2-Deoxy-D-Glucose (2-DG)

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Introduction:

2-Deoxy-D-glucose is a non-metabolizable glucose analog in which the hydroxyl group at position 2 of glucose is replaced by hydrogen, with potential glycolysis inhibiting and antineoplastic activities. Although the exact mechanism of action has yet to be fully elucidated, upon administration of 2-deoxy-D-glucose (2-DG), this agent competes with glucose for uptake by proliferating cells, such as tumor cells. 2-DG inhibits the first step of glycolysis and therefore prevents cellular energy production, which may result in decreased tumor cell proliferation.

Structure of 2-Deoxy-D-Glucose

2-Deoxy-D-Glucose was developed in the Defense Research and Development Organization (DRDO) laboratory, jointly by the Institute of Nuclear Medicine and Allied Sciences in collaboration with Dr. Reddy’s laboratories in Hyderabad in the context of radiation therapy for cancer. This drug was approved for emergency use authorization on May 18, 2021, in India as an adjunct therapy in moderate to severe COVID-19 patients by the Drugs Controller General of India (DCGI).

Synonyms:

  1. 2-DG.
  2. 2-Deoxyglucose.
  3. 2-Deoxy-D-arabino-hexose.
  4. 2-Deoxy-D-Mannose.

What Is 2-Deoxy-D-Glucose?

The 2-deoxy-d-glucose has historically been used in the radiolabeled form to determine glucose metabolism and is also used to test cancer patients, but till now, it is an unapproved drug for cancer, viral infections, and epilepsy. However, for COVID-19 disease, the drug showed effective results. The drug starts to accumulate in the virus-infected cells and stops the viral synthesis, and because of its selective accumulation in virally infected cells, this drug is considered unique.

The basic mechanism of 2-deoxy-d-glucose is to inhibit glycolysis, so it is still being used as an investigational drug to kill cancer cells and virus cells. For instance, during the pandemic in India, efforts were made to explore the possibilities of using this drug to defeat the COVID-19 disease. The tests at the centers of Hyderabad indicated that 2-deoxy-d-glucose killed virus cells, after which it progressed to trials in people.

What Are the Uses of 2-Deoxy-D-Glucose?

Therapeutic Drug:

2-Deoxy-d-glucose is known for its radiolabeled form. Radiolabeled 2-deoxy-d-glucose determines glucose metabolism in the following diseases as the glucose is altered in,

  • Cardiovascular disease.
  • Tumors.
  • Alzheimer’s disease.

It has been used as an adjunct to chemotherapy and radiotherapy in the treatment of,

  • Lung tumors.
  • Breast tumors.
  • Pancreatic tumors.
  • Head and neck tumors.
  • Gastric tumors.

Investigational Drug:

  • Anticancer Therapy – In hypoxic cancer cells, 2-deoxy-d-glucose inhibits glycolysis and prevents ATP production, that is, ultimately, cell survival.
  • Antiviral Therapy – 2-Deoxy-d-glucose is effective against the herpes simplex virus (HSV) as it affects the ability of the virus to penetrate cells.
  • Anticonvulsant Therapy – 2-Deoxy-d-glucose worked in the experimental trials as an anticonvulsant in temporal lobe epilepsy by suppressing certain proteins that are at high levels after a seizure.

It has been used as an experimental drug in these cases and has not been approved as a therapeutic agent.

How Effective Is 2-Deoxy-D-Glucose on COVID Patients?

2-Deoxy-d-glucose medicine structurally resembles glucose. It is now found to kill the virus causing COVID-19 disease.

Normally, the virus makes use of glucose to produce enough energy, and the produced energy helps in the multiplication of the virus.

But when COVID-19 patients take this medicine, it is readily absorbed by the virus. Thus, the virus-infected cells start to utilize the medicine and stop energy production by inhibiting the virus from making copies of itself. This inhibition of virus multiplication and killing helps too,

  • clearer the infection.
  • Prevent complications in patients even if it has spread to the lungs.
  • Reduces the usage of supplemental oxygen in both moderate to severely infected COVID-19 patients.

Available Forms of 2-Deoxy-D-Glucose:

2-Deoxy-d-Glucose medicine is available in powder form, which comes in a sachet.

2-Deoxy-D-Glucose Dosage:

It is taken twice a day orally by dissolving in water. However, to get cured completely, COVID-19 patients are instructed to take this drug for a week or 5 days. Most importantly, it should be taken when only prescribed by the doctor to avoid unwanted side effects.

2-Deoxy-D-Glucose the Safe Medicine:

2-Deoxy-d-glucose has been authorized to be used across India as the Drug Controller General of India (DCGI) has given emergency use approval knowing the medicine’s quality, safety (do not cause side effects under recommended doses), and efficacy. In clinical trials, 2-deoxy-d-glucose is considered to be safe if used under the doctor’s advised dose and duration. Do not skip the dose and take medicine as directed by the doctor. Reach your doctor if you come to notice abnormal symptoms or side effects (rare) and follow the doctor’s instructions carefully.

2-Deoxy-D-Glucose Efficacy:

  • It provides a faster recovery in hospitalized patients and helps to reduce supplemental oxygen dependence.
  • 2-Deoxy-d-glucose has been shown to work efficiently in COVID-19 patients and showed a faster symptomatic cure than Standard of Care (SoC).
  • A larger population improved symptomatically on the 3-rd. day of taking the drug and became free from supplemental oxygen dependence (42% vs. 31%) in comparison to SoC.

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