, the median preoperative values for prostate volume, IPSS, QoL score, and median peak urine flow rate were 90 cc, 18 points, 5 points, and 7.9 mL/s, respectively, with no significant differences between the groups. One month after surgery, in the study group, there was a more significant decrease in prostate volume (57% vs. 41%), although this difference was not statistically significant (p > 0.05). At the 6-month follow-up, bacteriuria was less common in the study group (42% vs. 67%), and there was a consistent trend toward a reduction in the incidence of fibrous complications, although these differences were not statistically significant either (p > 0.05). No adverse events occurred during the follow-up period.Conclusion. Our experience suggests that the use of Phlogenzym® is safe during the postoperative period following tLEP surgery. The use of this drug leads to a reduction in prostate volume postoperatively and significantly reduces the bacteriuria by the six-month follow-up. Additionally, there is a persistent positive trend towards reducing the overall incidence of fibrotic complications in the surgical site. The results achieved and the absence of significant side effects characterize Phlogenzym® as having a favorable clinical profile.

The modern treatment strategy for various forms of generalized periodontitis includes the use of a wide arsenal of drugs, which in turn leads to an excessive drug load on the body, this actualizes the search and use of drugs that have a systemic effect. The aim of the study is to develop and study the effectiveness of the use of systemic enzyme therapy in the treatment of aggressive (rapidly progressing) generalized periodontitis. The work is based on the results of comprehensive clinical and laboratory studies of 61 patients with an aggressive form of generalized periodontitis, without concomitant pathologies (30 main groups and 31 comparison groups). A control group consisted of 20 healthy donor volunteers. We used standard clinical, paraclinical, laboratory diagnostic methods, supplemented by dental volumetric tomography. In patients of both observation groups, standard protocol therapy was used, in the comparison group supplemented pathogenic therapy, and in the main group – multienzyme drug (Wobenzym) and rhBMP-2 injections. A comparative analysis of clinical, paraclinical, and laboratory studies has shown that the use of systemic enzyme therapy supplemented with recombinant morphogenetic protein (rhBMP-2) in patients with aggressive (rapidly progressing) generalized periodontitis is comparable to that of standard polymedicine therapy supplemented with pathogenic therapy, and leads to a faster control (average 13.7±0.7 days) of an active inflammatory and destructive process, normalization of indices of local humoral immunity, cytokine profile, free radical oxidation and antioxidant defense system, achievement of clinical and radiological remission in more than 90% of patients.

The use of systemic enzyme therapy in combination with antibiotics in the treatment of urogenital chlamydia infection in patients of both sexes proved to improve the therapeutic efficacy and to reduce the risk of the side effects.

The study objective is to evaluate the effectiveness and safety of systemic enzyme therapy drugs (Wobenzym, Phlogenzym) and the natural complex of multi-component dietary supplement Spermstrong in the treatment of immune infertility.Materials and methods. Sixty-four men with immune infertility, high levels of antisperm antibodies (ASA) in ejaculate, serum and reproductive disorders were examined. All patients were divided into 2 groups. For 8 weeks, 32 patients in the group 1 received systemic enzyme therapy drugs in combination with a natural complex of multi-component dietary supplement Spermstrong (combined therapy), and 32 patients of the group 2 received only Spermstrong (monotherapy), and their comparative assessment was carried out. Immediate results of treatment were evaluated 4 weeks later and remote 8 weeks after treatment.Results. Increased ejaculate volume was observed in patients receiving combination therapy and Spermstrong only: by 19.0 and 10.0 %, respectively, after 4 weeks of treatment and by 42.9 and 15.0 % after 8 weeks. Mean sperm count increased only in patients receiving combination therapy (by 55.4 % after 8 weeks of treatment, p

The paper presents the results of the study of the effectiveness and safety of the use of systemic enzyme therapy with Wobenzym in the complex treatment of patients with hormone-dependent severe bronchial asthma. It was found that the inclusion in the complex basic therapy of severe hormone-dependent bronchial asthma systemic enzyme Wobenzyme accompanied by improving the parameters of the functional state of the bronchi, reducing circulating immune complexes, a steady increase in cortisol levels. The data obtained convince of the safety of the inclusion of the preparation of systemic enzyme therapy in the complex treatment of patients with severe hormone-dependent bronchial asthma, improving the effectiveness of basic therapy, improving control over the course of the disease, allow to develop indications for the appointment of Wobenzyme patients with severe bronchial asthma.

Aim. Optimization of management tactics for patients with abnormal uterine bleeding on the background of benign endometrial and myometrial hyperplastic processes (BEMH) using systemic enzyme therapy. Materials and methods. 90 female patients with BEMH were included. They were divided into three groups: group 1 - women with endometrial hyperplasia, group 2 - women with uterine myoma of small size (6-8 weeks) in combination with endometrial hyperplasia and group 3 - women with endometrial hyperplasia in combination with endometriosis. Systemic enzyme therapy drug was used. Results and conclusions. BEMH are accompanied by inhibition of cellular immunity (pronounced suppression of T-lymphocytes) and excessive activation of humoral immunity. Therefore, an immunomodulatory effect of systemic enzyme therapy at hyperplastic processes is the basis for its prescription for comprehensive treatment of patients with combined endometrial and myometrial hyperplastic processes.

Objective: The aim of this study was to determine if the timing of administration of systemic enzyme therapy [SET] has any effect on its efficacy in controlling postoperative sequelae of third molar surgery. Study design: A double blinded prospective randomized control trial was planned. The sample included patients requiring impacted mandibular third molar surgical extraction. Patients were randomly allocated to four groups (50 patients per group). Group A included administration of SET 48 h prior to surgery; Group B, started on the day of surgery; Group C started immediately after surgery and control group D included NSAIDS started 3 h after surgery. The predictor variable was timing of administration of SET. The primary outcome variables were pain and swelling measured on 1st day, 5th day, and 7th day after surgery. Findings: Groups A and D reported lower mean and median VAS scores and lesser swelling than groups C and D on postop day 1. On days 5 and 7, all four groups were comparable. On overall analysis, no statistically significant difference (p > 0.05) was evident. Interpretation: The results of the study showed that the differences in swelling and pain with starting the SET 2 days before, on the day of surgery, or immediately after when compared with diclofenac was not statistically significant. Trial registration: CTRI Registration Number CTRI/2018/03/012502 [ABSTRACT FROM AUTHOR]

The modern treatment strategy for various forms of generalized periodontitis includes the use of a wide arsenal of drugs, which in turn leads to an excessive drug load on the body, this actualizes the search and use of drugs that have a systemic effect. The aim of the study is to develop and study the effectiveness of the use of systemic enzyme therapy in the treatment of aggressive (rapidly progressing) generalized periodontitis. The work is based on the results of comprehensive clinical and laboratory studies of 61 patients with an aggressive form of generalized periodontitis, without concomitant pathologies (30 main groups and 31 comparison groups). A control group consisted of 20 healthy donor volunteers. We used standard clinical, paraclinical, laboratory diagnostic methods, supplemented by dental volumetric tomography. In patients of both observation groups, standard protocol therapy was used, in the comparison group supplemented pathogenic therapy, and in the main group – multienzyme drug (Wobenzym) and rhBMP-2 injections. A comparative analysis of clinical, paraclinical, and laboratory studies has shown that the use of systemic enzyme therapy supplemented with recombinant morphogenetic protein (rhBMP-2) in patients with aggressive (rapidly progressing) generalized periodontitis is comparable to that of standard polymedicine therapy supplemented with pathogenic therapy, and leads to a faster control (average 13.7±0.7 days) of an active inflammatory and destructive process, normalization of indices of local humoral immunity, cytokine profile, free radical oxidation and antioxidant defense system, achievement of clinical and radiological remission in more than 90% of patients. [ABSTRACT FROM AUTHOR]

Current FDA-approved antifibrotic treatments for Idiopathic Pulmonary Fibrosis slow down disease progression but have little impact on symptoms or quality of life in patients. This study was conducted to evaluate the effects of systemic enzymes in relieving symptoms associated with PF and improving quality of life. Methods: an open-label, prospective study on subjects with a confirmed diagnosis of PF was conducted as proof-of-concept. The subjects (n = 13) received the oral systemic enzyme supplements Serracor-NK and Serra Rx for 12 weeks and completed Health-Related Quality of Life (HRQL) questionnaires. The effect of this regimen was examined by comparing the end-of-treatment questionnaire scores with baseline values. Results: significant improvement was seen in 61.5% of subjects, as assessed by the WHO well-being index; an improvement in scores was seen in 84.6% of the subjects, as assessed by the UCSD Shortness of Breath Questionnaire, with 38.4% of the subjects showing minimal clinically important difference; the supplementation was found to be efficacious in 69.2%, 84.6%, 69.2% and 61.5% of the subjects, as assessed by the Saint George’s Respiratory Questionnaire total, symptom, activity, and impact scores, respectively. Conclusions: Serracor-NK and Serra Rx improve symptoms, as well as mental and physical wellbeing and HRQL in patients with PF.

The article provides the data of the clinical study on effectiveness of application of the systemic enzyme therapy in patients with varicose veins of lower extremities of C6 clinical class by CEAP classification. The study was conducted in 2 groups. In the major group (20 patients) the protocol of the conservative therapy included systemic enzyme therapy (Flogenzyme MUCOS Emulsions GmbH, Germany), the control group included only conservative therapy including modern wound coverings adapted to the stage of the wound process, elastic compression and micronized purified fraction of flavonoids. The duration of therapy was 1 month. As a result of therapy complete ulcer healing was registered in 18(90%) of patients, in the control group – in 9 patients (50%). The analysis of immune hemostasis values affecting the inflammatory process showed considerable reduction of absolute and relative content of CD4+CD25Bright-cells and increase of T-lymphocytes with phenotype CD4+CD45RO+ in the major group, which corresponded to the positive changes in the clinical pattern. Inclusion in the therapeutic protocol of the systemic enzyme therapy drug Flogenzyme contributed to quick regression of the clinical symptoms of the chronic venous insufficiency and acceleration of the process of regeneration of the venous trophic ulcers at stage I-III of the wound process.

The objective of this systematic review was to assess the effectiveness, acceptability, and safety of systemic enzyme therapy, consisting of trypsin, bromelain, and rutoside trihydrate, as an anti-inflammatory agent, either when utilized independently or in conjunction with non-steroidal anti-inflammatory drugs (NSAIDs). This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two studies met the inclusion criteria and were assessed in the review. The bias risk was evaluated using the risk-of-bias tool for randomized trials (RoB 2). Both studies revealed highly significant results for the study population. Individuals receiving oral enzymes and diclofenac sodium combination therapy showed a significant improvement in pain reduction, better eating, and mouth opening, as well as a decrease in joint noise and jerky mandibular motions. Patients receiving systemic enzyme therapy with diclofenac combinations performed better than those receiving NSAIDs alone, and the differences were quite substantial. For the treatment of internal derangement of the temporomandibular joint (TMJ), we recommend combining enzymes and diclofenac. Systemic enzyme therapy can be used in the treatment of TMJ osteoarthritis, as it shows a highly significant result in the study population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Shekhar et al.)

Purpose. The aim of the study was to estimate the efficiency and economic feasibility of prescribing systemic enzyme therapy in the composition with standard etiotropic and pathogenetic therapy of erysipelas of lower extremities.Materials and methods. For this purpose, 62 patients with erysipelas of lower extremities were investigated. Standard therapy (antibiotics, non-steroids, anti-inflammatories) was administered in the 1th group of patients (n=32), patients of the 2th group (n=30) received natural systemic proteolytic enzymes within the acute period of disease additionally to the basic scheme of therapy. The clinic-economic parameters such as cost of illness and the indicator “cost-efficiency” were estimated.Results. The study has revealed the clinic and economic efficiency of systemic enzyme therapy in the combination therapy of erysipelas, which was confirmed by significant reduction of duration of in-patient treatment and decreasing the rate of recurrence of the disease, reduction of the full cost of the disease and the level of cost-effectivenes.Conclusion. Use of systemic enzymes is economically feasible and can reduce the full cost of treatment andincrease its efficiency

Abstract. An experimental group of 45 nondescript white mice was selected for a study of the influence of systemic enzyme therapy on performance and ability to withstand intensive physical loads, as well as on production of main cytokines. The findings were compared to a control group of 45 mice who received placebo. The physical performance was assessed after 1, 2, and 3 weeks according to the length of test swimming in the aquarium with the attached load of 5% of the body mass. Findings indicate that systemic enzyme therapy led to increased performance and endurance with increased physical load in the experimental group after three weeks of therapy. The mice in the experimental group showed decreased levels of anti-inflammatory TNFα and IL - 1β. Other observed changes were within the error range. (Med. Immunol., vol. 10, N 6, pp 577-582).

Systemic enzyme therapy (SET), developed by M. Wolf and K. Ransberger in 1954, is a method of treatment and prevention of diseases with the help of specially selected combination of hydrolytic enzymes of vegetable or animal origin (biological catalysts) that affect key physiological and pathophysiological processes in body. Systemic effects of exogenous enzymes provided direct or indirect effect on the hydrolase activity of the major organs and body systems through the modulation of their own enzyme systems or system antiproteaz and cytokines.

This study is devoted to systemic enzyme therapy (wobenzym and phlogenzym) influence on hemostasis, hemorheology, and clinical course of disease inpatients (n=54) with Functional Class II-III effort angina, receiving complex therapy. Systemic enzyme therapy improved blood rheology due to decreased red and white blood cell aggregation, increased elasticity of red blood cell membrane; optimized fibrinolysis and hemocoagulation systems' status; improved angina clinical course and quality of life. Including wobenzym and phlogenzym into complex therapy ofFC II-III effort angina patients is clinically rational, effective, and safe.

In this presented report female patients suffering from carpal tunnel syndromes were examined. The disorders were detected during the preventive occupational examinations. Median nerve lesions were detected 11 times in 6 electro-winders (risk of the long-term one-sided overloading, category No. 3) with electromyographic examination. Distinct subjective symptoms relief occurred after 6 weeks of treatment with Wobenzym in most cases. During a control examination 6 weeks after the cessation of treatment with Wobenzym the healing effect lasted. The electromyographic examination after 6 weeks of treatment confirmed the distal motor latency improvement in 8 out of 9 cases. 6 weeks after ceasing the treatment the improvement of the distal motor latency lasted in 7 out of 9 cases. Changes in the velocity of sensitive conduction were not unambiguous. On the basis of these and previously documented experiences a systemic therapy may be considered as a therapeutic modality extending the list of conservative treatment of the carpal tunnel syndrome methods or as a component of preventive beneficiary programs. However, verification in a more extensive study is desirable. [ABSTRACT FROM AUTHOR]

Introduction: In most cases, treatment of infectious and inflammatory diseases, including lower urinary tract infections, includes antibacterial drugs. However, their efficiency decreases every year. The absence of new groups of antibiotics makes it necessary to develop alternative treatment schemes and methods for improving efficiency of existing drugs. Systemic enzyme therapy is one of the promising directions in the treatment of lower urinary tract infections, which was shown to be effective for treating a number of diseases., Aim: to evaluate the results of complex treatment of women with chronic recurrent bacterial cystitis using a drug for systemic enzyme therapy., Materials and Methods: The examination and treatment of 60 women aged 19 to 45 years with an exacerbation of chronic recurrent bacterial cystitis, who were randomly divided into two groups of 30 patients, was performed. In the group 1, patients received standard antibiotic therapy. In the group 2, women additionally received Phlogenzym. An evaluation of the efficiency was carried out on the 1st, 7th and 14th day and included analysis of lower urinary tract symptoms, according to bladder diaries, assessment of pain intensity and laboratory tests (C-reactive protein [CRP], IL-6, IL-1, TNF. During long-term follow-up (6 months after completion of treatment), the relapse rate was evaluated in both groups., Results: At admission, all women had clinical and laboratory signs of cystitis. By the 14th day, there was normalization of evaluated parameters in both groups. However, in patients receiving systemic enzyme therapy a more rapid relief of the inflammatory process (a decrease in the frequency of urination, urgency, nocturia, severity of inflammatory changes in the blood and urine) by the 7th day of treatment was observed. During a further 6-month follow-up, relapses were detected in 9 (30%) and 4 (13.3%) patients in group 1 and 2, respectively., Conclusion: The results of the study demonstrated the high efficiency of systemic enzyme therapy. Its use for complex treatment provides more rapid relief of lower urinary tract symptoms and pain, as well as reduces the number of relapses in women with chronic recurrent bacterial cystitis.