Sirtuin deficiency and the adverse effects of fructose and uric acid synthesis

Fructose metabolism and hyperuricemia have been shown to drive insulin resistance, metabolic syndrome, hepatic steatosis, hypertension, inflammation, and innate immune reactivity in experimental studies. We suggest that these adverse effects are at least in part the result of suppressed activity of sirtuins, particularly Sirtuin1. Deficiency of sirtuin deacetylations is a consequence of reduced bioavailability of its cofactor nicotinamide adenine dinucleotide (NAD⁺). Uric acid-induced inflammation and oxidative stress consume NAD⁺ and activation of the polyol pathway of fructose and uric acid synthesis also reduces the NAD⁺-to-NADH ratio. Variability in the compensatory regeneration of NAD⁺ could result in variable recovery of sirtuin activity that may explain the inconsistent benefits of treatments directed to reduce uric acid in clinical trials. Here, we review the pathogenesis of the metabolic dysregulation driven by hyperuricemia and their potential relationship with sirtuin deficiency. In addition, we discuss therapeutic options directed to increase NAD⁺ and sirtuins activity that may improve the adverse effects resulting from fructose and uric acid synthesis.