Cui Yueying, An Peiyu, Li Feng, Duan Fengsen, Mei Zusong, Ye Qiao, Wang Guangyun, Zhang Haitao, Luo Yuan
Laboratory of Clinical Medicine, Air Force Medical Center, Air Force Medical University, PLA, Beijing, China.
Department of Aeromedical Support & Flight Safety, Air Force Medical Center, Air Force Medical University, PLA, Beijing, China.
Front Microbiol. 2025 Aug 29;16:1654152. doi: 10.3389/fmicb.2025.1654152. eCollection 2025.
Hyperuricaemia (HUA) is a metabolic disorder resulting from the dysregulation of purine metabolism. It is closely associated with gout and various metabolic syndromes, representing an increasing global public health challenge. Current treatment approaches for HUA and gout generally involve the lifelong administration of urate-lowering agents to maintain optimal serum urate concentrations. However, poor patient adherence, often due to potential hepatorenal toxicity, frequently leads to disease relapse. Recent evidence indicates that the gut microbiota plays a significant role in maintaining urate homeostasis through multiple mechanisms, including the modulation of purine metabolism, urate catabolism and excretion, regulation of inflammatory responses, and preservation of intestinal barrier integrity. These findings highlight the gut microbiota as a promising novel therapeutic target. This review synthesizes recent progress in three key areas: (1) the relationship between the gut microbiota and HUA; (2) microbial mechanisms underlying urate-lowering effects, such as microbial purine and urate metabolism, regulation of urate transporters like ABCG2, and production of anti-inflammatory metabolites; and (3) microbiota-based therapeutic interventions, including probiotics, engineered bacterial strains, fecal microbiota transplantation, and pharmabiotic strategies. Additionally, we explore the translational potential of microbiota modulation in clinical settings and outline directions for future research. By integrating mechanistic understanding with therapeutic innovation, this review offers researchers and clinicians a comprehensive framework for advancing microbiota-targeted approaches in the management of hyperuricaemia.
高尿酸血症（HUA）是一种由嘌呤代谢失调引起的代谢紊乱疾病。它与痛风及各种代谢综合征密切相关，是全球日益严峻的公共卫生挑战。目前针对高尿酸血症和痛风的治疗方法通常包括终身服用降尿酸药物以维持最佳血清尿酸浓度。然而，患者依从性差，这通常是由于潜在的肝肾毒性，经常导致疾病复发。最近的证据表明，肠道微生物群通过多种机制在维持尿酸稳态中发挥重要作用，包括调节嘌呤代谢、尿酸分解代谢和排泄、调节炎症反应以及维持肠道屏障完整性。这些发现凸显了肠道微生物群作为一个有前景的新型治疗靶点。本综述综合了三个关键领域的最新进展：（1）肠道微生物群与高尿酸血症之间的关系；（2）降尿酸作用的微生物机制，如微生物嘌呤和尿酸代谢、ABCG2等尿酸转运蛋白的调节以及抗炎代谢产物的产生；（3）基于微生物群的治疗干预措施，包括益生菌、工程菌株、粪便微生物群移植和药物微生物群策略。此外，我们探讨了微生物群调节在临床环境中的转化潜力，并概述了未来研究方向。通过将机制理解与治疗创新相结合，本综述为研究人员和临床医生提供了一个全面的框架，以推进针对高尿酸血症管理的微生物群靶向方法。
