Gout associated with reduced renal excretion of uric acid. Renal tubular disorder that nephrologists do not treat

Investigating Coriander Leaf Phenolics With HPLC-UV and Their Role in Modulating Nitrogen Metabolism

Coriander leaves (Coriandrum Sativum L.) contain quercetin, a flavanol from the flavonoid polyphenol group that helps prevent various metabolic disorders. This study aimed to use HPLC-UV to investigate phenolic compounds in coriander leaves and their impact on nitrogen metabolism. Twenty-four healthy Wistar albino rats weighing 160 ± 10 g were divided into four groups: NC (no coriander), CT1, CT2, and CT3. They received coriander leaf powder at levels of 12.2, 16, and 20.33 g/100 g of feed, respectively, based on the availability of quercetin on a dry matter (DM) basis. Feed intake was found higher in CT3 (27.27 g) and CT2 (25.43 g), while CT1 (24.96 g) and NC (24.66 g) showed a nonsignificant (p ≥ 0.05) trend; however, a similar trend was observed in weekly feed intake. After three weeks, rats in the CT3 group showed a 20 g reduction in body weight compared to the NC group (149.64 g vs. 163.41 g). The feed conversion and feed efficiency ratios (FCR & FER) were decreased in all treated groups due to the reduction in body weight (BW). The digestibility of DM and soluble carbohydrates was reduced in rats fed the CT3 diet while crude protein (CP), crude fiber (CF), ether extract (EE), and ash showed increasing trends. The rats that were fed different levels of coriander in the diet showed positive nitrogen balance. There was a reduction in serum uric acid in CT1 (0.72 ± 0.04 mg/dL) and CT2 (0.81 ± 0.03 mg/dL) as compared to other treatment groups. These nitrogen parameters had a positive impact on nitrogen metabolism, along with a significant (p ≤ 0.05) effect on total serum protein and a non-significant (p ≥ 0.05) effect on creatinine. Liver enzymes showed significant improvements in rats that were fed varying amounts of coriander powder. High-density lipoprotein (HDL) levels improved in all treatment groups, with a significant increase observed in CT1 (52.27 ± 0.27 mg/dL). In conclusion, 130 g of dry coriander containing 136 mg of quercetin can be effectively included in various food recipes in dry or wet form to improve serum indices and weight management in healthy people.

Recent Advances in the Application of Foodborne Substances in Hyperuricemia

Hyperuricemia (HUA) is a purine metabolism disorder characterized by the excessive production or inadequate excretion of uric acid. Current pharmacological strategies targeting uric acid reduction have potential adverse effects. Following the concept of "homology of medicine and food", food ingredients are increasingly being explored to prevent HUA and gout, with xanthine oxidase (XOD) emerging as a crucial therapeutic target in managing HUA. Recent scientific investigations have determined that uric acid-lowering substances come from various food sources, such as seafood, dairy products, and agricultural products. These bioactive substances have attracted wide attention because of their effective antihyperuricemia and XOD inhibitory ability. In this study, the pathogenesis, many side effects of uric acid-lowering drugs, and some components of uric acid-lowering drugs are mainly described, with emphasis on the source, composition, preparation technology, and mechanism of uric acid-lowering peptides.

Pyrazinamide-induced Hyperuricemia in Pulmonary Tuberculosis Patients

BACKGROUND

Pyrazinamide is one of the antitubercular drugs used for 2 months in the intensive phase. One of the adverse effects of pyrazinamide is hyperuricemia, with a symptom of arthralgia. This study aims to analyze the incidence of hyperuricemia and arthralgia and their causality in pulmonary tuberculosis (TB) patients undergoing treatment in the intensive phase.

METHODS

It was an analytic observational study with a prospective cohort design. Three ml of blood from each pulmonary TB patient was withdrawn to examine uric acid levels before and after 2 months of treatment with pyrazinamide. The Wilcoxon test was used to analyze changes in uric acid levels and the Chi-square test to analyze the association between uric acid levels and arthralgia. Naranjo algorithm is used to analyze the causality of hyperuricemia.

RESULTS

Twenty pulmonary TB patients met the inclusion criteria in this study. Eight out of 12 (60%) TB patients showed uric acid levels ≥7 mg/dl and 8 of them (66.6%) showed symptoms of arthralgia. The median uric acid level increased significantly before (5.14 mg/dl) and after 2 months of treatment (7.74 mg/dl), P-value = 0.001. Uric acid levels ≥7 mg/dl were significantly associated with arthralgia (P-value = 0.017; odds ratio 14.00; 95% confidence interval 1.25-156.61). Based on the Naranjo algorithm, those with hyperuricemia, eight and four patients had a total score of 7 and 8, respectively, which are classified as probable.

CONCLUSION

Uric acid levels significantly increased during the intensive phase. Pulmonary TB patients with hyperuricemia are a risk factor for arthralgia.

Emerging Urate-Lowering Drugs and Pharmacologic Treatment Strategies for Gout: A Narrative Review

Hyperuricemia with consequent monosodium urate crystal deposition leads to gout, characterized by painful, incapacitating inflammatory arthritis flares that are also associated with increased cardiovascular event and related mortality risk. This narrative review focuses on emerging pharmacologic urate-lowering treatment (ULT) and management strategies in gout. Undertreated, gout can progress to palpable tophi and joint damage. In oral ULT clinical trials, target serum urate of < 6.0 mg/dL can be achieved in ~ 80-90% of subjects, with flare burden reduction by 1-2 years. However, real-world ULT results are far less successful, due to both singular patient nonadherence and prescriber undertreatment, particularly in primary care, where most patients are managed. Multiple dose titrations commonly needed to optimize first-line allopurinol ULT monotherapy, and substantial potential toxicities and other limitations of approved, marketed oral monotherapy ULT drugs, promote hyperuricemia undertreatment. Common gout comorbidities with associated increased mortality (e.g., moderate-severe chronic kidney disease [CKD], type 2 diabetes, hypertension, atherosclerosis, heart failure) heighten ULT treatment complexity and emphasize unmet needs for better and more rapid clinically significant outcomes, including attenuated gout flare burden. The gout drug armamentarium will be expanded by integrating sodium-glucose cotransporter-2 (SGLT2) inhibitors with uricosuric and anti-inflammatory properties as well as clinically indicated antidiabetic, nephroprotective, and/or cardioprotective effects. The broad ULT developmental pipeline is loaded with multiple uricosurics that selectively target uric acid transporter 1 (URAT1). Evolving ULT approaches include administering selected gut anaerobic purine degrading bacteria (PDB), modulating intestinal urate transport, and employing liver-targeted xanthine oxidoreductase mRNA knockdown. Last, emerging measures to decrease the immunogenicity of systemically administered recombinant uricases should simplify treatment regimens and further improve outcomes in managing the most severe gout phenotypes.

Sex distinctive patterns in the association between serum bicarbonate and uric acid levels among healthy adults. Qatar biobank data

Background

Uric acid is the final product of purine metabolism and is a potent plasma antioxidant but with pro-inflammatory effects. At high levels, it may increase the risk of developing multiple chronic diseases, such as gout, atherosclerosis, hypertension, and renal diseases. The aim of this study was to assess the sex-specific association between serum bicarbonate and uric acid levels among healthy adults.

Methodology

This retrospective cross-sectional study included 2,989 healthy Qatari adults (36.4 ± 11.1  years) from the Qatar Biobank database. Serum uric acid and bicarbonate levels were estimated alongside other serological markers. Participants free from chronic diseases were divided into four quartiles based on serum bicarbonate levels. The sex-specific relationship between serum bicarbonate and uric acid levels was assessed through univariate and multivariate analyses.

Results

In men, low serum uric acid levels were significantly associated with higher quartiles of serum bicarbonate levels after adjusting for age. The association remained significant after further adjustment for BMI, smoking, and renal function. The subgroup analysis using the restricted cubic spline method confirmed a significant dose-response association between the variation coefficients of uric acid by serum bicarbonate level in men with adjustments for age, BMI, smoking, and renal function. In women, no significant association was found between quartiles of serum bicarbonate and uric acid levels following the same adjustments. However, using the restricted cubic spline method, a significant bidirectional relation was demonstrated between serum bicarbonate and the variation coefficients of uric acid that were positive for serum bicarbonate levels below 25 mEq/L and negative at higher levels.

Conclusion

Serum bicarbonate levels are linearly associated with reduced serum uric acid levels among healthy adult men, which may be a potential protective factor against hyperuricemia-related complications. Further research is needed to determine the underlying mechanisms.

Purine Metabolism Dysfunctions: Experimental Methods of Detection and Diagnostic Potential

Purines, such as adenine and guanine, perform several important functions in the cell. They are found in nucleic acids; are structural components of some coenzymes, including NADH and coenzyme A; and have a crucial role in the modulation of energy metabolism and signal transduction. Moreover, purines have been shown to play an important role in the physiology of platelets, muscles, and neurotransmission. All cells require a balanced number of purines for growth, proliferation, and survival. Under physiological conditions, enzymes involved in purines metabolism maintain a balanced ratio between their synthesis and degradation in the cell. In humans, the final product of purine catabolism is uric acid, while most other mammals possess the enzyme uricase that converts uric acid to allantoin, which can be easily eliminated with urine. During the last decades, hyperuricemia has been associated with a number of human extra-articular diseases (in particular, the cardiovascular ones) and their clinical severity. In this review, we go through the methods of investigation of purine metabolism dysfunctions, looking at the functionality of xanthine oxidoreductase and the formation of catabolites in urine and saliva. Finally, we discuss how these molecules can be used as markers of oxidative stress.