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Urinalysis

Heptacarboxyporphyrin

Optimal Result: 0 - 2.9 mcg/g creat.

Heptacarboxyporphyrin is a Porphyrin.

Porphyrins are precursors of heme and usually only occur in urine in negligible amounts.

However, disorders in heme biosynthesis lead to the syndrome of porphyria with increased formation and excretion of porphyrins. Porphyrias can be hereditary-related or acquired through exogenous influences such as alcohol consumption or lead poisoning. Different enzymes of the heme biosynthesis can be deficient, thus, several different porphyrias can be distinguished. Since these share some common symptoms, chromatographic measurement of the porphyrins is the only way to enable an exact diagnosis.

Porphyrias, which can be inherited or acquired, are often diagnosed with the aid of information regarding the distribution profile of individual porphyrin intermediates in urine. The term “porphyria” is derived from the Greek word porphyria, meaning “purple pigment”.

Porphyrins are particularly well suited as biomarkers for two reasons. First, the pathway is highly active, so any disturbance tends to cause rapid and relatively large accumulations of intermediates. Second, the enzymes of the porphyrin-producing pathway are widely distributed in human tissues and some of them are highly sensitive to the presence of various toxins.

Alterations of porphyrin synthesis that are not due to hereditary or toxic disturbances of porphyrin metabolism are adaptive responses. Such responses caused by alcohol or other drugs may not lead to clinical consequences. However, these disturbances often initiate biochemical and clinical manifestation of genetic porphyrias that previously may have been latent. Once initiated, the symptoms may be long-lasting, especially if the offending toxicant is not identified and removed or avoided. Numerous toxic porphyrias are precipitated by environmental mediators.

Multiple environmental and nutritional factors can cause additive effects. For example, hexachlorobenzene-induced porphyria is accentuated by estrogens and attenuated by vitamin C. The estrogen effect increases the susceptibility of women to porphyrias. Aluminum inhibits some heme synthetic enzymes and has been implicated in causing porphyria in chronic hemodialysis patients, whom are often aluminum overloaded.

Lead intoxication causes signs and symptoms similar to acute intermittent porphyria including abdominal pain, constipation and vomiting. However, anemia which is often found with lead intoxication may be absent in lower lead exposures that generate porphyria, indicating that the overall flux through the porphyrin pathway is not strongly reduced even though significant amounts of intermediates are spilled, due to the toxicant effect.

References:

– https://www.ncbi.nlm.nih.gov/pubmed/10830610

– https://www.ncbi.nlm.nih.gov/pubmed/15967199

– https://www.ncbi.nlm.nih.gov/pubmed/10787385

– https://pdfs.semanticscholar.org/285c/c5c73b7ce1b39abb1917168934ece917a434.pdf

– https://www.ncbi.nlm.nih.gov/pubmed/9114276

– https://www.ncbi.nlm.nih.gov/pubmed/16782144

– https://www.ncbi.nlm.nih.gov/pubmed/11353126

– https://www.tandfonline.com/doi/abs/10.1080/00039899909602482

– https://www.ncbi.nlm.nih.gov/pubmed/3615245

What does it mean if your Heptacarboxyporphyrin result is too high?

Possible reasons for elevated Heptacarboxyporphyrin levels:

– Environmental Toxin-induced Porphyrinurias (Arsenic, Hexachlorobenzene, Dioxin, Polybrominated biphenyl

– Alcohol (chronic hepatic porphyria – late)

– Inherited factors: Porphyria cutanea tardia (PCT) and hepatoerythropoietic porphyria (HEP)

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Heptacarboxyporphyrin and Porphyrias

Elevated levels of heptacarboxyporphyrin (HCP) can indicate disturbances in the heme biosynthesis pathway, often associated with certain types of porphyrias. Heptacarboxyporphyrin is an intermediate in the production of heme, and its accumulation may signify dysfunction in the enzymes involved in this process. However, it's important to note that HCP is typically not the primary diagnostic marker for porphyrias.

Acute Intermittent Porphyria (AIP)

AIP is characterized by acute neurovisceral symptoms such as abdominal pain, nausea, vomiting, and neurological disturbances like seizures and confusion. It is caused by a deficiency in the enzyme hydroxymethylbilane synthase (HMBS), also known as porphobilinogen deaminase. The primary diagnostic markers for AIP are elevated levels of porphobilinogen (PBG) and 5-aminolevulinic acid (ALA) in urine and plasma. While HCP levels may be elevated during acute attacks, they are not the primary diagnostic indicator.

Porphyria Cutanea Tarda (PCT)

PCT primarily affects the skin, leading to photosensitivity, blistering, and hyperpigmentation. It is characterized by a deficiency in the enzyme uroporphyrinogen decarboxylase (UROD). In PCT, the most prominent porphyrin elevations are typically uroporphyrin and 7-carboxylporphyrin in urine, and isocoproporphyrin in feces. Heptacarboxyporphyrin may be elevated but is not the primary diagnostic marker for PCT.

Diagnostic Approach

Porphyrias are diagnosed through a combination of clinical symptoms, biochemical tests, and genetic analysis. The pattern of porphyrin precursor and porphyrin elevations in urine, blood, and feces helps distinguish between different types of porphyrias. A comprehensive porphyrin profile, including multiple porphyrin intermediates, is typically used for diagnosis rather than relying on a single marker like heptacarboxyporphyrin.

The specific enzyme deficiency and its location in the heme biosynthetic pathway determine the pattern of porphyrin accumulation and excretion. Therefore, while elevated heptacarboxyporphyrin levels can indicate disturbances in heme biosynthesis, they are not typically the primary diagnostic marker for AIP or PCT.

A more comprehensive analysis, along with clinical symptoms and genetic testing, is usually required for accurate diagnosis and classification of porphyrias.

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