Glucose-6-Phosphate Dehydrogenase Deficiency Reduces Susceptibility to Cancer of Endodermal Origin

Background. Glucose‒6‒phosphate dehydrogenase (G6PD) deficiency is the most common inherited enzyme defect worldwide. There is a growing scientific evidence for a protective role of G6PD deficiency against carcinogenesis. In this retrospective analysis we tested the hypothesis that G6PD deficiency may reduce the risk of developing cancer in a tissue‒specific manner. Material and Methods. The study was conducted using data from 11,708 subjects undergoing gastrointestinal endoscopic procedures between 2002 and 2018 and tested for G6PD status in a teaching hospital of Northern Sardinia, Italy. Results. A 40% reduction of risk for cancer of endodermal origin was observed among G6PD‒deficient patients compared with subjects with normal enzyme activity [Relative Risk (RR) 0.61, 95% Confidence Interval (CI) 0.47‒0.80] in both genders, confirmed by multivariable generalized linear regression after adjusting for age, sex, smoking habits, body mass index, diabetes and socio−economic status. The “protective” effect of G6PD deficiency was larger for gastric cancer (RR 0.41, 95% CI 0.18 ‒ 0.99), hepatocellular carcinoma (RR 0.48, 95% CI 0.26 ‒ 0.92), and colorectal cancer (RR 0.72, 95% CI 0.53 ‒ 0.98), while a non‒significant risk was observed for breast, prostate, lung, hematopoietic and metastases (primary site unknown). Conclusion. Our results suggest a reduced susceptibility to develop cancers, mostly of endodermal origin (stomach, colon, and liver), but not of ectodermal/mesodermal origin, in carriers of G6PD deficiency. The effects of G6PD deficiency on carcinogenesis need further studies to better understand how cancer cells originating from different germ layers make use of pentose phosphate pathway to proliferate.