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Die Hexachlorbenzol (HCB)-Porphyrie

Teil III: Diskussion der bisher vorliegenden klinischen und experimentellen Befunde über die Entstehung der HCB-Porphyrie

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Zusammenfassung

Die Hexachlorbenzol-induzierte Porphyrie der Ratte ist durch eine vermehrte Ausscheidung hochcarboxylierter Porphyrine (vorherrschend Uro- und Heptaporphyrine) und der Porphyrinvorstufen (ALA und PBG) im Urin gekennzeichnet. Im Stuhl und in der Galle findet sich zusätzlich auch eine Vermehrung der niedriger carboxylierten Porphyrine, wie Copro- und Protoporphyrine. In der Leber werden ebenfalls vorherrschend Uro- und Heptaporphyrin abgelagert. Unter der HCB-Applikation kommt es zu einer allmählichen Hemmung der Uroporphyrinogen-Decarboxylase in der Leber und gleichzeitig zu einer massiven Induktion der ALA-Synthase. Während sich die HCB-Porphyrie bei der weiblichen Ratte unter einer 0,05% HCB-haltigen Diät erst nach 40–60 Tagen manifestiert, findet sich bereits nach wenigen Tagen eine massive Induktion der P-450-Isoenzyme.

HCB ist ein sogenannter Mischtyp-Induktor, d. h. es werden unter dem Einfluß von HCB mehrere P-450-Isoenzyme induziert, nämlich Phenobarbital (= P-450b), 3-Methylcholanthren (= P-450c), Isosafrol (= P-450d), Pregnenolon-16α-carbonitril (= P-450e) und Ethanol (MEOS = microsomal ethanol oxidizing system)-induzierbare P-450-Isoenzyme werden vermehrt gebildet. Eine Induktion der P-450-Isoenzyme durch Vorbehandlung und gleichzeitige Gabe entsprechend induzierender Substanzen: Pharmaka, Xenobiotika oder HCB-Metaboliten (PCP, PCB oder TCP) führt nicht zu einer schnelleren Porphyrieentstehung, wenn man die Porphyrinausscheidung der kombiniert behandelten Tiere mit ausschließlich HCB-behandelten Ratten vergleicht. Hexachlorbenzol wird durch P-450b zu Pentachlorphenol und Pentachlorphenol durch P-450c weiter zu Tetrachlorhydrochinon dechloriert. Nach neueren Untersuchungen ist es nicht ausgeschlossen, daß Tetrachlorhydrochinon von maßgeblicher Bedeutung für die Hemmung der Uroporphyrinogen-Decarboxylase in der Leber ist.

Unter der Gabe von HCB wird außerdem die τ4-5α-Steroid-Reduktase der Leber gehemmt. Dadurch fallen vermehrte 5β-H-Steroiden an, die eine Induktion der ALA-Synthase in diesem Organ bewirken. Zur Zeit der Manifestation der HCB-Porphyrie läßt sich auch eine Minderung des Glutathion-Gehalts der Leber nachweisen. Es ist vorstellbar, daß die Minderung von Glutathion in der Leber vergleichbar einer vermehrten Eisenablagerung in der Leber zu einer verstärkten Oxidation von Porphyrinogen zu Porphyrinen führt und so zur Ausbildung der hepatischen HCB-Porphyrie beiträgt.

Die Chloroquin-Therapie ist neben der Aderlaß-Behandlung die Therapie der Wahl bei der Behandlung der menschlichen PCT. Ihr Wirkungsmechanismus beruht teilweise auf der Ausbildung von Chloroquin-Porphyrin-Komplexen, die besser wasserlöslich sind und somit vermehrt aus der Leber oder dem Urin eliminiert werden können. Darüber hinaus konnte jedoch gezeigt werden, daß Chloroquin die HCB-bedingte Induktion der ALA-Synthase aufhebt und damit die verstärkte Porphyrin-Biosynthese „normalisiert“.

Somit ist die Pathogenese der HCB-Porphyrie noch immer nicht endgültig abgeklärt: Es steht außer Zweifel, daß im Rahmen der HCB-Applikation die Hemmung der Uroporphyrinogen-Decarboxylase die Grundlage für die Entstehung der hepatischen Porphyrie ist. Ob hierbei HCB selbst (vielleicht nach Erreichen einer Grenzkonzentration und einer bestimmten Einwirkungszeit auf das Enzym) oder ein oder mehrere HCB-Metaboliten, z. B. Tetrachlor-Hydrochinon, für die Ausbildung der HCB-Porphyrie entscheidend sind, muß weiterführenden Untersuchungen vorbehalten bleiben.

Abstract

The hexachlorobenzene induced porphyria is characterized by an increased excretion of highly carboxylated porphyrins (uro- and heptaporphyrin) and of the precursors δ-aminolevulinic acid (ALA) and porphobilinogen in the urine, whereas in feces and bile the lower carboxylated molecules (e.g. copro- and protoporphyrin) dominate. In the liver significant deposits of uro- and heptaporphyrin are found. During the course of HCB intoxication a gradual inhibition of the hepatic uroporphyrinogen-decarboxylase (URO-D) activity is observed whereas the ALA-synthase activities increased. Although female rats fed with a 0.05% HCB containing diet do not develop a full blown porphyric state before day 50 a characteristic pattern of induced P-450 isoenzymes can be measured 3–10 days after HCB-feeding. HCB induces concomitantly several types of isoenzymes at the same time (so-called mixed type induction): phenobarbital-type (= P-450b), 3-methylcholanthrene-type (= P-450c), isosafrol-type (P-450d), pregnenolone-16α-carbonitril-type (= P-450e), and the microsomal ethanol oxidizing system (MEOS). Pretreatment or concomitant application of other drugs, xenobiotics of hexachlorobenzene metabolites (PCP, PCB or TCP) does not result in a different (or earlier) porphyric state of the experimental animals when compared with the HCB controls. Hexachlorobenzene is dechlorinated to PCP by P-450b and the latter is metabolized by P-450c to tetrachlorohydrochinone. According to recent investigations it could be possible that tetrachlorohydroquinone is the real inhibitor of URO-D following HCB application. Administration of HCB to rats leads to the inhibition of the hepatic Δ4-3-oxo-5-steroid reductase with a subsequent augmentation of 5β-H-steroids that induce ALA-S. The manifestation of the HCB porphyria is accompanied by a decrease of GSH content in the liver, that results in a change of the hepatic redox system comparable with an increased iron storage in the organ. Consequently an increase of oxidative reactions could support the inhibition of URO-D. Most commonly the human PCT is treated with chloroquine (CQ) or by means of phlebotomy. The mechanism of action, by which chloroquine exerts its effects is not completely known: The drug forms complexes with porphyrins and the improved aqueous solubility results in better excretion. On the other hand CQ abolishes the induction of ALA-S by HCB, so that normalization of porphyrin biosynthesis might be achieved.

As a conclusion the final mechanism of the porphyrogenic action of HCB is still not clear but it is beyond any doubt that inhibition of URO-D activity is the underlying mechanism of thus experimental porphyria. If HCB (perhaps via a concentration gradient) or one of its reactive, short living metabolites represents the porphyrinogen principle, remains an open question.

Unserem Lehrer, Herrn Prof. Dr. med., Dipl. Chem. H. Ippen, Universitätshautklinik Göttingen, in Dankbarkeit gewidmet

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Authors and Affiliations

  1. Universitätshautklinik Düsseldorf, Moorenstraße 5, D 4000, Düsseldorf, Deutschland

    G. Goerz

  2. Biotest-Pharma GmbH, Flughafenstraße 4, D 6000, Frankfurt/Main, Deutschland

    R. Lissner

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  1. G. Goerz
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  2. R. Lissner
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Editors and Affiliations

  1. Erlangen, Deutschland

    O. P. Hornstein

  2. Münster-Hornheide, Deutschland

    M. Hundeiker

  3. Mannheim, Deutschland

    J. Schönfeld

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© 1988 Springer-Verlag Berlin Heidelberg

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Goerz, G., Lissner, R. (1988). Die Hexachlorbenzol (HCB)-Porphyrie. In: Hornstein, O.P., Hundeiker, M., Schönfeld, J. (eds) Neue Entwicklungen in der Dermatologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-73581-3_15

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  • DOI: https://doi.org/10.1007/978-3-642-73581-3_15

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-19142-1

  • Online ISBN: 978-3-642-73581-3

  • eBook Packages: Springer Book Archive

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