Urinary porphyrin patterns in hepatic porphyrias

Urinary porphyrins in children exposed transplacentally to polyhalogenated aromatics in Taiwan

In 1979, there was a large (greater than 2,000 cases) outbreak of poisoning due to contaminated rice oil in central Taiwan. The causal agent was a mixture of thermally degraded polychlorinated biphenyls (PCBs), polychlorinated quaterphenyls, and polychlorinated dibenzofurans, which had become mixed with the oil during processing. Patients remained symptomatic for several years afterward, and the chemicals persisted in their tissue. Women who became pregnant had children with high perinatal mortality and a dysmorphic syndrome. We examined urines from 75 children born to exposed mothers after the oil was confiscated, 74 controls, and 12 sibs of the exposed children. Four of the transplacentally exposed children, 2 controls, and 1 sib had a type B hepatic porphyria (i.e., uroporphyrin greater than coproporphyrin); total porphyrin excretion was elevated in the exposed children as a group (95 vs. 81 micrograms/L); and 8 of the 75 exposed children and 2 controls had total urinary porphyrin concentrations of greater than 200 micrograms/L.

Development and utilization of a procedure for measuring urinary porphyrins by high-performance liquid chromatography

We describe a procedure for determining the five principal urinary porphyrins--uroporphyrin, heptacarboxylporphyrin, hexacarboxylporphyrin, pentacarboxylporphyrin, and coproporphyrin--by using high-performance liquid chromatography (HPLC). The method involves a 12- to 15-min isocratic separation on a Bondapak Phenyl column. Studies have indicated that urine samples must be preserved to maintain porphyrin stability for extended periods. We have found that the pH of preserved samples must be adjusted into the acidic range before the samples can be accurately analyzed by this HPLC procedure. Our studies demonstrate that good reproducibility and recovery are achieved with this method. Urinary porphyrin values for normal and porphyric individuals are reported.

New type of hepatic porphyria with porphobilinogen synthase defect and intermittent acute clinical manifestation

In two young patients with acute hepatic porphyria syndrome and persisting paralyses, which increased in intensity during intermittent occurring crisis, the activity of erythrocyte porphobilinogen synthase (delta-aminolevulinic acid dehydratase) was found to be considerably diminished, below 1% of the value of normal control persons. In contrast, the activity of uroporphyrinogen synthase was normal. Both patients have been excreting high quantities of delta-aminolevulinic acid and porphyrins in urine for years. Lead intoxication has definitively been excluded. Since the relatives also show lower activities in porphobilinogen synthase, the disease of these two patients is probably a new enzymatic type of inherited acute hepatic porphyria, the excretion profile of which is qualitatively completely different from those of the known acute porphyrias. The discovery of this porphyria confirms the theory of overlapping transition in the biochemical and clinical symptoms and analogies among acute hepatic porphyrias.