Serum Uric Acid as a Mediator of Insulin Resistance: Molecular Mechanisms and Metabolic Pathways

Insulin resistance (IR) is a key factor in metabolic conditions such as type 2 diabetes (T2D) and metabolic syndrome, which significantly impact global health. Serum uric acid (SUA), is the end product of purine catabolism, has increasingly been recognized as a potential modulator of insulin sensitivity.

A comprehensive narrative review was conducted to synthesize current evidence on SUA-mediated insulin resistance, with a focus on underlying molecular mechanisms, clinical implications, and key gaps warranting future investigation. Relevant experimental, translational, and clinical studies examining the role of SUA in insulin resistance, its mechanistic pathways, and therapeutic potential were critically analysed.

Emerging evidence indicates that elevated SUA levels are associated with disturbances in insulin signaling pathways. Mechanistically, high SUA levels can lead to oxidative stress, endothelial dysfunction, inflammation, and impaired function of adipocytes-all of which collectively impede insulin receptor activity and downstream signaling. Key pathways involved include activation of the NLRP3 inflammasome, suppression of AMP-activated protein kinase (AMPK), and induction of mitochondrial dysfunction. These mechanisms contribute to altered insulin sensitivity in both hepatic and adipose tissues. Clinically, higher SUA levels are associated with increased risk of developing metabolic syndrome, T2D, and cardiovascular diseases, highlighting SUA's potential as both a biomarker and a therapeutic target. Despite these findings, the precise molecular interactions between SUA and insulin signaling remain incompletely understood, underscoring the need for further translational and mechanistic research.