Mannose

Mannose (D-Mannose)

1. Identity: Chemical Name, Natural Sources, and Common Forms

Chemical Identity

D-mannose is a C-2 epimer of D-glucose, which is a natural monosaccharide. Mannose is a simple sugar (monosaccharide) composed of the same elements (C₆H₁₂O₆) as glucose, but with a different arrangement of atoms. The chemical form that appears in foods and most supplements is called D-mannose. D-mannose is an important component of polysaccharides and glycoproteins.

As one of the most abundant monosaccharide units in nature, D-mannose is widely present in the form of D-mannose-linked conjugates, such as polysaccharides, glycoproteins, and glycolipids, but rarely exists in free form. It is an essential monosaccharide to humans, playing a crucial role in cellular communication and immune functions.

Natural Sources

Free D-mannose is rarely encountered in nature and is typically present only in trace amounts in certain fruits, such as apples, blueberries, and peaches. Mannose can be found in fruits (peaches, apples, oranges, blueberries, black currants, cranberries), legumes (green beans, kidney beans, lima beans, soybeans), vegetables (cabbage, turnip, tomatoes), ivory nuts, Aloe vera, and baker's yeast. The amount of mannose that can be absorbed from these foods is not known.

Free mannose is found in small amounts in many fruits such as oranges, apples, and peaches and in mammalian plasma at 50–100 μM. More often, mannose occurs in homo- or hetero-polymers such as yeast mannans (α-mannose) where it can account for nearly 16% of dry weight or in galactomannans. Ivory nut shavings were the original industrial source of mannose. Coffee beans, fenugreek, and guar gums are rich sources of galactomannans, but these plant polysaccharides are not degraded in the mammalian GI tract and therefore provide very little bioavailable mannose for glycan synthesis.

Konjac is a kind of herb that grows in China, Southeast Asia, Japan and other places, and has been used as human food for more than 2000 years. It can be used as a food and dietary supplement, with functions of detoxification, tumor suppression, and asthma inhibition. The main polysaccharide found in konjac is glucomannan, in which glucose and mannose are connected by β-1,4-glycosidic bonds in a ratio of 1:1.6.

D-mannose is also synthesized in the body from glucose for the synthesis of glycoproteins. D-mannose exists naturally in many plants and fruits and is found in human blood at concentrations less than one-fiftieth of that of glucose.

Commercial Production

D-mannose can be obtained from both plants and microorganisms. Chemical synthesis and biotransformation of D-mannose from D-fructose or D-glucose by using D-mannose isomerases, D-lyxose isomerases, and cellobiose 2-epimerase were intensively studied. Many studies have shown that the bioconversion of D-mannose from D-glucose and D-fructose through isomerase has great potential for large-scale production. The isomerases currently used in the production of D-mannose mainly include D-lyxose isomerase, D-mannose isomerase, cellobiose 2-epimerase, and mannose 2-epimerase.

D-mannose used as a dietary supplement or as a raw material for pharmaceuticals should avoid contamination by chemical extractants or other chemical by-products.

Common Forms and Preparations

D-mannose has been widely used in the food, pharmaceutical, and poultry industries, acting as the source of dietary supplements, starting material for the synthesis of drugs, and blocking colonization in animal feeds. As a dietary supplement, D-mannose is most commonly marketed as a powder to be dissolved in water, as capsules, or as tablets. The powdered form of D-mannose can be dissolved in water and administered without the additional additives required to encapsulate it, which limits possible additional side effects due to additives.

2. Traditional and Historical Use

D-mannose, as an isolated monosaccharide, does not have a documented traditional or ethnobotanical history of use in pre-modern medicine in the same way as plant-based herbal medicines. It is not listed in classical herbal pharmacopeias such as those of the German Commission E or ESCOP. Its use as a distinct dietary supplement is a modern development arising from biochemical and clinical research conducted primarily in the late 20th and early 21st centuries.

However, mannose-containing plants and polysaccharides have long traditional histories. Konjac is a kind of herb that grows in China, Southeast Asia, Japan, and other places, and has been used as human food for more than 2000 years. It can be used as a food and dietary supplement, with functions of detoxification, tumor suppression, and asthma inhibition. Aloe vera, another rich source of acetylated mannose-containing polysaccharides, has millennia of recorded medicinal use across numerous cultures, though these applications were for the whole plant gel rather than isolated mannose.

The modern use of purified D-mannose as a supplement began in the mid-1990s, initially driven by research into rare metabolic diseases (specifically, carbohydrate-deficient glycoprotein syndromes) and subsequently by interest in its potential as a non-antibiotic strategy against urinary tract infections. D-mannose is a glyconutrient with high research value in basic science because of its structure and function.

3. Key Constituents, Biochemistry, and Mechanisms of Action

Chemical Structure and Endogenous Role

A simple sugar, D-mannose has an important role in human metabolism through glycosylation of proteins. D-mannose is imported into mammalian cells via membrane glucose transporters and can be phosphorylated by hexokinase (HK) to produce mannose-6-phosphate (M6P). The defect in phosphomannose isomerase (PMI) deficiency involves the conversion of fructose-6-phosphate to mannose-6-phosphate. Hexokinase phosphorylates mannose to mannose-6-phosphate.

Anti-Adhesive Mechanism in Urinary Tract Infections

The principal mechanism by which D-mannose is proposed to act in the urinary tract is competitive inhibition of bacterial adhesion. D-mannose, a monosaccharide that is absorbed but not metabolized by the human body, has been proposed as an alternative approach for managing UTIs since it can inhibit the bacterial adhesion to the urothelium.

Adhesion of uropathogenic E. coli (UPEC) to the urothelium is mediated by UPEC binding to terminal D-mannose units on uroplakin Ia (UPIa). Without adhesion to the sugar, UPEC would remain free in the urine and be removed from the bladder during urination. To bind to terminal mannose units, UPEC produce multiple 3-μm-long rod-like structures on their surface known as type 1 pili.

D-mannose binds and blocks FimH adhesins located on the tip of type 1 bacterial fimbriae, playing a competitive inhibitor role against bacterial adhesion to the receptors of urothelial cells. This mechanism is based on the structural similarity between D-mannose and urothelial mannosylated receptors exposed by the epithelium of the urinary tract. Consequently, D-mannose prevents FimH-mediated bacterial adhesion to the bladder wall through a competitive inhibition mechanism. D-mannose exerts a urothelial barrier function, inhibiting the adhesion of bacteria to the urothelium. By binding free D-mannose, bacteria are blocked in the urine and then eliminated by the urinary tract.

Type 1 fimbriae have been documented on other members of the Enterobacteriaceae family, including Klebsiella pneumoniae, Shigella flexneri, Salmonella typhimurium, Serratia marcescens, and Enterobacter cloacae. Many of these are also uropathogens of recurrent UTIs.

Importantly, research has confirmed that D-mannose acts purely through anti-adhesive means rather than through antibiotic-like activity. The natural sugar D-mannose is considered as an alternative to antibiotics due to its ability to mask the bacterial adhesin FimH, thereby preventing its binding to urothelial cells. Despite its extensive use, the possibility that D-mannose exerts "antibiotic-like" activity by altering bacterial growth and metabolism or selecting FimH variants had not been investigated until recently. Results indicate that high D-mannose concentrations have no effect on bacterial growth and do not interfere with the activity of different antibiotics.

Role in Protein Glycosylation

D-mannose is an essential precursor for N-linked glycosylation of proteins. The enzymatic step involved in CDG type Ib—the conversion of fructose-6-phosphate to mannose-6-phosphate—is bypassed when exogenous mannose is administered. Hexokinase phosphorylates mannose to mannose-6-phosphate. A logical consequence of this fact is that PMI deficiency, unlike PMM deficiency, should be treatable by administration of mannose supplements.

Immunomodulatory Mechanisms

Experimental augmentation of mannose metabolism in adoptively transferred T cells via D-mannose supplementation enhances anti-tumor activity and restricts exhaustion differentiation both in vitro and in vivo. Mechanistically, D-mannose treatment induces intracellular metabolic programming and increases the O-GlcNAc transferase (OGT)-mediated O-GlcNAcylation of β-catenin, which preserves Tcf7 expression and epigenetic stemness, thereby promoting stem-like programs in T cells.

4. Scientific Evidence by Area of Use

4a. Urinary Tract Infections (UTIs) — Prevention

Although antibiotics still represent the standard treatment to manage recurrent UTI (rUTI), D-mannose, an inert monosaccharide that is metabolized and excreted in urine and acts by inhibiting bacterial adhesion to the urothelium, represents a promising nonantibiotic prevention strategy.

The evidence base for D-mannose in UTI prevention has grown considerably, but remains contested. After exclusion of non-pertinent studies, 13 studies have been analyzed in one review: six were randomized controlled trials (RCTs), one a randomized cross-over trial, five prospective cohort studies, and one a retrospective analysis.

Key RCT — Kranjčec et al. (2014): After initial antibiotic treatment of acute cystitis, 308 women with a history of recurrent UTI and no other significant comorbidities were randomly allocated to three groups. The first group (n = 103) received prophylaxis with 2 g of D-mannose powder in 200 mL of water daily for 6 months, the second (n = 103) received 50 mg nitrofurantoin daily, and the third (n = 102) did not receive prophylaxis. Overall 98 patients (31.8%) had recurrent UTI: 15 (14.6%) in the D-mannose group, 21 (20.4%) in the nitrofurantoin group, and 62 (60.8%) in the no-prophylaxis group. Patients in the D-mannose group and nitrofurantoin group had a significantly lower risk of recurrent UTI episode during prophylactic therapy compared to patients in the no-prophylaxis group (RR 0.239 and 0.335, P < 0.0001). In active groups, 17.9% of patients reported side effects but they were mild and did not require stopping the prophylaxis. Patients in the D-mannose group had a significantly lower risk of side effects compared to patients in the nitrofurantoin group (RR 0.276, P < 0.0001).

Porru et al. (2014) cross-over study: Porru 2014 compared oral D-mannose (3 g tablets/day for 2 weeks, reduced to 2 g/day for 22 weeks) to oral trimethoprim/sulfamethoxazole in 120 females who had acute or recurrent symptomatic UTI over a 24-week period. This was a cross-over study with no washout period and no available data from the first phase, and was therefore not included in Cochrane meta-analyses.

Hayward et al. (2024), JAMA Internal Medicine — the largest and most rigorous placebo-controlled RCT to date: This 2-group, double-blind randomized placebo-controlled trial took place across 99 primary care centers in the UK. Participants were recruited between March 28, 2019, and January 31, 2020, with 6 months of follow-up. Participants received 2 g of daily D-mannose powder or placebo with 6 months of follow-up. In this randomized clinical trial including 598 women with recurrent UTI recruited from primary care settings, the proportion experiencing a medically attended UTI was 51.0% in those taking daily D-mannose over 6 months and 55.7% in those taking placebo. Daily D-mannose did not reduce the proportion of women with recurrent UTI in primary care who experienced a subsequent clinically suspected UTI.

Systematic reviews and meta-analyses — mixed conclusions: One systematic review and meta-analysis was performed to determine whether D-mannose reduces urinary tract infection recurrence in adult women with recurrent UTI compared with other prevention agents. D-mannose appears protective for recurrent urinary tract infection (versus placebo) with possibly similar effectiveness as antibiotics. Overall, D-mannose appears well tolerated with minimal side effects—only a small percentage experiencing diarrhea. Meta-analysis interpretation must consider the small number of studies with varied study design and quality and the overall small sample size.

In contrast, a more recent meta-analysis incorporating the Hayward (2024) trial reached a different conclusion. The systematic review identified 4 randomized controlled trials including 890 participants (D-mannose n = 447, 50.22%). Recurrent UTI (RR 0.44; 95% CI 0.18–1.11; p = .082; I² = 90%) and adverse events (RR 2.19; 95% CI 0.68–7.05; p = .190; I² = 79%) did not differ significantly between the groups at the end of follow-up. Fewer number of studies and heterogeneity in the results make it difficult to draw conclusions about the efficacy of D-mannose in preventing recurrent UTI. More placebo-controlled RCTs are required to confirm the efficacy and safety.

An earlier Cochrane review also found limited evidence. One comparison reported no difference between D-mannose and nitrofurantoin on symptomatic and bacteriuria-confirmed UTIs (1 study, 206 participants: RR 0.71, 95% CI 0.39 to 1.31; very low certainty evidence).

NICE Guideline Committee assessment: D-mannose (200 mL of 1% solution once daily in the evening) used for up to 6 months significantly reduced the risk of recurrent infection in women who were not pregnant compared with no treatment (14.6% versus 60.8%, NNT 3 [range 2 to 3]; high-quality evidence). This was based on 1 RCT in women who were not pregnant presenting with a current UTI and a history of recurrent UTI (Kranjčec et al. 2014). The committee noted evidence suggesting that D-mannose was effective in reducing the risk of recurrent UTI in women who were not pregnant, and noted the low number needed to treat (NNT of 3; range 2 to 3) over 6 months, compared with no treatment. However, this was based on 1 small RCT. The committee agreed to make a recommendation that some women who are not pregnant may wish to try D-mannose as a self-care treatment, noting the sugar content of this product, which should be considered.

Overall evidence strength for UTI: The evidence is mixed and currently insufficient to support a firm recommendation. The Kranjčec (2014) trial showed promise compared with no treatment, but the largest placebo-controlled trial (Hayward, 2024) failed to demonstrate a significant benefit. There is low-level evidence, from a small number of studies, supporting the use of D-mannose or combination treatments for potentially preventing UTIs in adult women without producing burdening side effects. High heterogeneity across studies and methodological limitations constrain definitive conclusions.

4b. Congenital Disorder of Glycosylation Type Ib (MPI-CDG / CDG-Ib)

The most robustly established clinical application of mannose supplementation is in the treatment of a specific rare metabolic disease. Phosphomannose isomerase (PMI) deficiency is the cause of a new type of carbohydrate-deficient glycoprotein syndrome (CDGS). The disorder is caused by mutations in the PMI1 gene. The clinical phenotype is characterized by protein-losing enteropathy, while neurological manifestations prevailing in other types of CDGS are absent. Daily oral mannose administration is a successful therapy for this type of CDG syndrome classified as CDGS type Ib.

Oral administration of mannose was found to be effective therapy for CDG Ib. Mannose treatment corrected the clinical phenotype as well as the hypoglycosylation of serum glycoproteins. A logical consequence of the enzymatic defect is that PMI deficiency, unlike PMM deficiency, should be treatable by administration of mannose supplements.

This application is supported by multiple published case reports and small case series. MPI deficiency in humans was one of the first identified CDG disorders; it is extremely rare (<1:1,000,000) and characterized by protein-losing enteropathy, chronic diarrhea, cirrhosis, cyclic vomiting, anemia, and hyperinsulinemic hypoglycemia.

Limitations: Mannose is not effective for the more common CDG type Ia (PMM2-CDG). A case study in an infant with severe CDG type Ia found that intravenous D-mannose at 0.8 g/kg daily produced no biochemical or clinical improvement. Evidence for CDG-Ib consists of case series and open-label studies; no large-scale randomized controlled trials have been conducted due to the extreme rarity of the condition.

4c. Immune Regulation and T-Cell Function

Emerging preclinical research has identified D-mannose as a modulator of T-cell differentiation and immune function, though all human evidence in this area remains absent as of current publication.

Experimental augmentation of mannose metabolism in adoptively transferred T cells via D-mannose supplementation enhances anti-tumor activity and restricts exhaustion differentiation both in vitro and in vivo. Mechanistically, D-mannose treatment induces intracellular metabolic programming and increases OGT-mediated O-GlcNAcylation of β-catenin, which preserves Tcf7 expression and epigenetic stemness, thereby promoting stem-like programs in T cells. Furthermore, in vitro expansion with D-mannose supplementation yields T cell products for adoptive therapy with stemness characteristics, even after extensive long-term expansion, that exhibit enhanced anti-tumor efficacy.

D-mannose significantly increased TCF1 expression, promoted T cell differentiation toward a less differentiated state and enhanced anti-tumor activity, leading to prolonged survival in preclinical models. The ability of D-mannose to support long-term culture and maintenance of T cell states holds great promise for both the expansion of TILs and the generation of standardized, universal CAR-T cell products.

D-mannose promotes Treg cell differentiation and is therapeutic in mouse models of autoimmune diabetes and airway inflammation.

Evidence strength: Preclinical only (animal and cell-culture models). No human clinical trials have been conducted on D-mannose for immunotherapy, autoimmune disease, or cancer adjuvant applications. These findings are not a basis for supplemental use recommendations in humans.

4d. Cancer — Preclinical Models

D-mannose–mediated PD-L1 degradation promotes T cell activation and T cell killing of tumor cells. The combination of D-mannose and PD-1 blockade therapy dramatically inhibits triple-negative breast cancer (TNBC) growth and extends the lifespan of tumor-bearing mice. A recent study has shown that D-mannose enhances the effectiveness of immunotherapy and radiotherapy in TNBC by promoting the degradation of PD-L1.

Evidence strength: Preclinical only. All cancer-related research on D-mannose as of current evidence is conducted in cell culture and animal models. No human clinical trial data are available, and these findings should not be extrapolated to human benefit.

4e. Metabolic and Glycemic Considerations

D-mannose is imported into mammalian cells via membrane glucose transporters and can be phosphorylated by hexokinase to produce mannose-6-phosphate. In PMI-low cells, M6P is accumulated and inhibits the activity of glycolytic enzymes hexokinase and phosphoglucose isomerase, thus impairing glycolysis.

In animal studies, mannose has been shown to affect metabolic outcomes. A study in mice fed a high-fat diet found that D-mannose supplementation reduced weight gain, lowered body fat, improved liver fat accumulation, increased exercise endurance, and improved glucose tolerance. The proposed mechanism involves changes to gut bacteria that influence metabolism. However, these animal findings have not been confirmed in human clinical trials.

5. Body Systems and Health Areas Associated with Mannose

• Urinary tract / urothelium: 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 the urothelium and causing infection.
• Protein glycosylation / cellular metabolism: D-mannose is an important component of polysaccharides and glycoproteins. It serves as a necessary substrate for N-linked glycoprotein synthesis and is central to normal cellular signaling.
• Immune system / T-cell regulation: Findings underscore the role of mannose metabolism as a physiological regulator of T cell functionality and highlight its potential as a promising interventional target for immunotherapy.
• Gastrointestinal tract (as polysaccharide fibers): D-mannose is a key monosaccharide component of mannan and hemicellulose, and is typically the predominant unit in mannans, which are regarded as valuable dietary fibers for alleviating intestinal disorders.
• Rare metabolic diseases (CDG-Ib): D-mannose provides a substrate that bypasses the enzymatic defect in phosphomannose isomerase deficiency, correcting defective glycoprotein synthesis.

6. Dosage Forms and Dosages Reported in Studies

The following dosages are reported directly from published clinical studies and should not be taken as prescriptive guidance:

• UTI prophylaxis (Kranjčec 2014, RCT): 2 g of D-mannose powder in 200 mL of water daily for 6 months.
• UTI prevention (Hayward 2024, JAMA RCT): 2 g of daily D-mannose powder for 6 months of follow-up.
• UTI prevention/treatment (Porru 2014, cross-over study): 3 g tablets/day for 2 weeks, reduced to 2 g/day for 22 weeks.
• D-mannose dosage range reported in clinical trials for UTI prevention: The D-mannose dosage range for UTI prevention determined in clinical trials is between 2 and 3 g per day.
• CDG type Ib treatment: Researchers in one clinical study used a dose of 0.1 grams of mannose per kilogram body weight for CDG treatment without any notable side effects.
• Dose-related GI tolerability threshold: Alton et al. found the frequency of mannose adverse effects is dose-dependent, with only 10% of their study subjects experiencing gastrointestinal disturbances and bloating at 0.15 g mannose/kg body weight.

There is no FDA-approved dosing standard for D-mannose.

7. Safety, Adverse Effects, and Notable Interactions

General Tolerability

D-mannose is well tolerated, with few reported adverse events (diarrhea was reported in about 8% of patients receiving 2 g of D-mannose for at least 6 months). Overall, D-mannose appears well tolerated with minimal side effects—only a small percentage experiencing diarrhea.

Gastrointestinal Effects

In the largest published RCT, 17.9% of patients in both active treatment groups reported side effects but they were mild and did not require stopping the prophylaxis. In one of the largest clinical trials to date, only 8 out of 103 participants (around 8%) taking 2 g of D-mannose daily reported diarrhoea over six months. The majority experienced no side effects at all.

Adverse effects are dose-dependent, with only 10% of study subjects experiencing gastrointestinal disturbances and bloating at 0.15 g mannose/kg body weight. Using those numbers, if a study participant weighs 100 pounds, the participant would have a 10% chance of experiencing gastrointestinal side effects if a dose of 6.8 grams were used, which is a much larger dose than the 2 grams per day commonly studied.

Comparative Safety versus Antibiotics

There were significantly fewer adverse events (such as diarrhoea, nausea, and vaginal burning) with D-mannose compared with antibiotics in women who were not pregnant (7.8% versus 28.2%, number needed to harm [NNH] 5; Kranjčec et al. 2014).

Serious Adverse Events

In the Hayward 2024 trial, 28 serious adverse events were reported (20 in the D-mannose group and 8 in the placebo group). None were judged to be related to the intervention.

Considerations in Diabetes

Because D-mannose is a monosaccharide transported via glucose transporters, consideration is warranted in people with diabetes. While D-mannose is not primarily metabolized through glycolytic pathways in the same manner as glucose, and does not cause pronounced blood sugar spikes in healthy individuals, D-mannose is imported into mammalian cells via membrane glucose transporters and can be phosphorylated by hexokinase. In cells with low PMI activity, mannose-6-phosphate accumulates and may inhibit glycolytic enzyme activity. No formal drug interaction studies with antidiabetic medications have been published.

Drug Interactions

No significant drug interactions have been formally documented for D-mannose at typical supplemental doses in published clinical trials. D-mannose has been studied both alone and alongside antibiotic courses in UTI trials without evidence of pharmacokinetic antagonism.

CDG-Ib — Safety Caveats

In the specific context of intravenous mannose administration for CDG syndrome, adverse events have been documented. Seizures and stupor during intravenous mannose therapy have been reported in a patient with CDG syndrome type Ib (MPI-CDG). This underscores the importance of route of administration; oral supplementation at typical doses carries a substantially different risk profile.

Pregnancy and Breastfeeding

There is not enough safety data for pregnancy and breastfeeding. The absence of evidence of harm is not evidence of safety. In the Kranjčec 2014 trial, non-pregnant women were specifically selected, meaning the available clinical data does not extend to pregnant populations.

References

• Hu Y et al. d-Mannose: Properties, Production, and Applications: An Overview. Comprehensive Reviews in Food Science and Food Safety, 2021. PubMed PMID: 33401842
• Recent advances in biotransformation, extraction and green production of D-mannose. PMC8718577
• Scribano D et al. Considerations on D-mannose Mechanism of Action and Consequent Classification of Marketed Healthcare Products. Frontiers in Pharmacology, 2021
• Scribano D et al. d-Mannose Treatment neither Affects Uropathogenic Escherichia coli Properties nor Induces Stable FimH Modifications. PubMed PMID: 31941080
• Kranjčec B, Papeš D, Altarac S. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World Journal of Urology, 2014. PubMed PMID: 23633128
• Hayward G et al. d-Mannose for Prevention of Recurrent Urinary Tract Infection Among Women: A Randomized Clinical Trial. JAMA Internal Medicine, 2024. PMC11002776
• Lenger SM et al. D-mannose vs other agents for recurrent urinary tract infection prevention in adult women: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 2020
• Konesan J et al. The Clinical Trial Outcomes of Cranberry, D-Mannose and NSAIDs in the Prevention or Management of Uncomplicated Urinary Tract Infections in Women: A Systematic Review. Pathogens, 2022. PMC9788503
• Cooper TE et al. D‐mannose for preventing and treating urinary tract infections. Cochrane Database of Systematic Reviews, 2022. PMC9427198
• Role of D-Mannose in the Prevention of Recurrent Uncomplicated Cystitis: State of the Art and Future Perspectives. PMC8066587
• Laniewski P et al. Role of D-mannose in urinary tract infections – a narrative review. Nutrition Journal, 2022. Springer Nature
• Niehues R et al. Carbohydrate-deficient glycoprotein syndrome type Ib. Phosphomannose isomerase deficiency and mannose therapy. Journal of Clinical Investigation, 1998. PMC508719
• OMIM Entry #602579 — Congenital Disorder of Glycosylation, Type Ib (CDG1B)
• NICE Guideline: Urinary tract infection (recurrent). NCBI Bookshelf NBK611967
• Zhang H et al. Mannose metabolism reshapes T cell differentiation to enhance anti-tumor immunity. Cancer Cell, 2024
• D-mannose facilitates immunotherapy and radiotherapy of triple-negative breast cancer via degradation of PD-L1. PNAS, 2022
• Gu M et al. D-mannose induces regulatory T cells and suppresses immunopathology. Nature Medicine, 2017
• Intervening with Urinary Tract Infections Using Anti-Adhesives Based on the Crystal Structure of the FimH–Oligomannose-3 Complex. PLOS ONE, 2008
• Krishna MM et al. D-mannose for Prevention of Recurrent Urinary Tract Infection in Adult Women: An Updated Systematic Review and Meta-analysis. PMC11776761, 2025
• Recent advances on health effects and biological production of functional monosaccharide d-mannose. Trends in Food Science & Technology, 2025. ScienceDirect