Page 72 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology Gut microbiota and hyperuricemia: Mechanisms and therapeutic strategies

elimination. UA is transported from the bloodstream administered due to their effectiveness in easing pain
into the intestine, where it is either directly excreted or and reducing inflammation. Nonetheless, it is critical to
decomposed by bacteria such as E. coli, Lactobacillus, and recognize that NSAIDs may modify the homeostasis of the
Pseudomonas. Microbiome analysis has revealed that gout intestinal microbiota, possibly increasing the abundance of
patients have a distinct gut microbiota composition, with Gram-negative microscopic organisms and concurrently
an increased abundance of genera, such as Bacteroides and reducing the abundance of Gram-positive microbes within
Proteobacteria, and specific species, such as Bacteroides the intestinal environment. 42,60,61 HUA management is
caccae and Bacteroides xylanisolvens. Lactobacillus DM9218 a chronic and long-term commitment that demands
was found to improve the integrity of the intestinal barrier persistent adherence to treatment strategies to maintain
in high-fructose diet-fed mice. These findings highlight SUA levels below the therapeutic target of 360 μmol/L.
the gut microbiota as a potential therapeutic target for This approach is pivotal in reducing the risks associated
managing gout. 50-53 with elevated UA levels, which can precipitate both
Gout is associated with significant alterations in the asymptomatic and symptomatic conditions, such as gout,
gut microbiota, including changes in both composition kidney stones, and urate nephropathy. For asymptomatic
and function. Metagenomic analysis revealed an increased HUA, preventive pharmacological treatment is generally
abundance of Prevotella, Fusobacterium, and Bacteroides not recommended due to the potential for adverse drug
63
in gout patients, whereas Enterobacteriaceae and butyrate- effects, as evidenced by the findings of the CARES trial.
producing species were reduced. Lactiplantibacillus Instead, lifestyle modifications, including regular physical
plantarum X7022 demonstrated significant potential as a activity, dietary adjustments to limit alcohol, purine-rich
probiotic for managing HUA. Its ability to reduce UA levels, foods, and high-fat products, and promoting vegetable
improve kidney health, colonize the gut, degrade purines, consumption, are the primary management strategies to
and modulate the gut microbiota makes it a promising maintain UA levels within a healthy range.
candidate for further research and potential development In contrast, symptomatic HUA, characterized by the
as a therapeutic agent. HUA-induced dysbiosis affects presence of clinical symptoms, necessitates more aggressive
key bacterial phyla, such as Bacteroides, Firmicutes, treatment due to the significant risk of renal damage
and Proteobacteria, with Proteus proliferation playing a and the potential progression to end-stage renal disease.
crucial role in intestinal imbalance in gouty geese. Fecal Pharmacotherapy is the cornerstone of clinical treatment
microbiota transplantation (FMT) studies suggest that for symptomatic HUA, offering rapid relief of symptoms
bacterial genera, such as Vallitalea, Christensenella, and and UA control. Current pharmacological options target
Insolitispirillum, may contribute to HUA pathogenesis. 54-58 various points in the pathogenesis of HUA, including
In a recent study, Méndez-Salazar et al. investigated enzyme inhibition, UA excretion enhancement, or dual
59
the composition of gut microbiota in patients with gout inhibitory effects. However, the requirement for long-
and compared the differences between patients with tophi term or lifelong medication, coupled with the potential
and those without tophi. The results indicated that after the for serious side effects and the risk of UA rebound upon
deletion of the gut microbiota in patients with gout, the drug discontinuation, underscores the importance of
abundance of Ruminococcus, Akkermansia, Bacteroides, and exploring safer and more effective treatment alternatives.
Phascolarctobacterium appeared to be higher, whereas the This pursuit may involve the development of novel
abundance of other genera at the species level was reduced. pharmacological agents with improved safety profiles, as
These results suggest that there are significant differences well as further investigation into non-pharmacological
in the composition of the gut microbiota between patients interventions, such as dietary supplements, probiotics,
with tophi and those without tophi, which may have an and other complementary therapies, which could provide
impact on the development of the disease. The study aimed alternative strategies for managing HUA and its associated
to assess the structured profile of the intestinal microbiome complications (Table 1). 62-77
in these persistent groups and predict bacterial capacities 5. Treatment of HUA based on gut
that may affect urate metabolism. The research highlights
potential links between intestinal microbiota composition microbiota
and the pathophysiology of gout. 59 With the in-depth study of intestinal microbiota,
increasing evidence indicates that the gut microbiota is
4. Current status of treatment of HUA not only associated with the pathogenesis of HUA but

Within the routine treatment of intense gout, non- also serves as a promising drug target for treatment. The
steroidal anti-inflammatory drugs (NSAIDs) are commonly gut microbiota plays a crucial role in regulating host

Volume 9 Issue 2 (2025) 64 doi: 10.36922/ejmo.8579