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<article xml:lang="en" article-type="research-article" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">
    <front>
        <journal-meta>
            <journal-id journal-id-type="publisher-id">PSJFS</journal-id>
            <journal-title-group>
                <journal-title>Potravinarstvo Slovak Journal of Food Sciences</journal-title>
                <abbrev-journal-title abbrev-type="pubmed">Potr. S. J. F. Sci.</abbrev-journal-title>
            </journal-title-group>
            <issn pub-type="ppub">1338-0230</issn>
            <issn pub-type="epub">1337-0960</issn>
            <publisher>
                <publisher-name>Association HACCP Consulting</publisher-name>
            </publisher>
        </journal-meta>
        <article-meta>
            <article-id pub-id-type="publisher-id">PSJFS-14-1-995</article-id>
            <article-id pub-id-type="doi">10.5219/1416</article-id>
            <article-categories>
                <subj-group subj-group-type="heading">
                    <subject>ARTICLE</subject>
                </subj-group>
            </article-categories>
            <title-group>
                <article-title>INVESTIGATING CHEMICAL CHANGES DURING SNAKE FRUIT AND BLACK TEA KOMBUCHA FERMENTATION AND THE ASSOCIATED IMMUNOMODULATORY ACTIVITY IN <italic>SALMONELLA TYPHI</italic>-INFECTED MICE</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Zubaidah</surname>
                        <given-names>Elok</given-names>
                    </name>
                    <xref ref-type="corresp" rid="cor1">&#x002A;</xref>
                </contrib>
                <contrib contrib-type="author">
                    <name>
                        <surname>Valencia</surname>
                        <given-names>Vania</given-names>
                    </name>
                    <xref ref-type="aff" rid="aff2" />
                </contrib>
                <contrib contrib-type="author">
                    <name>
                        <surname>Rifa’i</surname>
                        <given-names>Muhaimin</given-names>
                    </name>
                    <xref ref-type="aff" rid="aff3" />
                </contrib>
                <contrib contrib-type="author">
                    <name>
                        <surname>Srianta</surname>
                        <given-names>Ignatius</given-names>
                    </name>
                    <xref ref-type="aff" rid="aff4" />
                </contrib>
                <contrib contrib-type="author">
                    <name>
                        <surname>Tewfik</surname>
                        <given-names>Ihab</given-names>
                    </name>
                    <xref ref-type="aff" rid="aff5" />
                </contrib>
                <aff id="aff2">
                    <institution>Department of Food Science and Technology, Faculty of Agricultural Technology, Brawijaya University, Jalan Veteran, Malang, Indonesia 65145, Tel.: +62341569214, E-mail: 20vaniavalencia94@gmail.com</institution>
                </aff>
                <aff id="aff3">
                    <institution>Department of Biology, Faculty of Science, Brawijaya University, Malang, Indonesia 65145, Tel: +62341578248, E-mail: rifa123@ub.ac.id</institution>
                </aff>
                <aff id="aff4">
                    <institution>Department of Food Technology, Faculty of Agricultural Technology, Widya Mandala Catholic University Surabaya, Jalan Dinoyo 42-44, Surabaya, Indonesia 60265, Tel: +62315678478, E-mail: srianta_wm@yahoo.com</institution>
                </aff>
                <aff id="aff5">
                    <institution>School of Life Sciences, Division of Food, Nutrition and Public Health, University of Westminster, 115 New Cavendish Street, London W1W 6UW, United Kingdom, Tel: +442079115000, E-mail: I.Tewfik@westminster.ac.uk</institution>
                </aff>
            </contrib-group>
            <author-notes>
                <corresp id="cor1">
                    <label>&#x002A;</label>
                    <email xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="elok@ub.ac.id">elok@ub.ac.id</email>
                </corresp>
            </author-notes>
            <pub-date pub-type="epub">
                <day>28</day>
                <month>10</month>
                <year>2020</year>
            </pub-date>
            <pub-date pub-type="ppub">
                <month>10</month>
                <year>2020</year>
            </pub-date>
            <volume>14</volume>
            <issue>1</issue>
            <fpage>995</fpage>
            <lpage>1000</lpage>
            <history>
                <date date-type="received">
                    <day>18</day>
                    <month>6</month>
                    <year>2020</year>
                </date>
                <date date-type="accepted">
                    <day>26</day>
                    <month>9</month>
                    <year>2020</year>
                </date>
            </history>
            <permissions>
                <copyright-statement>&#x00A9; Association HACCP Consulting. All rights reserved.</copyright-statement>
                <copyright-year>2020</copyright-year>
                <license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">
                    <license-p>This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<uri xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0</uri>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <abstract>
                <p>This study uncovered the chemical changes during kombucha's fermentation process and revealed the associated immunomodulatory activity in <italic>Salmonella typhi</italic>-infected mice. The snake fruit juice and black tea extract were processed into kombucha (a beverage known for its health benefits) by fermentation with SCOBY culture at room temperature for 14 days. Snake fruit kombucha showed high changes in fermentation parameters (total acidity, pH, and total sugar), as well as bioactive compounds and antioxidant activity. <italic>Salmonella typhi</italic> demonstrated a reduction in the population of CD8+TNF&#x3B1;+ and CD4+IFN&#x3B3;+ of infected experimental animals. Both snake fruit kombucha and black tea kombucha have the potential to be utilized as an immunomodulator to circumvent unstable conditions of the immune system caused by <italic>Salmonella typhi</italic>. Black tea kombucha and snake fruit kombucha cancan raise the production of CD8+TNF&#x3B1;+ and CD4+IFN&#x3B3;+ in mice infected with <italic>Salmonella typhi</italic>. In the group of normal mice, black tea and snake fruit kombucha were able to lower down the production of CD8+TNF&#x3B1;+, which is a potent mechanism to modulate the immune system. Further research is required to highlight the mechanism and role of black tea kombucha and snake fruit kombucha in the immune response that modulates and treats infection by <italic>Salmonella typhi</italic>.</p>
                <p>
                    <bold>Keywords:</bold> kombucha; snake fruit; black tea; immunomodulator; <italic>Salmonella typhi</italic></p>
            </abstract>
        </article-meta>
    </front>
    <body>
        <sec sec-type="intro">
            <title>INTRODUCTION</title>
            <p>Snake fruit (<italic>Salacca zalacca</italic> (Gaerth.) Voss) is a popular tropical fruit in South East Asian countries. In addition to its appetizing taste, snake fruit provides many health benefits due to its sugar content, dietary fiber, selected vitamins and minerals, and antioxidant compounds (<xref ref-type="bibr" rid="b5">Aralas, Mohamed and Abu Bakar, 2009;</xref> <xref ref-type="bibr" rid="b31">Suica-Bunghez et al., 2016</xref>). In our previous studies, we demonstrated that snake fruits have the potential to be processed into Kombucha (<xref ref-type="bibr" rid="b39">Zubaidah et al., 2018a</xref>).</p>
            <p>Kombucha is a fermented tea beverage, black tea is commonly used which is fermented by a symbiotic culture of bacteria and yeast (SCOBY) (<xref ref-type="bibr" rid="b16">Jayabalan et al., 2014</xref>). Kombucha has shown several beneficial effects, such as inhibit pathogenic bacteria growth (<xref ref-type="bibr" rid="b30">Sreeramulu, Zhu and Knol, 2000</xref>), acts as an antioxidant, protects hepar, in addition to its anti-cancer property (<xref ref-type="bibr" rid="b13">Dufresne and Farnworth, 2000</xref>). Furthermore, it reduces inflammation severity, prevents arthritis, and enhances the immune system as an &#x2018;immunomodulator&#x2019; (<xref ref-type="bibr" rid="b16">Jayabalan et al., 2014</xref>). An immunomodulator is a compound that can modulate the immune system, which is needed to overcome the unstable condition of health complications caused by antigen. Clinically, immunomodulation mechanisms are categorized as immunoadjuvant, immunostimulant, and immunosuppressant. On the other hand, instability in the immune system caused by bacterial invasion increases the occurrence of serious disease, e.g. typhoid (<xref ref-type="bibr" rid="b1">Abbas, Lichtman and Pilai, 2007</xref>). <italic>Salmonella typhi</italic> is a pathogenic bacteria that causes typhoid fever – a serious health issue globally (<xref ref-type="bibr" rid="b11">Crump, 2019;</xref> <xref ref-type="bibr" rid="b34">Thung et al., 2017</xref>). It spreads through non-hygienic consumption of water and food. The bacteria can invade gut mucosal through microfold cells and infects the area without resulting in any clinical symptoms. Lack of inflammation response caused a late treatment and worsened the condition of the patient (<xref ref-type="bibr" rid="b19">Khan et al., 2012</xref>).</p>
            <p>Studies reported that snake fruit kombucha can lower fasting blood glucose, increases superoxide dismutase, reduces malondialdehyde level, and promotes pancreatic beta-cell- regeneration in the hyperglycemic rat. Furthermore, snake fruit kombucha was proven to have a similarly significant effect compared to metformin in treating diabetic rats with a dosage of 5 mL.kg<sup>-1</sup> bodyweights per day given orally for 28 days. These positive effects of snake fruit kombucha known to be related with its chemical composition such as phenol, tannin, hexane, 1-methyl-2, 2-furancarboxaldehyde, glucopyranose, and caffeine, which are produced during the fermentation process (<xref ref-type="bibr" rid="b38">Zubaidah et al., 2018b;</xref> <xref ref-type="bibr" rid="b37">Zubaidah et al., 2018c</xref>).</p>
            <p>These beneficial effects of snake fruit kombucha, which have been reported, lacked scientific evidence to ascertain its potential immunomodulatory effect. Thus, this study aimed to investigate the chemical changes during fermentation of kombucha and its immunomodulatory activity in <italic>Salmonella typhi</italic>-infected mice, which will be ascertained through the population of CD4+TNF&#x3B1;+, CD4+IFN&#x3B3;+, CD8+TNF&#x3B1;+, and CD8+IFN&#x3B3;+.</p>
            <sec>
                <title>Scientific hypothesis</title>
                <p>The fermentation affects the chemical characteristics of the kombucha. The kombucha administration raises the production of CD8+TNF&#x3B1;+ and CD4+IFN&#x3B3;+ in mice infected with <italic>Salmonella typhi</italic>.</p>
            </sec>
        </sec>
        <sec sec-type="materials|methods">
            <title>MATERIAL AND METHODOLOGY</title>
            <sec>
                <title>Material</title>
                <p>Snake fruit (<italic>Suwaru salak</italic> cultivar) was obtained from a local farmer in Malang, East Java, Indonesia. Black tea was purchased from the local market. SCOBY culture was bought from Wiki Kombucha, Bali, Indonesia. <italic>Salmonella typhi</italic> was obtained from a national culture collection.</p>
            </sec>
            <sec>
                <title>Snake fruit kombucha and black tea kombucha preparation</title>
                <p>Peeled snake fruit was separated from its seed, cut, and washed with distilled water. Snake fruit was juiced in a food processor with distilled water at a ratio of 1:1 (w:v), then filtered. The juice was added with 10% sucrose (w/v) and brought to boil. While black tea extract was prepared by eight grams of black tea immersed in 1 L of boiling water, added with 10% sucrose (w/v), and let sit for 15 minutes. The prepared snake fruit juice or black tea extract was poured aseptically into a sterilized glass container, cooled until it reached room temperature, and then inoculated with 10% SCOBY culture (v/v). The container was covered with a sterile cloth and let aside to undergo fermentation at room temperature for 14 days. The cellulose layer was aseptically separated and the solution was subjected to chemical and immunomodulatory activity evaluation.</p>
            </sec>
            <sec>
                <title>Chemical Analysis</title>
                <p>Total acidity, total sugar, total dissolved solids [TDS] was analyzed according to (<xref ref-type="bibr" rid="b3">AOAC 1995</xref>). pH was measured by using a pH meter. Total phenolic content was determined according to <xref ref-type="bibr" rid="b36">Yang, Paulino and Janke-Stedronsky (2007)</xref>. Total flavonoid content was evaluated according to <xref ref-type="bibr" rid="b6">Atanassova, Georgieva and Ivancheva (2011)</xref>. Antioxidant activity (DPPH scavenging activity) was analyzed according to <xref ref-type="bibr" rid="b25">Pinsirodom, Rungcharoen and Liumminful (2010)</xref>. All analyses were carried out on a day 0 and day 14 of the fermentation process to ascertain any changes in both black tea kombucha and snake fruit kombucha.</p>
            </sec>
            <sec>
                <title>Immunomodulatory activity evaluation</title>
                <p>Thirty female Balb-C mice aged 12 weeks were adapted for 7 days given food and water ad libitum, then randomly categorized into 6 groups: Normal (N, healthy group), N-BTK (normal + black tea kombucha), N-SFK (normal + snake fruit kombucha), Infected with <italic>Salmonella typhi</italic> (I), I-BTK (infected + black tea kombucha), and I-SFK (infected + snake fruit kombucha), with each group, consists of 5 mice. The experimental protocols and procedures of care and use of animals used in the present study were approved by the Ethics Committee (ethical clearance No. 1059-KEP-UB). The National Institutes of Health guide for the care and use of laboratory animals (NIH Publications No. 8023, revised 1978) was followed in this experiment. Kombucha was given orally as much as 0.007 mL.g<sup>-1</sup> body weight per day for 21 days. On day 22, <italic>Salmonella typhi</italic> infection was carried out intraperitoneally with a dosage of 0.1 mL per mice with a concentration of 10<sup>8</sup> cells per mL. On day 29, lymph organ was taken for flow cytometry analysis to assess the population of CD4+TNF&#x3B1;+, CD4+IFN&#x3B3;+, CD8+TNF&#x3B1;+, and CD8+IFN&#x3B3;+.</p>
            </sec>
            <sec>
                <title>Statistical analysis</title>
                <p>The chemical characteristics data were analyzed with ANOVA at a significance level of 0.05% with SPSS. Flow cytometry data were analyzed with BD cell quest ProTM and statistically analyzed with ANOVA at a significance level of 0.05% with SPSS. A significant result was furtherly analyzed with Tukey.</p>
            </sec>
        </sec>
        <sec sec-type="results|discussion">
            <title>RESULTS AND DISCUSSION</title>
            <sec>
                <title>Chemical changes during fermentation</title>
                <p>The fermentation process is a metabolic process that triggers simultaneously changes to characteristics of the medium including its nutritional contents and antioxidant activity. Changes in both black tea kombucha and snake fruit kombucha are presented in Table <xref ref-type="table" rid="T1">1</xref>. The increase in total acid at the end of fermentation is the result of the culture metabolism which converts sugar into organic acids, mainly acetic acid as the primary metabolite. Other acids were also produced during bacteria metabolisms such as acetic acid, gluconic acid, glucuronic acid, L-lactic acid, malic acid, tartaric acid, and citric acid.</p>
                <table-wrap id="T1" position="float">
                    <label>Table 1</label>
                    <caption>
                        <p>Changes in chemical characteristics of black tea kombucha and snake fruit kombucha during fermentation.</p>
                    </caption>
                    <table frame="hsides" rules="none" width="100%">
                        <thead>
                            <tr>
                                <th rowspan="3" align="right">Parameter</th>
                                <th colspan="2">Black Tea Kombucha</th>
                                <th colspan="2">Snake Fruit Kombucha</th>
                            </tr>
                            <tr>
                                <th colspan="4" align="right">
                                    <hr/>
                                </th>
                            </tr>
                            <tr>
                                <th align="right">Day 0</th>
                                <th align="right">Day 14</th>
                                <th align="right">Day 0</th>
                                <th align="right">Day 14</th>
                            </tr>
                            <tr>
                                <th colspan="5" align="right">
                                    <hr/>
                                </th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr>
                                <td align="right">Total Acid (%)</td>
                                <td align="right">0.21&#x00B1;0.02<sup>&#x002A;</sup></td>
                                <td align="right">0.42&#x00B1;0.08<sup>&#x002A;</sup></td>
                                <td align="right">0.83&#x00B1;0.07<sup>&#x002A;</sup></td>
                                <td align="right">1.11&#x00B1;0.01<sup>&#x002A;</sup></td>
                            </tr>
                            <tr>
                                <td align="right">pH</td>
                                <td align="right">5.06&#x00B1;0.05<sup>&#x002A;</sup></td>
                                <td align="right">4.90&#x00B1;0.02<sup>&#x002A;</sup></td>
                                <td align="right">4.01&#x00B1;0.01<sup>&#x002A;</sup></td>
                                <td align="right">3.07&#x00B1;0.01<sup>&#x002A;</sup></td>
                            </tr>
                            <tr>
                                <td align="right">Total Sugar (%)</td>
                                <td align="right">10.99&#x00B1;0.01<sup>&#x002A;</sup></td>
                                <td align="right">8.27&#x00B1;0.04<sup>&#x002A;</sup></td>
                                <td align="right">13.00&#x00B1;0.11<sup>&#x002A;</sup></td>
                                <td align="right">8.09&#x00B1;0.03<sup>&#x002A;</sup></td>
                            </tr>
                            <tr>
                                <td align="right">TDS (&#x00B0;Brix)</td>
                                <td align="right">13.79&#x00B1;0.01<sup>&#x002A;</sup></td>
                                <td align="right">11.79&#x00B1;0.01<sup>&#x002A;</sup></td>
                                <td align="right">14.45&#x00B1;0.01<sup>&#x002A;</sup></td>
                                <td align="right">12.23&#x00B1;0.01<sup>&#x002A;</sup></td>
                            </tr>
                        </tbody>
                    </table>
                    <table-wrap-foot>
                        <fn id="T1FN1">
                            <p>Note: Data is the average of 3 replications &#x00B1;<italic>SD</italic>. A notation of * shows significant different at each parameter in the same day at significant level of <italic>p</italic> &#x003E;0.05.</p>
                        </fn>
                    </table-wrap-foot>
                </table-wrap>
                <p>High total acid increment in Snake fruit kombucha was predicted and caused by native acid in salak such as ascorbic acid (<xref ref-type="bibr" rid="b17">Jayabalan, Marimuthu and Swaminathan, 2007;</xref> <xref ref-type="bibr" rid="b16">Jayabalan et al., 2014;</xref> <xref ref-type="bibr" rid="b22">Malbasa et al., 2011;</xref> <xref ref-type="bibr" rid="b33">Supapvanich, Megia and Ding, 2011</xref>).</p>
                <p>Higher accumulation of organic acids during fermentation is related to lower pH value owing to acid ability to release H+ and cause a drop in pH level. By the end of the fermentation process, total sugar and total dissolved solid levels in the medium were lower compared to their levels at the beginning of fermentation as sugar is considered the primary carbon source for microorganisms that facilitates metabolism during fermentation. The reduction of TDS might be also caused by sedimentation of protein, pectin, pigment, and minerals.</p>
                <p>The fermentation process not only changed the chemical characteristics of a medium, but also its bioactive components such as phenolic content, flavonoid content, and antioxidant activity (<xref ref-type="bibr" rid="b17">Jayabalan, Marimuthu and Swaminathan, 2007;</xref> <xref ref-type="bibr" rid="b7">Bhattacharya, Gachhui and Sil, 2013</xref>). Changes in bioactive characteristics of black tea kombucha and snake fruit kombucha are presented in Table <xref ref-type="table" rid="T2">2</xref>. Kombucha fermentation has been known to produce several enzymes such as invertase, cellulase, and amylase that catalyzes the breakdown of the chain between phenolic and medium complex that contributed to the increase of phenolic content after fermentation. On the other hand, epicatechin in tea and salak is known to undergo isomerization and depletion form microbes cell during fermentation resulting in in an increase of total flavonoid by the end of fermentation (<xref ref-type="bibr" rid="b14">Essawet et al., 2015;</xref> <xref ref-type="bibr" rid="b17">Jayabalan, Marimuthu and Swaminathan, 2007;</xref> <xref ref-type="bibr" rid="b33">Supapvanich, Megia and Ding, 2011;</xref> <xref ref-type="bibr" rid="b4">Apriyadi, 2017</xref>). The antioxidant activity also increased during fermentation as the phenolic and flavonoid contents increased.</p>
                <table-wrap id="T2" position="float">
                    <label>Table 2</label>
                    <caption>
                        <p>Changes in bioactive characteristics of black tea kombucha and snake fruit kombucha during fermentation.</p>
                    </caption>
                    <table frame="hsides" rules="none" width="100%">
                        <thead>
                            <tr>
                                <th rowspan="3">Parameter</th>
                                <th colspan="2">Black Tea Kombucha</th>
                                <th colspan="2">Snake Fruit Kombucha</th>
                            </tr>
                            <tr>
                                <th colspan="4">
                                    <hr/>
                                </th>
                            </tr>
                            <tr>
                                <th>Day 0</th>
                                <th>Day 14</th>
                                <th>Day 0</th>
                                <th>Day 14</th>
                            </tr>
                            <tr>
                                <th colspan="5">
                                    <hr/>
                                </th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr align="center">
                                <td align="left">Phenolic  content (mg.L<sup>-1</sup> GAE)</td>
                                <td>181.18&#x00B1;0.98</td>
                                <td>407.14 &#x00B1;1.43<sup>&#x002A;</sup></td>
                                <td>280.48 &#x00B1;0.55</td>
                                <td>534.94 &#x00B1;0.24<sup>&#x002A;</sup></td>
                            </tr>
                            <tr align="center">
                                <td align="left">Flavonoid content (mg.L<sup>-1</sup> QE)</td>
                                <td>3388.03 &#x00B1;58.93<sup>&#x002A;</sup></td>
                                <td>3916.34 &#x00B1;31.70<sup>&#x002A;</sup></td>
                                <td>3762.81 &#x00B1;12.22<sup>&#x002A;</sup></td>
                                <td>4618.82 &#x00B1;85.84<sup>&#x002A;</sup></td>
                            </tr>
                            <tr align="center">
                                <td align="left">DPPH scavenging activity (%)</td>
                                <td>76.62&#x00B1;0.13<sup>&#x002A;</sup></td>
                                <td>80.92&#x00B1;0.11<sup>&#x002A;</sup></td>
                                <td>77.22&#x00B1;0.42<sup>&#x002A;</sup></td>
                                <td>83.90 &#x00B1;0.19<sup>&#x002A;</sup></td>
                            </tr>
                        </tbody>
                    </table>
                    <table-wrap-foot>
                        <fn id="T2FN1">
                            <p>Note: Data is the average of 3 replications &#x00B1;<italic>SD</italic>. A notation of * shows significant different at each parameter in the same day at significant level of <italic>p</italic> &#x003E;0.05.</p>
                        </fn>
                    </table-wrap-foot>
                </table-wrap>
            </sec>
            <sec>
                <title>Animal Observation</title>
                <p>The effect of treatment on mice body weight was monitored and evaluated on day 0, 7, 14, 21, and 28 the data were presented in Table <xref ref-type="table" rid="T3">3</xref>.</p>
                <table-wrap id="T3" position="float">
                    <label>Table 3</label>
                    <caption>
                        <p>Changes in mice body weight during treatment (n = 5).</p>
                    </caption>
                    <table frame="hsides" rules="none" width="100%">
                        <thead>
                            <tr>
                                <th/>
                                <th>Day 0</th>
                                <th>Day 7</th>
                                <th>Day 14</th>
                                <th>Day 21</th>
                                <th>Day 28</th>
                            </tr>
                            <tr>
                                <th colspan="6">
                                    <hr/>
                                </th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr align="center">
                                <td>Normal</td>
                                <td>32.00 &#x00B1;2.92</td>
                                <td>32.00 &#x00B1;2.92</td>
                                <td>33.00 &#x00B1;2.55</td>
                                <td>33.00 &#x00B1;2.92</td>
                                <td>33.20 &#x00B1;2.77</td>
                            </tr>
                            <tr align="center">
                                <td>N-BTK</td>
                                <td>32.40 &#x00B1;0.89</td>
                                <td>32.40 &#x00B1;0.89</td>
                                <td>32.40 &#x00B1;1.14</td>
                                <td>32.80 &#x00B1;1.48</td>
                                <td>32.80 &#x00B1;1.92</td>
                            </tr>
                            <tr align="center">
                                <td>N-SFK</td>
                                <td>31.40 &#x00B1;2.61</td>
                                <td>31.60 &#x00B1;2.51</td>
                                <td>32.00 &#x00B1;4.42</td>
                                <td>32.20 &#x00B1;4.32</td>
                                <td>34.00 &#x00B1;3.39</td>
                            </tr>
                            <tr align="center">
                                <td colspan="6"><hr/></td>
                            </tr>
                            <tr align="center">
                                <td>Infected</td>
                                <td>35.00 &#x00B1;3.00</td>
                                <td>34.80 &#x00B1;3.35</td>
                                <td>34.40 &#x00B1;3.29</td>
                                <td>33.60 &#x00B1;6.02</td>
                                <td>31.00 &#x00B1;2.92</td>
                            </tr>
                            <tr align="center">
                                <td>I-BTK</td>
                                <td>28.60 &#x00B1;2.88</td>
                                <td>28.60 &#x00B1;2.88</td>
                                <td>28.20 &#x00B1;4.49</td>
                                <td>28.60 &#x00B1;3.97</td>
                                <td>25.20 &#x00B1;3.42</td>
                            </tr>
                            <tr align="center">
                                <td>I-SFK</td>
                                <td>26.40 &#x00B1;2.07</td>
                                <td>26.40 &#x00B1;2.07</td>
                                <td>28.00 &#x00B1;3.81</td>
                                <td>28.60 &#x00B1;2.79</td>
                                <td>25.20 &#x00B1;2.49</td>
                            </tr>
                        </tbody>
                    </table>
                </table-wrap>
                <p>Weight gain was observed in the healthy group, black tea kombucha, and Snake fruit kombucha (Normal, N-BTK, N-SFK). On the contrary, <italic>Salmonella typhi</italic> infection has led to weight loss among an infected group, black tea kombucha, and snake fruit kombucha (Infected, I-BTK, I-SFK). Weight gain in the healthy group was related to the efficiency of gut activity in absorbing nutrients.</p>
                <p>Moreover, high phenol, flavonoid, and antioxidant activity enhanced the body's metabolism to positive energy balance (<xref ref-type="bibr" rid="b15">Fuller, 1989</xref>), thus healthy mice treated with snake fruit kombucha noted the highest weight gain (34.00 g).</p>
                <p>Weight loss was a clear indication of <italic>Salmonella typhi</italic> infection. <italic>Salmonella typhi</italic> invade the gut mucosal surface and impaired the gastrointestinal tract absorption activity causing diarrhea, nausea, and vomit. The bacteria have also produced enterotoxin which stimulates gut epithelium to metabolize adenyl cyclase enzyme and c-adenosine monophosphate, which facilitated the secretion of chloride, natrium, and water from the gut lumen into the cell. In response to such conditions, hyperperistaltic occurred reduce excess water in the intestine thus diarrhea case has been established (<xref ref-type="bibr" rid="b35">Ukhrowi, 2011;</xref> <xref ref-type="bibr" rid="b23">Nurhalimah, Wijayanti and Widyaningsih, 2015</xref>). Phenolic and flavonoid are known to have a bactericidal activity which is important to minimize the severity of diarrhea through inhibiting the growth of pathogenic bacteria (<xref ref-type="bibr" rid="b12">Damayanti and Suparjana, 2007;</xref> <xref ref-type="bibr" rid="b10">Clinton, 2009;</xref> <xref ref-type="bibr" rid="b20">Loresta, Murwani and Trisunuwati, 2012</xref>). Acetic acid as the result of kombucha fermentation also correlates with inhibition of <italic>Salmonella typhi</italic> growth thus increases the efficiency of nutrient absorption, leading to weight gain (<xref ref-type="bibr" rid="b30">Sreeramulu, Zhu and Knol, 2000</xref>).</p>
            </sec>
            <sec>
                <title>Immunomodulatory effect of Black Tea Kombucha and Snake Fruit Kombucha</title>
                <p>Figure <xref ref-type="fig" rid="F1">1</xref> demonstrated the relative percentage of CD4+TNF&#x3B1;+, CD8+TNF&#x3B1;+, CD4+IFN&#x3B3;+, and CD8+IFN&#x3B3;+. Statistical tests noted that both <italic>Salmonella typhi</italic> infection and kombucha treatment did not reveal a significant effect on the relative percentage of CD4+TNF&#x3B1;+ and CD8+IFN&#x3B3;+.</p>
                <fig id="F1" position="float">
                    <label>Figure 1</label>
                    <caption>
                        <p>Flow cytometry analysis of CD4+TNF&#x3B1;+, CD8+TNF&#x3B1;+, CD4+IFN&#x3B3;+, and CD8+IFN&#x3B3;+.</p>
                    </caption>
                    <graphic xlink:href="PSJFS-14-1-995_F1.jpg"/>
                </fig>
                <p>TNF&#x3B1; is an important cytokine produced in response to acute inflammation response stimulated by lipopolysaccharide. TNF&#x3B1; is needed to reduce pathogenic bacteria infection by inhibiting cell replication and destroying the infected cell. In the case of <italic>Salmonella typhi</italic> infection, TNF&#x3B1;+ mainly produced by CD8+ (<xref ref-type="bibr" rid="b24">Oppenheim and Ruscetti, 2003;</xref> <xref ref-type="bibr" rid="b8">Bhuiyan et al., 2014</xref>). (<xref ref-type="bibr" rid="b9">Buttler and Girard 1993</xref>) reported that TNF, IL-1, and IL-6 were increased as the response to <italic>Salmonella typhi</italic> infection. But, in this study we noticed that TNF&#x3B1; producing CD8+ has decreased. It is predicted that 3 – 7 days post-infection, macrophage effectively kill <italic>Salmonella typhi</italic> and eliminate dead cell (<xref ref-type="bibr" rid="b18">Keuter, 1998</xref>), thus the expression of CD8+TNF&#x3B1;+ were lower (for instance, in the infected group), thus it can be inferred that both kombuchas have immunostimulant activity toward CD8+TNF&#x3B1;+.</p>
                <p>Also, we revealed an immunosuppressant activity by both black tea kombucha and snake fruit kombucha. On the other hand, the non-infected group of mice treated with kombucha showed a lower CD8+TNF&#x3B1;+ relative percentage than the normal group. This may be due to bioactive components like flavonoid that causes lower expression of NF-kB transcription, followed by lower pro-inflammation cytokine production such as IL-17, IFN&#x3B3;, and TNF&#x3B1; (<xref ref-type="bibr" rid="b27">Saini, Sivanesan and Keum, 2016</xref>).</p>
                <p>IFN&#x3B3; is mainly produced by T- lymphocyte cells (CD4+ and CD8+) and natural killer cells which are activated as a response to antigen. High production of IFN&#x3B3; increased the efficiency of macrophage to scavenge and kill microbes, initiate Th1 development, increase natural killer cells activity to lyse infected cell, increase MHC I expression which is needed by CD8+ to identify antigen, and increase MHC II expression to enhance the antibacterial activity (<xref ref-type="bibr" rid="b24">Oppenheim and Ruscetti, 2003;</xref> <xref ref-type="bibr" rid="b28">Samuel, 2001</xref>).</p>
                <p>Several immunological studies noted an increased level of IFN&#x3B3; especially by CD4+ cells as a response to <italic>Salmonella typhi</italic> infection (<xref ref-type="bibr" rid="b29">Sheikh et al., 2011</xref>). In this study, the population of IFN&#x3B3; was decreasing compared to the normal group. Both black tea kombucha and snake fruit kombucha reported raising the population of CD4+IFN&#x3B3;+ in which can be an alternative way to overcome the infection of <italic>Salmonella typhi</italic> since increasing IFN&#x3B3;+ correlates to increasing activity of macrophage (<xref ref-type="bibr" rid="b1">Abbas, Lichtman and Pilai, 2007</xref>).</p>
                <p>Flavonoids also are known to have the ability to induce secretion of cytokines related to CD4+ cells and modulate its regulation by IL-2 production and increase CD8+ production (<xref ref-type="bibr" rid="b21">Lyu and Park, 2005</xref>). Moreover, IL-2 is known to trigger CD8+ activation to produce perforin and grazin to support CD8+ function in destroying infected cells and <italic>Salmonella typhi</italic> antigen. Flavonoids are recognized to have immunostimulant activity by affecting macrophage and T cell and eliminate an infection. Flavonoids were able to activate the natural killer cell to trigger the production of IFN&#x3B3; and increase the phagocytosis activity of macrophage. Also, phenols were proclaimed to initiate the production of IL-12 which activate natural killer cells to produce IFN&#x3B3; and furtherly activate macrophage to kill antigen through the mechanism of oxygen-dependent- and oxygen-independent- (<xref ref-type="bibr" rid="b1">Abbas, Lichtman and Pilai, 2007;</xref> <xref ref-type="bibr" rid="b2">Amit et al., 2017;</xref> <xref ref-type="bibr" rid="b32">Sulistiani and Rahayuningsih, 2015;</xref> <xref ref-type="bibr" rid="b26">Ramadhan, Mahfudh and Sulistyani, 2020</xref>).</p>
            </sec>
        </sec>
        <sec sec-type="conclusion">
            <title>CONCLUSION</title>
            <p>Snake fruit kombucha triggers higher changes in chemical parameters during the fermentation process when compared to black tea kombucha. Moreover, snake fruit kombucha has higher bioactive components at the end of fermentation compared to black tea kombucha. Both products have the potential to be utilized as an immunomodulator to circumvent the unstable conditions of the immune system caused by <italic>Salmonella typhi</italic>.</p>
        </sec>
    </body>
    <back>
        <ack>
            <title>Acknowledgments:</title>
            <p>This research was financially supported by Brawijaya University through Professor Research Grant with contract number of 2571/UN10.F10/PN/2019.</p>
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