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      The GLUT9 Gene Is Associated with Serum Uric Acid Levels in Sardinia and Chianti Cohorts

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          Abstract

          High serum uric acid levels elevate pro-inflammatory–state gout crystal arthropathy and place individuals at high risk for cardiovascular morbidity and mortality. Genome-wide scans in the genetically isolated Sardinian population identified variants associated with serum uric acid levels as a quantitative trait. They mapped within GLUT9, a Chromosome 4 glucose transporter gene predominantly expressed in liver and kidney. SNP rs6855911 showed the strongest association ( p = 1.84 × 10 −16), along with eight others ( p = 7.75 × 10 −16 to 6.05 × 10 −11). Individuals homozygous for the rare allele of rs6855911 (minor allele frequency = 0.26) had 0.6 mg/dl less uric acid than those homozygous for the common allele; the results were replicated in an unrelated cohort from Tuscany. Our results suggest that polymorphisms in GLUT9 could affect glucose metabolism and uric acid synthesis and/or renal reabsorption, influencing serum uric acid levels over a wide range of values.

          Author Summary

          High serum uric acid levels lead to gout and increase the risk of cardiovascular and kidney disease. To determine what genetic factors might contribute to uric acid levels, we conducted genome-wide scans of single nucleotide variations in DNA in population samples from Sardinia and Chianti. We report here that variants in the GLUT9 gene are associated with altered uric acid levels in both populations. Unexpectedly, rather than being directly involved in uric acid synthesis or secretion, the GLUT9 gene encodes a glucose transporter. It is of interest that the gene is predominantly expressed in liver, a major site of uric acid synthesis, and in kidney, where uric acid is excreted and reabsorbed. However, it now remains to be determined how altered glucose uptake can indirectly affect synthesis or excretion/reabsorption of uric acid, and whether GLUT9 may provide a target for the therapeutic modification of uric acid levels.

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          Most cited references16

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          Uric acid provides an antioxidant defense in humans against oxidant- and radical-caused aging and cancer: a hypothesis.

          During primate evolution, a major factor in lengthening life-span and decreasing age-specific cancer rates may have been improved protective mechanisms against oxygen radicals. We propose that one of these protective systems is plasma uric acid, the level of which increased markedly during primate evolution as a consequence of a series of mutations. Uric acid is a powerful antioxidant and is a scavenger of singlet oxygen and radicals. We show that, at physiological concentrations, urate reduces the oxo-heme oxidant formed by peroxide reaction with hemoglobin, protects erythrocyte ghosts against lipid peroxidation, and protects erythrocytes from peroxidative damage leading to lysis. Urate is about as effective an antioxidant as ascorbate in these experiments. Urate is much more easily oxidized than deoxynucleosides by singlet oxygen and is destroyed by hydroxyl radicals at a comparable rate. The plasma urate levels in humans (about 300 microM) is considerably higher than the ascorbate level, making it one of the major antioxidants in humans. Previous work on urate reported in the literature supports our experiments and interpretations, although the findings were not discussed in a physiological context.
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            Molecular identification of a renal urate anion exchanger that regulates blood urate levels.

            Urate, a naturally occurring product of purine metabolism, is a scavenger of biological oxidants implicated in numerous disease processes, as demonstrated by its capacity of neuroprotection. It is present at higher levels in human blood (200 500 microM) than in other mammals, because humans have an effective renal urate reabsorption system, despite their evolutionary loss of hepatic uricase by mutational silencing. The molecular basis for urate handling in the human kidney remains unclear because of difficulties in understanding diverse urate transport systems and species differences. Here we identify the long-hypothesized urate transporter in the human kidney (URAT1, encoded by SLC22A12), a urate anion exchanger regulating blood urate levels and targeted by uricosuric and antiuricosuric agents (which affect excretion of uric acid). Moreover, we provide evidence that patients with idiopathic renal hypouricaemia (lack of blood uric acid) have defects in SLC22A12. Identification of URAT1 should provide insights into the nature of urate homeostasis, as well as lead to the development of better agents against hyperuricaemia, a disadvantage concomitant with human evolution.
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              Uric acid: A new look at an old risk marker for cardiovascular disease, metabolic syndrome, and type 2 diabetes mellitus: The urate redox shuttle

              Background The topical role of uric acid and its relation to cardiovascular disease, renal disease, and hypertension is rapidly evolving. Its important role both historically and currently in the clinical clustering phenomenon of the metabolic syndrome (MS), type 2 diabetes mellitus (T2DM), atheroscleropathy, and non-diabetic atherosclerosis is of great importance. Results Uric acid is a marker of risk and it remains controversial as to its importance as a risk factor (causative role). In this review we will attempt to justify its important role as one of the many risk factors in the development of accelerated atherosclerosis and discuss its importance of being one of the multiple injurious stimuli to the endothelium, the arterial vessel wall, and capillaries. The role of uric acid, oxidative – redox stress, reactive oxygen species, and decreased endothelial nitric oxide and endothelial dysfunction cannot be over emphasized. In the atherosclerotic prooxidative environmental milieu the original antioxidant properties of uric acid paradoxically becomes prooxidant, thus contributing to the oxidation of lipoproteins within atherosclerotic plaques, regardless of their origins in the MS, T2DM, accelerated atherosclerosis (atheroscleropathy), or non-diabetic vulnerable atherosclerotic plaques. In this milieu there exists an antioxidant – prooxidant urate redox shuttle. Conclusion Elevations of uric acid > 4 mg/dl should be considered a "red flag" in those patients at risk for cardiovascular disease and should alert the clinician to strive to utilize a global risk reduction program in a team effort to reduce the complications of the atherogenic process resulting in the morbid – mortal outcomes of cardiovascular disease.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS Genet
                pgen
                plge
                plosgen
                PLoS Genetics
                Public Library of Science (San Francisco, USA )
                1553-7390
                1553-7404
                November 2007
                9 November 2007
                26 September 2007
                : 3
                : 11
                : e194
                Affiliations
                [1 ] Laboratory of Genetics, National Institute on Aging, Baltimore, Maryland, United States of America
                [2 ] Istituto di Neurogenetica e Neurofarmacologia, Consiglio Nazionale delle Ricerche, Cagliari, Italy
                [3 ] Geriatric Rehabilitation Unit, Azienda Sanitaria Firenze, Florence, Italy
                [4 ] Laboratory of Cardiovascular Science, National Institute on Aging, Baltimore, Maryland, United States of America
                [5 ] Unità Operativa Geriatria, Istituto Nazionale Ricovero e Cura Anziani, Rome, Italy
                [6 ] Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Maryland, United States of America
                [7 ] Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
                [8 ] Clinical Research Branch, National Institute on Aging, Baltimore, Maryland, United States of America
                University of Alabama at Birmingham, United States of America
                Author notes
                * To whom correspondence should be addressed. E-mail: nagarajar@ 123456mail.nih.gov
                Article
                07-PLGE-RA-0574R2 plge-03-11-07
                10.1371/journal.pgen.0030194
                2065883
                17997608
                f8ee9665-311d-48de-b890-db538fa8f249
                This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
                History
                : 27 July 2007
                : 24 September 2007
                Page count
                Pages: 7
                Categories
                Research Article
                Genetics and Genomics
                Homo (Human)
                Custom metadata
                Li S, Sanna S, Maschio A, Busonero F, Usala G, et al. (2007) The GLUT9 gene is associated with serum uric acid levels in Sardinia and Chianti cohorts. PLoS Genet 3(11): e194. doi: 10.1371/journal.pgen.0030194

                Genetics
                Genetics

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