Sevoflurane: its action on heme metabolism and Phase I drug metabolizing system.

Acute attacks of porphyria are most commonly precipitated by events that decrease heme concentrations. Enzyme inducing-drugs are the most important triggering factors, particularly in relation to anaesthesia. We have reported previously that Enflurane and Isoflurane produced significant heme metabolism alterations, indicating that the use of these anaesthetics in porphyric patients should be avoided. The aim of this work was to evaluate the effect of the anaesthetic Sevoflurane on heme pathway and drug metabolizing Phase I system in mice. To this end, animals received different doses of the anaesthetic (1-2 ml/kg) and were sacrificed at different times (5-60 min). Data revealed important alterations in the enzymes involved in Acute Intermittent Porphyria, such as an induction in hepatic 5-Aminolevulinic acid synthetase activity and a diminished Porphobilinogen deaminase activity in liver and blood 20 minutes after Sevoflurane administration to mice in a dose of 1.5 ml/kg. Heme oxygenase activity was also induced, indicating the onset of oxidative stress. Total CYP levels and CYP2E1 expression were enhanced. As a consequence of these events, heme free pool would be depleted. In conclusion, our results in mice would suggest that Sevoflurane should be used with caution and very careful control in porphyric patients.

Glutamatergic system: another target for the action of porphyrinogenic agents.

The N-methyl-diethyl-aspartate (NMDA) receptor has been reported to play an important role in several acute and chronic neuropathologic syndromes. 5-aminolevulinic acid (ALA) accumulates in acute porphyrias due to a deficiency in the heme biosynthetic pathway. Considering that glutamate uptake inhibition caused by ALA could be one of the reasons conducing to porphyric neuropathy, it was of interest to evaluate the effect of porphyrinogenic agents on NMDA glutamatergic system. To this end receptor levels and apparent affinity (Kd) were analyzed in mice brain cortex and cerebellum. NMDA levels were diminished after chronic Isoflurane anaesthesia in brain cortex. In cerebellum, a diminution was observed after acute Enflurane and Isoflurane and allylisopropylacetamide, while ethanol administration showed a significant increase. ALA administration diminished NMDA levels only in cerebellum. Affinity constant was only reduced in brain cortex after chronic Isoflurane treatment. In conclusion, glutamatergic system appears to be involved in the action of some of the porphyrinogenic drugs studied mainly in cerebellum. Receptors regulation should therefore be considered an important mechanism in the cellular response to specific drugs, with the aim of designing new therapies and elucidating the mechanisms leading to porphyric neuropathy and acute attack triggering.