Porphyria: A Bloodthirsty Biochemical Explanation

November 25, 2008

During this summer, I was preparing myself for medical school by doing foolish things, and I read a popular teen vampire novel called Twilight.  This week Twilight the movie premiered, although I haven’t had time to go see it yet.  However, it was during this same week at one of my final biochemistry lectures that I learned something very interesting and unexpected… vampires are real!

What?!  Why didn’t I hear about this disease before?  Oh yes, that’s probably because people who actually have this genetic disease would rather not be related to vampires.  Given that vampires are considered evil by many people and were tortured outcasts of society, this is a touchy subject. The legend of vampires exists nevertheless, and there is a real medical explanation for how it may have originated.  Therefore, I feel compelled to share this intriguing knowledge.

It makes sense that before science was able to explain strange genetic diseases and symptoms, people assumed that they were connected with the devil or a result of certain behaviors or diet.  In fact, when I lived in rural Ukraine, pregnant women refused to cut their hair, thinking it would cause birth defects.  Yet, now we know that genetic defects are often the result of a tiny, unlikely mistake in the duplication & division of DNA.  A single tiny rearrangement or deletion can cause a lot of strange things to happen- it’s amazing that most of us come out looking “normal.”

The possible explanation of the vampire legend is one of seven types of porphyrias, which are all diseases in the synthesis of heme (the compound in blood which carries oxygen and carbon dioxide to keep us alive).  Heme is synthesized in the liver and bone marrow.  There are eight steps, four of which take place inside mitchondria and four in the cytoplasm.  Therefore, there are multiple opportunities for defective enzymes and build up of intermediate products.

The interesting thing about the intermediates in heme synthesis is that they contain many benzene rings.  When these rings are oxidized, they can absorb light and appear to be colored (think of purple-yellow-brown-greenish bruising when heme is broken down right under the skin).  When there is a build up of intermediates, it causes purple urine, red and fluorescent teeth, and extreme sensitivity to light rays.

The type of porphyria believed to have started the legend of vampires is called porphyria cutanea tarda.  It leads to a build up of products which cause a variety of problems.  First, people suffer from extreme anemia, so they are very pale.  Additionally they have red and fluorescent teeth, which can look pretty strange.  The intermediate products in their blood can oxidize to become insoluble when exposed to sunlight.  This causes pain and blistering in their skin, so they would try to never go outside in sunlight.  Also, drinking fresh blood, which somebody may have figured out, could relieve the neurological symptoms.  This was a genetic defect, so it stayed within families.  Since these people were probably outcasts from society, they may have married cousins causing the disease to proliferate faster.

None of this is proven fact because nobody knows where any supposed “vampires” are buried.  Otherwise, it would be possible to dig them up and perform a genetic test.  Also, this explanation doesn’t explain a fear of garlic or why you have to put a stake through their hearts to kill them.  This is an extremely rare disease.  Yet, it’s interesting to know that we understand so much about the body now that we can go back in time to solve medical mysteries.


Thinking About Summer Already

November 9, 2008

Yesterday I had a phone interview to volunteer with a medical program in “campos” (villages) in rural Dominican Republic.  I want to go abroad this summer and observe a low-cost healthcare operation to see how people are served and how it is organized.  This program sounds quite interesting, especially since I would stay with a host family and be relatively isolated from phone or internet.  The program dates span over Ben and my first anniversary, so that would be challenging.  But I talked to Ben and he was not discouraged.  I get really excited to think about clinical experiences right now- I need to be reminded about why I am doing this.

Most of my days at school are spent looking at molecules and diagrams, and having information “poured” onto me.  Each day, I become aware of some other tiny process in the body.  Certain mysterious elements have started to become clearer.  I wonder what it will be like when I can look at others and myself and envision what is going on under the skin.  For example, right now, when I look at my torso, I can kind of imagine what things inside look like and where they go.  After a few months, I should be able to name, feel, envision, know the color and texture, and examine everything.  My torso will never be the same again after that.  Meanwhile, my brain is moving so fast, and I can’t help thinking about summer break.


A New President

November 5, 2008

This week was election week, and I’ve also been able to think a lot about that.  I skipped my first classes (for the first time) to stand in line to vote for 1 ½ hours.  It was a grand experience to see so many people in line, and to spend the evening watching the results of such a historic election with our international friends.

I can’t help comparing the atmosphere with the energy in Ukraine after the Orange Revolution ended and Yushchenko became president.  Ukrainians eventually became more discouraged than ever when Yushchenko’s presidency didn’t meet their expectations.  I don’t think that the same thing will happen in the USA, but I know that Americans have difficult times ahead.

As a future doctor, I’m not sure how the political situation will affect my career.  However, I know it will, and I hope positively.  The health care system in the USA needs change.  We don’t really even have a “system” because the current organization evolved without any real planning.  And to my surprise, I discovered this week that the government currently pays for over 50% of national health care costs already, and has already made several steps to influence the system.  I’m looking forward to seeing some major changes in the way healthcare is funded.