Perspectives for using serratiopeptidase in systemic enzyme therapy for low-intensity chronic inflammation and pain syndromes: from mechanisms of action to practical implementation (literature review)

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.