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Received: 2023/11/2 | Accepted: 2024/01/10 | Published: 2024/02/21
Received: 2023/11/2 | Accepted: 2024/01/10 | Published: 2024/02/21
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Nouripour-Sisakht S, Diba A, Razmjoue D, Sadeghi Mansourkhani H, Zanganeh P, Salahi M et al . Comparing the Anticandidal Activities of Salvia macrosiphon essential oil and Fluconazole. J Clinic Care Skill 2024; 5 (1) :5-9
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S. Nouripour-Sisakht1, A. Diba1, D. Razmjoue1, H. Sadeghi Mansourkhani1, P. Zanganeh1, M. Salahi1, M. Gharaghani *1
1- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Introduction
Candidiasis is the most opportunistic infection and causes a variety of clinical forms. This infection may be superficial (e.g., oral, nail), mucocutaneous (e.g., vaginal), or systemic (e.g., candidemia, candiduria) [1]. Different species of Candida have been introduced as agents of candidiasis such as C. albicans, C. glabrata, C. tropicalis, C. krusei, and C. dubliniensis [2]. Although C. albicans is the most common cause of the disease, the prevalence of non-albicans species is also increasing [3]. Even though common C. albicans infections are easily treatable, systemic infections, frequently nosocomial, have a high mortality rate. Therefore, early diagnosis and management of infection are necessary [4]. There are different classes of antifungal drugs and uses for various forms of candidiasis. These drugs included azole classes (e.g., imidazole and triazole), echinocandin (e.g., caspofungin), and polyene (e.g., amphotericin B) [5]. Fluconazole is one of the triazole drugs and is widely used in mucocutaneous and systemic forms of candidiasis. In the past two decades, several genes and mutations that increase resistance to fluconazole in clinical isolates, primarily in C. albicans, have been elucidated [6].
The use of herbal plants and their products has been considered for a long time. Some properties, such as ease of access, lack of side effects, and drug resistance, have always caused these compounds to be used to treat various diseases. The genus of Saliva belongs to the Lamiaceae family and possesses more than 100 species. Many countries have been introduced as the inhabitants of this genus [7]. Iran is also an endemic region of this genus, with 61 flora species in it [8]. Generally, Saliva species are used in foods, cosmetics, perfumery, and pharmaceutical industries. Salvia macrosiphon) S. macrosiphon), known as Maryam Goli Lolei or Marvak in Persian, has been used in traditional medicine. This species is the most valuable type of the Lamiaceae family and has therapeutic effects. The habitant of this species is in Iran and Afghanistan, and due to its essential oil and tannin, its leaves have a strengthening and tonic effect; in addition, they facilitate digestion, are diuretic, anticonvulsant, antipyretic, and reduce blood sugar. It is used externally to heal and disinfect wounds [9]. Some fractions of S. macrosiphon have been introduced as antibacterial agents. For instance, the antibacterial effects of the plant's n-hexane, chloroform, and ethyl acetate fractions on Staphylococcus aureus and E. coli were tested in one study, and the results showed good activity with MIC values ranging from 0.61 to 2.5mg/mL [10]. Today, the problem of resistance of Candida species to existing chemical drugs, as well as complications and high cost of chemical drugs, is observed, and there is a tendency to use medicinal plants as medicinal and antifungal compounds [11].
Therefore, this study aimed to investigate the chemical composition of essential oil from leaves of Salvia macrosiphon and compare its antifungal activity with fluconazole.
Materials and Methods
Design and samples
This study was designed based on the clinical laboratory research method from 2021 to 2022. Fifty-six C. albicans isolates were collected from the patient's samples, including vulvovaginal swabs, ear swabs, and blood and urine specimens studied.
Plant material
The aerial parts of S. macrosiphon were collected. The identification process was done and approved in the Kerman Agriculture and Natural Resources Research and Education Center, and the herbarium number was obtained (herbarium number: 17714). The aerial parts were crushed and dried at room temperature. 200g of dried powder mixed with 1L of distilled water and the essential oil hydrodistilled in a Clevenger apparatus according to the British method for 3h. Finally, the essential oil was preserved at 4ºC in a dark condition until other steps.
Gas chromatography/Mass spectrometry
The GC/MS method was used to analyze the components of the essential oil of the S. macrosiphon fruit at Kashan University of Medical Sciences. Chromatography instrument Model 6890 (Agilent; United States) and mass spectrometry were used for qualitative and quantitative measurements of compounds. The temperature was set at 60°C, then raised to 246°C at a rate of 3°C. The combination of gas chromatography and mass spectrometry characteristics is used to identify different substances present in a sample.
Antifungal susceptibility test
Preparation of Candida isolate
56 C. albicans (including 15 blood cultures, 40 vulvovaginitis, recurrent vulvovaginitis, and 1 otomycosis isolates), 12 C. glabrata (6 vulvovaginitis, 6 urine culture isolates), 12 C. parapsilosis (3 blood cultures, 9 otomycosis isolates) were studied. Candidal isolates were collected from the patient's samples (vulvovaginal swabs, ear swabs, and blood and urine specimens). Vaginal samples were taken from suspected patients with VVC that had been referred to gynecology and (obstetrics) private midwifery clinics in Yasuj, Iran, from 2021 to 2022. Other samples, including blood culture, urine, and ear swabs, were referred to the Yasuj University of Medical Science medical school and identified based on molecular methods. All Candida isolates were subculture on Sabouraud Dextrose Agar (Biolife; India) and incubated at 37°C. Then fresh isolates were used for other steps.
Determination of minimum inhibitory concentration (MIC)
An antifungal susceptibility test was carried out based on CLSI-M27-A3 guidelines [12]. Fungal suspensions were prepared by fresh colonies and distilled water and standardized using a Model 6320D Spectrophotometer (JENWAY; China) in 530nm and 75-77 transmittance. For broth microdilution processes, essential oil and fluconazole were diluted in RPMI 1640, and 100µL of each diluted solution was added to the 96-well microtiter plate. The standard fungal suspensions were also diluted 1:1000 in RPMI 1640 medium and added to each well. All microplates were incubated at 37°C for 24-48h. Growth inhibition was determined after the incubation period and compared with positive control.
Statistical analysis
Data were entered into Excel 2016 and analyzed in SPSS 16 software using descriptive statistics, and the Wilcoxon test was calculated. Also, the data distribution was checked using the Shapiro-Wilk and Kolmogorov-Smirnov tests, and it was not normal in any of the groups. Due to non-normality, non-parametric tests were used for data analysis.
Findings
Overall, 29 components were identified in the leaf essential oil (Table 1). The main constituents of the oil were Butyl benzoate (49.16%), n-hexyl benzoate (7%), Isospathulenol (4.8%), Cyperene (4.1%), Benzoic acid, 2-methyl-, butyl ester (3.88%), beta-caryophyllene (3.54%), and β-Elemene (3.02%).
Table 1. Chemical component of Saliva macrosiphon
Antifungal activities
According to the MIC value S. microsiphon had a better effect against different Candida species. Besides, the MIC value range was lower in non-albicans species (0.039-0.15µl/ml) than C. albicans (0.039-2.5µl/ml). Based on MIC90, fluconazole had poor activity against C. glabrata isolates (7.6µg/ml). However, a comparison of MICGM between S. macrosiphon and fluconazole revealed that only C. parapsilosis had this value lower in fluconazole (0.088µg/ml). Statistical analysis showed a significant difference between the mean of fluconazole and essential oil in total Candida isolates (p=0.001; Table 2).
Table 2. Minimum inhibitory concentration range, MIC50, MIC90, and MICGeoMean (MICGM) of S. macrosiphon compared with fluconazole against Candida species
A mean and standard deviation comparison showed that Candida isolates in S. macrosiphon essential oil were lower than fluconazole (Table 3). The difference in antifungal activity between S. macrosiphon essential oil and fluconazole was significant in all Candida species (p<0.05).
Table 3. Comparison of the mean of different Candida species in two essential oil and fluconazole groups (Wilcoxon test)
Discussion
Candidiasis is the most opportunistic infection, and its treatment has always been challenging [13]. The drug resistance of Candida isolates which are sometimes intrinsic and mostly acquired, has made it difficult to treat patients [14]. Therefore, choosing a suitable drug with the lowest cost and no recurrence of infection has always been desired. Herbal medicines with low side effects and availability have long been interesting [15]. In this study, the essential oil of S. macrosiphon was analyzed using the GC-MS method, and its constituent elements were determined. The most compounds in this essential oil are butyl benzoate (49.16%), n-hexyl benzoate (7%), isopatolenol (4.83%), cuprene (4.10%), benzoic acid 2-methyl-1-butyl ester (3.88%), linalool (3.31%), beta-caryophyllene (3.54%), and beta-Elemene (3.02%). Various studies investigated the main compounds found in different species of Saliva. For example, in the study, Sajadi et al. proved the presence of at least forty-six compounds in the essential oil of S. macrosiphon. Among these compounds, beta-pinene (15.3%), germacrene-di (10.1%), spatholenol (7.7%), and 1 and 8-cineole (7.4%) were the main compounds in the essential oil of S. macrosiphon [16]. Also, in the study conducted by Taari et al., the most important components of the essential oil of this plant, 9- and 8-cineole, alpha-thujone, viridiflurol, and beta-thujone, were introduced [17]. This is even though the above compounds were not detected in the present study. The difference in the composition of Salvia species essential oil can be attributed to ecological differences. The compounds in the essential oils of plants are caused by ecological differences such as latitude and longitude, altitude, temperature, humidity, climate and soil, metabolic pathways, and biosynthesis of effective substances in these plants, which result in various secondary metabolites being biosynthesized under different environmental conditions. Various studies have confirmed this. Also, in similar weather conditions, secondary compounds in different plants have similarities. Of course, the conditions and types of studies are different, which can affect the results.
The present study was done to test the antifungal activity of S. macrosiphon based on the microdilution method. In the literature, the antimicrobial activity of some genera of Salvia essential oils against microbes has been reported [9, 18]. However, the use of the broth microdilution method in the effect of antifungal activity of S. macrosiphon has been done for the first time in Iran in the present study. The results of the present study showed that the essential oil of S. macrosiphon had great activity against Candida isolates. So, the essential oil of S. macrosiphon affected the growth of C. albicans, and the MIC50 of this plant was equal to 0.78μl/ml. the MIC50 value was 1μg/ml for fluconazole against C. albicans isolates. Agreeing with the present study's results, the study conducted by Atai et al. reported MIC=1μg for Saliva species against C. albicans [19]. Also, in the study of Banaeian-Boroujeni et al., S. officinalis with a concentration of 1.25μg/ml was able to inhibit the standard strain of C. albicans [20]. However, in the study of Sookto et al., the effect of the extract and oil of several plants from the Lamiaceae family, including S. officinalis and Chamomile, on C. albicans was investigated. S. officinalis essential oil, with a concentration of 78.2mg/l, inhibited the growth of C. albicans [21]. Pozzatti et al. reported that the essential oil of S. officinalis had no effect against fluconazole resistance and susceptible C. albicans [22]. This difference between our results and Pozzatti et al., may be due to the different species of Salvia tested. Besides, the present study revealed that S. officinalis essential oil had an inhibition effect against C. glabrata isolates (MICGM=0.056μL/ml). This antifungal activity has a better inhibitory effect than fluconazole (MICGM=0.7μg/ml) against C. glabrata isolates. However, Salari et al., reported the methanolic extract of S. rhytidea had anti-fungal activity against C. glabrata isolates (MIC50=100μg/ml) [23]. Resistance to fluconazole has been reported during treating different forms of candidiasis [24, 25]. There is no study similar to the present study for the effect of S. macrosiphon on Candida isolates and its comparison with fluconazole. However, the results of the present study indicated that the MIC50 value of S. macrosiphon was lower than that of fluconazole against Candida isolates.
The mechanism of the inhibitory effect of S. macrosiphon is not clear. In one study, it was mentioned that it was probably due to the destruction of the cell wall by lipophilic compounds in this mechanism. Significant leakage of cell material indicates irreversible cell membrane damage [26]. On the other hand, the difference in the concentration of Saliva species in inhibiting the growth of Candida, which is observed in the results of various research, can be due to geophysical factors and different species of this plant or the methods of essential oil extraction, oil preparation, and laboratory methods [23, 27, 28].
One limitation of this study is the limited effect of essential oil on clinical isolates in vitro examination and the lack of simultaneous comparison in vivo conditions. Based on the results of this study, it can be hoped that recurrent candidal infections will be treated in the future with different formulations of S. macrosiphon along with antifungal drugs. However, confirmation of the present results in similar studies is necessary. Therefore, in future studies, this issue can also be investigated in the patient with candidiasis.
Conclusion
Saliva microsiphon has greater anticandidal activity than fluconazole. Therefore, it is hoped that it will be used as an antifungal compound in treating Candida infections in the future.
Acknowledgments: We thank Yasuj University of Medical Sciences for supporting this study.
Ethical Permissions: This study was approved with the ethical approval code of IR.YUMS.REC.1400.017.
Conflicts of Interests: The authors declare no conflict of interest.
Authors’ Contribution: Nouripour-Sisakht S (First Author), Methodologist/Discussion Writer (25%); Diba A (Second Author), Introduction Writer (10%); Razmjoue D (Third Author), Main Researcher (10%); Sadeghi Mansourkhani H (Fourth Author), Introduction Writer (10%); Zanganeh P (Fifth Author), Main Researcher (10%); Salahi M (Sixth Author), Introduction Writer (10%); Gharaghani M (Seventh Author), Assistant Researcher/Discussion Writer (25%)
Funding/Support: This work was financially supported by Yasuj University of Medical Sciences, Iran (grant No. 990241).
Candidiasis is the most opportunistic infection and causes a variety of clinical forms. This infection may be superficial (e.g., oral, nail), mucocutaneous (e.g., vaginal), or systemic (e.g., candidemia, candiduria) [1]. Different species of Candida have been introduced as agents of candidiasis such as C. albicans, C. glabrata, C. tropicalis, C. krusei, and C. dubliniensis [2]. Although C. albicans is the most common cause of the disease, the prevalence of non-albicans species is also increasing [3]. Even though common C. albicans infections are easily treatable, systemic infections, frequently nosocomial, have a high mortality rate. Therefore, early diagnosis and management of infection are necessary [4]. There are different classes of antifungal drugs and uses for various forms of candidiasis. These drugs included azole classes (e.g., imidazole and triazole), echinocandin (e.g., caspofungin), and polyene (e.g., amphotericin B) [5]. Fluconazole is one of the triazole drugs and is widely used in mucocutaneous and systemic forms of candidiasis. In the past two decades, several genes and mutations that increase resistance to fluconazole in clinical isolates, primarily in C. albicans, have been elucidated [6].
The use of herbal plants and their products has been considered for a long time. Some properties, such as ease of access, lack of side effects, and drug resistance, have always caused these compounds to be used to treat various diseases. The genus of Saliva belongs to the Lamiaceae family and possesses more than 100 species. Many countries have been introduced as the inhabitants of this genus [7]. Iran is also an endemic region of this genus, with 61 flora species in it [8]. Generally, Saliva species are used in foods, cosmetics, perfumery, and pharmaceutical industries. Salvia macrosiphon) S. macrosiphon), known as Maryam Goli Lolei or Marvak in Persian, has been used in traditional medicine. This species is the most valuable type of the Lamiaceae family and has therapeutic effects. The habitant of this species is in Iran and Afghanistan, and due to its essential oil and tannin, its leaves have a strengthening and tonic effect; in addition, they facilitate digestion, are diuretic, anticonvulsant, antipyretic, and reduce blood sugar. It is used externally to heal and disinfect wounds [9]. Some fractions of S. macrosiphon have been introduced as antibacterial agents. For instance, the antibacterial effects of the plant's n-hexane, chloroform, and ethyl acetate fractions on Staphylococcus aureus and E. coli were tested in one study, and the results showed good activity with MIC values ranging from 0.61 to 2.5mg/mL [10]. Today, the problem of resistance of Candida species to existing chemical drugs, as well as complications and high cost of chemical drugs, is observed, and there is a tendency to use medicinal plants as medicinal and antifungal compounds [11].
Therefore, this study aimed to investigate the chemical composition of essential oil from leaves of Salvia macrosiphon and compare its antifungal activity with fluconazole.
Materials and Methods
Design and samples
This study was designed based on the clinical laboratory research method from 2021 to 2022. Fifty-six C. albicans isolates were collected from the patient's samples, including vulvovaginal swabs, ear swabs, and blood and urine specimens studied.
Plant material
The aerial parts of S. macrosiphon were collected. The identification process was done and approved in the Kerman Agriculture and Natural Resources Research and Education Center, and the herbarium number was obtained (herbarium number: 17714). The aerial parts were crushed and dried at room temperature. 200g of dried powder mixed with 1L of distilled water and the essential oil hydrodistilled in a Clevenger apparatus according to the British method for 3h. Finally, the essential oil was preserved at 4ºC in a dark condition until other steps.
Gas chromatography/Mass spectrometry
The GC/MS method was used to analyze the components of the essential oil of the S. macrosiphon fruit at Kashan University of Medical Sciences. Chromatography instrument Model 6890 (Agilent; United States) and mass spectrometry were used for qualitative and quantitative measurements of compounds. The temperature was set at 60°C, then raised to 246°C at a rate of 3°C. The combination of gas chromatography and mass spectrometry characteristics is used to identify different substances present in a sample.
Antifungal susceptibility test
Preparation of Candida isolate
56 C. albicans (including 15 blood cultures, 40 vulvovaginitis, recurrent vulvovaginitis, and 1 otomycosis isolates), 12 C. glabrata (6 vulvovaginitis, 6 urine culture isolates), 12 C. parapsilosis (3 blood cultures, 9 otomycosis isolates) were studied. Candidal isolates were collected from the patient's samples (vulvovaginal swabs, ear swabs, and blood and urine specimens). Vaginal samples were taken from suspected patients with VVC that had been referred to gynecology and (obstetrics) private midwifery clinics in Yasuj, Iran, from 2021 to 2022. Other samples, including blood culture, urine, and ear swabs, were referred to the Yasuj University of Medical Science medical school and identified based on molecular methods. All Candida isolates were subculture on Sabouraud Dextrose Agar (Biolife; India) and incubated at 37°C. Then fresh isolates were used for other steps.
Determination of minimum inhibitory concentration (MIC)
An antifungal susceptibility test was carried out based on CLSI-M27-A3 guidelines [12]. Fungal suspensions were prepared by fresh colonies and distilled water and standardized using a Model 6320D Spectrophotometer (JENWAY; China) in 530nm and 75-77 transmittance. For broth microdilution processes, essential oil and fluconazole were diluted in RPMI 1640, and 100µL of each diluted solution was added to the 96-well microtiter plate. The standard fungal suspensions were also diluted 1:1000 in RPMI 1640 medium and added to each well. All microplates were incubated at 37°C for 24-48h. Growth inhibition was determined after the incubation period and compared with positive control.
Statistical analysis
Data were entered into Excel 2016 and analyzed in SPSS 16 software using descriptive statistics, and the Wilcoxon test was calculated. Also, the data distribution was checked using the Shapiro-Wilk and Kolmogorov-Smirnov tests, and it was not normal in any of the groups. Due to non-normality, non-parametric tests were used for data analysis.
Findings
Overall, 29 components were identified in the leaf essential oil (Table 1). The main constituents of the oil were Butyl benzoate (49.16%), n-hexyl benzoate (7%), Isospathulenol (4.8%), Cyperene (4.1%), Benzoic acid, 2-methyl-, butyl ester (3.88%), beta-caryophyllene (3.54%), and β-Elemene (3.02%).
Table 1. Chemical component of Saliva macrosiphon
Antifungal activities
According to the MIC value S. microsiphon had a better effect against different Candida species. Besides, the MIC value range was lower in non-albicans species (0.039-0.15µl/ml) than C. albicans (0.039-2.5µl/ml). Based on MIC90, fluconazole had poor activity against C. glabrata isolates (7.6µg/ml). However, a comparison of MICGM between S. macrosiphon and fluconazole revealed that only C. parapsilosis had this value lower in fluconazole (0.088µg/ml). Statistical analysis showed a significant difference between the mean of fluconazole and essential oil in total Candida isolates (p=0.001; Table 2).
Table 2. Minimum inhibitory concentration range, MIC50, MIC90, and MICGeoMean (MICGM) of S. macrosiphon compared with fluconazole against Candida species
A mean and standard deviation comparison showed that Candida isolates in S. macrosiphon essential oil were lower than fluconazole (Table 3). The difference in antifungal activity between S. macrosiphon essential oil and fluconazole was significant in all Candida species (p<0.05).
Table 3. Comparison of the mean of different Candida species in two essential oil and fluconazole groups (Wilcoxon test)
Discussion
Candidiasis is the most opportunistic infection, and its treatment has always been challenging [13]. The drug resistance of Candida isolates which are sometimes intrinsic and mostly acquired, has made it difficult to treat patients [14]. Therefore, choosing a suitable drug with the lowest cost and no recurrence of infection has always been desired. Herbal medicines with low side effects and availability have long been interesting [15]. In this study, the essential oil of S. macrosiphon was analyzed using the GC-MS method, and its constituent elements were determined. The most compounds in this essential oil are butyl benzoate (49.16%), n-hexyl benzoate (7%), isopatolenol (4.83%), cuprene (4.10%), benzoic acid 2-methyl-1-butyl ester (3.88%), linalool (3.31%), beta-caryophyllene (3.54%), and beta-Elemene (3.02%). Various studies investigated the main compounds found in different species of Saliva. For example, in the study, Sajadi et al. proved the presence of at least forty-six compounds in the essential oil of S. macrosiphon. Among these compounds, beta-pinene (15.3%), germacrene-di (10.1%), spatholenol (7.7%), and 1 and 8-cineole (7.4%) were the main compounds in the essential oil of S. macrosiphon [16]. Also, in the study conducted by Taari et al., the most important components of the essential oil of this plant, 9- and 8-cineole, alpha-thujone, viridiflurol, and beta-thujone, were introduced [17]. This is even though the above compounds were not detected in the present study. The difference in the composition of Salvia species essential oil can be attributed to ecological differences. The compounds in the essential oils of plants are caused by ecological differences such as latitude and longitude, altitude, temperature, humidity, climate and soil, metabolic pathways, and biosynthesis of effective substances in these plants, which result in various secondary metabolites being biosynthesized under different environmental conditions. Various studies have confirmed this. Also, in similar weather conditions, secondary compounds in different plants have similarities. Of course, the conditions and types of studies are different, which can affect the results.
The present study was done to test the antifungal activity of S. macrosiphon based on the microdilution method. In the literature, the antimicrobial activity of some genera of Salvia essential oils against microbes has been reported [9, 18]. However, the use of the broth microdilution method in the effect of antifungal activity of S. macrosiphon has been done for the first time in Iran in the present study. The results of the present study showed that the essential oil of S. macrosiphon had great activity against Candida isolates. So, the essential oil of S. macrosiphon affected the growth of C. albicans, and the MIC50 of this plant was equal to 0.78μl/ml. the MIC50 value was 1μg/ml for fluconazole against C. albicans isolates. Agreeing with the present study's results, the study conducted by Atai et al. reported MIC=1μg for Saliva species against C. albicans [19]. Also, in the study of Banaeian-Boroujeni et al., S. officinalis with a concentration of 1.25μg/ml was able to inhibit the standard strain of C. albicans [20]. However, in the study of Sookto et al., the effect of the extract and oil of several plants from the Lamiaceae family, including S. officinalis and Chamomile, on C. albicans was investigated. S. officinalis essential oil, with a concentration of 78.2mg/l, inhibited the growth of C. albicans [21]. Pozzatti et al. reported that the essential oil of S. officinalis had no effect against fluconazole resistance and susceptible C. albicans [22]. This difference between our results and Pozzatti et al., may be due to the different species of Salvia tested. Besides, the present study revealed that S. officinalis essential oil had an inhibition effect against C. glabrata isolates (MICGM=0.056μL/ml). This antifungal activity has a better inhibitory effect than fluconazole (MICGM=0.7μg/ml) against C. glabrata isolates. However, Salari et al., reported the methanolic extract of S. rhytidea had anti-fungal activity against C. glabrata isolates (MIC50=100μg/ml) [23]. Resistance to fluconazole has been reported during treating different forms of candidiasis [24, 25]. There is no study similar to the present study for the effect of S. macrosiphon on Candida isolates and its comparison with fluconazole. However, the results of the present study indicated that the MIC50 value of S. macrosiphon was lower than that of fluconazole against Candida isolates.
The mechanism of the inhibitory effect of S. macrosiphon is not clear. In one study, it was mentioned that it was probably due to the destruction of the cell wall by lipophilic compounds in this mechanism. Significant leakage of cell material indicates irreversible cell membrane damage [26]. On the other hand, the difference in the concentration of Saliva species in inhibiting the growth of Candida, which is observed in the results of various research, can be due to geophysical factors and different species of this plant or the methods of essential oil extraction, oil preparation, and laboratory methods [23, 27, 28].
One limitation of this study is the limited effect of essential oil on clinical isolates in vitro examination and the lack of simultaneous comparison in vivo conditions. Based on the results of this study, it can be hoped that recurrent candidal infections will be treated in the future with different formulations of S. macrosiphon along with antifungal drugs. However, confirmation of the present results in similar studies is necessary. Therefore, in future studies, this issue can also be investigated in the patient with candidiasis.
Conclusion
Saliva microsiphon has greater anticandidal activity than fluconazole. Therefore, it is hoped that it will be used as an antifungal compound in treating Candida infections in the future.
Acknowledgments: We thank Yasuj University of Medical Sciences for supporting this study.
Ethical Permissions: This study was approved with the ethical approval code of IR.YUMS.REC.1400.017.
Conflicts of Interests: The authors declare no conflict of interest.
Authors’ Contribution: Nouripour-Sisakht S (First Author), Methodologist/Discussion Writer (25%); Diba A (Second Author), Introduction Writer (10%); Razmjoue D (Third Author), Main Researcher (10%); Sadeghi Mansourkhani H (Fourth Author), Introduction Writer (10%); Zanganeh P (Fifth Author), Main Researcher (10%); Salahi M (Sixth Author), Introduction Writer (10%); Gharaghani M (Seventh Author), Assistant Researcher/Discussion Writer (25%)
Funding/Support: This work was financially supported by Yasuj University of Medical Sciences, Iran (grant No. 990241).
Keywords:
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