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Amrouche T, Lammi S, Drider D. Probiotics and Prebiotics Intervention in Respiratory and Digestive Infections Linked to Covid-19. Probiotics Antimicrob Proteins 2025; 17:1356-1367. [PMID: 39614066 DOI: 10.1007/s12602-024-10404-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2024] [Indexed: 12/01/2024]
Abstract
Probiotics and prebiotics have been suggested as natural agents against viral infections and dysbiosis and may encourage clinical applications. This review aims to analyze the main and recent advances related to viral infections such as Covid-19 and its gastrointestinal complications, antiviral immunity generated and possible preventive role that probiotics and/or prebiotics can play in controlling and promoting antiviral immunity. The literature search was performed through a critical analysis of relevant publications reported in PubMed and Scopus databases on clinical trials and assays conducted in vitro on colon cells and in vivo on mice. Some studies using probiotics and prebiotics for the prevention of viral infection in different age groups are discussed. Covid-19 patients have been shown to suffer from gastrointestinal complications in addition to respiratory symptoms due to interactions between the respiratory system and the gastrointestinal tract infected with SARS-CoV-2. Unfortunately, therapies used to prevent (or treat) symptoms of Covid-19 have proven to be of limited effectiveness. In addition, the lack of access to coronavirus vaccines around the world and vaccine hesitancy continue to hamper control of Covid-19. It is therefore crucial to find alternative methods that can prevent disease symptoms. Evidence-based efficacy of certain probiotics (Lactobacillus and Bifidobacterium) that may be useful in viral infections was shown with immunomodulatory properties (pro-inflammatory mediators reduction), promoting antiviral immunity (antibodies production, virus titers) and controlling inflammation (anti-inflammatory effect), as well as viral clearance and antimicrobial potential against opportunistic bacteria (anti-dysbiosis effect). But, available data about clinical application of probiotics in Covid-19 context remain limited and relevant scientific investigation is still in its early stages. Also, evidence for prebiotics potential in this field is limited, since the exact mechanism involved in systemic immune modulation by these compounds is till now unknown. Thus, further research is necessary to explore in the viral infection context the mechanism by which gut and lung interact in the presence of probiotics and prebiotics through more animal and clinical experiments.
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Affiliation(s)
- Tahar Amrouche
- Laboratoire Qualité Et Sécurité Des Aliments, Faculté Des Sciences Biologiques Et Des Sciences Agronomiques, Université Mouloud Mammeri, 15 000, Tizi Ouzou, Algeria.
| | - Sarah Lammi
- Laboratoire Qualité Et Sécurité Des Aliments, Faculté Des Sciences Biologiques Et Des Sciences Agronomiques, Université Mouloud Mammeri, 15 000, Tizi Ouzou, Algeria
| | - Djamel Drider
- UMR Transfrontalière BioEcoAgro INRAE 1158, Université de Lille (ULille), 59000, Lille, France
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Abdul Manan M. Progress in Probiotic Science: Prospects of Functional Probiotic-Based Foods and Beverages. INTERNATIONAL JOURNAL OF FOOD SCIENCE 2025; 2025:5567567. [PMID: 40259922 PMCID: PMC12011469 DOI: 10.1155/ijfo/5567567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Accepted: 03/27/2025] [Indexed: 04/23/2025]
Abstract
This comprehensive review explores the evolving role of probiotic-based foods and beverages, highlighting their potential as functional and "future foods" that could significantly enhance nutrition, health, and overall well-being. These products are gaining prominence for their benefits in gut health, immune support, and holistic wellness. However, their future success depends on addressing critical safety concerns and navigating administrative complexities. Ensuring that these products "do more good than harm" involves rigorous evaluations of probiotic strains, particularly those sourced from the human gastrointestinal tract. Lactic acid bacteria (LABs) serve as versatile and effective functional starter cultures for the development of probiotic foods and beverages. The review emphasizes the role of LABs as functional starter cultures and the development of precision probiotics in advancing these products. Establishing standardized guidelines and transparent practices is essential, requiring collaboration among regulatory bodies, industry stakeholders, and the scientific community. The review underscores the importance of innovation in developing "friendly bacteria," "super probiotics," precision fermentation, and effective safety assessments. The prospects of functional probiotic-based foods and beverages rely on refining these elements and adapting to emerging scientific advancements. Ultimately, empowering consumers with accurate information, fostering innovation, and maintaining stringent safety standards will shape the future of these products as trusted and beneficial components of a health-conscious society. Probiotic-based foods and beverages, often infused with LABs, a "friendly bacteria," are emerging as "super probiotics" and "future foods" designed to "do more good than harm" for overall health.
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Affiliation(s)
- Musaalbakri Abdul Manan
- Food Science and Technology Research Centre, Malaysian Agricultural Research and Development Institute (MARDI), MARDI Headquarters, Persiaran MARDI-UPM, Serdang, Selangor, Malaysia
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Campisciano G, Sorz A, Cason C, Zanotta N, Gionechetti F, Piazza M, Carli P, Uliana FM, Ballaminut L, Ricci G, De Seta F, Maso G, Comar M. Genital Dysbiosis and Different Systemic Immune Responses Based on the Trimester of Pregnancy in SARS-CoV-2 Infection. Int J Mol Sci 2024; 25:4298. [PMID: 38673883 PMCID: PMC11050260 DOI: 10.3390/ijms25084298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Respiratory infections are common in pregnancy with conflicting evidence supporting their association with neonatal congenital anomalies, especially during the first trimester. We profiled cytokine and chemokine systemic responses in 242 pregnant women and their newborns after SARS-CoV-2 infection, acquired in different trimesters. Also, we tested transplacental IgG passage and maternal vaginal-rectal microbiomes. IgG transplacental passage was evident, especially with infection acquired in the first trimester. G-CSF concentration-involved in immune cell recruitment-decreased in infected women compared to uninfected ones: a beneficial event for the reduction of inflammation but detrimental to ability to fight infections at birth. The later the infection was acquired, the higher the systemic concentration of IL-8, IP-10, and MCP-1, associated with COVID-19 disease severity. All infected women showed dysbiosis of vaginal and rectal microbiomes, compared to uninfected ones. Two newborns tested positive for SARS-CoV-2 within the first 48 h of life. Notably, their mothers had acute infection at delivery. Although respiratory infections in pregnancy are reported to affect babies' health, with SARS-CoV-2 acquired early during gestation this risk seems low because of the maternal immune response. The observed vaginal and rectal dysbiosis could be relevant for neonatal microbiome establishment, although in our series immediate neonatal outcomes were reassuring.
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Affiliation(s)
- Giuseppina Campisciano
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Alice Sorz
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
| | - Carolina Cason
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Nunzia Zanotta
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Fabrizia Gionechetti
- Department of Life Sciences, University of Trieste, Via Licio Giorgieri 5, 34127 Trieste, Italy;
| | - Maria Piazza
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
| | - Petra Carli
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Francesca Maria Uliana
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Lisa Ballaminut
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Giuseppe Ricci
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Francesco De Seta
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Gianpaolo Maso
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
| | - Manola Comar
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
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SeyedAlinaghi S, Shahidi R, Afzalian A, Paranjkhoo P, Ghorbanzadeh K, Mojdeganlou H, Razi A, Mojdeganlou P, Dashti M, Ghasemzadeh A, Parikhani SN, Pashaei A, Karimi A, Sepide A, Mehraeen E, Hackett D. Probiotics in prevention and treatment of COVID-19: a systematic review of current evidence. RUSSIAN JOURNAL OF INFECTION AND IMMUNITY 2023; 13:709-722. [DOI: 10.15789/2220-7619-pip-2118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
Introduction. Clinical evidence suggests that certain probiotics may help treat and prevent viral infections. To date, the effectiveness of probiotics in the alleviation of COVID-19 has not been established. The aim of this systematic review was to assess the role of probiotics in the prevention and treatment of COVID-19.
Materials and methods. An extensive search of four electronic databases was performed which included Embase, Scopus, Web of Science, and PubMed from November 2019 to June 2022. After reviewing the references list of related articles additional studies were identified. A multiple combination of keywords validated by MESH were used to search the databases. Study selection was performed according to an inclusion and exclusion criteria.
Results. Twenty-three articles met the study inclusion criteria. Six articles were conducted in vitro while the remaining studies were conducted in the human population (in vivo). The type of probiotic was defined in eighteen studies. There were two studies that used supplements (vitamins, herbals, minerals, etc.) in addition to probiotics. The largest sample size was 445 850 participants which were from a study that used an application-based survey. The majority of studies found that probiotics had a positive effect on the COVID-19 disease. The benefits included early remission of COVID-19 symptoms and a shorter duration of sickness (10 studies), lower mortality rates (3 studies), and decreased hospitalization and length of stay (3 studies). Six in vitro studies found that probiotics were beneficial against SARS-CoV-2 through antiviral effects. There were only two studies that found probiotics to be ineffective or caused negative effects when consumed in COVID-19 patients.
Conclusion. Available evidence supports the antiviral role of probiotics on prevention and treatment of COVID-19. The antiviral potential of Lactobacillus paracasei metabolite PlnE and PlnF against SARS-CoV-2 may explain the effectiveness of probiotics on COVID-19.
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Chioma Mgbodile F, Nwagu TNT. Probiotic therapy, African fermented foods and food-derived bioactive peptides in the management of SARS-CoV-2 cases and other viral infections. BIOTECHNOLOGY REPORTS 2023; 38:e00795. [PMID: 37041970 PMCID: PMC10066861 DOI: 10.1016/j.btre.2023.e00795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
The current paper focuses on the impact of probiotics, African fermented foods and bioactive peptides on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection severity and related viral infections. Using probiotics or bioactive peptides as therapeutic adjuncts appears superior to standard care alone. Probiotics play critical roles in innate and adaptive immune modulation by balancing the gut microbiota to combat viral infections, secondary bacterial infections and microbial dysbiosis. African fermented foods contain abundant potential probiotic microorganisms such as the lactic acid bacteria (LAB), Saccharomyces, and Bacillus. More so, fermented food-derived bioactive peptides play vital roles in preventing cardiovascular diseases, hypertension, lung injury, diabetes, and other COVID-19 comorbidities. Regularly incorporating potential probiotics and bioactive peptides into diets should enable a build-up of the benefits in the body system that may result in a better prognosis, especially in COVID-19 patients with underlying complexities. Despite the reported therapeutic potentials of probiotics and fermented foods, numerous setbacks exist regarding their application in disease management. These shortfalls underscore an evident need for more studies to evaluate the specific potentials of probiotics and traditional fermented foods in ameliorating SARS-CoV-2 and other viral infections.
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Vaezi M, Ravanshad S, Akbari Rad M, Zarrinfar H, Kabiri M. The effect of synbiotic adjunct therapy on clinical and paraclinical outcomes in hospitalized COVID-19 patients: A randomized placebo-controlled trial. J Med Virol 2023; 95:e28463. [PMID: 36602047 DOI: 10.1002/jmv.28463] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/01/2023] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
Therapeutic approaches with immune-modulatory effects such as probiotics and prebiotics adjuvant therapy may be essential to combat against COVID-19 pandemic. The present trial aimed to reveal the efficacy of synbiotic supplementation on clinical and paraclinical outcomes of hospitalized COVID-19 patients. The current randomized placebo-controlled trial enrolled 78 hospitalized patients with confirmed COVID-19 infection. Participants were randomly allocated to intervention and control groups that received synbiotic or placebo capsules twice daily for 2 weeks, respectively. The synbiotic capsule contains multi-strain probiotics such as Lactobacillus (L.) rhamnosus, L. helveticus, L. casei, Bifidobacterium (B.) lactis, L. acidophilus, B. breve, L. bulgaricus, B. longum, L. plantarum, B. bifidum, L. gasseri, and Streptococcus (S.) thermophilus (109 CFU), as well as fructooligosaccharides prebiotic agent. Besides COVID-19 clinical features, levels of proinflammatory interleukin-6 (IL-6), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), liver and renal function markers, as well as hematological parameters, were assessed during follow-up. The serum level of IL-6 was significantly decreased in the intervention group compared to the placebo after 2 weeks of intervention (p = 0.002). A significant difference was found regarding the count of white blood cells (WBC) within the synbiotic group from pre to post-treatment (p = 0.004). The levels of ESR (p = 0.935) and CRP (p = 0.952) had a higher reduction trend in the synbiotic group relative to the placebo, with no significant between-group differences. Other findings had no statistical differences between groups. Our results provide the support that synbiotic adjuvant therapy for 2 weeks can be effective to modulate inflammatory responses against COVID-19 infection.
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Affiliation(s)
- Mahsa Vaezi
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahar Ravanshad
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mina Akbari Rad
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Zarrinfar
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mona Kabiri
- Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Vaz-Rodrigues R, Mazuecos L, Villar M, Urra JM, Gortázar C, de la Fuente J. Serum biomarkers for nutritional status as predictors in COVID-19 patients before and after vaccination. J Funct Foods 2023; 101:105412. [PMID: 36644001 PMCID: PMC9829648 DOI: 10.1016/j.jff.2023.105412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/08/2023] [Accepted: 01/08/2023] [Indexed: 01/12/2023] Open
Abstract
The aim of this study was to characterize serum protein biomarkers for nutritional status that may be used as predictors for disease symptomatology in COVID-19 patients before and after vaccination. In pre-vaccine cohorts, proteomics analysis revealed significant differences between groups, with serum proteins alpha-1-acid glycoproteins (AGPs) 1 and 2, C-reactive protein (CRP) and retinol binding protein (RBP) increasing with COVID-19 severity, in contrast with serum albumin, transthyretin (TTR) and serotransferrin (TF) reduction as the symptomatology increased. Immunoassay reproduced and validated proteomics results of serum proteins albumin and RBP. In post-vaccine cohorts, the results showed the same pattern as in pre-vaccine cohorts for serum proteins AGPs, CRP, albumin and TTR. However, TF levels were similar between groups and RBP presented a slight reduction as COVID-19 symptomatology increased. In these cohorts, immunoassay validated proteomics results of serum proteins albumin, TTR and TF. Additionally, immune response to α-Gal in pre-vaccine cohorts varied in predominant immunoglobulin type profile, while post-vaccine groups presented mainly anti-α-Gal protective IgG antibodies. The study identified serum nutritional biomarkers that could potentially predict an accurate prognostic of COVID-19 disease to provide an appropriate nutritional care and guidance in non-vaccinated and vaccinated individuals against SARS-CoV-2. These results highlight the importance of designing personalized nutrition protocols to improve diet along with the application of prebiotics or probiotics for the control of COVID-19 and other infectious diseases.
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Affiliation(s)
- Rita Vaz-Rodrigues
- Health and Biotechnology (SaBio), Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo 12, 13071 Ciudad Real, Spain
| | - Lorena Mazuecos
- Health and Biotechnology (SaBio), Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo 12, 13071 Ciudad Real, Spain
| | - Margarita Villar
- Health and Biotechnology (SaBio), Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo 12, 13071 Ciudad Real, Spain,Biochemistry Section, Faculty of Science and Chemical Technologies, and Regional Centre for Biomedical Research (CRIB), University of Castilla-La Mancha, 13071 Ciudad Real, Spain
| | - José Miguel Urra
- Immunology, Hospital General Universitario de Ciudad Real, 13005 Ciudad Real, Spain,Medicine School, Universidad de Castilla la Mancha (UCLM), 13005 Ciudad Real, Spain
| | - Christian Gortázar
- Health and Biotechnology (SaBio), Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo 12, 13071 Ciudad Real, Spain
| | - José de la Fuente
- Health and Biotechnology (SaBio), Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo 12, 13071 Ciudad Real, Spain,Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078, USA,Corresponding author at: SaBio, Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo 12, 13071 Ciudad Real, Spain
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Immune System and Epidemics: The Role of African Indigenous Bioactive Substances. Nutrients 2023; 15:nu15020273. [PMID: 36678143 PMCID: PMC9864875 DOI: 10.3390/nu15020273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
With over 6 million coronavirus pandemic deaths, the African continent reported the lowest death rate despite having a high disease burden. The African community's resilience to the pandemic has been attributed to climate and weather conditions, herd immunity, repeated exposure to infectious organisms that help stimulate the immune system, and a disproportionately large youth population. In addition, functional foods, herbal remedies, and dietary supplements contain micronutrients and bioactive compounds that can help boost the immune system. This review identified significant traditional fermented foods and herbal remedies available within the African continent with the potential to boost the immune system in epidemics and pandemics. Methodology: Databases, such as PubMed, the Web of Science, and Scopus, were searched using relevant search terms to identify traditional African fermented foods and medicinal plants with immune-boosting or antiviral capabilities. Cereal-based fermented foods, meat-, and fish-based fermented foods, and dairy-based fermented foods containing antioxidants, immunomodulatory effects, probiotics, vitamins, and peptides were identified and discussed. In addition, nine herbal remedies and spices belonging to eight plant families have antioxidant, immunomodulatory, anti-inflammatory, neuroprotective, hepatoprotective, cardioprotective, and antiviral properties. Peptides, flavonoids, alkaloids, sterols, ascorbic acid, minerals, vitamins, and saponins are some of the bioactive compounds in the remedies. Bioactive compounds in food and plants significantly support the immune system and help increase resistance against infectious diseases. The variety of food and medicinal plants found on the African continent could play an essential role in providing community resilience against infectious diseases during epidemics and pandemics. The African continent should investigate nutritional, herbal, and environmental factors that support healthy living and longevity.
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Hassan D, Hossain A. Gut microbiome and COVID-19. VIRAL, PARASITIC, BACTERIAL, AND FUNGAL INFECTIONS 2023:263-277. [DOI: 10.1016/b978-0-323-85730-7.00033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Evaluation of the gut microbiome associated with COVID-19. INFORMATICS IN MEDICINE UNLOCKED 2023; 38:101239. [PMID: 37033411 PMCID: PMC10069162 DOI: 10.1016/j.imu.2023.101239] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/14/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023] Open
Abstract
Introduction In 2019, a new virus from the coronavirus family called SARS-CoV-2, infected populations throughout the world. Coronavirus disease 2019 (COVID-19), an illness induced by this virus, attacks vital organs in the body, such as the respiratory system and the gastrointestinal tract. Recent studies have confirmed changes in the gut microbiome caused by the COVID-19 disease. We examined the alteration of the gut microbiome in COVID-19 patients compared to healthy individuals. Materials and methods in this study, the 16s metagenomics dataset, publicly available in the Sequence Read Archive (SRA) database, was used for analysis (accession number PRJNA636824). The analysis processes were performed using the CLC Microbial Genomics Module 20.1.1 (Qiagen). At first, the sequence reads of samples were trimmed and classified into operational taxonomic units (OTUs) with 97% similarity and then assigned to the Greengenes reference database (v138). Differential abundance analysis was used to determine statistically significant differences in OTUs between COVID-19 and healthy groups. Next, biodiversity analyses including the alpha diversity (intragroup diversity) and beta diversity (intergroup diversity) using defined indexes were estimated. Then, the co-occurrence network at the species level was constructed using the Pearson correlation coefficient calculation between pairs of OTUs in R software and visualized using Cytoscape software. Ultimately, the hub OTUs at the species level were identified using the cytoHubba plugin of Cytoscape based on Maximal Clique Centrality (MCC) algorithm. Results The results of the metagenomic analysis revealed that the intestinal microbiome in healthy individuals has a higher biodiversity compared to COVID-19 patients. Indeed, healthy people also have a higher percentage of beneficial bacteria such as bifidobacteria adolescentis compared to COVID-19 patients; in contrast, COVID-19 patients have higher levels of opportunistic and pathogenic bacteria such as Streptococcus anginosus than healthy people. Also, by constructing a co-occurrence network at the species level, Bifidobacterium longum in the healthy group and Veillonella parvulain the COVID-19 group were found as hub species. Conclusion The results of this study shed light on the relationship between the gut microbiome and COVID-19. These results could be helpful for understanding the pathogenesis, clinical features, and treatment of COVID-9.
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Callens K, Fontaine F, Sanz Y, Bogdanski A, D‘Hondt K, Lange L, Smidt H, van Overbeek L, Kostic T, Maguin E, Meisner A, Sarand I, Sessitsch A. Microbiome-based solutions to address new and existing threats to food security, nutrition, health and agrifood systems' sustainability. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2022.1047765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In addition to challenges like climate change and biodiversity loss, the sustainability and resilience of agrifood systems worldwide are currently challenged by new threats, such as the COVID-19 pandemic and the Ukraine war. Furthermore, the resilience and sustainability of our agrifood systems need to be enhanced in ways that simultaneously increase agricultural production, decrease post-harvest food losses and food waste, protect the climate, environment and health, and preserve biodiversity. The precarious situation of agrifood systems is also illustrated by the fact that overall, around 3 billion people worldwide still do not have regular access to a healthy diet. This results in various forms of malnutrition, as well as increasing number of people suffering from overweight and obesity, and diet-related, non-communicable diseases (NCDs) around the world. Findings from microbiome research have shown that the human gut microbiome plays a key role in nutrition and diet-related diseases and thus human health. Furthermore, the microbiome of soils, plants, and animals play an equally important role in environmental health and agricultural production. Upcoming, microbiome-based solutions hold great potential for more resilient, sustainable, and productive agrifood systems and open avenues toward preventive health management. Microbiome-based solutions will also be key to make better use of natural resources and increase the resilience of agrifood systems to future emerging and already-known crises. To realize the promises of microbiome science and innovation, there is a need to invest in enhancing the role of microbiomes in agrifood systems in a holistic One Health approach and to accelerate knowledge translation and implementation.
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Neris Almeida Viana S, do Reis Santos Pereira T, de Carvalho Alves J, Tianeze de Castro C, Santana C da Silva L, Henrique Sousa Pinheiro L, Nougalli Roselino M. Benefits of probiotic use on COVID-19: A systematic review and meta-analysis. Crit Rev Food Sci Nutr 2022; 64:2986-2998. [PMID: 36178362 DOI: 10.1080/10408398.2022.2128713] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
SARS-CoV-2 is the virus that causes the new global pandemic, which has already resulted in millions of deaths, affecting the world's health and economy. Probiotics have shown benefits in a variety of diseases, including respiratory infections, and may be beneficial in the adjunctive treatment of COVID-19. This study analyzed the effectiveness of probiotics as adjunctive treatment in reducing symptoms of patients with COVID-19, through a systematic review with meta-analysis. The EMBASE (Elsevier), Pubmed, Scopus, Web of Science and International Clinical Trials Registry Platform (ICTRP) were searched through March 16, 2022. The risk ratio (RR) with 95% confidence intervals (CIs) was estimated using a fixed-effect model. RoB 2 and ROBINS I were used to assess the risk of bias of the included studies. Nine studies were included (7 clinical trials and 2 cohorts), of which three clinical trials comprised the meta-analysis. Results showed that probiotics were associated with a significant 51% reduction in symptoms reported by COVID-19 patients (RR 0.49, 95% CI 0.40-0.61). There was a significant improvement in cough (RR 0.56, 95% CI 0.37-0.83), headaches (RR 0.17, 95% CI 0.05-0.65), and diarrhea (RR 0. 33, 95% CI 0.12-0.96) of patients on probiotic therapy. These findings suggest that probiotic supplementation is effective in improving symptoms of COVID-19.
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Affiliation(s)
- Suelen Neris Almeida Viana
- Postgraduate Program in Food Science, Laboratory of Studies in Food Microbiology, Faculty of Pharmacy, Federal University of Bahia, Salvador-Bahia, Brazil
| | - Tamires do Reis Santos Pereira
- Postgraduate Program in Food Science, Laboratory of Studies in Food Microbiology, Faculty of Pharmacy, Federal University of Bahia, Salvador-Bahia, Brazil
| | - Janaína de Carvalho Alves
- Graduate Program in Biotechnology, Laboratory of Studies in Food Microbiology, Faculty of Pharmacy, Federal University of Bahia, Salvador-Bahia, Brazil
| | - Caroline Tianeze de Castro
- Postgraduate Program in Collective Health, Institute of Collective Health, Federal University of Bahia, Salvador-Bahia, Brazil
| | | | | | - Mariana Nougalli Roselino
- Laboratory of Studies in Food Microbiology, Faculty of Pharmacy, Federal University of Bahia, Salvador-Bahia, Brazil
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13
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Molecular Docking and In-Silico Analysis of Natural Biomolecules against Dengue, Ebola, Zika, SARS-CoV-2 Variants of Concern and Monkeypox Virus. Int J Mol Sci 2022; 23:ijms231911131. [PMID: 36232431 PMCID: PMC9569982 DOI: 10.3390/ijms231911131] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 11/20/2022] Open
Abstract
The emergence and rapid evolution of human pathogenic viruses, combined with the difficulties in developing effective vaccines, underline the need to develop innovative broad-spectrum antiviral therapeutic agents. The present study aims to determine the in silico antiviral potential of six bacterial antimicrobial peptides (AMPs), two phytochemicals (silvestrol, andrographolide), and two bacterial secondary metabolites (lyngbyabellin A, hapalindole H) against dengue virus, Zika virus, Ebola virus, the major variants of SARS-CoV-2 and monkeypox virus. The comparison of docking scores obtained with natural biomolecules was performed with specific neutralizing antibodies (positive controls for ClusPro) and antiviral drugs (negative controls for Autodock Vina). Glycocin F was the only natural biomolecule tested to show high binding energies to all viral surface proteins and the corresponding viral cell receptors. Lactococcin G and plantaricin ASM1 also achieved high docking scores with all viral surface proteins and most corresponding cell surface receptors. Silvestrol, andrographolide, hapalindole H, and lyngbyabellin A showed variable docking scores depending on the viral surface proteins and cell receptors tested. Three glycocin F mutants with amino acid modifications showed an increase in their docking energy to the spike proteins of SARS-CoV-2 B.1.617.2 Indian variant, and of the SARS-CoV-2 P.1 Japan/Brazil variant, and the dengue DENV envelope protein. All mutant AMPs indicated a frequent occurrence of valine and proline amino acid rotamers. AMPs and glycocin F in particular are the most promising biomolecules for the development of broad-spectrum antiviral treatments targeting the attachment and entry of viruses into their target cell.
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14
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Montazeri-Najafabady N, Kazemi K, Gholami A. Recent advances in antiviral effects of probiotics: potential mechanism study in prevention and treatment of SARS-CoV-2. Biologia (Bratisl) 2022; 77:3211-3228. [PMID: 35789756 PMCID: PMC9244507 DOI: 10.1007/s11756-022-01147-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/07/2022] [Indexed: 12/14/2022]
Abstract
SARS-CoV-2 is responsible for coronavirus disease 2019 (COVID-19), progressively extended worldwide countries on an epidemic scale. Along with all the drug treatments suggested to date, currently, there are no approved management protocols and treatment regimens for SARS-CoV-2. The unavailability of optimal medication and effective vaccines against SARS-CoV-2 indicates the requirement for alternative therapies. Probiotics are living organisms that deliberate beneficial effects on the host when used sufficiently and in adequate amounts, and fermented food is their rich source. Probiotics affect viruses by antiviral mechanisms and reduce diarrhea and respiratory tract infection. At this point, we comprehensively evaluated the antiviral effects of probiotics and their mechanism with a particular focus on SARS-CoV-2. In this review, we suggested the conceptual and potential mechanisms of probiotics by which they could exhibit antiviral properties against SARS-CoV-2, according to the previous evidence concerning the mechanism of antiviral effects of probiotics. This study reviewed recent studies that speculate about the role of probiotics in the prevention of the SARS-CoV-2-induced cytokine storm through the mechanisms such as induction of anti-inflammatory cytokines (IL-10), downregulation of pro-inflammatory cytokines (TNF-α, IL-2, IL-6), inhibition of JAK signaling pathway, and act as HDAC inhibitor. Also, the recent clinical trials and their outcome have been reviewed.
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Affiliation(s)
- Nima Montazeri-Najafabady
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Pharmaceutical Science Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kimia Kazemi
- Pharmaceutical Science Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Gholami
- Pharmaceutical Science Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Varsha KK, Narisetty V, Brar KK, Madhavan A, Alphy MP, Sindhu R, Awasthi MK, Varjani S, Binod P. Bioactive metabolites in functional and fermented foods and their role as immunity booster and anti-viral innate mechanisms. JOURNAL OF FOOD SCIENCE AND TECHNOLOGY 2022; 60:1-10. [PMID: 35789583 PMCID: PMC9243801 DOI: 10.1007/s13197-022-05528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 04/19/2022] [Accepted: 05/18/2022] [Indexed: 01/08/2023]
Abstract
Live microorganisms in the fermented foods termed probiotics and their secondary metabolites with bioactive potential were considered as potential anti-viral capabilities through various mechanisms. Given the importance of functional and fermented foods in disease prevention, there is a need to discuss the contextualization and deep understanding of the mechanism of action of these foods, particularly considering the appearance of coronavirus (COVID-19) pandemic, which is causing health concerns and increased social services globally. The mechanism of probiotic strains or their bioactive metabolites is due to stimulation of immune response through boosting T-lymphocytes, cytokines, and cell toxicity of natural killer cells. Proper consumption of these functional and fermented foods may provide additional antiviral approaches for public benefit by modulating the immune functions in the hosts. Supplementary Information The online version contains supplementary material available at 10.1007/s13197-022-05528-8.
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Affiliation(s)
| | - Vivek Narisetty
- Moolec Science, Innovation Centre, Gallows Hill, CV34 6UW, Warwick, UK
| | - Kamalpreet Kaur Brar
- Department of Civil Engineering, Lassonde School of Engineering, York University, North York, Toronto, Ontario M3J 1P3 Canada
- Centre Technologique des Résidus Industriels en Abitibi Témiscamingue, 433 Boulevard du collège, J9X0E1, Rouyn-Noranda, Canada
| | - Aravind Madhavan
- Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, 695 014 India
| | - Maria Paul Alphy
- Microbial Processes and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology, Trivandrum, Kerala 695 019 India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002 India
| | - Raveendran Sindhu
- Department of Food Technology, T K M Institute of Technology, Kollam, Kerala 691505 India
| | - Mukesh Kumar Awasthi
- College of Natural Resources and Environment, Northwest A & F University, Yangling, 712 100 Shaanxi China
| | - Sunita Varjani
- Gujarat Pollution Control Board, Paryavaran Bhavan, CHH Road, Sector 10 A, Gujarat Gandhinagar, 382010 India
| | - Parameswaran Binod
- Microbial Processes and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology, Trivandrum, Kerala 695 019 India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002 India
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16
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Tosato M, Ciciarello F, Zazzara MB, Pais C, Savera G, Picca A, Galluzzo V, Coelho-Júnior HJ, Calvani R, Marzetti E, Landi F. Nutraceuticals and Dietary Supplements for Older Adults with Long COVID. Clin Geriatr Med 2022; 38:565-591. [PMID: 35868674 PMCID: PMC9212635 DOI: 10.1016/j.cger.2022.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Matteo Tosato
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome 00168, Italy
| | - Francesca Ciciarello
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome 00168, Italy
| | - Maria Beatrice Zazzara
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome 00168, Italy
| | - Cristina Pais
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome 00168, Italy
| | - Giulia Savera
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome 00168, Italy
| | - Anna Picca
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome 00168, Italy
| | - Vincenzo Galluzzo
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome 00168, Italy
| | - Hélio José Coelho-Júnior
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, L.go F. Vito 8, Rome 00168, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome 00168, Italy.
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome 00168, Italy; Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, L.go F. Vito 8, Rome 00168, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome 00168, Italy; Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, L.go F. Vito 8, Rome 00168, Italy
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17
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Trukhan DI. Disorders of intestinal microbiocenosis: expanding the application of probiotics. MEDITSINSKIY SOVET = MEDICAL COUNCIL 2022:132-143. [DOI: 10.21518/2079-701x-2022-16-7-132-143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
The problem of interaction between a person and the intestinal microbiome is surrounded by many secrets and mysteries. The bacterial flora of the gastrointestinal tract has a local and systemic effect not only on the digestive system, but also on the entire body as a whole. Numerous studies have proved the pathogenetic relationship of the state of the intestinal biocenosis not only with diseases of the gastrointestinal tract, but also with pathological processes from other organs and systems of the body. In terms of its role in maintaining homeostasis, the intestinal microflora is not inferior to any other vital organ. In the presented review, the current aspects of the terminology and clinic of disorders of intestinal microbiocenosis are considered. Probiotics occupy an important place in the complex therapy of intestinal microbiocenosis disorders and the corresponding clinical manifestations. The review considers the main mechanisms of probiotic / host interaction, non-immunological and immunological effects of probiotics and the requirements for them, the main directions of use of representatives of the normal microflora Bifidobacterium and Lactobacillus. The data of meta-analyzes and systematic reviews, testifying to the expansion of indications for the appointment of probiotics, are considered the possibilities of probiotics in the complex therapy of Helicobacter pylori infection, syndrome of increased epithelial intestinal permeability, and the prevention of respiratory infections.The review concludes with the results of a search in the PubMed database on the possibility of using probiotics in the prevention and treatment of a new coronavirus infection COVID-19. The availability of modern, effective and safe probiotics in the arsenal of a practical doctor (primarily a general practitioner and general practitioner), and their use, contributes to the optimization of drug therapy not only in gastroenterological patients, but also in patients with other somatic pathologies, including those with new coronavirus infection COVID-19.
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18
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Włodarczyk J, Czerwiński B, Fichna J. Short-chain fatty acids-microbiota crosstalk in the coronavirus disease (COVID-19). Pharmacol Rep 2022; 74:1198-1207. [PMID: 36166147 PMCID: PMC9513287 DOI: 10.1007/s43440-022-00415-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/28/2022] [Accepted: 09/04/2022] [Indexed: 02/08/2023]
Abstract
The novel coronavirus disease (COVID-19) still remains a major challenge to the health-care systems worldwide, inciting ongoing search for pharmaceutical and non-pharmaceutical interventions which could benefit patients already infected with SARS-CoV-2 or at increased risk thereof. Although SARS-CoV-2 primarily affects the respiratory system, it may also infect other organs and systems, including gastrointestinal tract, where it results in microbial dysbiosis. There is an emerging understanding of the role the gut microbiota plays in maintaining immune homeostasis, both inside the gastrointestinal tract and beyond (i.e. through gut-lung and gut-brain axes). One family of compounds with recognized immunomodulatory and anti-inflammatory properties are short chain fatty acids (SCFAs). SCFAs are believed that they have a protective effect in case of gastrointestinal diseases. Moreover, they are responsible for maintaining proper intestinal barrier and they take part in relevant immune functions. This review presents mechanisms of action and potential benefits of SCFA-based probiotics and direct SCFA supplementation as a strategy to support immune function amid the COVID-19 pandemic.
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Affiliation(s)
- Jakub Włodarczyk
- grid.8267.b0000 0001 2165 3025Department of Biochemistry, Medical University of Lodz, Mazowiecka 6/8, 92-215 Lodz, Poland ,grid.8267.b0000 0001 2165 3025Department of General and Oncological Surgery, Medical University of Lodz, Pomorska 251, 92-215 Lodz, Poland
| | - Bartłomiej Czerwiński
- grid.8267.b0000 0001 2165 3025Department of Biochemistry, Medical University of Lodz, Mazowiecka 6/8, 92-215 Lodz, Poland
| | - Jakub Fichna
- grid.8267.b0000 0001 2165 3025Department of Biochemistry, Medical University of Lodz, Mazowiecka 6/8, 92-215 Lodz, Poland
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19
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Siregar GA, Tambunan AL. Role of Probiotic for Prevention and Management of COVID-19: A Literature Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Backgrounds: Coronavirus brought about by SARS-CoV-2 is a continuous worldwide pandemic. SARS-CoV-2 influences the human respiratory tracts’ epithelial cells, prompting a proinflammatory cytokine storm and ongoing lung inflammation. With various patients kicking the bucket day by day, an immunization and explicit antiviral medication regimens are being investigated. The choice to utilize this medication during the COVID-19 pandemic should be founded on cautious thought of the likely as preventive and curative in such context. Methods: A literature review changed into carried out through the PubMed, Science Direct, Medline, and Google Scholar search engines consist of probiotics preventive and management possibility in COVID-19. Results: The probiotics significantly affects the host insusceptible reaction, foundationally, and on invulnerable responses at close by mucosal locales, like the lung. Certain strains of probiotics have improved interferon type I levels, hoisting the number and capacity of antigen-introducing cells, regular executioner cells, and T cells, just as expanding the degree of specific antibodies at the fundamental and mucosal destinations. Conclusion: Probiotics have various advantages and potential in preventing and as the treatment of COVID-19, adjusting the arrangement of human gut microflora, reinforcing gut obstruction work, and defensive invulnerable reactions.
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