D-Lactic Acidosis: Pathologic Consequence of Saprophytism

Vella, Adrian; Farrugia, Gianrico

doi:10.1016/s0025-6196(11)63729-4

Cited by 61 publications

(24 citation statements)

References 26 publications

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“…Chronic hyperlactaemia has been suggested to have a role in the development of insulin resistance in muscle cells (48) . Excessive amounts of lactic acid in the blood circulation have been shown to cause neurotoxicity and cardiac arrhythmia (50,51) . Also dietary or microbe-derived phenolics can be absorbed from the GI tract, but their uptake can be incomplete (52) .…”

Section: Concentrations Of Sterolsmentioning

confidence: 99%

Effect of overweight on gastrointestinal microbiology and immunology: correlation with blood biomarkers

2009

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A cross-sectional study was carried out in order to compare intestinal microbiological and immunological biomarkers with blood glucose and lipids, satiety-related hormones and inflammatory biomarkers characterising differences between obese and normal weight subjects. Faecal and blood samples were obtained from twenty obese subjects with an average BMI of 32·9 kg/m 2 and twenty normal weight subjects with an average BMI of 23·3 kg/m 2 . Blood insulin, TAG and leptin were significantly elevated, whereas concentrations of HDL and ghrelin were significantly decreased in the obese subjects. Inflammatory status in the obese subjects was characterised by a trend for elevated blood C-reactive protein (CRP; P¼ 0·06) and IL-6 (P¼ 0·02). The faecal microbial composition differed between the groups; less sulphate-reducing bacteria (P¼0·05) and a trend for less Bacteroides (P¼ 0·07) were measured for overweight subjects. Furthermore, an inverse correlation was demonstrated between faecal Bacteroides levels and waist circumference (P¼ 0·05). The faecal microbial metabolites differed between the groups; increased concentrations of branched-chain fatty acids, phenolics, valeric acid, di-and hydroxy acids were described in the obese subjects. No differences between the measured intestinal inflammatory biomarkers were detected. However, systemic inflammation (CRP and IL-6) was correlated with the faecal concentrations of phenolics and lactic acid (P, 0·05 and 0·05, and P,0·01 and 0·05, respectively). In summary, weight-related differences were observed both in the intestinal microbial composition and its activity. The role of intestinal signals, such as phenolics and lactic acid in the development of weight-related problems, needs to be studied further.

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Section: Concentrations Of Sterolsmentioning

confidence: 99%

Effect of overweight on gastrointestinal microbiology and immunology: correlation with blood biomarkers

2009

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“…This dysbiosis has been proposed as a result of an impaired small intestine, either due to congenital causes, surgery for midgut volvulus, gangrene or inflammatory bowel disease [104]; functional SBS and carbohydrate malabsorption [32, 36]; or colonic stagnation [62]. With reduced absorptive capacity of the small intestine, malabsorbed carbohydrates are more likely to enter the colon and provide fuel for colonic bacteria leading to increased bacterial fermentation [54, 81]. Increased bacterial fermentation can further reduce bowel motility [31], alter colonic pH and change the level of bacterial metabolites.…”

Section: Part B Narrative Reviewmentioning

confidence: 99%

“…Previous research has proposed that d -lactate levels can reduce the pH balance within the brain and impede neurological processes [81]. Low pH can interfere with l -lactate metabolism [42].…”

Section: Part B Narrative Reviewmentioning

confidence: 99%

“…Overlap between symptoms of pyruvate metabolism disorders and d -la presentation suggest that d -lactate can interfere with pyruvate metabolism and consequently reduce energy (adenosine triphosphate: ATP) and neurotransmitter production [81, 123]. Lower levels of a primary enzyme required for pyruvate metabolism, pyruvate dehydrogenase, have been found in the healthy cerebellum [124].…”

Section: Part B Narrative Reviewmentioning

confidence: 99%

“…Lower levels of a primary enzyme required for pyruvate metabolism, pyruvate dehydrogenase, have been found in the healthy cerebellum [124]. An increased d -lactate level that further impedes pyruvate metabolism may explain the predominance of motor/cerebellar symptoms observed in d -la [81]. Pyruvate metabolism abnormalities can interfere with optimal mitochondrial energy production [123].…”

Section: Part B Narrative Reviewmentioning

confidence: 99%

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Examining clinical similarities between myalgic encephalomyelitis/chronic fatigue syndrome and d-lactic acidosis: a systematic review

et al. 2017

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BackgroundThe pursuit for clarity in diagnostic and treatment pathways for the complex, chronic condition of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) continues. This systematic review raises a novel question to explore possible overlapping aetiology in two distinct conditions. Similar neurocognitive symptoms and evidence of d-lactate producing bacteria in ME/CFS raise questions about shared mechanisms with the acute condition of d-lactic acidosis (d-la).Methods d-la case reports published between 1965 and March 2016 were reviewed for episodes describing both neurological symptoms and high d-lactate levels. Fifty-nine d-la episodes were included in the qualitative synthesis comparing d-la symptoms with ME/CFS diagnostic criteria. A narrative review of d-la mechanisms and relevance for ME/CFS was provided.ResultsThe majority of neurological disturbances reported in d-la episodes overlapped with ME/CFS symptoms. Of these, the most frequently reported d-la symptoms were motor disturbances that appear more prominent during severe presentations of ME/CFS. Both patient groups shared a history of gastrointestinal abnormalities and evidence of bacterial dysbiosis, although only preliminary evidence supported the role of lactate-producing bacteria in ME/CFS.LimitationsInterpretation of results are constrained by both the breadth of symptoms included in ME/CFS diagnostic criteria and the conservative methodology used for d-la symptom classification. Several pathophysiological mechanisms in ME/CFS were not examined.ConclusionsShared symptomatology and underlying microbiota–gut–brain interactions raise the possibility of a continuum of acute (d-la) versus chronic (ME/CFS) presentations related to d-lactate absorption. Measurement of d-lactate in ME/CFS is needed to effectively evaluate whether subclinical d-lactate levels affect neurological symptoms in this clinical population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-017-1229-1) contains supplementary material, which is available to authorized users.

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Short Bowel Syndrome and Small Bowel Transplantation

DiBaise

Sudan

2015

Yamada' S Textbook of Gastroenterology

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D-Lactic Acidosis: Pathologic Consequence of Saprophytism

Cited by 61 publications

References 26 publications

Effect of overweight on gastrointestinal microbiology and immunology: correlation with blood biomarkers

Effect of overweight on gastrointestinal microbiology and immunology: correlation with blood biomarkers

Examining clinical similarities between myalgic encephalomyelitis/chronic fatigue syndrome and d-lactic acidosis: a systematic review

Short Bowel Syndrome and Small Bowel Transplantation

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