Phytotherapeutic insights into hyperuricemia: a mechanistic and clinical perspective

Hyperuricemia (HU), a condition marked by an increase in serum uric acid (UA) levels, is a leading cause for the development of gout along with UA nephrolithiasis. Despite the accessibility of conventional urate-lowering therapies, many patients experience adverse effects or inadequate responses, prompting the exploration of alternative treatments. Herbal interventions have gained attention for their potential to manage HU due to their multi-targeted mechanisms, including inhibition of xanthine oxidase, enhancement of renal urate excretion, and modulation of inflammatory and oxidative stress pathways. This review emphasizes the bioactive compounds from various medicinal plants with urate-lowering properties, their molecular mechanisms, and synergistic effects when combined with synthetic drugs. Classical natural agents like salicylic acid and salsalate have also been reappraised for their mild uricosuric activity and anti-inflammatory action, offering a pharmacological bridge between traditional herbals and modern therapeutics. Certain plant-based formulations with their clinical data have also been highlighted. AI-driven screening and combinatorial chemistry are emerging tools to optimize herbal formulations while nanotechnology-based drug delivery systems offer enhanced bioavailability. Challenges of herbal therapy, such as extract standardization, dose optimization, and variability in experimental models, are also discussed. The article further explores the future scope of herbal treatments, emphasizing the need for large-scale clinical trials, regulatory approvals, and the development of standardized formulations to ensure consistency and efficacy. By integrating herbal interventions with conventional therapies, there is potential for improving patient outcomes for the management of HU, with few side effects.