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Quantitative Evaluation of D-Lactate Pathophysiology: New Insights into the Mechanisms Involved and the Many Areas in Need of Further Investigation

Authors Levitt MD, Levitt DG

Received 30 April 2020

Accepted for publication 20 July 2020

Published 8 September 2020 Volume 2020:13 Pages 321—337


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Prof. Dr. Everson L.A. Artifon

Michael D Levitt,1 David G Levitt2

1Research Service, Veterans Affairs Medical Center, Minneapolis, MN 55417, USA; 2Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN 55455, USA

Correspondence: David G Levitt
Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN 55455, USA
Tel +1 612 594 0272
Fax +1 612 301 1543

Abstract: In contrast to L-lactate, D-lactate is produced in minimal quantities by human cells, and the plasma D-lactate concentration normally is maintained at a concentration of only about 0.01 mM. However, in short bowel syndrome, colonic bacterial production of D-lactate may lead to plasma concentrations > 3mM with accompanying acidosis and neurological symptoms – a syndrome known as D-lactic acidosis. Minor increases in plasma D-lactate have been observed in various gastrointestinal conditions such as ischemia, appendicitis and Crohn’s disease, a finding touted to have diagnostic utility. The novel aspect of this review paper is the application of numerical values to the processes involved in D-lactate homeostasis that previously have been described only in qualitative terms. This approach provides a number of new insights into normal and disordered production, catabolism and excretion of D-lactate, and identifies multiple gaps in our understanding of D-lactate physiology that should be amenable to relatively simple investigative study.

Keywords: acidosis, short bowel syndrome, delirium

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