Harper's Biochemistry Chapter 31 - Porphyrins & Bile Pigments

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Questions and Answers

Which of the following is true regarding the function of cytochrome P450?

  • It catalyzes the hydroxylation of xenobiotics. (correct)
  • It is involved in oxygen storage in muscle tissues.
  • It is primarily responsible for oxygen transport in blood.
  • It mainly transports electrons in the cytoplasm.

What is a shared function of both hemoglobin and myoglobin?

  • They both degrade hydrogen peroxide.
  • They both catalyze the oxidation of tryptophan.
  • They are both involved in the transport of carbon dioxide.
  • They both bind and transport oxygen within different environments. (correct)

The effects of lead poisoning on heme synthesis can best be described as:

  • Inhibition of iron incorporation into heme. (correct)
  • Stimulating the production of cytochrome c.
  • Enhanced production of heme.
  • Increased activity of porphyrin enzymes.

Which metal ion is essential in the formation of heme porphyrin structures?

<p>Iron (D)</p> Signup and view all the answers

Which of the following statements is accurate regarding the presence of heme proteins in cells?

<p>Most mammalian cells produce heme, with exceptions in certain tissues. (B)</p> Signup and view all the answers

What specific role does ALA synthase play in heme biosynthesis?

<p>It facilitates the first step in heme synthesis by combining Succinyl-CoA and Glycine. (A)</p> Signup and view all the answers

Which metabolic disorder is directly associated with mutations in the gene encoding enzyme 1 of heme synthesis?

<p>X-linked sideroblastic anemia (C)</p> Signup and view all the answers

How does lead poisoning affect the heme synthesis pathway?

<p>It inhibits the activity of ALA dehydratase and ferrochelatase by binding to essential thiol groups. (B)</p> Signup and view all the answers

Elevated levels of which of the following substances can be indicative of a metabolic block in heme synthesis?

<p>Protoporphyrin and ALA (B)</p> Signup and view all the answers

Which of the following statements about porphyrias is true?

<p>Porphyrias can result from both genetic and acquired causes. (A)</p> Signup and view all the answers

What is the implication of identifying intermediates that accumulate prior to a metabolic block in heme synthesis?

<p>They provide a basis for metabolic screening tests to identify the impaired reaction. (C)</p> Signup and view all the answers

Which enzyme is responsible for catalyzing the conversion of 2-aminolevulinic acid (ALA) to porphobilinogen?

<p>ALA dehydratase (A)</p> Signup and view all the answers

Which of the following metals can significantly inhibit heme synthesis by complexing with essential thiol groups?

<p>Lead (D)</p> Signup and view all the answers

What is the primary consequence of mutations in genes involved in heme synthesis?

<p>Accumulation of heme precursors (D)</p> Signup and view all the answers

Which substance may help patients with photosensitivity by reducing free radical production?

<p>β-carotene (D)</p> Signup and view all the answers

In the catabolism of heme in human adults, what approximate weight of hemoglobin is turned over daily?

<p>6 g (C)</p> Signup and view all the answers

What effect does lead poisoning have on heme synthesis?

<p>Inhibits ALAS1 synthesis (A)</p> Signup and view all the answers

What is the primary underlying mechanism when ALA and PBG accumulate due to heme synthesis disorders?

<p>Decreased heme synthesis (A)</p> Signup and view all the answers

How do porphyrinogens in skin relate to neurological symptoms?

<p>They increase oxidative stress (C)</p> Signup and view all the answers

What is one function of heme proteins that may be impaired due to heme synthesis disorders?

<p>Oxygen transport (C)</p> Signup and view all the answers

What is the consequence of spontaneous oxidation of porphyrinogens?

<p>Compounds leading to photosensitivity (A)</p> Signup and view all the answers

Which of the following is not a result of heme catabolism?

<p>Decreased erythrocyte life span (A)</p> Signup and view all the answers

What is the optical property associated with hematoporphyrin that is potentially useful in medical applications?

<p>Visible light absorption (D)</p> Signup and view all the answers

What is the primary substrate for the synthesis of ALA in heme biosynthesis?

<p>Glycine and succinyl-CoA (D)</p> Signup and view all the answers

What is the effect of phenobarbital on heme biosynthesis?

<p>It triggers enhanced synthesis of ALAS1. (D)</p> Signup and view all the answers

What indicates intrahepatic or posthepatic obstructive jaundice in urinary analysis?

<p>Presence of conjugated bilirubin with absence of urobilinogen (C)</p> Signup and view all the answers

Which enzyme is not regulated by heme levels?

<p>ALAS2 (A)</p> Signup and view all the answers

What is the major site of expression for inherited porphyrias?

<p>Erythrocytes and liver (A)</p> Signup and view all the answers

Which of the following conditions is associated with the increased production of urobilinogen?

<p>Hemolytic jaundice (D)</p> Signup and view all the answers

Lead poisoning can lead to which type of porphyria?

<p>Acquired porphyrias (C)</p> Signup and view all the answers

Which symptom is commonly associated with porphyrias?

<p>Photosensitivity and neurologic problems (C)</p> Signup and view all the answers

What is the implication of a complete obstruction of the bile duct on bilirubin levels?

<p>Elevated levels of bilirubin without access to the intestine (B)</p> Signup and view all the answers

What color change is observed in urine during hemolytic jaundice?

<p>Light yellow due to urobilinogen (B)</p> Signup and view all the answers

What structural difference exists between heme c and heme b?

<p>Heme c is linked to an apoprotein through covalent thioether links. (C)</p> Signup and view all the answers

Which of the following intermediates are essential in heme biosynthesis?

<p>Succinyl-CoA and glycine (D)</p> Signup and view all the answers

In what way do porphyrins interact with metal ions?

<p>Porphyrins form complexes with metal ions through coordinate covalent bonds. (B)</p> Signup and view all the answers

Which of the following diseases may cause jaundice, resulting from elevated plasma bilirubin levels?

<p>Hemolytic anemias (D)</p> Signup and view all the answers

What is a notable characteristic of vertebrate heme proteins regarding heme binding?

<p>They generally bind one mole of heme c per mole of protein. (D)</p> Signup and view all the answers

What aspect of heme c synthesis distinguishes it from other heme forms?

<p>Association with an apoprotein for functionality. (C)</p> Signup and view all the answers

What process is affected by lead poisoning that influences heme synthesis?

<p>Inhibition of certain enzymes involved in porphyrin metabolism (C)</p> Signup and view all the answers

Which statement about porphyrin ring structure is accurate?

<p>The structure is formed by linking four pyrrole rings through methine bridges. (A)</p> Signup and view all the answers

What is a common function of heme proteins in biological systems?

<p>Participating in electron transport and redox reactions (A)</p> Signup and view all the answers

Which of the following statements about the side chains of porphyrins is incorrect?

<p>All porphyrins must have the same side chains for identical function. (A)</p> Signup and view all the answers

What does the presence of conjugated bilirubin in urine indicate?

<p>Intrahepatic or posthepatic obstructive jaundice (A)</p> Signup and view all the answers

Which enzyme is primarily responsible for the regulation of heme biosynthesis?

<p>ALAS1 (D)</p> Signup and view all the answers

What is the likely outcome in the urine of a patient with hemolytic jaundice?

<p>Increased levels of both bilirubin and urobilinogen (D)</p> Signup and view all the answers

How does phenobarbital influence heme biosynthesis?

<p>It triggers increased synthesis of ALAS1. (C)</p> Signup and view all the answers

Which statement is true regarding the inheritance of porphyrias?

<p>Genetic abnormalities can occur in several enzymes involved in heme biosynthesis. (C)</p> Signup and view all the answers

What biochemical findings are markedly increased in cases of hereditary coproporphyria?

<p>Urinary ALA, PBG, and coproporphyrin III (A)</p> Signup and view all the answers

Which enzyme deficiency is associated with variegate porphyria?

<p>Protoporphyrinogen oxidase (D)</p> Signup and view all the answers

Which symptom is most characteristically associated with protoporphyria?

<p>Photosensitivity (A)</p> Signup and view all the answers

What condition is characterized by elevated fecal protoporphyrin IX?

<p>Protoporphyria (C)</p> Signup and view all the answers

Which of the following statements about photosensitivity in porphyrias is incorrect?

<p>It leads to neuropsychiatric symptoms in all types. (A)</p> Signup and view all the answers

What factor influences enzyme translocation between cellular compartments in porphyrias?

<p>Metabolic block in heme synthesis (A)</p> Signup and view all the answers

Which of the following conditions is considered rare compared to the others in the context of porphyrias?

<p>Variegate porphyria (D)</p> Signup and view all the answers

Which enzyme is referred to as PBG deaminase?

<p>Protoporphyrinogen oxidase (B)</p> Signup and view all the answers

Which of these porphyrias reflects a low or absent activity of enzymes in heme synthesis?

<p>Hereditary coproporphyria (B)</p> Signup and view all the answers

What is the major cause of kernicterus related to bilirubin?

<p>Retention hyperbilirubinemia involving unconjugated bilirubin (B)</p> Signup and view all the answers

Which form of bilirubin can be found in urine?

<p>Conjugated bilirubin (A)</p> Signup and view all the answers

How do intestinal bacteria affect bilirubin in the gastrointestinal tract?

<p>They reduce conjugated bilirubin to urobilinogen (D)</p> Signup and view all the answers

Which form of hyperbilirubinemia is associated with biliary obstruction?

<p>Regurgitation hyperbilirubinemia (C)</p> Signup and view all the answers

What primarily causes jaundice in Dubin-Johnson syndrome?

<p>Increased levels of conjugated bilirubin in the bloodstream (C)</p> Signup and view all the answers

What role do hepatocyte proteins play in bilirubin metabolism?

<p>They prevent the efflux of bilirubin into the bloodstream (D)</p> Signup and view all the answers

What is a characteristic feature of acholuric jaundice?

<p>Presence of excess unconjugated bilirubin in blood (B)</p> Signup and view all the answers

Which bilirubin type is unable to cross the blood-brain barrier?

<p>Conjugated bilirubin (D)</p> Signup and view all the answers

What is indicated by the presence of choluric jaundice?

<p>Presence of conjugated bilirubin in urine (A)</p> Signup and view all the answers

What is the primary purpose of conjugating bilirubin with glucuronic acid?

<p>To increase its polarity and solubility in water (D)</p> Signup and view all the answers

Which of the following statements best describes the role of glutathione S-transferase in bilirubin metabolism?

<p>It prevents bilirubin from re-entering the bloodstream (A)</p> Signup and view all the answers

What type of drugs should be avoided in patients with porphyria?

<p>Drugs that induce cytochrome P450 production (A)</p> Signup and view all the answers

How does bilirubin's binding to albumin affect its disposition in the body?

<p>It prevents its diffusion into tissues (D)</p> Signup and view all the answers

What is the effect of administering large amounts of carbohydrates in the context of porphyrias?

<p>It decreases bilirubin production (B)</p> Signup and view all the answers

What is the consequence of bilirubin not being conjugated in the liver?

<p>It will remain unbound in the bloodstream and tissues (B)</p> Signup and view all the answers

What role does the facilitated transport system play in bilirubin metabolism?

<p>It assists in the uptake of bilirubin into cells (B)</p> Signup and view all the answers

What happens to the metabolic rate of bilirubin when there are pathological conditions affecting transport?

<p>It remains unaffected even in pathological states (B)</p> Signup and view all the answers

What is a characteristics of bilirubin that necessitates its conversion to a more polar form?

<p>Bilirubin is nonpolar and lipophilic (A)</p> Signup and view all the answers

What is the role of cytosolic proteins in bilirubin metabolism?

<p>They prevent bilirubin from diffusing out of cells (A)</p> Signup and view all the answers

What is the role of uroporphyrinogen decarboxylase in heme biosynthesis?

<p>It decarboxylates uroporphyrinogen to yield methyl substituents. (B)</p> Signup and view all the answers

What structural transformation occurs when uroporphyrinogen III undergoes decarboxylation?

<p>Conversion to coproporphyrinogen III along with the release of CO2. (D)</p> Signup and view all the answers

In what cellular compartment do the final three reactions of heme biosynthesis occur?

<p>Mitochondria. (C)</p> Signup and view all the answers

Why are porphyrinogens colorless, despite the presence of double bonds?

<p>They lack a conjugated double bond system. (C)</p> Signup and view all the answers

What happens to porphyrinogens over time, leading to the formation of colored compounds?

<p>They readily auto-oxidize to colored porphyrins. (C)</p> Signup and view all the answers

Which of the following correctly describes the relationship between uroporphyrinogen I and uroporphyrinogen III in heme biosynthesis?

<p>Uroporphyrinogen I can also be converted to coproporphyrinogen I. (C)</p> Signup and view all the answers

What is the chemical byproduct of the decarboxylation of uroporphyrinogen III?

<p>Carbon dioxide. (B)</p> Signup and view all the answers

Match the type of heme with its main characteristic:

<p>Heme b = Readily dissociates from its apoprotein Heme c = Contains covalent thioether links to an apoprotein Heme a = Involved in cytochrome c oxidase Heme d = Found in some bacterial heme proteins</p> Signup and view all the answers

Match the condition with its cause regarding jaundice:

<p>Hemolytic anemia = Overproduction of bilirubin Viral hepatitis = Failure of bilirubin excretion Pancreatic cancer = Elevated plasma bilirubin levels Obstructive jaundice = Intrahepatic bile duct obstruction</p> Signup and view all the answers

Match the component with its role in heme biosynthesis:

<p>Succinyl-CoA = Provides a carbon skeleton Glycine = A key amino acid for heme synthesis ALA (Aminolevulinic acid) = First committed step in heme production Porphobilinogen = Intermediate in porphyrin synthesis</p> Signup and view all the answers

Match the type of porphyrin with its property:

<p>Cyclic compounds = Formed by linked pyrrole rings Metal complexes = Bind metal ions in solution Side chains = Replace hydrogen atoms on pyrroles Methyne bridges = Connect pyrrole units in porphyrins</p> Signup and view all the answers

Match the heme-related protein with its characteristic:

<p>Cytochrome P450 = Involved in drug metabolism Hemoglobin = Transports oxygen in blood Myoglobin = Stores oxygen in muscles Catalase = Decomposes hydrogen peroxide</p> Signup and view all the answers

Match the enzyme involved in porphyrin metabolism with its associated condition:

<p>ALA synthase 2 (ALAS2) = X-linked sideroblastic anemia ALA dehydratase = ALA dehydratase deficiency Uroporphyrinogen I synthase = Acute intermittent porphyria Uroporphyrinogen III synthase = Congenital erythropoietic porphyria</p> Signup and view all the answers

Match the laboratory test results with their corresponding major signs and symptoms:

<p>Red cell counts and hemoglobin decreased = Anemia Urinary ALA and coproporphyrin III increased = Abdominal pain, neuropsychiatric symptoms Urinary ALA and PBG increased = Abdominal pain, neuropsychiatric symptoms Urinary uroporphyrin I increased = Photosensitivity</p> Signup and view all the answers

Match the porphyria type with its enzyme involvement:

<p>X-linked sideroblastic anemia = ALA synthase 2 (ALAS2) Porphyria cutanea tarda = Uroporphyrinogen decarboxylase Acute intermittent porphyria = Uroporphyrinogen I synthase Congenital erythropoietic porphyria = Uroporphyrinogen III synthase</p> Signup and view all the answers

Match the metabolic disorder with its OMIM number:

<p>X-linked sideroblastic anemia = OMIM 301300 ALA dehydratase deficiency = OMIM 125270 Acute intermittent porphyria = OMIM 176000 Congenital erythropoietic porphyria = OMIM 263700</p> Signup and view all the answers

Match the major symptoms with their respective types of porphyria:

<p>Anemia = X-linked sideroblastic anemia Photosensitivity = Porphyria cutanea tarda Neuropsychiatric symptoms = Acute intermittent porphyria</p> Signup and view all the answers

Flashcards

Uroporphyrinogen I synthase

An enzyme that plays a role in heme synthesis, a process in which porphyrins are produced.

Porphobilinogen

An intermediate, a molecule that is formed during a chemical process and is then processed further to create something else.

ALA dehydratase

Enzyme catalyzing the reaction to convert 2 molecules of ALA to one molecule of porphobilinogen.

ALA

Aminolevulinate, a precursor molecule in heme biosynthesis.

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ALA synthase

Enzyme catalyzing formation of porphyrin precursors, notably ALA.

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Succinyl-CoA + Glycine

Reactants/starting materials needed to form ALA in heme biosynthesis.

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Heme synthesis

A biochemical process creating heme, a crucial component of hemoglobin.

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Genetic porphyrias

A group of disorders resulting from inherited mutations in genes regulating heme synthesis.

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Lead poisoning

Acquired condition impacting heme synthesis, inactivating crucial enzymes.

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Porphyria

A group of genetic disorders affecting heme synthesis, leading to the accumulation of porphyrin precursors in body tissues.

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Heme synthesis

The metabolic pathway that produces heme, a crucial component of hemoglobin.

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ALA and PBG accumulation

A hallmark of porphyrias, these porphyrin precursors build up in body tissues, causing symptoms.

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Porphyrinogens

Intermediate molecules in porphyrin metabolism, their accumulation can cause issues.

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Hemoglobin Turnover

The daily breakdown and recycling of red blood cells, releasing heme components.

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Photosensitivity

Increased sensitivity to light, sometimes seen in porphyrias, due to the abnormal accumulation of porphyrin precursors

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Mutations in heme synthesis genes

Genetic variations can cause abnormalities in enzymes involved in porphyrin synthesis, affecting the whole process.

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Catabolism of Heme

The breakdown of heme, resulting in the production of bilirubin.

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Heme c vs Heme b

Heme c has covalent thioether links to an apoprotein, unlike heme b which easily dissociates from the apoprotein.

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Jaundice Cause

Jaundice is caused by high bilirubin levels in the blood, either from overproduction or excretion failure.

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Porphyrins Structure

Porphyrins are cyclic compounds made from four pyrrole rings linked by methyne bridges, with potential side chains replacing hydrogen atoms.

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Heme synthesis precursors

Heme synthesis starts with Succinyl-CoA and Glycine.

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Heme proteins distribution

Heme proteins are widely found in nature, with vertebrate proteins typically binding one heme c molecule per protein and invertebrate ones potentially binding more.

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Porphyrin function

Porphyrins can form complexes with metal ions.

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Heme protein function

Proteins that contain heme are widely distributed in nature, and vertebrates generally bind one heme c per mole.

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Heme biosynthesis

A process that creates heme, a vital component for many proteins like hemoglobin.

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Hemoglobin

A protein in red blood cells that carries oxygen.

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Myoglobin

A protein that stores oxygen in muscles.

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Cytochrome c

A protein involved in the electron transport chain.

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Cytochrome P450

A protein that helps process foreign substances.

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Catalase

A protein that breaks down hydrogen peroxide.

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Tryptophan pyrrolase

An enzyme involved in tryptophan breakdown.

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Heme Synthesis

The process of creating heme from succinyl-CoA and glycine.

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ALAS1

The regulatory enzyme in heme biosynthesis, its activity increases with low heme levels.

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Urobilinogen

A waste product formed from bilirubin in the intestines, detectable in urine.

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Bilirubin

A byproduct of red blood cell breakdown, processed in the liver and excreted in bile.

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Obstructive Jaundice

Jaundice caused by blocked bile ducts, preventing bilirubin from reaching the intestines.

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Hemolytic Jaundice

Jaundice resulting from increased red blood cell destruction, leading to higher urobilinogen levels.

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Porphyrias

Inherited disorders due to enzyme defects in heme biosynthesis.

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ALAS2

Another enzyme in heme synthesis, not regulated by heme levels.

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Increased Urine Urobilinogen

High levels of urobilinogen in the urine, suggesting increased red blood cell breakdown (hemolysis).

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Uroporphyrinogen III

A precursor molecule in heme biosynthesis, containing four propionic acid substituents.

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Decarboxylation

The removal of a carboxyl group (-COOH) from a molecule.

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Coproporphyrinogen III

A porphyrinogen intermediate formed from uroporphyrinogen III after decarboxylation.

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Uroporphyrinogen Decarboxylase

Enzyme catalyzing the conversion of uroporphyrinogen III to coproporphyrinogen III.

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Porphyrinogens

Colorless intermediate molecules in heme synthesis.

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Methyne bridges

Chemical linkages (-CH=), formed in the porphyrin structure, between pyrrole rings.

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Heme biosynthesis

The metabolic pathway creating heme from precursors.

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Protoporphyrinogen III

A porphyrinogen intermediate in the heme synthesis pathway, converting to protoporphyrin.

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Protoporphyrin III

The final porphyrin precursor in heme biosynthesis, containing specific substituents.

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Coproporphyrinogen oxidase (EC 1.3.3.3)

An enzyme involved in the heme synthesis pathway, specifically in the conversion of coproporphyrinogen III.

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Hereditary coproporphyria (hepatic)

A genetic disorder affecting heme synthesis, characterized by the accumulation of coproporphyrin precursors, causing photosensitivity and abdominal pain.

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Protoporphyrinogen oxidase (EC 1.3.3.4)

An enzyme in the heme biosynthesis pathway, responsible for the conversion of protoporphyrinogen to protoporphyrin.

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Variegate porphyria (hepatic)

A genetic porphyria impacting heme biosynthesis, leading to the accumulation of specific porphyrin precursors and symptoms like photosensitivity and abdominal pain.

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Ferrochelatase (EC 4.99.1.1)

Enzyme in the heme biosynthesis pathway, crucial for incorporating iron into protoporphyrin IX to form heme.

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Protoporphyria (erythropoietic)

A genetic porphyria impacting heme biosynthesis, leading to the accumulation of protoporphyrin, causing photosensitivity.

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Photosensitivity

An increased sensitivity to sunlight or ultraviolet radiation due to an abnormality in the heme synthesis pathway.

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Urinary ALA and PBG

Elevated levels of δ-aminolevulinic acid (ALA) and porphobilinogen (PBG) in the urine, indicative of certain porphyrias.

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Increased fecal coproporphyrin III

Elevated levels of coproporphyrin III in the feces, often observed in some porphyrias during active stages.

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Increased fecal protoporphyrin IX

An elevated level of protoporphyrin IX in the feces is a marker for some porphyrias.

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Increased red cell protoporphyrin IX

Elevated levels of protoporphyrin IX within red blood cells, a characteristic finding during the active phases in some porphyrias.

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Bilirubin Treatment

Porphyria treatment focuses on managing symptoms, avoiding drugs increasing cytochrome P450 production, limiting carbohydrate intake, and using antibiotics to adjust bilirubin levels.

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Bilirubin Metabolism

Bilirubin detachment and tissue absorption occurs after binding to albumin, with antibiotics also playing a part.

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Bilirubin Uptake

Bilirubin is taken up by cells, binding to cytosolic proteins to prevent its re-entry into the bloodstream.

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Bilirubin Conjugation

Bilirubin, initially nonpolar, is converted to a more water-soluble form through conjugation with glucuronic acid.

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Bilirubin Secretion

The process where the liver moves bilirubin from the blood into bile.

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Conjugated Bilirubin

Water-soluble form of bilirubin, processed by the liver, crucial for excretion.

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Unconjugated Bilirubin

Lipid-soluble form of bilirubin, not ready for excretion, can cross the blood-brain barrier.

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Jaundice

Yellowing of the skin and eyes, caused by bilirubin buildup in the blood.

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Bile Duct Blockage

Obstruction of bile ducts causes bilirubin to build up in the blood, leading to jaundice.

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Hyperbilirubinemia

High levels of bilirubin in the blood, leading to conditions like jaundice.

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Urobilinogen

Byproduct of bilirubin breakdown in the intestines, detectable in urine (choluric jaundice).

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Bile

Fluid produced by the liver, containing bile salts and bilirubin. Crucial for fat digestion.

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Heme Synthesis

The process of creating heme, a crucial component of hemoglobin, starting with succinyl-CoA and glycine.

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ALAS1

The regulatory enzyme in heme biosynthesis, its activity changes with heme levels.

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Urobilinogen

A waste product formed from bilirubin in the intestines, detectable in urine.

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Bilirubin

A byproduct of red blood cell breakdown, processed in the liver and excreted in bile.

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Obstructive Jaundice

Jaundice caused by blocked bile ducts, preventing bilirubin from reaching the intestines.

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Hemolytic Jaundice

Jaundice resulting from increased red blood cell destruction, leading to higher urobilinogen levels.

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Porphyrias

Inherited disorders due to enzyme defects in heme biosynthesis, leading to the accumulation of porphyrin precursors.

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Increased Urine Urobilinogen

High levels of urobilinogen in the urine, suggesting increased red blood cell breakdown (hemolysis).

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Heme c structure

Heme c differs from heme b by having covalent thioether links to an apoprotein, preventing its easy dissociation.

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Heme b

Heme b is easily dissociated from its apoprotein

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Porphyrin structure

Cyclic compounds formed from four linked pyrrole rings via methyne bridges. Side chains may replace some hydrogen atoms.

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Porphyrin biosynthesis precursors

Heme synthesis begins with succinyl-CoA and glycine.

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Jaundice cause

Elevated bilirubin levels in the blood, resulting from overproduction or excretion failure.

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Heme protein distribution

Heme proteins are widespread in nature, with vertebrates typically binding one heme c per protein.

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Heme Synthesis Location

Heme synthesis occurs in both the cytosol and mitochondria.

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ALA synthase 2 deficiency

An inherited condition where the enzyme ALA synthase 2 is not functioning properly, leading to issues in heme synthesis and potentially anemia.

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ALA dehydratase deficiency

A genetic condition characterized by an impaired ALA dehydratase enzyme, leading to the accumulation of porphyrin precursors, resulting in abdominal pain and neuropsychiatric symptoms.

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Acute intermittent porphyria

A genetic disorder affecting heme synthesis and causing attacks of abdominal pain and neurologic problems linked to the enzyme Uroporphyrinogen I synthase deficiency.

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Congenital erythropoietic porphyria

A genetic disorder causing the build-up of abnormal porphyrins in red blood cells, leading to sensitivity to light.

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Porphyria cutanea tarda

A genetic disease associated with a defect in the enzyme Uroporphyrinogen decarboxylase, causing sensitivity to sunlight and skin lesions.

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Laboratory Tests in Porphyrias

Quantitative assays of suspected defective enzymes are crucial for diagnosing genetic porphyrias.

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Study Notes

Porphyrins and Bile Pigments

  • Porphyrins are cyclic compounds formed by linking four pyrrole rings through methyne bridges.
  • Heme is synthesized from porphyrins and iron.
  • Bile pigments and iron are products of heme degradation.
  • Porphyrias are diseases arising from abnormalities in porphyrin biosynthesis.
  • Jaundice is a clinical condition caused by elevated plasma bilirubin, resulting from either overproduction of bilirubin or failure of its excretion.
  • Hemes are tetrapyrroles, often b or c, with varied functions like oxygen transport and storage (hemoglobin, myoglobin), and electron transport (cytochromes).
  • Heme b has vinyl groups, while heme c is covalently linked to an apoprotein.
  • Heme synthesis occurs in most mammalian cells, primarily in erythroid precursor cells of bone marrow (~85%) and hepatocytes.
  • Heme synthesis begins with the condensation of succinyl-CoA and glycine, a pyridoxal phosphate-dependent reaction, catalyzed by mitochondrial 6-aminolevulinate synthase (ALA synthase).
  • ALA dehydratase (porphobilinogen synthase, EC 4.2.1.24) condenses two molecules of ALA into porphobilinogen.
  • ALA dehydratase is a zinc metalloprotein susceptible to lead inhibition.
  • Hydroxymethylbilane synthase (uroporphyrinogen I synthase) condenses four molecules of porphobilinogen to form the linear tetrapyrrole hydroxymethylbilane.
  • Uroporphyrinogen III synthase converts the linear hydroxymethylbilane to uroporphyrinogen III.
  • Uroporphyrinogen III undergoes decarboxylation to form coproporphyrinogen III, a reaction catalyzed by uroporphyrinogen decarboxylase.
  • Coproporphyrinogen III is converted to protoporphyrinogen III, and then to protoporphyrin III through mitochondrial reactions.
  • Ferrochelatase (heme synthase) incorporates iron into protoporphyrin III, forming heme.
  • Porphyrins and porphyrinogens are different; porphyrinogens are colorless while porphyrins are colored, due to the conjugated system in porphyrins.
  • Porphyrins and their precursors are detected through spectrophotometry, measuring their absorption/fluorescence spectra.
  • Porphyrias result from defects in specific enzymes in heme synthesis leading to accumulation of porphyrin precursors, causing clinical symptoms.
  • Some types are acute intermittent porphyria, congenital erythropoietic porphyria.

Heme Biosynthesis

  • Heme synthesis involves both cytosolic and mitochondrial reactions.
  • Heme synthesis occurs in most mammalian cells except mature erythrocytes.
  • ALA synthase (ALAS1) is the rate-limiting enzyme in hepatic porphyrin synthesis, regulated by heme.

Catabolism of Heme

  • Heme is degraded, primarily in reticuloendothelial cells of the liver, spleen, and bone marrow.
  • Heme oxygenase (EC 1.14.18.1) catalyzes the degradation of heme.
  • Heme oxygenase converts heme to biliverdin and carbon monoxide (releasing iron), requiring oxygen and electrons from NADH/NADPH.
  • Biliverdin reductase reduces biliverdin to bilirubin.
  • Bilirubin is transported to the liver bound to serum albumin.
  • Bilirubin is conjugated with glucuronide, becoming water-soluble.
  • Conjugated bilirubin is secreted into bile.
  • Intestinal bacteria convert conjugated bilirubin to urobilinogen.
  • Urobilinogen is converted to urobilin, excreted in feces.
  • Some urobilinogen is reabsorbed and returned to the liver, completing the enterohepatic cycle.

Disorders of Bilirubin Metabolism

  • Neonatal physiologic jaundice: Immature hepatic system for bilirubin uptake/conjugation/secretion.
  • Gilbert syndrome: Reduced bilirubin UDP-glucuronosyltransferase activity.
  • Crigler-Najjar syndrome (types I and II): Absent or reduced bilirubin UDP-glucuronosyltransferase activity, resulting in severe hyperbilirubinemia and potential neurological damage.
  • Obstructive jaundice: Blockage of bile ducts, causing conjugated bilirubin to accumulate in the blood, leading to characteristic symptoms and lab test results.
  • Toxic hyperbilirubinemia: Toxin-induced liver dysfunction, resulting in impaired bilirubin conjugation.

Hyperbilirubinemia

  • Hyperbilirubinemia (excess bilirubin in the blood) causes jaundice (yellowing of tissues).
  • Hyperbilirubinemia arises from increased bilirubin production or impaired liver function.
  • Unconjugated and conjugated hyperbilirubinemia have different clinical presentations due to the different pathways of excretion.

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