Mutaciones del gen de la hemocromatosis en donantes de sangre voluntarios y en pacientes con porfiria cutanea tarda en chile / Mutations of hemochromatosis gene in volunteer blood donors and Chilean porphyria cutanea tarda patients

La acumulación de hierro hepático asociada a mutaciones en el gen HFE de la hemocromatosis hereditaria (HH) en los pacientes con porfiria cutánea tarda (PCT) podría tener un papel en la etiología y en la expresión clínica de esta enfermedad. Se estudió la frecuencia de las mutaciones H63D y C282Y en un grupo de pacientes con PCT y se la comparó con la observada en un grupo de donantes voluntarios desangre. Los pacientes con PCT fueron catalogados como portadores de la forma hereditaria o adquirida de laenfermedad, según presentaran o no mutaciones en el gen uroporfirinógeno decarboxilasa (UROD). El 50% delos pacientes con PCT eran portadores de la forma genética de la enfermedad, porcentaje significativamentemayor que lo informado en otras series. El 23% de los donantes voluntarios de sangre eran portadores de lamutación H63D y 2.4% lo era de la mutación C282Y. Frecuencias similares a lo encontrado por otros autoresen población chilena de etnia blanca, en población argentina y española, pero significativamente más alta quelo encontrado en estudios en población aborigen araucana. Esto tiene, probablemente, relación con el predominio de ascendencia española en la población blanca chilena. La frecuencia de mutación en el gen HFE en pacientes con PCT no fue significativamente diferente que la observada en donantes voluntarios de sangre. Tampoco hubo diferencias significativas en la frecuencia de estas mutaciones entre los casos con PCT adquirida respecto de aquellos en que ésta era de origen genético. Los resultados obtenidos no permiten afirmar que exista asociación entre la PCT y la condición de portador de mutaciones del gen HFE de la hemocromatosis hereditaria

In patients with porphyria cutanea tarda (PCT), hepatic iron accumulation associated to hereditary hemochromatosis (HH) could play a role in the etiology and in the clinical expression of the disease. The H63D and C282Y mutations of the HFE gene frequency were studied in a PCT group of patients and compared with the frequency observed in a group of volunteer blood donors. PCT patients were cataloged as hereditary or acquired PCT carriers, whether or not they presented uroporphyrinogen decarboxilase gene mutations. Fifty percent of PCT patients were carriers of the disease’s genetic type. Such percentage is significantlyhigher than what other authors have previously informed. H63D and C282Y mutations were present in23% and 2.4% of the volunteer blood donors, respectively. Similar frequencies were informed by others authors in Chilean white ethnic populations, and also in Spaniard and Argentinean populations, but significantly higherthan that observed in Chile’s Araucanean aboriginal population. Probably the frequency of H63D and C283Y mutations are related to the Spaniard ascendancy dominance of Chile’s white ethnic population. The frequency of HFE gene mutations in PCT patients was not different than what was observed in volunteer blood donors.Similarly, there was no statistical difference in the frequency of these mutations among patients with acquired or genetic PCT disease. With the obtained results, it is not possible postulate an association between PCT and the hereditary hemochromatosis of HFE gene mutations carrier conditions

Precipitating/aggravating factors of porphyria cutanea tarda in Spanish patients.

Erythrocyte uroporphyrinogen decarboxylase (UROD) activity was measured to classify 118 Spanish patients with porphyria cutanea tarda (PCT) into three subtypes: sporadic-, familial- and type III-PCT. Seventy-four patients (63%) had eythrocyte UROD activity within the normal range (74% to 126% of the mean activity of 43 healthy controls) and were classified as sporadic-PCT (47%) or as type III-PCT (16%) whenever a family history of PCT was documented. Forty-four patients (37%) had decreased UROD activity and were classified as familial-PCT. The frequency of both familial-PCT and type III-PCT was higher than reported in other countries. The clinical expression of PCT was associated with the coexistence of two or more risk factors in 80% of the sporadic-PCT patients and in 89% of the familial-PCT patients. Hepatitis C virus and alcohol abuse were risk factors frequently found in these patients, being unrelated to age of onset of skin lesions. A heavy alcohol intake was the main risk factor for type III-PCT. Estrogens appeared as a precipitating factor for women with familial-PCT. The H63D mutation in the hemochromatosis type 1 gene was more frequently found than the C282Y mutation. Both mutations appeared to play a role as precipitating factors in sporadic-PCT when associated with hepatitis C virus infection and alcohol abuse.

Carácter adquirido de la porfiria cutánea tarda en pacientes infectados con virus C de la hepatitis / Acquired character of porphyria cutanea tarda in patients infected with hepatitis C virus

Background: Porphyria cutanea tarda (PCT) is due to a partial defect of hepatic uroporphyrinogen decarboxylase (URO-D). In the hereditary form, both hepatic and erythrocytic enzymes are altered, whereas in the acquired form, only the hepatic enzyme fails. There is a high prevalence of hepatitis C virus infection in patients with PCT, specially in those without family history of the disease. Aim: To study erythrocytic URO-D activity in order to find out wether hepatitis C virus infection is associated to the acquired form of PCT or unveils an inactive hereditary form. Patients and methods: URO-D activity was measured in red blood cells of normal controls, hepatitis C virus carriers without symptoms of PCT and patients with PCT, with and without family history of the disease, with and without anti hepatitis C virus antibodies. Results: URO-D activity was similar in normal controls, patients with chronic liver disease associated to hepatitis C virus, and in patients with PCT without family history of the disease with and without hepatitis C virus antibodies. URO-D activity was lower in patients with PCT and family history of the disease, with and without hepatitis C virus antibodies. Conclusions: PCT in patients with hepatitis C virus infection is due to an acquired alteration of hepatic URO-D. Hepatitis C virus does not modify erythrocytic URO-D

Photodynamic and non-photodynamic action of several porphyrins on the activity of some heme-enzymes.

The action of porphyrins, uroporphyrin I and III (URO I and URO III), pentacarboxylic porphyrin I (PENTA I), coproporphyrin I and III (COPRO I and COPRO III), protoporphyrin IX (PROTO IX) and mesoporphyrin (MESO), on the activity of human erythrocytes delta-aminolevulinic acid dehydratase, porphobilinogenase, deaminase and uroporphyrinogen decarboxylase in the dark and under UV light was investigated. Both photoinactivation and light-independent inactivation was found in all four enzymes using URO I as sensitizer. URO III had a similar action as URO I on porphobilinogenase and deaminase and PROTO IX exerted equal effect as URO I on delta-aminolevulinic acid dehydratase and uroporphyrinogen decarboxylase. Photodynamic efficiency of the porphyrins was dependent on their molecular structure. Selective photodecomposition of enzymes by URO I, greater specificity of tumor uptake by URO I and enhanced porphyrin synthesis by tumors from delta-aminolevulic acid, with predominant formation of URO I, underline the possibility of using URO I in detection of malignant cells and photodynamic therapy.

Estudios espectrofotométricos de porfirinas: Parte II. Su aplicación a la determinación cuantitavia en porfirinurias y actividad enzimática de la uroporfirinógeno decarboxilasa / Spectrophotometric study of porphyrins: Part II. Their aplication to the quantitative determination in pophyrinurias and enzymatic activity of the uroporphyrinogen decarboxylase

Este trabajo consiste en un estudio espectrofotométrico de las porfirinas heptacarboxílica, hexacarboxílixa y pentacarboxílica. 1. Determinación de sus coeficientes de extinción en soluciones ácidas. 2. Cálculo de factores K aplicadas a la determinación de sus concentraciones en soluciones puras en HCL 5% y 10% (p/v). 3. Estimación de factores (f) aplicables a la determinación directa de estas porfirinas acidificadas. 4. Determinación de las porfirinas pentacarboxílica y coproporfirina libres en mexcla de ambas, en soluciones ácidas. 5. Aplicación del método anterior a la determinación de lactividad enzimática de "Decarboxilasa"

Uroporfirinógeno decarboxilase eritrocitaria: un método de detección de la porfiria cutánea tarda familiar latente / Uroporphyrinogen decarboxylase eritrocyte: detection method of the porphyria cutanea tarda familiar latent

Se determinaron los niveles de porfirinas y precursores en orina y la actividad uroporfirinógeno decarboxilasa (URO-D) en eritrocitos de 13 miembros de una familia. Los datos de actividad enzimática y de excreción de porfirinas mostraron que el defecto genético de la porfiria cutánea tarda (PCT) proviene del abuelo. En 9 de los casos analizados, que incluyen niños de 3 a 10 años, la actividad URO-D se hallaba disminuida alrededor de un 50 por ciento. Estos enfermos presentaron cuadros clínicos y de laboratorio diferentes: 5 paciente tuvieron manifestaciones cutáneas y excreción urinaria aumentada de porfirinas, principalmente uro y heptacarboxiporfirinas (PCT manifiesta); familiar presentó incremento de la eliminación de porfirinas por orina, sin alteraciones cutáneas (PCT subclínica) y en los tres restantes, el examen clínico y el perfil urinário de porfirinas fueron normales (PCT latente). Se discuten los factores capaces de desencadenar la manifestación de la enfermedad y se remarca el valor diagnostico de la determinación de la actividad URO-D eritrocitaria para la detección de los casos latentes

A potential biochemical explanation for the genesis of porphyria cutanea tarda. Studies on the inherent biochemical defect in highly purified human erythrocyte uroporphyrinogen decarboxylase and its amplification by iron.

Familial porphyria cutanea tarda (PCT) is a photocutaneous disease in which subnormal activity of uroporphyrinogen decarboxylase is observed both in the liver and red cells. Hepatic iron plays a key role in the genesis of overt biochemical and clinical PCT. In this report, we have studied the properties of 10 000-fold purified erythrocyte uroporphyrinogen decarboxylase preparations from two familial PCT patients and a non-porphyric control subject. The apparent Michaelis constants (Km), determined by using uroporphyrinogen III substrate, were approx. 3.2-times higher for the enzyme from the diseased subjects (Km = approximately 1.0 microM) as compared to the normal (Km = 0.3 microM). Though both abnormal and normal enzymes were inhibited progressively with increasing concentrations of iron, the enzymes from diseased subjects exhibited greater susceptibility e.g. 0.1 mM Fe2+ inhibited the former about 50% and the latter about 20%. These observations suggest that the inherent biochemical defect in PCT is the reduced enzyme-substrate affinity and the intrinsic abnormal conformation renders the PCT enzyme particularly susceptible to inhibition by iron.

[Uroporphyrinogen decarboxylase in erythrocytes: studies on the primary genetic enzyme defect in chronic hepatic porphyria (author's transl)]. / Uroporphyrinogen-Decarboxylase in Erythrocyten Untersuchungen zum primären genetischen Enzymdefekt bei chronischer hepatischer Porphyrie.

In chronic hepatic porphyria, including the clinical phase, porphyria cutanea tarda, the activity of uroporphyrinogen decarboxylase is decreased not only in the liver, but also in the erythrocytes. The synonomous decrease in the enzymic activity in liver and erythrocytes in both familial and sporadic hepatic porphyria shows that the disturbance of this enzyme is the primary genetic defect of this condition; inheritance of the defect is probably autosomal and dominant. The clinical manifestation of disturbances of porphyrin metabolism are precipitated, however, by additional factors, such as liver damage, alcohol, oestrogens and neoplastic growths. In the absence of these other pathogenic influences, the enzyme defect is compensated and does not result in disturbances of haem or haemoglobin synthesis, either in the liver or the bone marrow.

An inherited enzymatic defect in porphyria cutanea tarda: decreased uroporphyrinogen decarboxylase activity.

Uroporphyrinogen decarboxylase activity was measured in liver and erythrocytes of normal subjects and in patients with porphyria cutanea tarda and their relatives. In patients with porphyria cutanea tarda, hepatic uroporphyrinogen decarboxylase activity was significantly reduced (mean 0.43 U/mg protein; range 0.25-0.99) as compared to normal subjects (mean 1.61 U/mg protein; range 1.27-2.42). Erythrocyte uroporphyrinogen decarboxylase was also decreased in patients with porphyria cutanea tarda. The mean erythrocyte enzymatic activity in male patients was 0.23 U/mg Hb (range 0.16-0.30) and in female patients was 0.17 U/mg Hb (range 0.15-0.18) as compared with mean values in normal subjects of 0.38 U/mg Hb (range 0.33-0.45) in men and 0.26 U/mg Hb (range 0.18-0.36) in women. With the erythrocyte assay, multiple examples of decreased uroporphyrinogen decarboxylase activity were detected in members of three families of patients with porphyria cutanea tarda. In two of these families subclinical porphyria was also recognized. The inheritance pattern was consistant with an autosomal dominant trait. The difference in erythrocyte enzymatic activity between men and women was not explained but could have been due to estrogens. This possibility was supported by the observation that men under therapy with estrogens for carcinoma of the prostate had values in the normal female range. It is proposed that porphyria cutanea tarda results from the combination of an inherited defect in uroporphyrinogen decarboxylase and an acquired factor, usually siderosis associated with alcoholic liver disease.