Studies in porphyria. IV. Expression of the gene defect of acute intermittent prophyria in cultured human skin fibroblasts and amniotic cells: prenatal diagnosis of the porphyric trait

Abstract

The gene lesion of the porphyrin heme synthetic pathway in acute intermittent porphyria (AIP) is reflected in a deficient level of activity of the cytosol enzyme uroporphyrinogen I synthetase (URO S). A marked URO S deficiency was demonstrated in the liver and in circulating erythrocytes of individuals with both active and latent AIP. This enzymic abnormality accounts for the excessive production and excretion into urine of the porphyrin precursors, δ aminolevulinic acid (ALA) and porphobilinogen (PBG) in AIP subjects. In this study, utilizing cell culture techniques, a marked URO S deficiency was also demonstrated in skin fibroblasts from AIP patients and in cells derived through amniocentesis from an approximately 17 wk old fetus. The prenatal diagnosis of the AIP trait in this fetus was confirmed postnatally by the demonstration in the child of a deficient level of erythrocyte URO S activity which was comparable to those found in her AIP mother and an affected sibling and which was approximately one half the levels characterizing her normal father and aunt and a second unaffected sibling. The identification of the URO S deficiency in cultured human fibroblasts from AIP patients was facilitated by a newly developed, sensitive assay for the enzyme activity. In this assay, the ability of such cells to convert ALA to protoporphyrin was quantitated; in the sequence of reactions involved in this transformation, URO S is limiting so that the gene defect of AIP could be simply and precisely determined by appropriate spectrofluorometry of cell extracts. The technique described had distinct advantages over the direct enzymatic assay for URO S activity in cultured human skin fibroblasts and permits clear differentiation of AIP carriers from normal individuals.