antiuricase

Antiuicase refers to antibodies directed against uricase, an enzyme that converts uric acid to the more soluble allantoin. In humans, a functional uricase is absent, but recombinant uricases are used therapeutically to treat hyperuricemia and refractory gout. Pegylated forms of uricase, such as pegloticase, are among the agents developed for this purpose.

Immunogenicity is a key aspect of antiuricase. When a non-human or modified enzyme is administered, the immune system can recognize it as foreign and mount a humoral response, producing antiuricase antibodies. These antibodies can bind the enzyme, reducing its activity and accelerating clearance from the circulation. As a result, therapeutic efficacy may wane over time, and patients can experience loss of uric acid control. In some cases, antiuricase antibodies are associated with infusion reactions or hypersensitivity events.

Clinical implications include monitoring for loss of response to uricase therapy by tracking serum uric acid levels and watching for signs of infusion reactions. If antiuricase antibodies are detected or uric acid levels rise despite treatment, clinicians may discontinue the uricase therapy and consider alternative gout treatments, such as xanthine oxidase inhibitors, or switch to a different uricase formulation if appropriate.

Detection of antiuricase antibodies is typically performed with immunoassays, such as ELISA, and may be used to guide management decisions. Research continues to address immunogenicity through approaches like further protein engineering, alternative delivery methods, or using less immunogenic variants to improve durability and safety of uricase-based therapies.