For Physicians

See the science behind Wobenzym®




Inflammation – a natural and crucial response of the immune system

Inflammation is very common in everyday life. While acute inflammation is usually caused by an injury and lasts for a few days, chronic inflammation has a complex and multifaceted foundation and lasts for months and up to years. Osteoarthritis (OA) is one of the most common degenerative diseases associated with chronic inflammation.

Chronic and acute inflammatory states are characterized by pain and swelling of the affected tissue; depending on the location and duration of inflammation, it can be associated with loss in mobility, function, and quality of life of patients.

[There they can find a picture of the symptoms of inflammation]


Inflammation is the immune system’s natural and crucial response to a variety of potentially harmful stimuli, including infectious agents, tissue injury, autoimmune diseases, and obesity, and helps to maintain tissue homeostasis under stressful conditions[1][2][3][4] .

When tissue injury occurs, numerous substances are released by the injured tissues, which cause changes to the surrounding uninjured tissues. Activated macrophages produce and release numerous growth factors in the inflamed tissue. The dominant factors (cytokines) released by the macrophages provide a powerful feedback mechanism to help remove the cause of the inflammation. Cytokines are mediators necessary to conduct the inflammatory response in sites of infection and injury favoring proper wound healing and play a fundamental role in controlling the progression and duration of inflammatory responses. Pro-inflammatory cytokines promote the inflammatory response, while anti-inflammatory cytokines inhibit the inflammatory response[5][6]. The coordinated interplay of pro- and anti-inflammatory cytokines is a prerequisite for the normal progression of inflammations. In the event of an acute immune response, pro-inflammatory cytokines predominate, while in the case of chronic inflammatory processes anti-inflammatory cytokines prevail.


In chronic inflammation there is a progressive change in the type of cells that are present at the site of inflammation where the body is attempting to heal, but tissue damage is occurring at the same time[7]. Chronic inflammation is linked to the onset and development of many diseases, including obesity, atherosclerosis, metabolic disorders, autoimmune and degenerative diseases and asthma[8][9]. In particular, systemic low-grade inflammation is the main cause of chronic disorders related to aging, including OA which is a known degenerative joint disease. OA is the most common form of arthritis and a leading cause of disability among older individuals[10][11][12] . Recent research has uncovered the multiplicity, complexity, and multilevel nature of the inflammatory and degradative processes that occur in OA. Increasingly, inflammatory mediators are considered to participate in the onset and progression of OA[13]




Introduction into oral proteolytic enzymes


Wobenzym is a systemic enzyme therapy with anti-edematous and anti-inflammatory action.

The proteolytic enzymes contained in Wobenzym have a role in reducing inflammation by helping to restore the balance between pro-inflammatory and anti-inflammatory cytokines. Following absorption through the intestinal mucosa, these enzymes bind to the antiprotease alpha-2-macroglobulin in the blood to activate it. Activated alpha-2 macroglobulin is then able to irreversibly bind to excess cytokines and restore the balance necessary for reducing inflammatory responses (Table 1)[14][15].


Proteolytic enzymes, therefore, do not suppress the inflammatory response, but support and accelerate the controlled physiological progression of the immune response and inflammatory processes, strengthening the self-healing processes. In addition, they are better tolerated than NSAIDs[16], therefore being particularly suited to long-term therapy.


The mechanism of action of the enzyme preparation Wobenzym

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[2] Kunnumakkara AB, Sailo BL, Banik K, Harsha C, Prasad S, Gupta SC, et al. Chronic diseases, inflammation, and spices: how are they linked? Journal of translational medicine. 2018;16(1):14.

[3] Chen L, Deng H, Cui H, Fang J, Zuo Z, Deng J, et al. Inflammatory responses and inflammation-associated diseases in organs. Oncotarget. 2018;9(6):7204-18

[4] Medzhitov R. Inflammation 2010: new adventures of an old flame. Cell. 2010;140(6):771-6.

[5] Oliveira CMBd, Sakata RK, Issy AM, Gerola LR, Salomão R. Cytokines and pain. Revista brasileira de anestesiologia. 2011;61(2):260-5.

[6] Zhang J-M, An J. Cytokines, inflammation and pain. International anesthesiology clinics. 2007;45(2):27.

[7] Aggarwal BB, Van Kuiken ME, Iyer LH, Harikumar KB, Sung B. Molecular targets of nutraceuticals derived from dietary spices: potential role in suppression of inflammation and tumorigenesis. Experimental biology and medicine (Maywood, NJ). 2009;234(8):825-49.

[8] Scarpellini E, Tack J. Obesity and metabolic syndrome: an inflammatory condition. Digestive diseases (Basel, Switzerland). 2012;30(2):148-53.8.       

[9] Marques-Rocha JL, Samblas M, Milagro FI, Bressan J, Martínez JA, Marti A. Noncoding RNAs, cytokines, and inflammation-related diseases. FASEB journal : official publication of the Federation of American Societies for Experimental Biology. 2015;29(9):3595-611.

[10] Frasca D, Blomberg BB, Paganelli R. Aging, Obesity, and Inflammatory Age-Related Diseases. Frontiers in immunology. 2017;8:1745.

[11] Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58(1):26-35

[12] Rezuș E, Cardoneanu A, Burlui A, Luca A, Codreanu C, Tamba BI, et al. The Link Between Inflammaging and Degenerative Joint Diseases. Int J Mol Sci. 2019;20(3).

[13] Szychlinska M, Leonardi R, Al-Qahtani M, Mobasheri A, Musumeci G. Altered joint tribology in osteoarthritis: reduced lubricin synthesis due to the inflammatory process. New horizons for therapeutic approaches. Annals of physical and rehabilitation medicine. 2016;59(3):149-56.

[14] Lorkowski G. Gastrointestinal absorption and biological activities of serine and cysteine proteases of animal and plant origin: review on absorption of serine and cysteine proteases. International journal of physiology, pathophysiology and pharmacology. 2012;4(1):10.

[15] Wald M, Honzikova M, Lysikova M. Systemic enzyme support: an overview. Nutrition News. 2008;4:2-5.

[16] Ueberall MA, Mueller-Schwefe GH, Wigand R, Essner U. Efficacy, tolerability, and safety of an oral enzyme combination vs diclofenac in osteoarthritis of the knee: results of an individual patient-level pooled reanalysis of data from six randomized controlled trials. J Pain Res. 2016;9:941-61.