Article

Quantitative fluorometric screening test for fecal porphyrins

Department of Pathology, Vancouver General Hospital, University of British Columbia, Canada.
Clinical Chemistry (Impact Factor: 7.91). 07/1991; 37(6):826-31.
Source: PubMed

ABSTRACT

We describe a fluorometric method for screening and quantifying porphyrins in stool. A small sample of stool is extracted with concentrated HCI and is diluted 200-fold in 3 mol/L HCI before analysis. An excitation scan is done from 350 to 450 nm, monitoring emission at 603 nm. Total porphyrin is estimated at the isosbestic point for coproporphyrin and protoporphyrin (402.5 nm). Monitoring emission at 603 nm eliminates interference from chlorophyll, obviating the need for extraction with ether. The position of the excitation peak gives some indication of the nature of the porphyrins in the stool. The acid extract can be injected directly into an HPLC system for fractionation studies. Our method correlates well with the spectrophotometric method developed by Lockwood et al. (Clin Chem 1985;31:1163-7). However, in our method, the sample is easier to process and the assay has higher sensitivity than their assay. The reference interval for porphyrin in healthy individuals by the fluorometric method is less than 300 nmol/g dry weight. We can detect as little as 1 nmol of porphyrin per gram (dry weight) of stool. Results of the method vary linearly with stool porphyrin concentrations as great as 4000 nmol/g dry weight. The within-run imprecision of the method is 3%.

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    • "Fluorescence signals were recorded at the Soret band (i.e. absorption band in the blue region of all porphyrins) peak L exc = 400 nm (Martinez & Mills 1971, Schwartz et al. 1976, Westerlund et al. 1988, Pudek et al. 1991) and corrected for background uorescence by subtracting the corresponding values determined for the blank measurements. e detection limit was determined as the mean of three blank measurements plus three standard deviations. "
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    ABSTRACT: We compared a spectrophotometric screening test measuring faecal porphyrin concentration with an HPLC method. There was a good overall correlation between both methods although some scatter was observed. ROC plot analysis of the screening test leads to a cut-off value of 35 nmol porphyrin per g faeces, wet weight with a sensitivity of 97% and a specificity of 96%. These results indicate that the screening test is quite useful for detection of increased total faecal porphyrin concentration, but less useful in accurate measurement of increased total faecal porphyrin concentration.
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    ABSTRACT: The relative proportions of the four coproporphyrin isomers I-IV were analysed in faeces of 20 healthy subjects and 60 patients suffering from one of the seven common types of hepatic or erythropoietic hereditary porphyrias. A newly developed, reliable method for sample preparation was applied, using reversed-phase thin layer chromatography for the isolation of naturally occurring coproporphyrin free carboxylic acids. Accurate separation and quantitation of the individual isomers I-IV were achieved with the help of ion-pair high-performance liquid chromatography. The four coproporphyrin isomers I-IV were positively identified by on-line scanning of their fluorescence spectra in the emission and excitation modes. Recovery rates with this new analytical procedure were between 90 and 100%, and coefficients of variation varied between 0.8 and 5.7% (N = 7). Diagnostically important findings were greatly increased proportions of isomer I and decreased proportions of isomers III, II and IV in erythropoietic porphyrias, such as congenital erythropoietic porphyria and protoporphyria. Significantly increased proportions of isomers III, II and IV, on the other hand, were observed in acute hepatic porphyrias, e.g. acute intermittent porphyria and porphobilinogen synthase deficiency porphyria, as compared with porphyria cutanea tarda (p < 0.005 and p < 0.03, respectively). Inversion of the faecal coproporphyrin III to I ratios and markedly elevated percentages of the atypical isomers II and IV were important diagnostic markers for variegate porphyria and hereditary coproporphyria. The highest proportions of isomer III were found in hereditary coproporphyria, where the amount of the isomers II and IV exceeded that of isomer I. Asymptomatic carriers of the relevant gene defect in families with hereditary coproporphyria could be detected by an increased faecal coproporphyrin III to I ratio. Our results clearly demonstrate the potential of faecal coproporphyrin I-IV isomer ratios for the diagnosis and differential diagnosis of hereditary porphyrias.
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