Dosagem de porfobilinogênio urinário para confirmação diagnóstica ou prognóstico de porfirias hepáticas agudas / Dosage of urinary porphobilinogen for diagnostic confirmation or prognosis of acute hepatic porphyrias

INTRODUÇÃO: As porfirias são distúrbios metabólicos raros hereditários ou adquiridos em que há uma deficiência parcial ou completa em uma das oito enzimas da via de biossíntese do heme, que é grupo prostético que consiste de um átomo de ferro contido no centro de um largo anel orgânico heterocíclico. Esse grupo tem importância biológica por ser grupo prostético de proteínas, conhecidas como hemeproteínas. Com base no tecido afetado, as porfirias podem ser classificadas como eritropoiéticas ou hepáticas e, com base na apresentação dos sintomas, podem ser classificadas como porfirias hepáticas agudas (PHA) ou cutâneas. Os testes de primeira linha recomendados para diagnóstico da PHA incluem dosagem de PBG (dPBG; análise quantitativa), ácido delta-aminolevulinico (ALA) e porfirinas em uma amostra de urina aleatória. Atualmente, há disponível no SUS apenas o procedimento para a realização da pesquisa de PBG urinário (pPBGu; análise qualitativa). Tendo em vista a recorrência de falso-positivos ou falso-negativos provenientes da pPBGu urinário, foram analisadas as evidências científicas dis

Disordered porphyrin metabolism: a potential biological marker for autism risk assessment.

Autism (AUT) is a complex neurodevelopmental disorder that, together with Asperger's syndrome and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), comprises the expanded classification of autistic spectrum disorder (ASD). The heterogeneity of ASD underlies the need to identify biomarkers or clinical features that can be employed to identify meaningful subtypes of ASD, define specific etiologies, and inform intervention and treatment options. Previous studies have shown that disordered porphyrin metabolism, manifested principally as significantly elevated urinary concentrations of pentacarboxyl (penta) and coproporphyrins, is commonly observed among some children with ASD. Here, we extend these observations by specifically evaluating penta and coproporphyrins as biological indicators of ASD among 76 male children comprising 30 with validated AUT, 14 with PDD-NOS, and 32 neurotypical (NT) controls. ASD children (AUT and PDD-NOS) had higher mean urinary penta (P < 0.006) and copro (P < 0.006) concentrations compared with same-aged NT children, each characterized by a number of extreme values. Using Receiver Operating Characteristic curve analysis, we evaluated the sensitivity and specificity of penta, copro, and their combined Z-scores in ASD detection. The penta sensitivity was 30% for AUT and 36% for PDD-NOS, with 94% specificity. The copro sensitivity was 33% and 14%, respectively, with 94% specificity. The combined Z-score measure had 33% and 21% sensitivity for AUT and PDD-NOS, respectively, with 100% specificity. These findings demonstrate that porphyrin measures are strong predictors of both AUT and PDD-NOS, and support the potential clinical utility of urinary porphyrin measures for identifying a subgroup of ASD subjects in whom disordered porphyrin metabolism may be a salient characteristic.

A significant relationship between mercury exposure from dental amalgams and urinary porphyrins: a further assessment of the Casa Pia children's dental amalgam trial.

Previous studies noted specific changes in urinary porphyrin excretion patterns associated with exposure to mercury (Hg) in animals and humans. In our study, urinary porphyrin concentrations were examined in normal children 8-18 years-old from a reanalysis of data provided from a randomized, prospective clinical trial that was designed to evaluate the potential health consequences of prolonged exposure to Hg from dental amalgam fillings (the parent study). Our analysis examined dose-dependent correlations between increasing Hg exposure from dental amalgams and urinary porphyrins utilizing statistical models with adjustments for the baseline level (i.e. study year 1) of the following variables: urinary Hg, each urinary porphyrin measure, gender, race, and the level of lead (Pb) in each subject's blood. Significant dose-dependent correlations between cumulative exposure to Hg from dental amalgams and urinary porphyrins associated with Hg body-burden (pentacarboxyporphyrin, precoproporphyrin, and coproporphyrin) were observed. Overall, 5-10% increases in Hg-associated porphyrins for subjects receiving an average number of dental amalgam fillings in comparison to subjects receiving only composite fillings were observed over the 8-year course of the study. In contrast, no significant correlations were observed between cumulative exposure to Hg from dental amalgams and urinary porphyrins not associated with Hg body-burden (uroporphyrin, heptacarboxyporphyrin, and hexacarboxyporphyrin). In conclusion, our study, in contrast to the no-effect results published from the parent study, further establishes the sensitivity and specificity of specific urinary porphyrins as a biomarker for low-level Hg body-burden, and also reveals that dental amalgams are a significant chronic contributor to Hg body-burden.

A prospective assessment of porphyrins in autistic disorders: a potential marker for heavy metal exposure.

Autism was recently associated with a urinary porphyrin pattern indicative of mercury toxicity in a large cohort of French children. The IRB of the Institute for Chronic Illnesses approved the present study. A total of 37 consecutive American patients (> or = 7 years-old) with autism spectrum disorders (ASDs) (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-DSM IV), born from 1983-1998, that presented to the Genetic Centers of America for outpatient genetic evaluations were prospectively examined for urinary prophryin levels (LabCorp, Inc.) from June 2005-June 2006. Imaging and laboratory testing were conducted on each patient to rule-out other causal factors for their ASDs. As controls, age-, sex-, and race-matched neurotypical ASD siblings were examined. An apparent dose-response effect was observed between autism severity and increased urinary coproporphyrins. Patients with non-chelated autism (2.25-fold, 83% had levels > 2 SD above the control mean) and non-chelated ASDs (2-fold, 58% had levels > 2 SD above the control mean), but not patients with non-chelated pervasive developmental delay-not otherwise specified (PDD-NOS) or Asperger's disorder (1.4-fold, 46% had levels > 2 SD above the control mean), had significantly increased median coproporphyrin levels versus controls. A significant increase (1.7-fold) in median coproporphyrin levels was observed among non-chelated ASD patients versus chelated ASD patients. Porphyrins should be routinely clinically measured in ASDs, and potential ASD treatments should consider monitoring porphyrin levels. Additional research should be conducted to evaluate the potential role for mercury exposure in some ASDs.

The validity of spot urine samples for low-level occupational mercury exposure assessment and relationship to porphyrin and creatinine excretion rates.

Hg and porphyrin levels in single void urine specimens (spot samples) were compared with calculated 24-hr urine levels in 35 (20 [correction of 25] male and 15 female) practicing dentists who had been occupationally exposed to low levels of elemental Hg. The study aimed to: 1) determine the individual variability for Hg and porphyrin concentrations in spot samples over a 24-hr period; 2) test for the presence of diurnal variation in urinary Hg and porphyrin concentrations; and 3) determine the time of day at which a spot sample would give a Hg concentration closest to the 24-hr average concentration. Results confirmed previous reports of a first-order diurnal pattern with a mid-morning peak for Hg concentration (P < .001). A second-order model best described creatinine excretion (P = .0089), with peaks at about 5:00 and 19:00. The use of creatinine adjustment for Hg concentration significantly reduced the intraindividual variation around the diurnal curve. No diurnal patterns were found for any of the porphyrins examined. We recommend that, for small clinical studies using urinary Hg concentration, 24-hr sampling would be ideal, but that for mass screenings and cross-sectional studies, spot samples may be useful because they correlate fairly well with 24-hr averages (creatinine adjusted, r = 0.61; unadjusted, r = 0.74). Because of the existence of diurnal variation, for all cases using serial sampling attention should be paid to time of day.