Effect of hypouricaemic and hyperuricaemic drugs on the renal urate efflux transporter, multidrug resistance protein 4

A. A.K. El-Sheikh, J. J.M.W. Van Den Heuvel, J. B. Koenderink, F. G.M. Russel

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Background and purpose: The xanthine oxidase inhibitors allopurinol and oxypurinol are used to treat hyperuricaemia, whereas loop and thiazide diuretics can cause iatrogenic hyperuricaemia. Some uricosuric drugs and salicylate have a bimodal action on urate renal excretion. The mechanisms of action of these hypo- and hyperuricaemic drugs on the handling of urate in renal tubules have not been fully elucidated. Recently, we identified the multidrug resistance protein (MRP) 4 as a luminal efflux transporter for urate in the proximal tubule. Experimental approach: Here, we studied the effect of these drugs on [ 14C]urate transport using human embryonic kidney 293 cells overexpressing human MRP4 and in membrane vesicles isolated from these cells. Key results: Allopurinol stimulated MRP4-mediated cellular urate efflux and allopurinol and oxypurinol both markedly stimulated urate transport by MRP4 in membrane vesicles. Bumetanide and torasemide had no effect, whereas furosemide, chlorothiazide, hydrochlorothiazide, salicylate, benzbromarone and sulfinpyrazone inhibited urate transport, at concentrations ranging from nanomolar up to millimolar. Probenecid stimulated urate transport at 0.1 μM and inhibited transport at higher concentrations. Conclusions and implications: These data suggest that inhibition of MRP4-mediated urate efflux by furosemide and thiazide diuretics could have an important function in their hyperuricaemic mechanisms. Furthermore, stimulation of MRP4-mediated renal urate efflux could be a new mechanism in the hypouricaemic action of allopurinol and oxypurinol. In conclusion, MRP4 may provide a potential target for drugs affecting urate homoeostasis, which needs to be further evaluated in vivo.

Original languageEnglish
Pages (from-to)1066-1075
Number of pages10
JournalBritish Journal of Pharmacology
Volume155
Issue number7
DOIs
Publication statusPublished - 1 Dec 2008

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P-Glycoproteins
Uric Acid
Kidney
Allopurinol
Pharmaceutical Preparations
Oxypurinol
Sodium Chloride Symporter Inhibitors
torsemide
Salicylates
Furosemide
Benzbromarone
Sulfinpyrazone
Chlorothiazide
urate transporter
Sodium Potassium Chloride Symporter Inhibitors
Bumetanide
Probenecid
Hydrochlorothiazide
Membranes
Xanthine Oxidase

Keywords

  • Diuretic
  • Hyperuricaemia
  • Multidrug resistance protein
  • Urate transport
  • Uricosuric

Cite this

El-Sheikh, A. A.K. ; Van Den Heuvel, J. J.M.W. ; Koenderink, J. B. ; Russel, F. G.M. / Effect of hypouricaemic and hyperuricaemic drugs on the renal urate efflux transporter, multidrug resistance protein 4. In: British Journal of Pharmacology. 2008 ; Vol. 155, No. 7. pp. 1066-1075.
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Effect of hypouricaemic and hyperuricaemic drugs on the renal urate efflux transporter, multidrug resistance protein 4. / El-Sheikh, A. A.K.; Van Den Heuvel, J. J.M.W.; Koenderink, J. B.; Russel, F. G.M.

In: British Journal of Pharmacology, Vol. 155, No. 7, 01.12.2008, p. 1066-1075.

Research output: Contribution to journalArticle

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T1 - Effect of hypouricaemic and hyperuricaemic drugs on the renal urate efflux transporter, multidrug resistance protein 4

AU - El-Sheikh, A. A.K.

AU - Van Den Heuvel, J. J.M.W.

AU - Koenderink, J. B.

AU - Russel, F. G.M.

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AB - Background and purpose: The xanthine oxidase inhibitors allopurinol and oxypurinol are used to treat hyperuricaemia, whereas loop and thiazide diuretics can cause iatrogenic hyperuricaemia. Some uricosuric drugs and salicylate have a bimodal action on urate renal excretion. The mechanisms of action of these hypo- and hyperuricaemic drugs on the handling of urate in renal tubules have not been fully elucidated. Recently, we identified the multidrug resistance protein (MRP) 4 as a luminal efflux transporter for urate in the proximal tubule. Experimental approach: Here, we studied the effect of these drugs on [ 14C]urate transport using human embryonic kidney 293 cells overexpressing human MRP4 and in membrane vesicles isolated from these cells. Key results: Allopurinol stimulated MRP4-mediated cellular urate efflux and allopurinol and oxypurinol both markedly stimulated urate transport by MRP4 in membrane vesicles. Bumetanide and torasemide had no effect, whereas furosemide, chlorothiazide, hydrochlorothiazide, salicylate, benzbromarone and sulfinpyrazone inhibited urate transport, at concentrations ranging from nanomolar up to millimolar. Probenecid stimulated urate transport at 0.1 μM and inhibited transport at higher concentrations. Conclusions and implications: These data suggest that inhibition of MRP4-mediated urate efflux by furosemide and thiazide diuretics could have an important function in their hyperuricaemic mechanisms. Furthermore, stimulation of MRP4-mediated renal urate efflux could be a new mechanism in the hypouricaemic action of allopurinol and oxypurinol. In conclusion, MRP4 may provide a potential target for drugs affecting urate homoeostasis, which needs to be further evaluated in vivo.

KW - Diuretic

KW - Hyperuricaemia

KW - Multidrug resistance protein

KW - Urate transport

KW - Uricosuric

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