Molecular mechanisms of uric acid transport by the native human URAT1 and its inhibition by anti-gout drugs
Wu, C.; Zhang, C.; Jin, S.; Wang, J. J.; Dai, A.; Xu, J.; Zhang, H.; Yang, X.; He, X.; Yuan, Q.; Hu, W.; Xu, Y.; Wang, M.-W.; Jiang, Y.; Yang, D.; Xu, H. E.
Show abstract
Gout, a common and painful disease, stems from hyperuricemia, where elevated blood uric acid levels lead to urate crystal formation in joints and kidneys. The human urate transporter 1 (hURAT1) plays a critical role in urate homeostasis by facilitating urate reabsorption in the renal proximal tubule, making it a key target for gout therapy. Pharmacological inhibition of hURAT1 with drugs such as dotinurad, benzbromarone, lesinurad, and verinurad promotes uric acid excretion and alleviates gout symptoms. Here we present cryo-electron microscopy structures of native hURAT1 bound with these anti-gout drugs in the inward-open state, and with uric acid in inward-open, outward-open, and occluded states. Complemented by mutagenesis and cell-based assays, these structures reveal the mechanisms of uric acid reabsorption and hURAT1 inhibition. Our findings elucidate the molecular basis of uric acid transport and anti-gout medication action, and provide a structural framework for the rational design of next-generation therapies for hyperuricemia and gout.
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