Postbiotics as the new frontier in food and pharmaceutical research.

Food is the essential need of human life and has nutrients that support growth and health. Gastrointestinal tract microbiota involves valuable microorganisms that develop therapeutic effects and are characterized as probiotics. The investigations on appropriate probiotic strains have led to the characterization of specific metabolic byproducts of probiotics named postbiotics. The probiotics must maintain their survival against inappropriate lethal conditions of the processing, storage, distribution, preparation, and digestion system so that they can exhibit their most health effects. Conversely, probiotic metabolites (postbiotics) have successfully overcome these unfavorable conditions and may be an appropriate alternative to probiotics. Due to their specific chemical structure, safe profile, long shelf-life, and the fact that they contain various signaling molecules, postbiotics may have anti-inflammatory, immunomodulatory, antihypertensive properties, inhibiting abnormal cell proliferation and antioxidative activities. Consequently, present scientific literature approves that postbiotics can mimic the fundamental and clinical role of probiotics, and due to their unique characteristics, they can be applied in an oral delivery system (pharmaceutical/functional foods), as a preharvest food safety hurdle, to promote the shelf-life of food products and develop novel functional foods or/and for developing health benefits, and therapeutic aims. This review addresses the latest postbiotic applications with regard to pharmaceutical formulations and commercial food-based products. Potential postbiotic applications in the promotion of host health status, prevention of disease, and complementary treatment are also reviewed.

The promising biological role of postbiotics derived from probiotic Lactobacillus species in reproductive health.

Recent investigations have meaningfully developed our knowledge of the features of the reproductive microbiome/metabolome profile and their relations with host responses to offer an optimal milieu for the development of the embryo during the peri-implantation period and throughout pregnancy. In this context, the establishment of homeostatic circumstances in the Female Reproductive Tract (FRT), in various physiological periods, is a significant challenge, which appears the application of postbiotics can facilitate the achievement of this goal. So, currently, scientific literature confirms that postbiotics due to their antimicrobial, antiviral, and immunomodulatory properties can be considered as a novel biotherapeutic approach. Future investigation in this field will shed more translational mechanistic understanding of the interaction of the postbiotics derived from vaginal Lactobacilli with females' health and reproduction.

Maternal and infant probiotic administration for morbidity of very low birth weight infants: a three-arm randomized placebo-controlled trial.

PURPOSE: To determine whether oral probiotic administration (1.5 × 109 CFU/g Lacticaseibacillus paracasei subsp. paracasei) to breastfeeding mothers or to their very low birth weight (VLBW) infants reduces total serum bilirubin (TSB) level and increases weight gain of the infants. METHODS: In this double-blind trial, breastfeeding mothers and their VLBW infants at 48-72 h of age were allocated into three groups using stratified block randomization; administrating probiotic to the mothers and placebo to their infants, probiotic to the infants and placebo to their mothers, or placebo to the both. The intervention continued for 28 days. RESULTS: All 25 mothers and their 26 infants allocated into each group were fully followed up. There were three positive blood culture only in the placebo group. On the 3rd day of intervention, TSB level was not significantly different among the groups but on the 7th day, it was significantly lower in the both probiotic groups compared with the placebo group (mean difference  -2.4 mg/dL [95% confidence interval  -3.6 to  -1.2] in the both comparisons). Mean rank of infant weight gain during the first 7 days of intervention was significantly higher in the both maternal and infant probiotic groups compared with the placebo group (p = 0.007 and p = 0.003, respectively), but there was no statistically significant difference among the groups during the 8th-28th days. CONCLUSION: Administration of Lacticaseibacillus paracasei to breastfeeding mothers of VLBW infants or to their infants reduces infant TSB level but has no significant effect on weight gain after the first week of the intervention. TRIAL REGISTRATION: The Iranian Clinical Trials Registry IRCT20100414003706N38. protrospectively registered 24/01/2021.

Postbiotics as potential promising tools for SARS-CoV-2 disease adjuvant therapy.

The SARS-CoV-2 pandemic defines the global health tension of our time. There are several continuous efforts to find a definitive cure in this regard. According to some adverse effects and problems of customary SARS-CoV-2 disease therapies, bioactive compounds, for example probiotics-derived metabolites (postbiotics) have been accomplishing supreme importance by investigators for adjuvant cures in patients with SARS-CoV-2. Postbiotics inhibit angiotensin-converting enzyme 2 activity and stimulate the immune system. They also boost the SARS-CoV-2 disease treatment effectiveness and reduce its adverse effects in SARS-CoV-2 illness patients as a result of antiviral and anti-inflammatory effects. Furthermore, postbiotics having unique features such as high safety, high shelf life and stability to the gastrointestinal tract can be utilized as hopeful instruments for both adjuvant and inhibition strategies in SARS-CoV-2 patients with no earnest unfavourable adverse effects. The concept of postbiotics and their biocompatible characteristics are comprehensively discussed in the present review while highlighting the bilateral relationship between postbiotic biometabolites and respiratory tract infection with a special look at the potential biological role in the inactivation of SARS-CoV-2 and reduction of related inflammatory pathways.

Effects of prebiotic-rich yogurt on menopausal symptoms and metabolic indices in menopausal women: a triple-blind randomised controlled trial.

This study aimed to investigate the effects of prebiotics on metabolic indices and menopausal symptoms. This triple-blind randomised controlled trial was conducted on 60 menopausal women. The participants were assigned to two groups based on block randomisation. Over 6 weeks, the experimental group received 100 g of prebiotic-rich yogurt daily after lunch and the control group received regular yogurt. Menopausal symptoms and metabolic indices were assessed before and after the treatment. The mean total score of menopausal symptoms (p < 0.001), anxiety (p < 0.001), depression (p = 0.003), vasomotor (p < 0.001), and low-density lipoprotein (p = 0.028) was statistically lower in the experimental group than the control group. Moreover, the serum insulin level was statistically higher among those in the experimental group (p = 0.011). The study results demonstrated the positive effects of prebiotic-rich yogurt on menopausal symptoms and some metabolic indices. Trial registration: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N52; Date of registration: 12/4/2019. URL: https://en.irct.ir/user/trial/41105/view; Date of first registration: 12/5/2019.

Effect of Hibiscus sabdariffa and Camellia synensis extracts on microbial, antioxidant and sensory properties of ice cream.

Herbal extracts have been widely used by consumers for food fortification and medical purposes worldwide and are focused in traditional medicine in recent years. At this study, we aimed to examine the antimicrobial, antioxidant and sensory characteristics of ice creams fortified with different combinations of Hibiscus sabdariffa and Camellia synensis determined by Design of Experiments software. Levels of 10-100 and 40-400 mg/kg for Hibiscus sabdariffa and Camellia synensis extracts, respectively, were selected and experiments were conducted by central composite design. Generally, 13 runs were introduced by the software and followed in laboratory for analysis. Antimicrobial activity was studied against Escherichia coli and Staphylococcus aureus as indicators of gram negative and gram positive bacteria. Results showed that all combinations were active against both bacteria but Staphylococcus aureus was more sensitive than Escherichia coli. Importantly, Camellia synensis was more effective than Hibiscus sabdariffa in both antimicrobial and antioxidant experiments but sensory panelists selected the sample containing lowest concentrations of both extracts. However, frequent consumption of low-dose fortified dairies with Hibiscus sabdariffa and Camellia synensis could be helpful for consumers interested in functional foods.

Postbiotics: A novel strategy in food allergy treatment.

During the last two decades, the prevalence and severity of clinical appearances of food allergy (FA) have a significant rise. FA derives from a breakdown of immune tolerance. In recent year's clinical evidence have shown that the probiotics have significant influences on FA by improving the immune tolerance. Besides, postbiotics due to their unique characteristics (safe profile, more shelf life, resistance to mammalian enzymes and stable to digestive system conditions), may have safety superiority against their parent live cells and as a novel strategy can be applied for improvement immune tolerance and treatment of FA without any undesirable side-effects or human opportunistic infections, particularly in infants and pediatrics.

Optimization of prebiotic sucrose-free milk chocolate formulation by mixture design.

The purpose of the current research was to determine optimal situation by applying Simplex lattice mixture design for the formulation of prebiotic sucrose-free milk chocolate. Chocolate samples were prepared using two different sugar alcohols containing xylitol and maltitol along with galactooligosaccharide as prebiotic substance. The effects of sugar alcohols and prebiotic blends on rheological attributes and some physical characteristics were assessed. The outcomes represented the high coefficient of determination (≥ 90%) of fitted models. The optimization of the variables indicated that using 20.857 g maltitol, 7.131 g xylitol and 5.012 g galactooligosaccharide generated the optimized chocolate with the highest desirability (1.00) without undesirable changes in the rheological and physical properties. Furthermore, the optimum formulation was prepared to validate the optimum model. The sensory evaluation of the optimized formulation of chocolate pleased the consumer needs.

Effect of probiotic yoghurt on plasma glucose in overweight and obese pregnant women: a randomized controlled clinical trial.

INTRODUCTION: There is only some evidence about effectiveness of probiotics for preventing gestational hyperglycaemia. This trial examined the effects of probiotic yoghurts containing Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 on maternal plasma glucose (primary outcome) and on some maternal and infant complications (secondary outcomes) in overweight and obese women with no diabetes in pregnancy. METHODS: Using stratified block randomization, women with pre- or early-pregnancy BMI ≥ 25 and fasting plasma glucose < 92 mg/dl at 22 weeks of gestation were assigned into probiotic or conventional yoghurt group, consuming 100 g/day from 24 weeks of gestation until delivery. The women and their infants were followed up until 1 month after birth. RESULTS: In each group, one out of 65 women had intra-uterine foetal death and were not analysed for other outcomes. The mean BMI was 29.2 (SD 3.3) in probiotic and 30.3 (SD 4.1) in conventional yoghurt group. Four weeks after initiation of the treatment, plasma glucose levels were significantly lower in the probiotic than in conventional yoghurt group at fasting (mean difference adjusted for the BMI category) and baseline FPG (- 4.0 mg/dl; 95% confidence interval - 6.9, - 1.1) and 2-h OGTT (- 13.9; - 22.8, - 5.0). At the 1-h OGTT, however, the difference was not statistically significant (- 9.8; - 20.6, 0.9). Further, there was a significantly lower infant bilirubin level in the probiotic group on days 3-5 after birth (- 2.2 mg/dl; - 3.3, - 1.2). There were not statistically significant differences between the groups regarding the risk of gestational diabetes (6 vs 11; odds ratio 0.5; 0.2, 1.5), preterm delivery (3 vs 8; 0.3; 0.1, 1.2), and other maternal and infant outcomes. CONCLUSION: The probiotics supplementation has some beneficial effects on glucose metabolism of overweight and obese pregnant women. Nevertheless, further studies are required to judge the clinical significance of such effects.

Effects of Probiotic Supplementation on Oxidative Stress Indices in Women with Rheumatoid Arthritis: A Randomized Double-Blind Clinical Trial.

OBJECTIVE: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that causes great pain and disability and increasing oxidative stress in patients. The objective of the present study was to evaluate the effects of probiotics-live microorganisms with many health benefits, including antioxidant properties-on oxidative stress indices of patients with RA. This study is a secondary analysis from a previously published study Methods: In a randomized double-blind placebo-controlled clinical trial, 46 patients with RA were assigned to one of two groups; patients in the probiotic group received a daily capsule containing 10(8) colony forming units (CFUs) of Lactobacillus casei 01 (L. casei 01), while those in the placebo group took identical capsules containing maltodextrin, for 8 weeks. In the baseline and at the end of the study, anxiety, physical activity levels, and dietary intakes were assessed. Anthropometric parameters, serum malondialdehyde (MDA), total antioxidant capacity (TAC), erythrocyte superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) activities were measured. RESULTS: There was no significant difference between the two groups for demographic characteristics, anthropometric parameters, physical activity, anxiety levels, or dietary intakes, throughout the course of the study. No significant within- and between-group differences were observed for MDA, TAC, or CAT. SOD activity decreased only in the probiotic group and GPx activity decreased in both study groups (p < 0.05); however, no significant between-group difference was found for these enzymes activities at the end of the study (p > 0.05). CONCLUSION: No significant effect of L. casei 01 supplementation was observed on the oxidative status of patients with RA, compared to placebo.

Diabetes Management by Probiotics: Current Knowledge and Future Pespective.

Diabetes mellitus, a multifactorial disorder, is related to the intestinal microbiota via numerous molecular mechanisms. The vast increase in the prevalence of diabetes and its associated complications requires a natural and safe solution. There is a growing evidence of gut microbiota effi ciency in improving insulin resistance, impaired insulin secretion, and metabolic complications in diabetic patients. Probiotics are defi ned as live microorganisms that, when ingested in adequate amounts, exert health benefi ts to the host. Probiotics can increase insulin sensitivity and reduce autoimmune responses by modulating intestinal microbiota and decreasing the infl ammatory reactions and oxidative stress. Recent evidences show that the intestinal microbiota infl uences the host through modulating intestinal permeability and mucosal immune response, manipulating eating behaviors by appetite-regulating hormones, including agouti related protein (AgRP), glucagon like peptide-1 (GLP-1) and neuropeptide Y, and controlling gut endocannabinoid (eCB) system which is now believed to be associated with infl ammation and diabetes. Moreover, intestinal microbiota control the host metabolism by affecting energy extraction from food and by biochemically converting molecules derived from the host or from gut microbes themselves. Experimental studies and clinical trials support the hypothesis that the modulation of the intestinal microbiota by probiotics, especially Lactobacillus and Bifidobacterium strains may be effective in prevention and management of diabetes. This review will highlight the current evidences in probiotic effectiveness and future prospects for exploring probiotic therapy in prevention and control of diabetes.

Postbiotics in the Bakery Products: Applications and Nutritional Values.

In recent years, the consumption of postbiotics has gained significant attention due to their potential health benefits. However, their application in the bakery industry remains underutilized. This review focuses on recent advances in the use of postbiotics, specifically the metabolites of lactic acid bacteria, in bakery products. We provide a concise overview of the multifaceted benefits of postbiotics, including their role as natural antioxidants, antimicrobials, and preservatives, and their potential to enhance product quality, extend shelf-life, and contribute to consumer welfare. This review combines information from various sources to provide a comprehensive update on recent advances in the role of postbiotics in bakery products, subsequently discussing the concept of sourdough as a leavening agent and its role in improving the nutritional profile of bakery products. We highlighted the positive effects of postbiotics on bakery items, such as improved texture, flavor, and shelf life, as well as their potential to contribute to overall health through their antioxidant properties and their impact on gut health. Overall, this review emphasizes the promising potential of postbiotics to revolutionize the bakery industry and promote healthier and more sustainable food options. The integration of postbiotics into bakery products represents a promising frontier and offers innovative possibilities to increase product quality, reduce food waste, and improve consumer health. Further research into refining techniques to incorporate postbiotics into bakery products is essential for advancing the health benefits and eco-friendly nature of these vital food items.

Extrusion and Co-extrusion: A Technology in Probiotic Encapsulation with Alternative Materials.

Encapsulation, in particular extrusion and co-extrusion, is a common practice to protect probiotics from the harsh conditions of the digestive tract as well as processing. Hydrocolloids, including proteins and carbohydrates, natural or modified, are a group of ingredients used as the wall material in extrusion. Hydrocolloids, due to their specific properties, can significantly improve the probiotic survivability of the final powder during the microencapsulation process and storage. The present article will discuss the different kinds of hydrocolloids used for microencapsulation of probiotics by extrusion and co-extrusion, along with new sources of novel gums and their potential as wall material.

Fabrication of UF-white cheese: Obtaining a different proteolysis rate, texture, and flavor via using combinations of mesophilic starter culture and Lactobacillus helveticus.

The effect of using mesophilic starter culture (Lactococcus lactis ssp. lactis and Lactococcus lactis ssp. cremoris) and Lactobacillus helveticus (L. helveticus) at different ratios (100:0, 75:25, 50:50, 25:75, and 0:100) on the quality properties of UF-white cheese during 90 days of ripening was studied. The results revealed that an increase in L. helveticus ratio caused a significant decrease in the pH and total protein contents of the cheeses (p < .05). No significant changes were observed in the dry matter content of the cheeses (p > .05). The use of higher ratios of L. helveticus led to a noticeable increase in proteolysis and lipolysis indices in the cheeses (p < .05). The cheese produced with higher ratios of L. helveticus had less storage (G') and loss (G″) moduli compared to other cheeses. The more open structure was seen in the cheeses produced using higher ratios of L. helveticus. Regarding sensory properties, lower scores of body and texture, and higher scores of odor and flavor were assigned to the cheeses produced using higher ratios of L. helveticus. In conclusion, the use of combinations of mesophilic starter culture and L. helveticus at specific ratios (75:25 and 25:75) led to improve quality characteristics of UF-white cheese.

Designing and fabrication of colloidal nano-phytosomes with gamma-oryzanol and phosphatidylcholine for encapsulation and delivery of polyphenol-rich extract from pomegranate peel.

Nano-carriers are well-known delivery systems to encapsulate different bioactive compounds and extracts. Such nano-systems are used in various food and drug areas to protect active ingredients, increase bioavailability, control the release, and deliver bioactive substances. This study aimed to design and fabricate a stable colloidal nano-delivery system to better preserve the antioxidant properties of pomegranate peel extract (PPE) and protect its sustained release in a gastrointestinal model. To achieve this goal, a nano-phytosomal system was fabricated with plant-based, cost-effective, and food-grade compounds, i.e., phosphatidylcholine (PC) and gamma-oryzanol (GO) for encapsulation of PPE. To fabricate the nano-phytosomes, thin film hydration/sonication method was used. The parameters of particle size, zeta potential, polydispersity index (PDI), loading capacity (LC), and encapsulation efficiency (EE) were investigated to evaluate the efficiency of the produced nano-system. In summary, the size, zeta potential, PDI, LC, and EE of homogenous spherical PC-GO-PPE nano-phytosomes (NPs) in the ratio of 8:2:2 % w/w were achieved as 60.61 ± 0.81 nm, -32.24 ± 0.84 mV, 0.19 ± 0.01, 19.13 ± 0.30 %, and 95.66 ± 1.52 %, respectively. Also, the structure of NPs was approved by Fourier transform infrared spectroscopy (FT-IR) and scanning electron microscope (SEM). The optimized NPs were stable during one month of storage at 4 °C, and changes in the size of particles and PPE retention rate were insignificant (p > 0.05). The nano-encapsulation of PPE significantly decreased the loss of its antioxidant activity during one month of storage at 4 °C. The optimized NPs exhibited prolonged and sustained release of PPE in a gastrointestinal model, so that after 2 h in simulated gastric fluid (SGF) and 4 h in simulated intestinal fluid (SIF), 22.66 ± 2.51 % and 69.33 ± 4.50 % of initially loaded PPE was released, respectively. Optimized NPs had considerable cytotoxicity against the Michigan Cancer Foundation-7 cell line (MCF7) (IC50 = 103 µg/ml), but not against Human Foreskin Fibroblast cell line (HFF-2) (IC50 = 453 µg/ml). In conclusion, spherical PC-GO-PPE NPs were identified as a promising delivery system to efficiently encapsulate PPE, as well as protect and preserve its bioactivity, including antioxidant and cytotoxicity against cancer cell line.

Effect of probiotic administration to breastfeeding mothers with very low birthweight neonates on some neonatal and maternal outcomes: study protocol for a randomised, double-blind, placebo-controlled trial.

INTRODUCTION: Premature birth and very low birth weight (VLBW) are leading causes of neonatal mortality. Almost all premature infants experience hyperbilirubinaemia. Administering probiotics to breastfeeding mothers may positively affect infant outcomes. This trial aims to investigate whether probiotic supplementation for mothers with VLBW infants affects total serum bilirubin levels and postpartum depression scores (primary outcomes), as well as some other neonatal and maternal outcomes (secondary outcomes). METHODS AND ANALYSIS: This is a randomised, double-blind, placebo-controlled superiority trial with two parallel arms. Participants, caregivers and outcome assessors will be blinded. A total of 122 breastfeeding mothers of neonates with a birth weight of 1000-1500 g, along with their infants within 48 hours of birth, will be assigned to either the probiotic or placebo group in a 1:1 ratio through block randomisation, stratified by singleton and twin births. The intervention will involve oral administration of probiotics containing Lactobacillus paracasei 431 and Bifidobacterium lactis BB-12, or an indistinguishable placebo, for 42-45 days. Outcomes will be assessed through daily observations, laboratory assessments and the Edinburgh Postpartum Depression Scale. Adverse events will also be documented. Modified intention-to-treat analyses will be employed for the primary and secondary outcomes, excluding participants lost to follow-up from all postintervention assessments. ETHICS AND DISSEMINATION: This study protocol has been approved by the Medical University of Tabriz Ethics Committee (IR.TBZMED.REC.1401.735). Findings will be disseminated through publication in a peer-reviewed journal and presentations at relevant conferences. TRIAL REGISTRATION NUMBER: IRCT20100414003706N42.

Antioxidant Properties of Postbiotics: An Overview on the Analysis and Evaluation Methods.

Antioxidants found naturally in foods have a significant effect on preventing several human diseases. However, the use of synthetic antioxidants in studies has raised concerns about their potential link to liver disease and cancer. The findings show that postbiotics have the potential to act as a suitable alternative to chemical antioxidants in the food and pharmaceutical sectors. Postbiotics are bioactive compounds generated by probiotic bacteria as they ferment prebiotic fibers in the gut. These compounds can also be produced from a variety of substrates, including non-prebiotic carbohydrates such as starches and sugars, as well as proteins and organic acids, all of which probiotics utilize during the fermentation process. These are known for their antioxidant, antibacterial, anti-inflammatory, and anti-cancer properties that help improve human health. Various methodologies have been suggested to assess the antioxidant characteristics of postbiotics. While there are several techniques to evaluate the antioxidant properties of foods and their bioactive compounds, the absence of a convenient and uncomplicated method is remarkable. However, cell-based assays have become increasingly important as an intermediate method that bridges the gap between chemical experiments and in vivo research due to the limitations of in vitro and in vivo assays. This review highlights the necessity of transitioning towards more biologically relevant cell-based assays to effectively evaluate the antioxidant activity of postbiotics. These experiments are crucial for assessing the biological efficacy of dietary antioxidants. This review focuses on the latest applications of the Caco-2 cell line in the assessment of cellular antioxidant activity (CAA) and bioavailability. Understanding the impact of processing processes on the biological properties of postbiotic antioxidants can facilitate the development of new food and pharmaceutical products.

Effects of freeze-dried strawberry supplementation on metabolic biomarkers of atherosclerosis in subjects with type 2 diabetes: a randomized double-blind controlled trial.

BACKGROUND: To our knowledge there has been no study investigating the impact of freeze-dried strawberry (FDS) supplementation on metabolic biomarkers of atherosclerosis in subjects with type 2 diabetes (T2D). OBJECTIVE: This study was carried out to determine the effects of FDS supplementation on glycemic control, biomarkers of oxidative stress, inflammation and serum total antioxidant status in subjects with T2D compared to matched control subjects. METHODS: Thirty-six subjects with T2D (23 females; mean body mass index 27.90 ± 3.7; mean age 51.57 ± 10 years) were randomly divided into two groups. The treatment group consumed 2 cups of FDS beverage (50 g of FDS is equivalent to 500 g of fresh strawberries) or macronutrient matched placebo powder with strawberry flavor daily for 6 weeks in a randomized double-blind controlled trial. Anthropometric measurements, dietary intakes, hemoglobin (Hb)A1c, antioxidant status, C-reactive protein and malondialdehyde (MDA) levels were assessed at baseline and 6 weeks post-intervention. RESULTS: FDS supplementation significantly decreased C-reactive protein levels as a biomarker of inflammation (2.5 vs. 2.04 mg/l, p < 0.05) and lipid peroxidation in the form of MDA (3.36 vs. 2.7 nmol/ml, p < 0.05) at 6 weeks compared to the baseline. Moreover, supplementation led to a decreasing trend in HbA1c (-5.7%, p < 0.05) and significant increase in total antioxidant status in the FDS group (1.44 vs. 1.26 mmol/l, p < 0.01) compared to the placebo group. No significant changes were observed in serum glucose concentrations and anthropometric indices. CONCLUSIONS: FDS improved glycemic control and antioxidant status, and reduced lipid peroxidation and inflammatory response in patients with T2D. Supplementation with freeze-dried berry products, as natural sources of antioxidants with low glycemic index, could be considered as an adjunctive therapy in ameliorating metabolic complications of T2D.

The effect of probiotic supplementation on episiotomy wound healing among primiparous women: a triple-blind randomized clinical trial.

BACKGROUND: Probiotics increase the defense power of immune system and accelerate the wound healing process by anti-inflammatory mechanisms at the wound site. The present study aimed at evaluating the effect of Lactobacillus casei oral supplementation on episiotomy wound healing among primiparous women. METHODS: This triple-blind randomized clinical trial was performed on 74 primiparous women delivered in Alzahra Hospital, Tabriz, Iran. Participants with mediolateral episiotomy (incision length equal to and less than 5 cm) were randomly assigned to the probiotic and placebo groups. The probiotic group received Lactobacillus casei 431 with 1.5 * 109 colony-forming unit /capsule once a day from the day after birth to 14 days. Wound healing as a primary outcome was measured by Redness, Edema, Ecchymosis, Discharge, Approximation and pain as a secondary outcome by the Visual Analogue Scale before discharge, 5 ± 1 and 15 ± 1 days after birth. The data were analyzed using independent t-test and repeated measures one way analysis of variance. RESULTS: The mean (standard deviation: SD) score of wound healing in the probiotic group altered from 4.91(1.86) before discharge to 1.55 (0.99) during 5 ± 1 days after birth and reached to 0.95 (0.27) during 15 ± 1 days after birth. Further, the mean (SD) score of wound healing in the placebo group altered from 4.62 (1.99) before discharge to 2.80 (1.20) during 5 ± 1 days after birth and reached to 1.45(0.71) during 15 ± 1 days after birth (adjusted mean difference: -0.50, confidence interval 95%: -0.96 to -0.05, P = 0.03). CONCLUSION: Lactobacillus casei oral supplementation is effective in healing episiotomy wounds. It is suggested to evaluate the effect of topical use of Lactobacillus casei on episiotomy repair and pain in further studies. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20170506033834N7. Date of registration: 11/08/2021.

Ultrasonication/dynamic maceration-assisted extraction method as a novel combined approach for recovery of phenolic compounds from pomegranate peel.

According to recent studies, pomegranate peel (PP) has the potential to be inverted from environmental pollutant waste to wealth due to possessing valuable phenolic compounds at a higher amount compared to edible parts. So far, different types of biological activities such as antimutagenic, antiproliferative, anti-inflammatory, and chemo-preventive properties were stated for pomegranate peel extract (PPE) according to chemical composition. In the present research, the probable intensifying effects of two extraction methods and optimum conditions for novel combined method of ultrasonication and dynamic maceration-assisted extraction of PPE using response surface methodology (RSM) were determined. A Box-Behnken Design (BBD) was employed to optimize three extraction variables, including sonication time (X1), sonication temperature (X2), and stirring speed (X3) for the achievement of high extraction yield of the phenolic compounds and antioxidant activity. The optimized conditions to obtain maximum extraction efficiency were determined as X1 = 70 min, X2 = 61.8°C, and X3 = 1000 rpm. The experimental values were in line with the values anticipated by RSM models, which indicates the appropriateness of the applied quadratic model and the accomplishment of RSM in optimizing the extraction conditions. The results suggest that the extraction of PPE by mix of ultrasonication as a modern method and dynamic maceration as a conventional method could improve its bioactive extractability and the obtained values were higher than any of the methods used. In other words, these two methods together have intensifying effects in increasing extraction efficiency which could further be utilized in food and agricultural industry.