Management and Cure of Gouty Arthritis

Scaffold hopping-based structural modification of tranilast led to the identification of HNW005 as a promising NLRP3 inflammasome and URAT1 dual inhibitor for the treatment of gouty arthritis

Hyperuricemia and monosodium urate induced nod-like receptor family, pyrin domain-containing 3 (NLRP3) inflammasome activation is the major pathogenesis for gouty arthritis, and urate transporter 1 (URAT1) is a proven target for hyperuricemia. In this study, scaffold hopping modification with tranilast led to the identification of HNW005, an NLRP3 inflammasome and URAT1 dual-target inhibitor, which exhibited notable inhibitory potency against NLRP3 inflammasome activation (KD = 204.6 nM, IC50 = 1.7 μM) and uric acid transmembrane transportation (IC50 = 6.4 μM). Importantly, HNW005 displayed significant in vivo efficacy with respect to anti-inflammatory, analgesic, and uric acid-lowering effects (decreasing rate = 64.8 % at 2 mg/kg). In addition, HNW005 also displayed an acceptable pharmacokinetic profile (F = 41.37 %, t1/2 = 3.07 h). Collectively, the results showed that developing dual-target inhibitors of NLRP3 inflammasomes and URAT1 is a feasible strategy for the treatment of gouty arthritis, and HNW005 is worthy of further investigation.

The effect of Kuiyuan chewing tablet on hyperuricemia: protocol for a randomized, double-blind, multicenter, parallel-controlled trial

Background

Hyperuricemia (HUA) is a metabolic disorder characterized by elevated serum uric acid levels resulting from dysfunction in purine metabolism and/or inadequate uric acid excretion. It is an independent risk factor for many chronic diseases and is associated with a poor long-term prognosis. Existing uric acid-lowering drugs often lead to numerous adverse reactions, resulting in poor patient compliance and limited clinical application. Therefore, this study aims to investigate the effect of Kuiyuan Chewing Tablet (KYCT) on serum uric acid (SUA) levels in patients with HUA, and to seek a safe alternative therapy for reducing uric acid.

Methods and analysis

This study is a multicenter, randomized, double-blind, parallel-controlled trial. HUA patients who meet the inclusion criteria will be randomly assigned in a 1:1 ratio to either (1) the control group (placebo of KYCT, specifications: 0.3g per tablet, 1.2g per dose, twice a day, taken with warm water 30 minutes after meals) or (2) the experimental group (KYCT, specifications: 0.3g per tablet, 1.2g per dose, twice a day, taken with warm water 30 minutes after meals). Both groups will receive dietary control, comorbidity prevention, and health education during the intervention period. The primary outcome will be the proportion of subjects with SUA levels <420 umol/L. Secondary outcomes will include the proportion of subjects with SUA levels <360 umol/L, the percentage change in SUA levels from baseline to each visit, the maximum percentage change in SUA levels from baseline to the third month, the number of gout attacks, changes in body measurements (weight, waist circumference, hip circumference, BMI), blood pressure, blood lipids, fasting blood glucose levels, and the proportion of subjects reporting gout attacks (cumulative up to each visit). Each group of patients will be assessed at baseline, as well as at the 4th, 8th, and 12th weeks.

Discussion

This study aims to evaluate the effects of a 12-week treatment with KYCT on patients with HUA. We hypothesize that compared to placebo, KYCT would significantly improve SUA levels without provoking significant adverse reactions. These findings potentially pave the way for a safe and effective alternative therapy for HUA.

Bibliometric and visual assessment of research trends in the management of hyperuricemia (HUA)

OBJECTIVE

To analyze the development status and trend of related research in the health management of hyperuricemia and provide a theoretical basis for clinical treatment.

METHODS

A bibliometric analysis was conducted on hyperuricemia health management research data from 2000 to 2024 using the Web Science Core Collection database, PubMed, and SINOMED. A total of 789 articles were evaluated for specific characteristics, such as year of publication, journal, author, institution, country/region, reference, and keyword. The VOSviewer was used for co-author, co-occurrence, co-citation, and network visualization. Important sub-topics identified by bibliometric characteristics were discussed and reviewed.

RESULTS

The number of articles published in the last 24 years has generally followed a year-on-year trend, and the total number of papers published is increasing. Over 200 affiliations from 70 countries and regions contributed papers, and PLOS ONE has the highest number of linked publications. Dalbeth N, is the author with the most publications, with an H-index of 17. Hyperuricemia, gout, management, prevalence, allopurinol, risk, and other keywords were often used. Researchers formed mature teams, and the teams' study directions intersect and are comparable. However, these teams demonstrated a lack of communication and coordination.

CONCLUSIONS

This study highlights research hotspots, global cooperation models, and emerging frontiers in hyperuricemia, focusing on uric acid control, disease screening, health education, and epidemiological investigation in hyperuricemia-associated complications over the past two decades. However, there is still a lack of standardized management processes and systems, and the communication between research teams needs to be enhanced. Key Points • The study analyzed hyperuricemia health management research data from 2000 to 2024 using the Web Science Core Collection database, PubMed, and SINOMED, evaluating 789 articles and discussing key sub-topics using VOSviewer. • Over 200 articles from 70 countries, including PLOS ONE, have been published over the past 24 years, focusing on hyperuricemia, gout, management, prevalence, allopurinol risk, etc. • Our study outlines research hotspots, global cooperation models, and emerging hyperuricemia frontiers, emphasizing the need for standardized management processes and improved communication between research teams.

Gouty arthritis patients' diagnostic, biochemical, and hematological characteristics study: a single-center retrospective study

OBJECTIVE

This study aims to investigate the diagnostic, biochemical, and hematological characteristics of patients with gouty arthritis and analyze their correlations with baseline characteristics to guide clinical practice, develop personalized treatment strategies, and improve patient outcomes.

METHODS

A single-center retrospective analysis was conducted on 8,344 patients with acute gouty arthritis admitted to our hospital between January 2014 and December 2023. Baseline characteristics and laboratory data, including uric acid, blood glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), C-reactive protein (CRP), white blood cell count, neutrophil count, lymphocyte count, monocyte count, fibrinogen, and serum albumin, were collected. General linear and Pearson correlation analyses were performed to identify significant relationships.

RESULTS

Significant correlations were observed between baseline characteristics (age, body mass index (BMI), smoking, and drinking status) and uric acid levels. High uric acid levels were positively correlated with inflammatory markers (hs-CRP, white blood cell count, and neutrophil count) and metabolic indicators (triglycerides, LDL-C, and creatinine) but negatively correlated with HDL-C. Notable differences in blood and biochemical indicators were identified across age, gender, and BMI groups.

CONCLUSION

This study highlights key laboratory characteristics of gouty arthritis, emphasizing the need for individualized treatment strategies. Comprehensive interventions focusing on managing inflammation and metabolic disturbances in patients with elevated uric acid levels are critical for optimizing prognosis and improving quality of life.

Metabolic signatures of metabolites of the purine degradation pathway in human plasma using HILIC UHPLC-HRMS

The metabolic disorders in the purine degradation pathway have proven to be closely associated with several human diseases. However, the etiology is not yet fully understood. Profile assay of purine intermediates and uric acid involved in the metabolic pathway can provide additional insight into the nature and severity of related diseases. Purine metabolites are endogenous chemicals with high hydrophilicity, polarity, and similar structures, thus there is a great need for a specific method to quantify them directly in biological fluids with a short running time. Herein, eight purine degradation pathway metabolites, including xanthine, hypoxanthine, guanine, xanthosine, inosine, guanosine, adenosine and uric acid, in human plasma were quantitatively measured using hydrophilic interaction chromatography-tandem high-resolution mass spectrometry (HILIC-HRMS) in a short running time of 10 min. The method was systematically validated for specificity, linearity of the calibration curve, the limit of detection, the limit of quantification, the lower limit of quantification, precision, accuracy, extraction recovery, matrix effect, and stability. The results showed that the method was linear (R2 > 0.99), accurate (the intra- and inter-day recoveries of all analytes ranged from 90.0 % to 110.0 %), and precise (the intra- and inter-day precisions were less than 6.7 % and 8.9 %, respectively) with the lower limits of quantification ranging from 3 to 10,000 ng/mL. The extraction recoveries and matrix effects were repeatable and stable. All the analytes were stable in the autosampler and could be subject to three freeze-thaw cycles. The developed method was ultimately applied to 100 plasma specimens from healthy individuals. The results showed that the concentrations of different purine metabolites varied dramatically in plasma specimens. Diet and body mass index (BMI) were the most significant factors determining purine levels, followed by drinking and sex. Age, smoking and bedtime showed a very weak correlation with purine metabolism. The findings of the present work reveal the characteristics of purine metabolism in human plasma under non-pathological conditions. The results also highlight the factors that can cause changes in purine metabolism, which are useful in developing effective treatment strategies for metabolic disorders of purines, particularly for those caused by lifestyle factors.

Bone and Joint-on-Chip Platforms: Construction Strategies and Applications

Organ-on-a-chip, also known as "tissue chip," is an advanced platform based on microfluidic systems for constructing miniature organ models in vitro. They can replicate the complex physiological and pathological responses of human organs. In recent years, the development of bone and joint-on-chip platforms aims to simulate the complex physiological and pathological processes occurring in human bones and joints, including cell-cell interactions, the interplay of various biochemical factors, the effects of mechanical stimuli, and the intricate connections between multiple organs. In the future, bone and joint-on-chip platforms will integrate the advantages of multiple disciplines, bringing more possibilities for exploring disease mechanisms, drug screening, and personalized medicine. This review explores the construction and application of Organ-on-a-chip technology in bone and joint disease research, proposes a modular construction concept, and discusses the new opportunities and future challenges in the construction and application of bone and joint-on-chip platforms.

Nonlinear association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and hyperuricemia in cancer patients: evidence from NHANES 2007-2018

BACKGROUND

Evidence shows that cancer patients are more likely to have hyperuricemia (HUA) compared to the general population, with lipid metabolism playing a significant role. However, it is still unclear whether there is a non-linear relationship between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and HUA in these patients. This study aims to explore the association between NHHR and HUA in cancer patients.

METHODS

This study included participants from the NHANES database from 2007 to 2018. We used multivariable logistic regression, restricted cubic splines (RCS) analysis, and subgroup analysis to examine the association between NHHR and HUA and gout in cancer patients, as well as to investigate differences in this association among specific subgroups.

RESULTS

A total of 2826 participants were included, with a HUA prevalence of 24.30%. Weighted multivariable logistic regression showed that for each unit increase in NHHR, the odds of HUA in cancer patients increased by 16% (95% confidence interval [CI]: 1.06, 1.29, P = 0.002). When NHHR was divided into tertiles, those in the highest tertile (Q3) had a 1.84 times higher odds of developing HUA compared to those in the lowest tertile (Q1) (95% CI: 1.32, 2.58, P < 0.001). However, there was no significant association with gout. RCS analysis further revealed a significant non-linear positive association, particularly among males. Subgroup analysis and interaction tests indicated a stronger association in cancer patients who did not have a history of stroke.

CONCLUSION

There is a non-linear association between NHHR and HUA in cancer patients.

Cinnamomi cortex extract mitigated monosodium urate-induced acute gouty arthritis in rats through nuclear factor-κB-NOD-like receptor thermal protein domain associated protein 3 signaling pathway

Cinnamomi cortex was applied to mitigate joint injury since ancient China. However, the effect of Cinnamomi cortex on gouty arthritis (GA) was rarely reported. This study aimed to explore the effect of Cinnamomi cortex on monosodium urate (MSU)-induced acute GA (AGA) in rats, and clarify the underlying mechanism. The results showed that Cinnamomi cortex extract (CE) containing rich polyphenols and flavonoids alleviated joint swelling and inflammation by reducing programmed cell death in MSU-induced AGA rats. Network pharmacology analysis showed that CE's predictive inflammatory pathways included nuclear factor-κB (NF-κB) and necroptosis pathways. CE reduced expression of pyroptosis-related regulators including Gasdermin D and Caspase 1 via regulating NF-κB/NOD-like receptor thermal protein domain associated protein 3 signaling pathway in AGA rats. In conclusion, this study provided a theoretical basis for Cinnamomi cortex applied as a new veterinary medicine to protect against GA.

Relief of gouty arthritis in rats by total saponins from Dioscorea nipponica Makino through suppression of neutrophil extracellular trap formation via the PI3K/AKT/mTOR axis

Gouty arthritis (GA) is an inflammatory disorder that is associated with elevated serum levels of uric acid. Total saponins from Dioscorea nipponica Makino (TSDN) are a natural component that ameliorates inflammation while also decreasing uric acid levels. The aim of the present study was to unravel the mechanism of TSDN in gouty rats in regard to regulation of the formation of neutrophil extracellular traps (NETs) via the PI3K/AKT/mTOR axis. A total of 40 Wistar rats were divided into 4 groups: normal, model, TSDN and rapamycin groups. Reverse-transcription-quantitative PCR (RT-qPCR) and western blot analysis were used to assess the mRNA and protein expression levels of the PI3K/AKT/mTOR axis. The formation of NETs was detected by immunohistochemical and immunofluorescent methods. ELISA was used to measure the levels of IL-1β and TNF-α. RT-qPCR and western blotting demonstrated that TSDN compromised the mRNA and protein expression levels of activated protein kinase (AMPK) and mTOR, as well as the mRNA expression levels of AKT and PTEN. Furthermore, it increased the protein expression levels of phosphorylated (p-) PI3K, p-AKT and p-AMPK. Immunohistochemical and immunofluorescent analyses revealed that TSDN decreased the protein expression levels of neutrophil elastase, proteinase 3, cathepsin G, lactoferrin and myeloperoxidase, as well as the number of citrullinated histone 3+ cells. TSDN also reduced the release of IL-1β and TNF-α. Overall, the anti-inflammatory action of TSDN in gouty rats may be realized by suppressing the formation of NETs by regulating the PI3K/AKT/mTOR axis.

Anti-Inflammatory Effects of Polyphenols from Plum (Prunus salicina Lindl) on RAW264.7 Macrophages Induced by Monosodium Urate and Potential Mechanisms

Acute gouty arthritis is an acute inflammatory reaction caused by the deposition of monosodium urate (MSU) crystals in joints and surrounding soft tissues. Controlling inflammation is the key to preventing acute gouty arthritis. Anti-inflammatory activities and the possible molecular mechanisms of plum (Prunus salicina Lindl cv. "furong") polyphenols (PSLP) on RAW264.7 macrophage cells induced by monosodium urate were investigated. PPSF significantly inhibited the activity of inflammatory factors such as tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-18 (IL-18). In addition, PPSF exhibited excellent activation of superoxide dismutase (SOD) activity and reduction of intracellular reactive oxygen species (ROS) and malondialdehyde (MDA) levels in RAW264.7 macrophages. The results of global screening of all transcripts by RNA-seq revealed 8585 differentially expressed genes between the PSLP-treated group and the MUS group. From GO analysis, PSLP could affect the occurrence and development of RAW264.7 macrophage inflammation through biological processes, such as organic substance metabolism, intracellular organelles, and binding function. The regulation mechanism of PSLP on MSU-induced RAW264.7 macrophage inflammation may be achieved through the HIF-1 signaling pathway, renal cell carcinoma, the ErbB signaling pathway, and the FoxO signaling pathway. Therefore, PSLP has great prospects in the prevention of gout and similar inflammatory diseases.

Probiotics, bioactive compounds and dietary patterns for the effective management of hyperuricemia: a review

Hyperuricemia is closely linked with an increased risk of developing hypertension, diabetes, renal failure and other metabolic syndromes. Probiotics, bioactive compounds and dietary patterns are safe cost-efficient ways to control hyperuricemia, whereas comprehensive reviews of their anti-hyperuricemic mechanisms are limited. This review summarizes the roles of probiotics, bioactive compounds and dietary patterns in treating hyperuricemia and critically reviews the possible mechanisms by which these interventions exert their activities. The dietary patterns are closely related to the occurrence of hyperuricemia through the indirect action of gut microbiota or the direct effects of host purine metabolism. The Mediterranean and Dietary Approaches to Stop Hypertension diets help reduce serum uric acid concentrations and thus prevent hyperuricemia. Meanwhile, probiotics alleviate hyperuricemia by ways of absorbing purine, restoring gut microbiota dysbiosis and inhibiting xanthine oxidase (XO) activity. Bioactive compounds such as polyphenols, peptides and alkaloids exert various anti-hyperuricemic effects, by regulating urate transporters, blocking the active sites of XO and inhibiting the toll-like receptor 4/nuclear factor kappa B signaling pathway and NOD-, LRR- and pyrin domain-containing protein 3 signaling pathway. This review will assist people with hyperuricemia to adopt a healthy diet and contribute to the application of natural products with anti-hyperuricemic activity.