MUDr. Dana Maňasková

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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.
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

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