[Gout, beyond the joint: How should we treat it?] / La gota, más allá de la articulación: ¿cómo debemos tratarla?

Gout is a disease caused by the chronic deposition of monosodium urate crystals. Its clinical presentation as an acute, self-limiting arthritis and the belief that it is a banal, self-inflicted disease have led to its poor management. Despite advances in the knowledge of the disease and the simplicity of its management, no more than 30% of patients are well treated. In Spain, the prevalence of gout is 2.5% and its incidence is increasing. In the following article we will review the pathogenesis of gout and hyperuricaemia, highlighting the greater weight of genetics and renal function over diet. We will look at the consequences of crystal deposition. Gout, in addition to its joint presentation and renal involvement, has been shown to be an independent cardiovascular risk factor. Hypouricemic therapy is the most important treatment, as it is the one that dissolves the crystals and cures the disease. This requires the sustained achievement of uricemia levels below 6mg/dl. We will also review preventive and flares treatment, as well as the role of patient education in terms of both lifestyle and dietary habits and adherence to pharmacological treatment.

The NAD kinase: a phosphoryltransferase displaying an oxido-reductase activity--an electrophoretic study.

The search for a valuable technique for rapid detection, after electrophoresis, of the activity of various NAD kinase isoforms possibly present in different plant materials, has revealed interesting peculiarities of this enzyme (EC 2.7.1.23; also called ATP:NAD+ 2'-phosphotransferase). At first and in the unique but obligatory presence of NAD, the NAD kinase acts almost instantaneously as an oxido-reductase (probably coupled with the transformation of NAD to NADH). In the additional presence of ATP, the transformation of NAD+ to NADP+ reinforced such an oxido-reductase activity. Final assays testing for the specificity of the phosphoryl donor revealed that not only ATP but also GTP, G6P, and even NADP could be the substrate; the efficiencies of these phosphoryl donors varied with the different isoforms of NAD kinase, evidenced in the different seeds tested, and compared with NAD kinase from heterotropically grown Euglena cells, and NAD kinase purified from chicken liver (from Sigma Chemical Co.).

Coordinated stimulation by triiodothyronine of fatty acid synthesis and isoproterenol-sensitive fatty acid release in two preadipocyte cell lines of lean or genetically obese mice.

The development and thyroid hormone sensitivity of fatty acid and triacylglycerol synthesis from 14C-acetate and of the isoproterenol-sensitive fatty acid release, were studied in two preadipocyte cell lines during the adipose differentiation: the Ob 17 and the HGFu cell lines cloned from the periepididymal adipose tissue of adult mice genetically obese and phenotypically lean respectively. Both parameters increased and peaked in the same time-period during the second week of culture after confluence. Both parameters were also amplified when T3 was added to the culture medium at confluence. The increment due to T3 was concentration dependent: it peaked at the physiological concentration of 1.5 nM and declined thereafter with the same pattern. This shows that some steps of two opposite pathways of lipid metabolism in differentiating preadipose cells can be stimulated by triiodothyronine in a similar manner and suggests a coordinated regulation. No significant difference could be detected between cells from lean or genetically obese mice.

Triiodothyronine (T3)-induced down-regulation of the nuclear T3 receptor in mouse preadipocyte cell lines.

As previously reported, preadipocytes cloned from the epididymal fat of lean or genetically obese mice (HGFu and ob 17, respectively) contain the nuclear T3 receptor. The number of receptor sites was similar in confluent cells of both lines and approximately doubled during adipocyte differentiation. T3 added to the culture medium increased triacylglycerol synthesis. T3 also increased fatty acid synthase specific activity, relative synthesis rate, and relative mRNA content (1.5- to 2.5-fold). Optimal responses were obtained at 1.5 nM. This study shows that under the same culture conditions in both cell lines, 1.5 nM T3 decreased the receptor concentration with no significant change in the affinity for T3. The receptor depletion was time dependent, rapid, stable in the presence of T3, and reversible in less than 24 h after its withdrawal. Receptor depletion was also dependent on T3 concentration and close to maximum at 1.5 nM T3 [45.1 +/- 2.7% (+/- SE) of the data values without T3; n = 14]. A linear relationship was observed between receptor occupancy by T3 and receptor loss. T4 and triiodothyroacetic acid also decreased the T3 receptor content, as expected from their own affinity for the receptor. These last two observations suggest that the receptor reduction is related to its occupancy by T3. The reported results, also observed in several other cell types, indicate that down-regulation of the nuclear T3 receptor by thyroid hormones is probably a generalized event in T3 target cells at least in vitro. Interpretation of its significance in preadipocyte cell lines requires further studies of rapid nuclear events following T3 receptor occupancy.