Browsing by Author "Montenegro, Gloria"
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- ItemAntibacterial potential assessment of Nalca (Gunnera tinctoriaMol.) ethanolic extracts(2021) Velasquez, Patricia; Riquelme, Karla; Leyton, Felipe; Giordano, Ady; Gomez, Miguel; Montenegro, GloriaNalca is an edible rhubarb-type plant from the southern of Chile; with studies focussing on petiole chemical and biological properties. This work evaluated for the first time the antibacterial capacities of three organs of nalca againstEscherichia coli,Staphylococcus aureusandPseudomonas aeruginosa. Petiole (P), root (R) and flower (F) ethanolic extracts at three different concentrations (25, 50, 100 mg/mL) were evaluated by means of agar diffusion assay and MIC. The result showed that antibacterial activities are bacteria and concentration dependent, with root having the highest antimicrobial activity of the organs plant studied. Compared to commercial antibiotics, nalca extracts show promising control overPs. aeruginosa. The main polyphenolics of the extracts were identified by UPLC-MS/MS, observing for the first time caffeic, coumaric and gallic acids presence in all samples, with quercetin and rutin determined in petiole and flower extracts only. Our results contribute to better understanding of nalca attributes as potential source of antibacterial compounds to be used in nutraceutical, cosmetic and food industry.
- ItemAntioxidant Effect of Extracts from Native Chilean Plants on the Lipoperoxidation and Protein Oxidation of Bovine Muscle(2019) Bridi, Raquel; Giordano, Ady; Penailillo, Maria Fernanda; Montenegro, GloriaThe present study investigated the antioxidant potential and the ability to inhibit lipid and protein oxidation in bovine meat of four native Chilean species: canelo (Drimys winteri), nalca (Gunnera tinctoria), tiaca (Caldcluvia paniculata), and ulmo (Eucryphia cordifolia). Phenolic acids (gallic, chlorogenic, caffeic, and coumaric) and flavonoids (catechin, epicatechin, and rutin) were identified and quantified by HPLC-MS/MS. Drimys winteri extract exhibited the highest antioxidant capacity evaluated by oxygen radical absorption capacity-red pyrogallol method (ORAC-PGR) and ferric ion reducing antioxidant power (FRAP) assays. All extracts decreased lipid oxidation induced by 2,2'-azo-bis(2-amidinopropane) dihydrochloride (AAPH) derived peroxyl radicals by anywhere between 30% and 50% the. In addition, canelo and nalca extracts decreased spontaneous oxidation by around 57% and 37% in relation to the control group, being even more efficient than butylated hydroxyanisole (BHT) a synthetic antioxidant. Protein oxidation in the myofibrillar proteins was evaluated by the formation of protein carbonyls and loss of protein thiols. The canelo, ulmo, and nalca extracts decreased the formation of carbonyls by around 30%. Plant extracts and BHT did not show an antioxidant effect on protein thiol loss. However, tiaca and ulmo extracts exerted a pro-oxidant effect, favoring the oxidation of sulfhydryl groups. The oxidizing system induced structural changes in myofibrillar protein (SDS-PAGE). A protective effect on protein structure from the canelo extract can be observed during the incubation when compared to samples incubated with AAPH.
- ItemAplicación de la Norma Chilena Oficial de denominación de origen botánico de la miel para la caracterización de la producción apícola.(2008) Montenegro, Gloria; Gómez, Miguel; Díaz-Forestier, Javiera; Pizarro, Rodrigo
- ItemBiological activity of native Myrtaceae fruits from Chile as a potential functional food(2022) Velasquez, Patricia; Orellana, Jocelyn; Munoz-Carvajal, Eduardo; Faundez, Mario; Gomez, Miguel; Montenegro, Gloria; Giordano, AdyMyrtaceae fruits (Myrceugenia obtusa, Luma apiculata, and Luma chequen) were used as food and medicine by Chilean indigenous people. This study aimed to evaluate the bioactive properties of these berry-type fruits. The antioxidant capacity determined by the FRAP assay varied between 10.4 and 646.9 mmol Fe+2/g, while the antibacterial activity against Staphylococcus aureus and Salmonella typhi was 0 - 33 mm and 0 - 7.33 mm, respectively. All the extracts were rich in polyphenols and showed low cytotoxicity. Overall, M. obtusa presented dissimilar results compared to those of L. apiculata and L. chequen, encouraging the use of these native fruits as food, nutraceutical, or pharmacological ingredients.
- ItemBiological applications of honeys produced by Apis mellifera(2013) Montenegro, Gloria; Mejias, EnriqueHoney is a natural product with many attributes that are useful for humans. The consumption of honey is increasing because of its beneficial biological properties, including antioxidant and antibacterial activities. Even though honey is produced worldwide, many variants of this product have not been studied and their biological potential for alternative uses has not been evaluated. Because of its varied endemic native flora, Chile produces several types of honey. It is likely that these apian products have important biological properties inherited from specific floral sources, but it is absolutely necessary to conduct further chemical analyses to identify and characterize these biological attributes. Sadly, the potential antimicrobial and antitumor activities of Chilean honeys remain unproven at the present time. Further studies are needed to identify these attributes. In addition, the impact of human activities on the natural production of honey by bees should be considered. The use of honey as an environmental marker of pollution should also be considered, and care must be taken to diminish the effect of industry and human procedures on natural environments
- ItemBiological capacities of seven Chilean ferns(2024) Velasquez, Patricia; Trucco, Josefina; Munoz-Carvajal, Eduardo; Bustos, Daniela; Viteri, Rafael; Montenegro, Gloria; Giordano, AdySticherus squamulosus, Hymenophyllum dentatum, Blechnum microphyllum, Polypodium Feuillei, Blechnum chilense, Lophosoria quadripinnata, and Lissopimpla excelsa are native fern species found in southern Chile and are often used in traditional medicine. However, their bioactive properties have not been confirmed. In this study, ethanolic extracts of ferns exhibited significant antibacterial capacity against human pathogens. H. dentatum and S. squamulosus were selected for further analysis owing to their antimicrobial and antioxidant capacities. The entire H. dentatum extract exhibited fungistatic and fungicidal capacity on Botrytis cinerea and Penicillium digitatum, with minimum inhibitory concentration values of 1.56 mg/mL and 6.25 mg/mL and minimum fungicidal concentration values of 6.25 mg/mL and 12.5 mg/mL, respectively. The S. squamulosus extract presented the highest rutin content (222.5 mu g/g fern). In addition, the ethanolic extract of H. dentatum inhibited 91% of DPPH radicals. Therefore, both types of ferns can be used in the food industry.
- ItemBiological properties of the Chilean native moss Sphagnum magellanicum(2009) Montenegro, Gloria; Portaluppi, Mariana C.; Salas, Francisco A.; Diaz, Maria F.An ethanol extract prepared from the gametophyte Chilean native moss Sphagnum magellanicum was dried out, weighed and dissolved in distilled water. This extract was then assayed for its antibacterial activity against the G(-) bacteria Azotobacter vinelandii, Erwinia carotovora subsp. carotovora, Enterobacter aerogenes, Escherichia coli, Pseudomonas aeruginosa, Salmonella typhi, Vibrio cholerae, and the G(+) bacteria Staphylococcus aureus subsp. aureus, and Streptococcus type beta. The growth of the cultures of E. caraotovora subsp. carotovora, and V. cholerae was inhibited at a concentration of 581 mu g/ml of extract, while the cultures of E. coli, S. typhi and Streptococcus type beta were inhibited at a concentration of 1.16 mu g/mL of extract. The concentration of phenolic compounds was 4.294 mg/mL; the presence of vanillic, chlorogenic, syringic, caffeic, gallic, 3-4 hydrozybenzoic, p-coumaric and salicylic acids was identified using RP-High Pressure Liquid Chromatography.
- ItemBioprospecting, a tool to conserve Chilean bryophytes(2013) Cuvertino-Santoni, Jorge; Montenegro, GloriaHere, we present the current state of knowledge on the diversity of Chilean bryophytes (mosses, liverworts, and hornworts), the secondary metabolites present in these plants, and the biological activity of extracts from populations of Chilean species. Our goal is to establish the potential of these plants as a source of useful molecules for pharmaceutical and agricultural industries, thus promoting their conservation. Only 3,7% of Chilean bryophytes (55 spp.) have been analyzed using chemical characterization of their extracts (methanol, ether, ethanol, dichloromethane, acetone and hexane). Only four species from Chilean and Argentinian populations (Porella chilensis (Lehm. & Lindenb.) Trevi., Riccardia polyclada (Mitt. ex Thurn) Hassel, Balantiopsis cancellata (Nees) Stephani, and Sphagnum magellanicum Brid.) have been evaluated for biological activity. The majority of these studies have concentrated on liverworts widely distributed in the Southern Hemisphere and in the temperate forests of the southern half of Chile and adjacent Argentina. We briefly discuss aspects related to the use of bioprospecting as a conservation tool as well as the maintenance of in vitro bryophyte cultures with the goal of conservation and production.
- ItemChanges in the antibacterial capacity of Ulmo honey in relation to the contribution of Eucryphia cordifolia pollen(VUP FOOD RESEARCH INST, BRATISLAVA, 2021) Montenegro, Gloria; Velasquez, Patricia; Viteri, Rafael; Giordano, AdyUlmo honey is known for its antibacterial characteristics. However, the importance of the content from Eucryphia cordifolia in the honey regarding its non-peroxidic antibacterial capacity is unknown. The present work evaluated the antibacterial activity of Ulmo honey with various percentages of pollen from E. cordifolia against various bacteria, determine the non-peroxidic capacity of Ulmo honey and, finally, compare that capacity with Manuka and Jarrah honeys. The antibacterial activity was evaluated by agar diffusion test and the non-peroxide capacity was evaluated by the reactivity with the catalase enzyme. The tests were carried out against Escherichia coli, Staphylococcus aureus and Streptococcus pyogenes. The results showed a relationship between the percentage of floral pollen from E. cordifolia and the antibacterial activity of Ulmo honey. It was also observed than the antibacterial activity of Ulmo honey can have values similar to Manuka and Jarrah honeys.
- ItemCharacterisation of seed dormancy of 12 Chilean species of Nolana (Solanaceae) from the coastal Atacama Desert(CAMBRIDGE UNIV PRESS, 2021) Hepp, Josefina; Gomez, Miguel; Leon Lobos, Pedro; Montenegro, Gloria; Vilalobos, Luis; Contreras, SamuelThe genus Nolana (Solanaceae) comprises numerous species endemic to the coastal Atacama Desert of Chile and Peru of high ornamental potential and conservation value. The environments in which these species have evolved and are present today correspond to particular conditions in the midst of a hyper-arid habitat, so the study of their germination requirements and characterisation of seed dormancy becomes important in terms of conservation but also for ecological and evolutionary purposes. Different treatments were performed on mericarps of 12 species of Nolana: control (intact seeds imbibed in distilled water), scarification in funicular plug and distilled water and scarification in funicular plug and addition of GA(3) (500 ppm); their permeability to water was also tested. It was determined that the species did not present physical dormancy, as had been previously reported, but rather physiological dormancy (PD). Germination results after treatments were not homogeneous among all 12 species, indicating differences in their dormancy levels. Also, the important role of the endosperm in the prevention of germination for the studied Nolana species was highlighted. Regarding the relationship between the level of PD (expressed as the percentage of germination for the most successful treatment) and the latitudinal distribution of the species or their phylogenetic closeness, it was determined that, for the studied species, their proximity in terms of clades was more relevant than their latitudinal distribution.
- ItemChemical and botanical characterization of Chilean propolis and biological activity on cariogenic bacteria Streptococcus mutans and Streptococcus sobrinus(2013) Barrientos, Leticia; Herrera, Christian L.; Montenegro, Gloria; Ortega, Ximena; Veloz, Jorge; Alvear, Marysol; Cuevas, Alejandro; Saavedra, Nicolas; Salazar, Luis A.Propolis is a non-toxic natural substance with multiple pharmacological properties including anticancer, antioxidant, fungicidal, antibacterial, antiviral, and anti-inflammatory among others. The aim of this study was to determine the chemical and botanical characterization of Chilean propolis samples and to evaluate their biological activity against the cariogenic bacteria Streptococcus mutans and Streptococcus sobrinus. Twenty propolis samples were obtained from beekeeping producers from the central and southern regions of Chile. The botanical profile was determined by palynological analysis. Total phenolic contents were determined using colorimetric assays. Reverse phase HPLC and HPLC-MS were used to determine the chemical composition. The minimum inhibitory concentration (MIC) was determined on S. mutans and S. sobrinus. All propolis samples were dominated by structures from native plant species. The characterization by HPLC/MS, evidenced the presence of quercetin, myricetin, kaempferol, rutine, pinocembrin, coumaric acid, caffeic acid and caffeic acid phenethyl ester, that have already been described in these propolis with conventional HPLC. Although all propolis samples inhibited the mutans streptococci growth, it was observed a wide spectrum of action (MIC 0.90 to 8.22 mu g mL(-1)). Given that results it becomes increasingly evident the need of standardization procedures, where we combine both the determination of botanical and the chemical characterization of the extracts. Research conducted to date, describes a promising effectiveness of propolis in the prevention of caries and other diseases of the oral cavity, making it necessary to develop studies to identify and understand the therapeutic targets or mechanisms of molecular action of the various compounds present on them.
- ItemChemical Evidence for the Liverwort Complex, Chiloscyphus concavus and C. horizontalis(2014) Cuvertino-Santoni, Jorge; Asakawa, Yoshinori; Peralta, Denilson F.; Montenegro, GloriaDuring the phytochemical study of Chilean liverworts from Tierra del Fuego, two species were collected, Chiloscyphus concavus (Steph.) Hassel and C. horizontalis (Hook.) Nees. Their crude extracts, when analyzed by TLC and GC-MS, showed identical phytochemical profiles. In view of the macro- and micro-morphological differences used for the separation of both species, and the chemical evidence here presented, we conclude that variety is the more appropriate status for C. concavus.
- ItemChilean native species as source of natural polyphenols(CABI, 2013) Fredes, Carolina; Montenegro, Gloria; Céspedes, Carlos L.; Sampietro, Diego A.; Sigler, David; Rai, MahendraThis chapter discusses the traditional uses of native medicinal plants from Chile and provides tabulated data on Chilean medicinal plants, including the parts used and their effects, in order to analyse compounds that could be responsible for these medicinal effects. It presents scientific evidence supporting biological activity associated with the presence of polyphenols in Chilean plants. The determination of polyphenols in Chilean plants and their antioxidant capacity are described. The main factors affecting polyphenol content in plants are also mentioned, i.e. genotype, environment, storage and processing, and stage of harvest.
- ItemComparison of volatile compounds in Retanilla trinervia [Gillies & Hook] Hook & Arn honeys from central Chile(2015) Montenegro, Gloria; Santander, Francisca; Nunez, Gabriel; Fredes, CarolinaThe search for chemical markers for determining honey authenticity as a complementary tool for melissopalynological method is an important issue in the study of honeys from different botanical origins. The objective of this study was to determine the volatile compounds in tevo (Retanilla trinervia [Gillies & Hook] Hook & Arn [Fam. Rhamnaceae]) honey as one of the most relevant honeys from central Chile. For the identification and quantification of volatile compounds, Solid-Phase Microextraction and Gas Chromatography with Mass Spectrometry (SPME-GC-MS) was performed. A total of 28 out of 103 volatile compounds were found common to the five tevo honeys analyzed. Nevertheless, these compounds are common in unifloral honey of different floral sources from other countries. These results represent the first record in the identification of volatile compounds in tevo honey and would indicate that tevo honey does not present specific volatile compounds that allow its clear differentiation from other unifloral honey.
- ItemCONTENT OF HEAVY METALS IN SOILS NEAR A CHILEAN COPPER MINING TAILING(2009) Montenegro, Gloria; Fredes, Carolina; Mejias, Enrique; Bonomelli, Claudia; Olivares, LuisIn Chile, heavy metals pollution occurs mainly near copper mines in the northern and central regions of the country. Here, agricultural soils have been found to be polluted by heavy metals several kilometers from the source. The objective of this study was to analyze the contents of Fe, Cu, Mn, Zn, Cr, Cd and Pb and chemical variables (pH, EC, OM and CEC) of soils found near copper mine tailing in the north of the country. Available heavy metals were determined using AAS, and total heavy metals were determined with ICP-OES. Soils were grouped into three sectors, according to their proximity to the tailing, the course of an estuary, and the direction of the wind. Cu was the heavy metal found in the highest average concentrations relative to the rest of the elements determined. The samples that followed the course of the estuary had the highest average contents of Cu, with significant (p <= 0.05) statistical differences from the other sectors. Principal components analysis of the heavy metal contents of the 24 samples analyzed indicated that three principal components explained 75.5% of the data variability. In the dispersion graph of the first two components, a group of soils close to the interception axis and four distant soils, which had the highest contents of Fe (276.6 mg kg(-1)), Cu (375.1 mg kg(-1)), Mn (56.7 mg kg(-1)), Zn (21.7 mg kg(-1)), Cr (45.0 mg kg(-1)) and Pb (129.3 mg kg(-1)), are observed.
- ItemEucryphia cordifolia extracts: Phytochemical screening, antibacterial and antioxidant activities(2021) Viteri, Rafael; Giordano, Ady; Montenegro, Gloria; Zacconi, Flavia C. M.Eucryphia cordifolia is a native and dominant species from the Temperate Forest in the southern region of Chile. It is a crucial melliferous species producing unifloral honey with outstanding antibacterial properties with great commercial value at international markets. A phytochemical screening was developed by colorimetric and gravimetric methods. Antioxidant activities were assessed by using 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS), and ferric ion reducing antioxidant power (FRAP) method. The minimum bactericidal concentration (MBC) was the method used to determine the antibacterial activity. The results revealed the highest antioxidant activity for the methanolic extracts of branches (IC50 35.7 mu g/mL for DPPH, IC50 11.0 mu g/mL for ABTS, and 4.6 mM FeSO4 center dot 7H(2)O/g in FRAP), attributed to its high content of total phenols (332.8 mg GAE/g). The quantification of the MBC led to values in the range of 0.78-12.5 mg/mL for S. aureus and S. pyogenes, and 6.25-50 mg/mL for E. coli and P. aeruginosa, respectively. The presented work provides valuable first in vitro evidence regarding the potential application of E. cordifolia extracts as antioxidants and antibacterial agents in the nutraceutical and phytopharmaceutical industry.
- ItemExudate and Propolis from Escallonia pulverulenta: Phytochemical Characterization and Antibacterial Activity(2024) Jorquera, Bairon; Valenzuela-Barra, Gabriela; Mayorga, Ailin; Mejia, Jessica; Nunez, Gabriel; Gomez, Miguel; Montenegro, Gloria; Quezada, Waleska E. Vera; Echeverria, Javier; de Camargo, Adriano Costa; von Poser, Gilsane Lino; Bridi, RaquelPropolis is a complex mixture formed from exudates that bees collect from plants and then mix with beeswax and their own salivary enzymes. Chilean propolis is characterized by the presence of phenolic compounds, which are considered responsible for the biological activities. The endemic species Escallonia pulverulenta (Ruiz and Pav.) Pers. [Escalloniaceae] is a recognized source of exudate to produce propolis. This study reports for the first time the chemical profile and antibacterial activity of E. pulverulenta exudate and leaves, as well as two samples of Chilean propolis. Palynological and morphological analysis showed the presence of E. pulverulenta as one of the main species in the propolis samples. UPLC-MS/MS analyses enabled the identification of phenolic acids in the leaves and in the propolis. Conversely, flavonoids are mainly present in exudates and propolis. Quercetin is the most abundant flavonol in the exudate, with similar concentrations in the propolis samples. Nevertheless, the main compound present in both samples of propolis was the flavanone pinocembrin. The antibacterial results obtained for exudate and propolis have shown a similar behavior, especially in the inhibition of Streptococcus pyogenes. These results show the importance of the exudates collected by the bees in the chemical composition and antibacterial capacity of propolis.
- ItemFloral Pollen Bioactive Properties and Their Synergy in Honeybee Pollen(2023) Velásquez, Patricia; Muñoz-Carvajal, Eduardo; Grimau, Lissette; Bustos, Daniela; Montenegro, Gloria; Giordano, AdyVelásquez, Patricia; Muñoz-Carvajal, Eduardo; Grimau, Lissette; Bustos, Daniela; Montenegro, Gloria; Giordano, AdyHoneybee pollen (HBP) is a mixture of floral pollen collected by honeybees near the hive. It is characterized by a composition rich in phenolic compounds, carotenoids and vitamins that act as free radicals scavengers, conferring antioxidant and antibacterial capacity to the matrix. These bioactive properties are related to the botanical origin of the honeybee pollen. Honeybee pollen samples were collected from different geographical locations in central Chile, and their total carotenoid content, polyphenols profile by HPLC/MS/MS, DPPH radical scavenging capacity, and antimicrobial capacity against S. pyogenes, E. coli, S. aureus, and P. auriginosa strains were evaluated. Our results showed a good carotenoids content and polyphenols composition, while antioxidant capacity presented values between 0–95 % for the scavenging effect related to the botanical origin of the samples. Inhibition diameter for the different strains presented less variability among the samples, Furthermore, binary mixtures representing the two most abundant species in each HBP were prepared to assess the synergy effect of the floral pollen (FP) present in the samples. Data shows an antagonist effect was observed when assessing the carotenoid content, and a synergy effect often presents for antimicrobial and antioxidant capacity for bee pollen samples. The bioactive capacities of the honeybee pollen and their synergy effect could apply to develop new functional ingredients for the food industry.
- ItemGenetically modified crops in Chile(2009) Salazar, Erika; Montenegro, GloriaE. Salazar, and G. Montenegro. 2009. Genetically modified crops in Chile. Cien. Inv. Agr. 36(3): 353-368. The economical, environmental and social impacts associated with genetically modified (GM) crops are supported by the increased use of GM species by farmers. This increase in the use of GM species has included a global increase in both the number of hectares with GM crops and the number of countries using this technology. However, the use of GM crops has some drawbacks, due to the environmental risks associated with some of the events and social risks related to intellectual property rights issues and the monopoly associated with this technology. An overview of the current status of the use of GM crops in relation to the production, benefits, associated risks, intellectual property rights, legislation and regulatory framework is presented, focusing in the situation of ties crops in Chile.
- ItemHoneybee Pollen From Southern Chile: Phenolic Profile, Antioxidant Capacity, Bioaccessibility, and Inhibition of DNA Damage(2022) Bridi, Raquel; Echeverria, Javier; Larena, Arturo; Nunez Pizarro, Paula; Atala, Elias; De Camargo, Adriano Costa; Oh, Won Young; Shahidi, Fereidoon; Garcia, Olga; Ah-Hen, Kong S.; Montenegro, GloriaHoneybee pollen (HBP) chemical composition is highly variable conforming to the floral and geographical origin of the pollen grains. The beneficial effects and functional properties of the HBP are well-known and have been mainly attributed to their high content of antioxidant polyphenols. In this work, twelve HBPs samples from the Southern region of Chile (X Region de Los Lagos) were characterized for the first time according to their botanical origin, phenolic composition, and antioxidant activity. The in vitro gastrointestinal digestion assay was done to simulate the human upper digestive tract. Selected honeybee pollen extracts (HBPEs) were assessed as bioaccessible fractions during an in vitro gastrointestinal digestion. Contents of phenolic compounds, antioxidant capacity, and recovery index of quercetin, myricetin, and cinnamic acid were monitored in different steps of gastrointestinal digestion. Furthermore, the protective effect of in vitro digested HBP towards DNA damage induced by peroxyl radicals was evaluated. The introduced species Brassica rapa L. (Brassicaceae), Lotus pedunculatus Cav. (Fabaceae), and Ulex europaeus L. (Fabaceae) predominated in all the HBPs analyzed, while the native species Buddleja globosa Hope (Scrophulariaceae), Luma apiculata (DC.) Burret (Myrtaceae), Embothrium coccineum J.R. Forst. & G. Forst. (Proteaceae) and Eucryphia cordifolia Cav. (Cunoniaceae) appeared less frequently. The content of polyphenols and antioxidant capacity in HBPEs achieved full bioaccessibility at the end of the intestinal digestion step. However, results obtained by a state-of-the-art technique (i.e. HPLC-DAD) demonstrated relatively low values of bioaccessible quercetin and cinnamic acid after the digestion process. In contrast, myricetin showed a high bioaccessibility in the intestinal digestion steps. The protective effect of in vitro digested HBP towards DNA damage induced by peroxyl radicals showed promising results (up to 91.2% protection). In conclusion, HBPs from the X Region de Los Lagos are rich sources of phenolic antioxidants that protect DNA from strand breakage. Therefore, the potential of HBPEs in preventing gastric and/or intestinal cancer should be further considered.