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Heme

Heme (American English), or haem (Commonwealth English, both pronounced /hi:m/ HEEM), is a precursor to hemoglobin, which is necessary to bind oxygen in the bloodstream. Heme is biosynthesized in both the bone marrow and the liver.[1]

Binding of oxygen to a heme prosthetic group

In biochemical terms, heme is a coordination complex "consisting of an iron ion coordinated to a porphyrin acting as a tetradentate ligand, and to one or two axial ligands".[2] The definition is loose, and many depictions omit the axial ligands.[3] Among the metalloporphyrins deployed by metalloproteins as prosthetic groups, heme is one of the most widely used[4] and defines a family of proteins known as hemoproteins. Hemes are most commonly recognized as components of hemoglobin, the red pigment in blood, but are also found in a number of other biologically important hemoproteins such as myoglobin, cytochromes, catalases, heme peroxidase, and endothelial nitric oxide synthase.[5][6]

The word haem is derived from Greek αἷμα haima meaning 'blood'.

Space-filling model of the Fe-protoporphyrin IX subunit of heme B. Axial ligands omitted. Color scheme: grey=iron, blue=nitrogen, black=carbon, white=hydrogen, red=oxygen

Function edit

 
The heme group of succinate dehydrogenase bound to histidine, an electron carrier in the mitochondrial electron transfer chain. The large semi-transparent sphere indicates the location of the iron ion. From PDB: 1YQ3​.

Hemoproteins have diverse biological functions including the transportation of diatomic gases, chemical catalysis, diatomic gas detection, and electron transfer. The heme iron serves as a source or sink of electrons during electron transfer or redox chemistry. In peroxidase reactions, the porphyrin molecule also serves as an electron source, being able to delocalize radical electrons in the conjugated ring. In the transportation or detection of diatomic gases, the gas binds to the heme iron. During the detection of diatomic gases, the binding of the gas ligand to the heme iron induces conformational changes in the surrounding protein.[7] In general, diatomic gases only bind to the reduced heme, as ferrous Fe(II) while most peroxidases cycle between Fe(III) and Fe(IV) and hemeproteins involved in mitochondrial redox, oxidation-reduction, cycle between Fe(II) and Fe(III).

It has been speculated that the original evolutionary function of hemoproteins was electron transfer in primitive sulfur-based photosynthesis pathways in ancestral cyanobacteria-like organisms before the appearance of molecular oxygen.[8]

Hemoproteins achieve their remarkable functional diversity by modifying the environment of the heme macrocycle within the protein matrix.[9] For example, the ability of hemoglobin to effectively deliver oxygen to tissues is due to specific amino acid residues located near the heme molecule.[10] Hemoglobin reversibly binds to oxygen in the lungs when the pH is high, and the carbon dioxide concentration is low. When the situation is reversed (low pH and high carbon dioxide concentrations), hemoglobin will release oxygen into the tissues. This phenomenon, which states that hemoglobin's oxygen binding affinity is inversely proportional to both acidity and concentration of carbon dioxide, is known as the Bohr effect.[11] The molecular mechanism behind this effect is the steric organization of the globin chain; a histidine residue, located adjacent to the heme group, becomes positively charged under acidic conditions (which are caused by dissolved CO2 in working muscles, etc.), releasing oxygen from the heme group.[12]

Types edit

Major hemes edit

There are several biologically important kinds of heme:

Heme A Heme B Heme C Heme O
PubChem number 7888115 444098 444125 6323367
Chemical formula C49H56O6N4Fe C34H32O4N4Fe C34H36O4N4S2Fe C49H58O5N4Fe
Functional group at C3   –CH(OH)CH2Far –CH=CH2 –CH(cystein-S-yl)CH3 –CH(OH)CH2Far
Functional group at C8 –CH=CH2 –CH=CH2 –CH(cystein-S-yl)CH3 –CH=CH2
Functional group at C18 –CH=O –CH3 –CH3 –CH3
 
Structure of Fe-porphyrin subunit of heme B.
 
Structure of Fe-porphyrin subunit of heme A.[13] Heme A is synthesized from heme B. In two sequential reactions a 17-hydroxyethylfarnesyl moiety is added at the 2-position and an aldehyde is added at the 8-position.[14]

The most common type is heme B; other important types include heme A and heme C. Isolated hemes are commonly designated by capital letters while hemes bound to proteins are designated by lower case letters. Cytochrome a refers to the heme A in specific combination with membrane protein forming a portion of cytochrome c oxidase.[15]

Other hemes edit

The following carbon numbering system of porphyrins is an older numbering used by biochemists and not the 1–24 numbering system recommended by IUPAC, which is shown in the table above.
  • Heme l is the derivative of heme B which is covalently attached to the protein of lactoperoxidase, eosinophil peroxidase, and thyroid peroxidase. The addition of peroxide with the glutamyl-375 and aspartyl-225 of lactoperoxidase forms ester bonds between these amino acid residues and the heme 1- and 5-methyl groups, respectively.[16] Similar ester bonds with these two methyl groups are thought to form in eosinophil and thyroid peroxidases. Heme l is one important characteristic of animal peroxidases; plant peroxidases incorporate heme B. Lactoperoxidase and eosinophil peroxidase are protective enzymes responsible for the destruction of invading bacteria and virus. Thyroid peroxidase is the enzyme catalyzing the biosynthesis of the important thyroid hormones. Because lactoperoxidase destroys invading organisms in the lungs and excrement, it is thought to be an important protective enzyme.[17]
  • Heme m is the derivative of heme B covalently bound at the active site of myeloperoxidase. Heme m contains the two ester bonds at the heme 1- and 5-methyl groups also present in heme l of other mammalian peroxidases, such as lactoperoxidase and eosinophil peroxidase. In addition, a unique sulfonamide ion linkage between the sulfur of a methionyl amino-acid residue and the heme 2-vinyl group is formed, giving this enzyme the unique capability of easily oxidizing chloride and bromide ions to hypochlorite and hypobromite. Myeloperoxidase is present in mammalian neutrophils and is responsible for the destruction of invading bacteria and viral agents. It perhaps synthesizes hypobromite by "mistake". Both hypochlorite and hypobromite are very reactive species responsible for the production of halogenated nucleosides, which are mutagenic compounds.[18][19]
  • Heme D is another derivative of heme B, but in which the propionic acid side chain at the carbon of position 6, which is also hydroxylated, forms a γ-spirolactone. Ring III is also hydroxylated at position 5, in a conformation trans to the new lactone group.[20] Heme D is the site for oxygen reduction to water of many types of bacteria at low oxygen tension.[21]
  • Heme S is related to heme B by having a formyl group at position 2 in place of the 2-vinyl group. Heme S is found in the hemoglobin of a few species of marine worms. The correct structures of heme B and heme S were first elucidated by German chemist Hans Fischer.[22]

The names of cytochromes typically (but not always) reflect the kinds of hemes they contain: cytochrome a contains heme A, cytochrome c contains heme C, etc. This convention may have been first introduced with the publication of the structure of heme A.

Use of capital letters to designate the type of heme edit

The practice of designating hemes with upper case letters was formalized in a footnote in a paper by Puustinen and Wikstrom,[23] which explains under which conditions a capital letter should be used: "we prefer the use of capital letters to describe the heme structure as isolated. Lowercase letters may then be freely used for cytochromes and enzymes, as well as to describe individual protein-bound heme groups (for example, cytochrome bc, and aa3 complexes, cytochrome b5, heme c1 of the bc1 complex, heme a3 of the aa3 complex, etc)." In other words, the chemical compound would be designated with a capital letter, but specific instances in structures with lowercase. Thus cytochrome oxidase, which has two A hemes (heme a and heme a3) in its structure, contains two moles of heme A per mole protein. Cytochrome bc1, with hemes bH, bL, and c1, contains heme B and heme C in a 2:1 ratio. The practice seems to have originated in a paper by Caughey and York in which the product of a new isolation procedure for the heme of cytochrome aa3 was designated heme A to differentiate it from previous preparations: "Our product is not identical in all respects with the heme a obtained in solution by other workers by the reduction of the hemin a as isolated previously (2). For this reason, we shall designate our product heme A until the apparent differences can be rationalized.".[24] In a later paper,[25] Caughey's group uses capital letters for isolated heme B and C as well as A.

Synthesis edit

 
Heme synthesis in the cytoplasm and mitochondrion

The enzymatic process that produces heme is properly called porphyrin synthesis, as all the intermediates are tetrapyrroles that are chemically classified as porphyrins. The process is highly conserved across biology. In humans, this pathway serves almost exclusively to form heme. In bacteria, it also produces more complex substances such as cofactor F430 and cobalamin (vitamin B12).[26]

The pathway is initiated by the synthesis of δ-aminolevulinic acid (dALA or δALA) from the amino acid glycine and succinyl-CoA from the citric acid cycle (Krebs cycle). The rate-limiting enzyme responsible for this reaction, ALA synthase, is negatively regulated by glucose and heme concentration. Mechanism of inhibition of ALAs by heme or hemin is by decreasing stability of mRNA synthesis and by decreasing the intake of mRNA in the mitochondria. This mechanism is of therapeutic importance: infusion of heme arginate or hematin and glucose can abort attacks of acute intermittent porphyria in patients with an inborn error of metabolism of this process, by reducing transcription of ALA synthase.[27]

The organs mainly involved in heme synthesis are the liver (in which the rate of synthesis is highly variable, depending on the systemic heme pool) and the bone marrow (in which rate of synthesis of Heme is relatively constant and depends on the production of globin chain), although every cell requires heme to function properly. However, due to its toxic properties, proteins such as emopexin (Hx) are required to help maintain physiological stores of iron in order for them to be used in synthesis.[28] Heme is seen as an intermediate molecule in catabolism of hemoglobin in the process of bilirubin metabolism. Defects in various enzymes in synthesis of heme can lead to group of disorder called porphyrias, these include acute intermittent porphyria, congenital erythropoetic porphyria, porphyria cutanea tarda, hereditary coproporphyria, variegate porphyria, erythropoietic protoporphyria.[29][citation needed]

Synthesis for food edit

Impossible Foods, producers of plant-based meat substitutes, use an accelerated heme synthesis process involving soybean root leghemoglobin and yeast, adding the resulting heme to items such as meatless (vegan) Impossible burger patties. The DNA for leghemoglobin production was extracted from the soybean root nodules and expressed in yeast cells to overproduce heme for use in the meatless burgers.[30] This process claims to create a meaty flavor in the resulting products.[31][32]

Degradation edit

 
Heme breakdown

Degradation begins inside macrophages of the spleen, which remove old and damaged erythrocytes from the circulation.

In the first step, heme is converted to biliverdin by the enzyme heme oxygenase (HO).[33] NADPH is used as the reducing agent, molecular oxygen enters the reaction, carbon monoxide (CO) is produced and the iron is released from the molecule as the ferrous ion (Fe2+).[34] CO acts as a cellular messenger and functions in vasodilation.[35]

In addition, heme degradation appears to be an evolutionarily-conserved response to oxidative stress. Briefly, when cells are exposed to free radicals, there is a rapid induction of the expression of the stress-responsive heme oxygenase-1 (HMOX1) isoenzyme that catabolizes heme (see below).[36] The reason why cells must increase exponentially their capability to degrade heme in response to oxidative stress remains unclear but this appears to be part of a cytoprotective response that avoids the deleterious effects of free heme. When large amounts of free heme accumulates, the heme detoxification/degradation systems get overwhelmed, enabling heme to exert its damaging effects.[28]

heme heme oxygenase-1 biliverdin + Fe2+
     
H+ + NADPH + O2 NADP+ + CO
 
 
 

In the second reaction, biliverdin is converted to bilirubin by biliverdin reductase (BVR):[37]

biliverdin biliverdin reductase bilirubin
     
H+ + NADPH NADP+
 
 
 

Bilirubin is transported into the liver by facilitated diffusion bound to a protein (serum albumin), where it is conjugated with glucuronic acid to become more water-soluble. The reaction is catalyzed by the enzyme UDP-glucuronosyltransferase.[38]

This form of bilirubin is excreted from the liver in bile. Excretion of bilirubin from liver to biliary canaliculi is an active, energy-dependent and rate-limiting process. The intestinal bacteria deconjugate bilirubin diglucuronide releasing free bilirubin, which can either be reabsorbed or reduced to urobilinogen by the bacterial enzyme bilirubin reductase.[39]

bilirubin bilirubin reductase urobilinogen
     
4 NAD(P)H + 4 H+ 4 NAD(P)+
 
 
 


Some urobilinogen is absorbed by intestinal cells and transported into the kidneys and excreted with urine (urobilin, which is the product of oxidation of urobilinogen, and is responsible for the yellow colour of urine). The remainder travels down the digestive tract and is converted to stercobilinogen. This is oxidized to stercobilin, which is excreted and is responsible for the brown color of feces.[40]

In health and disease edit

Under homeostasis, the reactivity of heme is controlled by its insertion into the “heme pockets” of hemoproteins.[citation needed] Under oxidative stress however, some hemoproteins, e.g. hemoglobin, can release their heme prosthetic groups.[41][42] The non-protein-bound (free) heme produced in this manner becomes highly cytotoxic, most probably due to the iron atom contained within its protoporphyrin IX ring, which can act as a Fenton's reagent to catalyze in an unfettered manner the production of free radicals.[43] It catalyzes the oxidation and aggregation of protein, the formation of cytotoxic lipid peroxide via lipid peroxidation and damages DNA through oxidative stress. Due to its lipophilic properties, it impairs lipid bilayers in organelles such as mitochondria and nuclei.[44] These properties of free heme can sensitize a variety of cell types to undergo programmed cell death in response to pro-inflammatory agonists, a deleterious effect that plays an important role in the pathogenesis of certain inflammatory diseases such as malaria[45] and sepsis.[46]

Cancer edit

There is an association between high intake of heme iron sourced from meat and increased risk of colon cancer.[47] The heme content of red meat is 10 times higher than that of white meat such as chicken.[48]

The American Institute for Cancer Research (AICR) and World Cancer Research Fund International (WCRF) concluded in a 2018 report that there is limited but suggestive evidence that foods containing heme iron increase risk of colorectal cancer.[49] A 2019 review found that heme iron intake is associated with increased breast cancer risk.[50]

Genes edit

The following genes are part of the chemical pathway for making heme:

Notes and references edit

  1. ^ Bloomer, Joseph R. (1998). "Liver metabolism of porphyrins and haem". Journal of Gastroenterology and Hepatology. 13 (3): 324–329. doi:10.1111/j.1440-1746.1998.01548.x. PMID 9570250. S2CID 25224821.
  2. ^ Chemistry, International Union of Pure and Applied (2009). "Hemes (heme derivatives)". IUPAC Compendium of Chemical Terminology. IUPAC. doi:10.1351/goldbook.H02773. ISBN 978-0-9678550-9-7. from the original on 22 August 2017. Retrieved 28 April 2018.
  3. ^ A standard biochemistry text defines heme as the "iron-porphyrin prosthetic group of heme proteins"(Nelson, D. L.; Cox, M. M. "Lehninger, Principles of Biochemistry" 3rd Ed. Worth Publishing: New York, 2000. ISBN 1-57259-153-6.)
  4. ^ Poulos, Thomas L. (2014-04-09). "Heme Enzyme Structure and Function". Chemical Reviews. 114 (7): 3919–3962. doi:10.1021/cr400415k. ISSN 0009-2665. PMC 3981943. PMID 24400737.
  5. ^ Paoli, M. (2002). "Structure-function relationships in heme-proteins" (PDF). DNA Cell Biol. 21 (4): 271–280. doi:10.1089/104454902753759690. hdl:20.500.11820/67200894-eb9f-47a2-9542-02877d41fdd7. PMID 12042067. S2CID 12806393. (PDF) from the original on 2018-07-24.
  6. ^ Alderton, W.K. (2001). "Nitric oxide synthases: structure, function and inhibition". Biochem. J. 357 (3): 593–615. doi:10.1042/bj3570593. PMC 1221991. PMID 11463332.
  7. ^ Milani, M. (2005). "Structural bases for heme binding and diatomic ligand recognition in truncated hemoglobins". J. Inorg. Biochem. 99 (1): 97–109. doi:10.1016/j.jinorgbio.2004.10.035. PMID 15598494.
  8. ^ Hardison, R. (1999). "The Evolution of Hemoglobin: Studies of a very ancient protein suggest that changes in gene regulation are an important part of the evolutionary story". American Scientist. 87 (2): 126. doi:10.1511/1999.20.809.
  9. ^ Poulos, T. (2014). "Heme Enzyme Structure and Function". Chem. Rev. 114 (7): 3919–3962. doi:10.1021/cr400415k. PMC 3981943. PMID 24400737.
  10. ^ Thom, C. S. (2013). "Hemoglobin Variants: Biochemical Properties and Clinical Correlates". Cold Spring Harbor Perspectives in Medicine. 3 (3): a011858. doi:10.1101/cshperspect.a011858. PMC 3579210. PMID 23388674.
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  14. ^ Hegg, Eric L. (2004). "Heme A Synthase Does Not Incorporate Molecular Oxygen into the Formyl Group of Heme A". Biochemistry. 43 (27): 8616–8624. doi:10.1021/bi049056m. PMID 15236569.
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  25. ^ Caughey WS, Smythe GA, O'Keeffe DH, Maskasky JE, Smith ML (1975). "Heme A of cytochrome c oxidase. Structure and properties: comparisons with hemes B, C, and S and derivatives". J. Biol. Chem. 250 (19): 7602–22. doi:10.1016/S0021-9258(19)40860-0. PMID 170266.
  26. ^ Battersby, Alan R. (2000). "Tetrapyrroles: The pigments of life". Natural Product Reports. 17 (6): 507–526. doi:10.1039/B002635M. PMID 11152419.
  27. ^ Sridevi, Kolluri (28 April 2018). Upregulation of Heme Pathway Enzyme ALA Synthase-1 by Glutethimide and 4,6-Dioxoheptanoic Acid and Downregulation by Glucose and Heme: A Dissertation. EScholarship@UMMS (Thesis). University of Massachusetts Medical School. doi:10.13028/yyrz-qa79. from the original on 8 August 2016. Retrieved 28 April 2018.
  28. ^ a b Kumar, Sanjay; Bandyopadhyay, Uday (July 2005). "Free heme toxicity and its detoxification systems in human". Toxicology Letters. 157 (3): 175–188. doi:10.1016/j.toxlet.2005.03.004. PMID 15917143.
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  30. ^ Fraser, Rachel Z.; Shitut, Mithila; Agrawal, Puja; Mendes, Odete; Klapholz, Sue (2018-04-11). "Safety Evaluation of Soy Leghemoglobin Protein Preparation Derived FromPichia pastoris, Intended for Use as a Flavor Catalyst in Plant-Based Meat". International Journal of Toxicology. 37 (3): 241–262. doi:10.1177/1091581818766318. ISSN 1091-5818. PMC 5956568. PMID 29642729.
  31. ^ "Inside the Strange Science of the Fake Meat That 'Bleeds'". Wired. 2017-09-20. from the original on 24 March 2018. Retrieved 28 April 2018.
  32. ^ "Silicon Valley gets a taste for food". The Economist. 2015-03-05. ISSN 0013-0613. Retrieved 2019-04-08.
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  50. ^ Chang, Vicky C; Cotterchio, Michelle; Khoo, Edwin (2019). "Iron intake, body iron status, and risk of breast cancer: a systematic review and meta-analysis". BMC Cancer. 19 (1): 543. doi:10.1186/s12885-019-5642-0. PMC 6555759. PMID 31170936.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  51. ^ Plewinska, Magdalena; Thunell, Stig; Holmberg, Lars; Wetmur, James; Desnick, Robert (1991). "delta-Aminolevulinate dehydratase deficient porphyria: identification of the molecular lesions in a severely affected homozygote". American Journal of Human Genetics. 49 (1): 167–174. PMC 1683193. PMID 2063868.
  52. ^ Aurizi, C.; Lupia Palmieri, G.; Barbieri, L.; Macri, A.; Sorge, F.; Usai, G.; Biolcati, G. (February 2009). "Four novel mutations of the coproporphyrinogen III oxidase gene". Cellular and Molecular Biology. 55 (1): 8–15. PMID 19267996.
  53. ^ Bustad, H. J.; Vorland, M.; Ronneseth, E.; Sandberg, S.; Martinez, A.; Toska, K. (August 8, 2013). "Conformational stability and activity analysis of two hydroxymethylbilane synthase mutants, K132N and V215E, with different phenotypic association with acute intermittent porphyria". Bioscience Reports. 33 (4): 617–626. doi:10.1042/BSR20130045. PMC 3738108. PMID 23815679.
  54. ^ Martinez di Montemuros, F.; Di Pierro, E.; Patti, E.; Tavazzi, D.; Danielli, M. G.; Biolcati, G.; Rocchi, E.; Cappellini, M. D. (December 2002). "Molecular characterization of porphyrias in Italy: a diagnostic flow-chart". Cellular and Molecular Biology (Noisy-Le-Grand, France). 48 (8): 867–876. ISSN 0145-5680. PMID 12699245.
  55. ^ Badenas, C.; To Figueras, J.; Phillips, J. D.; Warby, C. A.; Muñoz, C.; Herrero, C. (April 2009). "Identification and characterization of novel uroporphyrinogen decarboxylase gene mutations in a large series of porphyria cutanea tarda patients and relatives". Clinical Genetics. 75 (4): 346–353. doi:10.1111/j.1399-0004.2009.01153.x. PMC 3804340. PMID 19419417.

heme, american, english, haem, commonwealth, english, both, pronounced, heem, precursor, hemoglobin, which, necessary, bind, oxygen, bloodstream, biosynthesized, both, bone, marrow, liver, binding, oxygen, heme, prosthetic, groupin, biochemical, terms, heme, c. Heme American English or haem Commonwealth English both pronounced hi m HEEM is a precursor to hemoglobin which is necessary to bind oxygen in the bloodstream Heme is biosynthesized in both the bone marrow and the liver 1 Binding of oxygen to a heme prosthetic groupIn biochemical terms heme is a coordination complex consisting of an iron ion coordinated to a porphyrin acting as a tetradentate ligand and to one or two axial ligands 2 The definition is loose and many depictions omit the axial ligands 3 Among the metalloporphyrins deployed by metalloproteins as prosthetic groups heme is one of the most widely used 4 and defines a family of proteins known as hemoproteins Hemes are most commonly recognized as components of hemoglobin the red pigment in blood but are also found in a number of other biologically important hemoproteins such as myoglobin cytochromes catalases heme peroxidase and endothelial nitric oxide synthase 5 6 The word haem is derived from Greek aἷma haima meaning blood Space filling model of the Fe protoporphyrin IX subunit of heme B Axial ligands omitted Color scheme grey iron blue nitrogen black carbon white hydrogen red oxygenContents 1 Function 2 Types 2 1 Major hemes 2 2 Other hemes 2 3 Use of capital letters to designate the type of heme 3 Synthesis 4 Synthesis for food 5 Degradation 6 In health and disease 6 1 Cancer 7 Genes 8 Notes and referencesFunction edit nbsp The heme group of succinate dehydrogenase bound to histidine an electron carrier in the mitochondrial electron transfer chain The large semi transparent sphere indicates the location of the iron ion From PDB 1YQ3 Hemoproteins have diverse biological functions including the transportation of diatomic gases chemical catalysis diatomic gas detection and electron transfer The heme iron serves as a source or sink of electrons during electron transfer or redox chemistry In peroxidase reactions the porphyrin molecule also serves as an electron source being able to delocalize radical electrons in the conjugated ring In the transportation or detection of diatomic gases the gas binds to the heme iron During the detection of diatomic gases the binding of the gas ligand to the heme iron induces conformational changes in the surrounding protein 7 In general diatomic gases only bind to the reduced heme as ferrous Fe II while most peroxidases cycle between Fe III and Fe IV and hemeproteins involved in mitochondrial redox oxidation reduction cycle between Fe II and Fe III It has been speculated that the original evolutionary function of hemoproteins was electron transfer in primitive sulfur based photosynthesis pathways in ancestral cyanobacteria like organisms before the appearance of molecular oxygen 8 Hemoproteins achieve their remarkable functional diversity by modifying the environment of the heme macrocycle within the protein matrix 9 For example the ability of hemoglobin to effectively deliver oxygen to tissues is due to specific amino acid residues located near the heme molecule 10 Hemoglobin reversibly binds to oxygen in the lungs when the pH is high and the carbon dioxide concentration is low When the situation is reversed low pH and high carbon dioxide concentrations hemoglobin will release oxygen into the tissues This phenomenon which states that hemoglobin s oxygen binding affinity is inversely proportional to both acidity and concentration of carbon dioxide is known as the Bohr effect 11 The molecular mechanism behind this effect is the steric organization of the globin chain a histidine residue located adjacent to the heme group becomes positively charged under acidic conditions which are caused by dissolved CO2 in working muscles etc releasing oxygen from the heme group 12 Types editMajor hemes edit There are several biologically important kinds of heme Heme A Heme B Heme C Heme OPubChem number 7888115 444098 444125 6323367Chemical formula C49H56O6N4Fe C34H32O4N4Fe C34H36O4N4S2Fe C49H58O5N4FeFunctional group at C3 nbsp CH OH CH2Far CH CH2 CH cystein S yl CH3 CH OH CH2FarFunctional group at C8 CH CH2 CH CH2 CH cystein S yl CH3 CH CH2Functional group at C18 CH O CH3 CH3 CH3 nbsp Structure of Fe porphyrin subunit of heme B nbsp Structure of Fe porphyrin subunit of heme A 13 Heme A is synthesized from heme B In two sequential reactions a 17 hydroxyethylfarnesyl moiety is added at the 2 position and an aldehyde is added at the 8 position 14 The most common type is heme B other important types include heme A and heme C Isolated hemes are commonly designated by capital letters while hemes bound to proteins are designated by lower case letters Cytochrome a refers to the heme A in specific combination with membrane protein forming a portion of cytochrome c oxidase 15 Other hemes edit The following carbon numbering system of porphyrins is an older numbering used by biochemists and not the 1 24 numbering system recommended by IUPAC which is shown in the table above Heme l is the derivative of heme B which is covalently attached to the protein of lactoperoxidase eosinophil peroxidase and thyroid peroxidase The addition of peroxide with the glutamyl 375 and aspartyl 225 of lactoperoxidase forms ester bonds between these amino acid residues and the heme 1 and 5 methyl groups respectively 16 Similar ester bonds with these two methyl groups are thought to form in eosinophil and thyroid peroxidases Heme l is one important characteristic of animal peroxidases plant peroxidases incorporate heme B Lactoperoxidase and eosinophil peroxidase are protective enzymes responsible for the destruction of invading bacteria and virus Thyroid peroxidase is the enzyme catalyzing the biosynthesis of the important thyroid hormones Because lactoperoxidase destroys invading organisms in the lungs and excrement it is thought to be an important protective enzyme 17 Heme m is the derivative of heme B covalently bound at the active site of myeloperoxidase Heme m contains the two ester bonds at the heme 1 and 5 methyl groups also present in heme l of other mammalian peroxidases such as lactoperoxidase and eosinophil peroxidase In addition a unique sulfonamide ion linkage between the sulfur of a methionyl amino acid residue and the heme 2 vinyl group is formed giving this enzyme the unique capability of easily oxidizing chloride and bromide ions to hypochlorite and hypobromite Myeloperoxidase is present in mammalian neutrophils and is responsible for the destruction of invading bacteria and viral agents It perhaps synthesizes hypobromite by mistake Both hypochlorite and hypobromite are very reactive species responsible for the production of halogenated nucleosides which are mutagenic compounds 18 19 Heme D is another derivative of heme B but in which the propionic acid side chain at the carbon of position 6 which is also hydroxylated forms a g spirolactone Ring III is also hydroxylated at position 5 in a conformation trans to the new lactone group 20 Heme D is the site for oxygen reduction to water of many types of bacteria at low oxygen tension 21 Heme S is related to heme B by having a formyl group at position 2 in place of the 2 vinyl group Heme S is found in the hemoglobin of a few species of marine worms The correct structures of heme B and heme S were first elucidated by German chemist Hans Fischer 22 The names of cytochromes typically but not always reflect the kinds of hemes they contain cytochrome a contains heme A cytochrome c contains heme C etc This convention may have been first introduced with the publication of the structure of heme A Use of capital letters to designate the type of heme edit The practice of designating hemes with upper case letters was formalized in a footnote in a paper by Puustinen and Wikstrom 23 which explains under which conditions a capital letter should be used we prefer the use of capital letters to describe the heme structure as isolated Lowercase letters may then be freely used for cytochromes and enzymes as well as to describe individual protein bound heme groups for example cytochrome bc and aa3 complexes cytochrome b5 heme c1 of the bc1 complex heme a3 of the aa3 complex etc In other words the chemical compound would be designated with a capital letter but specific instances in structures with lowercase Thus cytochrome oxidase which has two A hemes heme a and heme a3 in its structure contains two moles of heme A per mole protein Cytochrome bc1 with hemes bH bL and c1 contains heme B and heme C in a 2 1 ratio The practice seems to have originated in a paper by Caughey and York in which the product of a new isolation procedure for the heme of cytochrome aa3 was designated heme A to differentiate it from previous preparations Our product is not identical in all respects with the heme a obtained in solution by other workers by the reduction of the hemin a as isolated previously 2 For this reason we shall designate our product heme A until the apparent differences can be rationalized 24 In a later paper 25 Caughey s group uses capital letters for isolated heme B and C as well as A Synthesis editMain article Porphyrin Biosynthesis Further information Cobalamin biosynthesis nbsp Heme synthesis in the cytoplasm and mitochondrionThe enzymatic process that produces heme is properly called porphyrin synthesis as all the intermediates are tetrapyrroles that are chemically classified as porphyrins The process is highly conserved across biology In humans this pathway serves almost exclusively to form heme In bacteria it also produces more complex substances such as cofactor F430 and cobalamin vitamin B12 26 The pathway is initiated by the synthesis of d aminolevulinic acid dALA or dALA from the amino acid glycine and succinyl CoA from the citric acid cycle Krebs cycle The rate limiting enzyme responsible for this reaction ALA synthase is negatively regulated by glucose and heme concentration Mechanism of inhibition of ALAs by heme or hemin is by decreasing stability of mRNA synthesis and by decreasing the intake of mRNA in the mitochondria This mechanism is of therapeutic importance infusion of heme arginate or hematin and glucose can abort attacks of acute intermittent porphyria in patients with an inborn error of metabolism of this process by reducing transcription of ALA synthase 27 The organs mainly involved in heme synthesis are the liver in which the rate of synthesis is highly variable depending on the systemic heme pool and the bone marrow in which rate of synthesis of Heme is relatively constant and depends on the production of globin chain although every cell requires heme to function properly However due to its toxic properties proteins such as emopexin Hx are required to help maintain physiological stores of iron in order for them to be used in synthesis 28 Heme is seen as an intermediate molecule in catabolism of hemoglobin in the process of bilirubin metabolism Defects in various enzymes in synthesis of heme can lead to group of disorder called porphyrias these include acute intermittent porphyria congenital erythropoetic porphyria porphyria cutanea tarda hereditary coproporphyria variegate porphyria erythropoietic protoporphyria 29 citation needed Synthesis for food editImpossible Foods producers of plant based meat substitutes use an accelerated heme synthesis process involving soybean root leghemoglobin and yeast adding the resulting heme to items such as meatless vegan Impossible burger patties The DNA for leghemoglobin production was extracted from the soybean root nodules and expressed in yeast cells to overproduce heme for use in the meatless burgers 30 This process claims to create a meaty flavor in the resulting products 31 32 Degradation edit nbsp Heme breakdownDegradation begins inside macrophages of the spleen which remove old and damaged erythrocytes from the circulation In the first step heme is converted to biliverdin by the enzyme heme oxygenase HO 33 NADPH is used as the reducing agent molecular oxygen enters the reaction carbon monoxide CO is produced and the iron is released from the molecule as the ferrous ion Fe2 34 CO acts as a cellular messenger and functions in vasodilation 35 In addition heme degradation appears to be an evolutionarily conserved response to oxidative stress Briefly when cells are exposed to free radicals there is a rapid induction of the expression of the stress responsive heme oxygenase 1 HMOX1 isoenzyme that catabolizes heme see below 36 The reason why cells must increase exponentially their capability to degrade heme in response to oxidative stress remains unclear but this appears to be part of a cytoprotective response that avoids the deleterious effects of free heme When large amounts of free heme accumulates the heme detoxification degradation systems get overwhelmed enabling heme to exert its damaging effects 28 heme heme oxygenase 1 biliverdin Fe2 nbsp nbsp H NADPH O2 NADP CO nbsp In the second reaction biliverdin is converted to bilirubin by biliverdin reductase BVR 37 biliverdin biliverdin reductase bilirubin nbsp nbsp H NADPH NADP nbsp Bilirubin is transported into the liver by facilitated diffusion bound to a protein serum albumin where it is conjugated with glucuronic acid to become more water soluble The reaction is catalyzed by the enzyme UDP glucuronosyltransferase 38 bilirubin UDP glucuronosyltransferase bilirubin diglucuronide nbsp nbsp 2 UDP glucuronide 2 UMP 2 Pi nbsp This form of bilirubin is excreted from the liver in bile Excretion of bilirubin from liver to biliary canaliculi is an active energy dependent and rate limiting process The intestinal bacteria deconjugate bilirubin diglucuronide releasing free bilirubin which can either be reabsorbed or reduced to urobilinogen by the bacterial enzyme bilirubin reductase 39 bilirubin bilirubin reductase urobilinogen nbsp nbsp 4 NAD P H 4 H 4 NAD P nbsp Some urobilinogen is absorbed by intestinal cells and transported into the kidneys and excreted with urine urobilin which is the product of oxidation of urobilinogen and is responsible for the yellow colour of urine The remainder travels down the digestive tract and is converted to stercobilinogen This is oxidized to stercobilin which is excreted and is responsible for the brown color of feces 40 In health and disease editUnder homeostasis the reactivity of heme is controlled by its insertion into the heme pockets of hemoproteins citation needed Under oxidative stress however some hemoproteins e g hemoglobin can release their heme prosthetic groups 41 42 The non protein bound free heme produced in this manner becomes highly cytotoxic most probably due to the iron atom contained within its protoporphyrin IX ring which can act as a Fenton s reagent to catalyze in an unfettered manner the production of free radicals 43 It catalyzes the oxidation and aggregation of protein the formation of cytotoxic lipid peroxide via lipid peroxidation and damages DNA through oxidative stress Due to its lipophilic properties it impairs lipid bilayers in organelles such as mitochondria and nuclei 44 These properties of free heme can sensitize a variety of cell types to undergo programmed cell death in response to pro inflammatory agonists a deleterious effect that plays an important role in the pathogenesis of certain inflammatory diseases such as malaria 45 and sepsis 46 Cancer edit There is an association between high intake of heme iron sourced from meat and increased risk of colon cancer 47 The heme content of red meat is 10 times higher than that of white meat such as chicken 48 The American Institute for Cancer Research AICR and World Cancer Research Fund International WCRF concluded in a 2018 report that there is limited but suggestive evidence that foods containing heme iron increase risk of colorectal cancer 49 A 2019 review found that heme iron intake is associated with increased breast cancer risk 50 Genes editThe following genes are part of the chemical pathway for making heme ALAD aminolevulinic acid d dehydratase deficiency causes ala dehydratase deficiency porphyria 51 ALAS1 aminolevulinate d synthase 1 ALAS2 aminolevulinate d synthase 2 deficiency causes sideroblastic hypochromic anemia CPOX coproporphyrinogen oxidase deficiency causes hereditary coproporphyria 52 FECH ferrochelatase deficiency causes erythropoietic protoporphyria HMBS hydroxymethylbilane synthase deficiency causes acute intermittent porphyria 53 PPOX protoporphyrinogen oxidase deficiency causes variegate porphyria 54 UROD uroporphyrinogen decarboxylase deficiency causes porphyria cutanea tarda 55 UROS uroporphyrinogen III synthase deficiency causes congenital erythropoietic porphyria Notes and references edit Bloomer Joseph R 1998 Liver metabolism of porphyrins and haem Journal of Gastroenterology and Hepatology 13 3 324 329 doi 10 1111 j 1440 1746 1998 01548 x PMID 9570250 S2CID 25224821 Chemistry International Union of Pure and Applied 2009 Hemes heme derivatives IUPAC Compendium of Chemical Terminology IUPAC doi 10 1351 goldbook H02773 ISBN 978 0 9678550 9 7 Archived from the original on 22 August 2017 Retrieved 28 April 2018 A standard biochemistry text defines heme as the iron porphyrin prosthetic group of heme proteins Nelson D L Cox M M Lehninger Principles of Biochemistry 3rd Ed Worth Publishing New York 2000 ISBN 1 57259 153 6 Poulos Thomas L 2014 04 09 Heme Enzyme Structure and Function Chemical Reviews 114 7 3919 3962 doi 10 1021 cr400415k ISSN 0009 2665 PMC 3981943 PMID 24400737 Paoli M 2002 Structure function relationships in heme proteins PDF DNA Cell Biol 21 4 271 280 doi 10 1089 104454902753759690 hdl 20 500 11820 67200894 eb9f 47a2 9542 02877d41fdd7 PMID 12042067 S2CID 12806393 Archived PDF from the original on 2018 07 24 Alderton W K 2001 Nitric oxide synthases structure function and inhibition Biochem J 357 3 593 615 doi 10 1042 bj3570593 PMC 1221991 PMID 11463332 Milani M 2005 Structural bases for heme binding and diatomic ligand recognition in truncated hemoglobins J Inorg Biochem 99 1 97 109 doi 10 1016 j jinorgbio 2004 10 035 PMID 15598494 Hardison R 1999 The Evolution of Hemoglobin Studies of a very ancient protein suggest that changes in gene regulation are an important part of the evolutionary story American Scientist 87 2 126 doi 10 1511 1999 20 809 Poulos T 2014 Heme Enzyme Structure and Function Chem Rev 114 7 3919 3962 doi 10 1021 cr400415k PMC 3981943 PMID 24400737 Thom C S 2013 Hemoglobin Variants Biochemical Properties and Clinical Correlates Cold Spring Harbor Perspectives in Medicine 3 3 a011858 doi 10 1101 cshperspect a011858 PMC 3579210 PMID 23388674 Bohr Hasselbalch Krogh Concerning a Biologically Important Relationship The Influence of the Carbon Dioxide Content of Blood on its Oxygen Binding Archived from the original on 2017 04 18 a href Template Cite journal html title Template Cite journal cite journal a Cite journal requires journal help Ackers G K Holt J M 2006 Asymmetric cooperativity in a symmetric tetramer human hemoglobin J Biol Chem 281 17 11441 3 doi 10 1074 jbc r500019200 PMID 16423822 S2CID 6696041 Caughey W S Smythe G E O Keeffe D H Maskasky J E Smith M L 1975 Heme A of Cytochrome c Oxidase Structure and properties comparisons with hemes B C and S and derivatives J Biol Chem 250 19 7602 7622 doi 10 1016 S0021 9258 19 40860 0 PMID 170266 Hegg Eric L 2004 Heme A Synthase Does Not Incorporate Molecular Oxygen into the Formyl Group of Heme A Biochemistry 43 27 8616 8624 doi 10 1021 bi049056m PMID 15236569 Yoshikawa S 2012 Structural studies on bovine heart cytochrome c oxidase Biochim Biophys Acta 1817 4 579 589 doi 10 1016 j bbabio 2011 12 012 PMID 22236806 Rae T Goff H 1998 The heme prosthetic group of lactoperoxidase Structural characteristics of heme l and heme l peptides The Journal of Biological Chemistry 273 43 27968 27977 doi 10 1074 jbc 273 43 27968 PMID 9774411 S2CID 25780396 Purdy M A 1983 Effect of growth phase and cell envelope structure on susceptibility of Salmonella triumphant to the lactoperoxidase thiocyanate hydrogen peroxide system Infect Immun 39 3 1187 95 doi 10 1128 IAI 39 3 1187 1195 1983 PMC 348082 PMID 6341231 Ohshima H 2003 Chemical basis of inflammation induced carcinogenesis Arch Biochem Biophys 417 1 3 11 doi 10 1016 s0003 9861 03 00283 2 PMID 12921773 Henderson J P 2003 Phagocytes produce 5 chlorouracil and 5 bromouracil two mutagenic products of myeloperoxidase in human inflammatory tissue J Biol Chem 278 26 23522 8 doi 10 1074 jbc m303928200 PMID 12707270 S2CID 19631565 Murshudov G Grebenko A Barynin V Dauter Z Wilson K Vainshtein B Melik Adamyan W Bravo J Ferran J Ferrer J C Switala J Loewen P C Fita I 1996 Structure of the heme d of Penicillium vitale and Escherichia coli catalases PDF The Journal of Biological Chemistry 271 15 8863 8868 doi 10 1074 jbc 271 15 8863 PMID 8621527 Archived PDF from the original on 2018 07 24 Belevich I 2005 Oxygenated complex of cytochrome bd from Escherichia coli stability and photolability FEBS Letters 579 21 4567 70 doi 10 1016 j febslet 2005 07 011 PMID 16087180 S2CID 36465802 Fischer H Orth H 1934 Die Chemie des Pyrrols Liepzig Ischemia Verlagsgesellschaft Puustinen A Wikstrom M 1991 The heme groups of cytochrome o from Escherichia coli Proc Natl Acad Sci U S A 88 14 6122 6 Bibcode 1991PNAS 88 6122P doi 10 1073 pnas 88 14 6122 PMC 52034 PMID 2068092 Caughey WS York JL 1962 Isolation and some properties of the green heme of cytochrome oxidase from beef heart muscle J Biol Chem 237 7 2414 6 doi 10 1016 S0021 9258 19 63456 3 PMID 13877421 Caughey WS Smythe GA O Keeffe DH Maskasky JE Smith ML 1975 Heme A of cytochrome c oxidase Structure and properties comparisons with hemes B C and S and derivatives J Biol Chem 250 19 7602 22 doi 10 1016 S0021 9258 19 40860 0 PMID 170266 Battersby Alan R 2000 Tetrapyrroles The pigments of life Natural Product Reports 17 6 507 526 doi 10 1039 B002635M PMID 11152419 Sridevi Kolluri 28 April 2018 Upregulation of Heme Pathway Enzyme ALA Synthase 1 by Glutethimide and 4 6 Dioxoheptanoic Acid and Downregulation by Glucose and Heme A Dissertation EScholarship UMMS Thesis University of Massachusetts Medical School doi 10 13028 yyrz qa79 Archived from the original on 8 August 2016 Retrieved 28 April 2018 a b Kumar Sanjay Bandyopadhyay Uday July 2005 Free heme toxicity and its detoxification systems in human Toxicology Letters 157 3 175 188 doi 10 1016 j toxlet 2005 03 004 PMID 15917143 Puy Herve Gouya Laurent Deybach Jean Charles March 2010 Porphyrias The Lancet 375 9718 924 937 doi 10 1016 S0140 6736 09 61925 5 PMID 20226990 S2CID 208791867 Fraser Rachel Z Shitut Mithila Agrawal Puja Mendes Odete Klapholz Sue 2018 04 11 Safety Evaluation of Soy Leghemoglobin Protein Preparation Derived FromPichia pastoris Intended for Use as a Flavor Catalyst in Plant Based Meat International Journal of Toxicology 37 3 241 262 doi 10 1177 1091581818766318 ISSN 1091 5818 PMC 5956568 PMID 29642729 Inside the Strange Science of the Fake Meat That Bleeds Wired 2017 09 20 Archived from the original on 24 March 2018 Retrieved 28 April 2018 Silicon Valley gets a taste for food The Economist 2015 03 05 ISSN 0013 0613 Retrieved 2019 04 08 Maines Mahin D July 1988 Heme oxygenase function multiplicity regulatory mechanisms and clinical applications The FASEB Journal 2 10 2557 2568 doi 10 1096 fasebj 2 10 3290025 ISSN 0892 6638 PMID 3290025 S2CID 22652094 Lehninger s Principles of Biochemistry 5th ed New York W H Freeman and Company 2008 pp 876 ISBN 978 0 7167 7108 1 Hanafy K A 2013 Carbon Monoxide and the brain time to rethink the dogma Curr Pharm Des 19 15 2771 5 doi 10 2174 1381612811319150013 PMC 3672861 PMID 23092321 Abraham N G Kappas A 2008 Pharmacological and clinical aspects of heme oxygenase Pharmacol Rev 60 1 79 127 doi 10 1124 pr 107 07104 PMID 18323402 S2CID 12792155 Florczyk U M Jozkowicz A Dulak J January February 2008 Biliverdin reductase new features of an old enzyme and its potential therapeutic significance Pharmacological Reports 60 1 38 48 PMC 5536200 PMID 18276984 King C Rios G Green M Tephly T 2000 UDP Glucuronosyltransferases Current Drug Metabolism 1 2 143 161 doi 10 2174 1389200003339171 PMID 11465080 Hall Brantley Levy Sophia Dufault Thompson Keith Arp Gabriela Zhong Aoshu Ndjite Glory Minabou Weiss Ashley Braccia Domenick Jenkins Conor Grant Maggie R Abeysinghe Stephenie Yang Yiyan Jermain Madison D Wu Chih Hao Ma Bing 2024 01 03 BilR is a gut microbial enzyme that reduces bilirubin to urobilinogen Nature Microbiology doi 10 1038 s41564 023 01549 x ISSN 2058 5276 PMC 10769871 Helmenstine Anne Marie The Chemicals Responsible for the Color of Urine and Feces ThoughtCo Retrieved 2020 01 24 Bunn H F Jandl J H Sep 1966 Exchange of heme among hemoglobin molecules Proc Natl Acad Sci USA 56 3 974 978 Bibcode 1966PNAS 56 974B doi 10 1073 pnas 56 3 974 PMC 219955 PMID 5230192 Smith M L Paul J Ohlsson P I Hjortsberg K Paul K G Feb 1991 Heme protein fission under nondenaturing conditions Proc Natl Acad Sci USA 88 3 882 886 Bibcode 1991PNAS 88 882S doi 10 1073 pnas 88 3 882 PMC 50918 PMID 1846966 Everse J Hsia N 1197 The toxicities of native and modified hemoglobins Free Radical Biology and Medicine 22 6 1075 1099 doi 10 1016 S0891 5849 96 00499 6 PMID 9034247 Kumar Sanjay Bandyopadhyay Uday July 2005 Free heme toxicity and its detoxification systems in humans Toxicology Letters 157 3 175 188 doi 10 1016 j toxlet 2005 03 004 PMID 15917143 Pamplona A Ferreira A Balla J Jeney V Balla G Epiphanio S Chora A Rodrigues C D Gregoire I P Cunha Rodrigues M Portugal S Soares M P Mota M M Jun 2007 Heme oxygenase 1 and carbon monoxide suppress the pathogenesis of experimental cerebral malaria Nature Medicine 13 6 703 710 doi 10 1038 nm1586 PMID 17496899 S2CID 20675040 Larsen R Gozzelino R Jeney V Tokaji L Bozza F A Japiassu A M Bonaparte D Cavalcante M M Chora A Ferreira A Marguti I Cardoso S Sepulveda N Smith A Soares M P 2010 A central role for free heme in the pathogenesis of severe sepsis Science Translational Medicine 2 51 51ra71 doi 10 1126 scitranslmed 3001118 PMID 20881280 S2CID 423446 Bastide N M Pierre F H Corpet D E 2011 Heme iron from meat and risk of colorectal cancer a meta analysis and a review of the mechanisms involved PDF Cancer Prev Res 4 2 177 184 doi 10 1158 1940 6207 CAPR 10 0113 PMID 21209396 S2CID 4951579 Archived PDF from the original on 2015 09 25 Bastide Nadia M Pierre Fabrice H F Corpet Denis E 1 February 2011 Heme Iron from Meat and Risk of Colorectal Cancer A Meta analysis and a Review of the Mechanisms Involved Cancer Prevention Research 4 2 177 184 doi 10 1158 1940 6207 CAPR 10 0113 PMID 21209396 S2CID 4951579 Archived from the original on 11 October 2017 Retrieved 28 April 2018 via cancerpreventionresearch aacrjournals org Diet nutrition physical activity and colorectal cancer wcrf org Retrieved 12 February 2022 Chang Vicky C Cotterchio Michelle Khoo Edwin 2019 Iron intake body iron status and risk of breast cancer a systematic review and meta analysis BMC Cancer 19 1 543 doi 10 1186 s12885 019 5642 0 PMC 6555759 PMID 31170936 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint multiple names authors list link Plewinska Magdalena Thunell Stig Holmberg Lars Wetmur James Desnick Robert 1991 delta Aminolevulinate dehydratase deficient porphyria identification of the molecular lesions in a severely affected homozygote American Journal of Human Genetics 49 1 167 174 PMC 1683193 PMID 2063868 Aurizi C Lupia Palmieri G Barbieri L Macri A Sorge F Usai G Biolcati G February 2009 Four novel mutations of the coproporphyrinogen III oxidase gene Cellular and Molecular Biology 55 1 8 15 PMID 19267996 Bustad H J Vorland M Ronneseth E Sandberg S Martinez A Toska K August 8 2013 Conformational stability and activity analysis of two hydroxymethylbilane synthase mutants K132N and V215E with different phenotypic association with acute intermittent porphyria Bioscience Reports 33 4 617 626 doi 10 1042 BSR20130045 PMC 3738108 PMID 23815679 Martinez di Montemuros F Di Pierro E Patti E Tavazzi D Danielli M G Biolcati G Rocchi E Cappellini M D December 2002 Molecular characterization of porphyrias in Italy a diagnostic flow chart Cellular and Molecular Biology Noisy Le Grand France 48 8 867 876 ISSN 0145 5680 PMID 12699245 Badenas C To Figueras J Phillips J D Warby C A Munoz C Herrero C April 2009 Identification and characterization of novel uroporphyrinogen decarboxylase gene mutations in a large series of porphyria cutanea tarda patients and relatives Clinical Genetics 75 4 346 353 doi 10 1111 j 1399 0004 2009 01153 x PMC 3804340 PMID 19419417 Retrieved from https en wikipedia org w index php title Heme amp oldid 1195327598, wikipedia, wiki, book, books, library,

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