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Antiviral effect of Bromelain combined with acetylcysteine against SARS-CoV-2 Omicron variant

Reis et al., Scientific Reports, doi:10.1038/s41598-025-92242-y, Apr 2025
14th treatment shown to reduce risk in February 2021, now with p = 0.000028 from 24 studies, recognized in 3 countries.
Lower risk for mortality, hospitalization, and cases.
No treatment is 100% effective. Protocols combine treatments.
5,500+ studies for 121 treatments. c19early.org
In Vitro and Ex Vivo study showing that BromAc (bromelain and N-acetylcysteine) exhibits antiviral activity against SARS-CoV-2 Omicron variant. Authors demonstrate that BromAc at 250 μg/mL significantly reduces infectious viral particles by over 10-fold after 60 minutes of incubation and decreases viral yield by more than 1-log in Vero-ACE2/TMPRSS2 cells after 48 hours. Western blot analysis revealed that BromAc promotes cleavage of the S1 spike subunit in tracheal aspirate samples from critically ill COVID-19 patients. Flow cytometry confirmed decreased spike protein expression in epithelial cells. The compound showed no cytotoxicity at therapeutic concentrations and demonstrates both virucidal and anti-replication effects. BromAc also exhibited mucolytic properties, which could benefit patients with excess airway mucus.
9 preclinical studies support the efficacy of N-acetylcysteine for COVID-19:
N-acetylcysteine shows dose-dependent inhibition of SARS-CoV-23,6,8, shows anti-inflammatory and immunomodulatory effects against SARS-CoV-2-induced immune responses in combination with bromelain5, suppressed virus-induced reactive oxygen species and blocked viral replication in a humanized mouse model and in human lung cells4, may limit COVID-19 induced cardiac damage by boosting cellular antioxidant defenses and potentially mitigating the oxidative stress caused by spike protein-induced ROS production in cardiac fibroblasts2, and reduces disulfide bonds in proteins and exhibits antioxidant properties that may inhibit viral replication and modulate inflammatory responses9. NAC may be beneficial for COVID-19 by replenishing glutathione stores and reinforcing the glutathione peroxidase-4 pathway to inhibit ferroptosis, an oxidative stress-induced cell death pathway implicated in COVID-1910. NAC reinforces glutathione levels, reduces ROS, and minimizes ferroptosis and cytokine storm11.
Reis et al., 7 Apr 2025, peer-reviewed, 14 authors. Contact: sarah@mucpharm.com, david.morris@unsw.edu.au, reisjordana@gmail.com, jreis@icb.ufmg.br.
In Vitro studies are an important part of preclinical research, however results may be very different in vivo.
Antiviral effect of Bromelain combined with acetylcysteine against SARS-CoV-2 Omicron variant
Erik Vinicius De Sousa Reis, Linziane Lopes Ferreira, Felipe Alves Clarindo, Geovane Marques-Ferreira, Leonardo Camilo De Oliveira, Thaís De Fátima Silva Moraes, Luciana Debortoli De Carvalho, Flávio Guimarães Da Fonseca, Adriano De Paula Sabino, Mathew Suji Eapen, Mauro Martins Teixeira, Sarah J Valle, David L Morris, Jordana Grazziela Alves Coelho-Dos-Reis
Scientific Reports, doi:10.1038/s41598-025-92242-y
The recent pandemic represented one of the biggest challenges of modern civilization. SARS-CoV-2 remains an imminent public health threat and currently, there is no effective and greatly affordable treatment for severe COVID-19. Although standard management with dexamethasone, and physical management including physiotherapy, prone positioning and mechanical ventilation are used, severe disease patients may still succumb to infection. In this regard, BromAc ® is a combination therapy of a refined protein derived from Bromelain and acetylcysteine, that shows significant mucolytic and antiinflammatory properties. In the present study, we performed in vitro, and ex vivo analyses to assess the effect of BromAc ® in inhibiting Omicron variant of SARS-CoV-2 at different levels. Here, we provide evidence of the in vitro virucidal activity of BromAc ® in Vero-ACE2/TMPRSS2 cell line infected with the Omicron variant. BromAc ® can also abrogate SARS-CoV-2 RNA genomic copies in tracheal aspirate (TA) samples from critically ill COVID-19 patients after long term exposure. These results were confirmed by lower spike expression observed in EpCAM + PanCK neg epithelial cells from tracheal aspirate samples after BromAc ® treatment. Furthermore, atomized BromAc ® promoted cleavage of the S1 Spike subunit in TA samples, demonstrating the mechanism of the antiviral activity displayed by BromAc ® in human samples. These results bring novel evidence of antiviral activity in cell lines in vitro as well as in tracheal aspirate samples from critically ill COVID-19 patients, which support its potential use as an adjunct to COVID-19 management in future waves of Omicron subvariants.
Author contributions Designing research study: DLM, SJV, JGCdR. Conducting experiments, acquiring data: EVSR, LLF, FAC, GMF, LCO, TFSM. Analyzing data: EVSR, LDC, TFSM, JGCdR. Advisory Committee: FGF, APS, MSE, MMT. Provided reagents and funding: FGF, APS, MMT, SJV, DLM, JGCdR. Supervised research project and acquired funding: SJV, DLM, JGCdR. Writing the manuscript: EVSR, MMT, LLF, TFSM, SJV, MSE, DLM, TFSM, JGCdR. All authors reviewed and approved the final version. Declarations Competing interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. DLM, SJV and MSE are employed by MucPharm. All the remaining authors declare no conflict of interest. Ethics approval and consent to participate Research was approved by Institutional Research Board Committee. This research had approval from the Brazilian Institutional Ethics Committee (Approval number: 45919121.6.0000.5526). There was written consent from the next of kin on behalf of the patients for participation in the research. This study followed the principles of the Helsinki Declaration and resolution #466/2012 of the Brazilian Ministry of Health for research involving human subjects. Consent for publication Informed consent was obtained by next of kin of all participants enrolled in the study. Additional information Supplementary Information The online version contains supplementary..
References
Abuzinadah, Ahmad, Al-Thawdi, Zakai, Jamal, Exploring the binding interaction of active compound of pineapple against foodborne bacteria and novel coronavirus (SARS-CoV-2) based on molecular docking and simulation studies, Nutrients
Ahamad, Ali, Secco, Giacca, Gupta, Anti-fungal drug Anidulafungin inhibits SARS-CoV-2 spike-induced syncytia formation by targeting ACE2-spike protein interaction, Front. Genet
Akhter, The combination of bromelain and acetylcysteine (Bromac) synergistically inactivates SARS-CoV-2, Viruses
Alexpandi, De Mesquita, Pandian, Ravi, Quinolines-based SARS-CoV-2 3CLpro and RdRp inhibitors and spike-RBD-ACE2 inhibitor for drug-repurposing against COVID-19: An in Silico analysis, Front. Microbiol
Benton, The effect of the D614G substitution on the structure of the Spike glycoprotein of SARS-CoV-2, Proc. Natl. Acad. Sci
Cai, Distinct conformational states of SARS-CoV-2 spike protein, Science
Castro, Promotion of neutralizing antibody-independent immunity to wild-type and SARS-CoV-2 variants of concern using an RBD-Nucleocapsid fusion protein, Nat. Commun
Chen, SARS-CoV-2 activates lung epithelial cell proinflammatory signaling and leads to immune dysregulation in COVID-19 patients, eBioMedicine
Coelho-Dos-Reis, Ex-vivo mucolytic and anti-inflammatory activity of bromac in tracheal aspirates from COVID-19, Biomed. Pharmacother
Corman, Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR, Eurosurveillance
Douglas, Tracing the international arrivals of SARS-CoV-2 Omicron variants after aotearoa new Zealand reopened its border, Nat. Commun
Ferreira, Taming the SARS-CoV-2-mediated proinflammatory response with BromAc ®, Front. Immunol
Gonçalves, Timeline kinetics of systemic and airway immune mediator storm for comprehensive analysis of disease outcome in critically ill covid-19 patients, Front. Immunol
Hikisz, Bernasinska-Slomczewska, Beneficial properties of bromelain, Nutrients
Lee, Hong, Jang, N-acetylcysteine decreases airway inflammation and responsiveness in asthma by modulating Claudin 18 expression, Korean J. Intern. Med
Liu, SARS-CoV-2 cell tropism and multiorgan infection, Cell. Discov
Pillai, Ehteda, Akhter, Chua, Morris, Anticancer effect of bromelain with and without cisplatin or 5-FU on malignant peritoneal mesothelioma cells, Anticancer Drugs
Poppe, The NF-κB-dependent and -independent transcriptome and chromatin landscapes of human coronavirus 229E-infected cells, PLoS Pathog
Sagar, Bromelain inhibits SARS-CoV-2 infection via targeting ACE-2, TMPRSS2, and Spike protein, Clin. Transl. Med
Shntaif, Alrazzak, Bader, Almarzoqi, Determination the binding ability of n-acetyl cysteine and its derivatives with sars-cov-2 main protease using molecular docking and molecular dynamics studies, Ukr. Biochem. J
Tallei, An analysis based on molecular docking and molecular dynamics simulation study of bromelain as anti-SARS-CoV-2 variants, Front. Pharmacol
V'kovski, Kratzel, Steiner, Stalder, Thiel, Coronavirus biology and replication: Implications for SARS-CoV-2, Nat. Rev. Microbiol
Van Eijk, COVID-19: Immunopathology, pathophysiological mechanisms, and treatment options, J. Pathol
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