Protoporphyrin-induced photodamage: studies using cultured skin fibroblasts

The Influence of Depleted Glutathione Levels on the Photodynamic Action of Zinc Phthalocyanine in CHO K1 Cells

OBJECTIVE

The current study focuses on any influence that depletion of endogenous glutathione in CHO K1 cells may have on the photodynamic action of zinc phthalocyanine (ZnPc).

MATERIALS AND METHODS

Two lasers--a HeNe laser, 632.5 nm, maximum power output 3.5 mW, and a Toshiba semiconducting laser, 670 nm, maximum power of 7 mW--were used. Chinese Hamster Ovary cells (CHO K1) were exposed to light, 2-10 J. Cellular reduced glutathione levels [GSH] were depressed prior to exposure to ZnPc and laser light, using buthionine sulphoximine, a potent inhibitor of gamma-glutamylcysteine synthetase. The influence of hypoxic intracellular conditions was studied by reduction of oxygen content of cells by 80% following purging of cell cultures with nitrogen.

RESULTS

In well-aerated cells, doubling times are reduced by the photodynamic action of ZnPc by 29 +/- 6%, fig 2 (p = 0.01). Cells with lowered [GSH] do not show this effect (p = 0.1). When hypoxic cells are studied at normal [GSH], no photodynamic effect is observed (p = 0.1). When cell viability is studied, using the 670-nm laser, a photodynamic effect is observed, (80% fall from controls, p < 0.001), irrespective of the cellular [GSH] level for a single dose of 6 J. This effect is observed in cells with normal [GSH], for varied doses of 2 J and higher (63% fall at 2 J, p < 0.001).

CONCLUSIONS

Lowered [GSH] was observed to depress the photodynamic effect of ZnPc when cell-doubling times were the endpoint. The photostimulating effect of ZnPc was similarly suppressed by hypoxic conditions. When cell viability was the endpoint, then a photodynamic effect of ZnPc was observed irrespective of the endogenous [GSH] values.

Erythropoietic protoporphyria

Erythropoietic protoporphyria (EPP) is an inherited inborn error of porphyrin metabolism caused by decreased activity of the enzyme ferrochelatase, the terminal enzyme of the haem biosynthetic pathway, which catalyses the insertion of iron into protoporphyrin to form haem. EPP is characterized clinically by photosensitivity to visible light commencing in childhood, and biochemically by elevated red cell protoporphyrin levels. Although the majority of papers and reviews have classified EPP as an autosomal dominant disorder, the inheritance has now been shown to be more complex, and both autosomal dominant and recessive patterns of inheritance have been demonstrated using ferrochelatase activity. Further molecular studies should clarify the exact mode of inheritance. It seems likely that in the majority of families a defective allele from the apparently normal parent will be required for disease expression, but another possibility is autosomal dominant inheritance with low clinical penetrance. Exposure to bright sunlight, for as little as a few minutes in the worst affected patients, causes burning pain in exposed skin, which may be so severe and persistent that it prevents sleep for several nights. Patients usually attempt to relieve the pain by cold water or cold compresses. Apart from sun avoidance, the mainstay of prophylactic treatment has been beta-carotene. Although the published evidence for the effectiveness of beta-carotene is impressive, no controlled trials using adequate doses have been performed to unequivocally confirm its usefulness. The most serious complication of EPP is acute hepatic failure, which is due to accumulation of protoporphyrin in the liver. If jaundice develops, a rapidly fatal outcome often follows, unless liver transplantation is undertaken. Regular monitoring of liver function and red cell porphyrin levels is advisable, but this does not always identify patients before serious liver damage has occurred. Even when patients are identified at an early stage in the development of liver disease the therapeutic options available to prevent further damage are limited, and have not been fully evaluated. The gene for ferrochelatase has been cloned, sequenced and mapped to the long arm of chromosome 18. As mutations continue to be identified, phenotype/genotype correlations should become apparent, and it may eventually be possible to identify those patients at risk of developing hepatic failure. In addition, as the basic enzymatic defect in EPP is at the level of the bone marrow stem cells, which are the target cells of choice in the development of retroviral-mediated gene transfer, definitive treatment of EPP by gene therapy is a distinct hope for the future.(ABSTRACT TRUNCATED AT 400 WORDS)

Mechanisms of photosensitivity in porphyric patients with special emphasis on erythropoietic protoporphyria

In erythropoietic protoporphyria, protoporphyrin overproduction occurs mainly in erythroid tissue. Protoporphyrin can be released from erythrocytes in the dark, but the release is greatly increased if the erythrocytes are exposed to small amounts of light. Protoporphyrin can be bound in plasma either to albumin or to low density or high density lipoprotein. The cutaneous symptoms in erythropoietic protoporphyria are primarily elicited by protoporphyrin-sensitized photodamage of endothelial cells due to the presence of protoporphyrin in lipid structures. Which structures are damaged first in endothelial cells is unknown. Endothelial cells probably accumulate protoporphyrin from albumin or lipoproteins present in the plasma. A direct transfer from the erythrocyte membrane to the endothelial cell membrane can also occur. The transfer processes are probably facilitated by light exposure. Degranulation of mast cells, invasion of neutrophils into interstitial tissue and complement activation seem to be of less importance than endothelial cell injury in the pathogenesis of erythropoietic protoporphyria. These processes may, however, participate in the final expression of the cutaneous symptoms. Uroporphyrin and coproporphyrin are hydrophilic and are probably unbound in plasma, although weak binding to plasma proteins cannot be excluded. In the hepatic porphyrias and in erythropoietic porphyria, the clinical symptoms are probably evoked by uroporphyrin and coproporphyrin present in the interstitial tissue. Very little is known about the primary targets of uroporphyrin and coproporphyrin photodamage in these disorders, but photodamage to intercellular structures probably represents the initial event. Activation of complement may contribute to the final expression of the cutaneous symptoms.