This chapter focuses on the latest advances in the development of fermentation processes in carbohydrate-based therapeutics. Although fermentation has been the major route in producing bioactive compounds historically, the complexity of carbohydrates and the current remarkable accomplishments of glycobiology have forced a multidiscipline approach to the development of carbohydrate-based therapeutics. Current remarkable achievements of glycotechnology have been demonstrated in metabolic engineering, process optimization, analytical chemistry, monitoring techniques, enzymatic/ chemical synthesis, and separation techniques, etc. By intentionally incorporating these techniques into fermentation processes, numerous novel approaches have been generated to produce carbohydrate-based therapeutics with higher qualities in terms of authenticity and efficacy, and better yields. Besides, many novel bioactive compounds or drug candidates can be obtained by fermentation in a relatively economic approach.
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