Gout is considered as one of the most well-represented (and oldest) diseases in human history, primarily because this "disease of kings" impacted the most affluent of any given society. Alexander the Great, Charlemagne, and King Henry VIII all suffered from this pernicious form of arthritis. Benjamin Franklin even wrote letters to "Madame Gout," pleading as to why he must withstand these "cruel sufferings."
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With the dawn of modern medicine in the 19th century, scientists found an answer to Franklin’s painful inquiries. Put simply, rich diets of meats, alcohol, and sugar (common on the tables of the rich and powerful throughout history) are all high in chemical compounds known as purines, which produce uric acid when metabolized. When these uric levels climb too high, crystals can form in the liver and kidneys, leading to joint pain and kidney disease.
Today, a variety of treatments exist, including Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). But a new study revived a very old strategy for treating gout—like, 20 to 29 million years old.
In this study, published in the journal Scientific Reports, scientists used the gene-editing technology CRISPR-Cas9 (also sometimes referred to as 'molecular scissors') to bring back the uricase gene, which evolved out of primates during the Neogene period. It’s likely that our distant ancestors used uric acid to turn fruit sugars into fats, which is a pretty effective survival strategy during periods of food shortage. However, without the uricase gene, what once kept early primates alive became a primary vector for gout.
"Without uricase, humans are left vulnerable," Eric Gaucher, the co-author of the study from Georgia State University, said in a press statement. "By reactivating uricase in human liver cells, we lowered uric acid and stopped the cells from turning excess fructose into triglycerides—the fats that build up in the liver."
To test this idea, Gaucher and his team first tested the restored gene function in human liver cells and found that uric acid dropped dramatically, and fructose-driven fat buildup in those cells was prevented entirely. To up the ante a bit, they tested this same method on 3D liver spheroids—essentially collections of tissues that mimic miniature organs. Uric acid levels were lowered within these systems as well.
While uric acid is the key driver behind Franklin’s "cruel sufferings," hyperuricemia (excess uric acid in the blood) can cause a variety of different diseases, including hypertension and cardiovascular disease. According to the authors, a quarter of patients with high blood pressure also have elevated uric levels, and when it comes to hypertension, that overlap jumps to a staggering 90 percent.
However, the scientists aren’t celebrating yet. Gene-editing therapies still have safety hurdles to overcome, and this particular approach will need rigorous human trials. But if the results hold, the "disease of kings" will have finally met its match.