Role of diet in hyperuricemia and gout

Associations of low-carbohydrate diets patterns with the risk of hyperuricemia: a national representative cross-sectional study in Korea

BACKGROUND

The association between low-carbohydrate diets and hyperuricemia risk, a significant risk factor for gout and cardiometabolic morbidities, remains inconclusive, partly due to differing effects of replacing carbohydrates with animal- or plant-based macronutrients. This study examined associations between low-carbohydrate diet patterns and hyperuricemia risk in 39,880 adults in the Korea National Health and Nutritional Examination Study 2016-2022.

METHODS

Diet was assessed via a 24-hour dietary recall. The overall, animal-rich, and plant-rich low-carbohydrate diet score (LCDS) was calculated based on percent energy derived from protein and fat in animal and plant food sources. Hyperuricemia was defined as serum uric acid levels > 7.0 mg/dL for men and > 6.0 mg/dL for women. Multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression models to estimate the risk of hyperuricemia across quintiles of LCDS.

RESULTS

A significantly greater risk of hyperuricemia was observed among individuals with higher overall LCDS (OR for quintile 5 vs. quintile 1 [Q5vs.Q1]: 1.41, 95%CI:1.22-1.63, P-trend: <0.001) and animal-rich LCDS (ORQ5vs.Q1: 1.28, 95%CI:1.12-1.47, P-trend: <0.001), but not with plant-rich LCDS (ORQ5vs.Q1: 1.00, 95%CI: 0.87-1.16). These positive associations for overall LCDS and animal-rich LCDS were evident in overweight individuals (ORQ5vsQ1: 1.53, 95%CI: 1.29-1.82 for overall LCDS; and 1.39, 95%CI: 1.19-1.63 for animal-rich LCDS; all P-trends < 0.001), but not in non-overweight individuals (all P-interactions: <0.001).

CONCLUSIONS

In our study, animal-based low-carbohydrate diets were associated with a greater risk of hyperuricemia, while no association was observed for plant-based low-carbohydrate diets. Larger cohort studies are warranted to replicate these findings.

Uric acid-induced cardiomyocytic polyamines' insufficience: a potential mechanism mediates cardiomyocytic injury

Introduction

Maintaining polyamines homeostasis is essential for cardiovascular health, whereas elevated uric acid levels are recognized as a significant risk factor for the onset and progression of cardiovascular diseases. However, the interaction between uric acid and the regulation of polyamine homeostasis has not been extensively investigated. The objective of this study was to investigate the influence of uric acid on cardiac polyamines regulation and elucidate the role of polyamines in uric acid induced cardiomyocytic injury.

Methods

The in vitro experiments utilized H9C2 cardiomyocytes, the hyperuricemic mouse model was established via potassium oxonate and hypoxanthine. Techniques included energy metabolomics, HPLC for polyamine quantification, qPCR, ELISA, immunofluorescence, and mitochondrial membrane potential assessment using JC-1 staining, MTT cell viability analysis.

Results

Uric acid treatment can alter ornithine metabolism in cardiomyocytes, revealed a potential of shifting it from the traditional ornithine cycle towards the polyamine cycle. Both ODC1 and SAT1 protein levels were up-regulated in hyperuricemic mice indicated a dysorder of polyamines homostasis. A downregulation tendency of spermidine and spermine levels were observed in cardiomyocytes under uric acid treatment. Notably, exogenous supplementation with spermidine or spermine effectively mitigated the uric acid-induced decline in cardiomyocyte viability and mitochondrial membrane potential.

Discussion

Uric acid disrupts polyamine homeostasis, leading to mitochondrial dysfunction and cardiomyocyte damage. Exogenous polyamine supplementation demonstrates therapeutic potential by preserving mitochondrial integrity. These findings unveil a potential mechanism underlying uric acid-induced cardiac injury and propose polyamine replenishment as a viable intervention strategy for hyperuricemia-related cardiovascular complications.

Evaluation of the safety and probiotic properties of Limosilactobacillus fermentum BGI-AF16, a uric acid-lowering probiotic strain

Some beneficial microorganisms in the intestine have the potential to degrade uric acid, offering a novel strategy for the prevention of hyperuricemia. In this study, the safety and probiotic potentials of Limosilactobacillus fermentum BGI-AF16 were evaluated by whole genome sequence analysis and in vitro experiments. Based on the gene analysis of antibiotic resistance and virulence factors, L. fermentum BGI-AF16 has been shown to be safe. We identified probiotic-related genes by genome annotation tools and conducted in vitro experiments to evaluate the ability of L. fermentum BGI-AF16 to inhibit pathogenic bacteria, tolerate a simulated gastrointestinal environment, and degrade uric acid. The results from in vitro experiments showed that L. fermentum BGI-AF16 had inhibitory effects on four clinically relevant pathogens and was highly tolerant to the gastrointestinal environment. In addition, L. fermentum BGI-AF16 was able to rapidly degrade uric acid within the first hour, and the strain could degrade 56.36 ± 2.32 % of uric acid by the third hour. The genome of the strain contains genes encoding flavin adenine dinucleotide (FAD)-dependent urate hydroxylase (EC.1.14.13.113), an enzyme that directly metabolizes uric acid. And the strain has a complete uric acid metabolic pathway. These results suggest that L. fermentum BGI-AF16 is a probiotic candidate with significant potential for reducing uric acid level.

Functional properties amelioration of rosmarinic acid by covalently binding with soybean protein isolate

In this study, rosmarinic acid (RA) was covalently bound to soy protein isolate (SPI), and the changes in protein structure were characterized by multispectral analysis. The oil-water partition coefficient, bio-accessibility and adenosine deaminase (ADA) inhibitory activity of the complex were determined, and the effect of covalent binding on RA function was characterized. The possible mechanisms are revealed by molecular dynamics. The results show that new bands are generated on SDS-PAGE, which indicates that the two form a complex. FTIR results showed that the α-helix content of SPI decreased slightly after binding with RA, and the β-sheet content increased by 9.61%, indicating that polyphenols may bind to the hydrophobic pockets of proteins. The results of fluorescence and UV spectroscopy showed that the tertiary structure of the protein was unfolded and the fluorescence quenching mechanism was static quenching. The results of molecular dynamics show that the conformation is stable. After compounding with SPI, the lipid solubility of RA increased by 23.75-fold, the bio-accessibility increased by 41.55%, and the ADA inhibitory activity increased by 21.04%.

Two still unanswered questions about uric acid and cardiovascular prevention: Is a specific uric acid cut-off needed? Is hypouricemic treatment able to reduce cardiovascular risk?

AIMS

The most frequent consequence of elevated uric acid (UA) levels is the development of gout and urate kidney disease. Besides these effects, several studies have investigated the association between hyperuricemia and cardiovascular (CV) disease. High serum UA has been identified as an important determinant of all-cause and CV mortality and CV events (acute and chronic coronary syndrome, stroke and peripheral artery disease). Despite the high number of publications on this topic, there are two questions that are still unanswered: do we need a specific CV cut-off of serum UA to better refine the CV risk? Is urate lowering treatment (ULT) able to reduce CV risk in asymptomatic patients? In this review, we will focus on these two points.

DATA SYNTHESIS

Although no doubt exists that the relationship between CV events starts at lower levels than the actually used cut-off, different papers found dissimilar cut-offs. Furthermore, heterogeneity is present depending on the specific CV events evaluated and none of the found cut-off have been tested in external populations (in order to confirm its discriminatory capacity). Furthermore, only few randomized clinical trials on the role of hypouricemic agents in reducing the CV risk have been published giving heterogeneous results. The last published one (ALL-HEART) has strong limitations, that we will deeply discuss.

CONCLUSIONS

A definitive answer to the two questions is impossible with the actually published paper but, over identifying current gaps in knowledge we try to individuate how they can be overruled.

Gut microbiota as a new target for hyperuricemia: A perspective from natural plant products

BACKGROUND

Hyperuricemia, a prevalent chronic metabolic disorder caused by purine metabolism disturbances, is characterized by elevated serum uric acid (UA) levels. Prolonged hyperuricemia can cause severe complications such as gout or kidney damage. However, the toxic side effects of and adverse reactions to UA-lowering drugs are becoming increasingly prominent. Therefore, new targets and drugs for hyperuricemia are needed.

PURPOSE

This review aims to summarize recent research progress on the prevention and treatment mechanisms for gut microbiota-hyperuricemia from the perspective of plant-derived natural products.

METHODS

Data from PubMed, Web of Science, ScienceDirect, and the CNKI databases spanning from January 2020 to December 2024 were reviewed. The aim of this study is to categorize and summarize the relevant mechanisms through which natural products improve hyperuricemia via the gut microbiota. The retrieved data followed PRISMA criteria (Preferred Reporting Items for Systematic reviews and Meta-Analyses).

RESULTS

Regulating gut microbiota as a treatment for hyperuricemia. Targeting the gut microbiota could reduce host UA levels by promoting purine degradation, reducing UA production, and increasing UA excretion. Moreover, the gut microbiota also exerts anti-inflammatory and antioxidant effects that alleviate complications such as renal damage caused by hyperuricemia. Due to their diverse sources, multicomponent synergy, multitarget effects, and minimal side effects, plant-derived natural products have been extensively utilized in the management of hyperuricemia. Especially, utilizing natural products from plants to regulate the gut microbiota has become a new strategy for reducing UA levels.

CONCLUSION

This review comprehensively summarizes recent advances in understanding the preventive and therapeutic mechanisms of plant-derived natural products in ameliorating hyperuricemia and its comorbidities through gut microbiota modulation. This review contributes a novel perspective for the development of safer and more efficacious UA-lowering products.

Clinical features of inflammatory arthritis in daily practice-China's perspective

OBJECTIVE

This study aimed to analyze and compare the proportion of patients with different types of inflammatory arthritis and investigate the clinical characteristics, including symptoms and signs, medication choices, and disease activity, in the daily clinical practice of China.

METHODS

Patients with inflammatory arthritis were recruited from 16 Grade-A tertiary hospitals between August 2021 and April 2022. The medical profiles, encompassing sociodemographic characteristics, clinical and laboratory date, were collected.

RESULTS

This study included 2,693 patients with arthritis, with rheumatoid arthritis (RA) accounting for the highest proportion (50.50%). Significant differences were observed in terms of age, gender, body mass index (BMI), disease duration, smoking and family history among patients with different types of inflammatory arthritis. Physical activity and cold exposure were identified as the main predisposing factors for RA, psoriatic arthritis (PsA), osteoarthritis (OA), and ankylosing spondylitis (AS), while alcohol consumption was the most common inducing factor for gout. Hypertension and hyperlipidemia were the primary concomitant diseases in RA, OA, and AS, whereas hyperuricemia and hypertension were mainly associated with gout, psoriasis and diabetes were the most common comorbidities in PsA. Peripheral joints were predominantly affected in PsA, RA, OA, and gout, while axial joints were mainly affected in AS. Methotrexate and leflunomide were the main therapeutic drugs for RA, while biologics were commonly prescribed for PsA and AS. OA and gout patients mainly utilized nonsteroidal anti-inflammatory drugs (NSAIDs).

CONCLUSION

Patients with different types of inflammatory arthritis exhibited varying predisposing factors, joint inflammation, concomitant diseases, and medication choices, highlighting the importance of individualized approaches in the clinic. Key Points • 2,693 patients classified and diagnosed with inflammatory arthritis were recruited in this study from 16 Grade-A tertiary hospitals in China between August 2021 and April 2022. • This study analyzed and compared the proportion of patients with different types of arthritis in routine clinical practice in China. • Joint inflammation, comorbidities, and medication choices were assessed among patients with the most common types of arthritis in this study. • This study also provided some epidemiologically relevant information about inflammatory arthritis patients in China.

Weight Loss After Receiving Anti-Obesity Medications and Gout Among Individuals With Overweight and Obese: A Population-Based Cohort Study

OBJECTIVE

Weight loss is conditionally recommended for gout management; however, its impact on incident gout and recurrent gout flares among individuals who were overweight and obese remains unknown. We investigate the relationship between weight loss rate following treatment with anti-obesity medications and the risk of incident gout and recurrent gout flares among individuals who were overweight or obese.

METHODS

Using data from the Health Improvement Network, we selected individuals aged 18 and older who were overweight or obese and started anti-obesity medication. We emulated a target trial to examine the association of different weight loss rates, slow (2%-5%), moderate (5%-10%), or fast (≥10%), within the first year of treatment with incident gout and recurrent gout flares during a 5 year follow-up period.

RESULTS

Among 131,000 participants without gout being treated with orlistat, the 5-year risk of incident gout was 1.6% for those with weight gain or stability, compared with 1.5%, 1.3%, and 1.2% for those with slow, moderate, and fast weight loss, respectively. Compared with the group with weight gain or stability, the hazard ratios were 0.91 (95% confidence interval [CI] 0.81-1.01), 0.82 (95% CI 0.72-0.92), and 0.73 (95% CI 0.62-0.86) for those with a slow, moderate, and fast rate of weight loss, respectively. Similar results were observed for the recurrent gout flares among 3,847 individuals with overweight or obese with gout treated with orlistat.

CONCLUSION

A higher rate of weight loss after receiving treatment with orlistat within 1 year was associated with lower risks of incident gout and lower rates of recurrent gout flares among overweight or obese people.

Metabolomics Reveal the Anti-Hyperuricemia Effects and Mechanisms of Sunflower Head Extract in Hyperuricemia Mice Model

Hyperuricemia (HUA) is a globally prevalent metabolic disease characterized by excessive production or insufficient excretion of uric acid in the serum. Although several drugs are available for the treatment of HUA, they have been associated with undesirable side effects. Therefore, this study aims to evaluate the therapeutic effects of sunflower head extract (KHE) on HUA in a mouse model and explore its potential mechanisms. All mice were randomly divided into three groups: Normal control (NC, 0.5% CMC-Na), HUA model (MD, yeast extract paste 20 g/kg), and KHE treatment group (KHE, 1 g/kg). Biochemical indicators, the oxidative stress state, and metabolomics were analyzed. KHE reduced the levels of 5-aminoimidazole ribonucleotide, xanthine, hypoxanthine, and uric acid in the serum of mice with HUA but increased the levels of adenine and taurine. KHE decreased the activities of superoxide dismutase (SOD) enzymes, the hepatic hydrogen peroxide (H2O2) and malondialdehyde (MDA) levels, and the serum levels of betaine aldehyde and beta-D-glucosamine. KHE improved oxidative stress levels and mitigated potential damage to the kidneys and joints caused by urate deposition. These findings provide comprehensive evidence supporting the anti-HUA effects and underlying mechanisms of KHE in HUA mice.

Association between dietary coenzyme Q10 intake and hyperuricemia in Chinese adults: a nationwide cross-sectional study

BACKGROUND

The association of food-sourced Coenzyme Q10(CoQ10) intake with hyperuricemia (HUA) remains unclear. We aimed to investigate the association between dietary CoQ10 intake and HUA among Chinese adults.

METHODS

A total of 7953 Chinese adults from the 2009 China Health and Nutrition Survey (CHNS) were included in the present cross-sectional. Dietary CoQ10 was assessed by 3 consecutive 24-h dietary recall interviews combined with a household food inventory. Multivariable logistic regression models and restricted cubic spline models were used to explore the associations between dietary CoQ10 and HUA.

RESULTS

In an adjusted logistic regression model, the multivariable odds ratio (OR) and 95% confidence interval (CI) for HUA in the highest versus the lowest quartile of total, animal-based, and plant-based CoQ10 intake were 1.40 (95% CI: 1.15 to 1.70), 1.46 (95% CI: 1.20 to 1.78), and 0.80 (95% CI: 0.65 to 0.97), respectively. Dose-response analyses revealed similar linear patterns, with the exception of plant-derived CoQ10, which did not reach statistical significance (p for nonlinearity = 0.09). In stratified analysis, there were no significant interactions between sex, age, BMI, smoking status, drinking status and total dietary CoQ10 intake in relation to the HUA (All p for interaction > 0.05).

CONCLUSIONS

Our study documented a novel positive association between total dietary CoQ10 intake and HUA, with similar trends for animal-derived CoQ10 and an inverse trend for plant-derived CoQ10.

A Bidirectional Mendelian Randomization Study of Tea-Drinking Habits and Risk of Elevated Serum Uric Acid Levels

BACKGROUND

Although recent animal experiments have revealed that tea intake improves elevated serum uric acid (SUA) levels, a causal link between the consumption of different types of tea and SUA levels remains undetermined.

METHODS

Bidirectional Mendelian randomization (MR) analysis based on genome-wide association studies was used to assess the causal relationship between consumption of different types of tea and the risk of elevated SUA levels in European and Asian populations.

RESULTS

Forward MR analysis showed that tea intake was significantly associated with lower SUA levels (p = 0.0013). The estimated effect value (β $$ \beta $$  = $$ = $$  -0.0440) suggests that for every 1-unit increase in tea intake, there is a 0.044-unit decrease in SUA levels. However, there is no reverse causality between SUA and tea intake (p = 0.2824). No causal relationship was found between the consumption of different types of tea and risk of elevated SUA levels (p > 0.05).

CONCLUSION

Although this bidirectional MR study provided evidence of a causal relationship between tea intake and SUA levels, however, due to limitations associated with the sample size and strength of instrumental variables, a definite conclusion was not possible.

A study on the correlation between hyperuricemia and lifestyle and dietary habits

This study aimed to compare whether differences in lifestyle and dietary habits have an impact on hyperuricemia and to provide a reliable basis for the health management of citizens in our city. A total of 10,883 subjects who did not suffer from hyperuricemia, was anticipated in this study in 2018. After 2 years of follow-up, 7727 did not suffer from hyperuricemia and 3156 suffered from hyperuricemia. Dietary habits and lifestyle were collected by questionnaire. Multivariate logistic regression was used to identify the risk factors of hyperuricemia. For the analysis of the amount of change in uric acid (UA) before and after 2 years, t-tests and spearman correlation were used to explore the differences between the groups, and the trend effect of each variable on the amount of change in uric acid was analyzed by linear regression equations. The results showed that the prevalence of hyperuricemia varied by sex, high-fat food, smoked and fried food, milk and soy products, sugary drinks, sleep time, and the degree of smoking and drinking. Among them, infrequent consumption of milk and soy products, and short sleep time were risk factors for hyperuricemia, and men were more likely to have elevated uric acid levels after 2 years. It is recommended that people with hyperuricemia should actively limit their intake of fried foods, alcohol, and purine-rich foods, increase their intake of milk and soy foods, increase their sleep time, and seek to improve kidney and liver function.

The pathogenesis of gout

Gout is the most common inflammatory arthritis in adults, associated with hyperuricemia and the chronic deposition of monosodium urate (MSU) crystals. Hyperuricemia results from increased production of uric acid and decreased excretion by the kidneys and intestines. Urate excretion is regulated by a group of urate transporters, and decreased renal or intestinal excretion is the primary mechanism of hyperuricemia in most people. Genetic variability in these urate transporters is strongly related to variances in serum urate levels. Not all individuals with hyperuricemia show deposition of MSU crystals or develop gout. The initiation of the inflammatory response to MSU crystals is mainly mediated by the nucleotide-binding oligomerization domain-, leucine-rich repeat- and pyrin domain-containing protein 3 (NLRP3) inflammasome. The activated NLRP3 inflammasome complex cleaves pro-interleukin-1β (IL-1β) into its active form, IL-1β, which is a key mediator of the inflammatory response in gout. IL-1β leads to the upregulation of cytokines and chemokines, resulting in the recruitment of neutrophils and other immune cells. Neutrophils recruited to the site of inflammation also play a role in resolving inflammation. Aggregated neutrophil extracellular traps (NETs) trap and degrade cytokines and chemokines through NET-bound proteases, promoting the resolution of inflammation. Advanced gout is characterized by tophi, chronic inflammatory responses, and structural joint damage. Tophi are chronic foreign body granuloma-like structures containing collections of MSU crystals encased by inflammatory cells and connective tissue. Tophi are closely related to chronic inflammation and structural damage.

Discovery of cyanidin-3-O-galactoside as a novel CNT2 inhibitor for the treatment of hyperuricemia

Inhibition of human concentrative nucleoside transporter 2 (CNT2) could suppress increases in serum urate levels derived from dietary purines. However, the structural basis for substrate recognition of CNT2 is still unknown and only a few inhibitors have been reported. In this study, a homology model of CNT2 was constructed and residues T315, E316, N426, N491, E492, F536 and N538 were identified as binding sites for adenosine through site-directed mutagenesis and a 3H-adenosine uptake assay. To explore potential CNT2 inhibitors, a database containing 4704 saccharides and glycosides was constructed, followed by high-throughput virtual screening. The top 20 compounds with the highest docking scores were then evaluated their in vitro activity. Among them, cyanidin-3-O-galactoside (Cy3Gal) demonstrated the most potent inhibitory activity against CNT2, exhibiting an IC50 value of 9.40 μM. Docking analysis revealed that residues M314, T315, T347, N422, F536 and S541 contributed to a strong binding affinity with Cy3Gal. In addition, Cy3Gal exhibited minimal inhibitory effects on CNT3 and equilibrative nucleoside transporters (ENTs) in vitro. At doses of 5-20 mg/kg, Cy3Gal effectively reduced serum and urine levels of uric acid and adenosine in vivo. The CCK-8 assay revealed that Cy3Gal displayed minimal cytotoxicity to mTEC and hIEC cells at a concentration of 100 μM. The serum CR and BUN levels indicate that Cy3Gal does not exhibit any apparent renal toxicity compared to lesinurad and allopurinol. HE examination showed no noticeable pathological changes in the kidneys or colons after treatment with Cy3Gal. In summary, Cy3Gal could be a CNT2 inhibitor with favorable drugability for the treatment of hyperuricemia.

Microneedle Electrode Patch Modified with Graphene Oxide and Carbon Nanotubes for Continuous Uric Acid Monitoring and Diet Management in Hyperuricemia

Hyperuricemia is a common disorder induced by purine metabolic abnormality, which will further cause chronic kidney disease, cardiovascular disease, and gout. Its main pathological characteristic is the high uric acid (UA) level in the blood, so that the detection of UA is highly important for hyperuricemia diagnosis and therapy. Herein, we report a biocompatible and minimally invasive microneedle electrode patch (MEP) for continuous UA monitoring and diet management in hyperuricemia. The composite of graphene oxide and carboxylated multiwalled carbon nanotubes was modified on the microneedle electrode surface to enhance its sensitivity, selectivity, and stability, thus realizing the continuous detection of UA in the interstitial fluid to accurately predict the UA level in the blood. This further allowed us to study the hypouricemic effect of anthocyanins on the hyperuricemia model mouse. It was found that anthocyanins extracted from blueberry can effectively inhibit the activity of xanthine oxidase to reduce the production of UA. The UA level of hyperuricemia model mice fed with anthocyanins is ∼1.7 fold lower than that of the control group. We believe that this MEP offers enormous promise for continuous UA monitoring and diet management in hyperuricemia.

Gout and Hyperuricemia: A Narrative Review of Their Comorbidities and Clinical Implications

Gout is the most common form of inflammatory arthritis, caused by the deposition of monosodium urate crystals in the joints due to elevated serum uric acid levels. Its prevalence and associated healthcare burden have been rising in recent decades, a trend expected to continue. It is crucial to recognize that gout and hyperuricemia are not merely causes of painful joint flares, but systemic metabolic disorders linked to a broad spectrum of comorbidities such as cardiovascular diseases, chronic kidney disease, diabetes, insulin resistance, steatotic liver disease, osteoarthritis, and respiratory and eye diseases. Numerous risk factors for gout and hyperuricemia have been identified, with recent research uncovering further associations with other conditions. To optimize patient outcomes, gout and hyperuricemia must be addressed through a holistic approach that accounts for these risk factors while providing comprehensive management of related comorbidities affecting various organ systems. This review summarizes the current knowledge on the risk factors, comorbidities, and clinical implications of gout and hyperuricemia. Future research should focus on improving patient outcomes by tailoring treatments individually and addressing the underlying metabolic comorbidities of gout with multimodal treatment.

Potential candidates from a functional food Zanthoxyli Pericarpium (Sichuan pepper) for the management of hyperuricemia: high-through virtual screening, network pharmacology and dynamics simulations

Introduction

Hyperuricemia (HUA) is a metabolic syndrome caused by purine metabolism disorders. Zanthoxyli Pericarpium (ZP) is a medicinal and food homologous plant, and its ripe peel is used to treat diseases and as a spice for cooking. Some studies have shown that ZP can inhibit the formation of xanthine oxidase and reduce the production of uric acid.

Methods

Through network pharmacology, ZP's potential targets and mechanisms for HUA treatment were identified. Databases like TCMSP, UniProt, and Swiss Target Prediction were utilized for ZP's active ingredients and targets. HUA-related targets were filtered using GeneCards, Drugbank, and Open Targets. Core targets for ZP's HUA treatment were mapped in a PPI network and analyzed with Cytoscape. GO and KEGG pathway enrichments were conducted on intersected targets via DAVID. Molecular docking and virtual screening were performed to find optimal binding pockets, and ADMET screening assessed compound safety. Molecular dynamics simulations confirmed compound stability in binding sites.

Results

We identified 81 ZP active ingredient targets, 140 HUA-related targets, and 6 drug targets, with xanthine dehydrogenase (XDH) as the top core target. Molecular docking revealed ZP's active ingredients had strong binding to XDH. Virtual screening via Protein plus identified 48 compounds near the optimal binding pocket, with 2'-methylacetophenone, ledol, beta-sitosterol, and ethyl geranate as the most promising. Molecular dynamics simulations confirmed binding stability, suggesting ZP's potential in HUA prevention and the need for further experimental validation.

Conclusion

Our study provides foundations for exploring the mechanism of the lowering of uric acid by ZP and developing new products of ZP. The role of ZP in the diet may provide a new dietary strategy for the prevention of HUA, and more experimental studies are needed to confirm our results in the future.

Association of Klotho and Gout in Middle-Aged and Older Adults: National Health and Nutrition Survey (2007-2016)

BACKGROUND

Klotho, which is known to negatively regulate metabolic disorders and kidney disease, has a role in gout that remains unclear. This research explored how klotho levels correlate with the prevalence of gout.

METHODS

Participants aged 40 to 79 from the National Health and Nutrition Examination Survey (2007-2016) were examined in both lines. The connection between klotho levels and gout was analyzed through weighted multivariate logistic regression. Restricted cubic splines were used to assess linearity and investigate the dose-response relationship. To ensure the stability of the results, subgroup and sensitivity analyses were conducted.

RESULTS

In total, 9660 individuals participated, with the weighted sample size calculated at 88,892,738.77. The group included 47.79% males (4793), with the median age being 57.00 years. Upon adjusting for all covariates, the multivariate analysis indicated an odds ratio of 0.51 (95% confidence interval [CI]: 0.33~0.78, p = 0.003) for the likelihood of occurrence of gout. When compared with the lowest klotho quartile Q1 (≥151.3, <655.3 pg/mL), the adjusted odds ratios for the subsequent quartiles Q2 (≥655.5, <800.9 pg/mL), Q3 (≥801.0, <991.6 pg/mL), and Q4 (≥991.7, ≤3998.5 pg/mL) were 0.97 (95% CI: 0.68~1.38), 0.78 (95% CI: 0.50~1.21), and 0.48 (95% CI: 0.32~0.73), respectively. Analyses focusing on subgroups and sensitivity confirmed these results.

CONCLUSIONS

This research found a negative correlation between serum α-klotho concentrations and the occurrence of gout. Those with the highest levels of klotho exhibited the lowest likelihood of gout, indicating potential importance for future studies and clinical uses.

Investigation into optimizing fermentation processes to enhance uric acid degradation by probiotics

To enhance the activity of Lactiplantibacillus plantarum FS4722 (L. plantarum FS4722) in reducing uric acid, this study optimized the culture medium components and fermentation conditions using response surface methodology. The results indicated that the optimal culture medium comprised glucose at 25.61 g/L, yeast extract powder (YEP) at 26.86 g/L, and nucleoside addition at 0.48 g/L. The optimal fermentation conditions were: a fermentation time of 10 h, an initial pH of 6.5, a fermentation temperature of 33 °C, and an inoculum size of 1.0 %. Under these conditions, the nucleoside degradation ability of L. plantarum FS4722 increased by 41.9 times, enhancing its potential applications in reducing uric acid and developing anti-gout foods, health supplements, and pharmaceuticals.

Soy Protein and Safflower-Seed Oil Attenuate Inflammation and Immune Dysfunction in Rats with Hyperuricemia

A plant-based diet is considered a promising approach for managing hyperuricemia (HUA). This study examined the effects of soy protein and plant-based oils on HUA-induced inflammation and immune dysfunction. Male Wistar rats, induced with HUA using oxonic acid and uric acid (UA), were fed casein or soy protein with palm or safflower oil (2 × 2 factorial design) for 8 weeks. HUA rats had lower serum albumin and T cell percentages in peripheral blood leukocytes (PBLs) and splenocytes, along with increased leukocyte counts and spleen weights, compared to healthy rats (p < 0.05). Soy protein improved HUA-induced reductions in albumin, while safflower-seed oil ameliorated reductions in albumin, plasma interleukin (IL)-4, and T-suppressor splenocytes, and mitigated elevated serum UA, plasma IL-6, and B leukocytes (two-way ANOVA, p < 0.05). In PBL, soy protein alleviated HUA-induced decreases in TNF-α, casein and palm oil increased IL-6, and casein further reduced IFN-γ production. Under Con A stimulation, casein and safflower-seed oil alleviated decreases in IL-6 and IL-10, respectively, while under LPS stimulation, casein further increased TNF-α production. In splenocytes, soy protein and safflower-seed oil reduced HUA-induced increases in TNF-α and increased IL-10, and safflower-seed oil increased IL-6 production. Under Con A stimulation, soy protein and safflower-seed oil reduced TNF-α and increased IL-10 production in splenocytes. The findings suggest that soy protein and safflower-seed oil may counteract HUA-related inflammation, alleviate monocyte activation, and enhance Th2 immune response in HUA. A plant-based diet rich in soy protein and safflower-seed oil may help manage HUA and associated inflammation and immune dysfunction.

Life's essential 8 and cardiovascular disease among patients with hyperuricemia: The Kailuan Cohort Study

OBJECTIVES

Studies have found that a high Life's Essential 8 (LE8) score is associated with a reduced risk of cardiovascular disease(CVD) in cancer populations and young adults. However, the association between LE8 and the risk of CVD in hyperuricemia (HUA) is not fully understood.

METHODS

The main analysis included 6814 HUA participants. In a secondary analysis, 5,418 participants were selected from the main analysis to model the trajectory of uric acid (UA) levels from 2006 to 2010. Cox regression model was used to investigate the relationship between LE8 total score and cardiovascular disease risk in different populations.

RESULTS

Follow-up of 15.79 years in the main analysis, 986 CVD events occurred. With tertile 1 as the control group, the HR and 95 % CI of CVD in tertile 2 and tertile 3 were 0.75(0.65,0.87) and 0.56(0.47,0.66). In the secondary analysis, the HR and 95 %CI of individuals with low and medium levels of UA reduced CVD were 0.49(0.26,0.89) and 0.56(0.41,0.76), respectively, but this association was not found in individuals with sustained high UA levels. The risk of CVD was different between the sexes. There are differences in cardiovascular disease risk among different age groups.

CONCLUSIONS

The risk of CVD in HUA population decreased with the increase of LE8 score, especially in young and middle-aged people and women. However, it is important to note that LE8 may not reduce the risk of CVD in individuals with sustained high UA levels.

Daily Amount of Purine in Commonly Recommended Well-Balanced Diets in Japan and Overseas

Background/Objectives: A low purine diet has been recommended for patients with gout and hyperuricemia, but there are concerns about excessive carbohydrates and a lack of protein. A well-balanced diet in accordance with general dietary guidelines is widely recommended. The Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet are also recommended for gout and hyperuricemia patients. However, there is little information on the purine levels in these diets. The aim of this study is to determine the daily amount of purine in well-balanced diets that follows the dietary guidelines, including the Mediterranean diet and the DASH diet. Methods: We measured the purine content in various foodstuffs. Using these values, we calculated the amount of purine in generally recommended well-balanced diets-the Japanese diet, American My Plate Plan, the Mediterranean diet, and the DASH diet. To calculate the amount of purine, recipes tailored to the characteristics of each diet were created. Results: The amount of purine in the Japanese diet, in the American My Plate Plan, in the Mediterranean diet, and in the DASH diet were 308.5-366.1, 308.7-335.0, 346.6-394.1, 325.9-493.9 mg/day, respectively. These values were close to the 400 mg/day recommended in the Japanese Guideline for the management of Hyperuricemia and Gout. Conclusions: A well-balanced diet following the recommendation in the dietary guidelines is considered to provide adequate purines. Because a high purine diet can lead to the recurrence of gout, advising to eat a balanced diet is useful on lifestyle guidance for the patients with gout and hyperuricemia.

Imaging comparative analysis of familial and sporadic gout in Chinese men by multijoint ultrasonography

Objective

This study aimed to compare the imaging features of bilateral knees, ankles, and the first metatarsophalangeal joint using high-frequency ultrasonography in male patients with familial and sporadic primary gout and sought to elucidate the relationship between the presence of tophi and various clinical indicators.

Method

Male patients with primary gouty arthritis (GA) in the acute phase presenting to the Department of Rheumatology and Immunology at the First Affiliated Hospital of Chengdu Medical College from November 2020 to June 2022 were enrolled and classified into familial and sporadic gout groups. Comparative analyses of their clinical data and ultrasonographic imaging findings of the knees, ankles, and first metatarsophalangeal joints were performed between the groups. Univariate and multivariate logistic regression analyses, as well as receiver operating characteristic (ROC) analysis, were conducted to determine the effectiveness of significant factors in the prediction of tophi.

Result

In comparison to male patients with sporadic gout, those with familial primary gout exhibited lower age, body mass index, disease duration, and serum uric acid (SUA) levels. However, they demonstrated higher incidences of tophi and bone erosion (54.6% in familial gout vs. 35.1% in sporadic gout, p < 0.05; 71.2% in familial gout vs. 48.1% in sporadic gout, p < 0.05, respectively), with a greater prevalence of tophi in the right first metatarsophalangeal joint (44.2% in familial gout vs. 32.3% in sporadic gout, p < 0.05). Independent risk factors for tophi included family history (OR = 6.712), age (OR = 1.049), disease duration (OR = 1.134), and SUA levels (OR = 1.006). ROC analysis yielded an area under the curve of 0.883 (p < 0.05) for predicting joint tophi using these factors.

Conclusion

Male patients with familial primary GA in the acute phase experienced earlier onset, shorter disease duration compared to those with sporadic gout. They also had more affected joints, more frequent and a wider distribution of tophi, especially in the right first metatarsophalangeal joint. Family history, age, disease duration, and SUA levels are predictive of tophi formation.

Regulating Lipid Metabolism in Gout: A New Perspective with Therapeutic Potential

Gout is a metabolic disease characterized by inflammatory arthritis caused by abnormal uric acid metabolism. It is often complicated with cardio-renal damage and vascular lesions. In recent years, the relationship between lipid metabolism and gout has attracted increasing attention. Changes in blood lipids in gout patients are often clinically detectable and closely related to uric acid metabolism and inflammatory response in gout. With the development of lipidomics, the changes in small lipid molecules and their metabolic pathways have been gradually discovered, yielding a greater understanding of the lipid metabolism changes in gout patients and their potential role in gout development. Through searching the literature on lipid metabolism in gout since 2000 in PubMed and Web of Science, this article reviewed lipid metabolism changes in gout patients and their role in the risk of gout, uric acid metabolism, inflammatory response, and comorbidities. Additionally, the strategies to regulate the abnormal lipid metabolism in gout have also been summarized from the aspects of drugs, diet, and exercise. These will provide a new perspective for understanding gout pathogenesis and its treatment and management.

Relationships between different trends of the Mediterranean diet and cardiovascular disease-related risk factors in China: results from the CHNS study, 1997-2009

Objectives

The present study aimed to explore the associations between Mediterranean diet trajectories (MDTs) and cardiovascular disease-related risk factors in Chinese adults.

Methods

A total of 4,332 participants from the China Health and Nutrition Survey (CHNS) were included in this study. A group-based trajectory model (GBTM) was used to explore Mediterranean diet trajectories (MDTs). Linear regression analyses were conducted to assess the association between Mediterranean diet trajectories and cardiovascular disease-related risk factors. Stratified analyses by gender were also performed.

Results

The following four groups were identified in the total population: Group 1 (Persistently low MDT, n = 292, 6.74%), Group 2 (Descent MDT, n = 537, 12.40%), Group 3 (Ascent MDT, n = 454, 10.48%), and Group 4 (Persistently high MDT, n = 3,049, 70.38%). Compared to the persistently low MDT (Group 1), both Group 2 and Group 4 were negatively related to low-density lipoprotein cholesterol (LDL-C) (Group 2: β = -0.23, 95% CI: -0.36 to -0.09, p = 0.001; Group 4: β = -0.25, 95% CI: -0.37 to -0.14, p < 0.001), total cholesterol (TC) (Group 2: β = -0.18, 95% CI: -0.32 to -0.04, p = 0.010; Group 4: β = -0.31, 95% CI: -0.43 to -0.19, p < 0.001), and uric acid (UA) (Group 2: β = -15.16, 95% CI: -28.66 to -2.56, p = 0.019; Group 4: β = -27.51, 95% CI: -38.77 to -16.25, p < 0.001) after adjusting for potential risk factors. Only Group 4 exhibited a negative relationship with triglycerides (TG) (β = -0.18, 95% CI: -0.34 to -0.02, p = 0.028) and blood glucose (β = -0.19, 95% CI: -0.37 to -0.02, p = 0.032).

Conclusion

Four MDTs were identified among the total participants, including men and women. These trajectories were summarized as persistently low MDT, ascent MDT, descent MDT, and persistently high MDT. Adherence to high MDTs could reduce the level of some CVD-related risk factors. The impact of the remote MD on CVD-related risk factors may be greater than that of the proximal MD.

Association between serum carotenoids and hyperuricemia: a cross-sectional study based on NHANES 2001-2006

Purpose

This study aims to investigate the association between serum carotenoids and hyperuricemia.

Methods

Data were sourced from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2006. Hyperuricemia was defined as serum uric acid (UA) levels of ≥7 mg/dL for males and ≥ 6 mg/dL for females. Serum carotenoid levels were measured using high-performance liquid chromatography. Multivariate linear regression was used to analyze the correlation between serum carotenoids and UA levels. Multivariate logistic regression and restricted cubic spline (RCS) analyses were performed to explore the potential association between serum carotenoids and hyperuricemia. Additionally, subgroup and interaction analyses were conducted to determine variations across different population groups.

Result

This cross-sectional study included 13,561 participants. Multivariate linear regression analysis revealed that higher levels of serum carotenoids were correlated with lower UA levels. Specifically, the beta coefficients (β) and 95% confidence intervals (CIs) were as follows: α-carotene (-0.23 [-0.31, -0.15]), β-carotene (-0.30 [-0.38, -0.21]), β-cryptoxanthin (-0.17 [-0.25, -0.09]), lutein/zeaxanthin (-0.12 [-0.20, -0.04]), and total serum carotenoids (-0.25 [-0.33,-0.16]). However, lycopene showed no significant correlation with UA (-0.01 [-0.09, 0.08]). Multivariate logistic regression analysis indicates a significant inverse association between serum carotenoids and the risk of hyperuricemia. The odds ratios (ORs) and 95%CIs were as follows: α-carotene (0.61 [0.49, 0.77]), β-carotene (0.67 [0.51, 0.86]), β-cryptoxanthin (0.69 [0.51, 0.88]), lutein/zeaxanthin (0.72 [0.56, 0.97]), lycopene (0.82 [0.67, 1.00]) and total serum carotenoids (0.73 [0.57, 0.92]). RCS analysis indicated a potential nonlinear relationship between lycopene and hyperuricemia, with an inflection point at 33.45 μg/dL. Subgroup and interaction analyses demonstrated that the inverse association remained consistent across various demographic groups.

Conclusion

This study found that higher serum carotenoid levels are associated with lower UA levels and reduced risk of hyperuricemia. Notably, while lycopene was associated with reduced hyperuricemia risk, its effect showed some heterogeneity.

Role of HIF1A gene polymorphisms with serum uric acid and HIF-1α levels in monosodium urate crystal-induced arthritis

BACKGROUND

Gouty arthritis is a metabolic disease characterized by the deposition of monosodium urate crystals in the joints, which triggers the release of interleukin-1β (IL-β) by activating the NLRP3 inflammasome. Hypoxia-inducible factor-1α (HIF-1α) is a transcription factor involved in IL-β production and as a regulator of NLRP3.

OBJECTIVES

The aims were to analyze the association of HIF1A rs11549465, rs11549467, and rs2057482 variants in patients with gouty arthritis, and to evaluate the correlation between urate and HIF-1α levels according to the associated genotypes.

METHODS

Cases and controls were genotyped using TaqMan probes, and urate and HIF-1α levels were quantified. Data were analyzed using SPSS v21 software and P-values < 0.05 were considered statistically significant.

RESULTS

Urate and HIF-1α levels were higher in patients than in controls (P < 0.05). Under the three inheritance models (codominant, dominant, and recessive), the AA genotype of the rs11549467 variant was associated with gout risk (OR = 5.74, P = 0.009, OR = 3.33, P = 0.024, and OR = 9.09, P = 0.003, respectively). There were significant differences in the distribution of serum levels of both HIF-1α (P < 0.0001) and urate (P = 0.016) according to the genotypes of the rs11549467 variant.

CONCLUSION

These results suggest that the HIF1A rs11549467 variant may play a key role in the pathogenesis of gouty arthritis. Key Points • The pathogenesis of gouty arthritis involves the HIF1A gene. • In patients with gout, the AA genotype of the rs11549467 (HIF1A) variant is associated with increased serum levels of urate and HIF-1α. • HIF-1α is involved in the regulation of IL-1β and NLRP3.

Self-management behavior preferences and influencing factors in Chinese patients with recurrent gout: A qualitative study

Objectives

This study aimed to explore the preferences and influencing factors of self-management behaviors in patients with recurrent gout and provide a theoretical basis for developing targeted strategies to improve self-management preferences.

Methods

A total of 10 patients with recurrent gout were recruited from the gout specialist outpatient clinic at a tertiary hospital in Shenyang, Liaoning Province, China. Semi-structured interviews were conducted with these patients, and the Kawakita Jiro (KJ) method was used to analyze the interview data.

Results

After four rounds of screening by five researchers, 35 codes were selected from an initial 132. After three rounds of discussion and induction, the KJ method identified seven domains of self-management behavior preferences in patients with recurrent gout: 1) extensive knowledge of gout, yet difficulty in distinguishing between accurate and inaccurate information; 2) a passive attitude of "no pain, no management"; 3) the challenge of changing entrenched daily habits; 4) the optimistic but unrealistic belief of "self-delusion"; 5) a tendency to seek medical attention late due to hopelessness of cure and familiarity with recurrences; 6) preference for analgesics for gout recurrences while neglecting long-term urate-lowering therapy (ULT); and 7) gout-related stigma.

Conclusion

The results of this study showed that the self-management behavior of patients with recurrent gout could be improved, especially in the aspects of medical seeking behavior, medication compliance, daily management and emotional management. At the same time, we found that gout stigma, difficulty in distinguishing true and false knowledge of gout and negative attitude of "ignoring pain" were significantly associated with self-management behavior.

The impact of chrysanthemi indici flos-enriched flavonoid part on the model of hyperuricemia based on inhibiting synthesis and promoting excretion of uric acid

ETHNOPHARMACOLOGICAL RELEVANCE

In recent years, in addition to hypertension, hyperglycemia, and hyperlipidemia, the prevalence of hyperuricemia (HUA) has increased considerably. Being the fourth major health risk factor, HUA can affect the kidneys and cardiovascular system. Chrysanthemi Indici Flos is a flavonoid-containing traditional Chinese patent medicine that exhibits a uric acid (UA)-lowering effect. However, the mechanisms underlying Chrysanthemi Indici Flos-enriched flavonoid part (CYM.E) mediated alleviation of HUA remain unelucidated.

AIM OF THE STUDY

This study aimed to elucidate the efficacy of CYM.E in preventing and treating HUA and its specific effects on UA-related transport proteins, to explore possible mechanism.

METHODS

The buddleoside content in CYM.E was determined through high-performance liquid chromatography. HUA was induced in mice models using adenine and potassium oxonate. Subsequently, mice were administered 10 mg/kg allopurinol, and 30, 60, and 90 mg/kg CYM.E to evaluate the effects of CYM.E on the of HUA mice model. Herein, plasma uric acid (UA), creatinine (CR), blood urea nitrogen (BUN), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) contents, along with serum alanine aminotransferase (ALT), and aspartate aminotransferase (AST) activities were measured. Additionally, xanthine oxidase (XOD) and adenosine deaminase (ADA) activities in the liver were determined. The histomorphologies of the liver and kidney tissues were examined through hematoxylin and eosin staining. The messenger RNA (mRNA) expression of facilitated glucose transporter 9 (GLUT9), organic anion transporter (OAT)1, OAT3, and adenosine triphosphate binding cassette subfamily G2 (ABCG2) in the kidney was assessed by real-time quantitative polymerase chain reaction. Furthermore, the expression of urate transporter 1 (URAT1), GLUT9, OAT1, and OAT3 in the kidney, OAT4, and ABCG2 proteins was determined by immunohistochemistry and western blotting.

RESULTS

The buddleoside content in CYM.E was approximately 32.77%. CYM.E improved body weight and autonomous activity in HUA mice. Additionally, it reduced plasma UA, BUN, and CR levels and serum ALT and AST activities, thus improving hepatic and renal functions, which further reduced the plasma UA content. CYM.E reduced histopathological damage to the kidneys. Furthermore, it lowered plasma TC, TG, and LDL-c levels, thereby improving lipid metabolism disorder. CYM.E administration inhibited hepatic XOD and ADA activities and reduced the mRNA expression of renal GLUT9. CYM.E inhibited the protein expression of renal URAT1, GLUT9, and OAT4, and increased the mRNA and protein expression of renal OAT1, OAT3, and ABCG2. Altogether, these results show that CYM.E could inhibit the production and promote reabsorption of UA and its excretion.

The Underlying Effect of Urate Levels on Female Infertility

Female infertility is a complex and multifaceted condition that affects millions of women globally [...].

Remnant cholesterol elevates hyperuricemia risk in the middle aged and elderly Chinese: a longitudinal study

Evidence regarding the relationship between remnant cholesterol (RC) and hyperuricemia is limited. The purpose of this study is to investigate the association between RC and hyperuricemia in the middle aged and elderly Chinese. Information was extracted from the China Health and Retirement Longitudinal Study (CHARLS) survey 2011 and survey 2015. Four logistic regression models were established. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were applied to balance the baseline. Next, sensitivity analyses and restricted cubic spline (RCS) analysis were conducted to further explore the association. Cross-lagged panel model (CLPM) and mediation analysis were used to deduce the causal relationship between RC and hyperuricemia. This study contained 6,447 participants. A positive association between high RC and hyperuricemia was found in the full adjusted model (OR:1.80, P < 0.001). Similar results were also seen after PSM (OR:1.86, P < 0.001), IPTW (OR:1.80, P < 0.001) and sensitive analysis in non-overweight subgroups (OR:1.77, P < 0.001). Though non-linear relationship was not observed, CLPM exhibited that high level of RC can directly cause increase of blood uric acid (standardized β = 0.005, P < 0.001). Moreover, mediation analysis suggested that the positive association can be mediated by hypertension (β = 0.024; p = 0.004), CRP (β = 0.050; p < 0.001) and WBC (β = 0.024; p = 0.010). High level of RC is an independent risk factor for hyperuricemia, which can be mediated by inflammation and hypertension.

Effective xanthine oxidase inhibitor urate lowering therapy in gout is linked to an emergent serum protein interactome of complement and inflammation modulators

Urate-lowering treatment (ULT) to target with xanthine oxidase inhibitors (XOIs) paradoxically causes early increase in gouty arthritis flares. Because delayed reduction in flare burden is mechanistically unclear, we tested for ULT inflammation responsiveness markers. Unbiased proteomics analyzed blood samples (baseline, 48 weeks ULT) in two, independent ULT out trial cohorts (n = 19, n = 30). STRING-db and multivariate analyses supplemented determinations of altered proteins via Wilcoxon matched pairs signed rank testing in XOI ULT responders. Mechanistic studies characterized proteomes of cultured XOI-treated murine bone marrow macrophages (BMDMs). At 48 weeks ULT, serum urate normalized in all gout patients, and flares declined in association with significantly altered proteins (p < 0.05) in clustering and proteome networks in sera and peripheral blood mononuclear cells. Sera demonstrated altered complement activation and regulatory gene ontology biologic processes. In both cohorts, a treatment-emergent serum interactome included key gouty inflammation mediators (C5, IL-1B, CXCL8, IL6). Last, febuxostat treatment decreased complement activation biologic process proteins in cultured BMDMs. Reduced gout flares are linked with a XOI treatment-emergent serum protein interactome that includes inflammation regulators, associated with altered complement activation and regulatory biologic processes. Serum and leukocyte proteomics could help identify when gouty inflammatory processes begin to subside in response to ULT.Trial Registration: ClinicalTrials.gov Identifier NCT02579096, posted October 19, 2015.

Advances in Gouty Arthritis Management: Integration of Established Therapies, Emerging Treatments, and Lifestyle Interventions

Gouty arthritis, a prevalent inflammatory condition characterized by the deposition of monosodium urate crystals within joints, often results in debilitating pain and inflammation. Conventional therapeutic approaches, including nonsteroidal anti-inflammatory drugs, corticosteroids, and urate-lowering agents such as allopurinol and febuxostat, often have limitations such as adverse effects, drug interactions, and suboptimal patient compliance. This review presents a comprehensive overview of both established and emerging therapeutic strategies, developed between 2019 and 2024, for gouty arthritis; the review focuses on their mechanisms of action, efficacy, and safety profiles. Novel therapeutic approaches include pharmaceutical plant additives (e.g., Citrullus colocynthis, Atractylodes lancea), anti-inflammatory agents such as canakinumab and ozone therapy, and complementary therapies such as warm ginger compresses, Qingpeng ointment, and various lifestyle modifications. These strategies offer promising alternatives to conventional treatments by targeting uric acid metabolism, inflammatory pathways, and crystal formation, potentially reducing reliance on standard medications and minimizing adverse effects. Although therapies such as canakinumab have demonstrated significant efficacy in reducing gout flares, others such as polyphenol-rich foods offer favorable safety profiles. Further research, including large-scale clinical trials, is warranted to validate these findings and integrate these strategies into clinical practice to improve patient outcomes and quality of life.

A comprehensive review on recent xanthine oxidase inhibitors of dietary based bioactive substances for the treatment of hyperuricemia and gout: Molecular mechanisms and perspective

Hyperuricemia (HUA) has attained a considerable global health concern, related to the development of other metabolic syndromes. Xanthine oxidase (XO), the main enzyme that catalyzes xanthine and hypoxanthine into uric acid (UA), is a key target for drug development against HUA and gout. Available XO inhibitors are effective, but they come with side effects. Recent, research has identified new XO inhibitors from dietary sources such as flavonoids, phenolic acids, stilbenes, alkaloids, polysaccharides, and polypeptides, effectively reducing UA levels. Structural activity studies revealed that -OH groups and their substitutions on the benzene ring of flavonoids, polyphenols, and stilbenes, cyclic rings in alkaloids, and the helical structure of polysaccharides are crucial for XO inhibition. Polypeptide molecular weight, amino acid sequence, hydrophobicity, and binding mode, also play a significant role in XO inhibition. Molecular docking studies show these bioactive components prevent UA formation by interacting with XO substrates via hydrophobic, hydrogen bonds, and π-π interactions. This review explores the potential bioactive substances from dietary resources with XO inhibitory, and UA lowering potentials detailing the molecular mechanisms involved. It also discusses strategies for designing XO inhibitors and assisting pharmaceutical companies in developing safe and effective treatments for HUA and gout.

Transdermal delivery of iguratimod and colchicine ethosome by dissolving microneedle patch for the treatment of recurrent gout

This study introduces a novel approach of repetitive modeling to simulate the pathological process of recurrent gout attacks in humans. This methodology addresses the instability issues present in rat models of gout, providing a more accurate representation of the damage recurrent gout episodes inflict on human skeletal systems. A soluble nanoneedle system encapsulating colchicine and iguratimod ethosomal formulations was developed. This system aims to modulate inflammatory cytokines and inhibit osteoclast activity, thereby treating inflammatory pain and bone damage associated with recurrent gout. Additionally, a comprehensive evaluation of the microneedles' appearance, morphology, mechanical properties, and penetration capability confirmed their effectiveness in penetrating the stratum corneum. Dissolution tests and skin irritation assessments demonstrated that these microneedles dissolve rapidly without irritating the skin. In vitro permeation studies indicated that transdermal drug delivery via these microneedles is more efficient and incurs lower drug loss compared to traditional topical applications. In vivo pharmacodynamic assessments conducted in animal models revealed significant analgesic and anti-inflammatory effects when both types of microneedles were used together. Further analyses, including X-ray imaging, hematoxylin and eosin (H&E) staining, Safranin-O/fast green staining, tartrate-resistant acid phosphatase staining, and quantification of osteoclasts, confirmed the bone-protective effects of the microneedle combination. In conclusion, the findings of this research underscore the potential of this novel therapeutic approach for clinical application in the treatment of recurrent gout.

Innovative Formulation Platform: Paving the Way for Superior Protein Therapeutics with Enhanced Efficacy and Broadened Applications

Protein therapeutics offer high therapeutic potency and specificity; the broader adoptions and development of protein therapeutics, however, have been constricted by their intrinsic limitations such as inadequate stability, immunogenicity, suboptimal pharmacokinetics and biodistribution, and off-target effects. This review describes a platform technology that formulates individual protein molecules with a thin formulation layer of crosslinked polymers, which confers the protein therapeutics with high activity, enhanced stability, controlled release capability, reduced immunogenicity, improved pharmacokinetics and biodistribution, and ability to cross the blood brain barriers. Based on currently approved protein therapeutics, this formulating platform affords the development of a vast family of superior protein therapeutics with improved efficacy and broadened indications at significantly reduced cost.

Association between Visceral Adiposity Index and Hyperuricemia among Steelworkers: The Moderating Effects of Drinking Tea

BACKGROUND/OBJECTIVES

Steelworkers are more likely to have a higher prevalence of hyperuricemia due to their exposure to special occupational factors and dietary habits. The interrelationships of visceral adiposity index (VAI), hyperuricemia, and drinking tea remain uncertain. This study aimed to assess the association between VAI and hyperuricemia among steelworkers, and if drinking tea modified this association.

METHODS

A total of 9928 steelworkers from Hunan Hualing Xiangtan Iron and Steel Company participated in this cross-sectional study. All participants completed a questionnaire, received anthropometric measurements, and provided blood samples for biochemical testing. Three logistic regression models were used to analyze the association between VAI and hyperuricemia.

RESULTS

In this study, the prevalence of hyperuricemia was approximately 23.74% (males: 24.41%; females: 20.63%), and a positive correlation between VAI and hyperuricemia risk was observed. In multivariate logistic regression analysis, the risk of hyperuricemia increased 1.76 times (95% CI: 1.64-1.89) and 2.13 times (95% CI: 1.76-2.57) with the increase of ln VAI in males and females, respectively. For males, compared to quartile 1, the risk of hyperuricemia in the second, third, and fourth quartile of VAI were 1.75 (95% CI: 1.11-2.71), 2.56 (95% CI: 1.67-3.93) and 4.89 (95% CI: 3.22-7.43). For females, compared to quartile 1, the risk of hyperuricemia in the second, third, and fourth quartile of VAI were 1.99 (95% CI: 1.40-2.82), 2.92 (95% CI: 1.96-4.34) and 4.51 (95% CI: 2.89-7.02). Additionally, our study found that, compared with not consuming tea, drinking tea could reduce uric acid levels by 0.014 in male steelworkers (t = -2.051, p = 0.040), 0.020 in workers consuming smoked food (t = -2.569, p = 0.010), and 0.022 in workers consuming pickled food (t = -2.764, p = 0.006).

CONCLUSIONS

In conclusion, VAI is positively correlated with hyperuricemia in steelworkers. Drinking tea may lower uric acid levels in male steelworkers and steelworkers who prefer smoked and pickled foods.

Exploration of the potential mechanism of Yiyi Tongfeng Formula in the treatment of acute gouty arthritis based on network pharmacology and molecular docking: A review

The global prevalence of gout is on the rise. Yiyi Tongfeng Formula (YTF), a traditional herbal compound, has gained recognition for its efficacy in managing acute gouty arthritis (AGA). Despite its widespread use, the underlying mechanisms of YTF in AGA treatment remain largely undefined. This study employed network pharmacology and molecular docking to elucidate these mechanisms. We utilized the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform, SymMap database, and various literature sources to identify active components and corresponding targets of YTF. Relevant AGA-associated targets were identified through the Genecards, Drugbank, Therapeutic Target Database, and Online Mendelian Inheritance in Man databases. A protein-protein interaction network was constructed to delineate interactions between YTF targets and AGA. Key ingredients and central targets were further analyzed using Cytoscape. Functional enrichment analyses, including Gene Ontology and Kyoto Encyclopedia of Genes and Genomes, were conducted via Metascape. Additionally, molecular docking studies were performed using PyMOL and AutoDock4. It was found that quercetin, kaempferol, and luteolin may be the main active components of YTF for AGA treatment. Gene Ontology enrichment analysis shows that the main biological processes involved are cellular responses to lipids, and inflammatory responses. Kyoto Encyclopedia of Genes and Genomes enrichment analysis suggests the involvement of the IL-17 signaling pathway, AGE-RAGE signaling pathway in diabetic complications, TNF signaling pathway, and so on. The findings suggest a multi-faceted therapeutic approach of YTF in treating AGA, involving multiple components, targets, biological processes, and signaling pathways. This comprehensive mechanism offers a foundation for further experimental validation.

2024 Guidelines of the Taiwan Society of Cardiology on the Primary Prevention of Atherosclerotic Cardiovascular Disease --- Part I

Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death worldwide and in Taiwan. It is highly prevalent and has a tremendous impact on global health. Therefore, the Taiwan Society of Cardiology developed these best-evidence preventive guidelines for decision-making in clinical practice involving aspects of primordial prevention including national policies, promotion of health education, primary prevention of clinical risk factors, and management and control of clinical risk factors. These guidelines cover the full spectrum of ASCVD, including chronic coronary syndrome, acute coronary syndrome, cerebrovascular disease, peripheral artery disease, and aortic aneurysm. In order to enhance medical education and health promotion not only for physicians but also for the general public, we propose a slogan (2H2L) for the primary prevention of ASCVD on the basis of the essential role of healthy dietary pattern and lifestyles: "Healthy Diet and Healthy Lifestyles to Help Your Life and Save Your Lives". We also propose an acronym of the modifiable risk factors/enhancers and relevant strategies to facilitate memory: " ABC2D2EFG-I'M2 ACE": Adiposity, Blood pressure, Cholesterol and Cigarette smoking, Diabetes mellitus and Dietary pattern, Exercise, Frailty, Gout/hyperuricemia, Inflammation/infection, Metabolic syndrome and Metabolic dysfunction-associated fatty liver disease, Atmosphere (environment), Chronic kidney disease, and Easy life (sleep well and no stress). Some imaging studies can be risk enhancers. Some risk factors/clinical conditions are deemed to be preventable, and healthy dietary pattern, physical activity, and body weight control remain the cornerstone of the preventive strategy.

Hyperuricemia and its related diseases: mechanisms and advances in therapy

Hyperuricemia, characterized by elevated levels of serum uric acid (SUA), is linked to a spectrum of commodities such as gout, cardiovascular diseases, renal disorders, metabolic syndrome, and diabetes, etc. Significantly impairing the quality of life for those affected, the prevalence of hyperuricemia is an upward trend globally, especially in most developed countries. UA possesses a multifaceted role, such as antioxidant, pro-oxidative, pro-inflammatory, nitric oxide modulating, anti-aging, and immune effects, which are significant in both physiological and pathological contexts. The equilibrium of circulating urate levels hinges on the interplay between production and excretion, a delicate balance orchestrated by urate transporter functions across various epithelial tissues and cell types. While existing research has identified hyperuricemia involvement in numerous biological processes and signaling pathways, the precise mechanisms connecting elevated UA levels to disease etiology remain to be fully elucidated. In addition, the influence of genetic susceptibilities and environmental determinants on hyperuricemia calls for a detailed and nuanced examination. This review compiles data from global epidemiological studies and clinical practices, exploring the physiological processes and the genetic foundations of urate transporters in depth. Furthermore, we uncover the complex mechanisms by which the UA induced inflammation influences metabolic processes in individuals with hyperuricemia and the association with its relative disease, offering a foundation for innovative therapeutic approaches and advanced pharmacological strategies.

Association between acetaminophen administration and outcomes in critically ill patients with gout and hypertension

Background

Acetaminophen is a commonly used medication, yet its recommendation for patients with comorbid conditions of gout and hypertension is contradictory, and the impact of its usage on clinical outcomes in real-world practical settings remains uncertain. The aim of this study was to investigate the association between acetaminophen administration and clinical outcomes in critically ill patients with gout and hypertension, utilizing real-world data.

Methods

A retrospective cohort study was conducted based on the MIMIC-IV (Medical Information Mart in Intensive Care-IV) database. Adult critically ill patients with gout and hypertension were included in the analysis. The exposure was acetaminophen use during ICU stay. The primary outcome was in-hospital mortality. The secondary endpoints were frequent hospitalization, 30-day, and 60-day all-cause mortality, and incidence of hypertensive emergencies. Propensity score matching (PSM) was conducted at a 1:1 ratio. Multivariable analyses were used to adjust for confounders.

Results

The pre-matched and propensity score-matched cohorts included 2448 and 1012 patients, respectively. In the PSM analysis, in-hospital mortality was 9.7% (49/506) in the acetaminophen use group and 12.1% (61/506) in the no use group. Acetaminophen use was associated with a decrease in-hospital mortality (hazard ratio [HR], 0.62; 95% CI, 0.41-0.92; P = 0.018). In terms of secondary endpoints, after PSM, there was no statistically significant difference for both 30-day and 60-day all-cause mortality reductions in the acetaminophen use group, and HRs were 0.78 (95% CI 0.55-1.11; P = 0.175), and 0.75 (95% CI 0.55-1.02; P = 0.069), respectively. According to the analysis of dosage and treatment group, the use of APAP within the dosage range of 2-4 g and within 3-5 days of treatment significantly reduced the mortality rate of the entire cohort and PSM cohort, with statistical differences. Subgroup analysis demonstrated that lower in-hospital mortality was consistent across different baselines (age, gender, BMI, liver disease, and renal disease), with no interactions in all subgroups (interaction p-values >0.05), thereby affirming the robustness and reliability of the findings.

Conclusion

Acetaminophen use was associated with lower in-hospital mortality in critically ill patients with gout and hypertension. Prospective studies are needed to verify this finding.

Higher Dietary Inflammatory Index and Increased Mortality Rate of Adults With Hyperuricemia: Findings From the National Health and Nutritional Examination Survey (2001-2018)

OBJECTIVE

This study aimed to assess the association between Dietary Inflammatory Index (DII) score and death among adults with hyperuricemia.

METHODS

We collected data from the 2001 to 2018 cohorts of the National Health and Nutritional Examination Survey. Death information was obtained based on death certificate records from the National Death Index through December 31, 2019. The associations between DII score and all-cause, cardiovascular disease (CVD), and cancer death were investigated by using Cox proportional hazards regression models.

RESULTS

We enrolled 7,786 participants with hyperuricemia in this study. The DII score ranged from -4.42 to 4.61. Higher DII score was significantly associated with higher levels of body mass index, glycohemoglobin, glucose, low-density lipoprotein-cholesterol, and C-reactive protein (all P < 0.05). During 67,851 person-years of follow-up, deaths of 1,456 participants were identified, including 532 CVD deaths and 246 cancer deaths. After adjusting for potential variables, significant higher risk of all-cause (hazard ratio [HR] 1.18, 95% confidence interval [95% CI] 1.03-1.36, P = 0.01) and CVD (HR 1.30, 95% CI 1.03-1.63, P = 0.02) death was observed for individuals with higher DII scores. Considering the DII score as a continuous variable, the risk of all-cause and CVD death increases 5% (HR 1.05, 95% CI 1.01-1.08) and 8% (HR 1.08, 95% CI 1.02-1.15) with each one-unit increment in DII score, respectively. Subgroup analysis indicated that the association between DII score and all-cause death among participants with hyperuricemia was more significant in males.

CONCLUSION

DII score is found to be positively associated with all-cause and CVD death of adults with hyperuricemia. Controlling the intake of proinflammatory food might be a potential strategy to reduce the mortality rate.

Body mass index mediates the association between four dietary indices and phenotypic age acceleration in adults: a cross-sectional study

Background: Diet and body mass index (BMI) are widely recognized as being closely associated with aging. However, it remains unclear which dietary indices are associated with aging, and the extent to which BMI mediates the relationship between diet and aging. Therefore, this study investigates the mediating role of BMI in the association between various dietary indices and phenotypic age acceleration (PhenoAgeAccel). Methods: Data were sourced from the National Health and Nutrition Examination Survey (NHANES), using two 24 hour recall interviews to compute four dietary indices: the Dietary Inflammatory Index (DII), Healthy Eating Index-2020 (HEI-2020), Alternative Healthy Eating Index-2010 (AHEI-2010), and Composite Dietary Antioxidant Index (CDAI). Linear regression analyses and mediation analyses assessed the associations between dietary indices and PhenoAgeAccel and the mediating effects of BMI. Z-score transformations (zDII, zHEI-2020, zAHEI-2010, and zCDAI) were used to ensure comparability between different dietary indices. Results: After adjusting for covariates, the zHEI-2020, zAHEI-2010, and zCDAI were negatively associated with PhenoAgeAccel (P < 0.05), with β values being -0.36, -0.40, and -0.41, respectively. The zDII was positively associated with PhenoAgeAccel (P < 0.001) with a β value of 0.70. Mediation analyses suggested that BMI significantly mediated the relationships between these dietary indices and PhenoAgeAccel. The mediation proportions were 23.7% for zDII, 43.3% for zHEI-2020, 24.5% for zAHEI-2010, and 23.6% for zCDAI. Conclusions: This study indicates that all dietary indices and BMI were significantly associated with PhenoAgeAccel. In addition, BMI exhibited the highest mediation proportion in the relationship between HEI-2020 and PhenoAgeAccel.

[Gout, beyond the joint: How should we treat it?]

Gout is a disease caused by the chronic deposition of monosodium urate crystals. Its clinical presentation as an acute, self-limiting arthritis and the belief that it is a banal, self-inflicted disease have led to its poor management. Despite advances in the knowledge of the disease and the simplicity of its management, no more than 30% of patients are well treated. In Spain, the prevalence of gout is 2.5% and its incidence is increasing. In the following article we will review the pathogenesis of gout and hyperuricaemia, highlighting the greater weight of genetics and renal function over diet. We will look at the consequences of crystal deposition. Gout, in addition to its joint presentation and renal involvement, has been shown to be an independent cardiovascular risk factor. Hypouricemic therapy is the most important treatment, as it is the one that dissolves the crystals and cures the disease. This requires the sustained achievement of uricemia levels below 6mg/dl. We will also review preventive and flares treatment, as well as the role of patient education in terms of both lifestyle and dietary habits and adherence to pharmacological treatment.

The relationship between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and hyperuricaemia

PURPOSE

The ratio of non-high-density lipoprotein cholesterol (non-HDL-c) to high-density lipoprotein cholesterol (HDL-c) (NHHR) is a novel comprehensive lipid index. The aim of this study was to investigate the relationship between the NHHR and the prevalence of hyperuricaemia (HUA) in the adult population of the U.S.

METHODS

This cross-sectional study collected data from the National Health and Nutrition Examination Survey (NHANES) (2007-2018). HUA was defined as a serum uric acid (SUA) concentration ≥ 7 mg/dL in men and ≥ 6 mg/dL in women. Multivariate logistic regression models and the restricted cubic spline (RCS) method were applied to examine the relationship between the NHHR and the risk of developing HUA. Subgroup analyses and interaction tests were also performed.

RESULTS

The prevalence of HUA increased with increasing NHHR values (9.01% vs. 13.38% vs. 17.31% vs. 25.79%, P < 0.001). The NHHR was independently correlated with the risk of developing HUA (OR = 1.10, 95% CI: 1.05-1.16; P < 0.001). Furthermore, the risk of developing HUA was significantly greater among individuals with the highest NHHR quartile than among those with the lowest NHHR quartile (OR = 1.94, 95% CI: 1.62-2.33; P < 0.001). This relationship was consistent across subgroups. According to the RCS analysis, an inverted U-shaped relationship existed between the NHHR and the risk of developing HUA.

CONCLUSIONS

The NHHR was closely associated with an increased risk of developing HUA. Further studies on the NHHR could be beneficial for preventing and treating HUA.

Structural basis for urate recognition and apigenin inhibition of human GLUT9

Urate, the physiological form of uric acid and a potent antioxidant in serum, plays a pivotal role in scavenging reactive oxygen species. Yet excessive accumulation of urate, known as hyperuricemia, is the primary risk factor for the development of gout. The high-capacity urate transporter GLUT9 represents a promising target for gout treatment. Here, we present cryo-electron microscopy structures of human GLUT9 in complex with urate or its inhibitor apigenin at overall resolutions of 3.5 Å and 3.3 Å, respectively. In both structures, GLUT9 exhibits an inward open conformation, wherein the substrate binding pocket faces the intracellular side. These structures unveil the molecular basis for GLUT9's substrate preference of urate over glucose, and show that apigenin acts as a competitive inhibitor by occupying the substrate binding site. Our findings provide critical information for the development of specific inhibitors targeting GLUT9 as potential therapeutics for gout and hyperuricemia.

Knowledge, Attitudes, and Practices about Hyperuricemia and Gout in Community Health Workers and Patients with Diabetes

Hyperuricemia exhibits a high incidence among individuals with diabetes; however, the significance of hyperuricemia and gout is often underestimated. This study aimed to assess the knowledge, attitude, and practice of hyperuricemia and gout among community health workers and patients with diabetes. Two questionnaires were designed to investigate knowledge, attitudes, and practices of hyperuricemia and gout among community health workers and patients with diabetes in Chenghua District, Chengdu, from August 2021 to January 2022. A total of 709 community health workers were included, whose average score was 17.74/30. Approximately half of general practitioners (GPs) demonstrated knowledge regarding the target serum uric acid levels for hyperuricemia and gout. Only 11.2% of GPs were fully aware of the preferred medicine for acute gout. The majority of GPs (86.7%) demonstrated limited awareness regarding the contraindications associated with colchicine, while a significant proportion (65.1%) lacked knowledge about the specific classes of drugs that inhibit uric acid synthesis. Among the 508 patients with diabetes included in this survey, 32.3% demonstrated awareness of hyperuricemia, while 60.8% exhibited knowledge regarding gout. The average score attained by these individuals was recorded at 7.21 out of a total of 26 points. The majority of patients with diabetes (87.8%) held the mistaken belief that hyperuricemia definitely led to the development of gout. Almost 66% agreed that a massage or a hot compress could be used when acute gouty arthritis attacks. The knowledge rate of hyperuricemia and gout among community health workers was moderate, while it was low in patients with diabetes.

Diastolic and systolic blood pressure and gout: a Mendelian randomization study

Background

Although there is solid epidemiological evidence supporting the connection between hypertension and gout, little has been said about the relationship between diastolic and systolic blood pressure and gout, the causal relationship and direction associated are uncertain, so we aim to research the causal relationship between diastolic and systolic blood pressure and gout.

Methods

We conducted a two-sample Mendelian randomization (MR) analysis to assess the causal effect between 2 blood pressure phenotypes (including diastolic blood pressure and systolic blood pressure) and 5 gout phenotypes (including gout, drug-induced gout, idiopathic gout, unspecified gout, and strictly defined gout) using genome-wide association study statistics. The inverse variance weighting method was used to generate the main results, while sensitivity analyses using MR-Egger, weighted median, Cochran's Q test, Egger intercept test, and leave-one-out analysis, were performed to assess the stability and reliability of the results.

Results

After the screening, we found a causal relationship between diastolic blood pressure and gout, idiopathic gout, unspecified gout, and strictly defined gout, and a causal relationship between systolic blood pressure and gout, idiopathic gout, unspecified gout, and strictly defined gout.

Conclusion

From a genetic predisposition, controlling blood pressure may reduce the risk of gout.

Interpretable machine learning framework to predict gout associated with dietary fiber and triglyceride-glucose index

BACKGROUND

Gout prediction is essential for the development of individualized prevention and treatment plans. Our objective was to develop an efficient and interpretable machine learning (ML) model using the SHapley Additive exPlanation (SHAP) to link dietary fiber and triglyceride-glucose (TyG) index to predict gout.

METHODS

Using datasets from the National Health and Nutrition Examination Survey (NHANES) (2005-2018) population to study dietary fiber, the TyG index was used to predict gout. After evaluating the performance of six ML models and selecting the Light Gradient Boosting Machine (LGBM) as the optimal algorithm, we interpret the LGBM model for predicting gout using SHAP and reveal the decision-making process of the model.

RESULTS

An initial survey of 70,190 participants was conducted, and after a gradual exclusion process, 12,645 cases were finally included in the study. Selection of the best performing LGBM model for prediction of gout associated with dietary fiber and TyG index (Area under the ROC curve (AUC): 0.823, 95% confidence interval (CI): 0.798-0.848, Accuracy: 95.3%, Brier score: 0.077). The feature importance of SHAP values indicated that age was the most important feature affecting the model output, followed by uric acid (UA). The SHAP values showed that lower dietary fiber values had a more pronounced effect on the positive prediction of the model, while higher values of the TyG index had a more pronounced effect on the positive prediction of the model.

CONCLUSION

The interpretable LGBM model associated with dietary fiber and TyG index showed high accuracy, efficiency, and robustness in predicting gout. Increasing dietary fiber intake and lowering the TyG index are beneficial in reducing the potential risk of gout.

Investigating the Impact of Gut Microbiota on Gout Through Mendelian Randomization

Background

The relationship between gout and gut microbiota has attracted significant attention in current research. However, due to the diverse range of gut microbiota, the specific causal effect on gout remains unclear. This study utilizes Mendelian randomization (MR) to investigate the causal relationship between gut microbiota and gout, aiming to elucidate the underlying mechanism of microbiome-mediated gout and provide valuable guidance for clinical prevention and treatment.

Materials and Methods

The largest genome-wide association study meta-analysis conducted by the MiBioGen Consortium (n=18,340) was utilized to perform a two-sample Mendelian randomization investigation on aggregate statistics of intestinal microbiota. Summary statistics for gout were utilized from the data released by EBI. Various methods, including inverse variance weighted, weighted median, weighted model, MR-Egger, and Simple-mode, were employed to assess the causal relationship between gut microbiota and gout. Reverse Mendelian randomization analysis revealed a causal association between bacteria and gout in forward Mendelian randomization analysis. Cochran's Q statistic was used to quantify instrumental variable heterogeneity.

Results

The inverse variance weighted estimation revealed that Rikenellaceae exhibited a slight protective effect on gout, while the presence of Ruminococcaceae UCG_011 is associated with a marginal increase in the risk of gout. According to the reverse Mendelian Randomization results, no significant causal relationship between gout and gut microbiota was observed. No significant heterogeneity of instrumental variables or level pleiotropy was detected.

Conclusion

Our MR analysis revealed a potential causal relationship between the development of gout and specific gut microbiota; however, the causal effect was not robust, and further research is warranted to elucidate its underlying mechanism in gout development. Considering the significant association between diet, gut microbiota, and gout, these findings undoubtedly shed light on the mechanisms of microbiota-mediated gout and provide new insights for translational research on managing and standardizing treatment for this condition.