Fig. 1: Overview of epidemiological associations between G6PD deficiency, cardiovascular disease, and immunological disease.

a G6PD is the rate-limiting enzyme in the pentose phosphate pathway (PPP), producing NADPH and other biosynthetic molecules necessary for the synthesis of ribonucleic acids, fatty acids, nucleotides, and amino acids. NADPH produced by the PPP is critical for maintaining redox homeostasis and, conversely, for the production of reactive oxygen species by NADPH oxidases. b, c G6PD deficiency is associated with worsened cardiovascular disease outcomes and a higher incidence of immune-related diseases in epidemiological studies. However, the effect of G6PD-d and a dysfunctional PPP on immune cell function in the context of atherosclerosis has yet to be explored.