Gout, with a section on ocular disease in the goutyLlewellyn, Llewellyn J. (Llewellyn Jones)
Science
Gout, with a section on ocular disease in the gouty
Llewellyn, Llewellyn J. (Llewellyn Jones)
Eye -- Diseases; Gout
On the other hand, Wells, discussing the destruction of uric acid,
observes that repeated investigations show “that the tissues of man have
no power whatever to destroy uric acid _in vitro_; the earlier reports of
positive uricolysis undoubtedly being erroneous.” His final conclusion,
after weighing all available evidence, is that it is highly probable that
in man “most of the purin absorbed from the food, and practically all
the purin from cell metabolism, is converted into uric acid and excreted
as such.” MacLeod, however, reflecting on the fact that uric acid is not
destroyed when extracts of the organs are incubated at body temperature
with uric acid or its precursors, bids us bear in mind that, “although
the uric acid is thus shown not to be destroyed _in vitro_, it may
nevertheless be destroyed in the living animal.”
We see, therefore, that the question, Whether uric acid can undergo
destruction in the human body? is still a matter of dispute, and must,
pending further investigation, remain _sub judice_. Still, despite the
conflict of evidence, clinicians have felt justified in assuming that one
of the factors in the genesis of gout may be an entire _absence_ or a
_diminution_ in the amount or activity of this _uricolytic ferment_.
But the awkward fact remains that all researches up to date have failed
to establish the presence in the human body of any enzyme which can
decompose uric acid. Should, therefore, future investigators place beyond
the reach of cavil the claim that no _uric-acid-destroying enzyme exists
in the body_, it would seem that, _ipso facto_, man, through lack of this
capacity for rapid oxidation of uric acid, is, by this same disability,
rendered a potential victim of _uric acid retention_ and _deposition_.
Elucidation of this vexed point seems more probable in view of the
striking discovery recently made by R. Benedict, viz., that in one
particular breed of dog, the Dalmatian, _uricase_ is wholly absent. In
respect of this _lack of a uric-acid-destroying ferment_, the Dalmatian
breed of dog has a _purin_ metabolism apparently identical with that of
man.[16] Thus, if fed on a purin-free diet, he passes large quantities of
uric acid, and if the latter be injected subcutaneously, elimination in
quantity as such ensues; this, in striking contrast to what obtains in
all other animals in whom, as before noted, uric acid is mostly oxidised
to _allantoin_ before excretion. Now, as MacLeod observes, investigation
into the metabolism of nucleic acid has, in man, been hampered greatly,
in that the absence of uricase from his tissues, prior to Benedict’s
discovery, rendered experimental researches on the lower animals
valueless. But, in light of the above revelation later by R. Benedict, it
may reasonably be hoped that in the near future our knowledge as to the
location and nature of the intermediary chemical processes occurring in
the metabolism of nucleic acids may be materially clarified.
CHAPTER IX
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