March 2021
Shuai Li, Juanjing Wang, Yutian Xiao, Li Zhang, Jinren Fang, Nanyang Yang, Zhixia Zhang, Moussa Ide Nasser, and Hui Qin
Abstract
The quality of life of patients with certain diseases may be improved through the development of technologies and advancements in pharmacology, with the aim of prolonging their life. However, congestive heart failure (CHF), as well their complications, continue to be the leading cause of disease-associated death.
The mechanisms underlying the development and progression of diabetes and CHF have been uncovered in a stepwise manner and the understanding of these mechanisms has improved the management of these diseases, resulting in reduced mortality and morbidity rates; however, CHF remains the leading cause of death worldwide, particularly in developed countries.
In the past decades, research has indicated that several supplements and naturally occurring compounds may be used to treat muscle weakness, for cardiac failure management, rehabilitation following myocardial ischemia-reperfusion and various complications of diabetes.
D-ribose is an essential component of the respiratory, skeletal and nervous systems and is a popular compound, as its supplementation may have beneficial effects. In the present review, the physiological roles, toxic reactions and the potential use of D-ribose in the management of clinical diseases are summarized.
Keywords: D-ribose, physiological function, congestive heart failure, toxic reactions, diabetes, potential clinical application
Introduction
The biochemical agent ribose is present as L and D enantiomers (1). The L-ribose enantiomer is unstable and thus, D-ribose is the primary functional isoform of ribose (2). D-ribose is a highly water-soluble 5-carbon sugar, also known as D-furanose, which is present in different types of RNA molecule, including mRNA, transfer RNA and ribosomal RNA (3,4).
D-ribose was first identified as a physiologically important molecule in humans in 1958; however, its physiological and pathological roles in humans, and in particular in diseases, are still being studied (5). Until 1970, D-ribose had only been known to serve as a means of increasing blood sugar levels in states of low energy (6). D-ribose was subsequently indicated to be clinically beneficial for treating certain diseases, such as congestive heart failure (CHF) (7-10). Although D-ribose is not stored in cells, it is essential in cell resynthesizing (7,11,12), remedial synthesis and ischemia and hypoxia (13-15). D-ribose may also be supplemented intravenously, via oral therapy or via other exogenous means, and is utilized in several scenarios, including the clinic (9,16), in athletes (17,18) and in healthcare (19), and energy is rapidly recharged via the synthesis of adenosine triphosphate (ATP).
In the present review, the potential physiological functions of D-ribose, its toxic effects, clinical value and its utility for the treatment of several diseases are discussed.
Conclusions and future perspectives
Currently, research on the clinical use D-ribose is still in the relatively early stages and a considerable amount of further investigation is required. However, based on the body of literature available, it is well established that D-ribose has several and broad prospects in various areas, including medicine and healthcare, as well as sports and athletics. For instance, in emergencies, such as during myocardial ischemia-reperfusion injury caused by cardiac operations or cardiac arrest, D-ribose may directly accelerate PRPP synthesis, thereby rapidly increasing the ATP concentration and other mechanisms in myocardial cells by injecting a certain amount of D-ribose to reduce the occurrence of myocardial ischemic injury. At the same time, further research and confirmation of the appropriate concentration ranges of D-ribose to use during these procedures and whether it may be used in conjunction with other first-aid rescue medications, such as those for cardiac arrest, is required.
Furthermore, a series of existing studies on the relationship between D-ribose and diabetes indicated that the concentration of D-ribose in patients with diabetes is proportional to the incidence and severity of diabetic complications. For the majority of people with diabetes, the primary factors impacting the quality of life or reducing their lifespan is not diabetes itself, but the resulting complications. Whether D-ribose may be used as a medication to treat diabetic complications and the effects of the D-ribose concentration on the body should be further studied. Simultaneously, improving D-ribose concentration determination technologies is particularly important. Thus, assessing D-ribose concentrations in patients with early diabetes may be used to predict the probability and extent of diabetic complications. In addition, reducing D-ribose intake in everyday life in patients with diabetes may be of direct significance. Perhaps, D-ribose analogues or drugs that target D-ribose may be used in advance to minimize patient harm from diabetic complications and reduce the occurrence of diabetic complications. Ultimately, D-ribose may be used to improve the quality of life of patients with diabetes and extend their lifespan.
Finally, D-ribose is also used as an anti-fatigue medication to enhance muscle exercise intensity in athletes and is commonly used as a food additive in food and health products. However, there is still no definitive conclusion on its safe range. In addition, whether excessive use of D-ribose poses other potential health hazards, as well as whether D-ribose is suitable for everyone requires further study.
