Faiz Qamar, Ramsha Parveen, Mohd Vaseem, Tufail Ahmad, Divya Vohora, Manju Sharma
Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia and progressive multi-organ complications driven by oxidative stress, inflammation, and metabolic dysfunction. Accumulating experimental evidence identifies the thioredoxin-interacting protein (TXNIP)-NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome axis as a critical molecular link between hyperglycemia-induced oxidative stress and inflammatory cell death, although its therapeutic modulation in diabetes remains under active investigation. Activation of TXNIP promotes assembly of the NLRP3 inflammasome, leading to caspase-1 activation, maturation of interleukin (IL)-1β and IL-18, and subsequent pyroptosis. This pathway has been increasingly implicated in the pathogenesis of diabetic complications, including nephropathy, retinopathy, neuropathy, cardiomyopathy, and diabetic osteopathy. Therefore, therapeutic strategies targeting upstream regulators of inflammasome activation have gained considerable attention. Allopurinol, a xanthine oxidase (XO) inhibitor traditionally used for the management of gout and hyperuricemia, possesses well-established antioxidant and anti-inflammatory properties that extend beyond urate lowering. By inhibiting XO-mediated reactive oxygen species (ROS) generation, allopurinol attenuates oxidative stress, improves endothelial function, and modulates inflammatory signaling pathways associated with diabetic tissue injury. Emerging experimental evidence suggests that suppression of XO-derived oxidative stress may indirectly influence TXNIP-NLRP3 inflammasome activation and downstream pyroptotic pathways, although whether allopurinol directly modulates this pathway has not yet been conclusively established. This review critically examines the mechanistic relationship between XO-derived oxidative stress, TXNIP-NLRP3 inflammasome signaling, and pyroptosis in diabetes. We distinguish experimentally validated mechanisms from biologically plausible hypotheses and critically evaluate current evidence supporting the potential role of allopurinol as an upstream modulator of inflammasome activation, with particular emphasis on the emerging and underexplored field of diabetic osteopathy.