The catabolism of purine nucleotides involves the breakdown of adenine and guanine into uric acid, which is then excreted from the body. This process involves several enzymatic steps and occurs primarily in the liver.
 Breakdown of Adenine Nucleotides
1. Deamination of AMP:
– Enzyme: AMP deaminase.
– Reaction: AMP (adenosine monophosphate) is converted to IMP (inosine monophosphate) by removing an amino group.
2. Conversion of IMP to Inosine:
– Enzyme: Nucleotidase.
– Reaction: IMP is dephosphorylated to inosine.
3. Conversion of Inosine to Hypoxanthine:
– Enzyme: Purine nucleoside phosphorylase (PNP).
– Reaction: Inosine is cleaved to hypoxanthine and ribose-1-phosphate.
4. Oxidation of Hypoxanthine to Xanthine:
– Enzyme: Xanthine oxidase.
– Reaction: Hypoxanthine is oxidized to xanthine.
5. Oxidation of Xanthine to Uric Acid:
– Enzyme: Xanthine oxidase.
– Reaction: Xanthine is further oxidized to uric acid, which is less soluble and is excreted in urine.
 Breakdown of Guanine Nucleotides
1. Deamination of GMP:
– Enzyme: GMP reductase.
– Reaction: GMP (guanosine monophosphate) is dephosphorylated to guanosine.
2. Conversion of Guanosine to Guanine:
– Enzyme: Purine nucleoside phosphorylase (PNP).
– Reaction: Guanosine is cleaved to guanine and ribose-1-phosphate.
3. Deamination of Guanine to Xanthine:
– Enzyme: Guanase.
– Reaction: Guanine is deaminated to xanthine.
4. Oxidation of Xanthine to Uric Acid:
– Enzyme: Xanthine oxidase.
– Reaction: Xanthine is oxidized to uric acid.
 Hyperuricemia and Gout Disease
Hyperuricemia
Hyperuricemia is characterized by an abnormally high level of uric acid in the blood. This condition can arise from increased production or decreased excretion of uric acid.
Causes:
1. Increased Production:
– Diet: High intake of purine-rich foods (e.g., red meat, shellfish).
– Cell Turnover: Conditions like cancer and chemotherapy that increase cell turnover and purine breakdown.
– Genetic Disorders: Lesch-Nyhan syndrome, a deficiency of the HGPRT enzyme, leading to increased purine synthesis and breakdown.
2. Decreased Excretion:
– Renal Insufficiency: Kidney diseases that reduce the ability to excrete uric acid.
– Medications: Diuretics and other drugs that decrease uric acid excretion.
Consequences:
– Elevated levels of uric acid can lead to the formation of urate crystals, which can deposit in joints and tissues, causing inflammation and pain.
 Gout
Gout is an inflammatory arthritis caused by the deposition of monosodium urate crystals in joints and tissues due to hyperuricemia.
Pathophysiology:
1. Crystal Formation: When uric acid levels exceed its solubility threshold, monosodium urate crystals form and deposit in joints and soft tissues.
2. Inflammatory Response: The deposited crystals trigger an immune response, attracting neutrophils and other inflammatory cells to the site, causing pain, swelling, redness, and warmth.
Symptoms:
– Sudden and severe joint pain, often in the big toe (podagra).
– Swelling, redness, and tenderness of the affected joint.
– Chronic gout can lead to the formation of tophi, which are large aggregates of urate crystals in tissues.
Diagnosis:
– Clinical Assessment: Evaluation of symptoms and medical history.
– Serum Uric Acid Levels: Measuring uric acid concentration in the blood.
– Joint Aspiration: Examination of synovial fluid for the presence of urate crystals.
Treatment:
1. Acute Gout Attack:
– Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Reduce inflammation and pain.
– Colchicine: Reduces inflammation by inhibiting neutrophil activity.
– Corticosteroids: Reduce inflammation if NSAIDs and colchicine are not effective.
2. Chronic Management:
– Urate-Lowering Therapy:
– Xanthine Oxidase Inhibitors: Allopurinol and febuxostat reduce uric acid production.
– Uricosuric Agents: Probenecid increases renal excretion of uric acid.
– Lifestyle Modifications: Dietary changes to reduce purine intake, weight management, and avoidance of alcohol.
Prevention:
– Regular monitoring of serum uric acid levels.
– Adherence to prescribed medication and lifestyle modifications to prevent acute attacks and reduce urate crystal formation.
Summary
The catabolism of purine nucleotides involves a series of enzymatic steps converting adenine and guanine nucleotides into uric acid, which is then excreted. Hyperuricemia, characterized by high levels of uric acid, can lead to gout, a painful inflammatory arthritis caused by the deposition of urate crystals in joints. Understanding the biochemical pathways and clinical aspects of these conditions is essential for effective diagnosis, treatment, and management.
