For some people aches and pains in the joints flare up with cold weather. For several million Americans, however, suffering from arthritis, stiff and swollen joints are the result of a storm in the body’s immune system. The body normally produces chemicals that fight off infections. It is when the body turns on itself, and these chemicals practically flood the tissue in the joints, attacking them as if they were the pathogens invading the body, that the ravages of arthritis begin to take their toll on the body.

Figure 1.: Normal and Arthritic Joint - A Schematic Comparison

The term arthritis describes a set of symptoms and literally means inflammation (-itis) of the joint (arthro). There are different forms of arthritis with the three most common being osteoarthritis, rheumatoid arthritis and gout.¹ Whereas rheumatoid arthritis is caused by a malfunction of the body's immune system, osteoarthritis is the swelling, stiffness and pain in the joints by the wear and tear of the body tissues over decades. As such, osteoarthritis is an age-related disease. It is characterized by the breakdown of the joint’s cartilage. Cartilage is the part of the joint that cushions the end of the bones. As cartilage breaks down, the bones begin to rub against each other, causing pain and loss of movement.²

Osteoarthritis affects mostly middle-aged and older people and its symptoms can range from mild to quite severe. It affects hands and weight-bearing joints such as the knees, hips, feet and back. The relatively high incidence of mild osteoarthritis tends to obscure the impact of this disease on the overall health of the population and on more severely affected individuals.

What causes osteoarthritis? The exact mechanisms of the onset of osteoarthritis are not known. Whereas advanced age is a leading risk factor, research shows that osteoarthritis is not an inevitable part of aging. An array of other factors plays a significant role: Obesity, for instance, can lead to arthritis of the knee. Further, people with injuries to the joint because of sports, repetitive movements of one type or another, or accidents may be at increased risk for developing osteoarthritis. Genetic predisposition is suspected to be the main source of the arthritis of the hand.

One of the several theories about the onset of arthritis proposes that osteoarthritis is caused by an abnormal release of enzymes from cartilage cells, which leads to cartilage breakdown and progressive joint destruction. It is also likely that some people may be born with defective cartilage or may have slight abnormality in the manner the joints fit together. These conditions may accelerate cartilage breakdown with advancing age.³

It is commonly thought that there are no effective remedies to alleviate the persistent pain, let alone to correct the root cause of the disease. The standard medical treatment, therefore, has been routinely to treat the symptoms with medications such as non-steroidal anti-inflammatory drugs (NSAIDs). These medications, however, have serious side effects including headaches, dizziness, ringing in the ears and gastrointestinal problems, which could potentially lead to ulceration and microbleeding. One of the more pernicious side effects of NSAIDs, which is rarely mentioned, is that they inhibit the repair of the cartilage that, in turn, further aggravates the cartilage destruction and worsens the progression of the condition.⁴

Since there is good evidence suggesting that the depletion of enzymes leads to cartilage destruction, one of the more exciting recent developments has been the availability of orally ingestible systemic enzymes as a nutritional means to alleviate the pain in osteoarthritis.⁵ One of the major advantages of oral enzymes is that they do not have any appreciable side effects and are reasonably well-tolerated. They work in the body with its own resources to mitigate pain and suffering.^6,7

What are systemic enzymes, though? The term systemic enzymes encompasses those enzymes such as trypsin, chymotrypsin and the like, that are found naturally in the body. Of course, some of the enzymes found in plants are also included in this term, since they function in a manner similar to those indigenous to the human body. Systemic enzymes should be clearly differentiated from digestive enzymes, which are essentially responsible for aiding the digestive process. In contrast, systemic enzymes exert their beneficial effects at a cellular level replenishing, in advanced years, the declining reservoir of naturally occurring enzymes in cells. These enzymes belong to a category of protein that are referred to as proteases: Enzymes, that is, which break down other proteins. Therefore, systemic enzymes may be seen as a pair of molecular scissors that cut and prune.

The elucidation as to how oral enzymes work in the body is best demonstrated by an understanding of the processes that wreak havoc in the body as autoimmunity sets in with diseases such as arthritis. Cartilage in the joints is destroyed as the immune system turns on the body itself. Around the synovia, or the space between the joints, is the so-called synovial fluid, protected by synovial membranes,which essentially serves as a lubricant for the joints to move effortlessly without pain (Figure 1). In arthritis, the immune system goes awry when specific types of immune cells (such as lymphocytes, monocytes and granulocytes) penetrate the joint as invaders, migrate into the synovial membrane and attack the cartilage to destroy it. The invading cells produce a series of so-called proinflammatory chemicals (known collectively as cytokines, and include molecules like tumor necrosis factor [TNF - œ] and interleukins -1ß and -6). These cytokines trigger a local inflammatory response and continue to fuel the fire, so to speak, as the symptoms progress and worsen. As such it becomes a vicious circle that feeds on itself.⁸

Figure 2.: Horror Autotoxicus: With the onset of autoimmunity, activated immune cells enter the joint and produce cytokines and initate the attack on the cartilage by forming immune complexes.

How does this process of destruction perpetuate itself? As the activated immune cells move into the synovia and produce proinflammatory cytokines, certain “docking ports” on their surface, which harbor the so called receptor proteins, are occupied. That makes them more dangerous to the body, since they initiate the attack on the cartilage. This influx of activated immune cells is facilitated by yet another group of molecules, called the cell adhesion molecules, which upon deposition on the cell surface make them sticky (Figure 2). This provides a convenient causeway for activated immune cells to continue moving into the synovia and hasten the destructive process that, ultimately, results in pain, swelling and loss of joint movement. Systemic enzymes interfere with precisely these processes and provide the body with tools to heal itself over time. Systemic enzymes are a combination of proteases, again, a category of enzymes that breaks down complex proteins into smaller fragments of amino acid chains.

Figure 3.: Proteolytic enzymes digest immune complexes and thus hold in check the pernicious process of cartilage degradation and joint wasting.

How do systemic enzymes interfere with the processes that lead to the arthritic conditions? To begin with, systemic enzymes effectively reduce the production of proinflammatory cytokines. They inhibit the invasion of synovia by activated immune cells. At the same time, systemic enzymes have been shown to decrease the number of “docking ports” on the surface of immune cells. More important, they block the highway that allows the traffic of ever-increasing number of activated immune cells by breaking down the cell adhesion molecules.⁹ The smaller the number of these molecules the less sticky the surface with the result that fewer and fewer numbers of activated immune cells traverse their path to the synovia (Figure 3).

Thus, interfering with the basic processes while mobilizing the body’s own resources, over time, systemic enzymes help to reduce local pain and regional swelling and gradually improve joint function. The reason systemic enzymes are effective is that their unique combination simultaneously functions at different levels in the immune system. By reducing the amounts of proinflammatory immune complexes in the body, systemic enzymes empower the body to heal itself.¹⁰

References:

1. Lipsky, P., Isselbacher, et al. Editors "Harrison's Principles of Internal Medicine," 13th Edition. McGraw-Hill, Inc., New York, New York (1994). pp. 1648.
2. Bland, J., Cooper, S. "Osteoarthritis-A Review of the Cell Biology Involved and Evidence of Reversibility: Management Rationally Related to Known Genesis and Pathophysiology." Sem. Arthr. Rheum. (1994). Vol. 114, p. 106.
3. Clark, W. "The Double-Edged Sword of Immunity: At War Within." Oxford University Press, New York, New York (1995).
4. Shield, M. "Anti-Inflammatory Drugs and Their Effects on Cartilage Synthesis and Renal Function," Eur. J. Rheumatol. Inflam. (1993). Vol. 13, No. 7.
5. Wrba, H. and Pecher, O. "Enzymes: Strengthening the Immunological System with Enzyme Therapy." EcoMed, Landsberg/Lech, Germany (1993).
6. Klein, G., Pollman, G. and Kullich, W., "Clinical Experience with Enzyme Therapy in Patients with Rheumatoid Arthritis." Allgemeinemedizin (1990). Vol 19, p. 144.
7. Ahmed, A., Ransberger, K. and Williams, M. "Oral Enzyme Therapy," totalhealth (1998). Vol. 20. p. 37.
8. Kunze, R., Ransberger, K., Stauder, G., and Gebauer, F. "Proteolytic Enzymes Modulate the C1q-Binding Capacity of Fixed Immunocomplexes in vitro," Eur. J. Infec. Immunol. Dis. (1996). [Suppl: Biological Response Modifiers]: Vol. 1, p. 17.
9. Ahmed, A., Ransberger, K. and Kunze, R., in preparation, 1999.
10. Ahmed, A., in preparation.