(13) C mannitol as a novel biomarker for measurement of intestinal permeability

Neurogastroenterol Motil. 2016 Jul;28(7):1114-9. doi: 10.1111/nmo.12802. Epub 2016 Feb 23.


Background: Gastrointestinal (GI) and non-GI disorders are associated with altered intestinal permeability, which can be measured in vivo by urinary excretion after oral lactulose and mannitol ingestion. Inadvertent dietary consumption of (12) Carbon ((12) C, regular) mannitol in food or from other sources may interfere with the test's interpretation. (13) Carbon ((13) C) constitutes 1% of carbon in nature and (13) C mannitol is a stable isotope. Our aim was to determine the performance of (13) C mannitol for measurement of intestinal permeability.

Methods: Ten healthy volunteers underwent intestinal permeability assay using coadministered (12) C mannitol, (13) C mannitol and lactulose, followed by timed urine collections. Urinary sugar concentrations were measured using tandem high performance liquid chromatography-mass spectrometry.

Key results: We found that (13) C mannitol can be distinguishable from (12) C mannitol on tandem mass spectrometry. In addition, (13) C mannitol had ~20-fold lower baseline contamination compared to (12) C mannitol. We describe here the (13) C mannitol assay method for the measurement of intestinal permeability.

Conclusions & inferences: In conclusion, (13) C mannitol is superior to (12) C mannitol for measurement of intestinal permeability. It avoids issues with baseline contamination and erratic excretions during the testing period.

Keywords: barrier function; gastrointestinal; irritable bowel syndrome; lactulose.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers / metabolism
  • Biomarkers / urine
  • Carbon Isotopes / administration & dosage
  • Carbon Isotopes / metabolism*
  • Carbon Isotopes / urine*
  • Humans
  • Intestinal Absorption / drug effects
  • Intestinal Absorption / physiology*
  • Intestinal Mucosa / drug effects
  • Intestinal Mucosa / metabolism
  • Male
  • Mannitol / administration & dosage
  • Mannitol / metabolism*
  • Mannitol / urine*
  • Middle Aged
  • Permeability / drug effects
  • Tandem Mass Spectrometry / methods


  • Biomarkers
  • Carbon Isotopes
  • Mannitol