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Qi H, Sun M, Terkeltaub R, Merriman TR, Chen H, Li Z, Ji A, Xue X, Sun W, Wang C, Li X, He Y, Cui L, Dalbeth N, Li C. Hyperuricemia Subtypes Classified According to Renal Uric Acid Handling Manifesting Distinct Phenotypic and Genetic Profiles in People With Gout. Arthritis Rheumatol 2024; 76:1130-1140. [PMID: 38412854 DOI: 10.1002/art.42838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Hyperuricemia can be stratified into four subtypes according to renal uric acid handling. The aim of this study was to comprehensively describe the biologic characteristics (including genetic background) of clinically defined hyperuricemia subtypes in two large geographically independent gout cohorts. METHODS Hyperuricemia subtype was defined as renal uric acid overload (ROL), renal uric acid underexcretion (RUE), combined, or renal normal. Twenty single nucleotide polymorphisms (SNPs) previously identified as gout risk loci or associated with serum urate (SU) concentration in the East Asian population were genotyped. Weighted polygenic risk scores were calculated to assess the cumulative effect of genetic risks on the subtypes. RESULTS Of the 4,873 participants, 8.8% had an ROL subtype, 60.9% RUE subtype, 23.1% combined subtype, and 7.2% normal subtype. The ROL subtype was independently associated with older age at onset, lower SU, tophi, and diabetes mellitus; RUE was associated with lower body mass index (BMI) and non-diabetes mellitus; the combined subtype was associated with younger age at onset, higher BMI, SU, estimated glomerular filtration rate (eGFR), and smoking; and the normal subtype was independently associated with older age at onset, lower SU, and eGFR. Thirteen SNPs were associated with gout with 6 shared loci and subtype-dependent risk loci patterns. High polygenic risk scores were associated with ROL subtype (odds ratio [OR] = 9.63, 95% confidence interval [95% CI] 4.53-15.12), RUE subtype (OR = 2.18, 95% CI 1.57-3.03), and combined subtype (OR = 6.32, 95% CI 4.22-9.48) compared with low polygenic risk scores. CONCLUSION Hyperuricemia subtypes classified according to renal uric acid handling have subtype-specific clinical and genetic features, suggesting subtype-unique pathophysiologic mechanisms.
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Affiliation(s)
- Han Qi
- The Affiliated Hospital of Qingdao University, Qingdao University, and Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, China
| | - Mingshu Sun
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | | | - Tony R Merriman
- Qingdao University, Qingdao, China, and University of Alabama Birmingham
| | | | - Zhiqiang Li
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Aichang Ji
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaomei Xue
- The Affiliated Hospital of Qingdao University, Qingdao University, and Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, China
| | - Wenyan Sun
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Can Wang
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xinde Li
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuwei He
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lingling Cui
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | | | - Changgui Li
- The Affiliated Hospital of Qingdao University, Qingdao University, and Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, China
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Pascart T, Ducoulombier V, Jauffret C. Early-onset gout. Joint Bone Spine 2024; 91:105704. [PMID: 38336273 DOI: 10.1016/j.jbspin.2024.105704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/16/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
Early-onset gout (EOG) is characterized by the occurrence of the first symptoms of gout at an unusually young age, usually <40 years. The aim of this review is to provide an overview of the epidemiology, clinical presentation and prognosis, association with comorbidities and specific management of EOG. A particularly high proportion of patients with EOG come from ethnic groups with stronger genetic factors, such as populations in the Pacific and Taiwan, who therefore have the highest prevalence of gout overall. The clinical presentation and severity of gout are broadly similar between EOG and common gout, although a longer disease duration exacerbates the disease, which more often tends to become polyarticular. Patients suffering from EOG develop metabolic comorbidities commonly associated with gout earlier in life, although those tend to be less frequent at the time of diagnosis. Some international guidelines recommend early treatment of EOG patients with urate-lowering therapies.
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Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Saint-Philibert Hospital, Lille Catholic University, Lomme, France; ETHICS Laboratory, EA7446, Lille Catholic University, Lille, France.
| | - Vincent Ducoulombier
- Department of Rheumatology, Saint-Philibert Hospital, Lille Catholic University, Lomme, France
| | - Charlotte Jauffret
- Department of Rheumatology, Saint-Philibert Hospital, Lille Catholic University, Lomme, France; University of Lille, ULR 2694 - METRICS, CERIM, Lille, France
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Effects of a Macroporous Resin Extract of Dendrobium officinale Leaves in Rats with Hyperuricemia Induced by Anthropomorphic Unhealthy Lifestyle. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2023; 2023:9990843. [PMID: 36644440 PMCID: PMC9839412 DOI: 10.1155/2023/9990843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 01/09/2023]
Abstract
Aim Hyperuricemia (HUA) has received increased attention in the last few decades due to its global prevalence. Our previous study found that administration of a macroporous resin extract of Dendrobium officinale leaves (DoMRE) to rats with HUA that was induced by exposure to potassium oxazine combined with fructose and a high-purine diet led to a significant reduction in serum uric acid (SUA) levels. The aim of this study was to explore the effects of DoMRE on hyperuricemia induced by anthropomorphic unhealthy lifestyle and to elucidate its possible mechanisms of action. Methods Dosages (5.0 and 10.0 g/kg/day) of DoMRE were administered to rats daily after induction of HUA by anthropomorphic unhealthy lifestyle for 12 weeks. The levels of UA in the serum, urine, and feces; the levels of creatinine (Cr) in the serum and urine; and the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in serum were all measured using an automatic biochemical analyzer. The activities of xanthine oxidase (XOD) and adenosine deaminase (ADA) in the serum, liver, and intestine tissue supernatant were measured using appropriate kits for each biological target. The expressions levels of UA transporters (ABCG2 and GLUT9), tight junction (TJ) proteins (ZO-1 and occludin), and inflammatory factors (IL-6, IL-8, and TNF-α) in the intestine were assayed by immunohistochemical (IHC) staining. Hematoxylin and eosin (H&E) staining was used to assess histological changes in the renal and intestinal tissues. Results DoMRE treatment significantly reduced SUA levels and concomitantly increased fecal UA (FUA) levels and the fractional excretion of UA (FEUA) in HUA rats. Furthermore, DoMRE significantly reduced both the XOD activity in the serum, liver, and intestine and the ADA activity in the liver and intestine. DoMRE also effectively regulated the expression of GLUT9 and ABCG2 in the intestine, and it significantly upregulated the expression of the intestinal TJ proteins ZO-1 and occludin. Therefore, DoMRE reduced the damage to the intestinal barrier function caused by the increased production of inflammatory factors due to HUA to ensure normal intestinal UA excretion. Conclusion DoMRE demonstrated anti-HUA effects in the HUA rat model induced by an anthropomorphic unhealthy lifestyle, and the molecular mechanism appeared to involve the regulation of urate transport-related transporters (ABCG2 and GLUT9) in the intestine, protection of the intestinal barrier function to promote UA excretion, and inhibition of XOD and ADA activity in the liver and intestine to inhibit UA production in the HUA-induced rats.
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Tang J, Liu K, Eshak ES, Cui R, Sakaniwa R, Imano H, Dong JY, Iso H. Association between Serum Uric Acid and Impaired Endothelial Function: The Circulatory Risk in Communities Study. J Atheroscler Thromb 2022; 29:1534-1546. [PMID: 34853212 PMCID: PMC9529376 DOI: 10.5551/jat.63199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIMS Higher serum uric acid (UA) may impair endothelial function. However, population-based evidence examining the association between serum UA levels and endothelial function remains to be limited. Thus, in this study, we aimed to investigate this in the general population. METHODS In this cross-sectional study, 1000 participants (496 males and 504 females), aged 30-79 years, free from a history of gout, have undergone both serum UA and brachial artery flow-mediated dilation (FMD) measurements. Participants were divided into four groups based on serum UA quartiles. Logistic regression models were used to calculate odds ratios (ORs) for low FMD according to the serum UA levels. RESULTS In total, 203 participants (138 males and 65 females) with %FMD ≤ 5.0% were identified to have endothelial dysfunction. The multivariable OR of low FMD for highest quartiles vs. lowest quartiles was 2.39 (95% confidence interval [CI]: 1.32-4.34), while OR per 1-standard deviation (SD) increment was 1.28 (95% CI: 1.04-1.56). The positive association was noted to be more evident in females (OR per 1-SD increment: 1.46; 95% CI: 1.08-1.96) than in males and confined to individuals not using antihypertensive medications. The ORs per 1-SD increment were 1.01 (95% CI: 0.68-1.50) among individuals using antihypertensive medications and 1.43 (95% CI: 1.12-1.81) among individuals not using antihypertensive medications. CONCLUSION Higher serum UA was positively associated with the prevalence of endothelial dysfunction in samples of the general Japanese population and that positive association was confined to individuals not using antihypertensive medications.
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Affiliation(s)
- Jingyun Tang
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Keyang Liu
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ehab S Eshak
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan,Department of Public Health and Preventive Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Renzhe Cui
- Department of Internal Medicine, Okanami General Hospital, Mie, Japan
| | - Ryoto Sakaniwa
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hironori Imano
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jia-Yi Dong
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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Ho LJ, Lu CH, Su RY, Lin FH, Su SC, Kuo FC, Chu NF, Hung YJ, Liu JS, Hsieh CH. Association between glucokinase regulator gene polymorphisms and serum uric acid levels in Taiwanese adolescents. Sci Rep 2022; 12:5519. [PMID: 35365700 PMCID: PMC8975867 DOI: 10.1038/s41598-022-09393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 03/08/2022] [Indexed: 11/20/2022] Open
Abstract
The glucokinase regulator gene (GCKR) is located on chromosome 2p23. It plays a crucial role in maintaining plasma glucose homeostasis and metabolic traits. Recently, genome-wide association studies have revealed a positive association between hyperuricemia and GCKR variants in adults. This study investigated this genetic association in Taiwanese adolescents. Data were collected from our previous cross-sectional study (Taipei Children Heart Study). The frequencies of various genotypes (CC, CT, and TT) or alleles (C and T) of the GCKR intronic single-nucleotide polymorphism (SNP) rs780094 and the coding SNP rs1260326 (Pro446Leu, a common 1403C-T transition) were compared between a total of 968 Taiwanese adolescents (473 boys, 495 girls) with hyperuricemia or normal uric acid levels on the basis of gender differences. Logistic and linear regression analyses explored the role of GCKR in abnormal uric acid (UA) levels. Boys had higher UA levels than girls (6.68 ± 1.29 and 5.23 ± 0.95 mg/dl, respectively, p < 0.001). The analysis of both SNPs in girls revealed that the T allele was more likely to appear in patients with hyperuricemia than the C allele. After adjusting for confounders, the odds ratio (OR) for hyperuricemia incidence in the TT genotype was 1.75 (95% confidence interval [CI] 1.02–3.00), which was higher than that in the C allele carriers in rs1260326 in the girl population. Similarly, the TT genotypes had a higher risk of hyperuricemia, with an OR of 2.29 (95% CI 1.11–4.73) for rs1260326 and 2.28 (95% CI 1.09–4.75) for rs780094, than the CC genotype in girl adolescents. The T (Leu446) allele of GCKR rs1260326 polymorphism is associated with higher UA levels in Taiwanese adolescent girls.
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Affiliation(s)
- Li-Ju Ho
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, ROC
| | - Chieh-Hua Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, ROC
| | - Ruei-Yu Su
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.,Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Pathology and Laboratory Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, ROC
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Sheng-Chiang Su
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, ROC
| | - Feng-Chih Kuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, ROC
| | - Nain-Feng Chu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, ROC.,School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yi-Jen Hung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, ROC
| | - Jhih-Syuan Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, ROC.
| | - Chang-Hsun Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, ROC.
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Sun M, Sun W, Zhao X, Li Z, Dalbeth N, Ji A, He Y, Qu H, Zheng G, Ma L, Wang J, Shi Y, Fang X, Chen H, Merriman TR, Li C. A machine learning-assisted model for renal urate underexcretion with genetic and clinical variables among Chinese men with gout. Arthritis Res Ther 2022; 24:67. [PMID: 35264217 PMCID: PMC8905745 DOI: 10.1186/s13075-022-02755-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/28/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES The objective of this study was to develop and validate a prediction model for renal urate underexcretion (RUE) in male gout patients. METHODS Men with gout enrolled from multicenter cohorts in China were analyzed as the development and validation data sets. The RUE phenotype was defined as fractional excretion of uric acid (FEUA) <5.5%. Candidate genetic and clinical features were screened by the least absolute shrinkage and selection operator (LASSO) with 10-fold cross-validation. Machine learning algorithms (stochastic gradient descent (SGD), logistic regression, support vector machine) were performed to construct a predictive classifier of RUE. Models were assessed by the area under the receiver operating characteristic curve (AUC) and the precision-recall curve (PRC). RESULTS One thousand two hundred thirty-eight and two thousand twenty-three patients were enrolled as the development and validation cohorts, with 1220 and 754 randomly chosen patients genotyped, respectively. Rs3775948.GG of SLC2A9/GLUT9, rs504915.AA of NRXN2/URAT1, and 7 clinical features (age, hypertension, nephrolithiasis, blood glucose, serum urate, urea nitrogen, and creatinine) were generated by LASSO. Two additional SNP variants (rs2231142.GG of ABCG2 and rs11231463.GG of SLC22A9/OAT7) were selected based on their contributions to gout in the development cohort and their reported effects on renal urate handling. The optimized classifiers yielded AUCs of ~0.914 and PRCs of ~0.980 using these 11 variables. The SGD model was conducted in the validation cohort with an AUC of 0.899 and the PRC of 0.957. CONCLUSIONS A prediction model for RUE composed of four SNPs and readily accessible clinical features was established with acceptable accuracy for men with gout.
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Affiliation(s)
- Mingshu Sun
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout & Shandong Provincial Key Laboratory of Metabolic Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenyan Sun
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout & Shandong Provincial Key Laboratory of Metabolic Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuetong Zhao
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - Zhiqiang Li
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout & Shandong Provincial Key Laboratory of Metabolic Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Aichang Ji
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout & Shandong Provincial Key Laboratory of Metabolic Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuwei He
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout & Shandong Provincial Key Laboratory of Metabolic Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hongzhu Qu
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - Guangmin Zheng
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - Lidan Ma
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout & Shandong Provincial Key Laboratory of Metabolic Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jiayi Wang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Yongyong Shi
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout & Shandong Provincial Key Laboratory of Metabolic Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiangdong Fang
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - Haibing Chen
- Department of Endocrinology and Metabolism, Shanghai 10th People's Hospital, Tongji University, Shanghai, China.
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand. .,Department of Medicine, University of Alabama Birmingham, Birmingham, AL, USA.
| | - Changgui Li
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout & Shandong Provincial Key Laboratory of Metabolic Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Xue X, Yuan X, Han L, Li X, Merriman TR, Cui L, Liu Z, Sun W, Wang C, Yan F, He Y, Ji A, Lu J, Li C. Effect of Clinical Typing on Serum Urate Targets of Benzbromarone in Chinese Gout Patients: A Prospective Cohort Study. Front Med (Lausanne) 2022; 8:806710. [PMID: 35111784 PMCID: PMC8801777 DOI: 10.3389/fmed.2021.806710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Achieving a goal of serum urate levels in patients with gout is an important way to prevent gout and its complications while it remains difficult with a low targeting rate worldwidely. Currently, hyperuricemia classification has not been widely applied to the management of gout owing to insufficient clinical evidences. This study aimed to evaluate the effectiveness of achieving target urate based on hyperuricemia classification in Chinese patients with gout. Methods In this prospective study, patients with gout receiving urate lowering therapy with benzbromarone were assigned to two groups, a renal underexcretion and an unclassified type. The primary endpoint was the proportion of patients achieving the serum urate target (<360 μmol/L) during the 12-week study. The frequency of acute gout attacks as well as physical and chemical indicators were secondary endpoints. Results Target serum urate level was achieved in 60.5% of underexcretors compared with 39.0% of patients of the unclassified type at week 12 (P = 0.002). Blood glucose and cholesterol levels were lower in the underexcretor group compared with the unclassified type group at the end of the trial, without significant different frequencies in gout flare during the study. In subgroup analysis, stratified by body mass index and estimated glomerular filtration rate, the proportion of patients with serum urate <360 μmol/L was greater in the underexcretion compared with the unclassified type group. Conclusions The increased achievement of target serum urate in the underexcretion group supports the use of a clinical hyperuricemia typing treatment strategy for gout.
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Affiliation(s)
- Xiaomei Xue
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuan Yuan
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China
| | - Lin Han
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xinde Li
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tony R. Merriman
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
- Division of Clinical Immunology and Rheumatology, University of Alabama Birmingham, Birmingham, AL, United States
| | - Lingling Cui
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhen Liu
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenyan Sun
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China
| | - Can Wang
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fei Yan
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuwei He
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Aichang Ji
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jie Lu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Changgui Li
| | - Changgui Li
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, China
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, China
- Jie Lu
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8
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Murdoch R, Barry MJ, Choi HK, Hernandez D, Johnsen B, Labrador M, Reid S, Singh JA, Terkeltaub R, Vázquez Mellado J, Dalbeth N. Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) common language definition of gout. RMD Open 2021; 7:rmdopen-2021-001623. [PMID: 33903281 PMCID: PMC8076916 DOI: 10.1136/rmdopen-2021-001623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/23/2021] [Accepted: 04/02/2021] [Indexed: 12/27/2022] Open
Abstract
Objective To develop a Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) common language definition of gout, with the goal of increasing public understanding and awareness, and ensure consistent and understandable messages about gout. Methods A G-CAN working group that included patients, physicians and nongovernmental organisation (NGO) representatives was formed to develop a common language definition of gout for use with the public, media, healthcare providers and stakeholders. A literature search and interviews with patients, healthcare workers and stakeholders informed development of the definition. Following consultation with G-CAN members and partners, the definition was endorsed by the G-CAN board. Results The G-CAN common language definition of gout describes the epidemiology, pathophysiology, symptoms and impact, risk factors, comorbidities, management and healthcare and workforce considerations. Detailed information is provided to support the content of the definition. After the publication of the English-language version, the definition will be available for translation into other languages by G-CAN members. Conclusion G-CAN has developed a concise and easily understandable statement describing gout in language that can be used in conversations with the lay public, media, NGOs, funders, healthcare providers and other stakeholders.
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Affiliation(s)
- Rachel Murdoch
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Michael J Barry
- Department of Primary Care, Harvard Medical School, Boston, Massachusetts, USA
| | - Hyon K Choi
- Division of Rheumatology Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Brianne Johnsen
- Division of Rheumatology Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Manuel Labrador
- Department of Rheumatology, Hospital General de México, Ciudad de Mexico, Mexico
| | - Susan Reid
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jasvinder A Singh
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Medicine Service, Birmingham VA Medical Center, Birmingham, Alabama, USA
| | - Robert Terkeltaub
- Department of Rheumatology, University of California San Diego, La Jolla, California, USA
| | | | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Berger AA, Mawson TL, Dejam A. Fractional Excretion of Urate for Diuresis Management in Heart Failure and Cardiorenal Syndrome. JACC Case Rep 2021; 3:1051-1054. [PMID: 34317682 PMCID: PMC8311381 DOI: 10.1016/j.jaccas.2020.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 11/28/2022]
Abstract
Most heart failure hospitalizations are due to volume overload; however, it is not easily evaluated by physical examination. Avoidance of diuresis in patients with fluid overload to avoid acute kidney injury increases morbidity in heart failure. We hypothesize that fractional excretion of urate can be used to guide diuresis. (Level of Difficulty: Advanced.).
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Key Words
- AKI, acute kidney injury
- AS, aortic stenosis
- BNP, brain natriuretic peptide
- CKD, chronic kidney disease
- COPD, chronic obstructive pulmonary disease
- CRS
- CXR, chest x-ray
- DOE, dyspnea on exertion
- ECFV, extracellular fluid volume
- ED, emergency department
- EF, ejection fraction
- FeNa
- FeUa
- FeUa, fractional excretion of uric acid
- HF, heart failure
- HFrEF, heart failure with reduced ejection fraction
- ILD, interstitial lung disease
- IV, intravenous
- PE, physical examination
- SOB, shortness of breath
- diuresis
- uric acid
- volume overload
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Affiliation(s)
- Amnon A. Berger
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas L. Mawson
- Internal Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andre Dejam
- Internal Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Li Y, Zhao Z, Luo J, Jiang Y, Li L, Chen Y, Zhang L, Huang Q, Cao Y, Zhou P, Wu T, Pang J. Apigenin ameliorates hyperuricemic nephropathy by inhibiting URAT1 and GLUT9 and relieving renal fibrosis via the Wnt/β-catenin pathway. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 87:153585. [PMID: 34044255 DOI: 10.1016/j.phymed.2021.153585] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Hyperuricemia (HUA) is characterized by abnormal serum uric acid (UA) levels and demonstrated to be involved in renal injury leading to hyperuricemic nephropathy (HN). Apigenin (API), a flavonoid naturally present in tea, berries, fruits, and vegetables, exhibits various biological functions, such as antioxidant and anti-inflammatory activity. PURPOSE To investigate the effect of API treatment in HN and to reveal its underlying mechanisms. METHODS The mice with HN were induced by potassium oxonate intraperitoneally and orally administered for two weeks. The effects of API on renal function, inflammation, fibrosis, and uric acid (UA) metabolism in mice with HN were evaluated. The effects of API on urate transporters were further examined in vitro. RESULTS The mice with HN exhibited abnormal renal urate excretion and renal dysfunction accompanied by increased renal inflammation and fibrosis. In contrast, API reduced the levels of serum UA, serum creatinine (CRE), blood urea nitrogen (BUN) and renal inflammatory factors in mice with HN. Besides, API ameliorated the renal fibrosis via Wnt/β-catenin pathway suppression. Furthermore, API potently promoted urinary UA excretion and inhibited renal urate transporter 1 (URAT1) and glucose transporter 9 (GLUT9) in mice with HN. In vitro, API competitively inhibited URAT1 and GLUT9 in a dose-dependent manner, with IC50 values of 0.64 ± 0.14 μM and 2.63 ± 0.69 μM, respectively. CONCLUSIONS API could effectively attenuate HN through co-inhibiting UA reabsorption and Wnt/β-catenin pathway, and thus it might be a potential therapy to HN.
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Affiliation(s)
- Yongmei Li
- Guangdong Provincial Key Laboratory of Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Zean Zhao
- Guangdong Provincial Key Laboratory of Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Jian Luo
- Guangdong Provincial Key Laboratory of Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Yanqing Jiang
- Guangdong Provincial Key Laboratory of Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Lu Li
- Guangdong Provincial Key Laboratory of Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Yanyu Chen
- Guangdong Provincial Key Laboratory of Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Leqi Zhang
- Guangdong Provincial Key Laboratory of Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Qinghua Huang
- Guangdong Provincial Key Laboratory of Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Ying Cao
- Guangdong Provincial Key Laboratory of Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Pingzheng Zhou
- Guangdong Provincial Key Laboratory of Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Ting Wu
- Guangdong Provincial Key Laboratory of Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Jianxin Pang
- Guangdong Provincial Key Laboratory of Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China.
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Antihyperuricemic, Anti-Inflammatory and Antihypertensive Effect of a Dry Extract from Solidago virgaurea L. (Asteraceae). Sci Pharm 2021. [DOI: 10.3390/scipharm89020027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Solidago virgaurea L. is a perennial plant used in European traditional medicine as a diuretic or a remedy for inflammatory conditions of the urinary tract but also for gout, especially in the Balkans. The present study was focused on a preclinical, in vivo evaluation of antihyperuricemic, anti-inflammatory, and antihypertensive effects of a dry extract from S. virgaurea L. (ESV). Colorimetric and HPLC–MS techniques were used to identify the main chemical constituents of ESV. Antihyperuricemic effect of ESV was assessed in a rat model of hyperuricemia induced by the administration of potassium oxonate. Antihypertensive effect of ESV was evaluated in hyperuricemic rats by monitoring systolic blood pressure with a non-invasive blood-pressure recording system. The anti-inflammatory effect of ESV was tested using a rat model of paw edema. The main chemical constituents of ESV were rutin and phenolic acids represented by chlorogenic and caffeic acid. ESV demonstrated significant antihyperuricemic effects in rats due to an uricosuric mechanism. Additionally, ESV reduced the progression of arterial hypertension in hyperuricemic rats and also showed anti-inflammatory properties slightly inferior to diclofenac. The results suggest that ESV could be a natural remedy for the treatment of gout and protection against endothelial dysfunction caused by hyperuricemia.
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Stack AG, Han D, Goldwater R, Johansson S, Dronamraju N, Oscarsson J, Johnsson E, Parkinson J, Erlandsson F. Dapagliflozin Added to Verinurad Plus Febuxostat Further Reduces Serum Uric Acid in Hyperuricemia: The QUARTZ Study. J Clin Endocrinol Metab 2021; 106:e2347-e2356. [PMID: 33075806 PMCID: PMC8063233 DOI: 10.1210/clinem/dgaa748] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Indexed: 01/10/2023]
Abstract
CONTEXT Combining a sodium-glucose cotransporter 2 inhibitor with a xanthine oxidase inhibitor (XOI) and a urate transporter 1 (URAT1) inhibitor may enhance serum uric acid (sUA) lowering. However, concerns exist regarding high urinary UA (uUA) excretion rates and subsequent crystallization in renal tubules. OBJECTIVE To assess whether dapagliflozin added to verinurad, a selective URAT1 inhibitor, and febuxostat, an XOI, increases uUA excretion. DESIGN Randomized, placebo-controlled, 2-way crossover study (NCT03316131). PATIENTS Adults with asymptomatic hyperuricemia. INTERVENTIONS Subjects (N = 36) were randomized to oral once-daily 9 mg verinurad plus 80 mg febuxostat plus 10 mg dapagliflozin for 7 days and 7 days of oral once-daily 9 mg verinurad plus 80 mg febuxostat plus placebo with an intervening 7- to 21-day washout period. MAIN OUTCOME MEASURE Difference in peak uUA excretion between groups from baseline to day 7. Secondary outcomes included changes in sUA levels and 24-h uUA excretion. RESULTS Both regimens lowered mean peak uUA excretion (least squares mean changes from baseline: -12.9 mg/h [95% confidence interval (CI): -21.0 to -4.7], dapagliflozin; -13.2 mg/h [95% CI -21.3 to -5.0], placebo). sUA concentrations were lower with dapagliflozin (mean treatment difference -62.3 µmol/L [95% CI -82.8 to -41.8]). Dapagliflozin did not impact verinurad pharmacokinetics, its main metabolites, or febuxostat or fasting plasma glucose levels vs verinurad plus febuxostat. There were no clinically relevant changes in safety parameters. CONCLUSIONS Dapagliflozin further reduced sUA without influencing uUA excretion, suggesting that its combination with verinurad and febuxostat at the doses tested does not adversely affect kidney function. CLINICAL TRIAL REGISTRATION NUMBER NCT03316131.
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Affiliation(s)
- Austin G Stack
- University Hospital Limerick, School of Medicine and Health Research Institute (HRI), University of Limerick, Limerick, Ireland
- Correspondence and Reprint Requests: Austin G. Stack, University Hospital Limerick, School of Medicine and Health Research Institute (HRI), University of Limerick, Limerick, V94 T9PX, Ireland. E-mail:
| | - David Han
- Parexel International, Glendale, California, USA
| | | | - Susanne Johansson
- AstraZeneca BioPharmaceuticals Research and Development, Gothenburg, Sweden
| | - Nalina Dronamraju
- AstraZeneca BioPharmaceuticals Research and Development, Gaithersburg, Maryland, USA
| | - Jan Oscarsson
- AstraZeneca BioPharmaceuticals Research and Development, Gothenburg, Sweden
| | - Eva Johnsson
- AstraZeneca BioPharmaceuticals Research and Development, Gothenburg, Sweden
| | - Joanna Parkinson
- AstraZeneca BioPharmaceuticals Research and Development, Gothenburg, Sweden
| | - Fredrik Erlandsson
- AstraZeneca BioPharmaceuticals Research and Development, Gothenburg, Sweden
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