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Ebstein E, Ottaviani S. Managing Gout in Patients with Metabolic Syndrome. Drugs Aging 2024:10.1007/s40266-024-01132-x. [PMID: 39060816 DOI: 10.1007/s40266-024-01132-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 07/28/2024]
Abstract
Gout is characterized by monosodium urate (MSU) crystal deposition secondary to hyperuricemia. Gout is associated with metabolic syndrome (MetS) and its related comorbid conditions such as cardiovascular disease (CVD). Major advances have been made in the comprehension of the link between MetS and gout. Despite observational studies suggesting an association between MetS-related conditions and hyperuricemia, there is no proof of causality. Most studies using Mendelian randomization did not find hyperuricemia as a causal factor for MetS-related conditions. In contrast, these conditions were found associated with hyperuricemia, which suggests a reverse causality. Among patients with gout, this high CVD risk profile implies the need for systematic screening for MetS-related conditions. Most international guidelines recommend systematic screening for and care of CVD and related risk factors in patients with gout. Some anti-hypertensive agents, such as losartan and calcium channel blockers, are able to decrease serum urate (SU) levels. However, there are potential interactions between gout management therapies and the treatment of metabolic diseases. Some data suggest that anti-inflammatory drugs used for gout flare treatment, such as colchicine or canakinumab, might have benefits for CVD. Regarding the impact of urate-lowering therapies on CVD risk, recent studies found a similar CVD safety profile for allopurinol and febuxostat. Finally, sodium-glucose cotransporter-2 inhibitors are promising for gout because of their ability to decrease SU levels and risk of recurrent flares. In this review, we focus on the clinical challenge of managing MetS in patients with gout, particularly older patients with co-medications.
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Affiliation(s)
- Esther Ebstein
- Rheumatology Department, Université Paris Cité, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France
| | - Sébastien Ottaviani
- Rheumatology Department, Université Paris Cité, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France.
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Lin CN, Ho CC, Hsieh PC, Hsiao CH, Nfor ON, Liaw YP. Polymorphism rs3733591 of the SLC2A9 gene and metabolic syndrome affect gout risk in Taiwan Biobank subjects. Front Genet 2024; 15:1374405. [PMID: 38689651 PMCID: PMC11058208 DOI: 10.3389/fgene.2024.1374405] [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: 01/22/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
Background Over the past few decades, gout and diseases like metabolic syndrome (MetS) have become more prevalent. Attempts have been made in Taiwan to identify the genes responsible for gout. A few gene loci, among them SLC2A9, have been identified using Taiwan Biobank (TWB) data. We, therefore, examined whether MetS could also account for the association between polymorphism SLC2A9 rs3733591 and gout. Methods The final analysis consisted of 73,558 subjects, of whom 2,709 had gout. To estimate the likelihood of gout occurrence based on rs3733591 and MetS, we used logistic regression models. Results Rs3733591-TC + CC compared to TT genotype was associated with gout (OR, 1.15; 95% CI, 1.06-1.25). Also associated with gout was MetS (OR, 1.21; 95% CI, 1.10-1.33). A significant interaction was seen between rs3733591 and MetS (p-value = 0.039). Using rs3733591-TT/no MetS as the reference group, the ORs (95% CI) for gout was 1.24 (1.11-1.38) for TC + CC/no MetS, 1.35 (1.17-1.56) for TT/MetS, and 1.39 (1.22-1.58) for TC + CC/MetS. However, subgroup analysis defined by sex showed no significant associations in women. Conclusion In summary, metabolic syndrome and SLC2A9 rs3733591 genotypes were interactively associated with gout in Taiwanese men, but not women.
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Affiliation(s)
- Chun-Nan Lin
- Department of Emergency Medicine, Chung-Kang Branch, Cheng Ching Hospital, Taichung, Taiwan
| | - Chien-Chang Ho
- Department of Physical Education, Fu Jen Catholic University, New Taipei, Taiwan
- Research and Development Center for Physical Education, Health, and Information Technology, Fu Jen Catholic University, New Taipei, Taiwan
| | - Pao-Chun Hsieh
- Department of Obstetrics and Gynecology, Chung-Kang Branch, Cheng Ching Hospital, Taichung, Taiwan
| | - Chih-Hsuan Hsiao
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Oswald Ndi Nfor
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Yung-Po Liaw
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
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Lu S, Qian T, Cao F, Kang T, Liu X, Wang C, Xia Y, Hou X. Prevalence and treatment rate of gout by depressive symptom severity: A cross-sectional analysis of NHANES 2007-2018. Int J Rheum Dis 2024; 27:e14959. [PMID: 37984452 DOI: 10.1111/1756-185x.14959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/02/2023] [Accepted: 10/15/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The co-disease of depression and gout is becoming more common in the modern era. However, the relationship between the severity of depressive symptoms and gout prevalence and treatment rate was still unclear. OBJECTIVE This study aimed to determine the relationship between the prevalence, treatment rate of gout, and the severity of depression in the United States. METHOD The cross-sectional analysis of the 2007-2018 National Health and Nutrition Examination Survey (NHANES) for participants with depression was performed. According to their Patient Health Questionnaire-9 (PHQ-9) scores, participants were categorized as none, mild, moderate, moderately severe, and severe. To learn the correlation between the severity of depressive symptoms and the prevalence and treatment rate of gout using multivariate logistic regression to control for confounder interference. RESULTS A total of 25 022 patients were included in this study. As the severity of the depressive symptoms worsened (Mild, Moderate and Moderately severe), the risk of gout increased in non-adjusted model and model 1,2,3 (p-value for trend =.01 in non-adjusted model, <.0001 in model 1, <.01 in models 2 and 3; prevalence group in Model 1, aOR1.71, 95% CI (1.40, 2.08) in the mild group, aOR1.68, 95% CI (1.19, 2.39) in the moderate group, aOR1.31,95% CI (0.82, 2.11) in the moderately severe group, aOR1.21, 95% CI (0.62, 2.38) in the severe group). However, the lower gout prevalence trend has no statistical significance after adjusting all factors in Model 4(p-value for trend =.98). Compared with patients without depression, only a few patients received treatment, especially patients with severe depression (none, 80.1%; severe, 0.2%). The more severe the depression, the lower the treatment rate (p-value for trend: non-adjusted model, p < .001; model 1, p = .05; model 2, p = .02; model 3, p = .03). CONCLUSION Compared with patients without depression, the patients with depression had a higher risk of gout. With the aggravation of depression, the prevalence of gout and the rate of treatment both were decreased. Patients with gout and depression need to receive multidisciplinary care after diagnosis. However, currently, treatment cannot meet the needs of the current patients.
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Affiliation(s)
- Siyi Lu
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Tangliang Qian
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Fengjiao Cao
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Tianlun Kang
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoping Liu
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Chaoxin Wang
- Department of Functional Test, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Yun Xia
- IRB (Institutional Review Board) Office, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Xiujuan Hou
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
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Ahn JK. Epidemiology and treatment-related concerns of gout and hyperuricemia in Korean. JOURNAL OF RHEUMATIC DISEASES 2023; 30:88-98. [PMID: 37483480 PMCID: PMC10324937 DOI: 10.4078/jrd.2022.0001] [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: 12/15/2022] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 07/25/2023]
Abstract
Gout is the most common form of inflammatory arthritis that affects mainly middle-aged men, and there is clear evidence of an association between hyperuricemia and the risk for gout. Increasing prevalence of gout and hyperuricemia has been reported in many countries. The prevalence of gout and hyperuricemia are constantly increasing in Korea with the patients at risk for developing a variety of comorbidities. Although there have been studies on the association between gout or serum uric acid level and several neurodegenerative diseases, cancer, and cardiovascular mortality, the causal relationship between gout and these comorbidities are still unclear. The associations of substantial economic burden with hyperuricemia, gout attack, and suboptimal treatment are well known. Gout is a disease that requires lifelong management including lifestyle modification. However, gout is poorly managed worldwide although effective urate-lowering drugs exist. In this review, we addressed epidemiological studies and treatment-related problems in the Korean population with gout or hyperuricemia to obtain the best clinical outcomes and reduce their medical burden.
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Affiliation(s)
- Joong Kyong Ahn
- Divison of Rheumatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Choi HG, Kim SY, Chung J. The Risk of BPPV, Meniere's Disease, and Vestibular Neuronitis in Patients with Gout: A Longitudinal Follow-Up Study Using a National Health Screening Cohort. J Clin Med 2022; 12:jcm12010185. [PMID: 36614986 PMCID: PMC9821089 DOI: 10.3390/jcm12010185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/21/2022] [Accepted: 12/24/2022] [Indexed: 12/28/2022] Open
Abstract
This study evaluated the impact of pre-existing gout on the occurrence of benign paroxysmal positional vertigo (BPPV), Meniere’s disease, and vestibular neuronitis, with the goal of identifying novel associations of gout with other comorbid diseases. The 2002−2019 Korean National Health Insurance Service Health Screening Cohort data were retrospectively analyzed. 23,827 patients with gout were matched to 95,268 controls without gout for age, sex, income, region of residence, and index date. The occurrence of BPPV, Meniere’s disease, and vestibular neuronitis was evaluated in both groups. The hazard ratios (HRs) of gout for BPPV, Meniere’s disease, and vestibular neuronitis were calculated using a stratified Cox proportional hazard model. Participants with gout demonstrated a 1.13-fold higher risk of BPPV (95% CI, 1.06−1.21, p < 0.001) and a 1.15-fold higher risk of Meniere’s disease (95% CI, 1.15−1.37, p < 0.001) than the matched control group. However, the HR for vestibular neuronitis was not significantly higher in the gout group (adjusted HR = 1.06, 95% CI, 0.93−1.21, p = 0.391). A previous history of gout was related to a higher risk of BPPV and Meniere’s disease. Additional studies are necessary to elucidate the mechanism underlying the relationship between gout and comorbid diseases such as BPPV and Meniere’s disease.
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Affiliation(s)
- Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam 13488, Republic of Korea
| | - Juyong Chung
- Department of Otorhinolaryngology, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 54538, Republic of Korea
- Correspondence: ; Tel.: +82-63-859-1489; Fax: +82-63-858-3922
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Eun Y, Han K, Lee SW, Kim K, Kang S, Lee S, Cha HS, Koh EM, Kim H, Lee J. Increased risk of incident gout in young men with metabolic syndrome: A nationwide population-based cohort study of 3.5 million men. Front Med (Lausanne) 2022; 9:1010391. [DOI: 10.3389/fmed.2022.1010391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/24/2022] [Indexed: 11/15/2022] Open
Abstract
BackgroundTo date, few studies have focused on risk factors for gout in young people, and large-scale studies on the relationship between metabolic syndrome (MetS) and gout are lacking. We aimed to investigate the association between gout and MetS in a large nationwide population-based cohort of young men who participated in national health examination.Materials and methodsCohort included men aged 20–39 years who participated in a health check-up in 2009–2012. A total of 3,569,104 subjects was included in the study, excluding those who had a previous diagnosis of gout or had renal impairment. The outcome was the occurrence of gout, which was defined using the diagnosis code of gout in the claims database. Cox proportional hazard model was used to evaluate the association between MetS and incident gout.ResultsMean follow-up duration was 7.35 ± 1.24 years and the incidence rate of gout was 3.36 per 1,000 person-years. The risk of gout in subjects with MetS was 2.4-fold higher than subjects without MetS. Among the components of MetS, hypertriglyceridemia and abdominal obesity showed the greatest association with gout. As the number of MetS components increased, the risk of gout increased. The association between gout and MetS was more pronounced in relatively young subjects and in low- or normal-weight subjects.ConclusionMetabolic syndrome is an important risk factor for the gout in young men. In particular, the association between MetS and gout was greater in young and non-obese men. Management of MetS in young men will be important for future gout prevention.
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Cao Y, Han X, Wang X, Zhang Y, Xiao H, Zeng X. Risk factors of urinary calculi in men with gout. Clin Rheumatol 2022; 41:3143-3150. [PMID: 35739406 DOI: 10.1007/s10067-022-06246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate risk factors of urinary calculi in men with gout. METHOD A study was conducted at a tertiary hospital in Beijing from October 2016 to January 2020. Male gouty patients were included. Logistic regression was used to establish the association between patients' characteristics and urinary stone disease. A cluster analysis was performed to identify distinct phenotypes of gout based on nine common comorbidities. RESULT The prevalence of calculi was 23.6% among 454 patients. Longer disease courses and comorbid dyslipidemia were associated with an increased risk of urinary calculi, with an OR of 2.76 (95% CI 1.40-5.64) (p = 0.004) for patients with a disease course of 10 years or longer compared with those with a disease course of gout shorter than 1 year, and an OR of 1.71 (95% CI 1.04-2.88) (p = 0.039) for patients with dyslipidemia. Three clinical phenotypes were recognized. Cluster C1 consists of patients with large body mass index, dyslipidemia, and abnormal liver function. The prevalence of stone was 23.2%. Patients in cluster C2 had fewer comorbidities and the lowest stone risk (13.5%). Cluster C3 had more cardiovascular comorbidities and the highest prevalence of stone (47.1%). CONCLUSION Longer disease course and dyslipidemia contribute to stone risk in men with gout. Three distinct phenotypes represent distinct pathophysiological mechanisms underlying stone occurrence, which would help us to optimize gout management. Key points • Patients with gout have higher risks for urinary stones. This study found that longer disease courses and comorbid dyslipidemia were associated with an increased risk of urinary calculi in largely untreated young men with uncontrolled gout. • This study reveals three distinct phenotypes of gout based on comorbidities. Among all, the group with more cardiovascular comorbidities has the highest prevalence of stones.
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Affiliation(s)
- Yu Cao
- Department of Family Medicine and Division of General Internal Medicine, Department of Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, State Key Laboratory of Complex Severe and Rare Diseases (Peking Union Medical College Hospital), Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China
| | - Xinxin Han
- Department of Family Medicine and Division of General Internal Medicine, Department of Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, State Key Laboratory of Complex Severe and Rare Diseases (Peking Union Medical College Hospital), Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China
| | - Xiaoxue Wang
- Department of Family Medicine and Division of General Internal Medicine, Department of Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, State Key Laboratory of Complex Severe and Rare Diseases (Peking Union Medical College Hospital), Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China
| | - Yun Zhang
- Department of Family Medicine and Division of General Internal Medicine, Department of Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, State Key Laboratory of Complex Severe and Rare Diseases (Peking Union Medical College Hospital), Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China
| | - He Xiao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, State Key Laboratory of Complex Severe and Rare Diseases (Peking Union Medical College Hospital), Beijing, 100730, China
| | - Xuejun Zeng
- Department of Family Medicine and Division of General Internal Medicine, Department of Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, State Key Laboratory of Complex Severe and Rare Diseases (Peking Union Medical College Hospital), Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China.
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Choi HG, Kwon BC, Kwon MJ, Kim JH, Kim JH, Park B, Lee JW. Association between Gout and Dyslipidemia: A Nested Case-Control Study Using a National Health Screening Cohort. J Pers Med 2022; 12:jpm12040605. [PMID: 35455721 PMCID: PMC9032264 DOI: 10.3390/jpm12040605] [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: 03/11/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 01/25/2023] Open
Abstract
The association between lipid levels and uric acid disorders remains controversial. We evaluated the association between dyslipidemia and gout in a large cohort from the Korean National Health Insurance Service-Health Screening Cohort. Among the 514,866 participants aged ≥40 years, 16,679 gout participants were selected and matched with 66,716 control participants for income, region of residence, sex, and age. We used the ICD-10 codes to define dyslipidemia (E78) and gout (M10) and diagnosis was confirmed when each was reported ≥2 times. The odds ratios (ORs) of dyslipidemia history were calculated using conditional logistic regression in crude, partial, and fully adjusted models. The days of statin use, systolic and diastolic blood pressure, fasting glucose level, total cholesterol, obesity, Charlson comorbidity index, alcohol consumption, and smoking were used as covariates. Patients with gout had a significantly higher dyslipidemia history than those without gout (33.1% vs. 24.0%, p < 0.001). The association was significant after adjustment (OR in partial adjusted model = 1.50, 95% confidence interval (CI) = 1.44−1.57; OR in fully adjusted model = 1.43, 95% CI = 1.37−1.49). These findings were consistent with the subgroup analysis. Our findings suggest that dyslipidemia history is more likely in patients with gout aged ≥40 years than in healthy controls among Korean population.
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Affiliation(s)
- Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang 14068, Korea; (H.G.C.); (B.P.)
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Korea
| | - Bong-Cheol Kwon
- Department of Orthopedic Surgery, Hallym University College of Medicine, Anyang 14068, Korea;
| | - Mi Jung Kwon
- Department of Pathology, Hallym University College of Medicine, Anyang 14068, Korea;
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University College of Medicine, Anyang 14068, Korea;
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University College of Medicine, Anyang 14068, Korea;
| | - Bumjung Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang 14068, Korea; (H.G.C.); (B.P.)
| | - Jung Woo Lee
- Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
- Bigdata Platform Business Group, Wonju Yonsei Medical Center, Yonsei University, Wonju 26426, Korea
- Correspondence: ; Tel.: +82-33-741-0114
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Culture and establishment of self-renewing human liver 3D organoids with high uric acid for screening antihyperuricemic functional compounds. Food Chem 2021; 374:131634. [PMID: 34838408 DOI: 10.1016/j.foodchem.2021.131634] [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: 08/08/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022]
Abstract
Hyperuricemia (HUA) is a metabolic disease caused by disorders of purine metabolism, the prevalence of which has increased worldwide. At present, most drugs aimed at lowering uric acid have toxic side effects, and in vitro screening of uric acid-lowering active substances are inefficient. Here, a long-term 3D human liver organoid culture system with high uric acid for screening and evaluating the efficacy of uric acid-lowering functional compounds. This liver organoids can be established from single hepatocytes and grown for multiple months, while retaining key morphological and functional features. Furthermore, establishment of HUA organoids model was verified by antihyperuricemic drugs allopurinol, as well as reported bioactive peptides, which significantly reduced uric acid production in the liver organoids (p < 0.05). The results demonstrated that it has the potential to be used as a rapid and valid in vitro model to screen antihyperuricemic compounds that mimics in vivo cell growth patterns.
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Simple metabolic markers associated with tophaceous gout. Clin Rheumatol 2021; 40:5047-5053. [PMID: 34264406 DOI: 10.1007/s10067-021-05861-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/05/2021] [Accepted: 07/10/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The relationship between tophaceous gout and metabolic markers is not well understood. The aim of this study was to compare the correlations between different metabolic markers and tophi and evaluate their potential predictive values for tophus. METHOD We analysed the data of gout patients in Beijing Jishuitan Hospital from 2013 to 2020. Ten laboratory indicators (UA, eGFR, underexcretion, GLU, TRIG, HDL-C, ALT, TBIL, γ-GT and UPH) were included to evaluate the relationship between tophaceous gout and metabolic markers. RESULTS Tophi was present in 14.7% (119/808) of gout patients. UA, eGFR, ALT and γ-GT were independently related to the development of tophi; UA and γ-GT were positively correlated. The γ-GT/ALT ratio and UA/eGFR ratio showed a positive correlation with tophi, with (rho, P) of (0.305, < 0.001) and (0.195, < 0.001), respectively. The γ-GT/ALT ratio showed the best classificatory performance (AUC = 0.749, P < 0.001) for tophi among the four positive correlation indicators. With increasing integer γ-GT/ALT ratio, the incidence of tophi (4.9%, 9.7%, 22.3% and 38.4%, P < 0.001), chronic kidney disease (2.5%, 5.2%, 12.3% and 19.2%, P < 0.001) and hyperuricemia over 10 years (6.6%, 10.7%, 18.5% and 26.4%, P < 0.001) showed a progressive increase. The γ-GT/ALT ratio was positively correlated with the number of tophi and duration of hyperuricemia, negatively correlated with eGFR. CONCLUSIONS UA, eGFR, γ-GT and ALT were independently associated with tophi. The γ-GT/ALT ratio may be used as a predictor or monitor of tophi.
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Dong G, Feng J, Sun F, Chen J, Zhao XM. A global overview of genetically interpretable multimorbidities among common diseases in the UK Biobank. Genome Med 2021; 13:110. [PMID: 34225788 PMCID: PMC8258962 DOI: 10.1186/s13073-021-00927-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/22/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Multimorbidities greatly increase the global health burdens, but the landscapes of their genetic risks have not been systematically investigated. METHODS We used the hospital inpatient data of 385,335 patients in the UK Biobank to investigate the multimorbid relations among 439 common diseases. Post-GWAS analyses were performed to identify multimorbidity shared genetic risks at the genomic loci, network, as well as overall genetic architecture levels. We conducted network decomposition for the networks of genetically interpretable multimorbidities to detect the hub diseases and the involved molecules and functions in each module. RESULTS In total, 11,285 multimorbidities among 439 common diseases were identified, and 46% of them were genetically interpretable at the loci, network, or overall genetic architecture levels. Multimorbidities affecting the same and different physiological systems displayed different patterns of the shared genetic components, with the former more likely to share loci-level genetic components while the latter more likely to share network-level genetic components. Moreover, both the loci- and network-level genetic components shared by multimorbidities converged on cell immunity, protein metabolism, and gene silencing. Furthermore, we found that the genetically interpretable multimorbidities tend to form network modules, mediated by hub diseases and featuring physiological categories. Finally, we showcased how hub diseases mediating the multimorbidity modules could help provide useful insights for the genetic contributors of multimorbidities. CONCLUSIONS Our results provide a systematic resource for understanding the genetic predispositions of multimorbidities and indicate that hub diseases and converged molecules and functions may be the key for treating multimorbidities. We have created an online database that facilitates researchers and physicians to browse, search, or download these multimorbidities ( https://multimorbidity.comp-sysbio.org ).
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Affiliation(s)
- Guiying Dong
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433 China
- MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433 China
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433 China
- MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433 China
- Zhangjiang Fudan International Innovation Center, Shanghai, 200433 China
| | - Fengzhu Sun
- Molecular and Computational Biology Program, University of Southern California, Los Angeles, CA 90089 USA
| | - Jingqi Chen
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433 China
- MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433 China
- Zhangjiang Fudan International Innovation Center, Shanghai, 200433 China
| | - Xing-Ming Zhao
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433 China
- MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433 China
- Zhangjiang Fudan International Innovation Center, Shanghai, 200433 China
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Effects of Urate-Lowering Therapy on Risk of Hyperlipidemia in Gout by a Population-Based Cohort Study and on In Vitro Hepatic Lipogenesis-Related Gene Expression. Mediators Inflamm 2020; 2020:8890300. [PMID: 33273891 PMCID: PMC7683152 DOI: 10.1155/2020/8890300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/14/2020] [Accepted: 10/24/2020] [Indexed: 12/16/2022] Open
Abstract
Patients with gout are at a higher risk of cardiovascular disease, which is associated with hyperlipidemia. Management of gout in Taiwan is poor, and the association between urate-lowering therapy (ULT) among gout patients and hyperlipidemia is unclear. We conducted a retrospective cohort study using data from the Longitudinal Health Insurance Database (LHID) of Taiwan on new-onset gout patients and a comparison cohort without gout. A Cox proportional hazards model was used to analyze differences in the risk of hyperlipidemia between patients with and without gout after considering related comorbidities. We also examined the ULT medications on the hepatic expression of lipogenesis-related genes. After adjusting for potential confounders, the case group (44,413 patients) was found to have a higher risk of hyperlipidemia than the control cohort (177,652 patients) [adjusted hazards ratio (aHR) = 2.55]. Gout patients without antigout treatment had significantly higher risk of hyperlipidemia than the control cohort (aHR = 3.10). Among gout patients receiving ULT, except those receiving probenecid (aHR = 0.80), all had significantly lower risk of hyperlipidemia than gout patients without ULT (all aHR < 0.90). Using real-time polymerase chain reaction, we found that most of the antigout drugs decreased the expression of hepatic genes related to lipogenesis in differentiated HepaRG cells. These data indicate that these antigout drugs reduce hyperlipidemia in gout patients, partly via the reduction in expression of lipogenesis-related genes, leading to improved blood lipid profiles. We provide evidence of the strong association between gout and hyperlipidemia and highlight the need for appropriate treatment guidelines.
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Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol 2020; 16:380-390. [PMID: 32541923 DOI: 10.1038/s41584-020-0441-1] [Citation(s) in RCA: 537] [Impact Index Per Article: 134.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 12/12/2022]
Abstract
Gout is the most common inflammatory arthritis and occurs when hyperuricaemia, sustained elevation of serum urate levels resulting in supersaturation of body tissues with urate, leads to the formation and deposition of monosodium urate crystals in and around the joints. Recent reports of the prevalence and incidence of gout vary widely according to the population studied and methods employed but range from a prevalence of <1% to 6.8% and an incidence of 0.58-2.89 per 1,000 person-years. Gout is more prevalent in men than in women, with increasing age, and in some ethnic groups. Despite rising prevalence and incidence, suboptimal management of gout continues in many countries. Typically, only a third to half of patients with gout receive urate-lowering therapy, which is a definitive, curative treatment, and fewer than a half of patients adhere to treatment. Many gout risk factors exist, including obesity, dietary factors and comorbid conditions. As well as a firmly established increased risk of cardiovascular disease and chronic kidney disease in those with gout, novel associations of gout with other comorbidities have been reported, including erectile dysfunction, atrial fibrillation, obstructive sleep apnoea, osteoporosis and venous thromboembolism. Discrete patterns of comorbidity clustering in individuals with gout have been described. Increasing prevalence and incidence of obesity and comorbidities are likely to contribute substantially to the rising burden of gout.
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Affiliation(s)
- Mats Dehlin
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK. .,Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK.
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Cheon YH, Song JS. What is the Best Choice for Urate-lowering Therapy for Korean? JOURNAL OF RHEUMATIC DISEASES 2020. [DOI: 10.4078/jrd.2020.27.2.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Yun-Hong Cheon
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jung Soo Song
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, Korea
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Marques MS, Ferreira Freitas R, Araújo Veloso Popoff D, Piana Santos Lima de Oliveira F, Rodrigues Moreira MH, Araújo Drummond AM, Schmidt França D, Nogueira dos Santos LA, de Siqueira e Rocha ME, Brant Rocha JP, Brant Rocha MC, Santos Figueiredo Brito MF, Prates Caldeira A, Maria Borborema FA, Santos VM, Santos Brant Rocha J. Health conditions associated with overweight in climacteric women. PLoS One 2019; 14:e0218497. [PMID: 31830047 PMCID: PMC6907811 DOI: 10.1371/journal.pone.0218497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/18/2019] [Indexed: 01/01/2023] Open
Abstract
This study aims to investigate the association between health conditions and overweight in climacteric women assisted by primary care professionals. It is a cross-sectional study conducted with 874 women from 40 to 65 years of age, selected by probabilistic sampling between August 2014 and August 2015. In addition to the outcome variable, overweight and obesity, other variables such as sociodemographic, reproductive, clinical, eating and behavioural factors were evaluated. Descriptive analyses of the variables investigated were performed to determine their frequency distributions. Then, bivariate analyses were performed through Poisson regression. For the multivariate analyses, hierarchical Poisson regression was used to identify factors associated with overweight and obesity in the climacteric period. The prevalence of overweight and obesity was 74%. Attending public school (PR: 1.30-95% CI 1.14-1.50), less schooling (PR: 1.11-95% CI 1.01-1.23), gout (PR: 1.18-95% CI 1.16-1.44), kidney disease (PR: 1.18-95% CI 1.05-1.32), metabolic syndrome (MS) (PR: 1.19-95% CI 1.05-1.34) and fat intake (PR: 1.12-95% CI 1.02-1.23) were considered risk factors for overweight. Having the first birth after 18 years of age (PR: 0.89-95% CI 0.82 to 0.97) was shown to be a protective factor for overweight and obesity. The presence of overweight and obesity is associated with sociodemographic, reproductive, clinical and eating habits.
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Affiliation(s)
- Maria Suzana Marques
- State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
- Fipmoc University Center (UNIFIPMoc), Montes Claros, Minas Gerais, Brazil
| | | | - Daniela Araújo Veloso Popoff
- State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
- Fipmoc University Center (UNIFIPMoc), Montes Claros, Minas Gerais, Brazil
| | | | | | | | | | - Luís Antônio Nogueira dos Santos
- State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
- Fipmoc University Center (UNIFIPMoc), Montes Claros, Minas Gerais, Brazil
| | | | | | | | | | - Antônio Prates Caldeira
- State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
- Fipmoc University Center (UNIFIPMoc), Montes Claros, Minas Gerais, Brazil
| | | | | | - Josiane Santos Brant Rocha
- State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
- Fipmoc University Center (UNIFIPMoc), Montes Claros, Minas Gerais, Brazil
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Abstract
PURPOSE OF REVIEW There is a growing, largely inconsistent, literature on the role of vitamin D in association with type 2 diabetes, insulin resistance/insulin secretion, glycemic indices, and complications of type 2 diabetes. Pathophysiologic, bystander, preventive, and treatment roles of vitamin D have all been proposed. In this focused review, we attempt to organize and clarify our current information in this area. RECENT FINDINGS Clinical study interpretation is difficult because of variability in dosage, dosage form, study duration, and populations studied, as well as recently reported normal human polymorphisms in vitamin D synthesis and catabolism, vitamin D-binding protein, and vitamin D receptors in addition to a host of potential epigenetic confounders. Low vitamin D status appears to be associated with type 2 diabetes and most other insulin resistance disorders reported to date. The extraskeletal benefits of supplementation/repletion in these disorders in our species, with a few highlighted exceptions, remain to be established. This focused review attempts to summarize our current knowledge in this burgeoning area through a review of key meta-analyses, observational studies, randomized control trials, and Mendelian randomization studies and will hopefully serve as a guide to indicate future research directions and current best practice.
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Affiliation(s)
- Alan Sacerdote
- Division with Endocrinology, New York City Health + Hospitals/Woodhull, 760 Broadway, Brooklyn, NY, 11206, USA.
- Division of Endocrinology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
- NYU School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.
- St. George's University, St. George's, WI, Grenada.
| | - Paulomi Dave
- Department of Medicine, New York City Health + Hospitals/Woodhull, 760 Broadway, Brooklyn, NY, 11206, USA
| | - Vladimir Lokshin
- Division of Endocrinology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Gül Bahtiyar
- Division with Endocrinology, New York City Health + Hospitals/Woodhull, 760 Broadway, Brooklyn, NY, 11206, USA
- Division of Endocrinology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
- NYU School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
- St. George's University, St. George's, WI, Grenada
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Zhang Y, Yang Y, Xue L, Wen J, Bo L, Tang M, Yang R, Yan D, Liu Z. Clinical characteristics of patients under 40 years old with early-onset hyperuricaemia: a retrospective monocentric study in China. BMJ Open 2019; 9:e025528. [PMID: 31462461 PMCID: PMC6720558 DOI: 10.1136/bmjopen-2018-025528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate the clinical characteristics of patients with early-onset hyperuricaemia (HUC). METHODS A retrospective study using data from the Second Affiliated Hospital of Soochow University was conducted. 623 patients with HUC were divided into early-onset group and late-onset group. Another 201 healthy subjects ≤40 years old were regarded as control group. The data of physical measurements and biochemistry test were collected. Clinical data of early-onset group were compared with late-onset group and control group by analysis of variance (ANOVA) and χ2 test. Principal component analysis (PCA) was applied. Logistic regression was used to identify the clinical factors correlated with patients with early-onset HUC. RESULTS The patients of early-onset group had different body mass index (BMI), serum albumin, alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP), gamma-glutamyltransferase (GGT), creatinine (Cr), triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), TG/high density lipoprotein (HDL) ratio, HDL and percentage of males, hypertension (HBP) as well as fatty liver compared with healthy people in the control group. Early-onset group patients had different albumin, ALT, fasting blood glucose, Cr, percentage of males and HBP compared with late-onset group patients. PCA identified four significant patterns including PC1 (labelled 'TG and HDL'), PC2 (labelled 'fatty liver and liver enzymes'), PC3 (labelled 'TC and LDL') and PC4 (labelled 'AKP'). The results of univariate and multivariate logistic regression analysis showed that BMI, HBP and albumin were correlative factors for early onset of HUC when the patients with early-onset and late-onset HUC were involved, while gender, BMI, PC1, PC2 and PC4 were correlative factors for early-onset HUC when the early-onset and control groups were involved. CONCLUSION This study described a group of patients with early-onset HUC with distinct clinical features. Gender, BMI, 'TG and HDL', 'fatty liver and liver enzymes' and 'AKP' have higher values than HBP, type 2 diabetes mellitus and 'TC and LDL' in patients under 40 years old with early-onset HUC.
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Affiliation(s)
- Yi Zhang
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yong Yang
- Center Laboratory, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Leixi Xue
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian Wen
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lin Bo
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Mei Tang
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ru Yang
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Dong Yan
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhichun Liu
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, China
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Wu J, Zhang YP, Qu Y, Jie LG, Deng JX, Yu QH. Efficacy of uric acid-lowering therapy on hypercholesterolemia and hypertriglyceridemia in gouty patients. Int J Rheum Dis 2019; 22:1445-1451. [PMID: 31317680 DOI: 10.1111/1756-185x.13652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 06/03/2019] [Accepted: 06/13/2019] [Indexed: 12/17/2022]
Abstract
AIM To investigate the effects on hypercholesterolemia and hypertriglyceridemia in gouty patients receiving uric acid-lowering therapy (UALT). METHODS A retrospective study was performed from January 2015 to December 2017 in gouty patients receiving UALT. A total of 124 gouty patients with hypercholesterolemia or hypertriglyceridemia who were administered UALT were monitored. Of the 124 patients with gout, 52 were treated with febuxostat, 29 were treated with allopurinol, and 43 were treated with benzbromarone. Cholesterol and triglyceride levels were recorded and analyzed following treatment for 8-10 weeks. RESULTS We compared the efficacy of febuxostat, allopurinol, and benzbromarone. All therapies mildly influenced serum cholesterol and triglyceride levels. Febuxostat significantly decreased cholesterol and triglyceride levels in patients who did not receive lipid-lowering therapy. Allopurinol and benzbromarone modestly decreased triglyceride levels, but cholesterol levels were unaffected. CONCLUSION Uric acid-lowering therapy benefits hyperlipidemia in gouty patients. Febuxostat effectively improved serum cholesterol and triglyceride levels compared to allopurinol and benzbromarone in patients with gout.
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Affiliation(s)
- Jing Wu
- Department of Rheumatology and Clinical Immunology, ZhuJiang Hospital, Southern Medical University, Guangzhou, China
| | - Yu-Ping Zhang
- Department of Rheumatology and Clinical Immunology, ZhuJiang Hospital, Southern Medical University, Guangzhou, China
| | - Yuan Qu
- Department of Rheumatology and Clinical Immunology, ZhuJiang Hospital, Southern Medical University, Guangzhou, China
| | - Li-Gang Jie
- Department of Rheumatology and Clinical Immunology, ZhuJiang Hospital, Southern Medical University, Guangzhou, China
| | - Jia-Xin Deng
- Department of Rheumatology and Clinical Immunology, ZhuJiang Hospital, Southern Medical University, Guangzhou, China
| | - Qing-Hong Yu
- Department of Rheumatology and Clinical Immunology, ZhuJiang Hospital, Southern Medical University, Guangzhou, China
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Hou C, Liu D, Wang M, Gong C, Li Y, Yang L, Yao M, Yuan E, Ren J. Novel xanthine oxidase-based cell model using HK-2 cell for screening antihyperuricemic functional compounds. Free Radic Biol Med 2019; 136:135-145. [PMID: 30980888 DOI: 10.1016/j.freeradbiomed.2019.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/26/2019] [Accepted: 04/05/2019] [Indexed: 01/02/2023]
Abstract
Hyperuricemia is a metabolic disease caused by disorders of purine metabolism, the prevalence of which has increased worldwide. Here, a cell model for high uric acid production was established in vitro employing cultured human kidney cells (HK-2 cells), and its molecular basis was analyzed using gene expression profile. High performance liquid chromatography (HPLC) was used to monitor the content of metabolites in cell culture media. Adenosine addition was found to induce HK-2 cells to produce uric acid precursors (inosine and hypoxanthine). Furthermore, the cell model was verified by confirming the antihyperuricemic effect of the widely used antihyperuricemic drugs allopurinol, probenecid, and febuxostat, as well as reported bioactive peptides and amino acids, encompassing glutathione, tryptophan and carnosine, which significantly reduced uric acid production in the HK-2 cells (p < 0.05). RNA-Seq technology was used to perform a wide transcriptome analysis of the hyperuricemic cell model, and the results demonstrated that it has the potential to be used as a rapid and valid in vitro model to screen antihyperuricemic compounds that mimics in vivo cell growth patterns.
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Affiliation(s)
- Chuanli Hou
- School of Food Sciences and Engineering, South China University of Technology, Guangzhou 510641, China
| | - Dan Liu
- School of Food Sciences and Engineering, South China University of Technology, Guangzhou 510641, China
| | - Ming Wang
- School of Food Sciences and Engineering, South China University of Technology, Guangzhou 510641, China
| | - Congcong Gong
- School of Food Sciences and Engineering, South China University of Technology, Guangzhou 510641, China
| | - Yujuan Li
- School of Food Sciences and Engineering, South China University of Technology, Guangzhou 510641, China
| | - Liu Yang
- School of Food Sciences and Engineering, South China University of Technology, Guangzhou 510641, China
| | - Maojin Yao
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia, Charlottesville, USA
| | - Erdong Yuan
- School of Food Sciences and Engineering, South China University of Technology, Guangzhou 510641, China
| | - Jiaoyan Ren
- School of Food Sciences and Engineering, South China University of Technology, Guangzhou 510641, China; Sino-Singapore International Joint Research Institute, Guangzhou Knowledge City, Huangpu District, Guangzhou, 510663, China.
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