Gut microbiota and hyperuricemia: From mechanisms to therapeutic strategies

Hyperuricemia (HUA), a condition characterized by elevated levels of uric acid (UA) in the bloodstream, is intricately connected to an imbalance in the gut microbiota. UA, a byproduct of purine metabolism, serves as a crucial endogenous antioxidant. Recent research indicates that modifying the gut microbiome offers a promising avenue for managing HUA. This work delves into the complex relationship between HUA and changes in the gut microbiota, examining its impact on UA excretion, reabsorption, and the activity of enzymes involved in purine breakdown. Elucidating the precise mechanisms behind this connection is essential for developing effective treatments, and exploring various therapeutic approaches, including probiotics, prebiotics, dietary interventions, and fecal microbiota transplantation, which target the gut microbiota to reduce UA levels. These treatments may exert their effects through diverse pathways, such as inhibiting key enzymes, regulating UA transporters, reducing oxidative stress and inflammation, and restoring the balance of the gut microbiome. Furthermore, maintaining a healthy gut barrier is a valuable complementary therapy. This review aims to provide insights into the potential of gut microbiota manipulation as a novel and promising strategy for managing HUA. While this approach holds great promise, it is important to consider the potential risks and challenges associated with gut microbiota manipulation, and further research and clinical trials are warranted to fully understand its efficacy and safety.