Published May 14, 2026
| Version v1
Working paper
Open
Camouflaged Sepsis: How ETBF Cleavage Transforms Antivirals into Multi-Organ Toxins
Description
- In high-acuity clinical environments, multi-organ dysfunction syndrome (MODS) is traditionally attributed to primary viral or bacterial pathogenesis. This perspective paper introduces a complex systems-safety forensic framework evaluating a hidden metabolic failure pathway where host tissue, the intravenous 1′-cyano-substituted adenosine analogue remdesivir, and translocated Enterotoxigenic Bacteroides fragilis (ETBF) intersect. Utilizing historical enzymatic data demonstrating that B. fragilis possesses an aggressive 1,700-fold baseline glycosidase/hydrolase capacity relative to other fecal flora, we map a dual-front toxicological mechanism. If disseminated ETBF enzymes cleave the single covalent carbon-nitrile bond at the 1′-position of the ribose ring, two catastrophic outcomes result: (1) the localized liberation of free cyanide (CN-), which irreversibly inhibits mitochondrial Cytochrome c Oxidase (Complex IV), halting ATP production, and (2) the generation of a de-protected 1′-carboxylic acid nucleoside clone that slips past human nuclear RNA Polymerase II steric filters, causing mass genomic transcription failure and apoptosis. Furthermore, we outline how the resulting clinical indicators—hyperlactatemia, elevated transaminases, and anomalous central venous oxygenation (ScvO2>85%)—are systematically misclassified by automated EHR algorithms as standard viral sepsis or class-expected drug reactions. This paper serves as a root-cause incident investigation model, providing safety boards and pharmaceutical regulators with precise stable-isotope (
[1′-13C, 15N]) and high-resolution mass spectrometry protocols to identify hidden xenobiotic-microbiome toxicities in future public health crises. - KEYWORDS: Xenobiotic-Microbiome Interaction; Enterotoxigenic Bacteroides fragilis (ETBF); Remdesivir Triphosphate; Mitochondrial Suffocation; Complex IV Inhibition; Forensic Incident Investigation; Perceptual Masking; Clinical Chart Failure. [1]
Files
Camouflaged Sepsis.pdf
Additional details
Dates
- Copyrighted
-
2026-05-14