PHOTOREACTIONS ASSOCIATED WITH IN VITRO HEMOLYSIS IN ERYTHROPOIETIC PROTOPORPHYRIA*

Abstract— –Photohemolysis of erythrocytes. from patients with erythropoietic protoporphyria results from damage to the cell membrane following photoexcitation of the protoporphyrin molecule by 400 nm radiation. Photochemical reactions were assessed for their roles in initiating cell destruction in an in vitro model in which erythrocytes from patients with erythropoietic protoporphyria were irradiated. Electron transfer properties were demonstrated using 2,3,6-trichloroindophenol as an electron acceptor. Photohemolysis of these abnormal cells is due to cell membrane damage initiating colloid osmotic hemolysis. Additional data are offered demonstrating that this type of photohemolysis is oxygen-dependent, associated with peroxide formation, and preceded by increased osmotic fragility. An hypothesis explaining the interrelationship of the photochemistry of protoporphyrin with the photobiologic observation of hemolysis is offered.     

ERYTHROPOIETIC PROTOPORPHYRIA: PHOTODYNAMIC TRANSFER OF PROTOPORPHYRIN FROM INTACT ERYTHROCYTES TO OTHER CELLS

Erythrocytes in patients with erythropoietic protoporphyria (EPP) contain large amounts of protoporphyrin and are regarded as the main source of protoporphyrin in this disease. Cells in the skin of EPP patients accumulate protoporphyrin released from the erythrocytes and upon sun exposure endothelial cells are photodamaged. In the present study a light-induced transfer of protoporphyrin directly from EPP erythrocytes to cultured cells is demonstrated. Erythrocytes were layered upon cultured cells and irradiated. The nearness of erythrocyte and cultured cell membranes potentiated the transfer of protoporphyrin between these cells. This transfer was rapid and preceded the release of protoporphyrin to proteins in the medium. Further irradiation of the protoporphyrin-enriched cultured cells, after removal of the erythrocytes, caused severe photodamage to the cells and survival was dependent on both the amount of protoporphyrin transferred and on the light fluence. Clinical observations and the results of this study indicate that light energy may be involved in two steps in the pathophysiology of EPP: (A) light-induced release of protoporphyrin from erythrocytes to endothelial cells and (B) photodynamic damage to protoporphyrin-enriched endothelial cells.     

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 neutrophus 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.     

Light-induced redistribution and photobleaching of protoporphyrin in erythrocytes from patients with erythropoietic protoporphyria: an explanation of the rapid fading of fluorocytes

Erythrocytes from patients with erythropoietic protoporphyria (EPP) contain large amounts of protoporphyrin. By fluorescence microscopy it has been found that the erythrocytes show red fluorescence which fades very rapidly. During irradiation of erythrocytes from patients with EPP, a decrease in the fluorescence intensity and a red shift in the fluorescence emission maximum is observed. Since the human eye has a diminishing sensitivity in the red part of the spectrum, the red shift will augment the fluorescence decrease observed in the microscope. The decrease in fluorescence intensity is greater than what would be expected by photobleaching of protoporphyrin alone. We suggest that the rapid fading of fluorocytes observed in a fluorescence microscope can be explained both by photoinduced detachment of protoporphyrin from hemoglobin followed by a redistribution to the erythrocyte membrane and by protoporphyrin photobleaching.     

HEMOGLOBIN OXYGEN AFFINITY IS INCREASED IN ERYTHROPOIETIC PROTOPORPHYRIA

Abstract— Whole blood and hemolysates from seven normal and three erythropoietic protoporphyria patients were compared in terms of their hemoglobin function. The oxygen affinity (P₅₀) of the erythropoietic protoporphyria hemolysates compared to normals (13.1 ± 0.2 vs 17.5 ± 0.3 mmHg; P < 0.001) and erythropoietic protoporphyria erythrocytes compared to normals (23.4 ± 0.6 vs 27.1 ± 0.5 mmHg; P < 0.001) were increased while oxygen-binding cooperativity (n-value of the Hill equation) were similar. We conclude that hemoglobin function in erythropoietic protoporphyria patients is altered, but without pathophysiologic consequences. Because hemoglobin in which protoporphyrin IX substitutes for heme has a low oxygen affinity, our findings of a higher than normal affinity in erythropoietic protoporphyria red cells and hemolysates may indirectly support the findings by others that protoporphyrin IX binds to hemoglobin at non-heme-binding sites. In addition, based on the effect of other abnormal hemoglobins, this shift in P₅₀ will decrease any tendency for anemia in erythropoietic protoporphyria patients.     

Transfer of protoporphyrin IX between cells

Human adenocarcinoma cells of the line WiDr and human leukemia T cells of the line Jurkat were incubated with 5-aminolevulinic acid and found to produce protoporphyrin IX (PpIX). They were able to transfer a fraction of the sensitizer to neighboring control cells. The transfer took place through direct membrane contact. Light exposures, inactivating about 20% of the sensitized cells, did not result in any acceleration of the transfer of PpIX. This is in contrast to what has been reported for PpIX in erythrocytes from patients with erythropoietic protoporphyria. In these cells light exposure transfers PpIX from the binding sites on hemoglobin to the plasma membrane and further to neighboring cells. The lack of light-induced transfer in the WiDr and Jurkat cells may be related to the binding sites of PpIX, supposedly membrane lipids and proteins embedded therein. Light exposure slightly increased the rate of loss of PpIX from WiDr cells.     

PROTOPORPHYRIN-INDUCED PHOTODAMAGE: STUDIES USING CULTURED SKIN FIBROBLASTS

A new system is described for the study of protoporphyrin-induced photodamage of cells. This system differs from those previously described in that fibroblasts are induced to synthesize protoporphyrin from its precursor δ-aminolevulinic acid.
Fibroblasts were cultured from skin biopsies of 6 normal individuals and 6 patients with protoporphyria. All cell lines in both groups accumulated protoporphyrin when incubated with δ-aminolevulinic acid in the absence of iron. Irradiation for 2 min with long-wave UV light caused death of cells which had accumulated protoporphyrin, but not of cells which had been incubated without δ-aminolevulinic acid. Cell damage could be quantitatively assessed by the release of chromium-51 into the medium.
Examination of irradiated protoporphyrin-rich fibroblasts by electron microscopy revealed no significant differences between lines from patients with protoporphyria and normal individuals. The earliest indications of photodamage were rarifaction of the mitochondrial matrix with dilatation of cristae. dilatation of endoplasmic reticulum, and loss of plasma membrance integrity. Condensation of the cells correlated with cell death. These structural alterations suggest a generalized cellular injury.     

Red cell zinc protoporphyrin and protoporphyrin by HPLC with fluorescence detection

A high performance liquid chromatographic (HPLC) method was developed for the determination of zinc protoporphyrin (ZnPP) and protoporphyrin (PP) in whole blood. After adding the blood to dilute acetic acid, ZnPP and PP were extracted with dimethyl sulfoxide-acetone containing mesoporphyrin as internal standard. Following evaporation of the acetone, the haemin-free extract was analysed by HPLC. ZnPP and PP were separated on a reversed-phase column and quantitated by measuring fluorescence peak areas. The extraction method is simple, and applicable to batch analysis, and the HPLC separation is rapid and repoducible. The coefficient of variation for ZnPP was 5.6% and 3.3% for total red cell porphyrin levels of 3.5 and 10.2 mumol per litre RBC respectively. Results are discussed in patients with erythrohepatic protoporphyria, lead exposure, iron-deficiency and nonspecifically elevated total red cell porphyrins.     

CROSS-LINKING OF MEMBRANE PROTEINS AND PROTOPORPHYRIN-SENSITIZED PHOTOHEMOLYSIS*

Abstract— Irradiation of protoporphyrin-sensitized red cells with blue light in the presence of oxygen alters many components of their membranes and eventually leads to hemolysis. Extensive cross-linking of membrane proteins can be observed before hemolysis occurs (Girotti, 1976).
Facile oxidative hemolysis can be achieved without observable cross-linking of membrane proteins upon incubation (37°C) of red cells containing membrane-bound 3ß-hydroxy-5α-hydroperoxy-△⁶-cholcstene. Thus, protein cross-linking is not obligatory for oxidative lysis. Deoxygenation by Ar bubbling strongly retards the light-induced increase in osmotic fragility and strongly inhibits eventual hemolysis of protoporphyrin-sensitized erythrocytes. However, similar reduction in oxygen concentration only partially inhibits cross-linking of membrane proteins. These results suggest that membrane protein cross-linking and photohemolysis are not coupled processes.     

Antioxidant inhibition of porphyrin-induced cellular phototoxicity.

Porphyrins such as protoporphyrin IX (PP IX) and uroporphyrin I (UP I) can be phototoxic to human cells. To study the protective ability of antioxidants (beta-carotene, lycopene, ascorbic acid and alpha-tocopherol), against such porphyrin phototoxicity, membrane destruction experiments (Jurkat cells) and human cell cultures (fibroblasts) were performed. Both beta-carotene and lycopene and also the combination of beta-carotene, ascorbic acid and alpha-tocopherol offered cell protection against PP IX phototoxicity. Investigations of both cell membrane protection and of cell growth showed differences in terms of the protection afforded by the anti-oxidants. Thus, for PP IX, carotenoids alone, and in combination with ascorbic acid and alpha-tocopherol, showed higher protection factors in general than UP I. However, for membrane protection there was significant protection against UP I by the combination of beta-carotene, ascorbic acid and alpha-tocopherol but not by any of these anti-oxidants alone. The membrane protection against PP IX by beta-carotene, and especially lycopene, is significant presumably because of the high lipophilicity of all these molecules. However, the hydrophilic UP I will cause phototoxicity mainly via H(2)O(2), radical or singlet oxygen production in the aqueous phase, and these reactive species may be generated some distance from the cell membrane. This may lead to the little or no protection observed for UP I by the individual antioxidants. Nevertheless, a combination of beta-carotene, ascorbic acid and alpha-tocopherol offers membrane protection against the phototoxicity of both porphyrins. This is believed to occur as a result of synergistic processes. Our results suggest that the treatment of porphyria cutanea tarda and erythropoietic protoporphyria may be improved by the use of a combination of the antioxidants studied.     

Isolation of Hemoglobin from Bovine Erythrocytes by Controlled Hemolysis in the Membrane Bioreactor

In this work, we describe an optimized procedure based on gradual hemolysis for the isolation of hemoglobin derived from bovine slaughterhouse erythrocytes in a membrane bioreactor. The membrane bioreactor system that provided high yields of hemoglobin (mainly oxyhemoglobin derivate) and its separation from the empty erythrocyte membranes (ghosts) was designed at a pilot scale. Ten different concentrations of hypotonic media were assessed from the aspect of the extent of hemolysis, hematocrit values of the erythrocyte suspensions, cell swelling, and membrane deformations induced by decreased salt concentration. Effective gradual osmotic hemolysis with an extent of hemolysis of 88% was performed using 35 mM Na-phosphate/NaCl buffer of pH 7.2–7.4. Under these conditions most of the cell membranes presented the appearance of the normal ghosts under phase contrast microscope. The hemoglobin purity of >80% was confirmed by SDS-PAGE. Kinetic studies showed that maximal concentration of hemoglobin was reached after 40 min, but the process cycle at which recovery of 83% was achieved lasted for 90 min. The dynamics of both steps, (1) transport through the membrane of erythrocytes during process of hemolysis and (2) transport through the reactor filters, were evaluated.     

STUDY OF THE EFFECTS OF ULTRAVIOLET LIGHT ON BIOMEMBRANES—IV. THE EFFECT OF OXYGEN ON UV-INDUCED HEMOLYSIS AND LIPID PHOTOPEROXIDATION IN RAT ERYTHROCYTES AND LIPOSOMES

Abstract— Hemolysis induced by irradiation with ultraviolet (UV) light at 254 nm showed a pronounced oxygen effect: under irradiation in vacuum, the rate of hemolysis was decreased by an order of magnitude. Irradiation at 254 nm in air but not under vacuum caused the peroxidation of erythrocyte membrane lipids. These results suggest that membrane lipid photoperoxidation is one of the causative factors of UV hemolysis. Irradiation at different wavelengths showed that UV-induced lipid photoperoxidation in erythrocyte membranes developed while the antioxidant α-tocopherol was directly photooxidized. It is shown that the process of lipid photolysis in erythrocyte membranes involves sensitization, possibly by protoporphyrin, whose presence in liposomes accelerates the photoperoxidation at 254 and 365 nm of unsaturated fatty acid residues in lecithin. Possible mechanisms of photochemical damage to erythrocyte membranes are discussed.     

THE EFFECT OF PROTOPORPHYRIN ON HISTAMINE SECRETION BY RAT PERITONEAL MAST CELLS: A DUAL PHOTOTOXIC REACTION

Abstract— Protoporphyrin-induced phototoxicity in rat peritoneal mast cells was manifested either by inhibition of 48/80-stimulated histamine secretion or by cell lysis. At a protoporphyrin concentration of 100ng/m/ (0.17 μM), histamine secretion was completely inhibited after 30min illumination. After initiation, the inhibited state progressed in the dark, and was irreversible, however, it did not develop into cell lysis. More severe phototoxic reactions in mast cells could not be produced by increasing the PP concentration or the incubation time; however, cell lysis was evoked by increasing the light intensity between 180–950W/m², using a light source with emission maxima in the 350–470nm region. Dual phototoxic effects could also be demonstrated in erythrocytes by manipulating the illumination conditions. Increased resistance to osmotic lysis was seen under moderate conditions, and decreased resistance and cell lysis were seen under severe conditions. In the absence of protoporphyrin, the effect of light alone on mast cells was similar to protoporphyrin-phototoxicity, although the light intensities required were higher both for inhibition (60–130W/m²) and lysis (280–950W/m²). The data therefore indicate that certain cell functions can be specifically disrupted by phototoxic reactions that are not cytotoxic; however, phototoxic reactions that lead to severe membrane protein denaturation and cell lysis also occur. The manifestation of these dual effects depends on the intensity of illumination in the 350–470nm region.     

Saccharomyces cerevisiae Mutants Defective in Heme Biosynthesis as a Tool for Studying the Mechanism of Phototoxicity of Porphyrins

Abstract— Mutants of Saccharomyces cerevisiae accumulating uroporphyrin (UP) or protoporphyrin (PP) were used as a model for the in vivo phototoxic effect of porphyrins observed in the human skin photosensitivity associated with porphyrias (porphyria cutanea tarda and erythropoietic protoporphyria). We have found that UP is localized in vacuoles and PP is present in all compartments except vacuoles in yeast cells. Endogenous PP is much more effective as a photosensitizer of yeast cells than UP. Protoporphyrin action is strictly dependent on the presence of oxygen. In contrast, UP displays a phototoxic effect even if oxygen is not present in the suspension, implicating a free radical mechanism that operates in anaero-biosis upon photosensitization by UP. Catalase or superoxide dismutase deficiency affects photosensitization by UP. A possible mechanism of UP photosensitizing activity is discussed.     

INTERACTION OF HUMAN SERUM LOW DENSITY LIPOPROTEINS WITH PORPHYRINS: A SPECTROSCOPIC AND PHOTOCHEMICAL STUDY

The incorporation of proto-, uro- and hematoporphyrin in low density lipoproteins (LDL) of human blood has been studied by equilibrium dialysis, fluorescence and absorption spectroscopy. The lipoproteins may efficiently compete with albumin in the binding of protoporphyrin to human blood proteins in patients suffering from protoporphyria. It can be concluded that hydrophobic porphyrins bind to blood proteins.
The complexation of hydrophobic porphyrins in LDL is responsible not only for efficient photodynamic effect at the lipoprotein level, but also for photoinduced lipid peroxidation and for consumption of β-carotene incorporated into LDL which are one of their natural carriers. The water-soluble uroporphyrin, although an efficient photosensitizer for the LDL apoprotein photoinactivation, is much less efficient for lipid peroxidation and β-carotene bleaching. The 353 nm laser flash photolysis shows that porphyrin triplet states are not affected by the physiological β-carotene content of LDL but are fully accessible to oxygen.     

THE EFFECTS OF PHOTOACTIVATED PROTOPORPHYRIN ON RETICULOCYTE MEMBRANES, INTRACELLULAR ACTIVITIES and HEMOGLOBIN PRECIPITATION

Abstract— Photoactivated protoporphyrin effects were studied on reticulocyte membranes and distinct intracellular activities. Membrane bound (Na ₊ -K ₊)-ATPase activity and incorporation of ₅₅Fe into heme were almost 80% inhibited at a low concentration of protoporphyrin (3 fiM). On the other hand, a much higher protoporphyrin concentration (15 nM) was needed to cause 80% inhibition of protein synthesis. By 15 JXM protoporphyrin and treatment with light, an initial leak of hemoglobin out of the cells was observed. Electron microscopic examination showed that the lytic effects seem to be a result of membrane damage which appeared as holes in the membrane. Heinz-body-like particles of condensed hemoglobin were observed in the protoporphyrin-treated cells. The condensed hemoglobin spheres were shown to be bound to disrupted membranes prepared from photoactivated protoporphyrin-treated reticulocytes     

Fluorescence and Treatment Light Monitoring for Interstitial Photodynamic Therapy

In interstitial photodynamic therapy, light is distributed to the tumor via light diffusers. The light dose and the related phototoxic effect achieved throughout the target volume critically depend on absorption, scattering and diffuser positioning. Using liquid tissue phantoms, we investigated the dependencies of treatment light transmission and protoporphyrin IX (PpIX) fluorescence on these parameters. This enabled monitoring hemoglobin oxygenation and methemoglobin formation during irradiation (635 nm, 200 mW cm⁻¹ diffuser length). Starting with two parallel cylindrical diffusers at 10 mm radial separation, the light transmitted between the fibers was largely determined by the minimal distance between the diffusers, but rather insensitive to an additional axial displacement or tilting of one fiber with respect to the other. For fixed distance between the diffusor centers, however, tilting up to direct contact resulted in a 10-fold signal increase. For hemoglobin within erythrocytes, irradiation leads to photobleaching of PpIX without marked change in hemoglobin oxygenation until hemolysis occurs. Afterward, hemoglobin is rapidly deoxygenized and methemoglobin is formed, leading to a dramatic increase in absorption. For lysed blood, these effects start immediately. A comparison of intraoperative monitoring of the signals with the experimental results might help prevent insufficient treatment by reconsidering treatment planning or prolonging irradiation.     

HEMOLYSIS OF HUMAN ERYTHROCYTES BY ACTIVATED OXYGEN SPECIES

Abstract— The hemolysis of human erythrocytes by irradiation at 254 nm has been studied. Neither superoxide radicals nor singlet oxygen play a significant rôle and it is likely that the major species involved are hydroxyl radicals and, indirectly, carbonate anion or formate radicals. Similarly, when erythrocytes are treated with a system commonly used as source of superoxide radicals (photoreduction of riboflavin) it has been demonstrated that O^-₂ does not participate in lysis, but that singlet oxygen (possibly with hydroxyl radicals) is a major oxygen species involved in destruction of the cell membrane.     

PENETRATION POTENCY OF TOPICAL APPLIED δ-AMINOLEVULINIC ACID FOR PHOTODYNAMIC THERAPY OF BASAL CELL CARCINOMA *

Abstract Penetration potency of δ-aminolevulinic acid (ALA) was studied by examining fluorescence of endogenous protoporphyrin IX in different histological types of basal cell carcinoma. Ten basal cell carcinomas were coated with an ointment containing 10% ALA prior to excision; five served as controls. Tumors were excised either 4 h or 12 h after application of ALA using a modified Mohs’micrographic surgical technique. Horizontal sections were cut from deep dermis to tumor surface and examined under a fluorescence microscope. After 4 h of application, only skin appendages demonstrated fluorescence typical of protoporphyrin IX. After 12 h, fluorescence was detectable in tumor cells in deep dermis. The five controls revealed no fluorescence at any site. These results may confirm the high penetration potential of topically applied ALA and its usefulness in photodynamic therapy. For tumors penetrating to deep dermis, an application time of more than 4 h seems necessary, at least when hydrophilic solvents for ALA are used.     

MEASUREMENT OF CELL LYSIS BY LIGHT SCATTERING

Abstract— A method is presented which is capable of continuously monitoring the degree of hemolysis in erythrocyte suspensions too dilute to be monitored by conventional light transmission techniques. Scattered light is used to non-destructively assess hemolysis in sparse monolayers which are particularly well suited to many photohemolytic studies. The small angle scattering (<10°), measured here, shows a transient decline as cells settle in a culture dish and then is constant if no lysis occurs. Lysis is indicated by a decrease in scattered light to < 20% of initial intensity when lysis is complete. The light used to monitor lysis is restricted to wavelengths longer than 700 nm which is outside the absorption band of many. photosensitizers of current interest, and is a wavelength range at which light scattering is relatively independent of changes in cell volume. In photohemolytic studies with phloxine B lysis values from light scattering are shown to correlate well with lysis values from hemoglobin release. An apparatus is described which is capable of periodically measuring lysis in eight suspensions without intervention by the experimenter.