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Dela Torre GLT, Villanueva SYAM. Initial culture media pH influences the antibacterial activity and metabolic footprint of Lactobacillus acidophilus BIOTECH 1900. Prep Biochem Biotechnol 2024; 54:535-544. [PMID: 37671992 DOI: 10.1080/10826068.2023.2253461] [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] [Indexed: 09/07/2023]
Abstract
This study investigated the impact of initial culture media pH on the antibacterial properties and metabolic profile of cell-free supernatants (CFSs) from Lactobacillus acidophilus BIOTECH 1900 (LAB1900). The CFSs harvested from LAB1900 grown in de Man, Rogosa, Sharpe broth with initial pH of 5.5 (CFS5.5) and 6.6 (CFS6.6) were tested. The two CFSs elicited varying degrees of activity against three gram-negative bacteria. In the agar-well diffusion against Pseudomonas aeruginosa, CFS5.5 and CFS6.6 recorded 14.36 ± 1.34 and 13.06 ± 1.29 mm inhibition, respectively. Interestingly, against Klebsiella pneumoniae, CFS5.5 showed 14.36 ± 1.56 mm inhibition which was significantly higher than the 12.22 ± 1.31 mm inhibition of CFS6.6 (p = 0.0464). While against Acinetobacter baumannii, significantly higher inhibition of 10.66 ± 0.51 mm was observed in CFS6.6 compared to the 7.58 ± 1.93 mm inhibition of CFS5.5 (p = 0.0087). Nonetheless, both CFSs were bactericidal, with a minimum inhibitory and bactericidal concentration range of 3.90625-7.8125 mg/mL. The varied antibacterial activities may be attributed to the metabolite compositions of CFSs. A total of 152 metabolites driving the separation between CFSs were noted, with the majority upregulated in CFS5.5. Furthermore, 15 were putatively identified belonging to acylcarnities, vitamins, gibberellins, glycerophospholipids, and peptides. In summary, initial culture media pH affects the production of microbial metabolites with antibacterial properties.
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Affiliation(s)
- Gerwin Louis T Dela Torre
- Department of Medical Microbiology, College of Public Health, University of the Philippines Manila, Manila, Philippines
- Institute of Pharmaceutical Sciences, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
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Xu J, Chen X, Song J, Wang C, Xu W, Tan H, Suo H. Antibacterial activity and mechanism of cell-free supernatants of Lacticaseibacillus paracasei against Propionibacterium acnes. Microb Pathog 2024; 189:106598. [PMID: 38423403 DOI: 10.1016/j.micpath.2024.106598] [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] [Received: 12/03/2023] [Revised: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
Propionibacterium acnes (P. acnes) is an anaerobic and gram-positive bacterium involved in the pathogenesis and inflammation of acne vulgaris. This study particularly focuses on the antimicrobial effect of Lacticaseibacillus paracasei LPH01 against P. acnes, a bacterium that causes acne vulgaris. Fifty-seven Lactobacillus strains were tested for their ability to inhibit P. acnes growth employing the Oxford Cup and double dilution methods. The cell-free supernatant (CFS) of L. paracasei LPH01 demonstrated a strong inhibitory effect, with an inhibition zone diameter of 24.65 ± 0.27 mm and a minimum inhibitory concentration of 12.5 mg/mL. Among the CFS, the fraction over 10 kDa (CFS-10) revealed the best antibacterial effect. Confocal laser scanning microscopes and flow cytometry showed that CFS-10 could reduce cell metabolic activity and cell viability and destroy the integrity and permeability of the cell membrane. A scanning electron microscope revealed that bacterial cells exhibited obvious morphological and ultrastructural changes, which further confirmed the damage of CFS-10 to the cell membrane and cell wall. Findings demonstrated that CFS-10 inhibited the conversion of triglycerides, decreased the production of free fatty acids, and down-regulated the extracellular expression of the lipase gene. This study provides a theoretical basis for the metabolite of L. paracasei LPH01 as a potential antibiotic alternative in cosmeceutical skincare products.
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Affiliation(s)
- Jiahui Xu
- College of Food Science, Southwest University, Chongqing, 400715, PR China
| | - Xiaoyong Chen
- College of Food Science, Southwest University, Chongqing, 400715, PR China; Chongqing Agricultural Product Processing Technology Innovation Platform, Chongqing, 400715, PR China; Chongqing Key Laboratory of Speciality Food Co-Built By Sichuan and Chongqing, Chongqing, 400715, PR China; Citrus Research Institute, National Citrus Engineering Research Center, Southwest University, Chongqing, 400715, PR China
| | - Jiajia Song
- College of Food Science, Southwest University, Chongqing, 400715, PR China; Chongqing Agricultural Product Processing Technology Innovation Platform, Chongqing, 400715, PR China; Chongqing Key Laboratory of Speciality Food Co-Built By Sichuan and Chongqing, Chongqing, 400715, PR China; Citrus Research Institute, National Citrus Engineering Research Center, Southwest University, Chongqing, 400715, PR China
| | - Chen Wang
- College of Food Science, Southwest University, Chongqing, 400715, PR China; Chongqing Agricultural Product Processing Technology Innovation Platform, Chongqing, 400715, PR China; Chongqing Key Laboratory of Speciality Food Co-Built By Sichuan and Chongqing, Chongqing, 400715, PR China; Citrus Research Institute, National Citrus Engineering Research Center, Southwest University, Chongqing, 400715, PR China
| | - Weiping Xu
- College of Food Science, Southwest University, Chongqing, 400715, PR China
| | - Han Tan
- College of Food Science, Southwest University, Chongqing, 400715, PR China
| | - Huayi Suo
- College of Food Science, Southwest University, Chongqing, 400715, PR China; Chongqing Agricultural Product Processing Technology Innovation Platform, Chongqing, 400715, PR China; Chongqing Key Laboratory of Speciality Food Co-Built By Sichuan and Chongqing, Chongqing, 400715, PR China; Citrus Research Institute, National Citrus Engineering Research Center, Southwest University, Chongqing, 400715, PR China.
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Maione A, Imparato M, Buonanno A, Salvatore MM, Carraturo F, de Alteriis E, Guida M, Galdiero E. Evaluation of Potential Probiotic Properties and In Vivo Safety of Lactic Acid Bacteria and Yeast Strains Isolated from Traditional Home-Made Kefir. Foods 2024; 13:1013. [PMID: 38611319 PMCID: PMC11011881 DOI: 10.3390/foods13071013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Probiotics are known for their health-promoting resources and are considered as beneficial microorganisms. The current study focuses on the isolation, and on a complete in vitro and in vivo characterization, of yeast and lactic acid bacteria acquired from traditional homemade kefir in order to assess their potentiality as probiotic candidates. In particular, the isolates Pichia kudriavzevii Y1, Lactococcus lactis subsp. hordniae LAB1 and Lactococcus lactis subsp. lactis LAB2 were subjected to in vitro characterization to evaluate their suitability as probiotics. Resistance to acid and bile salts, auto-aggregation, co-aggregation, hydrophobicity, and biofilm production capability were examined, as well as their antioxidant activity. A safety assessment was also conducted to confirm the non-pathogenic nature of the isolates, with hemolysis assay and antibiotic resistance assessment. Moreover, mortality in the invertebrate model Galleria mellonella was evaluated. Current findings showed that P. kudriavzevii exhibited estimable probiotic properties, placing them as promising candidates for functional foods. Both lactic acid bacteria isolated in this work could be classified as potential probiotics with advantageous traits, including antimicrobial activity against enteric pathogens and good adhesion ability on intestinal cells. This study revealed that homemade kefir could be a beneficial origin of different probiotic microorganisms that may enhance health and wellness.
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Affiliation(s)
- Angela Maione
- Department of Biology, University of Naples "Federico II", 80126 Naples, Italy
| | - Marianna Imparato
- Department of Biology, University of Naples "Federico II", 80126 Naples, Italy
| | - Annalisa Buonanno
- Department of Biology, University of Naples "Federico II", 80126 Naples, Italy
| | | | - Federica Carraturo
- Department of Biology, University of Naples "Federico II", 80126 Naples, Italy
| | | | - Marco Guida
- Department of Biology, University of Naples "Federico II", 80126 Naples, Italy
- BAT Center-Interuniversity Center for Studies on Bioinspired Agro-Environmental Technology, University of Naples Federico II, 80055 Portici, Italy
| | - Emilia Galdiero
- Department of Biology, University of Naples "Federico II", 80126 Naples, Italy
- BAT Center-Interuniversity Center for Studies on Bioinspired Agro-Environmental Technology, University of Naples Federico II, 80055 Portici, Italy
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Al-Hazmi NE, Naguib DM. Antioxidant and Antibacterial Activities of Nano-probiotics Versus Free Probiotics Against Gastrointestinal Pathogenic Bacteria. Indian J Microbiol 2024; 64:141-152. [PMID: 38468740 PMCID: PMC10924813 DOI: 10.1007/s12088-023-01140-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/03/2023] [Indexed: 03/13/2024] Open
Abstract
Antibiotic-resistant pathogenic bacteria and the oxidative stress related to their infections are dangerous health problems. Finding new safe, effective antibacterial and antioxidant agents is an urgent global need. Probiotics are a strong candidate for possible antibacterial and antioxidant agents. The delivery of these probiotics without any effect on gastrointestinal digestion is the most important point for their application. The encapsulation of the probiotics on nanoparticles or other supports is a well-known method for the safe delivery of the probiotics. Little information is known about the effect of the probiotic encapsulation on its antibacterial and antioxidant activity. The present study tried to investigate the effect of probiotic encapsulation on nano-chitosan on its antioxidant activity and antibacterial activity against some pathogenic bacteria. We encapsulated some known probiotic species on nano-chitosan and investigated the antibacterial activity of the nano-probiotics and free probiotics against gastrointestinal pathogenic bacteria. The antioxidant characters of the free and encapsulated probiotics were investigated in terms of DPPH radicle scavenging activity, ferric ion chelating activity, hydroxyl radicle scavenging activity, superoxide anion radicle scavenging activity, and anti-lipid peroxidation activity. Results showed the superiority of the encapsulated probiotics as antibacterial and antioxidant agents over the free ones. The encapsulation improved the antibacterial activity of Sporolactobacillus laevolacticus against Bacteroides fragilis by 134% compared to the free one. Also, significantly, the encapsulation increased the hydroxyl radicle scavenging activity of Enterococcus faecium by about 180% compared to the free one. Nano-chitosan encapsulation synergistically increased the antioxidant and antibacterial activity of the studied probiotics. This can be promising for controlling pathogenic bacteria. Supplementary Information The online version contains supplementary material available at 10.1007/s12088-023-01140-2.
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Affiliation(s)
- Nawal E. Al-Hazmi
- Department of Chemistry, Division of Biology (Microbiology), University College of Qunfudah, Umm Al-Qura University, Al Qunfudhah, Saudi Arabia
| | - Deyala M. Naguib
- Botany and Microbiology Department, Faculty of Science, Zagazig University, Zagazig, Egypt
- Biology Department, Faculty of Science and Arts in Al-Mikhwah, Al-Baha University, Al Mikhwah, Saudi Arabia
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Paul S, Hossain TJ, Ali F, Hossain ME, Chowdhury T, Faisal IK, Ferdouse J. Assessment of the in-vitro probiotic efficacy and safety of Pediococcus pentosaceus L1 and Streptococcus thermophilus L3 isolated from Laban, a popular fermented milk product. Arch Microbiol 2024; 206:82. [PMID: 38294545 DOI: 10.1007/s00203-023-03812-5] [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] [Received: 10/31/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
Probiotics are beneficial microorganisms, mostly lactic acid bacteria (LAB), that offer health benefits to the host when consumed in adequate amounts. This study assessed the probiotic efficacy and safety of LAB strains isolated from Laban, a traditional fermented milk product. Seven primarily selected Gram-positive, catalase-negative, non-spore-forming isolates were examined for their antimicrobial activity against the bacterial pathogens Bacillus cereus, Salmonella typhi, Staphylococcus aureus, and Vibrio cholera, and the fungal pathogen Candida albicans. Two isolates, identified as Pediococcus pentosaceus L1 and Streptococcus thermophilus L3, which showed antimicrobial activity against all pathogens, were further evaluated for their probiotic competence. The selected isolates demonstrated strong resistance to low pH, bile salts, and phenol, indicating their potential for gastric endurance. They also exhibited high cell surface hydrophobicity to various hydrocarbons, autoaggregation, and coaggregation properties, demonstrating strong adhesion abilities. In addition, both isolates showed strong antioxidant activity and were non-hemolytic. Although the isolates had some resistance to certain antibiotics, they were generally susceptible to commonly used antibiotics. The two LAB strains also exhibited promising technological properties, such as milk coagulation and exopolysaccharide production, indicating their potential to enhance the quality of dairy products. The results suggest that the LAB strains isolated from Laban have strong potential as probiotics, and due to their food origin, they are highly likely to exhibit maximal efficacy in food and pharmaceutical products for human consumption.
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Affiliation(s)
- Shanta Paul
- Department of Microbiology, University of Chittagong, Chattogram, 4331, Bangladesh
| | - Tanim Jabid Hossain
- Department of Biochemistry and Molecular Biology, University of Chittagong, Chattogram, 4331, Bangladesh.
- Biochemistry and Pathogenesis of Microbes - BPM Research Group, Chattogram, 4331, Bangladesh.
| | - Ferdausi Ali
- Department of Microbiology, University of Chittagong, Chattogram, 4331, Bangladesh
| | - Md Elias Hossain
- Department of Microbiology, University of Chittagong, Chattogram, 4331, Bangladesh
| | - Tasneem Chowdhury
- Department of Microbiology, University of Chittagong, Chattogram, 4331, Bangladesh
| | - Ibrahim Khalil Faisal
- Department of Biochemistry and Molecular Biology, University of Chittagong, Chattogram, 4331, Bangladesh
- Biochemistry and Pathogenesis of Microbes - BPM Research Group, Chattogram, 4331, Bangladesh
| | - Jannatul Ferdouse
- Department of Microbiology, University of Chittagong, Chattogram, 4331, Bangladesh.
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Khataybeh B, Jaradat Z, Ababneh Q. Anti-bacterial, anti-biofilm and anti-quorum sensing activities of honey: A review. JOURNAL OF ETHNOPHARMACOLOGY 2023; 317:116830. [PMID: 37400003 DOI: 10.1016/j.jep.2023.116830] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Man has used honey to treat diseases since ancient times, perhaps even before the history of medicine itself. Several civilizations have utilized natural honey as a functional and therapeutic food to ward off infections. Recently, researchers worldwide have been focusing on the antibacterial effects of natural honey against antibiotic-resistant bacteria. AIM OF THE STUDY This review aims to summarize research on the use of honey properties and constituents with their anti-bacterial, anti-biofilm, and anti-quorum sensing mechanisms of action. Further, honey's bacterial products, including probiotic organisms and antibacterial agents which are produced to curb the growth of other competitor microorganisms is addressed. MATERIALS AND METHODS In this review, we have provided a comprehensive overview of the antibacterial, anti-biofilm, and anti-quorum sensing activities of honey and their mechanisms of action. Furthermore, the review addressed the effects of antibacterial agents of honey from bacterial origin. Relevant information on the antibacterial activity of honey was obtained from scientific online databases such as Web of Science, Google Scholar, ScienceDirect, and PubMed. RESULTS Honey's antibacterial, anti-biofilm, and anti-quorum sensing activities are mostly attributed to four key components: hydrogen peroxide, methylglyoxal, bee defensin-1, and phenolic compounds. The performance of bacteria can be altered by honey components, which impact their cell cycle and cell morphology. To the best of our knowledge, this is the first review that specifically summarizes every phenolic compound identified in honey along with their potential antibacterial mechanisms of action. Furthermore, certain strains of beneficial lactic acid bacteria such as Bifidobacterium, Fructobacillus, and Lactobacillaceae, as well as Bacillus species can survive and even grow in honey, making it a potential delivery system for these agents. CONCLUSION Honey could be regarded as one of the best complementary and alternative medicines. The data presented in this review will enhance our knowledge of some of honey's therapeutic properties as well as its antibacterial activities.
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Affiliation(s)
- Batool Khataybeh
- Department of Nutrition and Food Technology, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Ziad Jaradat
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Qutaiba Ababneh
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, 22110, Jordan
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Megur A, Daliri EBM, Balnionytė T, Stankevičiūtė J, Lastauskienė E, Burokas A. In vitro screening and characterization of lactic acid bacteria from Lithuanian fermented food with potential probiotic properties. Front Microbiol 2023; 14:1213370. [PMID: 37744916 PMCID: PMC10516296 DOI: 10.3389/fmicb.2023.1213370] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
The present work aimed to identify probiotic candidates from Lithuanian homemade fermented food samples. A total of 23 lactic acid bacteria were isolated from different fermented food samples. Among these, only 12 showed resistance to low pH, tolerance to pepsin, bile salts, and pancreatin. The 12 strains also exhibited antimicrobial activity against Staphylococcus aureus ATCC 29213, Salmonella Typhimurium ATCC 14028, Streptococcus pyogenes ATCC 12384, Streptococcus pyogenes ATCC 19615, and Klebsiella pneumoniae ATCC 13883. Cell-free supernatants of isolate 3A and 55w showed the strongest antioxidant activity of 26.37 μg/mL and 26.06 μg/mL, respectively. Isolate 11w exhibited the strongest auto-aggregation ability of 79.96% as well as the strongest adhesion to HCT116 colon cells (25.671 ± 0.43%). The selected strains were tested for their synbiotic relation in the presence of a prebiotic. The selected candidates showed high proliferation in the presence of 4% as compared to 2% galactooligosaccharides. Among the strains tested for tryptophan production ability, isolate 11w produced the highest L-tryptophan levels of 16.63 ± 2.25 μm, exhibiting psychobiotic ability in the presence of a prebiotic. The safety of these strains was studied by ascertaining their antibiotic susceptibility, mucin degradation, gelatin hydrolysis, and hemolytic activity. In all, isolates 40C and 11w demonstrated the most desirable probiotic potentials and were identified by 16S RNA and later confirmed by whole genome sequencing as Lacticaseibacillus paracasei 11w, and Lactiplantibacillus plantarum 40C: following with the harboring plasmid investigation. Out of all the 23 selected strains, only Lacticaseibacillus paracasei 11w showed the potential and desirable probiotic properties.
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Affiliation(s)
- Ashwinipriyadarshini Megur
- Department of Biological Models, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Eric Banan-Mwine Daliri
- Department of Biological Models, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Toma Balnionytė
- Department of Biological Models, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Jonita Stankevičiūtė
- Department of Molecular Microbiology and Biotechnology, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Eglė Lastauskienė
- Department of Microbiology and Biotechnology, Institute of Biosciences, Life Science Center, Vilnius University, Vilnius, Lithuania
| | - Aurelijus Burokas
- Department of Biological Models, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
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Mihailovskaya VS, Sutormin DA, Karipova MO, Trofimova AB, Mamontov VA, Severinov K, Kuznetsova MV. Bacteriocin-Producing Escherichia coli Q5 and C41 with Potential Probiotic Properties: In Silico, In Vitro, and In Vivo Studies. Int J Mol Sci 2023; 24:12636. [PMID: 37628817 PMCID: PMC10454217 DOI: 10.3390/ijms241612636] [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: 07/08/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Commensal bacteriocin-producing Escherichia coli are of interest for possible use as probiotics to selectively control the spread of pathogenic bacteria. Here, we evaluated the biosafety and efficacy of two new bacteriocin-producing E. coli strains, Q5 (VKM B-3706D) and C41 (VKM B-3707D), isolated from healthy farm animals. The genomes of both strains were sequenced, and genes responsible for the antagonistic and colonization abilities of each strain were identified. In vitro studies have shown that both strains were medium-adhesive and demonstrated antagonistic activity against most enteropathogens tested. Oral administration of 5 × 108 to 5 × 1010 colony-forming units of both strains to rats with drinking water did not cause any disease symptoms or side effects. Short-term (5 days) oral administration of both strains protected rats from colonization and pathogenic effects of a toxigenic beta-lactam-resistant strain of E. coli C55 and helped preserve intestinal homeostasis. Taken together, these in silico, in vitro, and in vivo data indicate that both strains (and especially E. coli Q5) can be potentially used for the prevention of colibacillosis in farm animals.
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Affiliation(s)
- Veronika S. Mihailovskaya
- Institute of Ecology and Genetics of Microorganisms, Ural Branch of the Russian Academy of Sciences, Goleva Street 13, 614081 Perm, Russia;
| | - Dmitry A. Sutormin
- Skolkovo Institute of Science and Technology, 121205 Moscow, Russia; (D.A.S.); (V.A.M.)
| | - Marina O. Karipova
- Department of Microbiology and Virology, Perm State Medical University Named after Academician E. A. Wagner, 614000 Perm, Russia;
| | - Anna B. Trofimova
- Institute of Gene Biology Russian Academy of Sciences, 119334 Moscow, Russia;
| | - Victor A. Mamontov
- Skolkovo Institute of Science and Technology, 121205 Moscow, Russia; (D.A.S.); (V.A.M.)
| | - Konstantin Severinov
- Waksman Institute for Microbiology, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA;
- Institute of Molecular Genetics, National Research Center “Kurchatov Institute”, 123182 Moscow, Russia
| | - Marina V. Kuznetsova
- Institute of Ecology and Genetics of Microorganisms, Ural Branch of the Russian Academy of Sciences, Goleva Street 13, 614081 Perm, Russia;
- Department of Microbiology and Virology, Perm State Medical University Named after Academician E. A. Wagner, 614000 Perm, Russia;
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