D-arabinitol
Microbial overgrowth
- Can include
- benzoate,
- Hippurate,
- Phenylacetate,
- Phenylpropionate,
- cresol,
- Hydroxybenzoate,
- Hydroxyphenylacetate,
- Hydroxyphenylpropionate
- 3,4-dihydroxyphenylpropionate,
- Indican,
- Tricarballylate,
- D-lactate,
- D-arabinitol
Clinical Applications of Urinary Organic Acids. Part 2. Dysbiosis Markers, Richard S. Lord, PhD, and J. Alexander Bralley, PhD, Alternative Medicine Review Volume 13, Number 4 2008
D-arabinitol (DA)
- Metabolite of most pathogenic Candida species
- In vitro as well as in vivo
- Five-carbon sugar alcohol
- Can be assayed by enzymatic analysis
- Important to distinguish the sugar alcohol from the sugar D-arabinose that is unrelated
- Associated with candidiasis in a variety of clinical situations
- Enzymatic method using D-arabinitol dehydrogenase is precise
- Mean intra-assay coefficients of variation [CVs], 0.8%
- Mean interassay CVs, 1.6%
- Excellent recovery of added DA
- Transmission by direct invasion of the gastrointestinal and genitourinary tracts and their ability to rapidly overwhelm immune responses in many hospitalized patients
- Most species of Candida grow best on carbohydrate substrates
- Aldose reductase and xylitol dehydrogenase
- Are induced in Candida tenuis when the organism is grown on arabinose
- Rate of DA appearance in the body
- Equals the urinary excretion rate
- Directly proportional to the concentration ratio of DA to creatinine in serum or urine
- Measuring serum DA allows prompt diagnosis of invasive candidiasis
- Immunocompromised patients with invasive candidiasis have elevated DA/creatine ratios in urine.
- Positive DA results
- Several days to weeks before positive blood cultures
- Normalization of DA levels
- Correlate with therapeutic response in both humans and animals
- Elevated DA/creatinine ratios
- Reported in 69-, 36-, and nine-percent of patients with
- Candida sepsis, Candida colonization, and bacterial sepsis
- Patients divided into categories of superficial candidiasis; possible deep, invasive candidiasis; and definite, deep invasive candidiasis
- All three groups showed significant DA elevations
- Another group reported highly elevated, slightly elevated, and normal DA levels in two, two, and three patients, respectively, with superficial Candida colonization
- Appearance of DA in both disseminated and simple peripheral candidiasis
- More discriminating elevated urine D-arabinitol/L-arabinitol (DA/LA) ratio
- Found to be a sensitive diagnostic marker for invasive candidiasis in infants treated in neonatal intensive care units
- Ratio of D- to L-arabinitol in serum reveals the presence of disseminated candidiasis in immunosuppressed patients
- D-arabinitol is the only urinary biomarker of invasive Candida sp. overgrowth that has reliable scientific support.
