Apart from tackling over-production and under-excretion of uric acid in the management of Gout (and I hope I have convinced you that increasing excretion is the far better way), there is still one more way to treat hyperuricaemia that we have not considered. And that is: to break down uric acid into highly soluble and easily excreted allantoin.
All hominids (we're the only ones left) and the higher primates (gorilla, chimpanzees) lack uricase. We're the only ones who get spontaneous Gout. So, in addition to the host of transporters designed to retain uric acid, we did away with the ability to break it down, shutting off the only escape valve, as it were. Uric acid must be really important to our higher development, perhaps intellectual even, considering the numerous scientific illuminairies throughout history with Gout. I'm in exalted company😉
This is a very intriguing if not philosophical read.
While a synthetic uricase, Pegloticase (Krystexxa) exists, we hardly ever use it. It is derived from the pig and baboon, and elicits a rapid and violent immune response which neutralises it at best, or severe allergic reaction at worst.
This article considers the possibility of genetically engineering a prehistoric humanised version of the enzyme.
Perhaps in the future, we can CRISPR edit the promoter site and the main gene to permanently reactivate the uricase gene, and fine tune it just enough to keep Gout at bay and not render us stupid.
That's when Gout is cured.