Caramboxin

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Caramboxin (CBX) is a neurotoxin that is found in bilimbi (Averrhoa bilimbi) and the related star fruit (Averrhoa carambol). It is a non-proteinogenic amino acid similar to phenylalanine, but containing hydroxyl, methoxy, and carboxyl substituents on the aromatic ring. Like phenylalanine, it contains a single chiral atom, meaning that two enantiomers are possible, with the (S) form being the one found in the plant. Star fruit also contains oxalic acid. This is also found in other food sources like cabbage, broccoli, and quinoa. Oxalic acid can react with calcium ions in blood to form calcium oxalate. Calcium oxalate can form crystals in kidney tubules which is linked to “an acute and/or chronic decrease in kidney function”. Eating too much star fruit in a short time can cause acute kidney injury (AKI) to occur, which in turn increases the risk of caramboxin doing severe damage to the body. Therefore, oxalate also influences the effect of caramboxin. The consumption of substantial amounts of star fruit or its juice on an empty stomach is not recommended, regardless of whether individuals have a normal kidney function or not. When this happens, intense haemodialysis is used to lower the concentration of caramboxin and oxalic acid, as these are water soluble.