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McCormick N, Lin K, Yokose C, Lu N, Zhang Y, Choi HK. Unclosing Premature Mortality Gap Among Patients With Gout in the US General Population, Independent of Serum Urate and Atherosclerotic Cardiovascular Risk Factors. Arthritis Care Res (Hoboken) 2024; 76:691-702. [PMID: 38191784 PMCID: PMC11039387 DOI: 10.1002/acr.25292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Gout flares are followed by transient major cardiovascular (CV) risk, implicating the role of inflammation; the aim of this study was to determine whether premature mortality rates in patients with gout and CV risk are independent of serum urate (SU) and atherosclerotic CV disease (ASCVD) risk factors. METHODS Using serial US nationwide prospective cohorts, we evaluated the independent association of prevalent gout with all-cause and CV mortality, adjusting for SU, ASCVD risk factors, comorbidities, medications, and kidney function and compared mortality rates between the early (1988-1994 baseline) and late cohorts (2007-2016 baseline). We replicated late cohort findings among patients with gout in a nationwide UK cohort (2006-2010 baseline). RESULTS Adjusted hazard ratios (HRs) for mortality rates in patients with prevalent gout were similar in early and late US cohorts (1.20 [1.03-1.40] and 1.19 [1.04-1.37], respectively); HRs with further adjustment for SU were 1.19 (1.02-1.38) and 1.19 (1.03-1.37), respectively. Adjusted HR among patients with gout from the UK late cohort was 1.61 (1.47-1.75); these associations were larger among women (P = 0.04) and prominent among Black individuals. Adjusted HR for CV mortality rates in the late US cohort was 1.39 (1.09-1.78); those for circulatory, CV, and coronary heart disease deaths among UK patients with incident gout were 1.48 (1.24-1.76), 1.49 (1.20-1.85), and 1.59 (1.26-1.99), respectively. CONCLUSIONS Patients with gout experience a persistent mortality gap in all-cause and CV deaths, even adjusting for SU and ASCVD risk factors, supporting a role for gout-specific pathways (eg, flare inflammation). These findings suggest gaps in current care, particularly in women and possibly among Black patients.
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Affiliation(s)
- Natalie McCormick
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston MA USA
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston MA
- Department of Medicine, Harvard Medical School, Boston MA USA
- Arthritis Research Canada, Vancouver BC Canada
| | - Kehuan Lin
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston MA USA
| | - Chio Yokose
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston MA USA
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston MA
- Department of Medicine, Harvard Medical School, Boston MA USA
| | - Na Lu
- Arthritis Research Canada, Vancouver BC Canada
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston MA USA
| | - Yuqing Zhang
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston MA USA
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston MA
- Department of Medicine, Harvard Medical School, Boston MA USA
| | - Hyon K. Choi
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston MA USA
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston MA
- Department of Medicine, Harvard Medical School, Boston MA USA
- Arthritis Research Canada, Vancouver BC Canada
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Mahomoodally MF, Coodian K, Hosenally M, Zengin G, Shariati MA, Abdalla AN, Alhazmi HA, Khuwaja G, Mohan S, Khalid A. Herbal remedies in the management of hyperuricemia and gout: A review of in vitro, in vivo and clinical evidences. Phytother Res 2024. [PMID: 38655878 DOI: 10.1002/ptr.8211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
Gout, or hyperuricemia is a multifactorial and multi-faceted metabolic disease that is quite difficult to manage and/or treat. Conventional therapies such as non-steroidal anti-inflammatory drugs (NSAIDs) such as allopurinol, corticosteroids and colchicine amongst others, have helped in its management and treatment to some extent. This study aimed to compile and analyze the different herbal remedies used in the management of hyperuricemia and gout. A literature search was conducted from key databases (PubMed, ScienceDirect, Cochrane Library, Google Scholar) using relevant keywords via the PRISMA model. Smilax riparia A.DC. from Traditional Chinese Medicine is used in many countries for its therapeutic effect on lowering serum urate levels. No single study was able to establish the efficacy of a specific traditionally used herb via in vitro, in vivo, and clinical studies. Patients were found to use a panoply of natural remedies, mainly plants to treat hyperuricemia and gout, which have been validated to some extent by in vitro, in vivo, and clinical studies. Nonetheless, further research is needed to better understand the ethnopharmacological relationship of such herbal remedies.
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Affiliation(s)
- Mohamad Fawzi Mahomoodally
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
- School of Engineering & Technology, Duy Tan University, Da Nang, Vietnam
| | - Kaisavadee Coodian
- Department of Health Sciences, Faculty of Medicine and Health Sciences, University of Mauritius, Réduit, Mauritius
| | - Muzzammil Hosenally
- Department of Economics and Statistics, Faculty of Social Sciences & Humanities, University of Mauritius, Réduit, Mauritius
| | - Gokhan Zengin
- Department of Biology, Faculty of Science, Selcuk University, Konya, Turkey
| | - Mohammad Ali Shariati
- Semey Branch of the Institute, Kazakh Research Institute of Processing and Food Industry, Almaty, Kazakhstan
| | - Ashraf N Abdalla
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hassan A Alhazmi
- Substance Abuse and Toxicology Research Center, Jazan University, Jazan, Saudi Arabia
- Department of Pharmaceutical Chemistry and Pharmacognosy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Gulrana Khuwaja
- Department of Pharmaceutical Chemistry and Pharmacognosy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Syam Mohan
- Substance Abuse and Toxicology Research Center, Jazan University, Jazan, Saudi Arabia
- School of Health Sciences, University of Petroleum and Energy Studies, Dehradun, India
| | - Asaad Khalid
- Substance Abuse and Toxicology Research Center, Jazan University, Jazan, Saudi Arabia
- Medicinal and Aromatic Plants and Traditional Medicine Research Institute, National Center for Research, Khartoum, Sudan
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Stamp LK, Dalbeth N. Moving urate-lowering therapy in gout beyond guideline recommendations. Semin Arthritis Rheum 2024; 65:152358. [PMID: 38219395 DOI: 10.1016/j.semarthrit.2023.152358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
The 'treat-to target serum urate strategy' when using urate-lowering therapy has been recommended by most specialist rheumatology societies for many years. An alternative "treat-to-avoid-symptoms" in gout has been suggested, albeit without a clear definition of what this means and how it might be implemented in clinical trials or clinical practice. This has hampered efforts to design clinical trials that compare the "treat-to-target [urate]" and "treat-to-avoid-symptoms" strategies in the long-term management of gout. In this review we consider the rationale for the treat-to-target urate strategy when using urate-lowering therapy, potential definitions of a "treat-to-avoid-symptoms" strategy, or perhaps what is not "treat-to-avoid-symptoms", and approaches that might address this uncertainty.
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Affiliation(s)
- Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.
| | - Nicola Dalbeth
- Faculty of Medicine, University of Auckland, Auckland, New Zealand
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Ahmed MM, Saad NE, Abbas SM, El Azizi TMS, El Sayed I. Elevated uric acid in gestational diabetes and its risk on pregnancy outcomes. SAGE Open Med 2024; 12:20503121241241934. [PMID: 38566965 PMCID: PMC10986170 DOI: 10.1177/20503121241241934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Background Over the past few years, gestational diabetes mellitus has become more common. According to earlier research, gestational diabetes mellitus is linked to higher uric acid levels, and gestational hyperuricemia is linked to poor maternal and neonatal outcomes. Aim and objectives To assess the influence of elevated uric acid >5 mg/dl on pregnancy outcomes such as neonatal weight, respiratory distress, preterm delivery, neonatal intensive care unit admission, premature membrane rupture, oligohydramnios, cesarean section, and intensive care admission for mothers. Setting and methods It is a prospective cohort study, carried out at obstetric/family medicine outpatient clinics, Cairo University Hospitals on 221 pregnant females with gestational diabetes mellitus in their third trimester of pregnancy, selected by random sampling, performed structured interviews, and tested for serum uric acid level and were separated into two groups, those with elevated uric acid >5 mg/dl (121) and those without elevated uric acid ⩽5 mg/dl (100) patients and then followed up until delivery in Cairo University Hospitals for collecting pregnancy outcome data. Results There were statistically significant differences between the antepartum uric acid and neonatal complications, maternal complications, preterm, macrosomia, neonatal intensive care unit admission, premature rupture of membranes, oligohydramnios, and cesarean section between both groups. Conclusions This study showed that elevated serum uric acid >5 mg/dl can predict the incidence of maternal and neonatal problems in gestational diabetes mellitus including preterm, macrosomia, neonatal intensive care unit admission, premature rupture of membranes, oligohydramnios, and cesarean section.
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Helget LN, O'Dell JR, Newcomb JA, Androsenko M, Brophy MT, Davis-Karim A, England BR, Ferguson R, Pillinger MH, Neogi T, Palevsky PM, Wu H, Kramer B, Mikuls TR. Determinants of Achieving Serum Urate Goal with Treat-to-Target Urate-Lowering Therapy in Gout. Arthritis Rheumatol 2024; 76:638-646. [PMID: 37842953 DOI: 10.1002/art.42731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/22/2023] [Accepted: 10/12/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Using trial data comparing treat-to-target allopurinol and febuxostat in gout, we examined participant characteristics associated with serum urate (SU) goal achievement. METHODS Participants with gout and SU ≥6.8 mg/dL were randomized to allopurinol or febuxostat, titrated during weeks 0 to 24, and maintained weeks 25 to 48. Participants were considered to achieve SU goal if the mean SU from weeks 36, 42, and 48 was <6.0 mg/dL or <5 mg/dL if tophi were present. Possible determinants of treatment response were preselected and included sociodemographics, comorbidities, diuretic use, health-related quality of life (HRQoL), body mass index, and gout measures. Determinants of SU response were assessed using multivariable logistic regression with additional analyses to account for treatment adherence. RESULTS Of 764 study participants completing week 48, 618 (81%) achieved SU goal. After multivariable adjustment, factors associated with a greater likelihood of SU goal achievement included older age (adjusted odds ratio [aOR] 1.40 per 10 years), higher education (aOR 2.02), and better HRQoL (aOR 1.17 per 0.1 unit). Factors associated with a lower odds of SU goal achievement included non-White race (aORs 0.32-0.47), higher baseline SU (aOR 0.83 per 1 mg/dL), presence of tophi (aOR 0.29), and the use of diuretics (aOR 0.52). Comorbidities including chronic kidney disease, hypertension, diabetes, and cardiovascular disease were not associated with SU goal achievement. Results were not meaningfully changed in analyses accounting for adherence. CONCLUSIONS Several patient-level factors were predictive of SU goal achievement among patients with gout who received treat-to-target urate-lowering therapy (ULT). Approaches that accurately predict individual responses to treat-to-target ULT hold promise in facilitating personalized management and improving outcomes in patients with gout.
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Affiliation(s)
- Lindsay N Helget
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - James R O'Dell
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Jeff A Newcomb
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Maria Androsenko
- VA Boston Cooperative Studies Program Coordinating Center, Boston, Massachusetts
| | - Mary T Brophy
- VA Boston Cooperative Studies Program Coordinating Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Anne Davis-Karim
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Bryant R England
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Ryan Ferguson
- VA Boston Cooperative Studies Program Coordinating Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Michael H Pillinger
- VA New York Harbor Health Care System and New York University Grossman School of Medicine, New York
| | - Tuhina Neogi
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Paul M Palevsky
- VA Pittsburgh Health Care System and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hongsheng Wu
- VA Boston Cooperative Studies Program Coordinating Center, Boston, and Babson College, Wellesley, Massachusetts
| | - Bridget Kramer
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Ted R Mikuls
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
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Lecona OA, Arroyo-Valerio AG, Bueno-Hernández N, Carrillo-Ruíz JD, Ruelas L, Márquez-Franco R, Aguado-García A, Barrón EV, Escobedo G, Ibarra-Coronado E, Olguín-Rodríguez PV, Barajas-Martínez A, Rivera AL, Fossion R. Risk factors contributing to infection with SARS-CoV-2 are modulated by sex. PLoS One 2024; 19:e0297901. [PMID: 38416704 PMCID: PMC10901358 DOI: 10.1371/journal.pone.0297901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/15/2024] [Indexed: 03/01/2024] Open
Abstract
Throughout the early stages of the COVID-19 pandemic in Mexico (August-December 2020), we closely followed a cohort of n = 100 healthcare workers. These workers were initially seronegative for Immunoglobulin G (IgG) antibodies against SARS-CoV-2, the virus that causes COVID-19, and maintained close contact with patients afflicted by the disease. We explored the database of demographic, physiological and laboratory parameters of the cohort recorded at baseline to identify potential risk factors for infection with SARS-CoV-2 at a follow-up evaluation six months later. Given that susceptibility to infection may be a systemic rather than a local property, we hypothesized that a multivariate statistical analysis, such as MANOVA, may be an appropriate statistical approach. Our results indicate that susceptibility to infection with SARS-CoV-2 is modulated by sex. For men, different physiological states appear to exist that predispose to or protect against infection, whereas for women, we did not find evidence for divergent physiological states. Intriguingly, male participants who remained uninfected throughout the six-month observation period, had values for mean arterial pressure and waist-to-hip ratio that exceeded the normative reference range. We hypothesize that certain risk factors that worsen the outcome of COVID-19 disease, such as being overweight or having high blood pressure, may instead offer some protection against infection with SARS-CoV-2.
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Affiliation(s)
- Octavio A. Lecona
- Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | | | - Nallely Bueno-Hernández
- Dirección de Investigación, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - José Damian Carrillo-Ruíz
- Dirección de Investigación, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
- Coordinación de Neurociencias, Facultad de Psicología, Universidad Anahuac México, Mexico City, Mexico
| | - Luis Ruelas
- Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - René Márquez-Franco
- Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Alejandro Aguado-García
- Dirección de Investigación, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
- Centro de Investigación en Ciencias (CInC), Universidad Autónoma del Estado de Morelos, Cuernavaca, Morelos, Mexico
| | - Eira Valeria Barrón
- Servicio de Medicina Genómica “Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Galileo Escobedo
- Dirección de Investigación, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Elizabeth Ibarra-Coronado
- Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Paola V. Olguín-Rodríguez
- Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Centro de Investigación en Ciencias (CInC), Universidad Autónoma del Estado de Morelos, Cuernavaca, Morelos, Mexico
| | - Antonio Barajas-Martínez
- Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ana Leonor Rivera
- Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ruben Fossion
- Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Wu S, Xue W, Yu H, Yu H, Shi Z, Wang L, Peng A. Serum uric acid levels and health outcomes in CKD: a prospective cohort study. Nephrol Dial Transplant 2024; 39:510-519. [PMID: 37698875 DOI: 10.1093/ndt/gfad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Hyperuricemia is prevalent in individuals with chronic kidney disease (CKD). Elevated serum uric acid (SUA) concentrations have been considered an independent risk factor for the onset of CKD. However, the relationship between SUA concentrations and long-term health outcomes among patients with CKD remains unclear. METHODS We performed a prospective cohort study with nationally representative sample to investigate the relationship between SUA concentrations and mortality risk including all-cause, cardiovascular disease (CVD) and cancer mortality, among patients with CKD. The weighted restricted cubic spline analyses combined with the multivariate-adjusted Cox proportional hazard models were used to test the nonlinearity of relationship. RESULTS The 6642 patients participating in National Health and Nutrition Examination Survey 1999-2018 were enrolled. During 656 885 person-months of follow-up time, 2619 all-cause deaths were recorded, including 1030 CVD deaths and 458 cancer deaths. Our study presented J-shaped non-linear relationships between SUA concentrations and all-cause and CVD mortality with inflection points at 311.65 μmol/L and 392.34 μmol/L, respectively. When SUA concentration was higher than those inflection points, every increase of 50 μmol/L SUA was associated with 11.7% and 17.0% greater multivariable-adjusted hazard ratio of all-cause and CVD mortality, respectively. In addition, a negative linear correlation with cancer mortality was detected. CONCLUSION These findings suggested that maintaining appropriate SUA concentrations may improve long-term health outcomes among CKD patients. The corresponding inflection points of J-shaped non-linear relationships were 311.65 and 392.34 μmol/L for all-cause and CVD mortality. Further clinical trials are required to investigate uric acid-lowering targets.
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Affiliation(s)
- Shijie Wu
- Center for Nephrology and Clinical Metabolomics and Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Wen Xue
- Center for Nephrology and Clinical Metabolomics and Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Hanqing Yu
- Center for Nephrology and Clinical Metabolomics and Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Hanjie Yu
- Center for Nephrology and Clinical Metabolomics and Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Zhaoqiang Shi
- Center for Nephrology and Clinical Metabolomics and Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Ling Wang
- Center for Nephrology and Clinical Metabolomics and Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Ai Peng
- Center for Nephrology and Clinical Metabolomics and Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
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Yu Y, Yang X, Hu G, Tong K, Yin Y, Yu R. Effect of tea intake on genetic predisposition to gout and uric acid: a Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 14:1290731. [PMID: 38440060 PMCID: PMC10911082 DOI: 10.3389/fendo.2023.1290731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/26/2023] [Indexed: 03/06/2024] Open
Abstract
Objective The effect of tea on gout and uric acid is still controversial. This study aims to analyze the effect of tea intake on genetic predisposition to gout, idiopathic gout, gout due to impairment of renal function as well as uric acid by Mendelian randomization (MR). Methods Forty independent single nucleotide polymorphisms (SNPs) associated with tea intake were selected from UK Biobank. SNPs for uric acid were obtained from BioBank Japan, SNPs for gout were obtained from UK Biobank, and SNPs for gout due to impairment of renal function and idiopathic gout were derived from FinnGen. The causal relationship of exposure-outcome was tested using inverse variance weighted, MR-Egger and weighted median. MR-Egger intercept was employed to assess horizontal pleiotropy, Cochran's Q test was used to assess heterogeneity, and leave-one-out sensitivity analysis was utilized to analyze the stability of the results. Results The results of MR analysis showed that tea intake was negatively associated with gout due to impairment of renal function (OR 0.997, 95% CI 0.994 to 0.999, P = 0.017), whereas there was no causal association with gout, idiopathic gout, and uric acid (P > 0.05), for which sensitivity analysis suggested that these results were robust. Conclusions There was a genetic predisposition effect of increased tea intake on the reduced risk of gout due to impairment of renal function, whereas there was no such effect on gout, idiopathic gout, and uric acid. Tea intake may become an important option in the dietary treatment of gout due to impairment of renal function.
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Affiliation(s)
- Yunfeng Yu
- Department of Endocrinology, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Xinyu Yang
- College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Gang Hu
- College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Keke Tong
- Department of Gastroenterology, The Hospital of Hunan University of Traditional Chinese Medicine, Changde, Hunan, China
| | - Yuman Yin
- College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Rong Yu
- Department of Endocrinology, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
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Pantakitcharoenkul J, Touma J, Jovanovic G, Coblyn M. Enzyme-functionalized hydrogel film for extracorporeal uric acid reduction. J Biomed Mater Res B Appl Biomater 2024; 112:e35375. [PMID: 38359171 DOI: 10.1002/jbm.b.35375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 11/22/2023] [Accepted: 01/02/2024] [Indexed: 02/17/2024]
Abstract
Enzyme replacement therapy for hyperuricemia treatment has been proven effective for critical state hyperuricemia patients. Still, direct administration of recombinant uricase can induce several fatal side effects. To circumvent this drawback, hydrogel protein carriers can be used in platforms for extracorporeal treatment such as microscale-based devices. In this work, calcium alginate and poly-(vinyl alcohol) hydrogel films were studied for their urate oxidase immobilization and uric acid reduction, which could be implemented in microscale-based extracorporeal devices. A mathematical model was developed in conjunction with uric acid reduction experiments to evaluate the influence of mass transfer and reaction parameters in the Michaelis-Menten kinetic expression. Alginate hydrogels prepared with crosslinker 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide and N-(hydroxysuccinimide) offered superior diffusivity of uric acid in the gel matrix at the maximum value ofD g , UA ≈ $$ {D}_{\mathrm{g},\mathrm{UA}}\approx $$ 1.98 × 10-11 m2 /s compared with alginate prepared solely from ionic crosslinking withD g , UA ≈ $$ {D}_{\mathrm{g},\mathrm{UA}}\approx $$ 5.31 × 10-12 m2 /s at the same alginate concentration. The maximum value of νmax was experimentally determined at 7.78 × 10-5 mol/(m3 s). A 3% sodium alginate hydrogel with crosslinkers yielded the highest reduction of uric acid at 92.70%. The mathematical model demonstrated an excellent prediction of uric acid conversion suggesting potential use of the model for formulation and maximizing the therapeutic performance of functionalized hydrogels.
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Affiliation(s)
- Jaturavit Pantakitcharoenkul
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Oregon, USA
- Center for Research Innovation and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Jad Touma
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Oregon, USA
| | - Goran Jovanovic
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Oregon, USA
| | - Matthew Coblyn
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Oregon, USA
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van der Pol KH, Nijenhuis M, Soree B, de Boer-Veger NJ, Buunk AM, Guchelaar HJ, Risselada A, van Schaik RHN, Swen JJ, Touw D, van der Weide J, van Westrhenen R, Deneer VHM, Houwink EJF, Rongen GA. Dutch pharmacogenetics working group guideline for the gene-drug interaction of ABCG2, HLA-B and Allopurinol, and MTHFR, folic acid and methotrexate. Eur J Hum Genet 2024; 32:155-162. [PMID: 36056234 PMCID: PMC10853275 DOI: 10.1038/s41431-022-01180-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 11/09/2022] Open
Abstract
The Dutch Pharmacogenetics Working Group (DPWG) aims to facilitate PGx implementation by developing evidence-based pharmacogenetics guidelines to optimize pharmacotherapy. This guideline describes the gene-drug interaction of ABCG2 with allopurinol, HLA-B with allopurinol, MTHFR with folic acid, and MTHFR with methotrexate, relevant for the treatment of gout, cancer, and rheumatoid arthritis. A systematic review was performed based on which pharmacotherapeutic recommendations were developed. Allopurinol is less effective in patients with the ABCG2 p.(Gln141Lys) variant. In HLA-B*58:01 carriers, the risk of severe cutaneous adverse events associated with allopurinol is strongly increased. The DPWG recommends using a higher allopurinol dose in patients with the ABCG2 p.(Gln141Lys) variant. For HLA-B*58:01 positive patients the DPWG recommends choosing an alternative (for instance febuxostat). The DPWG indicates that another option would be to precede treatment with allopurinol tolerance induction. Genotyping of ABCG2 in patients starting on allopurinol was judged to be 'potentially beneficial' for drug effectiveness, meaning genotyping can be considered on an individual patient basis. Genotyping for HLA-B*58:01 in patients starting on allopurinol was judged to be 'beneficial' for drug safety, meaning it is advised to consider genotyping the patient before (or directly after) drug therapy has been initiated. For MTHFR-folic acid there is evidence for a gene-drug interaction, but there is insufficient evidence for a clinical effect that makes therapy adjustment useful. Finally, for MTHFR-methotrexate there is insufficient evidence for a gene-drug interaction.
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Affiliation(s)
- Karel H van der Pol
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marga Nijenhuis
- Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands.
| | - Bianca Soree
- Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands
| | | | | | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arne Risselada
- Department of Clinical Pharmacy, Wilhelmina Hospital, Assen, The Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daan Touw
- University of Groningen, Groningen Research Institute of Pharmacy, Department of PharmacoTherapy, -Epidemiology and -Economy, Groningen, The Netherlands
| | - Jan van der Weide
- Department of Clinical Chemistry, St. Jansdal Hospital, Harderwijk, The Netherlands
| | - Roos van Westrhenen
- Parnassia Psychiatric Institute/PsyQ, Amsterdam, The Netherlands
- Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vera H M Deneer
- Department of Clinical Pharmacy, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Elisa J F Houwink
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, The Netherlands
| | - Gerard A Rongen
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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11
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Jin Z, Wang Z, Wang R, Xiang S, Zhang W, Tang Y, Tong P, Gu Y, Lv S. Global burden and epidemic trends of gout attributable to high body mass index from 1990 to 2019. Arch Med Sci 2024; 20:71-80. [PMID: 38414454 PMCID: PMC10895944 DOI: 10.5114/aoms/175469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/19/2023] [Indexed: 02/29/2024] Open
Abstract
Introduction Gout is an inflammatory and metabolic disease characterized by arthritis and elevation of the serum uric acid (SUA) level. More and more studies have shown that high body mass index (BMI) has become one of the most important risk factors for gout. Material and methods We used the data of gout burden attributed to high body mass index (BMI) from global burden of disease (GBD) study 2019 to provide insights for reducing the global burden of gout. Results From 1990 to 2019, the prevalence and DALYs of gout caused by high BMI worldwide has been increasing. The burden of gout caused by high BMI is heavier in the elderly male group and regions with high SDI worldwide. Conclusions Our findings provide evidence for the burden of gout caused by high BMI. Developing a weight management plan and lifestyle habits for groups severely affected by gout will effectively reduce the global disease and economic burden.
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Affiliation(s)
- Zhaokai Jin
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Zhengming Wang
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Rui Wang
- Guanghua Hospital, Affiliated to Shanghai University of Traditional Chinese Medicine, Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sicheng Xiang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Weiqing Zhang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University (Xinhua Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
| | - Yi Tang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Yong Gu
- Translational Medical Innovation Center, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China
- Department of Orthopedics, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China
| | - Shuaijie Lv
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
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12
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Petry N, Forest K, Wilke RA. The expanding role of HLA gene tests for predicting drug side effects. Am J Med Sci 2024; 367:14-20. [PMID: 37838157 DOI: 10.1016/j.amjms.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
Adverse drug reactions can be either dose-dependent (Type A) or idiosyncratic (Type B). Type B adverse drug reactions tend to be extremely rare and difficult to predict. They are usually immune-mediated. Examples include severe skin reactions and drug-induced liver injury. For many commonly prescribed drugs (such as antibiotics), the risk of developing an idiosyncratic adverse drug reaction is influenced by variability in the human leukocyte antigen (HLA) genes. Because these HLA-mediated adverse drug reactions can be lethal, there is growing interest in defining which specific drug-gene relationships might benefit from pre-emptive HLA genotyping and automated clinical decision support. This review summarizes the literature for HLA-mediated adverse reactions linked to common drugs.
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Affiliation(s)
- Natasha Petry
- School of Pharmacy, North Dakota State University, Fargo, ND 58102, USA
| | - Kennedy Forest
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - Russell A Wilke
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA.
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13
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Stamp L, Horne A, Mihov B, Drake J, Haslett J, Chapman PT, Frampton C, Dalbeth N. Is colchicine prophylaxis required with start-low go-slow allopurinol dose escalation in gout? A non-inferiority randomised double-blind placebo-controlled trial. Ann Rheum Dis 2023; 82:1626-1634. [PMID: 37652661 DOI: 10.1136/ard-2023-224731] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES To determine whether placebo is non-inferior to low-dose colchicine for reducing gout flares during the first 6 months of allopurinol using the 'start-low go-slow' dose approach. METHODS A 12-month double-blind, placebo-controlled non-inferiority trial was undertaken. Adults with at least one gout flare in the preceding 6 months, fulfilling the American College of Rheumatology (ACR) recommendations for starting urate-lowering therapy and serum urate ≥0.36 mmol/L were recruited. Participants were randomised 1:1 to colchicine 0.5 mg daily or placebo for the first 6 months. All participants commenced allopurinol, increasing monthly to achieve target urate <0.36 mmol/L. The primary efficacy outcome was the mean number of gout flares/month between 0 and 6 months, with a prespecified non-inferiority margin of 0.12 gout flares/month. The primary safety outcome was adverse events over the first 6 months. RESULTS Two hundred participants were randomised. The mean (95% CI) number of gout flares/month between baseline and month 6 was 0.61 (0.47 to 0.74) in the placebo group compared with 0.35 (0.22 to 0.49) in the colchicine group, mean difference 0.25 (0.07 to 0.44), non-inferiority p=0.92. There was no difference in the mean number of gout flares/month between randomised groups over the 12-month period (p=0.68). There were 11 serious adverse events in 7 participants receiving colchicine and 3 in 2 receiving placebo. CONCLUSIONS Placebo is not non-inferior to colchicine in prevention of gout flares in the first 6 months of starting allopurinol using the 'start-low go-slow' strategy. After stopping colchicine, gout flares rise with no difference in the mean number of gout flares/month between groups over a 12-month period. TRIAL REGISTRATION NUMBER ACTRN 12618001179224.
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Affiliation(s)
- Lisa Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Anne Horne
- Department of Medicine, The Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Borislav Mihov
- Department of Medicine, The Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jill Drake
- Department of Rheumatology, Immunology and Allergy, Te Whatu Ora Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Janine Haslett
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Peter T Chapman
- Department of Rheumatology, Immunology and Allergy, Te Whatu Ora Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Christopher Frampton
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, The Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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14
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Farias-Jofre M, Romero R, Galaz J, Xu Y, Miller D, Garcia-Flores V, Arenas-Hernandez M, Winters AD, Berkowitz BA, Podolsky RH, Shen Y, Kanninen T, Panaitescu B, Glazier CR, Pique-Regi R, Theis KR, Gomez-Lopez N. Blockade of IL-6R prevents preterm birth and adverse neonatal outcomes. EBioMedicine 2023; 98:104865. [PMID: 37944273 PMCID: PMC10665693 DOI: 10.1016/j.ebiom.2023.104865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Preterm birth preceded by spontaneous preterm labour often occurs in the clinical setting of sterile intra-amniotic inflammation (SIAI), a condition that currently lacks treatment. METHODS Proteomic and scRNA-seq human data were analysed to evaluate the role of IL-6 and IL-1α in SIAI. A C57BL/6 murine model of SIAI-induced preterm birth was developed by the ultrasound-guided intra-amniotic injection of IL-1α. The blockade of IL-6R by using an aIL-6R was tested as prenatal treatment for preterm birth and adverse neonatal outcomes. QUEST-MRI evaluated brain oxidative stress in utero. Targeted transcriptomic profiling assessed maternal, foetal, and neonatal inflammation. Neonatal biometrics and neurodevelopment were tested. The neonatal gut immune-microbiome was evaluated using metagenomic sequencing and immunophenotyping. FINDINGS IL-6 plays a critical role in the human intra-amniotic inflammatory response, which is associated with elevated concentrations of the alarmin IL-1α. Intra-amniotic injection of IL-1α resembles SIAI, inducing preterm birth (7% vs. 50%, p = 0.03, Fisher's exact test) and neonatal mortality (18% vs. 56%, p = 0.02, Mann-Whitney U-test). QUEST-MRI revealed no foetal brain oxidative stress upon in utero IL-1α exposure (p > 0.05, mixed linear model). Prenatal treatment with aIL-6R abrogated IL-1α-induced preterm birth (50% vs. 7%, p = 0.03, Fisher's exact test) by dampening inflammatory processes associated with the common pathway of labour. Importantly, aIL-6R reduces neonatal mortality (56% vs. 22%, p = 0.03, Mann-Whitney U-test) by crossing from the mother to the amniotic cavity, dampening foetal organ inflammation and improving growth. Beneficial effects of prenatal IL-6R blockade carried over to neonatal life, improving survival, growth, neurodevelopment, and gut immune homeostasis. INTERPRETATION IL-6R blockade can serve as a strategy to treat SIAI, preventing preterm birth and adverse neonatal outcomes. FUNDING NICHD/NIH/DHHS, Contract HHSN275201300006C. WSU Perinatal Initiative in Maternal, Perinatal and Child Health.
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Affiliation(s)
- Marcelo Farias-Jofre
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Roberto Romero
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.
| | - Jose Galaz
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Yi Xu
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Derek Miller
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Valeria Garcia-Flores
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Marcia Arenas-Hernandez
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Andrew D Winters
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MO, USA
| | - Bruce A Berkowitz
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine; Detroit, MI, USA
| | - Robert H Podolsky
- Division of Biostatistics and Design Methodology, Center for Translational Research, Children's National Hospital, Silver Spring, MD, USA
| | - Yimin Shen
- Department of Radiology, School of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Tomi Kanninen
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Bogdan Panaitescu
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Catherine R Glazier
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Roger Pique-Regi
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Kevin R Theis
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MO, USA
| | - Nardhy Gomez-Lopez
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA; Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MO, USA; Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.
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15
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Zhang S, Huang G, Li M, Mao Y, Li Y. Interleukin-41 as a biomarker of the anti-inflammatory response associated with hyperuricemia. Immunol Lett 2023; 264:25-30. [PMID: 37944821 DOI: 10.1016/j.imlet.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Interleukin (IL)-41 is a recently discovered secreted protein that is expressed in a variety of tissues, and it is associated with several immune and metabolic diseases. However, IL-41 has not been studied in hyperuricemia (HUA). METHODS Forty-four HUA patients and 44 healthy controls (HCs) were included in this study, and we collected theirgeneral and biochemical parameters, including white blood cell, neutrophil, lymphocyte, and platelet counts, mean platelet volume, platelet distribution width, serum creatinine, blood urea nitrogen, fasting blood glucose, total triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein, total protein, albumin, alkaline phosphatase, gamma-glutamyltransferase, and hemoglobin concentration. The level of serum IL-41 was determined using an enzyme-linked immunosorbent assay. Multivariate logistic regression analysis was exploited to identify the independent risk factors associated with HUA, and the clinical diagnostic value of IL-41 was analyzed by applying the receiver operating characteristic (ROC) curve. We assessed the association between IL-41 and clinical parameters with Spearman's rank correlation. RESULTS Circulating IL-41 levels were significantly higher in HUA patients than in the HCs group (460.3 pg/mL vs. 261.3 pg/mL, respectively; P < 0.001). The area under the ROC curve (AUC) for IL-41 in HUA patients was 0.7443 (with a cut-off value of 311.055 pg/mL, a sensitivity of 68.18 %, and a specificity of 72.73 %), while the AUC for IL-41 combined with the platelet count was 0.8109. Correlation analysis revealed that the circulating IL-41 level was positively correlated with age in HCs and HUA patients. CONCLUSIONS We herein demonstrated that serum IL-41 was elevated in HUA patients and that it may constitute a novel biomarker of anti-inflammatory response related to HUA.
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Affiliation(s)
- Shujie Zhang
- Department of Endocrinology, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China; Department of Immunology and Zhejiang Key Laboratory of Pathophysiology, School of Basic Medical Sciences, Health Science Center, Ningbo University, Ningbo 315211, China
| | - Guoqing Huang
- Department of Endocrinology, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China; Department of Immunology and Zhejiang Key Laboratory of Pathophysiology, School of Basic Medical Sciences, Health Science Center, Ningbo University, Ningbo 315211, China
| | - Mingcai Li
- Department of Immunology and Zhejiang Key Laboratory of Pathophysiology, School of Basic Medical Sciences, Health Science Center, Ningbo University, Ningbo 315211, China
| | - Yushan Mao
- Department of Endocrinology, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China.
| | - Yan Li
- Department of Endocrinology, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China; Department of Immunology and Zhejiang Key Laboratory of Pathophysiology, School of Basic Medical Sciences, Health Science Center, Ningbo University, Ningbo 315211, China.
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16
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Huffman N, Pasqualini I, Surace P, Molloy RM, Piuzzi NS, Deren ME. Diagnosis, Treatment, and Outcomes of Crystalline Arthropathy in the Setting of Total Knee Arthroplasty: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202312000-00010. [PMID: 38134288 DOI: 10.2106/jbjs.rvw.23.00163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
» Emerging evidence suggests the prevalence of crystalline arthropathy (CA) in the setting of total knee arthroplasty (TKA) is increasing, and diagnosis of CA is often intricate because of symptom overlap with other common postoperative complications such as periprosthetic joint infection (PJI). Consequently, an accurate and timely diagnosis becomes pivotal in guiding the choice of treatment.» CA includes gout and calcium pyrophosphate deposition (CPPD) disease, and accurate diagnosis in patients with prior TKA requires a multifaceted approach. The diagnosis algorithm plays a critical role in determining the appropriate treatment approach.» Management of CA typically involves a conservative strategy, encompassing the administration of nonsteroidal anti-inflammatory drugs, colchicine, and steroids, regardless of whether patients have undergone prior TKA.» There is conflicting evidence on the effect CA has on the surgical outcomes in postoperative TKA patients. While these patients may expect excellent functional outcomes and pain relief, they may be at a higher risk of complications such as infections, medical complications, and revision procedures.» Additional research is required to fully comprehend the impact of CA on postoperative TKA outcomes and to establish effective strategies for enhancing patient care and optimizing long-term joint function.
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Affiliation(s)
- Nickelas Huffman
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Peter Surace
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert M Molloy
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
- Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Matthew E Deren
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
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17
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Kwok TSH, Kuriya B, Hawker G, Li P, Choy G, Widdifield J. Serum Urate Monitoring Among Older Adults With Gout: Initiating Urate-Lowering Therapy in Ontario, Canada. Arthritis Care Res (Hoboken) 2023; 75:2463-2471. [PMID: 37248652 DOI: 10.1002/acr.25167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess the proportion of, and factors associated with, older adults with gout receiving a serum urate (SUA) test after starting urate-lowering therapy (ULT). METHODS We performed a population-based retrospective cohort study in Ontario, Canada in patients ages ≥66 years with gout, newly dispensed ULT between 2010 and 2019. We characterized patients with SUA testing within 6 and 12 months after ULT dispensation. Multilevel logistic regression clustered by ULT prescriber evaluated the factors associated with SUA monitoring within 6 months. RESULTS We included 44,438 patients with a mean ± SD age of 76.0 ± 7.3 years and 64.4% male. Family physicians prescribed 79.1% of all ULTs. SUA testing was lowest in 2010 (56.4% at 6 months) and rose over time to 71.3% in 2019 (P < 0.0001). Compared with rheumatologists, family physicians (odds ratio [OR] 0.26 [95% confidence interval (95% CI) 0.23-0.29]), internists (OR 0.34 [95% CI 0.29-0.39]), nephrologists (OR 0.37 [95% CI 0.30-0.45]), and other specialties (OR 0.25 [95% CI 0.21-0.29]) were less likely to test SUA, as were male physicians (OR 0.87 [95% CI 0.83-0.91]). Patient factors associated with lower odds of SUA monitoring included rural residence (OR 0.81 [95% CI 0.77-0.86]), lower socioeconomic status (OR 0.91 [95% CI 0.85-0.97]), and patient comorbidities. Chronic kidney disease, hypertension, diabetes mellitus, and coprescription of colchicine/oral corticosteroids (OR 1.31 [95% CI 1.23-1.40]) were correlated with increased SUA testing. CONCLUSION SUA testing is suboptimal among older adults with gout initiating ULT but is improving over time. ULT prescriber, patient, and prescription characteristics were correlated with SUA testing.
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Affiliation(s)
| | | | - Gillian Hawker
- University of Toronto and Women's College Hospital, Toronto, Ontario, Canada
| | - Ping Li
- ICES, Toronto, Ontario, Canada
| | - Gregory Choy
- University of Toronto and Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jessica Widdifield
- University of Toronto, ICES, and Sunnybrook Research Institute, Toronto, Ontario, Canada
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Cui K, Song Y, Yin D, Song W, Wang H, Zhu C, Feng L, Fu R, Jia L, Lu Y, Zhang D, Song C, Yang Y, Dong Q, Dou K. Uric Acid Levels, Number of Standard Modifiable Cardiovascular Risk Factors, and Prognosis in Patients With Coronary Artery Disease: A Large Cohort Study in Asia. J Am Heart Assoc 2023; 12:e030625. [PMID: 37804199 PMCID: PMC10757509 DOI: 10.1161/jaha.123.030625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/14/2023] [Indexed: 10/09/2023]
Abstract
Background Serum uric acid (UA) is correlated closely with traditional cardiovascular risk factors, which might interfere with the action of UA, in patients with coronary artery disease. We performed this study to evaluate the prognostic effect of UA levels in individuals with different numbers of standard modifiable cardiovascular risk factors (SMuRFs). Methods and Results In this prospective study, we consecutively enrolled 10 486 patients with coronary artery disease. They were stratified into 3 groups according to the tertiles of UA concentrations and, within each UA tertile, further classified into 3 groups by the number of SMuRFs (0-1 versus 2-3 versus 4). The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including death, myocardial infarction, stroke, and unplanned revascularization. Over a median follow-up of 2.4 years, 1233 (11.8%) MACCEs were recorded. Patients with high UA levels developed significantly higher risk of MACCEs than those with low UA levels. In addition, UA levels were positively associated with MACCEs as a continuous variable. More importantly, in patients with 0 to 1 SMuRF, the risks of MACCEs were significantly higher in the high-UA-level group (adjusted hazard ratio [HR], 1.469 [95% CI, 1.197-1.804]) and medium-UA-level group (adjusted HR, 1.478 [95% CI, 1.012-2.160]), compared with the low-UA-level group, whereas no significant association was found between UA levels and the risk of MACCEs in participants with 2 to 3 or 4 SMuRFs. Conclusions In patients with coronary artery disease who received evidence-based secondary prevention therapies, elevated UA levels might affect the prognosis of individuals with 0 to 1 SMuRF but not that of individuals with ≥2 SMuRFs.
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Affiliation(s)
- Kongyong Cui
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseBeijingChina
- National Clinical Research Center for Cardiovascular DiseasesBeijingChina
| | - Yanjun Song
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseBeijingChina
- National Clinical Research Center for Cardiovascular DiseasesBeijingChina
| | - Dong Yin
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseBeijingChina
- National Clinical Research Center for Cardiovascular DiseasesBeijingChina
| | - Weihua Song
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseBeijingChina
- National Clinical Research Center for Cardiovascular DiseasesBeijingChina
| | - Hongjian Wang
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseBeijingChina
- National Clinical Research Center for Cardiovascular DiseasesBeijingChina
| | - Chenggang Zhu
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseBeijingChina
- National Clinical Research Center for Cardiovascular DiseasesBeijingChina
| | - Lei Feng
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseBeijingChina
- National Clinical Research Center for Cardiovascular DiseasesBeijingChina
| | - Rui Fu
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseBeijingChina
- National Clinical Research Center for Cardiovascular DiseasesBeijingChina
| | - Lei Jia
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseBeijingChina
- National Clinical Research Center for Cardiovascular DiseasesBeijingChina
| | - Ye Lu
- Medical Research & Biometrics Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Dong Zhang
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseBeijingChina
- National Clinical Research Center for Cardiovascular DiseasesBeijingChina
| | - Chenxi Song
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseBeijingChina
- National Clinical Research Center for Cardiovascular DiseasesBeijingChina
| | - Yuejin Yang
- State Key Laboratory of Cardiovascular DiseaseBeijingChina
- National Clinical Research Center for Cardiovascular DiseasesBeijingChina
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Qiuting Dong
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseBeijingChina
- National Clinical Research Center for Cardiovascular DiseasesBeijingChina
| | - Kefei Dou
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseBeijingChina
- National Clinical Research Center for Cardiovascular DiseasesBeijingChina
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Yu LL, Li CN, Fang MY, Ma Y, Wang B, Lin FP, Liu WH, Tu SH, Chen Z, Xie WX, Zhang RY, Huang Y, Zheng CH, Wang Y. Evaluating the effectiveness and safety of acupuncture on serum uric acid in asymptomatic hyperuricemia population: a randomized controlled clinical trial study protocol. Front Endocrinol (Lausanne) 2023; 14:1218546. [PMID: 37900149 PMCID: PMC10611493 DOI: 10.3389/fendo.2023.1218546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/01/2023] [Indexed: 10/31/2023] Open
Abstract
Background The clinical dangers of asymptomatic hyperuricemia to human health have become increasingly prominent over the past 20 years. Previous studies have shown the potential benefits of acupuncture on uric acid levels in the body. However, definitive evidence is lacking. Our objective is to evaluate the efficacy and safety of acupuncture on serum uric acid (SUA) in individuals with asymptomatic hyperuricemia. Methods This is a randomized, single-blind, sham-controlled trial. A total of 180 eligible patients with asymptomatic hyperuricemia will be recruited at three hospitals in China. Patients will be randomly assigned in a 1:1 ratio to receive 16 sessions of manual acupuncture or sham acupuncture for 8 weeks. Patients will be followed up for 12 weeks. The primary outcome will be the change in SUA levels at week 8 after randomization. Secondary outcomes will include dynamic changes in SUA levels, efficacy rates, proportion of gout flare, body weight, and acute medication intake. The MGH Acupuncture Sensation Scale and adverse events related to acupuncture will be measured after each treatment. A blinding assessment will be performed on patients who receive at least one session of acupuncture. Data analyses will be performed on a full analysis set and a per-protocol set. Ethics and dissemination Ethics approval has been obtained from the Clinical Trial Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (approval no. 2021-S135). Written informed consent will be obtained from enrolled patients. The findings will be disseminated in a peer-reviewed journal. Clinical trial registration ClinicalTrials.gov identifier, NCT05406830.
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Affiliation(s)
- Ling-ling Yu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chen-nan Li
- The Second School of Clinical Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Meng-yue Fang
- The Second School of Clinical Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yan Ma
- Department of Rehabilitation Medicine, Wuhan No.1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bo Wang
- Department of Rehabilitation Medicine, Wuhan No.1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Feng-ping Lin
- Department of Endocrinology, Xianning Central Hospital, Hubei University of Science and Technology, Xianning, Hubei, China
| | - Wen-hua Liu
- Clinical Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Sheng-hao Tu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhe Chen
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wen-xi Xie
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rui-yuan Zhang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yao Huang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Cui-hong Zheng
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yu Wang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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20
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Yuan W, Liu T, Wang YY, He S, Zhang F, Wang XB, Deng SH, Zhang T, Wu DM, Xu Y. Autophagy induced by PP121 alleviates MSU crystal-induced acute gouty arthritis via inhibition of the NLRP3 inflammasome. Int Immunopharmacol 2023; 123:110756. [PMID: 37573689 DOI: 10.1016/j.intimp.2023.110756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
Acute gouty arthritis (AGA) is a frequent self-limiting inflammatory condition produced by the deposition of monosodium urate (MSU) crystals in the joints and periarticular tissues of patients with hyperuricemia. However, no effective interventional measures currently exist for AGA. Pyroptosis, a kind of pro-inflammatory programmed cell death, plays a crucial role in MSU crystal-induced inflammation and represents a potential treatment target for AGA. Therefore, we determined the therapeutic benefits and mechanism of PP121, a pyroptosis-related compound, on AGA. First, we injected an MSU crystal solution intra-articularly into the left foot pad of C57BL/6 mice to create an AGA mouse model. Subsequent treatment with PP121 substantially decreased tissue damage, pro-inflammatory cytokine release, and inflammatory cell infiltration caused by MSU crystals in the ankle joint. Consistent with these observations, the beneficial effects of PP121 on AGA were cancelled in Beclin1+/-(Becn1+/-) mice. Furthermore, after PP121 treatment, super-resolution microscopy revealed a strong relationship between lysosome-connected membrane protein/light chain 3 positive vesicles and the nucleotide-binding domain of leucine-rich family pyrin domain-containing 3 (NLPR3), demonstrating that PP121 promotes phagocytosis of the NLPR3 inflammasome. In summary, PP121-mediated autophagy can improve degradation of the NLRR3 inflammasome in AGA, which suggests the therapeutic potential of PP121 in AGA.
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Affiliation(s)
- Wei Yuan
- School of Clinical Medicine & The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China.
| | - Teng Liu
- School of Clinical Medicine & The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China.
| | - Yuan-Yi Wang
- School of Clinical Medicine & The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China.
| | - Shuang He
- School of Clinical Medicine & The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China.
| | - Feng Zhang
- Laboratory Medical College of Chengdu Medical College, Chengdu 610500, China.
| | - Xiao-Bian Wang
- Laboratory Medical College of Chengdu Medical College, Chengdu 610500, China.
| | - Shi-Hua Deng
- School of Clinical Medicine & The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China.
| | - Ting Zhang
- School of Clinical Medicine & The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China.
| | - Dong-Ming Wu
- School of Clinical Medicine & The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China.
| | - Ying Xu
- School of Clinical Medicine & The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China.
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21
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Wen YF, Brundage RC, Roman YM, Culhane-Pera KA, Straka RJ. Population pharmacokinetics, pharmacodynamics and pharmacogenetics modelling of oxypurinol in Hmong adults with gout and/or hyperuricemia. Br J Clin Pharmacol 2023; 89:2964-2976. [PMID: 37202871 PMCID: PMC10527451 DOI: 10.1111/bcp.15792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023] Open
Abstract
AIMS The aim of this study was to quantify identifiable sources of variability, including key pharmacogenetic variants in oxypurinol pharmacokinetics and their pharmacodynamic effect on serum urate (SU). METHODS Hmong participants (n = 34) received 100 mg allopurinol twice daily for 7 days followed by 150 mg allopurinol twice daily for 7 days. A sequential population pharmacokinetic pharmacodynamics (PKPD) analysis with non-linear mixed effects modelling was performed. Allopurinol maintenance dose to achieve target SU was simulated based on the final PKPD model. RESULTS A one-compartment model with first-order absorption and elimination best described the oxypurinol concentration-time data. Inhibition of SU by oxypurinol was described with a direct inhibitory Emax model using steady-state oxypurinol concentrations. Fat-free body mass, estimated creatinine clearance and SLC22A12 rs505802 genotype (0.32 per T allele, 95% CI 0.13, 0.55) were found to predict differences in oxypurinol clearance. Oxypurinol concentration required to inhibit 50% of xanthine dehydrogenase activity was affected by PDZK1 rs12129861 genotype (-0.27 per A allele, 95% CI -0.38, -0.13). Most individuals with both PDZK1 rs12129861 AA and SLC22A12 rs505802 CC genotypes achieve target SU (with at least 75% success rate) with allopurinol below the maximum dose, regardless of renal function and body mass. In contrast, individuals with both PDZK1 rs12129861 GG and SLC22A12 rs505802 TT genotypes would require more than the maximum dose, thus requiring selection of alternative medications. CONCLUSIONS The proposed allopurinol dosing guide uses individuals' fat-free mass, renal function and SLC22A12 rs505802 and PDZK1 rs12129861 genotypes to achieve target SU.
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Affiliation(s)
- Ya-Feng Wen
- Department of Experimental and Clinical Pharmacology,
College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Richard C. Brundage
- Department of Experimental and Clinical Pharmacology,
College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Youssef M. Roman
- Department of Pharmacotherapy & Outcomes Science,
School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA
| | | | - Robert J. Straka
- Department of Experimental and Clinical Pharmacology,
College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
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22
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Dewi C, Puspita F, Puspitasari IM, Zakiyah N. Hepatic Safety of Febuxostat and Allopurinol for Gout Patients: A Systematic Review of Randomized Controlled Trial. Ther Clin Risk Manag 2023; 19:731-743. [PMID: 37744559 PMCID: PMC10516211 DOI: 10.2147/tcrm.s424598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Purpose This study aims to systematically review the hepatic safety of febuxostat and allopurinol in adult gout patients. Methods We searched for information using the following databases: PubMed, Cochrane Library, and Scopus. The inclusion criteria were to review all randomized controlled trials (RCT) that compared allopurinol and febuxostat for adult gout patients that had an assessment of liver function outcomes. Non-English studies on case reports, case series, reviews, and abstracts only were excluded. We extracted information from the studies to answer the research question, ie, study design, publication year, population, sample size, patient characterization, duration, Jadad score, and liver function outcomes. Results We screened 512 publications from the databases and identified 11 studies that met the inclusion criteria. Ten out of 11 included studies were double-blind RCTs. In the majority of the included studies, no statistically significant differences were observed in terms of hepatic safety data between febuxostat and allopurinol. However, in studies where allopurinol titration was used, it posed a challenge to maintain blinding. Notably, consistent adverse events related to liver function findings were observed across all reviewed RCTs. These abnormal liver function test results sometimes led to study withdrawal based on the investigators' assessment. Nevertheless, the investigators classified most liver function test elevations as mild to moderate in severity. Conclusion Our analysis concluded that adult gout patients enrolled in the included RCTs exhibited similar hepatic safety profiles for both febuxostat and allopurinol treatment. Liver function abnormalities were identified in all RCTs included in this systematic review. Consequently, it is important for the product labeling information of both allopurinol and febuxostat to present and describe the current safety data to guide healthcare practitioners when prescribing these medications to patients. Pharmacovigilance and post-marketing pharmacoepidemiology data are essential in establishing the comprehensive safety profile.
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Affiliation(s)
- Christiyanti Dewi
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Falerina Puspita
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Irma Melyani Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
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23
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Rotaru L, Groppa L, Russu E, Cazac V, Agachi S, Cătălin C, Spinei L, Arnaut O, Sârbu O, Cornea C. Analysis of the Economic-Financial Efficiency of Gout Treatment in Elderly Patients with Comorbidities in the Republic of Moldova. Mediterr J Rheumatol 2023; 34:327-331. [PMID: 37941869 PMCID: PMC10628866 DOI: 10.31138/mjr.20230725.ao] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/28/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2023] Open
Abstract
Introduction The costs of treating an elderly patient with gout are largely related to the treatment of concomitant pathological conditions and complications. Determining the costs of treating the disease is made by clinical and economic analysis, the task of which is to calculate the "cost of the illness". Material and methods A descriptive, selective study of 237 patients with gout. In order to study the clinical characteristics of gout in the elderly, all those included in the study was divided according to age at the time of examination: group I made up of patients with gout up to and including 59 years n=91, average age 48.1±7.4 years (from 30 years to 59 years), group II - over the age of 60 years inclusive n=146, average age 69.2±6.0 years, (60-86 years, p<0.01). Results For calculations, the hospitalisation rate during the year was used, which had significant differences in groups: in group I it was 0.7; in group II - 1.2 (p=0,001). The costs of clinical management of gout and each of the diseases that accompany it for 1 calendar year have been determined. Conclusions The direct costs for the treatment of patients with gout, calculated taking into account National Clinical Protocol and comorbid pathology, increase significantly with the age of the patients: the average cost per year of the treatment of gout in patients of mature age was 1337 Euro without and 7320 Euro taking into account the concomitant pathology, and in the elderly 2067 Euro and, respectively, 15230 Euro.
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Affiliation(s)
- Larisa Rotaru
- Department of Internal Medicine, Rheumatology and Nephrology, Universitatea de Stat de Medicina si Farmacie Nicolae Testemitanu, Chişinău, Moldova
- Rheumatology Laboratory, Timofei Mosneaga Republican Clinical Hospital, Chişinău, Chişinău, Moldova
| | - Liliana Groppa
- Department of Internal Medicine, Rheumatology and Nephrology, Universitatea de Stat de Medicina si Farmacie Nicolae Testemitanu, Chişinău, Moldova
- Rheumatology Laboratory, Timofei Mosneaga Republican Clinical Hospital, Chişinău, Chişinău, Moldova
| | - Eugeniu Russu
- Department of Internal Medicine, Rheumatology and Nephrology, Universitatea de Stat de Medicina si Farmacie Nicolae Testemitanu, Chişinău, Moldova
| | - Victor Cazac
- Department of Internal Medicine, Rheumatology and Nephrology, Universitatea de Stat de Medicina si Farmacie Nicolae Testemitanu, Chişinău, Moldova
| | - Svetlana Agachi
- Department of Internal Medicine, Rheumatology and Nephrology, Universitatea de Stat de Medicina si Farmacie Nicolae Testemitanu, Chişinău, Moldova
| | - Codreanu Cătălin
- Faculty of Dentistry, Department 5 - Internal Medicine (Cardiology, Gastroenterology, Hepatology, Rheumatology, Geriatrics), Family Medicine, Occupational Medicine, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - Larisa Spinei
- Department of Social Medicine and Management “Nicolae Testemitanu”, Universitatea de Stat de Medicina si Farmacie Nicolae Testemitanu, Chişinău, Moldova
| | - Oleg Arnaut
- Information Laboratory, Universitatea de Stat de Medicina si Farmacie Nicolae Testemitanu, Chişinău, Moldova
| | - Oxana Sârbu
- Department of Internal Medicine, Rheumatology and Nephrology, Universitatea de Stat de Medicina si Farmacie Nicolae Testemitanu, Chişinău, Moldova
| | - Cornelia Cornea
- Department of Internal Medicine, Rheumatology and Nephrology, Universitatea de Stat de Medicina si Farmacie Nicolae Testemitanu, Chişinău, Moldova
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Joshi AD, McCormick N, Yokose C, Yu B, Tin A, Terkeltaub R, Merriman TR, Eliassen AH, Curhan GC, Raffield LM, Choi HK. Prediagnostic Glycoprotein Acetyl Levels and Incident and Recurrent Flare Risk Accounting for Serum Urate Levels: A Population-Based, Prospective Study and Mendelian Randomization Analysis. Arthritis Rheumatol 2023; 75:1648-1657. [PMID: 37043280 PMCID: PMC10524152 DOI: 10.1002/art.42523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/21/2023] [Accepted: 04/06/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To prospectively investigate population-based metabolomics for incident gout and reproduce the findings for recurrent flares, accounting for serum urate. METHODS We conducted a prediagnostic metabolome-wide analysis among 105,615 UK Biobank participants with nuclear magnetic resonance metabolomic profiling data (168 total metabolites) from baseline blood samples collected 2006-2010 in those without history of gout. We calculated hazard ratios (HRs) for incident gout, adjusted for gout risk factors, excluding and including serum urate levels, overall and according to fasting duration before sample collection. Potential causal effects were tested with 2-sample Mendelian randomization. Poisson regression was used to calculate rate ratios (RRs) for the association with recurrent flares among incident gout cases. RESULTS Correcting for multiple testing, 88 metabolites were associated with risk of incident gout (N = 1,303 cases) before serum urate adjustment, including glutamine and glycine (inversely), and lipids, branched-chain amino acids, and most prominently, glycoprotein acetyls (GlycA; P = 9.17 × 10-32 ). Only GlycA remained associated with incident gout following urate adjustment (HR 1.52 [95% confidence interval (95% CI) 1.22-1.88] between extreme quintiles); the HR increased progressively with fasting duration before sample collection, reaching 4.01 (95% CI 1.36-11.82) for ≥8 hours of fasting. Corresponding HRs per SD change in GlycA levels were 1.10 (95% CI 1.04-1.17) overall and 1.54 (95% CI 1.21-1.96) for ≥8 hours of fasting. GlycA levels were also associated with recurrent gout flares among incident gout cases (RR 1.90 [95% CI 1.27-2.85] between extreme quintiles) with larger associations with fasting. Mendelian randomization corroborated a potential causal role for GlycA on gout risk. CONCLUSION This prospective, population-based study implicates GlycA, a stable long-term biomarker reflecting neutrophil overactivity, in incident and recurrent gout flares (central manifestation from neutrophilic synovitis) beyond serum urate.
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Affiliation(s)
- Amit D. Joshi
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston MA USA
| | - Natalie McCormick
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston MA USA
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston MA USA
- Department of Medicine, Harvard Medical School, Boston MA USA
- Arthritis Research Canada, Vancouver BC Canada
| | - Chio Yokose
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston MA USA
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston MA USA
- Department of Medicine, Harvard Medical School, Boston MA USA
| | - Bing Yu
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston TX USA
| | - Adrienne Tin
- Department of Medicine, University of Mississippi Medical Center, Jackson MS USA
| | - Robert Terkeltaub
- San Diego VA Healthcare Service and University of California San Diego, La Jolla, CA
| | - Tony R. Merriman
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham AL USA
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - A. Heather Eliassen
- Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, Boston MA USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston MA USA
| | - Gary C. Curhan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston MA USA
| | - Laura M. Raffield
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill NC USA
| | - Hyon K. Choi
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston MA USA
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston MA USA
- Department of Medicine, Harvard Medical School, Boston MA USA
- Arthritis Research Canada, Vancouver BC Canada
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Okobi OE, Oletu H, Chukwuedozie-Echeazu AB, Keke VC, Nwachukwu OB, Akunne HS, Ekpemiro CU, Oranika US, Akueme NT, Akanle OE, Ogbuagu BC, Mbah LA. The Stiff Joint: Comparative Evaluation of Monotherapy and Combination Therapy With Urate Lowering Agents in Managing Acute Gout. Cureus 2023; 15:e45087. [PMID: 37842401 PMCID: PMC10568651 DOI: 10.7759/cureus.45087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Gout, an extremely painful form of arthritis, is triggered by the innate immune system's response to the accumulation of monosodium urate crystals in specific joints and surrounding tissues. This condition is characterized by recurring episodes of excruciating arthritis flares, interspersed with periods of disease quiescence. Over time, gout can result in disability, tophi formation, and severe pain. The treatment of gout is centered around two main objectives: alleviating inflammation and pain during acute gout attacks and long-term management to reduce serum urate levels and mitigate the risk of future attacks. Addressing inflammation and pain during acute attacks is often complicated by various factors, including underlying health conditions commonly associated with gout, such as hypertension, chronic kidney disease, cardiovascular disease, and diabetes mellitus. Moreover, gout patients are frequently older and have multiple coexisting health issues, necessitating complex medication regimens. Given the rising prevalence of gout and its associated comorbidities, there's a growing demand for improved treatment options. While existing treatments effectively manage gout in some patients, a significant portion, particularly those with comorbidities, face contraindications to these treatments and require alternative approaches. Innovative medications are required to enhance gout treatment, especially for individuals with concurrent health conditions. These considerations underscore the importance of reviewing both monotherapy and combination therapy approaches for acute gout treatment.
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Affiliation(s)
- Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, Maryland, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Helen Oletu
- Medicine and Surgery, University of Benin, Benin City, NGA
- Public Health, University of Wolverhampton, Wolverhampton, GBR
| | | | | | - Onyinyechukwu B Nwachukwu
- Neurosciences and Psychology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Family Medicine, American International School of Medicine Georgetown, Guyana, USA
| | | | | | | | - Ngozi T Akueme
- Dermatology, University of Medical Sciences (UNIMEDTH), Ondo State, NGA
| | | | - Buchi C Ogbuagu
- Family Medicine, Deer Ridge Family Clinic (DRFC), Calgary, CAN
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26
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Jatuworapruk K, De Vera R, Estrella AM, Sollano MHMZ, Vaidya B, Rahman MM, Lim AL, Wulansari Manuaba IAR, Hellmi RY, Keen H, Lorenzo JP. The APLAR Gout Registry: A multinational collaboration to better understand people with gout in the Asia-Pacific. Int J Rheum Dis 2023; 26:1432-1434. [PMID: 37527022 DOI: 10.1111/1756-185x.14765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 08/03/2023]
Affiliation(s)
| | | | | | | | - Binit Vaidya
- National Center for Rheumatic Diseases, Kathmandu, Nepal
| | | | - Ai Lee Lim
- Penang General Hospital, Penang, Malaysia
| | | | - Rakhma Yanti Hellmi
- Dr Kariadi General Hospital Medical Center, Diponegoro University, Semarang, Indonesia
| | - Helen Keen
- University of Western Australia, Perth, Western Australia, Australia
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27
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Duong KN, Nguyen DV, Chaiyakunapruk N, Nelson RE, Malone DC. Cost-effectiveness of HLA-B*58:01 testing to prevent Stevens-Johnson syndrome/toxic epidermal necrolysis in Vietnam. Pharmacogenomics 2023; 24:713-724. [PMID: 37706247 DOI: 10.2217/pgs-2023-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Background: HLA-B*58:01 is strongly associated with allopurinol-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) in Vietnam. This study assessed the cost-effectiveness of this testing to prevent SJS/TEN. Methods: A model was developed to compare three strategies: no screening, use allopurinol; HLA-B*58:01 screening; and no screening, use probenecid. A willingness-to-pay of three-times gross domestic product per capita was used. Results: Compared with 'no screening, use allopurinol', 'screening' increased quality-adjusted life-years by 0.0069 with the incremental cost of Vietnam dong (VND) 14,283,633 (US$617), yielding an incremental cost-effectiveness ratio of VND 2,070,459,122 (US$89,398) per quality-adjusted life-year. Therefore, 'screening' was unlikely to be cost-effective under the current willingness-to-pay. Testing's cost-effectiveness may change with targeted high-risk patients, reimbursed febuxostat or lower probenecid prices. Conclusion: The implementation of nationwide HLAB*58:01 testing before the use of allopurinol is not cost-effective, according to this analysis. This may be due to the lack of quality data on the effectiveness of testing and costing data in the Vietnamese population.
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Affiliation(s)
- Khanh Nc Duong
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Dinh Van Nguyen
- Department of Internal Medicine, Respiratory, Allergy & Clinical Immunology Unit, Vinmec Healthcare System, Hanoi, Vietnam
- College of Health Sciences, Vin University, Hanoi, Vietnam
- Department of Medicine, Penn State University, Hershey, PA 17033, USA
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84108, USA
| | - Richard E Nelson
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84108, USA
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT 84108, USA
| | - Daniel C Malone
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
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Li H, Shi L, Chen X, Wang M. Association between dietary intake of flavonoids and hyperuricemia: a cross-sectional study. BMC Public Health 2023; 23:1227. [PMID: 37355562 PMCID: PMC10290396 DOI: 10.1186/s12889-023-16134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Previous research has demonstrated flavonoid intake was closely related to hyperuricemia. The purpose of this study was to examine whether flavonoid intake was associated with serum uric acid and hyperuricemia in U.S. adults. METHODS The study sample consisted of 8,760 participants enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2010. Flavonoid consumption was measured using a two-day recall questionnaire on dietary intake. Hyperuricemia was defined based on the serum uric acid levels, determined as ≥ 7 mg/dL for males and ≥ 6 mg/dL for females. The study utilized multivariate linear regression to determine the correlation between flavonoid consumption and serum uric acid levels. Additionally, analyses involving multivariate logistic regression and restricted cubic splines (RCS) were conducted to evaluate the potential link between flavonoid consumption and hyperuricemia. All analyses were adjusted for possible confounding variables. RESULTS The study revealed a negative correlation between serum uric acid levels and elevated levels of anthocyanidins and flavanones, with significant p-trends of < 0.001 and 0.02 respectively. The multivariate analysis showed that anthocyanidins and flavanones intake had a significant negative association with the risk of hyperuricemia, with p-trend value being < 0.001 and 0.01, respectively. Flavan-3-ols, flavonols, and all flavonoids exhibited a non-linear association with the incidence of hyperuricemia, with significant p-nonlinear values of < 0.001, 0.04, and 0.01 respectively. CONCLUSION Our study demonstrated that individuals who follow a diet rich in anthocyanins and flavanones had significantly lower serum uric acid levels and a lower incidence of hyperuricemia.
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Affiliation(s)
- Houlin Li
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, No. 136, Zhongshan Er Road, Yuzhong District, Chongqing, 400014, China
| | - Lin Shi
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, No. 136, Zhongshan Er Road, Yuzhong District, Chongqing, 400014, China
| | - Xuelan Chen
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, No. 136, Zhongshan Er Road, Yuzhong District, Chongqing, 400014, China.
| | - Mo Wang
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, No. 136, Zhongshan Er Road, Yuzhong District, Chongqing, 400014, China.
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29
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Liu Y, Liu X, Wang M, Chen C, Li X, Liang Z, Shan Y, Yin Y, Sun F, Li Z, Li H. Characterizations of microRNAs involved in the molecular mechanisms underlying the therapeutic effects of noni ( Morinda citrifolia L.) fruit juice on hyperuricemia in mice. Front Nutr 2023; 10:1121734. [PMID: 37426193 PMCID: PMC10324520 DOI: 10.3389/fnut.2023.1121734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Background Hyperuricemia is generally defined as the high level of serum uric acid and is well known as an important risk factor for the development of various medical disorders. However, the medicinal treatment of hyperuricemia is frequently associated with multiple side-effects. Methods The therapeutic effect of noni (Morinda citrifolia L.) fruit juice on hyperuricemia and the underlying molecular mechanisms were investigated in mouse model of hyperuricemia induced by potassium oxonate using biochemical and high-throughput RNA sequencing analyses. Results The levels of serum uric acid (UA) and xanthine oxidase (XOD) in mice treated with noni fruit juice were significantly decreased, suggesting that the noni fruit juice could alleviate hyperuricemia by inhibiting the XOD activity and reducing the level of serum UA. The contents of both serum creatinine and blood urine nitrogen of the noni fruit juice group were significantly lower than those of the model group, suggesting that noni fruit juice promoted the excretion of UA without causing deleterious effect on the renal functions in mice. The differentially expressed microRNAs involved in the pathogenesis of hyperuricemia in mice were identified by RNA sequencing with their target genes further annotated based on both Gene Ontology and Kyoto Encyclopedia of Genes and Genomes databases to explore the metabolic pathways and molecular mechanisms underlying the therapeutic effect on hyperuricemia by noni fruit juice. Conclusion Our study provided strong experimental evidence to support the further investigations of the potential application of noni fruit juice in the treatment of hyperuricemia.
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Affiliation(s)
- Yue Liu
- College of Biological and Food Engineering, Jilin Engineering Normal University, Changchun, China
- School of Chemistry and Life Science, Changchun University of Technology, Changchun, China
| | - Xianjun Liu
- College of Biological and Food Engineering, Jilin Engineering Normal University, Changchun, China
| | - Mengyuan Wang
- College of Biological and Food Engineering, Jilin Engineering Normal University, Changchun, China
- School of Chemistry and Life Science, Changchun University of Technology, Changchun, China
| | - Changwu Chen
- College of Biological and Food Engineering, Jilin Engineering Normal University, Changchun, China
| | - Xiaohong Li
- College of Biological and Food Engineering, Jilin Engineering Normal University, Changchun, China
| | - Zhiyong Liang
- College of Biological and Food Engineering, Jilin Engineering Normal University, Changchun, China
- Qingdao Haoda Marine Biotechnology Co., Ltd., Qingdao, China
| | - Yaming Shan
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
- Key Laboratory for Molecular Enzymology and Engineering, Ministry of Education, School of Life Sciences, Jilin University, Changchun, China
| | - Yuhe Yin
- School of Chemistry and Life Science, Changchun University of Technology, Changchun, China
| | - Fengjie Sun
- School of Science and Technology, Georgia Gwinnett College, Lawrenceville, GA, United States
| | - Zhandong Li
- College of Biological and Food Engineering, Jilin Engineering Normal University, Changchun, China
| | - Hao Li
- College of Biological and Food Engineering, Jilin Engineering Normal University, Changchun, China
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30
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Abstract
Xanthine oxidoreductase (XOR) is an enzyme found in various organisms. It converts hypoxanthine to xanthine and urate, which are crucial steps in purine elimination in humans. Elevated uric acid levels can lead to conditions like gout and hyperuricemia. Therefore, there is significant interest in developing drugs that target XOR for treating these conditions and other diseases. Oxipurinol, an analogue of xanthine, is a well-known inhibitor of XOR. Crystallographic studies have revealed that oxipurinol directly binds to the molybdenum cofactor (MoCo) in XOR. However, the precise details of the inhibition mechanism are still unclear, which would be valuable for designing more effective drugs with similar inhibitory functions. In this study, molecular dynamics and quantum mechanics/molecular mechanics calculations are employed to investigate the inhibition mechanism of XOR by oxipurinol. The study examines the structural and dynamic effects of oxipurinol on the pre-catalytic structure of the metabolite-bound system. Our results provide insights on the reaction mechanism catalyzed by the MoCo center in the active site, which aligns well with experimental findings. Furthermore, the results provide insights into the residues surrounding the active site and propose an alternative mechanism for developing alternative covalent inhibitors.
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Affiliation(s)
- Yazdan Maghsoud
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Chao Dong
- Department of Chemistry and Physics, The University of Texas Permian Basin, Odessa, Texas 79762, United States
| | - G Andrés Cisneros
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, Richardson, Texas 75080, United States
- Department of Physics, The University of Texas at Dallas, Richardson, Texas 75080, United States
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31
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Tanner RM, Chaudary N, Colantonio LD, Merriman TR, Reynolds RJ, Bridges SL, Cushman M, Saag K, Limdi N, Muntner P, Howard G, Irvin MR. Hypertension severity, apparent treatment resistant hypertension and hyperuricemia in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. J Hypertens 2023; 41:1033-1039. [PMID: 37016935 DOI: 10.1097/hjh.0000000000003425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND Prior studies have identified an association between hypertension and hyperuricemia; however, there has been limited research on the association between hypertension severity and hyperuricemia. METHOD We studied 997 Black and white adults with serum urate data from the reasons for geographic and racial differences in stroke (REGARDS) study. Hypertension was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or self-reported use of antihypertensive medication. Apparent treatment-resistant hypertension (aTRH) was defined as a SBP ≥ 140 mmHg or DBP ≥ 90 mmHg with concurrent use of three classes of antihypertensive medications, or taking four or more classes of antihypertensive medication regardless of BP level. Controlled BP was defined as SBP <140 mmHg and DBP <90 mmHg. RESULTS Overall 5.9% of participants had aTRH and 36.6% had hyperuricemia, defined as serum urate >7.0 mg/dl for men and >6.0 mg/dl for women. After full multivariable adjustment, the odds ratio (OR) for hyperuricemia associated with hypertension was 1.60 [95% confidence interval (95% CI): 1.06-2.40]. Compared to participants not taking antihypertensive medication, the ORs for hyperuricemia for participants taking one, two and three classes of antihypertensive medication without aTRH were 1.98 (95% CI: 1.23-3.20), 2.08 (95% CI: 1.25-3.43), 4.31 (95% CI: 2.07-8.97), respectively, and 3.96 (95% CI: 1.75-8.96) for aTRH. Compared to participants without hypertension, the odds ratios for hyperuricemia were 1.67 (95% CI: 1.08-2.58) and 1.46 (95% CI: 0.88-2.44) among those with hypertension with and without controlled BP, respectively. Diuretic use was associated with a higher odds of hyperuricemia. CONCLUSION This study suggests that individuals taking more classes of antihypertensive medication may benefit from monitoring for hyperuricemia.
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Affiliation(s)
- Rikki M Tanner
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Ninad Chaudary
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | - S Louis Bridges
- University of Alabama at Birmingham, Birmingham, Alabama
- Hospital for Special Surgery and Weill Cornell Medical College, New York, New York, USA
| | - Mary Cushman
- University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Kenneth Saag
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Nita Limdi
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Paul Muntner
- University of Alabama at Birmingham, Birmingham, Alabama
| | - George Howard
- University of Alabama at Birmingham, Birmingham, Alabama
| | - M Ryan Irvin
- University of Alabama at Birmingham, Birmingham, Alabama
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Abstract
Xanthine oxidase (XO) is a member of the molybdopterin-containing enzyme family. It interconverts xanthine to uric acid as the last step of purine catabolism in the human body. The high uric acid concentration in the blood directly leads to human diseases like gout and hyperuricemia. Therefore, drugs that inhibit the biosynthesis of uric acid by human XO have been clinically used for many years to decrease the concentration of uric acid in the blood. In this study, the inhibition mechanism of XO and a new promising drug, topiroxostat (code: FYX-051), is investigated by employing molecular dynamics (MD) and quantum mechanics/molecular mechanics (QM/MM) calculations. This drug has been reported to act as both a noncovalent and covalent inhibitor and undergoes a stepwise inhibition by all its hydroxylated metabolites, which include 2-hydroxy-FYX-051, dihydroxy-FYX-051, and trihydroxy-FYX-051. However, the detailed mechanism of inhibition of each metabolite remains elusive and can be useful for designing more effective drugs with similar inhibition functions. Hence, herein we present the computational investigation of the structural and dynamical effects of FYX-051 and the calculated reaction mechanism for all of the oxidation steps catalyzed by the molybdopterin center in the active site. Calculated results for the proposed reaction mechanisms for each metabolite's inhibition reaction in the enzyme's active site, binding affinities, and the noncovalent interactions with the surrounding amino acid residues are consistent with previously reported experimental findings. Analysis of the noncovalent interactions via energy decomposition analysis (EDA) and noncovalent interaction (NCI) techniques suggests that residues L648, K771, E802, R839, L873, R880, R912, F914, F1009, L1014, and A1079 can be used as key interacting residues for further hybrid-type inhibitor development.
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Affiliation(s)
- Yazdan Maghsoud
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Chao Dong
- Department of Chemistry and Physics, The University of Texas Permian Basin, Odessa, Texas 79762, United States
| | - G Andrés Cisneros
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, Richardson, Texas 75080, United States; Department of Physics, The University of Texas at Dallas, Richardson, Texas 75080, United States
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33
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Khan Z, Gul A. Gout in an Obese Patient with Nonalcoholic Steatohepatitis on a Thiazide Diuretic and Association Between Hyperuricemia and Nonalcoholic Steatohepatitis: A Case Report. Cureus 2023; 15:e39207. [PMID: 37378123 PMCID: PMC10292010 DOI: 10.7759/cureus.39207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
Gout is a common inflammatory arthritis caused by increased uric acid crystals in and around various joints, mainly the big toe in adults. It happens due to the increase of urate or uric acid levels either because of increased production or decreased excretion from the body. Uric acid is the final product of purine metabolism, and many patients with hyperuricemia may remain asymptomatic. We present a case of a 46-year-old male who presented to the ambulatory care unit with the clinical features of acute pharyngitis and left toe pain for the past three days. On further questioning, he added that he had pain in the left lumber region and left side of the toe for the past few months. He also had a known case of type 2 diabetes mellitus, hypertension, and gastritis, for which he has been taking the thiazide diuretic, angiotensin-converting enzyme (ACE) inhibitors, metformin, sitagliptin, aspirin, and atorvastatin. Laboratory tests showed elevated uric acid along with raised inflammatory markers. As a result, he was referred to the specialist for arthrocentesis in order to confirm the diagnosis, and the thiazide diuretic was replaced with calcium channel blockers. He also suffered from nonalcoholic steatohepatitis (NASH) based on his ultrasound abdomen. On the follow-up visit, his symptoms had resolved, and his uric acid level had normalized.
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Affiliation(s)
- Zahid Khan
- Acute Medicine, Mid and South Essex National Health Service (NHS) Foundation Trust, Southend-on-Sea, GBR
- Cardiology, Barts Heart Centre, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals National Health Service (NHS) Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
| | - Amresh Gul
- General Practice, Lifeline Hospital, Salalah, OMN
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34
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Yip RM, Cheung TT, So H, Chan JP, Ho CT, Tsang HH, Yu CK, Wong PC. The Hong Kong Society of Rheumatology consensus recommendations for the management of gout. Clin Rheumatol 2023:10.1007/s10067-023-06578-9. [PMID: 37014501 DOI: 10.1007/s10067-023-06578-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/09/2023] [Accepted: 03/12/2023] [Indexed: 04/05/2023]
Abstract
Gout is one of the most common noncommunicable diseases in Hong Kong. Although effective treatment options are readily available, the management of gout in Hong Kong remains suboptimal. Like other countries, the treatment goal in Hong Kong usually focuses on relieving symptoms of gout but not treating the serum urate level to target. As a result, patients with gout continue to suffer from the debilitating arthritis, as well as the renal, metabolic, and cardiovascular complications associated with gout. The Hong Kong Society of Rheumatology spearheaded the development of these consensus recommendations through a Delphi exercise that involved rheumatologists, primary care physicians, and other specialists in Hong Kong. Recommendations on acute gout management, gout prophylaxis, treatment of hyperuricemia and its precautions, co-administration of non-gout medications with urate-lowering therapy, and lifestyle advice have been included. This paper serves as a reference guide to all healthcare providers who see patients who are at risk and are known to have this chronic but treatable condition.
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Affiliation(s)
- Ronald Ml Yip
- Tung Wah Group of Hospitals Integrated Diagnostic and Medical Centre, Kwong Wah Hospital, 25, Waterloo Road, Kowloon, Hong Kong.
| | - Tommy T Cheung
- Rheumatology Centre, Department of Medicine, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong
| | - Ho So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong
| | - Julia Ps Chan
- Rheumatology Centre, Department of Medicine, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong
| | - Carmen Tk Ho
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Helen Hl Tsang
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Carrel Kl Yu
- Hong Kong Autoimmune and Rheumatic Diseases Centre, Central, Hong Kong
| | - Priscilla Ch Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong
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Tao H, Mo Y, Liu W, Wang H. A review on gout: Looking back and looking ahead. Int Immunopharmacol 2023; 117:109977. [PMID: 37012869 DOI: 10.1016/j.intimp.2023.109977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/11/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
Gout is a metabolic disease caused by the deposition of monosodium urate (MSU) crystals inside joints, which leads to inflammation and tissue damage. Increased concentration of serum urate is an essential step in the development of gout. Serum urate is regulated by urate transporters in the kidney and intestine, especially GLUT9 (SLC2A9), URAT1 (SLC22A12) and ABCG. Activation of NLRP3 inflammasome bodies and subsequent release of IL-1β by monosodium urate crystals induce the crescendo of acute gouty arthritis, while neutrophil extracellular traps (NETs) are considered to drive the self-resolving of gout within a few days. If untreated, acute gout may eventually develop into chronic tophaceous gout characterized by tophi, chronic gouty synovitis, and structural joint damage, leading the crushing burden of treatment. Although the research on the pathological mechanism of gout has been gradually deepened in recent years, many clinical manifestations of gout are still unable to be fully elucidated. Here, we reviewed the molecular pathological mechanism behind various clinical manifestations of gout, with a view to making contributions to further understanding and treatment.
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Hu Y, Liu J, Jin H. Association between serum uric acid and phase angle in patients with type 2 diabetes mellitus: A cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1124565. [PMID: 37051205 PMCID: PMC10083473 DOI: 10.3389/fendo.2023.1124565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
Background The purpose of this analysis was to investigate the associations between serum uric acid and phase angle in patients with type 2 diabetes mellitus. Methods In this retrospective cross-sectional study, we included 200 type 2 diabetes mellitus (T2DM) patients treated during 2018-2019 at Zhongda Hospital Southeast University. Phase angle (PhA) and other body composition indicators were measured by bioelectrical impedance analysis (BIA). All patients underwent routine clinical examinations on the day of hospitalization, and the basic information and clinical symptoms of these patients were recorded. Results Serum uric acid (UA) was significantly associated with PhA (p <0.001). Overall, in the crude model and minor, all adjusted models (crude model, Models I-II), the phase angle increased as the tertiles of serum uric acid increased. In the minor adjusted model (Model I, adjustment for age and duration) fully adjusted model (Model II, adjustment for age, duration, Lpa, BMI, and WHR), the adjusted β for participants in tertiles of serum uric acid were 0.26 (95% CI: 0.05-0.46) and 0.32 (95% CI: 0.11-0.54), respectively, compared with those in the lowest tertile 1. Conclusion There was a nonlinear relationship between serum uric acid and PhA in T2DM patients, and the phase angle increased as uric acid increased within a certain range, and this effect disappeared when uric acid exceeded a certain value.
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Affiliation(s)
- Yezi Hu
- Department of Clinical Nutrition, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Jie Liu
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Hui Jin
- Department of Clinical Nutrition, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
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Grubišić F, Jordan K. Are interventions for treatment of tophi in gout efficient? - A Cochrane Review summary with commentary. Int J Rheum Dis 2023. [PMID: 36891663 DOI: 10.1111/1756-185x.14648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/03/2023] [Accepted: 02/23/2023] [Indexed: 03/10/2023]
Affiliation(s)
- Frane Grubišić
- Department of Rheumatology, Physical Medicine and Rehabilitation, School of Medicine University of Zagreb, Referral Center for Spondyloarthropathies, Ministry of Health of the Republic of Croatia, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
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Zhu L, Wang X, Sun J, Qian Q, Yu J, An X. Hyperuricemia Predicts the Progression of Type 2 Diabetic Kidney Disease in Chinese Patients. Diabetes Ther 2023; 14:581-591. [PMID: 36757669 PMCID: PMC9981872 DOI: 10.1007/s13300-023-01374-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Diabetic kidney disease (DKD) has a high global disease burden and substantially increases the risk of end-stage renal disease and cardiovascular events. High levels of serum uric acid (SUA), or hyperuricemia, may indicate patients with type 2 diabetes (T2D) at risk for kidney disease. METHODS This study explored the association between SUA levels and progression of kidney disease among patients with T2D. A cross-sectional study of 993 Chinese patients aged 20-75 years with T2D and DKD was conducted. Patients were stratified by progression risk of kidney disease based on estimated glomerular filtration rate and ratio of urinary albumin to creatinine, according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Ordinal logistic regression was used to assess associations between SUA and different KDIGO risk categories. RESULTS Among 768 patients in the final analysis, those with hyperuricemia and higher SUA were more likely to be assigned to higher KDIGO risk categories. Patients with SUA > 420 μmol/L were ninefold more likely to be in a higher KDIGO risk category than those with SUA < 300 μmol/L (odds risk 9.74, 95% confidence interval 5.47-17.33, P < 0.001). CONCLUSIONS Hyperuricemia may be associated with higher risk of DKD progression in individuals with T2D.
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Affiliation(s)
- Lin Zhu
- Physical Examination Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China
| | - Xuening Wang
- Department of Endocrinology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China
| | - Jiaxing Sun
- Department of Endocrinology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China
| | - Qi Qian
- Department of Endocrinology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China
| | - Jiangyi Yu
- Department of Endocrinology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China.
| | - Xiaofei An
- Department of Endocrinology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China.
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Lei T, Guo J, Wang P, Zhang Z, Niu S, Zhang Q, Qing Y. Establishment and Validation of Predictive Model of Tophus in Gout Patients. J Clin Med 2023; 12. [PMID: 36902542 DOI: 10.3390/jcm12051755] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/04/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
(1) Background: A tophus is a clinical manifestation of advanced gout, and in some patients could lead to joint deformities, fractures, and even serious complications in unusual sites. Therefore, to explore the factors related to the occurrence of tophi and establish a prediction model is clinically significant. (2) Objective: to study the occurrence of tophi in patients with gout and to construct a predictive model to evaluate its predictive efficacy. (3) Methods: The clinical data of 702 gout patients were analyzed by using cross-sectional data of North Sichuan Medical College. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were used to analyze predictors. Multiple machine learning (ML) classification models are integrated to analyze and identify the optimal model, and Shapley Additive exPlanations (SHAP) interpretation was developed for personalized risk assessment. (4) Results: Compliance of urate-lowering therapy (ULT), Body Mass Index (BMI), course of disease, annual attack frequency, polyjoint involvement, history of drinking, family history of gout, estimated glomerular filtration rate (eGFR), and erythrocyte sedimentation rate (ESR) were the predictors of the occurrence of tophi. Logistic classification model was the optimal model, test set area under curve (AUC) (95% confidence interval, CI): 0.888 (0.839-0.937), accuracy: 0.763, sensitivity: 0.852, and specificity: 0.803. (5) Conclusions: We constructed a logistic regression model and explained it with the SHAP method, providing evidence for preventing tophus and guidance for individual treatment of different patients.
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Kong X, Liang H, An W, Bai S, Miao Y, Qiang J, Wang H, Zhou Y, Zhang Q. Rapid identification of early renal damage in asymptomatic hyperuricemia patients based on urine Raman spectroscopy and bioinformatics analysis. Front Chem 2023; 11:1045697. [PMID: 36762194 PMCID: PMC9905717 DOI: 10.3389/fchem.2023.1045697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
Objective: The issue of when to start treatment in patients with hyperuricemia (HUA) without gout and chronic kidney disease (CKD) is both important and controversial. In this study, Raman spectroscopy (RS) was used to analyze urine samples, and key genes expressed differentially CKD were identified using bioinformatics. The biological functions and regulatory pathways of these key genes were preliminarily analyzed, and the relationship between them as well as the heterogeneity of the urine components of HUA was evaluated. This study provides new ideas for the rapid evaluation of renal function in patients with HUA and CKD, while providing an important reference for the new treatment strategy of HUA disease. Methods: A physically examined population in 2021 was recruited as the research subjects. There were 10 cases with normal blood uric acid level and 31 cases with asymptomatic HUA diagnosis. The general clinical data were collected and the urine samples were analyzed by Raman spectroscopy. An identification model was also established by using the multidimensional multivariate method of orthogonal partial least squares discriminant analysis (OPLS-DA) model for statistical analysis of the data, key genes associated with CKD were identified using the Gene Expression Omnibus (GEO) database, and key biological pathways associated with renal function damage in CKD patients with HUA were analyzed. Results: The Raman spectra showed significant differences in the levels of uric acid (640 cm-1), urea, creatinine (1,608, 1,706 cm-1), proteins/amino acids (642, 828, 1,556, 1,585, 1,587, 1,596, 1,603, 1,615 cm-1), and ketone body (1,643 cm-1) (p < 0.05). The top 10 differentially expressed genes (DEGs) associated with CKD (ALB, MYC, IL10, FOS, TOP2A, PLG, REN, FGA, CCNA2, and BUB1) were identified. Compared with the differential peak positions analyzed by the OPLS-DA model, it was found that the peak positions of glutathione, tryptophan and tyrosine may be important markers for the diagnosis and progression of CKD. Conclusion: The progression of CKD was related to the expression of the ALB, MYC, IL10, PLG, REN, and FGA genes. Patients with HUA may have abnormalities in glutathione, tryptophan, tyrosine, and energy metabolism. The application of Raman spectroscopy to analyze urine samples and interpret the heterogeneity of the internal environment of asymptomatic HUA patients can be combined with the OPLS-DA model to mine the massive clinical and biochemical examination information on HUA patients. The results can also provide a reference for identifying the right time for intervention for uric acid as well as assist the early detection of changes in the internal environment of the body. Finally, this approach provides a useful technical supplement for exploring a low-cost, rapid evaluation and improving the timeliness of screening. Precise intervention of abnormal signal levels of internal environment and energy metabolism may be a potential way to delay renal injury in patients with HUA.
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Affiliation(s)
- Xiaodong Kong
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
| | - Haoyue Liang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Wei An
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
| | - Sheng Bai
- Department of Ultrasound, Xiangya Hospital Central South University, Changsha, Hunan, China
| | | | - Junlian Qiang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
| | - Haoyu Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yuan Zhou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China,*Correspondence: Qiang Zhang, ; Yuan Zhou,
| | - Qiang Zhang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China,*Correspondence: Qiang Zhang, ; Yuan Zhou,
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Jang YS, Nerobkova N, Yun I, Kim H, Park EC. Association between smoking behavior and serum uric acid among the adults: Findings from a national cross-sectional study. PLoS One 2023; 18:e0285080. [PMID: 37130102 PMCID: PMC10153749 DOI: 10.1371/journal.pone.0285080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/16/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Gout incidence is increasing worldwide; appropriate management of serum uric acid levels and a healthy lifestyle may help its prevention. The popularity of electronic cigarettes and the resultant emergence of dual smokers is increasing. Despite many studies on the effects of various health behaviors on serum uric acid levels, the association between smoking and serum uric acid levels remains controversial. This study aimed to investigate the association between smoking and serum uric acid levels. METHODS In this study, total sample of 27,013 participants (11,924 men and 15,089 women) were analyzed. This study used data from the Korea National Health and Nutrition Examination Survey (2016-2020) and grouped adults into dual smokers, single smokers, ex-smokers, and non-smokers. Multiple logistic regression analyses were performed to investigate the association between smoking behavior and serum uric acid levels. RESULTS Compared to male non-smokers, male dual smokers had significantly higher serum uric acid level (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.08-1.88). In female, serum uric acid level was higher among single smokers than non-smokers (OR, 1.68; 95% CI, 1.25-2.25). Higher serum uric acid levels were more likely to be present in male dual smokers with a > 20 pack-year smoking habit (OR, 1.84; 95% CI, 1.06-3.18). CONCLUSION Dual smoking may contribute to high serum uric acid levels in adults. Thus, serum uric acid levels should be properly managed through smoking cessation.
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Affiliation(s)
- Yun Seo Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Nataliya Nerobkova
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Il Yun
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hyunkyu Kim
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Lu Y, Wang J, An Y, Liu J, Wang Y, Wang G, Leng S. Impaired sensitivity to thyroid hormones is associated with hyperuricemia in a Chinese euthyroid population. Front Endocrinol (Lausanne) 2023; 14:1132543. [PMID: 37152966 PMCID: PMC10154591 DOI: 10.3389/fendo.2023.1132543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
Objective Impaired sensitivity to thyroid hormones has been reported as a common metabolic disorder, and it remains poorly understood whether it interplays with uric acid (UA) metabolism as an established risk factor for cardiovascular diseases (CVDs). We aimed to investigate the relationship between thyroid hormone sensitivity and elevated UA in a Chinese euthyroid population. Methods A total of 15,955 euthyroid subjects were included in this study. Thyroid hormone sensitivity indices were calculated, including the thyroid feedback quantile-based index (TFQI), the Chinese-referenced parametric TFQI (PTFQI), the TSH index (TSHI), and the thyrotropin thyroxine resistance index (TT4RI), and the FT3/FT4 ratio. Linear and logistic regression analyses were performed to detect the association between thyroid hormone sensitivity and elevated UA. Results Subjects with reduced sensitivity to thyroid hormones had increased UA levels in both genders (p for trend < 0.001). Logistic and linear regression analyses showed that higher TFQI, PTFQI, TSHI, and TT4RI were positively associated with elevated UA levels, but negatively associated with the FT3/FT4 ratio. The odds ratio (OR) of the highest versus the first quartile of TFQI was 1.20 (1.05, 1.38) in men and 1.80 (1.46, 2.23) in women (p < 0.001). PTHQI, TSHI, and TT4RI obtained similar results in both genders. Conversely, the highest quartile of the FT3/FT4 ratio was negatively correlated with elevated UA levels [men: OR 0.78 (0.68,0.89), women: OR 0.66 (0.53,0.81)]. Conclusion Impaired sensitivity to thyroid hormones was associated with elevated UA levels in euthyroid subjects. Our findings shed light on the role of thyroid hormone sensitivity in UA metabolism.
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Affiliation(s)
- Yingning Lu
- Health Management Center, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jie Wang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yu An
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Wang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Song Leng
- Health Management Center, The Second Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Song Leng,
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Han Y, Lu X, Xiao S, Qin J, Zheng L, Feng Y, Cai Y, Qiu R, Huang Q, Yang M. Association between serum uric acid level and systemic lupus erythematosus kidney outcome: An observational study in Southern Chinese population and a meta-analysis. Lupus 2023; 32:83-93. [PMID: 36396610 DOI: 10.1177/09612033221140267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The study aimed to explore the effect of serum uric acid (SUA) level on the progression of kidney function in systemic lupus erythematosus (SLE) patients. METHODS A total of 123 biopsy-proven lupus nephritis (LN) patients were included in this retrospective observational study. Cox proportional hazard regression analyses as well as restricted cubic spline analyses were performed to identify predictors of renal outcome in LN patients. We also performed a systematic review and meta-analysis for SUA and overall kidney outcomes in SLE patients. RESULTS Based on the laboratory tests at renal biopsy, 72 (58.5%) of the 123 patients had hyperuricemia. The median (IQR) follow-up duration was 3.67 years (1.79-6.63 years), and a total of 110 (89.4%) patients experienced progression of LN. Increased serum uric acid level, whether analyzed as continuous or categorical variable, was associated with higher risk of LN progression in Cox proportional hazard regression model (hazard ratio [HR]: 1.003, 95% confidence interval [CI]: 1.001-1.005; HR: 1.780, 95% CI: 1.201-2.639, respectively). This relationship maintained in women (HR: 1.947, 95% CI: 1.234-3.074) but not men (HR: 2.189, 95% CI: 0.802-5.977). The meta-analysis showed a similar result that both continuous and categorical SUA were positively associated with the risk of kidney function progression in LN (weighted mean difference [WMD]: 1.73, 95% CI: 0.97-2.49; odds ratio [OR]: 1.55, 95% CI: 1.20-2.01, respectively). CONCLUSIONS Our study found overall and especially in women that higher SUA in LN patients were associated with increased risk of renal progression. Meta-analysis yielded consistent results. Future studies are required to establish if uric acid can be used as a biomarker for risk assessment and/or as a novel therapeutic target in SLE.
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Affiliation(s)
- Yipeng Han
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Xiaoxi Lu
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Shibai Xiao
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Jiayu Qin
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Lijuan Zheng
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Yi Feng
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Yujie Cai
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Rong Qiu
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Qin Huang
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
| | - Min Yang
- Department of Rheumatology and Immunology, Nanfang Hospital, 198153Southern Medical University, Guangzhou, China
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Choi H, Ryu J, Lee S, Kim YJ, Bang S. [Detection of Monosodium Urate Crystal of Hand and Wrist in Suspected Gouty Arthritis Patients on Dual-Energy CT and Relationship with Serum Urate Level]. J Korean Soc Radiol 2023; 84:212-225. [PMID: 36818719 PMCID: PMC9935968 DOI: 10.3348/jksr.2021.0003n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 04/24/2022] [Accepted: 05/17/2022] [Indexed: 02/10/2023]
Abstract
Purpose We retrospectively investigated the characteristics of patients with monosodium urate (MSU) deposits of the hand and wrist on dual-energy CT (DECT) compared to those without. We also attempted to determine the pattern of MSU distribution in DECT. Materials and Methods In total, 93 patients were included who had undergone DECT for evaluation of the hand or wrist pain under the clinical impression of gouty arthritis. The total volume of MSU deposits on DECT was calculated and the pattern of MSU distribution on DECT was analyzed. Also, the level of the serum urate at the time of DECT and the highest level of the serum urate of the patients were obtained from their records and the relationship between MSU and serum urate level was evaluated. Results The range of the volume of MSU deposits on DECT was 0.01-16.11 cm3 (average: 1.07 cm3). The average level of serum urate was significantly higher in the MSU positive group than that in the MSU negative group. MSU deposits were most frequently observed in the wrists followed by fingers and digitorum tendons. Conclusion On DECT, MSU deposits were most frequently detected in the wrist and related with high serum urate level.
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Affiliation(s)
- Hana Choi
- Department of Radiology, Hanyang University School of Medicine, Guri Hospital, Guri, Korea
| | - Jeongah Ryu
- Department of Radiology, Hanyang University School of Medicine, Guri Hospital, Guri, Korea
| | - Seunghun Lee
- Department of Radiology, Hanyang University School of Medicine, Seoul Hospital, Seoul, Korea
| | - Yeo Ju Kim
- Department of Radiology, Hanyang University School of Medicine, Seoul Hospital, Seoul, Korea
| | - Soyoung Bang
- Department of Rheumatology, Hanyang University School of Medicine, Guri Hospital, Guri, Korea
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Yan F, Xue X, Lu J, Dalbeth N, Qi H, Yu Q, Wang C, Sun M, Cui L, Liu Z, He Y, Yuan X, Chen Y, Cheng X, Ma L, Li H, Ji A, Hu S, Ran Z, Terkeltaub R, Li C. Superiority of Low-Dose Benzbromarone to Low-Dose Febuxostat in a Prospective, Randomized Comparative Effectiveness Trial in Gout Patients With Renal Uric Acid Underexcretion. Arthritis Rheumatol 2022; 74:2015-2023. [PMID: 35795968 PMCID: PMC9771863 DOI: 10.1002/art.42266] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/13/2022] [Accepted: 06/10/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The predominant mechanism driving hyperuricemia in gout is renal uric acid underexcretion; however, the standard urate-lowering therapy (ULT) recommendation is first-line xanthine oxidase inhibitor (XOI), irrespective of the cause of hyperuricemia. This comparative effectiveness clinical trial was undertaken to compare first-line nontitrated low-dose benzbromarone (LDBen) uricosuric therapy to XOI ULT with low-dose febuxostat (LDFeb) in gout patients with renal uric acid underexcretion. METHODS We conducted a prospective, randomized, single-center, open-label trial in men with gout and renal uric acid underexcretion (defined as fractional excretion of urate <5.5% and uric acid excretion ≤600 mg/day/1.73 m2 ). A total of 196 participants were randomly assigned to receive LDBen 25 mg daily or LDFeb 20 mg daily for 12 weeks. All participants received daily urine alkalization with oral sodium bicarbonate. The primary end point was the rate of achieving the serum urate target of <6 mg/dl. RESULTS More participants in the LDBen group achieved the serum urate target than those in the LDFeb group (61% compared to 32%, P < 0.001). Rates of adverse events, including gout flares and urolithiasis, did not differ between groups, with the exception of greater transaminase elevation in the LDFeb group (4% for LDBen compared to 15% for LDFeb, P = 0.008). CONCLUSION Compared to LDFeb, LDBen has superior urate-lowering efficacy and similar safety in treating relatively young and healthy patients with renal uric acid underexcretion-type gout.
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Affiliation(s)
- Fei Yan
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, Institute of Metabolic Diseases, Qingdao University, and China Shandong Provincial Clinical Research Center for Immune Diseases and GoutQingdaoChina
| | - Xiaomei Xue
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, Institute of Metabolic Diseases, Qingdao University, and China Shandong Provincial Clinical Research Center for Immune Diseases and GoutQingdaoChina
| | - Jie Lu
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, Institute of Metabolic Diseases, Qingdao University, and China Shandong Provincial Clinical Research Center for Immune Diseases and GoutQingdaoChina
| | - Nicola Dalbeth
- Department of MedicineUniversity of AucklandAucklandNew Zealand
| | - Han Qi
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, Institute of Metabolic Diseases, Qingdao University, and China Shandong Provincial Clinical Research Center for Immune Diseases and GoutQingdaoChina
| | - Qing Yu
- Department of Endocrinology and Metabolismthe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Can Wang
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and the Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and GoutQingdaoChina
| | - Mingshu Sun
- Department of Rheumatology and Immunologythe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Lingling Cui
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and the Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and GoutQingdaoChina
| | - Zhen Liu
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and the Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and GoutQingdaoChina
| | - Yuwei He
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and the Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and GoutQingdaoChina
| | - Xuan Yuan
- Institute of Metabolic DiseasesQingdao UniversityQingdaoChina
| | - Ying Chen
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and the Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and GoutQingdaoChina
| | - Xiaoyu Cheng
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and the Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and GoutQingdaoChina
| | - Lidan Ma
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, Institute of Metabolic Diseases, Qingdao University, and China Shandong Provincial Clinical Research Center for Immune Diseases and GoutQingdaoChina
| | - Hailong Li
- Institute of Metabolic DiseasesQingdao UniversityQingdaoChina
| | - Aichang Ji
- Institute of Metabolic DiseasesQingdao UniversityQingdaoChina
| | - Shuhui Hu
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, Institute of Metabolic Diseases, Qingdao University, and China Shandong Provincial Clinical Research Center for Immune Diseases and GoutQingdaoChina
| | - Zijing Ran
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, Institute of Metabolic Diseases, Qingdao University, and China Shandong Provincial Clinical Research Center for Immune Diseases and GoutQingdaoChina
| | | | - Changgui Li
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, Institute of Metabolic Diseases, Qingdao University, and China Shandong Provincial Clinical Research Center for Immune Diseases and GoutQingdaoChina
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Tong Q, Du Y, Cui R, Chen M, Wang SI, Wei JCC, Dai SM. Risk of Erectile Dysfunction in Male Patients with Gout Treated with Febuxostat or Allopurinol: A Propensity Score-Matched Cohort Study. Drugs 2022; 82:1717-1726. [PMID: 36479686 DOI: 10.1007/s40265-022-01816-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate and compare the risk of erectile dysfunction (ED) associated with the use of allopurinol and febuxostat in adult male gout patients. METHODS We conducted a cohort study using TriNetX (Cambridge, MA, USA), a global federated health research network that provides real-time electronic medical record datasets. We analyzed and compared the associated risk of ED in gout patients who started taking allopurinol or febuxostat within 12 months. Propensity score matching was performed to adjust for demographic variables, comorbidities, and medication use. Kaplan-Meier analysis was used to estimate the probability of the outcome of interest. The hazard ratio (HR) and associated confidence intervals were calculated along with the proportionality test using R's Survival Package v3.2-3. RESULTS We identified 679,862 patients with gout among 107,517,445 patients in the database. Of these patients, 24,000 were treated with febuxostat and 299,726 with allopurinol. After propensity matching, 9075 patients receiving febuxostat without allopurinol (febuxostat group) and 9075 corresponding patients receiving allopurinol without febuxostat (allopurinol group) were analyzed for comparison. Among all male patients over 19 years of age, febuxostat was associated with a significantly higher risk of ED versus allopurinol (HR 1.354; 95% confidence interval (CI) 1.003-1.829; log rank test, p = 0.047). After subgroup analysis, in gout patients aged 19-64 years, a significantly higher incidence of ED was observed in the febuxostat group than in the allopurinol group (HR 2.002, 95% CI 1.282-3.126). The risk of ED did not differ significantly between the allopurinol and febuxostat groups in gout patients older than 65 years. CONCLUSIONS Febuxostat may be associated with a higher risk of ED than allopurinol in adult male patients with gout. Future large-scale prospective studies are warranted to confirm our results.
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Affiliation(s)
- Qiang Tong
- Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Du
- Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ran Cui
- Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Miao Chen
- Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shiow-Ing Wang
- Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan. .,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
| | - Sheng-Ming Dai
- Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Kang EH. Considerations for Choosing First-Line Urate-Lowering Treatment in Older Patients with Comorbid Conditions. Drugs Aging 2022; 39:923-33. [PMID: 36437395 DOI: 10.1007/s40266-022-00986-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/29/2022]
Abstract
Gout is the most common inflammatory arthritis in adults. The prevalence of gout increases with age. Urate-lowering treatment (ULT) among older patients is often challenging in that patients frequently suffer insufficient effectiveness or adverse events due to comorbidities, concurrent medications, and altered pharmacokinetics. The large-scale randomized controlled trials (RCTs) directly investigating gout patients regarding cardiovascular (CV) safety have only recently been introduced; CARES and FAST compared the CV safety of the two xanthine oxidase inhibitors (XOis), febuxostat versus allopurinol, in patients with gout. Based on the CARES trial that showed CV concerns with febuxostat, the current international guidelines recommend allopurinol as first-line ULT in gout, while preserving other agents as a second-line treatment, despite a higher potency of febuxostat. XOis would be more suitable than uricosurics to treat older patients with gout due to the high prevalence of chronic kidney disease (CKD) in older patients. However, allopurinol alone might not achieve the target serum uric acid levels below 6 mg/dL and CKD might confer an increased risk of allopurinol induced cutaneous adverse reactions in older patients. Furthermore, as well as the later analysis of CARES participants who were lost to follow-up, data from the FAST trial and real-world studies suggest non-inferior CV safety for febuxostat compared to allopurinol even in the presence of CV diseases. Thus, febuxostat use in older patients with renal impairment may be more positively considered. The combination therapy of a novel uricosuric, verinurad, plus febuxostat reduced albuminuria in hyperuricemic patients with type 2 diabetes and CKD in a phase 2a trial, and further RCTs are awaited. Finally, the sodium-glucose cotransporter-2 inhibitor class of oral hypoglycemic agents, known to exert beneficial CV and renal effects independent of glycemic control, have shown a uricosuric effect and could be used as adjunctive therapy in older patients with cardiorenal comorbidities.
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Tong S, Zhang P, Cheng Q, Chen M, Chen X, Wang Z, Lu X, Wu H. The role of gut microbiota in gout: Is gut microbiota a potential target for gout treatment. Front Cell Infect Microbiol 2022; 12:1051682. [PMID: 36506033 PMCID: PMC9730829 DOI: 10.3389/fcimb.2022.1051682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
Numerous studies have demonstrated that gut microbiota is essential for the host's health because it regulates the host's metabolism, endocrine, and immune systems. In recent years, increasing evidence has shown that gut microbiota plays a role in the onset and progression of gout. Changes in the composition and metabolism of the gut microbiota, result in abnormalities of uric acid degradation, increasing uric acid generation, releasing pro-inflammatory mediators, and intestinal barrier damage in developing gout. As a result, gout therapy that targets gut microbiota has drawn significant interest. This review summarized how the gut microbiota contributes to the pathophysiology of gout and how gout affects the gut microbiota. Additionally, this study explained how gut microbiota might serve as a unique index for the diagnosis of gout and how conventional gout treatment medicines interact with it. Finally, prospective therapeutic approaches focusing on gut microbiota for the prevention and treatment of gout were highlighted, which may represent a future avenue in gout treatment.
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Affiliation(s)
| | | | | | | | | | | | - Xiaoyong Lu
- *Correspondence: Xiaoyong Lu, ; Huaxiang Wu,
| | - Huaxiang Wu
- *Correspondence: Xiaoyong Lu, ; Huaxiang Wu,
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Yu Z, Cao Y, Kan R, Ji H, Zhao W, Wu S, Liu J, Shiuan D. Identification of egg protein-derived peptides as xanthine oxidase inhibitors: virtual hydrolysis, molecular docking, and in vitro activity evaluation. Food Science and Human Wellness 2022. [DOI: 10.1016/j.fshw.2022.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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50
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Liang B, Wang J, Bai N, Zhuo J, Wang R, Lin H, Cai Y. Effect of Food on the Pharmacokinetics and Pharmacodynamics of a Single Oral Dose of SHR4640, a Selective Urate Transporter 1 Inhibitor, in Healthy Chinese Male Volunteers. Clin Pharmacol Drug Dev 2022; 12:392-396. [PMID: 36317751 DOI: 10.1002/cpdd.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022]
Abstract
SHR4640, also named as ruzinurad, is a selective human urate transporter 1 (URAT1) inhibitor developed for the treatment of hyperuricemia and gout. This study evaluated the high-fat, high-calorie food effect on the pharmacokinetics and pharmacodynamics of SHR4640 in healthy Chinese male volunteers. In this open-label, randomized, 2-period crossover phase 1 trial, 14 healthy male subjects were randomized to receive a single 10-mg dose of SHR4640 under both fasted and fed conditions. The washout period was 7 days. Blood samples were collected for pharmacokinetic and pharmacodynamic analysis. Pharmacokinetic parameters were analyzed by a noncompartmental method. The safety of the drug was also evaluated in the trial. A total of 14 healthy male volunteers were enrolled in the study, and finally 13 healthy volunteers completed the study. A single 10-mg dose of SHR4640 was safe and well tolerated in healthy Chinese male volunteers. After single-dose administration of SHR4640, the 90%CIs of the geometric mean ratios of the area under the plasma concentration-time curve from time 0 to the last quantifiable concentration and the area under the plasma concentration-time curve from time 0 to infinity were within the equivalence criteria of 0.80-1.25. The 90%CIs of maximum plasma concentration was slightly outside the lower limit of bioequivalent criteria, with about 13.40% decrease in the fed versus fasted condition. The time to maximum concentration was slightly delayed under the fasted condition. A single 10-mg dose of SHR4640 was safe and well tolerated in this trial. The main pharmacokinetic parameters and serum uric acid lowering of SHR4640 were not affected by food effect; thus, SHR4640 can be recommended to be administered with or without food.
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Affiliation(s)
- Beibei Liang
- Department of Pharmacy, Medical Supplier Center, Center of Medicine Clinical Research PLA General Hospital Beijing China
| | - Jin Wang
- Department of Pharmacy, Medical Supplier Center, Center of Medicine Clinical Research PLA General Hospital Beijing China
| | - Nan Bai
- Department of Pharmacy, Medical Supplier Center, Center of Medicine Clinical Research PLA General Hospital Beijing China
| | - Jiaju Zhuo
- Department of Pharmacy, Medical Supplier Center, Center of Medicine Clinical Research PLA General Hospital Beijing China
| | - Rui Wang
- Department of Pharmacy, Medical Supplier Center, Center of Medicine Clinical Research PLA General Hospital Beijing China
| | - Hongda Lin
- Department of Clinical Pharmacology Jiangsu Hengrui Medicine Co. Ltd Shanghai China
| | - Yun Cai
- Department of Pharmacy, Medical Supplier Center, Center of Medicine Clinical Research PLA General Hospital Beijing China
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