D‑ribose: Potential clinical applications in congestive heart failure and diabetes, and its complications (Review)

Figures

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  Figure 1. Overview of the biochemical processes to synthesize ATP from D-ribose. The generation of ATP from D-ribose involves PRPP, IMP, AMP and ADP. ATP, adenosine triphosphate; ADP, adenosine diphosphate; AMP, adenosine monophosphate; IMP, inosine monophosphate; PRPP, phosphoribosyl pyrophosphate; HPRT, hypoxanthine phosphoribosyl transferase; PPi, pyrophosphoric acid; R5-P, ribulose 5-phosphate.

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  Figure 2. Dual roles of D-ribose: Therapeutic implications and side effects. AGEs, advanced glycation end products.

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  Figure 3. Schematic of the pathological processes of D-ribose-induced diabetes. The production of formaldehyde is triggered by the high concentration of D-ribose and a condition of pH>7 via the retro aldol reaction in nerves cell, which is one of the mechanisms leading to diabetic encephalopathy. On the other hand, the presence of a high concentration of D-ribose, which can act as an activation signal, leads to the release of NLRP3 inflammatory bodies from lysosomes following the activation of NLRP3 inflammatory bodies, thereby promoting the occurrence of diabetic kidney disease. This is caused by the gradual renal fibrosis which is induced by the release of the pro-inflammatory cytokine IL-1β. Additionally, D-ribose can also lead to the glycosylation of HbAlc and AGEs, that both contribute to the development of diabetic associated complications. AGEs, advanced glycation end products; NLRP3, nucleotide-binding oligomerization domain-like receptor family protein 3.