J. Pharm. Pharmacogn. Res., vol. 11, no. 6, pp. 1002-1016, Nov-Dec 2023.
DOI: https://doi.org/10.56499/jppres23.1732_11.6.1002
Original Article
Hepatoprotective study of Indonesian water kefir against CCl4-induced liver injury in rats
[Estudio hepatoprotector del kéfir de agua indonesio contra la lesión hepática inducida por CCl4 en ratas]
Widhya Aligita1,3*, Marlia Singgih2, Entris Sutrisno3, I Ketut Adnyana1*
1Department of Pharmacology & Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung, Indonesia.
2Department of Pharmacochemistry, School of Pharmacy, Bandung Institute of Technology, Bandung, Indonesia.
3Department of Pharmacology & Clinical Pharmacy, Faculty of Pharmacy, Bhakti Kencana University, Bandung, Indonesia.
*E-mail: widhya.aligita@bku.ac.id; ketut@itb.ac.id
Abstract
Context: Water kefir is a fermented beverage that is typically made in the home by inoculating a sugar-rich solution with a microbial community (water kefir grains). Several studies on the metabolite content and hepatoprotective effects of water kefir have been published, but carbon tetrachloride (CCl4)-induced acute liver injury has not been studied.
Aims: To evaluate the efficacy of water kefir in vivo against hepatoprotective CCl4-induced acute liver injury and to in silico investigate metabolites that play an important role in hepatoprotective mechanisms.
Methods: The present study aimed to investigate the hepatoprotective activity of water kefir in an animal model caused by CCl4. Furthermore, using molecular docking, the metabolites found in water kefir were evaluated for their role in the NF-κB and Nrf2 signaling pathways.
Results: Water kefir significantly and dose-dependently alleviated acute liver injury caused by CCl4. Water kefir administration at all doses produced results comparable to the positive control (Curcuma extract). Molecular docking simulations showed that, compared to Nrf2, the 25 metabolites were more likely to interact with the NF-kB receptor. Fumaric acid is the strong metabolite that interacts with the NF-κB receptor with a free energy of binding and an inhibition constant of -6.66 kcal/mol and 13.22 µM, respectively.
Conclusions: Water kefir administration improved the condition of liver damage, characterized by a decrease in serum levels of AST, ALT, TNF-a, TGF-b, and an improvement in the liver tissue profile. In silico evaluation showed that the metabolites in water kefir were able to interact with target proteins in the NF-kB and Nrf2 pathways. It was concluded that water kefir improves the condition of the liver by reducing the level of necrosis and fibrosis.
Keywords: free radicals; liver diseases; kefir; molecular docking simulation; probiotics.

Resumen
Contexto: El kéfir de agua es una bebida fermentada que se suele elaborar en casa inoculando una solución rica en azúcar con una comunidad microbiana (granos de kéfir de agua). Se han publicado varios estudios sobre el contenido de metabolitos y los efectos hepatoprotectores del kéfir de agua, pero no se ha estudiado la lesión hepática aguda inducida por tetracloruro de carbono (CCl4).
Objetivos: Evaluar la eficacia del kéfir de agua in vivo contra la lesión hepática aguda inducida por CCl4 hepatoprotectora e investigar in silico los metabolitos que desempeñan un papel importante en los mecanismos hepatoprotectores.
Métodos: El presente estudio tuvo como objetivo investigar la actividad hepatoprotectora del kéfir de agua en un modelo animal causado por CCl4. Además, mediante docking molecular, se evaluó el papel de los metabolitos presentes en el kéfir de agua en las vías de señalización NF-κB y Nrf2.
Resultados: El kéfir de agua alivió de forma significativa y dependiente de la dosis la lesión hepática aguda causada por CCl4. La administración de kéfir de agua a todas las dosis produjo resultados comparables a los del control positivo (extracto de cúrcuma). Las simulaciones de acoplamiento molecular mostraron que, en comparación con el Nrf2, los 25 metabolitos eran más propensos a interactuar con el receptor NF-kB. El ácido fumárico es el metabolito más potente. El ácido fumárico es el metabolito fuerte que interacciona con el receptor NF-κB con una energía libre de unión y una constante de inhibición de -6,66 kcal/mol y 13,22 µM, respectivamente.
Conclusiones: La administración de kéfir de agua mejoró el estado de daño hepático, caracterizado por una disminución de los niveles séricos de AST, ALT, TNF-α, TGF-b, y una mejora del perfil tisular hepático. La evaluación in silico mostró que los metabolitos del kéfir de agua eran capaces de interactuar con proteínas diana en las vías NF-kB y Nrf2. Se concluyó que el kéfir de agua mejora el estado del hígado al reducir el nivel de necrosis y fibrosis.
Palabras Clave: enfermedades hepáticas; kéfir; probióticos; radicales libres; simulación de acoplamiento molecular.

Citation Format: Aligita W, Singgih M, Sutrisno E, Adnyana IK (2023) Hepatoprotective study of Indonesian water kefir against CCl4-induced liver injury in rats. J Pharm Pharmacogn Res 11(6): 1002–1016. https://doi.org/10.56499/jppres23.1732_11.6.1002
References
Aligita W, Alex V, Taaraungan S, Susilawati E (2021) Hepatoprotective activity of water kefir. Int J Biol Pharm Allied Sci10: 1784–1794. https://doi.org/10.31032/IJBPAS/2021/10.6.5493
Aligita W, Tarigan PN, Susilawati E (2020) Anti inflammatory and antioxidant activity of kefir water. Int J Biol Pharm Allied Sci9: 2454–2464. https://doi.org/10.31032/IJBPAS/2020/9.1.4904
Al-Mohammadi A-R, Ibrahim RA, Moustafa AH, Ismaiel AA, Zeid AA, Enan G (2021) Chemical constitution and antimicrobial activity of kefir fermented beverage. Molecules 26: 2635. https://doi.org/10.3390/molecules26092635
Alsayadi M, Jawfi YA, Belarbi M, Soualem-Mami Z, Merzouk H, Sari DC, Sabri F, Ghalim M (2014) Evaluation of anti-hyperglycemic and anti-hyperlipidemic activities of water kefir as probiotic on streptozotocin-induced diabetic wistar rats. J Diabetes Mellit 4: 85–95. https://doi.org/10.4236/jdm.2014.42015
Asnawi A, Aman LO, Nursamsiar, Yuliantini A, Febrina E (2022a) Molecular docking and molecular dynamic studies: Screening phytochemicals of Acalypha indica against BRAF kinase receptors for potential use in melanocytic tumours. Rasayan J Chem 15: 1352–1361. https://doi.org/10.31788/RJC.2022.1526769
Asnawi A, Febrina E, Aligita W, Kurnia D, Aman LO, Yuliantini A (2022b) Screening of ashitaba (Angelica keiskei K.) compounds as potential Mycobacterium tuberculosis kasa inhibitors. Int J App Pharm 14: 80–85. https://doi.org/10.22159/ijap.2022.v14s5.13
Asnawi A, Nedja M, Febrina E, Purwaniati (2023) Prediction of a stable complex of compounds in the ethanol extract of celery leaves (Apium graveolens L.) function as a VKORC1 antagonist. Trop J Nat Prod Res 7: 2362–2370. https://doi.org/10.26538/tjnpr/v7i2.10
Aspiras BEE, Flores RFAC, Pareja MC (2015) Hepatoprotective effect of fermented water kefir on Sprague-Dawley rats (Rattus norvegicus) induced with sublethal dose of acetaminophen. Int J Curr Sci 17: 18–28.
Calatayud M, Börner RA, Ghyselinck J, Verstrepen L, De Medts J, Van den Abbeele P, Boulangé CL, Priour S, Marzorati M, Damak S (2021) Water kefir and derived pasteurized beverages modulate gut microbiota, intestinal permeability and cytokine production in vitro. Nutrients 13: 3897. https://doi.org/10.3390/nu13113897
Dai C, Li H, Wang Y, Tang S, Velkov T, Shen J (2021) Inhibition of oxidative stress and ALOX12 and NF-κB pathways contribute to the protective effect of baicalein on carbon tetrachloride-induced acute liver injury. Antioxidants 10: 976. https://doi.org/10.3390/antiox10060976
Dallakyan S, Olson AJ (2015) Small-Molecule Library Screening by Docking with PyRx. In: Hempel JE, Williams CH, Hong CC (eds) Chemical Biology. New York: Springer New York, pp. 243–250. https://doi.org/10.1007/978-1-4939-2269-7_19
Darvishzadeh P, Orsat V, Martinez JL (2021) Process optimization for development of a novel water kefir drink with high antioxidant activity and potential probiotic properties from Russian olive fruit (Elaeagnus angustifolia). Food Bioprocess Technol 14: 248–260. https://doi.org/10.1007/s11947-020-02563-1
De Souza Basso B, Haute GV, Ortega-Ribera M, Luft C, Antunes GL, Bastos MS, Carlessi LP, Levorse VG, Cassel E, Donadio MVF, Santarém ER, Gracia-Sancho J, Rodrigues De Oliveira J (2021) Methoxyeugenol deactivates hepatic stellate cells and attenuates liver fibrosis and inflammation through a PPAR-ɣ and NF-kB mechanism. J Ethnopharmacol 280: 114433. https://doi.org/10.1016/j.jep.2021.114433
Diniz RO, Garla LK, Schneedorf JM, Carvalho JCT (2003) Study of anti-inflammatory activity of Tibetan mushroom, a symbiotic culture of bacteria and fungi encapsulated into a polysaccharide matrix. Pharmacol Res 47: 49–52. https://doi.org/10.1016/S1043-6618(02)00240-2
Du X, Li Y, Xia YL, Ai SM, Liang J, Sang P, Ji XL, Liu SQ (2016) Insights into protein–ligand interactions: Mechanisms, models, and methods. Int J Mol Sci 17: 144. https://doi.org/10.3390/ijms17020144
Elshaghabee FMF, Rokana N, Gulhane RD, Sharma C, Panwar H (2017) Bacillus as potential probiotics: status, concerns, and future perspectives. Front Microbiol 8: 1490. https://doi.org/10.3389/fmicb.2017.01490
Febrina E, Alamhari RK, Asnawi A, Abdulah R, Lestari K, Levita J, Supratman U (2021) Molecular docking and molecular dynamics studies of Acalypha indica L. phytochemical constituents with caspase-3. Int J App Pharm 13: 210–215. https://doi.org/10.22159/ijap.2021.v13s4.43861
Febrina E, Asnawi A, Abdulah R, Lestari K, Supratman U (2022) Identification of flavonoids from Acalypha indica L. (Euphorbiaceae) as caspase-3 activators using molecular docking and molecular dynamics. Int J App Pharm 14: 162–166. https://doi.org/10.22159/ijap.2022.v14s5.34
Fijan S (2014) Microorganisms with claimed probiotic properties: an overview of recent literature. Int J Environ Res Public Health 11: 4745–4767. https://doi.org/10.3390/ijerph110504745
Gamba RR, Yamamoto S, Sasaki T, Michihata T, Mahmoud AH, Koyanagi T, Enomoto T (2019) Microbiological and functional characterization of kefir grown in different sugar solutions. Food Sci Technol Res 25: 303–312. https://doi.org/10.3136/fstr.25.303
Ganesh Yerra V, Negi G, Sharma SS, Kumar A (2013) Potential therapeutic effects of the simultaneous targeting of the Nrf2 and NF-κB pathways in diabetic neuropathy. Redox Biol 1: 394–397. https://doi.org/10.1016/j.redox.2013.07.005
Gao W, Guo L, Yang Y, Wang Y, Xia S, Gong H, Zhang BK, Yan M (2022) Dissecting the crosstalk between Nrf2 and NF-κB response pathways in drug-induced toxicity. Front Cell Dev Biol 9: 809952. https://doi.org/10.3389/fcell.2021.809952
Hong Y, Sheng L, Zhong J, Tao X, Zhu W, Ma J, Yan J, Zhao A, Zheng X, Wu G, Li B, Han B, Ding K, Zheng N, Jia W, Li H (2021) Desulfovibrio vulgaris, a potent acetic acid-producing bacterium, attenuates nonalcoholic fatty liver disease in mice. Gut Microbes 13: 1930874. https://doi.org/10.1080/19490976.2021.1930874
Ischak NI, Aman LO, Hasan H, Kilo AL, Asnawi A (2023) In silico screening of Andrographis paniculata secondary metabolites as anti-diabetes mellitus through PDE9 inhibition. Res Pharm Sci 18: 100–111. https://doi.org/10.4103/1735-5362.363616
Ji Y, Xie Q, Meng X, Wang W, Li S, Lang X, Zhao C, Yuan Y, Ye H (2022) Lactobacillus paracasei improves dietary fatty liver by reducing insulin resistance and inflammation in obese mice model. J Funct Foods 95: 105150. https://doi.org/10.1016/j.jff.2022.105150
Jiang ZY, Lu MC, You QD (2019) Nuclear factor erythroid 2-related factor 2 (Nrf2) inhibition: An emerging strategy in cancer therapy. J Med Chem 62: 3840–3856. https://doi.org/10.1021/acs.jmedchem.8b01121
Kaur G, Shivanandappa TB, Kumar M, Kushwah AS (2020) Fumaric acid protect the cadmium-induced hepatotoxicity in rats: Owing to its antioxidant, anti-inflammatory action and aid in recast the liver function. Naunyn-Schmiedeberg’s Arch Pharmacol 393: 1911–1920. https://doi.org/10.1007/s00210-020-01900-7
Kebler LF (1921) California bees. J Am Pharm Assoc 10: 939–943. https://doi.org/10.1002/jps.3080101206
Kim B, Kwon J, Kim MS, Park H, Ji Y, Holzapfel W, Hyun CK, Aguila MB (2018) Protective effects of Bacillus probiotics against high-fat diet-induced metabolic disorders in mice. PLoS One 13: e0210120. https://doi.org/10.1371/journal.pone.0210120
Kondo T, Kishi M, Fushimi T, Kaga T (2009) Acetic acid upregulates the expression of genes for fatty acid oxidation enzymes in liver to suppress body fat accumulation. J Agric Food Chem 57: 5982–5986. https://doi.org/10.1021/jf900470c
Konstantopoulos P, Doulamis I, Tzani A, Korou ML, Agapitos E, Vlachos I, Pergialiotis V, Verikokos C, Mastorakos G, Katsilambros N, Perrea D (2017) Metabolic effects of Crocus sativus and protective action against non-alcoholic fatty liver disease in diabetic rats. Biom Rep 6: 513–518. https://doi.org/10.3892/br.2017.884
Laureys D, Aerts M, Vandamme P, De Vuyst L (2018) Oxygen and diverse nutrients influence the water kefir fermentation process. Food Microbiol 73: 351–361. https://doi.org/10.1016/j.fm.2018.02.007
Laureys D, De Vuyst L (2014) Water kefir as a promising low-sugar probiotic fermented beverage. Arch Public Health 72: P1. https://doi.org/10.1186/2049-3258-72-S1-P1
Laureys D, De Vuyst L (2017) The water kefir grain inoculum determines the characteristics of the resulting water kefir fermentation process. J Appl Microbiol 122: 719–732. https://doi.org/10.1111/jam.13370
Lee NY, Shin MJ, Youn GS, Yoon SJ, Choi YR, Kim HS, Gupta H, Han SH, Kim BK, Lee DY, Park TS, Sung H, Kim BY, Suk KT (2021) Lactobacillus attenuates progression of nonalcoholic fatty liver disease by lowering cholesterol and steatosis. Clin Mol Hepatol 27: 110–124. https://doi.org/10.3350/cmh.2020.0125
Lee TH, Kim WR, Poterucha JJ (2012) Evaluation of elevated liver enzymes. Clin Liver Dis 16: 183–198. https://doi.org/10.1016/j.cld.2012.03.006
Li H, Weng Q, Gong S, Wang J, Huang Y, Li Y, Guo J, Lan T (2023) Kaempferol prevents acetaminophen-induced liver injury by suppressing hepatocyte ferroptosis via Nrf2 pathway activation. Food Funct 14: 1884–1896. https://doi.org/10.1039/D2FO02716J
Li L, He M, Xiao H, Liu X, Wang K, Zhang Y (2018) Acetic acid influences BRL-3A cell lipid metabolism via the AMPK signalling pathway. Cell Physiol Biochem 45: 2021–2030. https://doi.org/10.1159/000487980
Li YT, Ye JZ, Lv LX, Xu H, Yang LY, Jiang XW, Wu WR, Shi D, Fang DQ, Bian XY, Wang KC, Wang QQ, Xie JJ, Lu YM, Li LJ (2019a) Pretreatment with Bacillus cereus preserves against D-galactosamine-induced liver injury in a rat model. Front Microbiol 10: 1751. https://doi.org/10.3389/fmicb.2019.01751
Li Z, Huang Y, Wu Y, Chen J, Wu D, Zhan CG, Luo HB (2019b) Absolute binding free energy calculation and design of a subnanomolar inhibitor of phosphodiesterase-10. J Med Chem 62: 2099–2111. https://doi.org/10.1021/acs.jmedchem.8b01763
Liu Z, Zhang Y, Zhang L, Zhou T, Li YY, Zhou GC, Miao ZM, Shang M, He JP, Ding N, Liu YQ (2022) Duality of interactions between TGF-β and TNF-α during tumor formation. Front Immunol 12: 810286. https://doi.org/10.3389/fimmu.2021.810286
Luedde T, Schwabe RF (2011) NF-κB in the liver—linking injury, fibrosis and hepatocellular carcinoma. Nat Rev Gastroenterol Hepatol 8: 108–118. https://doi.org/10.1038/nrgastro.2010.213
Lynch KM, Wilkinson S, Daenen L, Arendt EK (2021) An update on water kefir: Microbiology, composition and production. Int J Food Microbiol 345: 109128. https://doi.org/10.1016/j.ijfoodmicro.2021.109128
Meng XY, Zhang HX, Mezei M, Cui M (2011) Molecular docking: A powerful approach for structure-based drug discovery. Curr Comput Aided Drug Des 7: 146–157. https://doi.org/10.2174/157340911795677602
Moinas M, Horisberger M, Bauer H (1980) The structural organization of the Tibi grain as revealed by light, scanning and transmission microscopy. Arch Microbiol 128: 157–161. https://doi.org/10.1007/BF00406153
Moreira MEC, Santos MHD, Zolini GPP, Wouters ATB, Carvalho JCT, Schneedorf JM (2008) Anti-inflammatory and cicatrizing activities of a carbohydrate fraction isolated from sugary kefir. J Med Food 11: 356–361. https://doi.org/10.1089/jmf.2007.329
Neag MA, Catinean A, Muntean DM, Pop MR, Bocsan CI, Botan EC, Buzoianu AD (2020) Probiotic Bacillus spores protect against acetaminophen induced acute liver injury in rats. Nutrients 12: 632. https://doi.org/10.3390/nu12030632
Nursamsiar, Nur S, Febrina E, Asnawi A, Syafiie S (2022) Synthesis and inhibitory activity of curculigoside a derivatives as potential anti-diabetic agents with β-cell apoptosis. J Mol Struct 1265: 133292. https://doi.org/10.1016/j.molstruc.2022.133292
Parasuraman S, Raveendran R, Kesavan (2010) Blood sample collection in small laboratory animals. J Pharmacol Pharmacother 1: 87–93. https://doi.org/10.4103/0976-500X.72350
Patel SH, Tan JP, Börner RA, Zhang SJ, Priour S, Lima A, Ngom-Bru C, Cotter PD, Duboux S (2022) A temporal view of the water kefir microbiota and flavour attributes. Innov Food Sci Emerg Technol 80: 103084. https://doi.org/10.1016/j.ifset.2022.103084
Rahman ZU, Al Kury LT, Alattar A, Tan Z, Alshaman R, Malik I, Badshah H, Uddin Z, Khan Khalil AA, Muhammad N, Khan S, Ali A, Shah FA, Li JB, Li S (2021) Carveol a naturally-derived potent and emerging Nrf2 activator protects against acetaminophen-induced hepatotoxicity. Front Pharmacol 11: 621538. https://doi.org/10.3389/fphar.2020.621538
Ritesh KR, Suganya A, Dileepkumar HV, Rajashekar Y, Shivanandappa T (2015) A single acute hepatotoxic dose of CCl4 causes oxidative stress in the rat brain. Toxicol Rep 2: 891–895. https://doi.org/10.1016/j.toxrep.2015.05.012
Rocha-Gomes A, Escobar A, Soares JS, Da Silva AA, Dessimoni-Pinto NA, Riul TR (2018) Chemical composition and hypocholesterolemic effect of milk kefir and water kefir in Wistar rats. Rev Nutr 31: 137–145. https://doi.org/10.1590/1678-98652018000200001
Rodrigues KL, Araújo TH, Schneedorf JM, Ferreira CS, Moraes GO, Coimbra RS, Rodrigues MR (2016) A novel beer fermented by kefir enhances anti-inflammatory and anti-ulcerogenic activities found isolated in its constituents. J Funct Foods 21: 58–69. https://doi.org/10.1016/j.jff.2015.11.035
Romero-Luna HE, Peredo-Lovillo A, Hernández-Mendoza A, Hernández-Sánchez H, Cauich-Sánchez PI, Ribas-Aparicio RM, Dávila-Ortiz G (2020) Probiotic potential of Lactobacillus paracasei CT12 isolated from water kefir grains (tibicos). Curr Microbiol 77: 2584–2592. https://doi.org/10.1007/s00284-020-02016-0
Semjonovs P, Denina I, Linde R (2014) Evaluation of physiological effects of acetic acid bacteria and yeast fermented non-alchocolic beverage consumption in rat model. J Med Sci 14: 147–152. https://doi.org/10.3923/jms.2014.147.152
Sharifi-Rad J, Seidel V, Izabela M, Monserrat-Mequida M, Sureda A, Ormazabal V, Zuniga FA, Mangalpady SS, Pezzani R, Ydyrys A, Tussupbekova G, Martorell M, Calina D, Cho WC (2023) Phenolic compounds as Nrf2 inhibitors: Potential applications in cancer therapy. Cell Commun Signal 21: 89. https://doi.org/10.1186/s12964-023-01109-0
Šilhavý J, Zídek V, Mlejnek P, Landa V, Šimáková M, Strnad H, Oliyarnyk O, Škop V, Kazdová L, Kurtz T, Pravenec M, Sookoian SC (2014) Fumaric acid esters can block pro-inflammatory actions of human CRP and ameliorate metabolic disturbances in transgenic spontaneously hypertensive rats. PLoS One 9: e101906. https://doi.org/10.1371/journal.pone.0101906
Tsai YS, Lin SW, Chen YL, Chen CC (2020) Effect of probiotics Lactobacillus paracasei GKS6, L. plantarum GKM3, and L. rhamnosus GKLC1 on alleviating alcohol-induced alcoholic liver disease in a mouse model. Nutr Res Pract 14: 299. https://doi.org/10.4162/nrp.2020.14.4.299
Wang B, Cui S, Mao B, Zhang Q, Tian F, Zhao J, Tang X, Chen W (2022a) Cyanidin alleviated CCl4-induced acute liver injury by regulating the Nrf2 and NF-κB signaling pathways. Antioxidants 11: 2383. https://doi.org/10.3390/antiox11122383
Wang Y, Liu F, Liu M, Zhou X, Wang M, Cao K, Jin S, Shan A, Feng X (2022b) Curcumin mitigates aflatoxin B1-induced liver injury via regulating the NLRP3 inflammasome and Nrf2 signaling pathway. Food Chem Toxicol 161: 112823. https://doi.org/10.1016/j.fct.2022.112823
Ward M (1892) The ginger-beer plant, and the organisms composing it: A contribution to the study of fermentation-yeasts and bacteria. Phil Trans R Soc Lond B 183: 125–197. https://doi.org/10.1098/rstb.1892.0006
Weber LWD, Boll M, Stampfl A (2003) Hepatotoxicity and mechanism of action of haloalkanes: Carbon tetrachloride as a toxicological model. Crit Rev Toxicol 33: 105–136. https://doi.org/10.1080/713611034
Xue J, Shen K, Hu Y, Hu Y, Kumar V, Yang G, Wen C (2020) Effects of dietary Bacillus cereus, B. subtilis, Paracoccus marcusii, and Lactobacillus plantarum supplementation on the growth, immune response, antioxidant capacity, and intestinal health of juvenile grass carp (Ctenopharyngodon idellus). Aquac Reports 17: 100387. https://doi.org/10.1016/j.aqrep.2020.100387
Yang H, Meng L, Ai D, Hou N, Li H, Shuai X, Peng X (2019) Acetic acid alleviates the inflammatory response and liver injury in septic mice by increasing the expression of TRIM40. Exp Ther Med 17: 2789-2798. https://doi.org/10.3892/etm.2019.7274
Yang YM, Seki E (2015) TNFα in liver fibrosis. Curr Pathobiol Rep 3: 253–261. https://doi.org/10.1007/s40139-015-0093-z
Yao F, Jia R, Huang H, Yu Y, Mei L, Bai L, Ding Y, Zheng P (2019) Effect of Lactobacillus paracasei N1115 and fructooligosaccharides in nonalcoholic fatty liver disease. Arch Med Sci 15: 1336–1344. https://doi.org/10.5114/aoms.2019.86611
Yeh Y-H, Hsieh Y-L, Lee Y-T, Hsieh C-H (2011) Protective effects of cholestin against carbon tetrachloride-induced hepatotoxicity in rats. E Spen Eur E J Clin Nutr Metab 6: e264–e271. https://doi.org/10.1016/j.eclnm.2011.09.002
Zamberi NR, Abu N, Mohamed NE, Nordin N, Keong YS, Beh BK, Zakaria ZAB, Nik Abdul Rahman NM, Alitheen NB (2016) The antimetastatic and antiangiogenesis effects of kefir water on murine breast cancer cells. Integr Cancer Ther 15: NP53–NP66. https://doi.org/10.1177/1534735416642862
Zavala L, Golowczyc MA, van Hoorde K, Medrano M, Huys G, Vandamme P, Abraham AG (2016) Selected Lactobacillus strains isolated from sugary and milk kefir reduce Salmonella infection of epithelial cells in vitro. Benef Microbes 7: 585–595. https://doi.org/10.3920/BM2015.0196
Zhao H, Eguchi S, Alam A, Ma D (2017) The role of nuclear factor-erythroid 2 related factor 2 (Nrf-2) in the protection against lung injury. Am J Physiol Lung Cell Mol Physiol 312: L155–L162. https://doi.org/10.1152/ajplung.00449.2016
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