Acute hepatic porphyria syndrome with porphobilinogen synthase defect

On the basis of metabolite and enzyme studies a new type of acute hepatic porphyria with porphobilinogen synthase defect and repeated intermittent acute manifestations, abdominal colics, tachycardia and hypertension, and a persistent neurological syndrome was found in two young male patients. The main characteristic features are the following:

• 1.1. High urinary δ-aminolevulinic acid excretion( ⪢ 1 mmol/24hr), slight increase of porphobilinogen (up to 25 μmol/24 hr) and high increase of porphyrins (up to 22 μmol/24 hr) with coproporphyrin dominance.
• 2.2. Normal fecal and liver porphyrins.
• 3.3. Slight increase of erythrocyte protoporphyrin.
• 4.4. Decrease of porphobilinogen synthase activity in erythrocytes in both cases below 1% of healthy and not lead-exposed persons; normal activities of uroporphyrinogen synthase and decarboxylase in erythrocytes.
• 5.5. Low-normal lead concentrations in blood and low-normal lead excretion in urine in both cases; normal lead content in bone.
• 6.6. Normal plasma and urinary amino acids.
• 7.7. Irrelevant hepatological (liver biopsy), general clinical chemical and hematological findings.
• 8.8. Diminished activity of porphobilinogen synthase in nearly all family members of both patients. From these investigations it can be concluded that there is no exogeneous, “toxic” cause of this porphyria. Porphobilinogen synthase in lead poisoning is not diminished to such an extent as demonstrated here; in contrast to lead intoxication, porphobilinogen synthase activity cannot be activated or reactivated by thiols. All clinical and pathobiochemical data point at a new enzymatic type of endogeneous acute hepatic porphyria with intermittent acute manifestations, clinically analogous to so-called acute intermittent porphyria. Porphyrin precursors and porphyrin excretion both reflects the enzymatic defect and the regulatory consequences starting with the induction of δ-aminolevulinic acid synthase.

     

Experience with the red cell uroporphyrinogen synthase (URO-S) assay in kindreds with acute intermittent porphyria (AIP)

• 1.1. Erythrocyte URO-S activity was assessed in members of 14 AIP kindreds and correlated with clinical symptoms and urinary excretion of porphobilinogen (PBG).
• 2.2. When a single URO-S assay showed levels in an indeterminate range, in most cases genotype ascertainment was achieved by repeat assay, assay by more than one laboratory, PBG quantitation in the urine, and analysis of pedigrees. In about 5% of cases, this approach still precluded definition of the genotype.
• 3.3. Neither symptoms of AIP nor urinary excretion of PBG correlated with red cell URO-S activity.

     

Comparison of the porphyrin patterns in patients with porphyria cutanea tarda in Czechoslovakia and Denmark

• 1.1. The incidence of porphyria cutanea tarda (PCT) has increased considerably in Denmark during the last decade (Table 1) but is much higher in Czechoslovakia than in Denmark.
• 2.2. We therefore made a detailed study of the urinary porphyrin excretion pattern in 10 cases of PCT from Copenhagen and 10 from Prague.
• 3.3. The results are presented (Table 2). They show no simple pattern.
• 4.4. Comparison with the type subdivision of Doss et al. (Table 3) and the important findings of Piñol Aguade et al. show that such elaborate type division, involving considerable and time-consuming analytical work, belong to research and have limited value in clinical work.

     

Biochemistry of porphyria

• 1.1. The porphyrias are a group of metabolic disorders arising from defects in the haem biosynthetic pathway. Most forms are inherited as Mendelian autosomal dominants, but some types are recessive and others acquired through exposure to porphyrinogenic drugs and chemicals. There is a linked group of diseases, which are not porphyrias, but have in common alterations of haem biosynthesis.
• 2.2. The processes of haem biosynthesis are now well understood and the molecular biology of the functions and dysfunctions in the porphyrias are currently an area of intensive investigation.
• 3.3. The acute porphyrias. Acute Intermittent Porphyria, Variegate Porphyria and Hereditary Coproporphyria are of most importance since attacks of these may be life-threatening.
• 4.4. These diseases that usually present with a neurovisceral attack are characterized by excess production of the porphyrin precursors, 5-aminolaevulinate and porphobilinogen because of lowered activity of Porphobilinogen deaminase.
• 5.5. A variety of factors may precipitate these attacks including various drugs, alcohol, smoking, dieting or fasting and variations in steroid hormone levels.
• 6.6. The non-acute porphyrias are largely dermatological conditions, which present clinically as cutaneous photosensitivity. The dermatological changes are caused by the photosensitizing properties of circulating porphyrins and are accompanied by systemic effects of these porphyrins.

     

Development of chronic hepatic porphyria (porphyria cutanea tarda) with inherited uroporphyrinogen decarboxylase deficiency under exposure to dioxin

• 1.1. Exposure to dioxin triggered a clinically manifest chronic hepatic porphyria (porphyria cutanea tarda) in two patients (brother and sister) with hereditary uroporphyrinogen decarboxylase deficiency.
• 2.2. The patients showed a decrease of erythrocyte uroporphyrinogen decarboxylase activity to ~ 50% of controls even in reinvestigations after three years, whereas clinical symptoms and porphyrinuria had improved considerably. Only a subclinical phase of chronic hepatic porphyria persisted. Subnormal uroporphyrinogen decarboxylase activity could be determined in altogether nine family members.
• 3.3. The remission of porphyria cutanea tarda into a subclinical phase occurred after chloroquine therapy. Subclinical phases of chronic hepatic porphyria (type A) in other family members remitted without special therapy.
• 4.4. Among the 60 persons dioxin-exposed by the Seveso accident, a secondary coproporphyrinuria was found in 22% of examined patients with transition to a subclinical chronic hepatic porphyria in 5 cases. The changes had subsided completely after one year. A persistence of the transition state in 3 cases is probably due to alcohol influence. None of these cases developed a porphyria cutanea tarda.
• 5.5. The investigations showed that a hereditary disposition is necessary for biochemical and clinical expression of chronic hepatic porphyria after a unique dioxin exposure. This is not given in the sporadic cases: after a unique dioxin exposure they indeed develop a symptomatic disturbance of porphyrin metabolism but not a clinically relevant chronic hepatic porphyria.
• 6.6. We conclude that a unique acute exposure to dioxin can trigger the chronic hepatic porphyria disease process in persons with an underlying genetic abnormality of uroporphyrinogen decarboxylase.

     

The peculiarities of nitrogen excretion in sturgeons (Acipenser ruthenus) (Pisces,Acipenseridae)—I. the influence of ration size

• 1.1. The nonfaecal nitrogenous excretion rate in starved sterlet fingerlings and fingerlings fed on different rations was investigated. The weight of the fish and temperature of the water was 43 g and 17.5°C, respectively.
• 2.2. In the nonfaecal excrements of starved sterlets the ammonia: urea ratio was substantially lower than in teleosts. This ratio was found to be 1.4:1.
• 3.3. In fed sterlets the urea excretion rate was higher than in starved ones but independent of ration size.
• 4.4. During the day the urea excretion rate in sterlets was constant.
• 5.5. The ammonia excretion rate accelerated 2 hr after feeding and reached its peak duration 6–11 hr after depending on the ration size.
• 6.6. Total ammonia output in the sterlet increased following the increase of ration size up to 8.4% of body wt. Further increases in ration size did not cause the corresponding elevation of ammonia excretion rate.

     

Renal response to hypoxia in carp,Cyprinus carpio: Changes in glomerular filtration rate,urine and blood properties and plasma catecholamines of carp exposed to hypoxic conditions

• 1.1. Changes in glomerular nitration rate (GFR), urine and blood properties and plasma catecholamines of carp were investigated during and following hypoxia.
• 2.2. GFR and urine flow decreased with increased urinary concentrations of bio-components, except protein, in the course of hypoxia.
• 3.3. Decreases in blood pH, and increases in haematocrit value and plasma K⁺, Ca²⁺, Mg²⁺, inorganic phosphate (P_i), ammonia, lactic acid and catecholamines (CAs) were observed as hypoxia progressed.
• 4.4. Increased GFR and urine flow, and higher values for urinary components, except protein, compared with those of the control were found in the initial post-stress stage.
• 5.5. The possible significance of increased plasma CAs in relation to changes in renal function in hypoxic carp is discussed.

     

Kinetics of porphyrin accumulation in cultured epithelial cells exposed to ALA

• 1.1. The kinetics of porphyrin accumulation in cultured mammalian epithelial cells (CNCM-I-221) during exposure to ALA was investigated.
• 2.2. The total porphyrin synthesized is a function of ALA concentration and the incubation time. The cellular porphyrin content exhibited a saturation pattern, reaching a plateau at about 0.04 fmol porphyrins/cell. A biphasic time-dependent increase in the total porphyrin synthesized was observed.
• 3.3. After 3 hr of exposure to ALA the rate of synthesis increased to ahnost twice the initial rate, reaching between 0.02 and 0.05 fmol porphyrins/cell/hr depending on serum concentration in the medium.
• 4.4. Two effects of FBS on ALA-stimulated porphyrin accumulation were observed. Greater total porphyrin synthesis was found when incubations were made in 10% FBS compared to those in 1% FBS.
• 5.5. The higher serum concentration also caused a greater release into the medium of the porphyrins generated in the cells with a calculated half-life of 24 min in 10% serum-supplemented medium compared with 62 min in 1% serum.
• 6.6. The results obtained from cell synchronization experiments suggest that there is little obvious cell cycle-dependent variation in the synthesis of porphyrins from ALA.
• 7.7. The small differences in the intracellular porphyrin content that were observed may be attributed to a slight reduction in the rate of loss of porphyrins in G2/M cells.

     

The effect of osmotic and ion-osmotic stresses on the blood and urine composition and urine flow of rainbow trout (Salmo gairdneri)

• 1.1. Changes in urine and plasma concentrations (sodium, potassium, magnesium, calcium and total osmotic) and urine production were determined in fish exposed to various concentrations of an ionically active substance, sodium chloride, and a non-electrolyte, mannitol, as well as freshwater.
• 2.2. Responses occurred for the most part over a short crisis period preceeding establishment of new stable conditions.
• 3.3. It was shown that plasma homeostasis was not maintained in response to changing ion-osmotic and osmotic gradients.
• 4.4. Urinary osmotic and ionic concentrations were unaffected and urine production was shown to be inversely related to the external concentration.
• 5.5. It is suggested that ionic shifts between body compartments are an important aspect of ion-osmotic adaptation.

     

Study of the heme catabolism of fish

• 1.1. The composition of bile pigments in the blood and bile of 39 species were studied.
• 2.2. Conjugated bilirubin (trace to 4.62 mg/100 ml) was detected in the serum of most fish, while biliverdin (trace to 2.0 mg/100ml) was detected only in Anguilla Japonica, Thalassoma lunare and Clinocottus analis.
• 3.3. Analysis showed tht there are two types of bile pigments excretion pattern in these fishes. The first pattern excretes bilirubin (most conjugate) predominantly, the other excretes mostly biliverdin with some bilirubin. However, during starvation, the excretion of conjugate bilirubin gradually shifted to unconjugated biliverdin. The rate of shifting varies with species.
• 4.4. Introduction of bilirubin into Anguilla japonica produced an initial excretion of mono-conjugates, followed by di-conjugates. Introduction of biliverdin caused an increased in the excretion of unconjugated biliverdin, but no significant increase of bilirubin in the bile was detected.
• 5.5. A binary excretion pathway of bile pigments in fish is proposed. The evolutionary characteristics of heme catabolism in terrestrial animals with respect to this pathway is discussed.

     

How the atmosphere and the presence of substrate affect the photo and non-photoinactivation of heme enzymes by uroporphyrin I

• 1.1. The effect of URO I on the activity of ALA-D, PBGase, deaminase and URO-D, both in aerobiosis and anaerobiosis, was studied.
• 2.2. Photoinactivation of the enzymes was much lower in an anaerobic than in an aerobic atmosphere.
• 3.3. Dark inactivation in the absence of oxygen was lower than its presence.
• 4.4. Preincubation in the presence of ALA or PBG protected the enzymic activity of ALA-D, PBGase and deaminase against URO I-inactivation both under u.v. light and in the dark.
• 5.5. Photoinactivating action of URO I would be mediated by reactive oxygen species generated by the excited porphyrin after its absorption of light. Dark inactivation, in aerobiosis, can also be partly mediated by amino acid oxidation, although to a lesser extent than that observed under u.v. light.

     

Unusual porphyrins in porphyric bullous fluid

• 1.1. The porphyrins in bullous fluids from two female patients, one with variegate porphyria (VP) and the other with congenital erythropoietic porphyria (CEP), have been analyzed and in each case found to contain an unusual porphyrin, a 4-COOH porphyrin resembling isocoproporphyrin in the VP patient. In the patient with CEP the blister fluid was shown to contain a porphyrin with a Chromatographie mobility compatible with that of isocoproporphyrin.

     

Heart mitochondrial and microsomal phospholipid fluctuations induced by chronic exercise in rats

• 1.1. The possible changes of heart mitochondrial and microsomal individual phospholipid concentrations after exercise and training in relation to time were investigated.
• 2.2. The most remarkable alterations observed after 40 days of exercise and training are namely a decrease of PC and PE and an increase of PS and DPG in heart mitochondria.
• 3.3. Regarding heart microsomes we found only a reduced concentration of PE and PS.
• 4.4. All the above mentioned changes are time-dependent and reversible.

     

Comprehensive Analysis of Individual Variation in the Urinary Proteome Revealed Significant Gender Differences

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Highlights

• •Comprehensive analysis of inter-individual variation of normal urinary proteome.
• •Significant gender differences were observed.
• •Proteins increased in female urine are enriched in immunological pathways.
• •Estimated reference intervals of proteins as the baseline for biomarker discovery.

     

δ-Aminolevulinic acid dehydratase inactivation by uroporphyrin I in light and darkness

• 1.1. The action of uroporphyrin I on erythrocytic ALA-D activity under dark and light conditions was examined.
• 2.2. Photo and non-photoinactivation of ALA-D induced by uroporphyrin I were observed.
• 3.3. Both effects were dependent on uroporphyrin concentration, temperature and time of exposure of the protein to the porphyrin.
• 4.4. Light-dependent effect of uroporphyrin I is related with the phototoxicity of porphyrins and could be produced by primary amino acid photooxidation followed by secondary cross-linking of the protein.
• 5.5. Light-dependent effect of uroporphyrin I could be ascribed to a direct enzyme inhibition due to binding of the porphyrin to the protein inducing structural changes at or near its active site.

     

Epidermal growth factor alters the electrolyte profile of lactating ewes Ovis aries

• 1.1. Lactating ewes were treated with mouse epidermal growth factor (EGF) at a dose rate of 0.5 mg/day for 4 days and its effects on the electrolyte profile were observed.
• 2.2. There was no effect of EGF on plasma concentrations of sodium or potassium, although urinary and total (in urine and milk) losses of both were reduced.
• 3.3. EGF-induced hypocalcaemia was associated with reduced milk calcium secretion and increased urinary calcium excretion whereas EGF-induced hypermagnesaemia was associated with reduced urinary and total magnesium losses.
• 4.4. Glomerular filtration rate was reduced during EGF infusion.
• 5.5. Chronic intravenous EGF infusion affects the electrolyte profile by altering electrolyte secretion by the mammary gland and renal electrolyte excretion.

     

Purification and some properties of an atypical alkaline p-nitrophenylphosphate phosphatase activity from Halobacterium halobium

• 1.1. An alkaline p-nitrophenylphosphate phosphatase has been purified 440-fold from extracts of Hatobacterium halobium.
• 2.2. The enzyme has an apparent molecular weight of 24,000.
• 3.3. A K_m value for p-nitrophenylphosphate of 1.12mM has been found under optimal conditions.
• 4.4. The enzyme is selectively activated and stabilized by Mn²⁺.
• 5.5. It requires high salt concentrations for stability and maximum activity.
• 6.6. It displays an unusual restricted substrate specificity of 25 phosphate esters tested, only phosphotyrosine and casein were hydrolysed besides p-nitrophenylphosphate.

     

Effects of lysine administration on plasma arginine and on some nitrogenous catabolites in rainbow trout

• 1.1. Rainbow trout were fed either graded levels of lysine (0.8, 1.8 and 3%) at a constant level of arginine (1.4%) or excess arginine (2.4%) at a fixed level of lysine (1.8%).
• 2.2. Increasing the dietary lysine level affected plasma urea, plasma arginine and ammonia excretion.
• 3.3. Trout fed graded levels of lysine received an arginine challenge (U¹⁴C-l-arginine) and it was found that excess dietary lysine led to a decrease in arginine degradation.
• 4.4. Injection of l-lysine induced a decrease in urea excretion, while injection of l-arginine increased both urea and ammonia excretion in control well-fed trout.
• 5.5. These results are discussed in the light of current knowledge on the antagonism between lysine and arginine.

     

Immunoaffinity purification of a diuretic hormone from the nervous ventral cord of the migratory locust

• 1.1. An antibody raised against the mammal arginine-vasopressin (AVP) is used to immunopurify a neurohormone, structurally related to AVP, which enhances the excertion of the primary urine from the locust Malpighian tubules.
• 2.2. The best procedure of immunopurification is developed by testing with different solvents.
• 3.3. This procedure is applied to purify a semi-crude extract from 1000 suboesophageal and thoracic ganglia, the main source of hormone.
• 4.4. The interest of this technique in the purification of biological materials, when only minute amounts are available, is discussed.

     

The measurement of glutamate dehydrogenase activity in Praunus flexuosus and its role in the regulation of ammonium excretion

• 1.1. A strong correlation (r² = 0.916) was found between glutamate dehydrogenase (GDH) activity and ammonium excretion in Praunus flexuosus suggesting a key regulatory role for this enzyme.
• 2.2. The high level of GDH activity found in this mysid was sufficient to account for all the ammonium excreted.
• 3.3. Activator-inhibitor studies imply that GDH may regulate energy production and growth, in addition to ammonium excretion.
• 4.4. The GDH assay presented here appears useful as a technique for quantifying zooplankton ammonium excretion impacts in the world oceans.