allopurinol and Dyslipidemias

The prevalence of chronic kidney disease (CKD) has increased markedly over past decades due to the aging of the worldwide population. Despite the progress in the prevention and treatment, the cardiovascular (CV) morbidity and mortality remain high among patients with CKD. Although CKD is a progressive and irreversible condition, it is possible to slow decreasing kidney function, as well as the development and progression of associated with kidney disease comorbidities. Diabetes mellitus has become major cause of CKD worldwide. It is estimated that the prevalence of diabetes will increase from 425 million worldwide in 2017 to 629 million by 2045, substantially the percentage of diabetic nephropathy among CKD patients is set to rise markedly. The results of multicenter trials concerning novel antidiabetic drugs suggest that efficacy in reducing CV risk is independent of the improvement in glycemic control. This review discusses underlying causes of high CV risk and strategies reducing individual burden among CKD patients.

Topics: Adipose Tissue; Aging; Allopurinol; Blood Glucose; Blood Pressure; Cardiovascular Diseases; Diabetes Mellitus; Diabetic Nephropathies; Diet; Disease Progression; Dyslipidemias; Exercise; Hemodynamics; Humans; Renal Insufficiency, Chronic; Risk Factors; Smoking

Gout has significant impact on the quality of life with over-utilisation of health resources. While lowering serum urate (SU) to ≤ 360 µmol/L improves clinical outcomes, this is usually not achieved. We describe the burden of gout and determine predictors of achieving SU target in gout patients in Singapore. This was a cross-sectional study of 282 gout patients from a Singapore hospital rheumatology service. Sociodemographic and lifestyle factors, co-existing medical conditions and medications, gout history and severity, SU levels and treatment were obtained. Patients with SU ≤ 360 µmol/L were compared with those > 360 µmol/L to determine factors associated with achieving SU target. Descriptive statistics and multivariate model were used. Severe disease was reported in 50%, with emergency attendances and hospitalisations in 33% and 19% respectively, and unemployment in 32%. Only 22% were at SU target and 67% on urate-lowering therapy (ULT) at recruitment. Hypertension, dyslipidaemia, chronic kidney disease and diabetes were prevalent in 56.7%, 48.2%, 32.3% and 18.8%, respectively. Malays had more comorbidities compared to Chinese participants. In multivariate analysis, ULT prescription and ≥ 2 comorbidities were associated with reaching SU target with odds ratios of 3.92 [95% confidence interval (CI) (1.75-8.71)] and 2.65 [95% CI (1.59-4.43)] respectively, independent of age, tophi, disease duration, body mass index, alcohol and diuretic use. Patients with gout have high disease burden resulting in significant healthcare utilisation. SU control is sub-optimal hence the use of ULT remains key in achieving SU target. Patients with other comorbidities are more likely to reach target than those with only gout as a single diagnosis.

Topics: Adult; Aged; Allopurinol; Comorbidity; Cross-Sectional Studies; Diabetes Mellitus; Dyslipidemias; Emergency Service, Hospital; Ethnicity; Febuxostat; Female; Gout; Gout Suppressants; Hospitalization; Humans; Hypertension; Hyperuricemia; Male; Middle Aged; Probenecid; Renal Insufficiency, Chronic; Severity of Illness Index; Singapore; Treatment Outcome; Uric Acid

The dysfunctional adipose tissue of rats fed a sucrose-rich diet was investigated following the time course of the development of oxidative stress, changes in proinflammatory cytokines and adiponectin levels, and their relationship with insulin resistance. We analyzed the morphometric characteristics of epididymal adipocytes, de novo lipogenesis enzyme activities and cellular antioxidant defense, inflammatory mediators, adiponectin levels and insulin resistance in rats fed a sucrose-rich diet for 3, 15 or 30 weeks and compared to those fed a control diet. The results showed a depletion of antioxidant enzyme activities in the fat pads of rats fed a sucrose-rich diet, with an increase in xanthine oxidase activity and lipid peroxidation after 3, 15 and 30 weeks on the diet. Superoxide dismutase activity and the redox state of glutathione showed a significant decrease at weeks 15 and 30. This was accompanied by visceral adiposity and enhanced lipogenic enzyme activities. An increase in the plasma levels of proinflammatory markers (TNF-α and IL-6) was recorded only after 30 weeks on the diet. A reduction in plasma adiponectin levels accompanied the time course of deterioration of whole-body insulin sensitivity. The results suggest that lipid peroxidation, depletion of antioxidant defenses and changes in inflammatory cytokines induced by a sucrose-rich diet contribute to the dysregulation of adipose tissue and insulin resistance. Finally, these results show that the progressive deterioration of adipose tissue function, which begins in the absence of both visceral adiposity and overweight, is highly dependent on the length of time on the diet.

Topics: Adipocytes; Adiponectin; Adipose Tissue; Animals; Antioxidants; Biomarkers; Dietary Sucrose; Disease Models, Animal; Dyslipidemias; Energy Intake; Inflammation; Insulin; Insulin Resistance; Interleukin-6; Lipid Peroxidation; Lipogenesis; Male; Oxidative Stress; Rats; Rats, Wistar; Tumor Necrosis Factor-alpha; Xanthine Oxidase

The NOD-like receptor 3 (NLRP3) inflammasome-mediated inflammation is recently recognized in the development of renal injury. However, the mechanisms of the inflammasome-mediated inflammation and lipid accumulation in renal injury and the actions of lowing urate agents remain unclear. The present study used fructose to induce hyperuricemia and dyslipidemia, which caused renal NLRP3 inflammasome activation characterized by over-expression of the NLRP3, apoptosis-associated speck-like protein (ASC) and caspase-1, resulting in overproduction of interleukin (IL)-1β and IL-18, as well as IL-6 and tumor necrosis factor α (TNF-α) in rats. The elevated levels of these pro-inflammatory cytokines impaired renal janus-activated kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3)/peroxisome proliferator-activated receptor α (PAPR-α), and insulin receptor (IR)/insulin receptor substrate 1 (IRS1)/protein kinase B (Akt)/extracellular signal-regulated kinase1/2 (ERK1/2) signaling pathways with over-expression of suppressor of cytokine signaling 3 (SOCS3), exacerbating renal lipid accumulation and injury in fructose-fed rats. The restoration of fructose-induced hyperuricemia and dyslipidemia by the treatment of allopurinol, quercetin and rutin blocked the NLRP3 inflammasome activation to improve the signaling impairments and reduce lipid accumulation in the kidney of rats. These results suggest that the activation of renal NLRP3 inflammasome may play an important role in the link among renal inflammation, JAK2/STAT3/PAPR-α and IR/IRS1/Akt/ERK1/2 signaling impairment, and lipid accumulation driven by fructose. The NLRP3 inflammasome may be the target mediating the improvement of urate-lowering agents allopurinol, quercetin and rutin on fructose-induced renal lipid accumulation and injury.

Topics: Allopurinol; Animals; Blotting, Western; Carrier Proteins; Cholesterol; Creatinine; Dyslipidemias; Fructose; Glucose Tolerance Test; Hyperuricemia; Inflammasomes; Insulin Resistance; Kidney; Lipid Metabolism; Male; NLR Family, Pyrin Domain-Containing 3 Protein; Quercetin; Rats; Rats, Sprague-Dawley; Receptors, Cytoplasmic and Nuclear; Rutin; Uric Acid

Metabolomics is an emerging technology that reveals homeostatic imbalances in biological systems. Global determination of metabolite concentrations in body fluid and tissues provides novel anatomical aspects of pathological conditions that cannot be obtained from target-specific measurements. Here, we characterised metabolic imbalance in Watanabe heritable hyperlipidaemic rabbits as a model of hypercholesterolaemia. Using a mass spectrometry-based system, we measured a total of 335 metabolites in plasma and tissues (liver, aorta, cardiac muscle, and brain) from WHHL and healthy control rabbits. From the comparison between two metabolomic profiles, pathophysiological features including glutathione and phosphatidylcholine metabolism indicated the occurrence of oxidative stress in several tissues. Especially for the liver, imbalanced purine catabolism shed light on the transcriptional activation of xanthine oxidase, which is thought to act in absorbing or possibly triggering oxidative stress. We also applied this system to assess the therapeutic effects of simvastatin administration. After the treatment, a portion of the metabolomic features in pathological conditions showed alterations suggesting restoration of metabolism to the healthy condition. These changes were considered to be due to the pleiotropic action of statin, including antioxidant effects, rather than its main inhibitory action on cholesterol biosynthesis.

Topics: Animals; Disease Models, Animal; Dyslipidemias; Gene Expression Regulation; Homeostasis; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Lipid Metabolism; Lipids; Liver; Male; Metabolomics; Oxidative Stress; Rabbits; Simvastatin; Xanthine Oxidase

A series of novel benzocoumarin derivatives were synthesized and evaluated for their in vivo antidyslipidemic and in vitro antioxidant activities. Among 11 compounds tested, 2 compounds showed potent antidyslipidemic activity and 3 compounds showed potent antioxidant activity.

Topics: Coumarins; Dyslipidemias; Humans

8-Hydroxyquinoline when subjected to Duff reaction resulted in the formation of unexpected 7-methylaminomethylene-8-oxo-7, 8-dihydroquinoline-5-carbaldehyde 2, which existed in the keto-enamine form, in which the aromaticity of the relevant ring was disrupted, which upon subsequent treatment with various primary amines resulted in its nucleophilic substitution of aliphatic methyl amine. These interesting novel derivatives were evaluated in vitro for their antioxidant and in vivo for their antidyslipidemic and post-heparin lipolytic activities. Compound 6 was found to be most active antidyslipidemic and antioxidative agent in this series, respectively, and thus represent a new class of promising lead.

Topics: Amines; Animals; Antioxidants; Dyslipidemias; Fluorescence; Heparin; Hydroxyl Radical; Hydroxyquinolines; Lipid Metabolism; Male; Rats; Schiff Bases; Superoxides

A series of N-per-O-acetyl-glucosyl arylthiosemicarbazide and thiosemicarbazone derivatives have been synthesized and evaluated for their in vivo anti-dyslipidemic and in vitro antioxidant activities. Among 16 compounds tested, 3 compounds showed potent anti-dyslipidemic activity and 6 compounds showed potent antioxidant and scavenger of oxygen free radicals activity.

Topics: Animals; Antioxidants; Drug Evaluation, Preclinical; Dyslipidemias; Hypolipidemic Agents; Rats; Semicarbazides; Thiosemicarbazones