Role of D-mannose in urinary tract infections – a narrative review

Abstract

Urinary tract infections (UTIs) are one of the most prevalent bacterial diseases worldwide. Despite the efficacy of antibiotics targeted against UTI, the recurrence rates remain significant among the patients. Furthermore, the development of antibiotic resistance is a major concern and creates a demand for alternative treatment options. D-mannose, a monosaccharide naturally found in fruits, is commonly marketed as a dietary supplement for reducing the risk for UTIs. Research suggests that supplemented D-mannose could be a promising alternative or complementary remedy especially as a prophylaxis for recurrent UTIs. When excreted in urine, D-mannose potentially inhibits Escherichia coli, the main causative organism of UTIs, from attaching to urothelium and causing infection. In this review, we provide an overview of UTIs, E. coli pathogenesis and D-mannose and outline the existing clinical evidence of D-mannose in reducing the risk of UTI and its recurrence. Furthermore, we discuss the potential effect mechanisms of D-mannose against uropathogenic E.coli.

D-Mannose prevents bone loss under weightlessness

“…In the present study, H&E staining revealed a large zone of infiltrating inflammatory cells in renal tissue from rats in the TS group. D-mannose is widely regarded as a treatment for UTIs [ 35 , 73 , 74 ]. Here, we found that UTI symptoms were reduced in the TS + Man group based on histological staining of renal and urethral tissue, as well as inflammatory cell counts.…”

D-mannose ameliorates age-associated cellular senescence in the bladder urothelium and NLRP3/Gasdermin/IL-1β -driven pyroptotic epithelial cell shedding

“…Finally, we report on the utility of a simple sugar monosaccharide, D-mannose, as a surprisingly effective senotherapeutic in limiting pyroptotic epithelial cell death, reversing cell cycle arrest, limiting SASP, and restoring autophagic flux that is otherwise notably increased in non-treated aged mice. D-Mannose is a sugar that is considered as an alternative treatment to UTIs (Chiu et al, 2022; Lenger et al, 2020) as it binds to the adhesion protein FimH on uropathogens and prevents their adherence to bladder epithelial cells (Scribano et al, 2020) and has been known to decrease secretion of inflammatory cytokines (Ala-Jaakkola et al, 2022). Our results show that D-mannose has a cell intrinsic impact in addition to the known extrinsic roles, as treatment reduces accumulation of SA-β-galactosidase and activates autophagic flux.…”

Nature of the Interaction of Alpha-D-Mannose and Escherichia coli Bacteria, and Implications for Its Regulatory Classification. A Delphi Panel European Consensus Based on Chemistry and Legal Evidence

“…(Figure 1) [4]. D-mannose is one of the nine monosaccharides (Dglucose, D-galactose, D-mannose, D-xylose, L-fucose, D-glucuronic acid, N-acetyl-Dglucosamine, N-acetyl-D-galactosamine, and N-acetylneuraminic acid) commonly found in animal glycans and in vertebrate glycoconjugates [2]. Figure 1.…”

“…The idea to "disarm" bacteria instead of killing them is dated around the '80s and has driven structural biology studies and clinical research versus diverse small molecule strategies that inhibit the bacterial binding to the urothelial cells [2,3].…”