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Gherghina ME, Peride I, Tiglis M, Neagu TP, Niculae A, Checherita IA. Uric Acid and Oxidative Stress-Relationship with Cardiovascular, Metabolic, and Renal Impairment. Int J Mol Sci 2022; 23:ijms23063188. [PMID: 35328614 PMCID: PMC8949471 DOI: 10.3390/ijms23063188] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 01/27/2023] Open
Abstract
Background: The connection between uric acid (UA) and renal impairment is well known due to the urate capacity to precipitate within the tubules or extra-renal system. Emerging studies allege a new hypothesis concerning UA and renal impairment involving a pro-inflammatory status, endothelial dysfunction, and excessive activation of renin–angiotensin–aldosterone system (RAAS). Additionally, hyperuricemia associated with oxidative stress is incriminated in DNA damage, oxidations, inflammatory cytokine production, and even cell apoptosis. There is also increasing evidence regarding the association of hyperuricemia with chronic kidney disease (CKD), cardiovascular disease, and metabolic syndrome or diabetes mellitus. Conclusions: Important aspects need to be clarified regarding hyperuricemia predisposition to oxidative stress and its effects in order to initiate the proper treatment to determine the optimal maintenance of UA level, improving patients’ long-term prognosis and their quality of life.
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Affiliation(s)
- Mihai-Emil Gherghina
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (M.-E.G.); (I.A.C.)
| | - Ileana Peride
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (M.-E.G.); (I.A.C.)
- Correspondence: (I.P.); (A.N.)
| | - Mirela Tiglis
- Department of Anesthesiology and Intensive Care, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
| | - Tiberiu Paul Neagu
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
| | - Andrei Niculae
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (M.-E.G.); (I.A.C.)
- Correspondence: (I.P.); (A.N.)
| | - Ionel Alexandru Checherita
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (M.-E.G.); (I.A.C.)
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Abstract
Uric acid, the end product of purine metabolism, plays a key role in the pathogenesis of gout and other disease processes. The circulating serum uric acid concentration is governed by the relative balance of hepatic production, intestinal secretion, and renal tubular reabsorption and secretion. An elegant synergy between genome-wide association studies and transport physiology has led to the identification and characterization of the major transporters involved with urate reabsorption and secretion, in both kidney and intestine. This development, combined with continued analysis of population-level genetic data, has yielded an increasingly refined mechanistic understanding of uric acid homeostasis as well as greater understanding of the genetic and acquired influences on serum uric acid concentration. The continued delineation of novel and established regulatory pathways that regulate uric acid homeostasis promises to lead to a more complete understanding of uric acid-associated diseases and to identify new targets for treatment.
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Affiliation(s)
| | - Asim K Mandal
- Renal Division, Brigham and Women's Hospital, Boston, MA
| | - David B Mount
- Renal Division, Brigham and Women's Hospital, Boston, MA; Renal Division, VA Boston Healthcare System, Harvard Medical School, Boston, MA.
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Johnson RJ, Sautin YY, Oliver WJ, Roncal C, Mu W, Sanchez-Lozada LG, Rodriguez-Iturbe B, Nakagawa T, Benner SA. Lessons from comparative physiology: could uric acid represent a physiologic alarm signal gone awry in western society? J Comp Physiol B 2009; 179:67-76. [PMID: 18649082 PMCID: PMC2684327 DOI: 10.1007/s00360-008-0291-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 06/18/2008] [Accepted: 06/23/2008] [Indexed: 02/07/2023]
Abstract
Uric acid has historically been viewed as a purine metabolic waste product excreted by the kidney and gut that is relatively unimportant other than its penchant to crystallize in joints to cause the disease gout. In recent years, however, there has been the realization that uric acid is not biologically inert but may have a wide range of actions, including being both a pro- and anti-oxidant, a neurostimulant, and an inducer of inflammation and activator of the innate immune response. In this paper, we present the hypothesis that uric acid has a key role in the foraging response associated with starvation and fasting. We further suggest that there is a complex interplay between fructose, uric acid and vitamin C, with fructose and uric acid stimulating the foraging response and vitamin C countering this response. Finally, we suggest that the mutations in ascorbate synthesis and uricase that characterized early primate evolution were likely in response to the need to stimulate the foraging "survival" response and might have inadvertently had a role in accelerating the development of bipedal locomotion and intellectual development. Unfortunately, due to marked changes in the diet, resulting in dramatic increases in fructose- and purine-rich foods, these identical genotypic changes may be largely responsible for the epidemic of obesity, diabetes and cardiovascular disease in today's society.
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Affiliation(s)
- Richard J. Johnson
- Division of Nephrology, Hypertension and Transplantation, University of Florida, PO Box 100224, Gainesville, FL 32610, USA, e-mail:
| | - Yuri Y. Sautin
- Division of Nephrology, Hypertension and Transplantation, University of Florida, PO Box 100224, Gainesville, FL 32610, USA, e-mail:
| | | | - Carlos Roncal
- Division of Nephrology, Hypertension and Transplantation, University of Florida, PO Box 100224, Gainesville, FL 32610, USA, e-mail:
| | - Wei Mu
- Division of Nephrology, Hypertension and Transplantation, University of Florida, PO Box 100224, Gainesville, FL 32610, USA, e-mail:
| | | | | | - Takahiko Nakagawa
- Division of Nephrology, Hypertension and Transplantation, University of Florida, PO Box 100224, Gainesville, FL 32610, USA, e-mail:
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Lopes HF, Stojiljkovic MP, Zhang D, Goodfriend TL, Egan BM. Moderate sodium restriction enhances the pressor response to hyperlipidemia in obese, hypertensive patients. J Clin Hypertens (Greenwich) 2002; 4:173-80. [PMID: 12045366 PMCID: PMC8112383 DOI: 10.1111/j.1524-6175.2002.00712.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The effect of dietary sodium restriction on insulin, lipids, and blood pressure has been controversial. Evidence suggests that adverse short-term effects in response to very low-salt diets do not persist long-term with modest sodium restriction. In this study, the effects of modest dietary sodium restriction (60 and 120 mmol sodium) were measured for 3 weeks in 12 lean normotensives and 10 obese hypertensives. Blood pressure, plasma lipids, and the pressor response to an infusion of Intralipid and heparin were obtained. In contrast to previous reports concerning very low-salt diets, obese hypertensives did not manifest a pressor response or an adverse lipid effect with moderate salt restriction. Obese hypertensives were not more salt-sensitive than lean normotensives and did not manifest a different hemodynamic response to 4-hour infusion of Intralipid and heparin while on the 120-mmol/day salt diet. During the 60-mmol/day salt diet, however, plasma triglycerides increased more in obese than in lean volunteers during the Intralipid and heparin infusion (398+/-38 vs. 264+/-18 mg/dL; p<0.05), and there were greater increases in mean blood pressure (12+/-2 vs. 7+/-2 mm Hg; p<0.05) and systemic vascular resistance (111+/-38 vs. 225+/-44 dyne.sec.cm-5) as well as a larger decrease in small artery compliance (22.5+/-0.6 vs. 20.4+/-0.6 mL/mm Hg x 100; p<0.05). These data suggest that modest dietary sodium restriction in obese hypertensives does not adversely affect baseline blood pressure or lipids, but it does magnify their adverse lipid and hemodynamic response to fat loading.
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Affiliation(s)
- Heno F. Lopes
- From the Departments of Pharmacology and Medicine, Medical University of South Carolina, Charleston, SC; and the Departments of Medicine and Pharmacology, William S. Middleton Veterans Hospital, University of Wisconsin, Madison, WICurrently in the Department of Pharmacology and Toxicology, Military Medical Academy, Belgrade, FR Yugoslavia
| | - Milos P. Stojiljkovic
- From the Departments of Pharmacology and Medicine, Medical University of South Carolina, Charleston, SC; and the Departments of Medicine and Pharmacology, William S. Middleton Veterans Hospital, University of Wisconsin, Madison, WICurrently in the Department of Pharmacology and Toxicology, Military Medical Academy, Belgrade, FR Yugoslavia
| | - Da Zhang
- From the Departments of Pharmacology and Medicine, Medical University of South Carolina, Charleston, SC; and the Departments of Medicine and Pharmacology, William S. Middleton Veterans Hospital, University of Wisconsin, Madison, WICurrently in the Department of Pharmacology and Toxicology, Military Medical Academy, Belgrade, FR Yugoslavia
| | - Theodore L. Goodfriend
- From the Departments of Pharmacology and Medicine, Medical University of South Carolina, Charleston, SC; and the Departments of Medicine and Pharmacology, William S. Middleton Veterans Hospital, University of Wisconsin, Madison, WICurrently in the Department of Pharmacology and Toxicology, Military Medical Academy, Belgrade, FR Yugoslavia
| | - Brent M. Egan
- From the Departments of Pharmacology and Medicine, Medical University of South Carolina, Charleston, SC; and the Departments of Medicine and Pharmacology, William S. Middleton Veterans Hospital, University of Wisconsin, Madison, WICurrently in the Department of Pharmacology and Toxicology, Military Medical Academy, Belgrade, FR Yugoslavia
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