Abstract
Parkinson’s disease (PD) is a progressive neurodegenerative disease with characteristic motor manifestations. Although appreciation of PD as a multisystem disorder has grown, loss of dopaminergic neurons in the substantia nigra remains a pathological and neurochemical hallmark, accounting for the substantial symptomatic benefits of dopamine replacement therapies. However, currently no treatment has been shown to prevent or forestall the progression of the disease in spite of tremendous efforts. Among multiple environmental and genetic factors that have been implicated in the pathogenesis of PD, oxidative stress is proposed to play a critical role. A recent confluence of clinical, epidemiological, and laboratory evidence identified urate, an antioxidant and end product of purine metabolism, as not only a molecular predictor for both reduced risk and favorable progression of PD but also a potential neuroprotectant for the treatment of PD. This review summarizes recent findings on urate in PD and their clinical implications.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Graham DG. Oxidative pathways for catecholamines in the genesis of neuromelanin and cytotoxic quinines. Mol Pharmacol. 1978;14:633–43.
Tse DC, McCreery RL, Adams RN. Potential oxidative pathways of brain catecholamines. J Med Chem. 1976;19:37–40.
Adams RN, Murrill E, McCreery R, et al. 6-hydroxy-dopamine, a new oxidation mechanism. Eur J Pharmacol. 1972;17:287–92.
Youdim MB, Ben Shachar D, Riederer P. Is Parkinson’s disease a progressive siderosis of substantia nigra resulting in iron and melanin induced neurogeneration? Acta Neurol Scand Suppl. 1989;126:47–54.
Surmeier DJ, Guzman JN, Sanchez-Padilla J, et al. The origins of oxidant stress in Parkinson’s disease and therapeutic strategies. Antioxid Redox Signal. 2011;14(7):1289–301.
Guzman JN, Sanchez-Padilla J, Wokosin D, Kondapalli J, et al. Oxidant stress evoked by pacemaking in dopaminergic neurons is attenuated by DJ-1. Nature. 2010;468(7324):696–700.
Mosharov EV, Larsen KE, Kanter E, et al. Interplay between cytosolic dopamine, calcium, and alpha-synuclein causes selective death of substantia nigra neurons. Neuron. 2009;62(2):218–29.
Tsang AH, Chung KK. Oxidative and nitrosative stress in Parkinson’s disease. Biochim Biophys Acta. 2009;1792(7):643–50.
Alam ZI, Jenner A, Daniel SE, et al. Oxidative DNA damage in the parkinsonian brain: an apparent selective increase in 8-hydroxyguanine levels in substantia nigra. J Neurochem. 1997;69:1196–203.
Dexter DT, Holley AE, Flitter WD, et al. Increased levels of lipid hydroperoxides in the parkinsonian substantia nigra: an HPLC and ESR study. Mov Disord. 1994;9:92–7.
Dexter DT, Sian J, Rose S, et al. Indices of oxidative stress and mitochondrial function in individuals with incidental Lewy body disease. Ann Neurol. 1994;35:38–44.
Henchcliffe C, Beal MF. Mitochondrial biology and oxidative stress in Parkinson disease pathogenesis. Nat Clin Pract Neurol. 2008;4(11):600–9.
Hart RG, Pearce LA, Ravina BM, et al. Neuroprotection trials in Parkinson’s disease: systematic review. Mov Disord. 2009;24(5):647–54.
Olanow CW, Kieburtz K, Schapira AH. Why have we failed to achieve neuroprotection in Parkinson’s disease? Ann Neurol. 2008;64 Suppl 2:S101–10.
Olanow CW, Rascol O, Hauser R, et al. A double-blind, delayed-start trial of rasagiline in Parkinson’s disease. N Engl J Med. 2009;361(13):1268–78.
Ahlskog JE, Uitti RJ. Rasagiline, Parkinson neuroprotection, and delayed-start trials: still no satisfaction? Neurology. 2010;74(14):1143–8.
National Institute of Neurological Disorders and Stroke: Statement on the Termination of QE3 Study. Available at http://www.ninds.nih.gov/disorders/clinical_trials/CoQ10-Trial-Update.htm.
Hung AY, Schwarzschild MA. Clinical trials for neuroprotection in Parkinson’s disease: overcoming angst and futility? Curr Opin Neurol. 2007;20(4):477–83.
Ravina BM, Fagan SC, Hart RG, et al. Neuroprotective agents for clinical trials in Parkinson’s disease: a systematic assessment. Neurology. 2003;60(8):1234–40.
Morelli M, Carta AR, Kachroo A, et al. Pathophysiological roles for purines: adenosine, caffeine and urate. Prog Brain Res. 2010;183:183–208.
Quik M, Huang LZ, Parameswaran N, et al. Multiple roles for nicotine in Parkinson’s disease. Biochem Pharmacol. 2009;78(7):677–85.
Ames BN, Cathcart R, Schwiers E, et al. Uric acid provides an antioxidant defense in humans against oxidant- and radical-caused aging and cancer: a hypothesis. Proc Natl Acad Sci U S A. 1981;78(11):6858–62.
Davies KJ, Sevanian A, Muakkassah-Kelly SF, et al. Uric acid-iron ion complexes. A new aspect of the antioxidant functions of uric acid. Biochem J. 1986;235(3):747–54.
Hink HU, Santanam N, Dikalov S, et al. Peroxidase properties of extracellular superoxide dismutase: role of uric acid in modulating in vivo activity. Arterioscler Thromb Vasc Biol. 2002;22(9):1402–8.
Sevanian A, Davies KJ, Hochstein P. Conservation of vitamin C by uric acid in blood. J Free Radic Biol Med. 1985;1(2):117–24.
Kuzkaya N, Weissmann N, Harrison DG, et al. Interactions of peroxynitrite with uric acid in the presence of ascorbate and thiols: implications for uncoupling endothelial nitric oxide synthase. Biochem Pharmacol. 2005;70(3):343–54.
Whiteman M, Halliwell B. Protection against peroxynitrite-dependent tyrosine nitration and alpha 1-antiproteinase inactivation by ascorbic acid. A comparison with other biological antioxidants. Free Radic Res. 1996;25(3):275–83.
Yeum KJ, Russell RM, Krinsky NI, et al. Biomarkers of antioxidant capacity in the hydrophilic and lipophilic compartments of human plasma. Arch Biochem Biophys. 2004;430(1):97–103.
Proctor P. Similar functions of uric acid and ascorbate in man? Nature. 1970;228(5274):868.
Hershfield MS, Roberts 2nd LJ, Ganson NJ, et al. Treating gout with pegloticase, a PEGylated urate oxidase, provides insight into the importance of uric acid as an antioxidant in vivo. Proc Natl Acad Sci U S A. 2010;107(32):14351–6.
Waring WS, Webb DJ, Maxwell SR. Systemic uric acid administration increases serum antioxidant capacity in healthy volunteers. J Cardiovasc Pharmacol. 2001;38(3):365–71.
Amaro S, Chamorro Á. Translational stroke research of the combination of thrombolysis and antioxidant therapy. Stroke. 2011;42(5):1495–9.
Scott GS, Hooper DC. The role of uric acid in protection against peroxynitrite-mediated pathology. Med Hypotheses. 2001;56:95–100.
O’Neill RD, Lowry JP. On the significance of brain extracellular uric acid detected with in-vivo monitoring techniques: a review. Behav Brain Res. 1995;71(1–2):33–49.
Church WH, Ward VL. Uric acid is reduced in the substantia nigra in Parkinson’s disease: effect on dopamine oxidation. Brain Res Bull. 1994;33(4):419–25.
Larumbe Ilundain R, Ferrer Valls JV, Vines Rueda JJ, et al. Case–control study of markers of oxidative stress and metabolism of blood iron in Parkinson’s disease. Rev Esp Salud Publica. 2001;75(1):43–53.
Annanmaki T, Muuronen A, Murros K. Low plasma uric acid level in Parkinson’s disease. Mov Disord. 2007;22(8):1133–7.
Andreadou E, Nikolaou C, Gournaras F, et al. Serum uric acid levels in patients with Parkinson’s disease: their relationship to treatment and disease duration. Clin Neurol Neurosurg. 2009;111(9):724–8.
Bogdanov M, Matson WR, Wang L, et al. Metabolomic profiling to develop blood biomarkers for Parkinson’s disease. Brain. 2008;131(Pt. 2):389–96.
Sun C, Luo F, Wei L, et al. Association of serum uric acid levels with the progression of Parkinson’s disease in Chinese patients. Chin Med J. 2012;125(4):583–7.
Tohgi H, Abe T, Takahashi S, et al. The urate and xanthine concentrations in the cerebrospinal fluid in patients with vascular dementia of the Binswanger type, Alzheimer type dementia, and Parkinson’s disease. J Neural Transm Park Dis Demet Sect. 1993;6(2):119–26.
Maetzler W, Stapf AK, Schulte C, Hauser AK, et al. Serum and cerebrospinal fluid uric acid levels in lewy body disorders: associations with disease occurrence and amyloid-β pathway. J Alzheimers Dis. 2011;27(1):119–26.
Davis JW, Grandinetti A, Waslien CI, et al. Observations on serum uric acid levels and the risk of idiopathic Parkinson’s disease. Am J Epidemiol. 1996;144(5):480–4.
de Lau LM, Koudstaal PJ, Hofman A, et al. Serum uric acid levels and the risk of Parkinson disease. Ann Neurol. 2005;58(5):797–800.
Weisskopf MG, O’Reilly E, Chen H, et al. Plasma urate and risk of Parkinson’s disease. Am J Epidemiol. 2007;166(5):561–7.
Chen H, Mosley TH, Alonso A, et al. Plasma urate and Parkinson’s disease in the Atherosclerosis Risk In Communities (ARIC) study. Am J Epidemiol. 2009;169(9):1064–9.
Winquist A, Steenland K, Shankar A. Higher serum uric acid associated with decreased Parkinson’s disease prevalence in a large community-based survey. Mov Disord. 2010;25(7):932–6.
Jain S, Ton TG, Boudreau RM, et al. The risk of Parkinson disease associated with urate in a community-based cohort of older adults. Neuroepidemiology. 2011;36(4):223–9.
Gao X, Chen H, Choi HK, et al. Diet, urate, and Parkinson’s disease risk in men. Am J Epidemiol. 2008;167(7):831–8.
Alonso A, Rodriguez LA, Logroscino G, et al. Gout and risk of Parkinson disease: a prospective study. Neurology. 2007;69(17):1696–700.
De Vera M, Rahman MM, Rankin J, et al. Gout and the risk of Parkinson’s disease: a cohort study. Arthritis Rheum. 2008;59(11):1549–54.
Facheris MF, Hicks AA, Minelli C, et al. Variation in the uric acid transporter gene SLC2A9 and its association with AAO of Parkinson’s disease. J Mol Neurosci. 2011;43(3):246–50. This article reports that variation in the urate transporter gene SLC2A9 that was previously shown to be related to low serum urate levels, may be associated with an earlier age at onset of PD. It is the first study linking epidemiological findings to a genetic polymorphism and it strengthens the link between urate and risk of developing PD.
O’Reilly EJ, Gao X, Weisskopf MG, et al. Plasma urate and Parkinson’s disease in women. Am J Epidemiol. 2010;172(6):666–70.
Ascherio A, LeWitt PA, Xu K, et al. Urate predicts rate of clinical decline in Parkinson disease. Arch Neurol. 2009;66(12):1460–8. This study established association between serum urate and clinical progression in PD. It is also the first study identifying CSF urate as a predictor of rate of clinical decline in PD. These findings promoted a phase II clinical trial testing urate elevation as a therapeutic strategy for disease modification.
Schwarzschild MA, Schwid SR, Marek K, et al. Serum urate as a predictor of clinical and radiographic progression in Parkinson disease. Arch Neurol. 2008;65(6):716–23.
Schwarzschild MA, Marek K, Eberly S, et al. Serum urate and probability of dopaminergic deficit in early “Parkinson’s disease”. Mov Disord. 2011;26(10):1864–8.
Annanmaki T, Pessala-Driver A, Hokkanen L, et al. Uric acid associates with cognition in Parkinson’s disease. Parkinsonism Relat Disord. 2008;14(7):576–8.
Wang XJ, Luo WF, Wang LJ, et al. Study on uric acid and the related factors associated with cognition in the patients with Parkinson’s disease. Chin Med J. 2009;89(23):1633–5.
Annanmaki T, Pohja M, Parviainen T, et al. Uric acid and cognition in Parkinson’s disease: a follow-up study. Parkinsonism Relat Disord. 2011;17(5):333–7.
Euser SM, Hofman A, Westendorp RGJ, et al. Serum uric acid and cognitive function and dementia. Brain. 2009;132:377–82.
Maetzler W, Stapf AK, Schulte C, et al. Serum and cerebrospinal fluid uric acid levels in lewy body disorders: associations with disease occurrence and amyloid-β pathway. J Alzheimers Dis. 2011;27(1):119–26.
Maesaka JK, Wolf-Klein G, Piccione JM, et al. Hypouricemia, abnormal renal tubular urate transport, and plasma natriuretic factor(s) in patients with Alzheimer’s disease. J Am Geriatr Soc. 1993;41(5):501–6.
Rinaldi P, Polidori MC, Metastasio A, et al. Plasma antioxidants are similarly depleted in mild cognitive impairment and in Alzheimer’s disease. Neurobiol Aging. 2003;24(7):915–9.
Polidori MC, Mattioli P, Aldred S, et al. Plasma antioxidant status, immunoglobulin g oxidation and lipid peroxidation in demented patients: relevance to Alzheimer disease and vascular dementia. Dement Geriatr Cogn Disord. 2004;18(3–4):265–70.
Beal MF, Matson WR, Storey E, et al. Kynurenic acid concentrations are reduced in Huntington’s disease cerebral cortex. J Neurol Sci. 1992;108(1):80–7.
Zoccolella S, Simone IL, Capozzo R, et al. An exploratory study of serum urate levels in patients with amyotrophic lateral sclerosis. J Neurol. 2011;258:238–43.
Keizman D, Ish-Shalom M, Berliner S, et al. Low uric acid levels in serum of patients with ALS: further evidence for oxidative stress? J Neurol Sci. 2009;285:95–9.
Auinger P, Kieburtz K, McDermott MP. The relationship between uric acid levels and Huntington’s disease progression. Mov Disord. 2010;25(2):224–8.
Paganoni S, Zhang M, Quiroz Zárate A, et al. Uric acid levels predict survival in men with amyotrophic lateral sclerosis. J Neurol. 2012 Feb 10.
Irizarry MC, Raman R, Schwarzschild MA, et al. Plasma urate and progression of mild cognitive impairment. Neurodegener Dis. 2009;6(1–2):23–8.
Logallo N, Naess H, Idicula TT, et al. Serum uri acid: neuroprotection in thrombolysis. The Bergen NORSTROKE study. BMC Neurol. 2011;11:114.
Yu ZF, Bruce-Keller AJ, Goodman Y, et al. Uric acid protects neurons against excitotoxic and metabolic insults in cell culture and against focal ischemic brain injury in vivo. J Neurosci Res. 1998;53(5):613–25.
Romanos E, Planas AM, Amaro S, et al. Uric acid reduces brain damage and improves the benefits of rt-PA in a rat model of thromboembolic stroke. J Cereb Blood Flow Metab. 2007;27(1):14–20.
Chen P, Goldberg DE, Kolb B, et al. Inosine induces axonal rewiring and improves behavorial outcome after stroke. Proc Natl Acad Sci USA. 2002;99(13):9031–6.
Shen H, Chen GJ, Harvey BK, et al. Inosine reduces ischemic brain injury in rats. Stroke. 2005;36:654–9.
Hooper CD, Bagasra O, Marini JC, et al. Prevention of experimental allergic encephalomyelitis by targeting nitric oxide and peroxynitrite: implications for the treatment of multiple sclerosis. Proc Natl Acad Sci. 1997;94:2528–33.
Hooper DC, Spitsin S, Kean RB, et al. Uric acid, a natural scavenger of peroxynitrite in experimental allergic encephalomyelitis and multiple sclerosis. Proc Natl Acad Sci. 1998;95:675–80.
Scott GS, Spitsin SV, Kean RB, et al. Therapeutic intervention in experimental allergic encephalomyelitis by administration of uric acid precursors. Proc Natl Acad Sci. 2002;99(25):16303–8.
Du Y, Chen CP, Tseng CY, et al. Astroglia-mediated effects of uric acid to protect spinal cord neurons from glutamate toxicity. Glia. 2007;55(5):463–72.
Scott GS, Cuzzocrea S, Genovese T, et al. Uric acid protects against secondary damage after spinal cord injury. Proc Natl Acad Sci. 2005;102(9):3483–8.
Aoyama K, Matsumura N, Watabe M, et al. Caffeine and uric acid mediate glutathione synthesis for neuroprotection. Neuroscience. 2011;181:206–15.
Serra PA, Sciola L, Delogu MR, et al. The neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine(MPTP) induces apoptosis in mouse nigrostriatal glia. Relevance to nigral neuronal death and striatal neurochemical changes. J Biol Chem. 2002;277(37):34451–61.
Desole MS, Esposito G, Fresu L, et al. Further investigation of allopurinol effects on MPTP-induced oxidative stress in the striatum and brain stem of the rat. Pharmacol Biochem Behav. 1996;54(2):377–83.
Church WH, Fong YT. Changes in uric acid during acute infusion of MPP+, 6-OHDA, and FeCl3. A microdialysis studying the substantia nigra of the guinea pig. Mol Chem Neurpathol. 1996;27(2):131–44.
Moor E, Shohami E, Kanevsky E, et al. Impairment of the ability of the injured aged brain in elevating urate and ascorbate. Exp Gerontol. 2006;41(3):303–11.
Jones DC, Gunasekar PG, Borowitz JL, et al. Dopamine induced apoptosis is mediated by oxidative stess and is enhanced by cyanide in differentiated PC12 cells. J Neurochem. 2000;74(6):2296–304.
Zhu TG, Wang XX, Luo WF, et al. Protective effects of urate against 6-OHDA-induced cell injury in PC12 cells through antioxidant action. Neurosci Lett. 2012;506(2):175–9.
Duan W, Ladenheim B, Cutler RG, et al. Dietary folate deficiency and elevated homoocysteine levels endanger dopaminergic neurons in models of Parkinson’s disease. J Neurchem. 2002;80(1):101–10.
Guerreiro S, Ponceau A, Toulorge D, et al. Protection of midbrain dopaminergic neurons by the end-product of purine metabolism uric acid: potentiation by low-level depolarization. J Neurochem. 2009;109(4):1118–28.
Wang LJ, Luo WF, Wang HH, et al. Protective effects of uric acid on nigrostriatal system injury induced by 6-hydroxydopamine in rats. [Article in Chinese]. Zhonghua Yi Xue Za Zhi. 2010;90(19):1362–5.
Cipriani S, Desjardins CA, Burdett TC, et al. Protective effect of urate on a dopaminergic cell line is potentiated by astrocytes (abstract 858.29). Presented at the annual meeting of Society of Neuroscience. San Diego, CA, Nov 12–17, 2010.
Cipriani S, Desjardins CA, Burdett TC, et al. Urate protects midbrain dopaminergic neurons from MPP + −induced toxicity (52.05). Presented at the annual meeting of Society of Neuroscience. Washington, DC, Nov 11–16, 2011.
Chen X, Desjardins CA, Burdett T, et al. Effects of urate oxidase transgene or knockout on 6-ohda neurotoxicity. Presented at the annual meeting of Society of Neuroscience. Washington, DC, Nov 11–16, 2011.
The Parkinson Study Group: Safety of Urate Elevation in Parkinson’s Disease (SURE-PD). Available at http://clinicaltrials.gov/ct2/show/NCT00833690. Accessed September 2010.
Álvarez-Lario B, Macarrón-Vicente J. Uric acid and evolution. Rheumatology (Oxford). 2010;49(11):2010–5.
Kutzing MK, Firestein BL. Altered uric acid levels and disease states. J Pharmacol Exp Ther. 2008;324(1):1–7.
Goldman L, Caldera DL, Nussbaum SR. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297:845–50.
Schlossmacher MG, Mollenhauer B. Biomarker research in Parkinson’s disease: objective measures needed for patient stratification in future cause-directed trials. Biomark Med. 2010;4(5):647–50.
Cipriani S, Chen X, Schwarzschild MA. Urate: a novel biomarker of Parkinson’s disease risk, diagnosis and prognosis. Biomark Med. 2010;4(5):701–12.
Acknowledgment
This paper is supported by the National Institutes of Health/National Institute of Neurological Disorders and Stroke grant K24NS060991 and the US Department of Defense grant W81XWH-11-1-0150.
Disclosure
Conflicts of interest: X. Chen: is employed by Massachusetts General Hospital; G. Wu: is employed by Suzhou Municipal Hospital; M.A. Schwarzschild: has been a consultant for Harvard University; is employed by Massachusetts General Hospital; has received payment for lectures including service on speakers bureaus from Emory University; has received = travel/accommodations/meeting expenses unrelated to activities listed from Emory University, Columbia University.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chen, X., Wu, G. & Schwarzschild, M.A. Urate in Parkinson’s Disease: More Than a Biomarker?. Curr Neurol Neurosci Rep 12, 367–375 (2012). https://doi.org/10.1007/s11910-012-0282-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11910-012-0282-7