{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T03:22:09Z","timestamp":1791429729720,"version":"4.3.3"},"reference-count":96,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,5,26]],"date-time":"2023-05-26T00:00:00Z","timestamp":1685059200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>D-lactate is produced in very low amounts in human tissues. However, certain bacteria in the human intestine produce D-lactate. In some gastrointestinal diseases, increased bacterial D-lactate production and uptake from the gut into the bloodstream take place. In its extreme, excessive accumulation of D-lactate in humans can lead to potentially life-threatening D-lactic acidosis. This metabolic phenomenon is well described in pediatric patients with short bowel syndrome. Less is known about a subclinical rise in D-lactate. We discuss in this review the pathophysiology of D-lactate in the human body. We cover D-lactic acidosis in patients with short bowel syndrome as well as subclinical elevations of D-lactate in other diseases affecting the gastrointestinal tract. Furthermore, we argue for the potential of D-lactate as a marker of intestinal barrier integrity in the context of dysbiosis. Subsequently, we conclude that there is a research need to establish D-lactate as a minimally invasive biomarker in gastrointestinal diseases.<\/jats:p>","DOI":"10.3390\/children10060945","type":"journal-article","created":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T16:19:37Z","timestamp":1685204377000},"page":"945","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":88,"title":["D-Lactate: Implications for Gastrointestinal Diseases"],"prefix":"10.3390","volume":"10","author":[{"given":"Barblin","family":"Remund","sequence":"first","affiliation":[{"name":"Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1888-9226","authenticated-orcid":false,"given":"Bahtiyar","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"},{"name":"Maurice M\u00fcller Laboratories, Department for Biomedical Research, University of Bern, 3008 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiane","family":"Sokollik","sequence":"additional","affiliation":[{"name":"Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/S0021-9258(18)83822-4","article-title":"Glycogen formation in the liver from Dand L-lactic acid","volume":"81","author":"Carl","year":"1929","journal-title":"J. Biol. Chem."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1186\/cc1518","article-title":"Bench-to-bedside review: Lactate and the kidney","volume":"6","author":"Bellomo","year":"2002","journal-title":"Crit. Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/j.clinbiochem.2008.06.011","article-title":"Analytical investigation: Assay of D-lactate in diabetic plasma and urine","volume":"41","author":"Talasniemi","year":"2008","journal-title":"Clin. Biochem."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1007\/BF02065417","article-title":"Colonic lactate metabolism and D-lactic acidosis","volume":"40","author":"Hove","year":"1995","journal-title":"Dig. Dis. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2959","DOI":"10.1007\/s00018-017-2509-x","article-title":"Mechanisms and consequences of intestinal dysbiosis","volume":"74","author":"Weiss","year":"2017","journal-title":"Cell. Mol. Life Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1007\/s00535-019-01618-1","article-title":"Manipulating resident microbiota to enhance regulatory immune function to treat inflammatory bowel diseases","volume":"55","author":"Mishima","year":"2020","journal-title":"J. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1093\/ajcn\/87.3.534","article-title":"Early differences in fecal microbiota composition in children may predict overweight","volume":"87","author":"Kalliomaki","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.1086\/341914","article-title":"Gastrointestinal microflora studies in late-onset autism","volume":"35","author":"Finegold","year":"2002","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1136\/gut.2006.100164","article-title":"Gut microbiota composition and development of atopic manifestations in infancy: The KOALA Birth Cohort Study","volume":"56","author":"Penders","year":"2007","journal-title":"Gut"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1007\/BF02087915","article-title":"Abnormal fecal flora in a patient with short bowel syndrome. An in vitro study on effect of pH on D-lactic acid production","volume":"41","author":"Caldarini","year":"1996","journal-title":"Dig. Dis. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1023\/A:1018836709808","article-title":"Lactobacillus flora in short bowel syndrome","volume":"42","author":"Bongaerts","year":"1997","journal-title":"Dig. Dis. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"476215","DOI":"10.1155\/2015\/476215","article-title":"D-lactic acidosis: An underrecognized complication of short bowel syndrome","volume":"2015","author":"Kowlgi","year":"2015","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/1056-8719(93)90044-F","article-title":"Methods for the analysis of enantiomers of racemic drugs application to pharmacological and pharmacokinetic studies","volume":"29","author":"Wright","year":"1993","journal-title":"J. Pharmacol. Toxicol. Methods"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1002\/9780470122822.ch2","article-title":"Lactate dehydrogenases: Structure and function","volume":"37","author":"Everse","year":"1973","journal-title":"Adv. Enzymol. Relat. Areas Mol. Biol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4561","DOI":"10.1242\/jeb.01961","article-title":"Lactate\u2014A signal coordinating cell and systemic function","volume":"208","author":"Philp","year":"2005","journal-title":"J. Exp. Biol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1016\/S0006-291X(02)00768-4","article-title":"Identification of putative mammalian D-lactate dehydrogenase enzymes","volume":"295","author":"Flick","year":"2002","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1159\/000187245","article-title":"D-lactate metabolism in patients with chronic renal failure undergoing CAPD","volume":"63","author":"Yasuda","year":"1993","journal-title":"Nephron"},{"key":"ref_18","unstructured":"Alberts, B., Johnson, A., Lewis, J., Raff, M., Roberts, K., and Walter, P. (2002). Molecular Biology of The Cell, Garland Science. [4th ed.]."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1128\/ecosalplus.3.4.3","article-title":"Glycerol and Methylglyoxal Metabolism","volume":"1","author":"Booth","year":"2005","journal-title":"EcoSal Plus"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/S0378-4274(99)00160-5","article-title":"Methylglyoxal in living organisms: Chemistry, biochemistry, toxicology and biological implications","volume":"110","author":"Kalapos","year":"1999","journal-title":"Toxicol. Lett."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/BF00399499","article-title":"Carbohydrate metabolism in lactic acid bacteria","volume":"49","author":"Kandler","year":"1983","journal-title":"Antonie Leeuwenhoek"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1080\/1040-840291046759","article-title":"The Lactic Acid Bacteria: A Literature Survey","volume":"28","author":"Carr","year":"2022","journal-title":"Crit. Rev. Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/MPG.0000000000003633","article-title":"Probiotics for the Management of Pediatric Gastrointestinal Disorders: Position Paper of the ESPGHAN Special Interest Group on Gut Microbiota and Modifications","volume":"76","author":"Szajewska","year":"2023","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5810","DOI":"10.1128\/AEM.70.10.5810-5817.2004","article-title":"Lactate-utilizing bacteria, isolated from human feces, that produce butyrate as a major fermentation product","volume":"70","author":"Duncan","year":"2004","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"9980","DOI":"10.3168\/jds.2020-18704","article-title":"Isolation and characterization of lactic acid bacteria from human milk","volume":"103","author":"Kang","year":"2020","journal-title":"J. Dairy. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Markowiak-Kopec, P., and Slizewska, K. (2020). The Effect of Probiotics on the Production of Short-Chain Fatty Acids by Human Intestinal Microbiome. Nutrients, 12.","DOI":"10.3390\/nu12041107"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.3389\/fmicb.2020.01131","article-title":"Metabolic Profiles of Carbohydrates in Streptococcus thermophilus During pH-Controlled Batch Fermentation","volume":"11","author":"Liu","year":"2020","journal-title":"Front. Microbiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/ki.1996.1","article-title":"D-lactic acidosis: Turning sugar into acids in the gastrointestinal tract","volume":"49","author":"Halperin","year":"1996","journal-title":"Kidney Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1002\/jps.10389","article-title":"Molecular features, regulation, and function of monocarboxylate transporters: Implications for drug delivery","volume":"92","author":"Enerson","year":"2003","journal-title":"J. Pharm. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1574-6941.2011.01086.x","article-title":"Rates of production and utilization of lactate by microbial communities from the human colon","volume":"77","author":"Belenguer","year":"2011","journal-title":"FEMS Microbiol. Ecol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1177\/0115426505020006634","article-title":"D-lactic acidosis","volume":"20","author":"Petersen","year":"2005","journal-title":"Nutr. Clin. Pract."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3419034","DOI":"10.1155\/2020\/3419034","article-title":"D-Lactic Acid as a Metabolite: Toxicology, Diagnosis, and Detection","volume":"2020","author":"Pohanka","year":"2020","journal-title":"BioMed Res. Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1056\/NEJM197908023010505","article-title":"D-Lactic Acidosis in a Man with the Short-Bowel Syndrome","volume":"301","author":"Oh","year":"1979","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/00005792-199803000-00001","article-title":"D-lactic acidosis. A review of clinical presentation, biochemical features, and pathophysiologic mechanisms","volume":"77","author":"Uribarri","year":"1998","journal-title":"Medicine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5049\/EBP.2006.4.1.53","article-title":"D-lactic acidosis in humans: Review of update","volume":"4","author":"Kang","year":"2006","journal-title":"Electrolyte Blood Press."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/j.jpedsurg.2003.12.026","article-title":"D-lactic acidosis in short-bowel syndrome managed with antibiotics and probiotics","volume":"39","author":"Uchida","year":"2004","journal-title":"J. Pediatr. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/0261-5614(90)90069-5","article-title":"D-lactic acid metabolism after an oral load of dl-lactate","volume":"9","year":"1990","journal-title":"Clin. Nutr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1111\/j.1749-6632.1965.tb47452.x","article-title":"The metabolism of d-alpha hydroxy acids in animal tissues","volume":"119","author":"PK","year":"1965","journal-title":"Ann. N. Y Acad. Sci."},{"key":"ref_39","first-page":"454","article-title":"Bacteria, Bones, and Stones: Managing Complications of Short Bowel Syndrome","volume":"33","author":"Erika","year":"2008","journal-title":"Nutr. Clin. Pract."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/S0025-6196(11)63729-4","article-title":"D-lactic acidosis: Pathologic consequence of saprophytism","volume":"73","author":"Vella","year":"1998","journal-title":"Mayo Clin. Proc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/0026-0495(85)90088-5","article-title":"Metabolic utilization and renal handling of D-lactate in men","volume":"34","author":"Oh","year":"1985","journal-title":"Metabolism"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"E9","DOI":"10.1053\/ajkd.2000.9005","article-title":"D-lactic acidosis 23 years after jejuno-ileal bypass","volume":"36","author":"Narula","year":"2000","journal-title":"Am. J. Kidney Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3675","DOI":"10.1111\/j.1572-0241.2000.03416.x","article-title":"Don\u2019t forget to test for D-lactic acid in short bowel syndrome","volume":"95","author":"Godey","year":"2000","journal-title":"Am. J. Gastroenterol."},{"key":"ref_44","first-page":"75","article-title":"D-lactic acidosis\u2014Case report and review of the literature","volume":"55","author":"Fabian","year":"2017","journal-title":"Z. Gastroenterol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1097\/00005176-200003000-00014","article-title":"Lactobacilli and acidosis in children with short small bowel","volume":"30","author":"Bongaerts","year":"2000","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1081\/CLT-120030942","article-title":"Unusual D-lactic acid acidosis from propylene glycol metabolism in overdose","volume":"42","author":"Jorens","year":"2004","journal-title":"J. Toxicol. Clin. Toxicol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"839","DOI":"10.7326\/0003-4819-122-11-199506010-00005","article-title":"Antibiotic-induced D-lactic acidosis","volume":"122","author":"Coronado","year":"1995","journal-title":"Ann. Intern. Med."},{"key":"ref_48","first-page":"157","article-title":"D-lactic acidosis in short bowel syndrome--an examination of possible mechanisms","volume":"74","author":"Hudson","year":"1990","journal-title":"Q. J. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1016\/S0140-6736(00)04565-7","article-title":"Confusion after antibiotics","volume":"357","author":"Gavazzi","year":"2001","journal-title":"Lancet"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1542\/peds.2018-0337","article-title":"D-lactic Acidosis: Successful Suppression of D-lactate-Producing Lactobacillus by Probiotics","volume":"142","author":"Yilmaz","year":"2018","journal-title":"Pediatrics"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1177\/0148607115619931","article-title":"Fecal Transplantation Successfully Treats Recurrent D-Lactic Acidosis in a Child with Short Bowel Syndrome","volume":"41","author":"Davidovics","year":"2017","journal-title":"J. Parenter. Enteral Nutr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"4264","DOI":"10.3748\/wjg.v16.i34.4264","article-title":"Intestinal epithelial cells in inflammatory bowel diseases","volume":"16","author":"Roda","year":"2010","journal-title":"World J. Gastroenterol."},{"key":"ref_53","first-page":"6605","article-title":"Small intestinal bacterial overgrowth and evaluation of intestinal barrier function in patients with ulcerative colitis","volume":"13","author":"Yang","year":"2021","journal-title":"Am. J. Transl. Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"3916","DOI":"10.3748\/wjg.15.3916","article-title":"Soluble intercellular adhesion molecule-1, D-lactate and diamine oxidase in patients with inflammatory bowel disease","volume":"15","author":"Song","year":"2009","journal-title":"World J. Gastroenterol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"8536952","DOI":"10.1155\/2019\/8536952","article-title":"Diagnostic and Clinical Significance of Serum Levels of D-Lactate and Diamine Oxidase in Patients with Crohn\u2019s Disease","volume":"2019","author":"Cai","year":"2019","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1097\/PEC.0000000000000596","article-title":"Effects of Timing to Diagnosis and Appendectomy in Pediatric Appendicitis","volume":"31","author":"Mandeville","year":"2015","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/S1015-9584(09)60056-7","article-title":"Plasma D-lactic acid level: A useful marker to distinguish perforated from acute simple appendicitis","volume":"27","author":"Demircan","year":"2004","journal-title":"Asian J. Surg."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1080\/08941930390215033","article-title":"Plasma D-lactate levels in diagnosis of appendicitis","volume":"16","author":"Caglayan","year":"2003","journal-title":"J. Investig. Surg."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"218","DOI":"10.3109\/08941931003596877","article-title":"The role of d-lactate in differential diagnosis of acute appendicitis","volume":"23","author":"Filiz","year":"2010","journal-title":"J. Investig. Surg."},{"key":"ref_60","first-page":"1483","article-title":"Serum D-lactate: A useful diagnostic marker for acute appendicitis","volume":"54","author":"Duzgun","year":"2007","journal-title":"Hepatogastroenterology"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/j.ajem.2009.06.004","article-title":"Diagnosing pediatric appendicitis: Usefulness of laboratory markers","volume":"28","author":"Kwan","year":"2010","journal-title":"Am. J. Emerg. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/0002-9610(94)90101-5","article-title":"Serum D(-)-lactate levels as an aid to diagnosing acute intestinal ischemia","volume":"167","author":"Murray","year":"1994","journal-title":"Am. J. Surg."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1007\/s00134-003-1944-3","article-title":"Gastric PgCO2 and Pg-aCO2 gap are related to D-lactate and not to L-lactate levels in patients with septic shock","volume":"29","author":"Poeze","year":"2003","journal-title":"Intensive Care Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"R163","DOI":"10.1186\/cc5102","article-title":"Luminal concentrations of L- and D-lactate in the rectum may relate to severity of disease and outcome in septic patients","volume":"10","author":"Jorgensen","year":"2006","journal-title":"Crit. Care"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1046\/j.1365-2168.1998.00837.x","article-title":"D-lactate as an early marker of intestinal ischaemia after ruptured abdominal aortic aneurysm repair","volume":"85","author":"Poeze","year":"1998","journal-title":"Br. J. Surg."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.ejvs.2005.10.031","article-title":"Plasma D-lactate as a potential early marker for colon ischaemia after open aortic reconstruction","volume":"31","author":"Assadian","year":"2006","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/0922-338X(96)82222-7","article-title":"L-Lactic Acid Production by Bacillus sp. in Anaerobic and Aerobic Culture","volume":"81","author":"Ohara","year":"1996","journal-title":"J. Ferment. Bioeng."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"S73","DOI":"10.1136\/gut.35.1_Suppl.S73","article-title":"Gut ischaemia","volume":"35","author":"Haglund","year":"1994","journal-title":"Gut"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.jhep.2019.10.003","article-title":"The gut-liver axis in liver disease: Pathophysiological basis for therapy","volume":"72","author":"Albillos","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1136\/gutjnl-2017-314458","article-title":"Mucosa-associated invariant T cells link intestinal immunity with antibacterial immune defects in alcoholic liver disease","volume":"67","author":"Riva","year":"2018","journal-title":"Gut"},{"key":"ref_71","first-page":"58","article-title":"Changes of plasma D(-)-lactate, diamine oxidase and endotoxin in patients with liver cirrhosis","volume":"3","author":"Ruan","year":"2004","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"100151","DOI":"10.1016\/j.jhepr.2020.100151","article-title":"Faecal cytokine profiling as a marker of intestinal inflammation in acutely decompensated cirrhosis","volume":"2","author":"Riva","year":"2020","journal-title":"JHEP Rep."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1097\/MEG.0000000000002456","article-title":"Elevated serum levels of diamine oxidase, D-lactate and lipopolysaccharides are associated with metabolic-associated fatty liver disease","volume":"35","author":"Zhang","year":"2023","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.pcl.2016.04.008","article-title":"Gastrointestinal, Pancreatic, and Hepatobiliary Manifestations of Cystic Fibrosis","volume":"63","author":"Sathe","year":"2016","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"6593","DOI":"10.1038\/s41598-022-10328-3","article-title":"Alterations of mucosa-attached microbiome and epithelial cell numbers in the cystic fibrosis small intestine with implications for intestinal disease","volume":"12","author":"Kelly","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"5940893","DOI":"10.1155\/2018\/5940893","article-title":"Serum Level of D-Lactate in Patients with Cystic Fibrosis: Preliminary Data","volume":"2018","author":"Wiecek","year":"2018","journal-title":"Dis. Markers"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1007\/s00216-003-2108-6","article-title":"Determination of serum D-lactic and L-lactic acids in normal subjects and diabetic patients by column-switching HPLC with pre-column fluorescence derivatization","volume":"377","author":"Hasegawa","year":"2003","journal-title":"Anal. Bioanal. Chem."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/S0003-2697(05)80004-1","article-title":"Fluorimetric assay of D-lactate","volume":"206","author":"McLellan","year":"1992","journal-title":"Anal. Biochem."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"198","DOI":"10.2337\/diabetes.48.1.198","article-title":"Metformin reduces systemic methylglyoxal levels in type 2 diabetes","volume":"48","author":"Beisswenger","year":"1999","journal-title":"Diabetes"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"R591","DOI":"10.1186\/cc3806","article-title":"Circulating anions usually associated with the Krebs cycle in patients with metabolic acidosis","volume":"9","author":"Forni","year":"2005","journal-title":"Crit. Care"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.cca.2010.10.020","article-title":"Closing the anion gap: Contribution of D-lactate to diabetic ketoacidosis","volume":"412","author":"Lu","year":"2011","journal-title":"Clin. Chim. Acta"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/0168-8227(89)90101-0","article-title":"The human red blood cell glyoxalase system in diabetes mellitus","volume":"7","author":"Thornalley","year":"1989","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1042\/cs0870021","article-title":"Glyoxalase system in clinical diabetes mellitus and correlation with diabetic complications","volume":"87","author":"McLellan","year":"1994","journal-title":"Clin. Sci."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s11010-007-9535-1","article-title":"Plasma methylglyoxal and glyoxal are elevated and related to early membrane alteration in young, complication-free patients with Type 1 diabetes","volume":"305","author":"Han","year":"2007","journal-title":"Mol. Cell. Biochem."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.bios.2019.03.010","article-title":"Methylglyoxal\u2014An emerging biomarker for diabetes mellitus diagnosis and its detection methods","volume":"133","author":"Vedantham","year":"2019","journal-title":"Biosens. Bioelectron."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1042\/bj2690001","article-title":"The glyoxalase system: New developments towards functional characterization of a metabolic pathway fundamental to biological life","volume":"269","author":"Thornalley","year":"1990","journal-title":"Biochem. J."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.semnephrol.2021.03.005","article-title":"Diabetes and the Gut Microbiome","volume":"41","author":"Lau","year":"2021","journal-title":"Semin. Nephrol."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Larsen, N., Vogensen, F.K., van den Berg, F.W., Nielsen, D.S., Andreasen, A.S., Pedersen, B.K., Al-Soud, W.A., Sorensen, S.J., Hansen, L.H., and Jakobsen, M. (2010). Gut microbiota in human adults with type 2 diabetes differs from non-diabetic adults. PLoS ONE, 5.","DOI":"10.1371\/journal.pone.0009085"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"101507","DOI":"10.1016\/j.beem.2021.101507","article-title":"Gut microbiome, prebiotics, intestinal permeability and diabetes complications","volume":"35","author":"Snelson","year":"2021","journal-title":"Best. Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/00004836-200204000-00003","article-title":"Intestinal permeation and gastrointestinal disease","volume":"34","author":"DeMeo","year":"2002","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1097\/shk.0b013e3180644e32","article-title":"Evidence for intestinal and liver epithelial cell injury in the early phase of sepsis","volume":"28","author":"Derikx","year":"2007","journal-title":"Shock"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1053\/j.gastro.2020.04.077","article-title":"Contribution of the Intestinal Microbiome and Gut Barrier to Hepatic Disorders","volume":"159","author":"Chopyk","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jhep.2013.07.044","article-title":"Pathological bacterial translocation in liver cirrhosis","volume":"60","author":"Wiest","year":"2014","journal-title":"J. Hepatol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"102674","DOI":"10.1016\/j.jaut.2021.102674","article-title":"Intestinal permeability in type 1 diabetes: An updated comprehensive overview","volume":"122","author":"Monsted","year":"2021","journal-title":"J. Autoimmun."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Allam-Ndoul, B., Castonguay-Paradis, S., and Veilleux, A. (2020). Gut Microbiota and Intestinal Trans-Epithelial Permeability. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21176402"},{"key":"ref_96","first-page":"702372","article-title":"A review of the predictive role of plasma d-lactate level in acute appendicitis: A myth or truth?","volume":"2011","author":"Unverir","year":"2011","journal-title":"Int. Sch. Res. 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