Gout is a common inflammatory arthritis that is caused by chronically-elevated serum uric acid (sUA) levels (hyperuricemia).
KeywordsGout; hyperuricemia; uricase; URAT1; coevolution; urate transporters for urate homeostasis
Overview
Gout and hyperuricemiaGout is a debilitating inflammatory arthritis of increasing prevalence that is caused by chronically elevated levels of serum uric acid (sUA), or hyperuricemia, defined as concentrations exceeding 6.8 mg/dL (408 μM). In healthy nongouty individuals, serum urate levels are normally in the range of 3.5-7 mg/dL (210 -420 μM) [1]. Prolonged hyperuricemia can initiate the precipitation of the uric acid in joints and other tissues, and these deposits can trigger an acute and painful immune response known as a gout flare. Hyperuricemia is also strongly and independently associated with a number of other important disorders including hypertension, cardiovascular disease and metabolic syndrome [2]. A number of therapies for gout that lower sUA levels target transporters for uric acid, some which are also important drug transporters.
Uric acid homeostasis in humans in health and diseaseUric acid is produced mainly in the liver and gastrointestinal tract by the degradation of endogenous and dietary purines. Sources of endogenous purines include nucleotides such as ATP, and DNA and RNA that are recovered from dying cells. These purines are degraded into uric acid by xanthine oxidase in the liver. Dietary purines are absorbed in the gut by the CNT2 transporter and are quantitatively metabolized to uric acid by endogenous xanthine oxidase within intestinal enterocytes (see Figure 1b). In non-primate mammals, uric acid is converted to more highly soluble allantoin by urate oxidase (uricase). In primates including humans, however, uric acid is the end product of purine catabolism due to the progressive