PHOTODYNAMIC RELEASE OF PROTOPORPHYRIN FROM INTACT ERYTHROCYTES IN ERYTHROPOIETIC PROTOPORPHYRIA: THE EFFECT OF SMALL REPETITIVE LIGHT DOSES

Abstract— Erythrocytes from patients with erythropoietic protoporphyria contain large amounts of protoporphyrin bound to (hemo)globin. Irradiation of these cells causes a shift in fluorescence emission maximum and a decreased fluorescence intensity which is consistent with transfer of protoporphyrin from (hemo)globin to the cell membrane. When the erythrocytes were irradiated intermittently, nearly 70% of the protoporphyrin was released and the hemolysis was less than 3%. Giving the total light dose as a single pulse, resulted in 84% protoporphyrin release and 16% hemolysis. In vivo the erythrocytes obtain small, repetitive light doses when circulating in the dermal capillaries. We suggest the possibility that in patients with erythropoietic protoporphyria these small light pulses could be sufficient to photodamage the binding place of protoporphyrin on (hemo)globin. In the dark, protoporphyrin can then move from (hemo)globin through the cell membrane and bind to albumin in the serum. Our findings indicate that if protoporphyrin is not present in the cell membrane during irradiation, no photohemolysis will occur. This may explain why patients with erythropoietic protoporphyria have no abnormal hemolysis. The effect of intermittent light pulses may also contribute to the understanding of the protoporphyrin release from erythrocytes in patients with erythropoietic protoporphyria.