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1.
FASEB J ; 38(10): e23676, 2024 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-38783765

RESUMEN

The escalating prevalence of metabolic syndrome poses a significant public health challenge, particularly among aging populations, with metabolic dysfunctions contributing to pro-inflammatory states. In this review, we delved into the less recognized association between hyperuricemia (HUA), a manifestation of metabolic syndrome and a primary risk factor for gout, and age-related macular degeneration (AMD), a sight-threatening ailment predominantly affecting the elderly. In recent years, inflammation, particularly its involvement in complement pathway dysregulation, has gained prominence in AMD pathophysiology. The contradictory role of uric acid (UA) in intercellular and intracellular environments was discussed, highlighting its antioxidant properties in plasma and its pro-oxidant effects intracellularly. Emerging evidence suggests a potential link between elevated serum uric acid levels and choroid neovascularization in AMD, providing insights into the role of HUA in retinal pathologies. Various pathways, including crystal-induced and non-crystal-induced mechanisms, were proposed to indicate the need for further research into the precise molecular interactions. The implication of HUA in AMD underscores its potential involvement in retinal pathologies, which entails interdisciplinary collaboration for a comprehensive understanding of its impact on retina and related clinical manifestations.


Asunto(s)
Gota , Hiperuricemia , Degeneración Macular , Humanos , Hiperuricemia/complicaciones , Hiperuricemia/metabolismo , Degeneración Macular/etiología , Degeneración Macular/metabolismo , Gota/metabolismo , Gota/etiología , Ácido Úrico/metabolismo , Ácido Úrico/sangre , Animales
2.
Clin Med Res ; 21(4): 196-200, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38296638

RESUMEN

Benjamin Franklin, one of the founding fathers of the United States, was not just a politician and a political philosopher but an inventor with a scientific temperament. He was overweight and likely suffered from the consequences of metabolic syndrome including gout. He woke up with a gout attack on October 22, 1780 and wrote the "Dialogue Between Franklin and the Gout." His observations on the risk factors for gout are re-examined in the modern context 243 years later.


Asunto(s)
Personajes , Gota , Síndrome Metabólico , Masculino , Humanos , Estados Unidos , Gota/etiología , Factores de Riesgo , Síndrome Metabólico/complicaciones , Personal Administrativo
3.
Crit Rev Food Sci Nutr ; 62(25): 7129-7137, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-33866874

RESUMEN

Alcohol is recognized a risk factor for increased uric acid and gout flare. The aim of the study was to review the literature in order to find out what is the role of alcohol consumption in pathogenesis of gout. A search in PubMed, Google Scholar, Medline Complete database was performed in January 2021. The databases were searched with the phrases: "uric acid and alcohol," "alcoholic beverages and gout," "hyperuricemia and alcoholic beverages consumption" published between 2000 and 2021. A total of 2642 results were found. The 99 non-duplicate citations were screened. Then 81 articles were excluded after abstract screen. After that 18 articles were retrieved. Eventually 15 articles were included for systematic review. Several authors see the positive correlation between beer or distilled spirits consumption and gout. Some include wine to the list of triggers of gout. Others state that moderate wine consumption protects from gout attacks due to antioxidants and phytoestrogen content. Majority noticed the relationship between episodic alcohol consumption and gout attacks. Episodic alcohol intake triggers gout attacks, regardless of type of alcohol. Thus, individuals with established gout and pre-existing risk factors should limit all types of alcohol intake to prevent gout episodes.


Asunto(s)
Gota , Hiperuricemia , Vino , Consumo de Bebidas Alcohólicas/efectos adversos , Bebidas Alcohólicas/efectos adversos , Cerveza , Etanol , Gota/epidemiología , Gota/etiología , Gota/prevención & control , Humanos , Hiperuricemia/epidemiología , Hiperuricemia/prevención & control , Brote de los Síntomas , Ácido Úrico
4.
Environ Res ; 212(Pt C): 113377, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-35500858

RESUMEN

Gout is a chronic disease with inflammatory arthritis caused by monosodium urate (MSU) crystals deposition, an elevated serum urate level (hyperuricaemia) is the critical factor leading to MSU crystals deposition and promoting the progression of gout. The onset and development of gout is generally the result of multiple factors, such as diet, heredity and environmental factors. Although genetics and diet are thought to play as major factors, a growing body of research evidence has highlighted that environmental factors also play a significant role in the onset and exacerbation of gout. Recent studies have shown that air pollutants such as particulate matter, sulfur dioxide (SO2) and carbon monoxide (CO) may increase the risk of hospitalizations for gout, and that the changes in temperature and humidity may affect uric acid (UA) levels. There is also seasonal trend in gout. It has been demonstrated that environmental factors may induce or accelerate the production and release of pro-inflammatory mediators, causing an unbalance oxidative stress and systemic inflammation, and then participating in the overall process or a certain link of gout. Moreover, several environmental factors have shown the ability to induce the production urate and regulate the innate immune pathways, involving in the pathogenesis of gout. Nevertheless, the role of environmental factors in the etiology of gout remains unclear. In this review, we summarized the recent literatures and aimed to discuss the relationship between environmental factors (such as microclimate, season, ambient/indoor air pollution and extreme weather) and gout. We further discussed the inflammatory mechanisms of environmental factors and gout and the comprehensive effects of environmental factors on gout. We also made a prospect of the management and treatment of gout, with special consideration to environmental factors associated with gout.


Asunto(s)
Gota , Ácido Úrico , Gota/etiología , Gota/genética , Humanos , Inflamación , Ácido Úrico/química , Ácido Úrico/metabolismo , Ácido Úrico/farmacología
5.
Rheumatol Int ; 42(3): 403-412, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34586473

RESUMEN

Humans do not produce uricase, an enzyme responsible for degrading uric acid. However, some bacteria residing in the gut can degrade one-third of the dietary and endogenous uric acid generated daily. New insights based on metagenomic and metabolomic approaches provide a new interest in exploring the involvement of gut microbiota in gout. Nevertheless, the exact mechanisms underlying this association are complex and have not been widely discussed. In this study, we aimed to review the evidence that suggests uric acid extrarenal excretion and gut microbiome are potential risk factors for developing gout. A literature search was performed in PubMed, Web of Science, and Google Scholar using several keywords, including "gut microbiome AND gout". A remarkable intestinal dysbiosis and shifts in abundance of certain bacterial taxa in gout patients have been consistently reported among different studies. Under this condition, bacteria might have developed adaptive mechanisms for de novo biosynthesis and salvage of purines, and thus, a concomitant alteration in uric acid metabolism. Moreover, gut microbiota can produce substrates that might cross the portal vein so the liver can generate de novo purinogenic amino acids, as well as uric acid. Therefore, the extrarenal excretion of uric acid needs to be considered as a factor in gout development. Nevertheless, further studies are needed to fully understand the role of gut microbiome in uric acid production and its extrarenal excretion, and to point out possible bacteria or bacterial enzymes that could be used as probiotic coadjutant treatment in gout patients.


Asunto(s)
Microbioma Gastrointestinal , Gota/metabolismo , Ácido Úrico/metabolismo , Gota/etiología , Humanos , Factores de Riesgo
6.
PLoS Genet ; 15(8): e1008318, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31415568

RESUMEN

Elevated uric acid (UA) is a key risk factor for many disorders, including metabolic syndrome, gout and kidney stones. Despite frequent occurrence of these disorders, the genetic pathways influencing UA metabolism and the association with disease remain poorly understood. In humans, elevated UA levels resulted from the loss of the of the urate oxidase (Uro) gene around 15 million years ago. Therefore, we established a Drosophila melanogaster model with reduced expression of the orthologous Uro gene to study the pathogenesis arising from elevated UA. Reduced Uro expression in Drosophila resulted in elevated UA levels, accumulation of concretions in the excretory system, and shortening of lifespan when reared on diets containing high levels of yeast extract. Furthermore, high levels of dietary purines, but not protein or sugar, were sufficient to produce the same effects of shortened lifespan and concretion formation in the Drosophila model. The insulin-like signaling (ILS) pathway has been shown to respond to changes in nutrient status in several species. We observed that genetic suppression of ILS genes reduced both UA levels and concretion load in flies fed high levels of yeast extract. Further support for the role of the ILS pathway in modulating UA metabolism stems from a human candidate gene study identifying SNPs in the ILS genes AKT2 and FOXO3 being associated with serum UA levels or gout. Additionally, inhibition of the NADPH oxidase (NOX) gene rescued the reduced lifespan and concretion phenotypes in Uro knockdown flies. Thus, components of the ILS pathway and the downstream protein NOX represent potential therapeutic targets for treating UA associated pathologies, including gout and kidney stones, as well as extending human healthspan.


Asunto(s)
Gota/etiología , Cálculos Renales/etiología , Redes y Vías Metabólicas/genética , Transducción de Señal/genética , Ácido Úrico/metabolismo , Animales , Animales Modificados Genéticamente , Estudios de Cohortes , Modelos Animales de Enfermedad , Drosophila melanogaster , Conducta Alimentaria , Femenino , Técnicas de Silenciamiento del Gen , Gota/metabolismo , Humanos , Insulina/metabolismo , Cálculos Renales/metabolismo , Longevidad/genética , Masculino , Persona de Mediana Edad , NADPH Oxidasas/genética , NADPH Oxidasas/metabolismo , Polimorfismo de Nucleótido Simple , Purinas/administración & dosificación , Purinas/efectos adversos , Urato Oxidasa/genética , Urato Oxidasa/metabolismo
7.
Mol Med ; 27(1): 50, 2021 05 24.
Artículo en Inglés | MEDLINE | ID: mdl-34030623

RESUMEN

OBJECTIVE: To evaluate the taxonomic composition of the gut microbiome in gout patients with and without tophi formation, and predict bacterial functions that might have an impact on urate metabolism. METHODS: Hypervariable V3-V4 regions of the bacterial 16S rRNA gene from fecal samples of gout patients with and without tophi (n = 33 and n = 25, respectively) were sequenced and compared to fecal samples from 53 healthy controls. We explored predictive functional profiles using bioinformatics in order to identify differences in taxonomy and metabolic pathways. RESULTS: We identified a microbiome characterized by the lowest richness and a higher abundance of Phascolarctobacterium, Bacteroides, Akkermansia, and Ruminococcus_gnavus_group genera in patients with gout without tophi when compared to controls. The Proteobacteria phylum and the Escherichia-Shigella genus were more abundant in patients with tophaceous gout than in controls. Fold change analysis detected nine genera enriched in healthy controls compared to gout groups (Bifidobacterium, Butyricicoccus, Oscillobacter, Ruminococcaceae_UCG_010, Lachnospiraceae_ND2007_group, Haemophilus, Ruminococcus_1, Clostridium_sensu_stricto_1, and Ruminococcaceae_UGC_013). We found that the core microbiota of both gout groups shared Bacteroides caccae, Bacteroides stercoris ATCC 43183, and Bacteroides coprocola DSM 17136. These bacteria might perform functions linked to one-carbon metabolism, nucleotide binding, amino acid biosynthesis, and purine biosynthesis. Finally, we observed differences in key bacterial enzymes involved in urate synthesis, degradation, and elimination. CONCLUSION: Our findings revealed that taxonomic variations in the gut microbiome of gout patients with and without tophi might have a functional impact on urate metabolism.


Asunto(s)
Disbiosis , Microbioma Gastrointestinal , Gota/metabolismo , Metagenoma , Metagenómica , Ácido Úrico/metabolismo , Biodiversidad , Biología Computacional/métodos , Gota/etiología , Gota/patología , Humanos , Metagenómica/métodos , Mapeo de Interacción de Proteínas , Mapas de Interacción de Proteínas
8.
Biochem Biophys Res Commun ; 581: 6-11, 2021 12 03.
Artículo en Inglés | MEDLINE | ID: mdl-34637964

RESUMEN

Cluster of differentiation (CD) 38, a major enzyme for nicotinamide adenine dinucleotide (NAD+) degradation, plays a key role in inflammation. Meanwhile, intracellular NAD+ decline is also associated with inflammatory responses. However, whether CD38 activation is involved in gouty inflammation has not been elucidated. The present study aimed to clarify the role of CD38 in monosodium urate crystals (MSU)-triggered inflammatory responses. The results showed that MSU crystals increased the protein expression of CD38 in time- and concentration-dependent manner in THP-1 macrophages and mouse bone marrow-derived macrophages (BMDMs). Moreover, intracellular NAD+ levels were reduced by MSU crystals along with the increased IL-1ß release. However, CD38 inhibition by 78c elevated intracellular NAD+ levels and suppressed IL-1ß release in MSU crystals-treated THP-1 macrophages and BMDMs. Interestingly, CD38 inhibition without significant elevation of intracellular NAD+ also decreased IL-1ß release driven by MSU crystals in THP-1 macrophages. In conclusion, the present study revealed that MSU crystals could activate CD38 with the ensuing intracellular NAD+ decline to promote inflammatory responses in THP-1 macrophages and BMDMs, while CD38 inhibition could suppress MSU crystals-triggered inflammatory responses, indicating that CD38 is a potential therapeutic target for gout.


Asunto(s)
ADP-Ribosil Ciclasa 1/genética , Interleucina-1beta/genética , Macrófagos/efectos de los fármacos , Glicoproteínas de Membrana/genética , Ácido Úrico/farmacología , ADP-Ribosil Ciclasa 1/agonistas , ADP-Ribosil Ciclasa 1/metabolismo , Animales , Cristalización , Femenino , Regulación de la Expresión Génica , Gota/etiología , Gota/genética , Gota/metabolismo , Gota/patología , Humanos , Hiperuricemia/etiología , Hiperuricemia/genética , Hiperuricemia/metabolismo , Hiperuricemia/patología , Inflamación , Interleucina-1beta/metabolismo , Macrófagos/metabolismo , Macrófagos/patología , Masculino , Glicoproteínas de Membrana/agonistas , Glicoproteínas de Membrana/metabolismo , Ratones , Ratones Endogámicos C57BL , Modelos Biológicos , NAD/metabolismo , Cultivo Primario de Células , Transducción de Señal , Células THP-1
9.
J Hum Genet ; 66(5): 465-473, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33100326

RESUMEN

Observational studies have identified gout patients are often comorbid with dyslipidemia. However, the relationship between dyslipidemia and gout is still unclear. We first performed Mendelian randomization (MR) to evaluate the causal effect of four lipid traits on gout and serum urate based on publicly available GWAS summary statistics (n ~100,000 for lipid, 69,374 for gout and 110,347 for serum urate). MR showed each standard deviation (SD) (~12.26 mg/dL) increase in HDL resulted in about 25% (95% CI 9.0%-38%, p = 3.31E-3) reduction of gout risk, with 0.09 mg/dL (95% CI: -0.12 to -0.05, p = 7.00E-04) decrease in serum urate, and each SD (~112.33 mg/dL) increase of TG was associated with 0.10 mg/dL (95% CI: 0.06-0.14, p = 9.87E-05) increase in serum urate. Those results were robust against various sensitive analyses. Additionally, independent effects of HDL and TG on gout/serum urate were confirmed with multivariable MR. Finally, mediation analysis demonstrated HDL or TG could also indirectly affect gout via the pathway of serum urate. In conclusion, our study confirmed the causal associations between HDL (and TG) and gout, and further revealed the effect of HDL or TG on gout could also be mediated via serum urate.


Asunto(s)
Dislipidemias/complicaciones , Estudio de Asociación del Genoma Completo , Gota/sangre , Lípidos/sangre , Análisis de Mediación , Análisis de la Aleatorización Mendeliana/métodos , Polimorfismo de Nucleótido Simple , Factores de Edad , Causalidad , Colesterol/sangre , Dislipidemias/genética , Gota/etiología , Gota/genética , Humanos , Hiperlipoproteinemias/complicaciones , Hiperlipoproteinemias/genética , Hipertrigliceridemia/complicaciones , Hipertrigliceridemia/genética , Funciones de Verosimilitud , Modelos Lineales , Lipoproteínas HDL/sangre , Lipoproteínas LDL/sangre , Modelos Biológicos , Sensibilidad y Especificidad , Factores Sexuales , Triglicéridos/sangre , Ácido Úrico/sangre , Población Blanca
10.
Int J Mol Sci ; 22(13)2021 Jun 22.
Artículo en Inglés | MEDLINE | ID: mdl-34206432

RESUMEN

Urate homeostasis in humans is a complex and highly heritable process that involves i.e., metabolic urate biosynthesis, renal urate reabsorption, as well as renal and extrarenal urate excretion. Importantly, disturbances in urate excretion are a common cause of hyperuricemia and gout. The majority of urate is eliminated by glomerular filtration in the kidney followed by an, as yet, not fully elucidated interplay of multiple transporters involved in the reabsorption or excretion of urate in the succeeding segments of the nephron. In this context, genome-wide association studies and subsequent functional analyses have identified the ATP-binding cassette (ABC) transporter ABCG2 as an important urate transporter and have highlighted the role of single nucleotide polymorphisms (SNPs) in the pathogenesis of reduced cellular urate efflux, hyperuricemia, and early-onset gout. Recent publications also suggest that ABCG2 is particularly involved in intestinal urate elimination and thus may represent an interesting new target for pharmacotherapeutic intervention in hyperuricemia and gout. In this review, we specifically address the involvement of ABCG2 in renal and extrarenal urate elimination. In addition, we will shed light on newly identified polymorphisms in ABCG2 associated with early-onset gout.


Asunto(s)
Transportador de Casetes de Unión a ATP, Subfamilia G, Miembro 2/genética , Susceptibilidad a Enfermedades , Gota/etiología , Hiperuricemia/etiología , Proteínas de Neoplasias/genética , Transportador de Casetes de Unión a ATP, Subfamilia G, Miembro 2/metabolismo , Edad de Inicio , Alelos , Animales , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Variación Genética , Genotipo , Gota/diagnóstico , Gota/metabolismo , Gota/terapia , Humanos , Hiperuricemia/diagnóstico , Hiperuricemia/metabolismo , Hiperuricemia/terapia , Proteínas de Neoplasias/metabolismo , Fenotipo , Polimorfismo de Nucleótido Simple
11.
Ann Rheum Dis ; 79(3): 418-423, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31811060

RESUMEN

OBJECTIVES: Hospitalisation is a risk factor for flares in people with gout. However, the predictors of inpatient gout flare are not well understood. The aim of this study was to develop a prediction model for inpatient gout flare among people with comorbid gout. METHODS: We used data from a retrospective cohort of hospitalised patients with comorbid gout from Wellington, Aotearoa/New Zealand, in 2017 calendar year. For the development of a prediction model, we took three approaches: (A) a clinical knowledge-driven model, (B) a statistics-driven model and (C) a decision tree model. The final model was chosen based on practicality and performance, then validated using bootstrap procedure. RESULTS: The cohort consisted of 625 hospitalised patients with comorbid gout, 87 of whom experienced inpatient gout flare. Model A yielded 9 predictors of inpatient gout flare, while model B and C produced 15 and 5, respectively. Model A was chosen for its simplicity and superior C-statistics (0.82) and calibration slope (0.93). The final nine-item set of predictors were pre-admission urate >0.36 mmol/L, tophus, no pre-admission urate-lowering therapy (ULT), no pre-admission gout prophylaxis, acute kidney injury, surgery, initiation or increase of gout prophylaxis, adjustment of ULT and diuretics prior to flare. Bootstrap validation of the final model showed adequate C-statistics and calibration slope (0.80 and 0.78, respectively). CONCLUSION: We propose a set of nine predictors of inpatient flare for people with comorbid gout. The predictors are simple, practical and are supported by existing clinical knowledge.


Asunto(s)
Reglas de Decisión Clínica , Árboles de Decisión , Gota/diagnóstico , Modelos Estadísticos , Medición de Riesgo/métodos , Adulto , Calibración , Comorbilidad , Femenino , Gota/etiología , Supresores de la Gota/uso terapéutico , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Estudios Retrospectivos , Factores de Riesgo , Brote de los Síntomas
12.
Heart Fail Rev ; 25(1): 43-51, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31745840

RESUMEN

Uric acid, the metabolic mediator of gout and urate renal stones, is associated with increased cardiovascular risk burden. Hyperuricemia is an old emerging metabolic disorder, and interaction among uric acid and cardiovascular diseases has been clearly described. Several illness including hypertension, myocardial infarction, metabolic syndrome, and heart failure, are related with uric acid levels increase. In this review, we will discuss the pathophysiology of hyperuricemia and describe the biological plausibility for this metabolite to participate in the pathogenesis of cardiovascular disorders. In particular, we will focus on the implications of hyperuricemia in the onset and progression of heart failure, paying special attention to the pathophysiology and the possible clinical implications. We will conclude by discussing the effects of lowering plasma uric acid concentration on the prognosis of heart failure by reviewing most of available data on the different classes of drugs directly or indirectly involved in the hyperuricemia management.


Asunto(s)
Enfermedades Cardiovasculares/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Hiperuricemia/tratamiento farmacológico , Ácido Úrico/sangre , Xantina Oxidasa/antagonistas & inhibidores , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Enfermedades Cardiovasculares/etiología , Progresión de la Enfermedad , Gota/tratamiento farmacológico , Gota/etiología , Supresores de la Gota/uso terapéutico , Insuficiencia Cardíaca/etiología , Humanos , Hiperuricemia/fisiopatología , Inhibidores de Proteasas/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Inhibidores del Cotransportador de Sodio-Glucosa 2
13.
Am Fam Physician ; 102(9): 533-538, 2020 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-33118789

RESUMEN

Gout is caused by monosodium urate crystal deposition in joints and tissues. Risk factors include male sex; obesity; hypertension; alcohol intake; diuretic use; a diet rich in meat and seafood; chronic kidney disease; a diet heavy in fructose-rich food and beverages; being a member of certain ethnic groups, including Taiwanese, Pacific Islander, and New Zealand Maori; and living in high-income countries. Gout is characterized by swelling, pain, or tenderness in a peripheral joint or bursa, including the development of a tophus. Diagnosis of gout can be made using several validated clinical prediction rules. Arthrocentesis should be performed when suspicion for an underlying septic joint is present; synovial fluid or tophus analysis should be performed if the diagnosis is uncertain. Colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids relieve pain in adults with acute gout episodes. Indications for long-term urate-lowering therapy include chronic kidney disease, two or more flare-ups per year, urolithiasis, the presence of tophus, chronic gouty arthritis, and joint damage. Allopurinol and febuxostat are used to prevent flare-ups, although febuxostat is associated with an increase in all-cause and cardiovascular mortality and is therefore not routinely recommended.


Asunto(s)
Gota/complicaciones , Obesidad/complicaciones , Corticoesteroides/uso terapéutico , Alopurinol/uso terapéutico , Colchicina/uso terapéutico , Febuxostat/uso terapéutico , Gota/etiología , Gota/fisiopatología , Supresores de la Gota/uso terapéutico , Humanos , Factores de Riesgo , Factores Sexuales , Ácido Úrico/análisis , Ácido Úrico/sangre
14.
Ren Fail ; 42(1): 978-986, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32972284

RESUMEN

BACKGROUND: Hyperuricemia is a state in which the serum levels of uric acid are elevated. As such it has a pronounced effect on vascular and renal function with their consequences, while also showing some antioxidant effects that show to be beneficial. SUMMARY: Hyperuricemia has shown to have a J-shaped relationship with mortality, is frequently associated with development and progression of heart and kidney disease, and is correlated with malnutrition-inflammation-atherosclerosis syndrome, although several Mendelian studies have failed to show an association with morbidity and mortality. Hyperuricemia is usually associated with gout flares and tophi development but can also present as asymptomatic hyperuricemia. It is still uncertain whether asymptomatic hyperuricemia is an independent risk factor for cardiovascular or renal disease and as such its treatment is questionable. KEY MESSAGES: Some possible tools for future decision making are the use of noninvasive techniques such as pulse wave analysis, urinary sediment analysis, and joint ultrasound, which could help identify individuals with asymptomatic hyperuricemia that could benefit from urate lowering therapy most.


Asunto(s)
Gota/etiología , Hiperuricemia/complicaciones , Riñón/metabolismo , Miocardio/metabolismo , Enfermedades Cardiovasculares/etiología , Humanos , Hiperuricemia/diagnóstico , Hiperuricemia/terapia , Insuficiencia Renal Crónica/etiología , Ácido Úrico/sangre
15.
Reumatismo ; 72(1): 31-43, 2020 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-32292019

RESUMEN

The objective was to assess knowledge and therapeutic approaches to the management of gout among healthcare professionals and people with/without gout, in Italy. This was a cross-sectional internet-based survey targeting general practitioners (GPs), specialists, pharmacists, and people with/without gout. Between December 2017 and March 2018, participants completed questionnaires on epidemiology, cause/risk factors, therapy objectives and management/treatment strategies to improve outcomes. Overall, 3184 people completed the survey: 699 GPs, 426 specialists, 655 pharmacists and 1404 subjects from the general population: 126 (9.0%) with and 1278 (91.0%) without gout. Notably, less than half of GPs, specialists and people without gout confirmed the published 1% prevalence of gout in Italy. Lifestyle was acknowledged as the main risk factor for gout by nearly 50% of specialists and GPs, while only 13.8% and 12.4%, respectively, considered the role of genetic factors. Uric acid overproduction was deemed as the cause of gout by 60% of GPs and specialists, whereas insufficient excretion by only 30%. Fewer than half of patients were aware that gout permanently damages joints, and even fewer of the renal and cardiovascular implications (19.4% and 12%, respectively); moreover, most people without gout replied that their doctor had never talked with them about uric acid and its correlation with gout development. Finally, GPs were divided on uric acid target levels (48.3% said <6 mg/dL and 18.9% <7 mg/dL). Despite major advances in the knowledge of physiopathological mechanisms of gout, the results of our survey highlight the many treatment and knowledge gaps in its management. Cooperation between multidisciplinary teams is required to break down barriers and ensure optimal treatment with effective and innovative agents of this ever-increasing debilitating condition.


Asunto(s)
Médicos Generales/estadística & datos numéricos , Gota , Conocimientos, Actitudes y Práctica en Salud , Farmacéuticos/estadística & datos numéricos , Especialización/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricos , Competencia Clínica/estadística & datos numéricos , Estudios Transversales , Gota/epidemiología , Gota/etiología , Gota/terapia , Humanos , Italia/epidemiología , Estilo de Vida , Prevalencia , Opinión Pública , Factores de Riesgo , Ácido Úrico/metabolismo
16.
J Cell Biochem ; 120(12): 19660-19672, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31407397

RESUMEN

BACKGROUND: In this study, we established both an animal model and a cellular model of hyperuricemia (HUC). Subsequently, we treated these models with allopurinol (ALLO) to study the effect of uric acid (UA) and ALLO on the differentiation and proliferation of osteoblasts and vascular smooth muscle cells (VSMC). METHODS: Western Blot, immunohistochemistry assay, and real-time polymerase chain reaction were conducted to measure the changes in the expression of differentiation-related factors in osteoblasts and VSMCs in HUC and HUC+ALLO groups. MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay and flow cytometry were utilized to observe the changes in the proliferation of osteoblasts in HUC and HUC+ALLO groups. Von Kossa staining was performed along with calcium content measurement to investigate the effect of HUC/ALLLO on vascular calcification. RESULTS: In this study, the levels of Wnt3a and differentiation-related factors, including Runx2, Sp7, Ibsp, Bglap, Dmp1, and Col1a1, were all evidently decreased in HUC rats, while the presence of ALLO increased the levels of above factors. In addition, the viability of osteoblasts was reduced while their apoptosis was elevated in the HUC group, and ALLO treatment reduced the apoptosis and increased the viability of osteoblasts to a certain extent. Moreover, HUC elevated the levels of Wnt3a, Runx2, Sp7, Bglap, Col1a1, SM22a, and Acta2 in VSMCs of HUC rats, leading to greatly increased calcium content and obvious vascular calcification. In contrary, ALLO treatment reduced the effect of HUC. Furthermore, the effect of UA and ALLO on osteoblasts and VSMCs was also validated in cellular models treated with monosodium urate (MSU) crystals or MSU+ALLO. CONCLUSIONS: HUC can suppress the differentiation and proliferation of osteoblasts while promoting the differentiation of VSMCs both in vivo and in vitro. The treatment by ALLO exhibited a therapeutic effect on HUC by promoting the differentiation and proliferation of osteoblasts while reducing vascular calcification.


Asunto(s)
Enfermedades Óseas Metabólicas/patología , Diferenciación Celular , Proliferación Celular , Gota/patología , Hiperuricemia/fisiopatología , Músculo Liso Vascular/patología , Osteoblastos/patología , Calcificación Vascular/patología , Alopurinol/farmacología , Animales , Apoptosis , Enfermedades Óseas Metabólicas/tratamiento farmacológico , Enfermedades Óseas Metabólicas/etiología , Enfermedades Óseas Metabólicas/metabolismo , Gota/tratamiento farmacológico , Gota/etiología , Gota/metabolismo , Supresores de la Gota/farmacología , Masculino , Músculo Liso Vascular/efectos de los fármacos , Músculo Liso Vascular/metabolismo , Osteoblastos/efectos de los fármacos , Osteoblastos/metabolismo , Ratas , Ratas Sprague-Dawley , Calcificación Vascular/tratamiento farmacológico , Calcificación Vascular/etiología , Calcificación Vascular/metabolismo
17.
Rheumatology (Oxford) ; 58(5): 836-839, 2019 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-30590724

RESUMEN

OBJECTIVE: To investigate temporal trends in the incidence and prevalence of gout in the adult Danish population. METHODS: Using the nationwide Danish National Patient Registry, we calculated the number of incident gout patients (per 100 000 person-years) within each 1 year period from 1995 to 2015 and the prevalence of gout in 2000 and 2015. Further, we calculated age- and gender-specific incidence rates of gout from 1995 to 2015. RESULTS: We identified a total of 45 685 incident gout patients (72.9% males) with a mean age of 65 years (s.d. 16) at diagnosis. In both genders, an increase in age-standardized incidence rates was observed from 32.3/100 000 (95% CI 30.7, 33.9) in 1995 to 57.5/100 000 (95% CI 55.6, 59.5) in 2015 (P < 0.001). Similar trends were observed for 8950 cases diagnosed in rheumatology departments. We likewise observed an increase in the prevalence of gout from 0.29% (95% CI 0.29, 0.30) in 2000 to 0.68% (95% CI 0.68, 0.69) in 2015. CONCLUSIONS: The annual incidence rate of gout increased by almost 80% in Denmark between 1995 and 2015. The prevalence increased by nearly 130% between 2000 and 2015. Reasons for this are unknown but may include an increase in risk factors (e.g. obesity, diabetes mellitus), longer life expectancy and increased awareness of the disease among patients and/or health professionals.


Asunto(s)
Gota/epidemiología , Adulto , Distribución por Edad , Anciano , Dinamarca/epidemiología , Femenino , Gota/etiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Sistema de Registros , Factores de Riesgo , Distribución por Sexo , Factores de Tiempo
18.
Rheumatology (Oxford) ; 58(7): 1133-1141, 2019 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-31004140

RESUMEN

The consumption of fructose has gained increased attention as a potential cause of hyperuricaemia since fructose metabolism produces urate as a byproduct. In addition to sucrose and high fructose corn syrup, fresh fruits also contain fructose, suggesting that patients with hyperuricaemia or gout might also avoid fresh fruit. However, the effect of fruits is complex. Some studies reported that fruit intake was associated with gout flares while other studies showed that fruits rather lowered the risk for gout. Thus, fruits should not be simply viewed as a source of fructose. The complexity of fruits is accounted for by several nutrients existing in fruits. Vitamin C, epicatechin, flavonols, potassium and fibre are all nutrients in fruits, and these factors could modify fructose and urate effects. In this review, we discuss clinical studies evaluating the effect of fruit and fruit juice intake on hyperuricaemia and gout, and propose potential mechanisms for how fruit may influence urate levels.


Asunto(s)
Frutas/efectos adversos , Gota/etiología , Hiperuricemia/etiología , Ácido Ascórbico/análisis , Fibras de la Dieta/farmacología , Fructosa/análisis , Fructosa/metabolismo , Frutas/química , Jugos de Frutas y Vegetales/efectos adversos , Gota/prevención & control , Humanos , Hiperuricemia/prevención & control , Prunus avium , Ácido Úrico/sangre
19.
J Clin Lab Anal ; 33(5): e22868, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30803031

RESUMEN

BACKGROUND: Hyperuricemia is the only biochemical index in the classification of acute gouty arthritis in American Rheumatism Association 1977 and the main basis of clinical diagnosis for most doctors. However, nearly half of the time gout occurs without hyperuricemia, especially in an acute attack,which leads to an urgent need to find a new substitute diadynamic criteria of gout. Xanthine and hypoxanthine, as precursors of uric acid, have been reported to be high in gout patients with hyperuricemia and presumed to be gout biomarkers. OBJECTIVES: To further explore the possibility of xanthine and hypoxanthine to be gout biomarkers as substitutes for uric acid. METHODS: A reversed-phase HPLC-UV method was employed for simultaneous quantitative detection of uric acid (UA), xanthine (X), and hypoxanthine (HX) in gout patients' (with and without hyperuricemia) and healthy persons' serum. RESULTS: The xanthine and hypoxanthine concentrations in gout patients with hyperuricemia and without hyperuricemia are higher than in healthy persons with a P < 0.001. CONCLUSIONS: This study supplements previous researches by confirming that xanthine and hypoxanthine are significantly elevated in gout patients' serum especially in patients' with normouricemia, which supported xanthine and hypoxanthine may have clinical application for the diagnosis of gout.


Asunto(s)
Gota/diagnóstico , Hipoxantina/sangre , Xantina/sangre , Análisis Químico de la Sangre/normas , Cromatografía Líquida de Alta Presión/métodos , Cromatografía Líquida de Alta Presión/normas , Gota/sangre , Gota/etiología , Humanos , Hiperuricemia/sangre , Límite de Detección , Masculino , Reproducibilidad de los Resultados , Ácido Úrico/sangre
20.
Molecules ; 24(22)2019 Nov 16.
Artículo en Inglés | MEDLINE | ID: mdl-31744056

RESUMEN

Gout is a disease with a high incidence and causing great harm, and the current treatment drugs are not satisfactory. In this study, novel water-soluble carbon dots (CDs) with anti-gout effect, named Puerariae lobatae Radix CDs (PLR-CDs), are reported. PLR-CDs were synthesized with an improved pyrolysis method at 300 °C, and their characterization was performed with multifaceted approaches, such as transmission electron microscopy (TEM) and ultraviolet-visible (UV-vis) and Fourier-transform infrared (FTIR) spectroscopy. In addition, the biocompatibility of PLR-CDs was studied using the cell counting kit (CCK)-8 in LO2 cells and RAW264.7 cells, and the anti-gout activity of PLR-CDs was examined on animal models of hyperuricemia and gouty arthritis. The characterization of PLR-CDs indicated that they were nearly spherical, with diameters ranging from 3.0 to 10.0 nm, and the lattice spacing was 0.283 nm. The toxicity experiment revealed that PLR-CDs were non-poisonous for LO2 cells and RAW264.7 cells at concentrations below 250 µg/mL. The results of pharmacodynamic experiments showed that PLR-CDs could lower the blood uric acid level in model rats by inhibiting the activity of xanthine oxidase and reduce the degree of swelling and pathological damage of gouty arthritis. Thus, PLR-CDs with anti-gout biological activity and good biocompatibility have the prospect of clinical application for the treatment of gout.


Asunto(s)
Carbono/química , Supresores de la Gota/química , Supresores de la Gota/farmacología , Pueraria/química , Puntos Cuánticos/química , Animales , Biopsia , Supervivencia Celular/efectos de los fármacos , Modelos Animales de Enfermedad , Gota/tratamiento farmacológico , Gota/etiología , Gota/patología , Ratones , Nanopartículas/química , Nanopartículas/ultraestructura , Puntos Cuánticos/ultraestructura , Células RAW 264.7 , Ratas , Análisis Espectral
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