Cammalleri Lisa, Malaguarnera Mariano
Dept of Senescence, Urological and Neurological Sciences, University of Catania, Catania, Italy.
Int J Med Sci. 2007 Mar 2;4(2):83-93. doi: 10.7150/ijms.4.83.
Hyperuricemia is a feature of several pathologies and requires an appropriate and often early treatment, owing to the severe consequences that it may cause. A rapid and massive raise of uric acid, during tumor lysis syndrome (TLS), and also a lower and chronic hyperuricemia, as in gout, mainly damage the kidney. To prevent or treat these consequences, a new therapeutic option is represented by rasburicase, a recombinant form of an enzyme, urate oxidase. This enzyme converts hypoxanthine and xanthine into allantoin, a more soluble molecule, easily cleared by kidney. The several types of urate oxidase have followed each other, with progressive reduction of adverse reactions. The most important among them are allergenicity and the development of antibodies which compromise their effectiveness. Nevertheless, a limit of rasburicase's use remains its cost, which obliges to a judicious choice to prevent TLS in high risk patients with cancer and in case of allergy or impossibility to take allopurinol orally both in TLS and in gout. A large body of evidence confirms the efficacy and safety of rasburicase, even in comparison to the standard drugs used in the aforementioned pathologies.
高尿酸血症是多种病症的一个特征，由于其可能导致的严重后果，需要进行恰当且往往是早期的治疗。在肿瘤溶解综合征（TLS）期间尿酸会快速大量升高，而在痛风中尿酸是较低水平的慢性升高，这主要会损害肾脏。为预防或治疗这些后果，一种新的治疗选择是拉布立酶，它是一种酶（尿酸氧化酶）的重组形式。这种酶将次黄嘌呤和黄嘌呤转化为尿囊素，尿囊素是一种更易溶解的分子，能被肾脏轻松清除。几种类型的尿酸氧化酶相继出现，不良反应逐渐减少。其中最重要的是致敏性以及抗体的产生，这会影响其有效性。然而，拉布立酶使用的一个限制仍然是其成本，这使得在预防癌症高危患者的TLS时以及在TLS和痛风中出现过敏或无法口服别嘌醇的情况下，必须谨慎选择。大量证据证实了拉布立酶的有效性和安全性，即使与上述病症中使用的标准药物相比也是如此。
