A metabolomic signatures in hyperuricemia: a systematic review.

backgroundHyperuricemia (HUA) is traditionally viewed as a disorder of purine metabolism. However, its broader metabolic alterations remain incompletely understood. Metabolomics provides a useful approach for exploring metabolite changes associated with HUA, but a comprehensive synthesis of existing findings is still lacking. AIM OF REVIEW: This systematic review and meta-analysis aimed to characterize the systemic metabolic signature of HUA beyond purine pathways. By synthesizing data from 27 metabolomics studies involving 12,335 participants, the study sought to identify consistent metabolite biomarkers and key dysregulated pathways to provide new insights for diagnosis and therapeutic targeting. KEY SCIENTIFIC CONCEPTS OF REVIEW: This review included 27 metabolomics studies involving 12,335 participants and identified 1,187 metabolites reported in association with HUA. Qualitative synthesis showed 54 consistently elevated and 20 consistently decreased blood metabolites, mainly involving amino acids, lipid-related metabolites, energy-related compounds, vitamins and their derivatives, and purine nucleoside metabolites. The meta-analysis was limited to two eligible studies, with one study contributing most of the statistical weight; it suggested higher levels of Alanine, Leucine, Phenylalanine, and Tyrosine and lower Histidine levels in HUA. Pathway enrichment analysis highlighted "One carbon pool by folate," "Arginine biosynthesis," "Glutathione metabolism," and related amino acid and energy metabolism pathways. Overall, these findings suggest that HUA may be associated with metabolic perturbations beyond purine metabolism alone, but the candidate metabolites and pathways require further validation in longitudinal, standardized, and mechanistic studies.