In gout, the uric acid crystals activate complement by the alternative pathway, but also by the classical pathway through the accumulation of immunoglobulin. The crystals interact with macrophages, produce cytokine interleukin-1, and then generate other cytokines.
Dr. Pillinger said that uric acid has multiple and complex effects on cells, depending on their concentration and whether they are soluble or crystalline. Some effects have apparently been—and perhaps still are—evolutionarily advantageous. “Understanding uric acid biology may permit more rational targeting of future antiinflammatory and antihyperuricemic agents,” Dr. Pillinger concluded.
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Kathy Holliman is a medical journalist based in New Jersey.
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