97 A new study found that bromelain, an enzyme that comes from pineapple stems, could make heated intraperitoneal chemotherapy (HIPEC) a much more effective way to treat appendix cancer. Researchers from Wake Forest University conducted a preclinical investigation that demonstrated bromelain’s potential as a valuable pretreatment in combating this rare and often aggressive form of cancer. Appendix cancer frequently involves the production of excessive mucin, which acts as a barrier and limits the effectiveness of chemotherapy. The standard course of treatment entails HIPEC after cytoreductive surgery to remove as much mucin as possible. But even after surgery, residual mucin can hinder chemotherapy drugs from reaching and destroying cancer cells effectively. The study, published in the Annals of Surgical Oncology, explored how bromelain could break down mucin and enhance drug delivery during HIPEC. The researchers used patient-derived tumour organoids (PTOs), which are 3D cell cultures grown from the tumour cells of patients. These organoids were treated with bromelain before being exposed to common HIPEC drugs, such as cisplatin and mitomycin C. The results were promising. Bromelain alone reduced tumour cell viability by over 31% within just 60 minutes and by more than 66% after 48 hours. When used as a pretreatment before HIPEC, bromelain increased the cytotoxicity of chemotherapy drugs by approximately 30% to 35%, significantly enhancing their ability to kill tumour cells. This effect was observed across multiple patients and tumour samples, suggesting that bromelain could be broadly effective. Further analysis indicated that bromelain’s effectiveness may be due to its ability to induce apoptosis, a process where damaged or unwanted cells self-destruct. Treatment with bromelain increased apoptosis markers in the tumour organoids, which suggests that it not only breaks down the protective mucin barrier but also kills cancer cells directly. The study’s authors highlighted the significance of these findings for improving outcomes in patients with appendixl cancer, particularly those with mucinous tumours. Incorporating bromelain into the HIPEC treatment protocol could potentially overcome one of the major challenges in treating this type of cancer. Currently, there are no FDA-approved mucolytic agents specifically for appendixl cancer in the US, making this discovery particularly noteworthy. The research team plans to investigate bromelain’s potential further in clinical trials, with the aim of translating their preclinical success into tangible benefits for patients. Although the study is in its early stages, the findings have generated considerable interest within the oncology community. If successful in clinical trials, bromelain could become a crucial component in the treatment of appendix cancer, offering new hope to patients facing this difficult-to-treat disease. This research adds to the growing body of evidence supporting the use of natural compounds like bromelain in cancer therapy. As researchers continue to explore the enzyme’s potential, the future of appendix cancer treatment may soon include this tropical extract as a standard part of care.