metabolism of heme - ju medicine...heme structure it is a complex of protoporphyrin ix + iron...
TRANSCRIPT
![Page 1: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/1.jpg)
Metabolism of heme
Prof. Mamoun Ahram2019
![Page 2: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/2.jpg)
Heme structureIt is a complex of protoporphyrin IX + Iron (Fe2+).
The porphyrin is planar and consists of four rings (designated A-D) called pyrrole rings.
Each pyrrole can bind two substituents.
Two rings have a propionate group each.
Note: the molecule is hydrophobic.
Fe has six coordinates of binding.
A B
C D
![Page 3: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/3.jpg)
Biosynthesis of heme
![Page 4: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/4.jpg)
Sites of synthesis
The major sites of heme biosynthesis areLiver, which synthesizes a number of heme proteins (particularly the CYP proteins),
The rate of heme synthesis is highly variable
Erythrocyte-producing cells (Hb synthesis)Relatively constant production and matches the rate of globin synthesis, but synthesis is regulated at multiple points.
Synthesis occurs in
mitochondria → cytosol → mitochondria
![Page 5: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/5.jpg)
Synthesis of heme
The first reaction is catalyzed by ALAS1 (liver) or ALAS2 (erythrocytes).
It is the rate limiting and committed step.
It requires vitamin B6 (pyrodoxalphosphate).
ALAS1 is regulated by hemin.Degradation of mRNA
Inhibition of mitochondrial transport
Drugs induce ALAS1.
ALAS2 is regulated by level of iron.
ALA moves out of mitochondria to cytosol.
Porphobilinogen is formed by 2X ALA.
![Page 6: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/6.jpg)
More reactions
4X PBG form uroporphobilinogen III
Coproporphyrnogen III moves back into mitochondria.
The last reaction is spontaneous, but can be catalyzed by ferrochelatase.
In erythrocytes, synthesis is regulated at ferrochelatase and porphobilinogen deaminase (→).
![Page 7: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/7.jpg)
![Page 8: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/8.jpg)
Porphyrias
Porphyrias are inherited or acquired disorders caused by a deficiency of enzymes in the heme biosynthetic pathway resulting in elevations in the serum and urine content of intermediates in heme synthesis.Porphyria = purple.These disorders are classified as either erythroid or hepatic (acute or chronic).
Abdominal and neuropsychiatric signs or not versus photosensitive or not photosensitive (tetrapyrrrole or not)
![Page 9: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/9.jpg)
![Page 10: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/10.jpg)
Treatment
Hemin or hematin strongly inhibits the activity of ALAS.
Glucose: fasting (hypoglycemia) exacerbates acute porphyria attack due to activation of the transcription factor, PGC-1α, in the liver induces synthesis of gluconeogenic genes and the ALAS1 gene resulting in accumulation of heme intermediates.
![Page 11: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/11.jpg)
Catabolism of heme
![Page 12: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/12.jpg)
Challenges
RBCs are the largest storage place of heme.
Erythrocytes are mainly destroyed by macrophages in the spleen and bone marrow, releasing hemoglobin, which is degraded to heme.
The protein is metabolized into amino acids
6 g/day of hemoglobin are turned over, butFirst, the porphyrin ring is hydrophobic.
Second, iron must be conserved.
![Page 13: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/13.jpg)
Heme degradation
The roles of heme oxygense and NADPH
The production of CO
The world of colors
![Page 14: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/14.jpg)
Transport of billirubin
The role of albumin
Salicylates and sulfonamides can displace bilirubin from albumin permitting bilirubin to enter the central nervous system (CNS).
This causes the potential for neural damage in infants.
Formation of bilirubin diglucuronide.Crigler-Najjar I and II and Gilbert syndrome
Transport into bileDubin-Johnson syndrome
![Page 15: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/15.jpg)
![Page 16: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/16.jpg)
Measurement of billurubin
It is done via a reaction known as Van den Bergh reaction.
Direct measurement of conjugated bilirubin (in water)
Total measurement of bilirubin (in ethanol or methanol)
Indirect unconjugated bilirubin = total bilirubin – direct billirubin
![Page 17: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/17.jpg)
Lab results of jaundice
Unconjugated
hyperbillirubinemia
Conjugated
hyperbillirubinemia
Clayish color
![Page 18: Metabolism of heme - JU Medicine...Heme structure It is a complex of protoporphyrin IX + Iron (Fe2+). The porphyrin is planar and consists of four rings (designated A-D) called pyrrole](https://reader031.vdocument.in/reader031/viewer/2022041516/5e2b6abc4531a76683166069/html5/thumbnails/18.jpg)
Jaundice in newborns