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Baking soda may prevent fungal infection in DKA
In patients with diabetic ketoacidosis suspected of having mucormycosis, sodium bicarbonate therapy could halt the growth of the fungus and prevent the spread of infection, recent study findings show.
“DKA patients suspected of having mucormycosis are likely to benefit from reversing their acidosis by the use of sodium bicarbonate (in addition to the current use of insulin injection) because of its complex effect on halting the growth of the fungus, preventing further tissue invasion and boosting the immune response to the infection,” Ashraf S. Ibrahim, PhD, senior research investigator at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, and professor of medicine at the David Geffen School of Medicine at UCLA, told Endocrine Today. “The addition of sodium bicarbonate is likely to help in treating the infection and improving the outcome of the disease in this patient population.”
Ibrahim, Teclegiorgis Gebremariam, also of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and the David Geffen School of Medicine at UCLA, and colleagues investigated what host factors in DKA influence the ability of the rhizopus oryzae, the fungus that causes mucormycosis, to invade host cells in mice. Researchers found that fungal cell surface proteins CotH bind to the mammalian cell receptor GRP78 during invasion of host tissues. In DKA patients, researchers found that elevated glucose, iron and ketone bodies enhanced the expression of both the fungal and mammalian cell receptors, promoting host tissue damage. In addition, the study noted that acidosis seen in DKA exerts an indirect effect by liberating iron from transferrin, augmenting the expression of GRP78 and CotH, suppressing phagocyte function and enhancing growth of the fungus.
Using disease models, the researchers found the sodium bicarbonate treatment reversed many of these effects.
“Our data provide an explanation for the increased susceptibility of DKA [patients], but not lactic acidosis patients, to mucormycosis and emphasize the critical role of pH homeostasis, iron, and glucose in the pathogenesis of this lethal infection” the researchers wrote. “While patients with DKA do not routinely have their acidosis corrected with bicarbonate administration unless the acidosis is severe, our results suggest that DKA patients with mucormycosis should have aggressive treatment to correct the acidosis.”
Ibrahim said next steps to further research should should include a proof-of-concept study in patients with DKA, likely conducted in a country known to have higher incidents of mucormycosis among diabetic patients, such as India. – by Regina Schaffer
For more information: Ashraf S. Ibrahim, PhD, can be reached at the Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Division of Infectious Diseases (RB2), 1124 W. Carson St., Torrance, CA 90502; email: ibrahim@labiomed.org.
Disclosure: This study was funded by a grant from the NIH/NIAID. Ibrahim founded Vitalex Biosciences, a company developing immunotherapy and diagnostics based on the Mucorales CotH protein.