2-Deoxy-d-glucose is a glucose molecule which has the 2-hydroxyl group replaced by hydrogen, so that it cannot undergo further glycolysis.

Viruses like SARS-CoV-2 place increased demand on glucose and up-regulate their host cell’s metabolic processes. SARS-CoV-2 virus uses glucose which provides energy in the form of adenosine triphosphate (ATP) to viral host cells via glycolysis, as well as enabling glycan formation supporting creation of glycoproteins during glycosylation. Glycolysis & glycosylation of glucose by SARS-CoV-2 increases its infectivity & replication power inside the host cell.

To cells, 2-DG looks like glucose, but it lacks one of the hydroxyl groups (the OH symbol shown here in red) found in the chemical structure of natural glucose removed.  2-DG used by SARS-CoV-2 virus will not convert into energy via glycolysis and it will not form the proper building-blocks for glycan formation during glycosylation.  Furthermore, 2-DG helps in restoring CD/CD8 ratio, enhancing NK cells and IFN-gamma levels coupled with improved antigen & helps in improving immunity of COVID-19 patient.

Currently there is no approved therapeutic indications for 2-DG however it may have several potential indications as an adjunct to chemotherapy and radiotherapy in the treatment of solid tumors, as an antiviral treatment in herpes simplex patients, and as an antiepileptic in temporal lobe epilepsy patients. Currently it is approved by the Drugs Controller General of India (DCGI) for Emergency use as an adjunct therapy to the standard of care in the treatment of COVID-19.

2-DG is currently available in the powder form packed in the sachet.

2-DG can be administered orally twice daily on empty stomach. To prepare one dose, the entire contents of sachet of 2-DG should be completely dissolved in 100ml drinking water. Based on a patient’s body weight, the required quantity of the 2-DG solution should be measured out and administered.

As quoted by DRDO on twitter (1^st June 2021), “2-DG should be prescribed as early as possible by doctors for moderate to severe COVID patients for a maximum duration of up to 10 days”.

2-DG is not recommended for an out-patient setting.

Patients who have a known hypersensitivity to 2-DG or any of its analogues, such as fluorodeoxyglucose, should avoid it. Pregnancy and breastfeeding are two other contraindications.

As quoted by DRDO on twitter (1^st June 2021), “2-DG is not recommended to be used in the paediatric population or in patients below 18 years of age”.

As quoted by DRDO on twitter (1^st June 2021), “2-DG can be used in the patients with diabetes mellitus however caution should be exercised as it is not yet studied in patients with diabetes”.

As quoted by DRDO on twitter (1^st June 2021), “2-DG can be used in the patients with hepatic and renal impairment however caution should be exercised as it is not yet studied in patients with hepatic and renal impairment”.

There have been no major signs of toxicity or side –effects reported. Some side effects associated with high doses of 2-DG are: Fatigue, Dizziness, Nausea, Hypoglycemia.

2-DG accumulates more readily in cells infected with viruses. Normal lung cells that are not infected will only take up a small quantity of 2-DG, which has no effect on their function.

As quoted by DRDO on twitter (1^st June 2021), “2DG should be prescribed as early as possible by doctors for moderate to severe Covid patients for maximum duration up to 10 days”

2-DG will exert its anti-inflammatory action and become a beneficial in patient.

No clinically significant increase in blood glucose was observed with the doses of 2-DG administered during Phase 2 and Phase 3 clinical studies to COVID-19 patients, as compared to patients who only got standard-of-care treatment. Based on literature, 2-DG has anti-fungal properties as well.

No, 2-DG is only recommended in emergency use as an adjunct therapy to the standard of care in the treatment of moderate to severe COVID-19.