Phototesting as an objective measure of improvement in erythropoietic protoporphyria.
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Biomedical subjects
Publications and source records attributed to M M Mathews-Roth.
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Carotenoid pigments protect photosynthetic organisms against photosensitization by their own chlorophyll. This photoprotective function of carotenoids was utilized in the treatment of a human photosensitivity disease, erythropoietic protoporphyria.
Leukocytes and leukocyte membranes isolated from the blood of carotenemic (serum carotene, 4.0 mg/liter) and non-carotenemic individuals were found to contain small amounts of carotenoid pigments. The principal pigment isolated from the leukocyte membranes of carotenemic individuals was beta-carotene. Traces of beta-carotene and other carotenoids were found in the leukocytes and leukocyte membranes of the non-carotenemic individuals.
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We treated with high doses of oral beta carotene (Solatene) (15 to 180 mg/day) 133 patients suffering from erythropoietic protoporphyria (EPP), 27 patients with polymorphous light eruption, six patients with solar urticaria, three patients with hydroa aestivale, one patient with porphyria cutanea tarda, and two patients with actinic reticuloid to relieve the photosensitivity associated with these diseases. Eighty-four percent of the patients with erythropoietic protoporphyria increased by a factor of 3 or more their ability to tolerate sunlight. On the other hand, only nine of the patients with polymorphous light eruption, and one fifth of the patients with all of the other forms of photosensitivity treated showed similar improvement. We conclude that beta carotene is an effective treatment for EPP, but that other forms of photosensitivity will need empirical therapeutic study with beta carotene to determine the range of effectiveness, if any, of this compound in conditions other than EPP.
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We measured carotene in the livers of two patients receiving beta-carotene therapy for photosensitivity. In both patients, the amount of carotene was within reported ranges for patients on normal diets; no abnormal amounts of beta-carotene had accumulated in the livers after oral administration of large amounts of beta-carotene. Light-microscopic examination of the liver (specimen obtained at cholecystectomy) of one patient with erythropoietic protoporphyria and cholesterosis showed findings characteristic of these conditions. Electron-microscopically, semicrystalline inclusions were seen in the mitochondria of the hepatocytes; such inclusions have been reported in several conditions, including erythropoietic protoporphyria and porphyria cutanea tarda, and in control subjects. Microscopic examination of the liver of the other patient, who had Rothmund-Rhomson syndrome and died of acute bacterial meningitis, revealed no abnormalities. The cerebrum of the latter patient contained 13 mug of carotene per kilogram (wet weight) of brain. No previous report of analysis of human brain for carotenoids could be found.
Carotenoid pigments were extracted chemically from both epidermis and dermis obtained from non-carotenemic individuals at autopsy. Absorption maxima characteristic of beta-carotene were found in the extracts of specimens of epidermis following cantharidin application in volunteers made carotenemic by the ingestion of beta-carotene (180 mg/day for 10 weeks). These maxima were absent in the extracts of epidermis obtained from the volunteers before beta-carotene ingestion.
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Erythrocytes and erythrocyte membranes obtained from carotenemic (serum carotene greater than 4.0 mg/liter) and noncarotenemic individuals contain a small amount of carotenoid pigments. The principal pigment isolated from erythrocytes and erythrocyte membranes from carotenemic individuals cochromatographed with, and has an absorption spectrum similar to, authentic beta-carotene. Traces of beta-carotene were also found in the extracts of the erythrocytes and membranes obtained from the noncarotenemic individuals. These pigments were demonstrable only when the erythrocytes were extracted in the presence of an anti-oxidant (pyrogallol). Anti-oxidants should be used in the extraction and saponification process when only small samples are available or when only small amounts of carotenoid pigments are present in the material to be extracted.
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