Biallelic inactivation of protoporphyrinogen oxidase and hydroxymethylbilane synthase is associated with liver cancer in acute porphyrias

Xiaoye Schneider-Yin, Anne-Moon van Tuyll van Serooskerken, Marko Siegesmund, Philip Went, Jasmin Barman-Aksoezen, Reno S. Bladergroen, Paul Komminoth, Roy H. E. Cloots, Veronique J. Winnepenninckx, Axel Zur Hausen, Markus Weber, Ann Driessen, Pamela Poblete-Gutierrez, Peter Bauer, Christopher Schroeder, Michel van Geel, Elisabeth I. Minder, Jorge Frank*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Variegate porphyria (VP) and acute intermittent porphyria (AIP), the two most common types of acute porphyrias (AHPs), result from a partial deficiency of protoporphyrinogen oxidase (PPOX) and hydroxymethylbilane synthase (HMBS), respectively. A rare but serious complication in the AHPs is hepatocellular carcinoma (HCC). However, the underlying pathomechanisms are yet unknown. We performed DNA sequence analysis in cancerous and non-cancerous liver tissue of a VP and an AIP patient, both with HCC. In samples of both cancerous and non-cancerous liver tissues from the patients, we identified the underlying PPOX and HMBS germline mutations, c.1082dupC and p.G111R, respectively. Additionally, we detected a second somatic mutation, only in the cancer tissue i.e., p.L416X in the PPOX gene of the VP patient and p.L220X in the HMBS gene of the AIP patient, both located in trans to the respective germline mutations. Both somatic mutations were not detected in 10 non-porphyriaassociated HCCs. Our data demonstrate that in the hepatic cancer tissue of AHP patients, somatic second-hit mutations result in nearly complete inactivation of the enzymes catalyzing major steps in the heme biosynthetic pathway. Both PPOX and HMBS, which might act as tumor suppressors, play a crucial role in the development of HCC in these individuals.
Original languageEnglish
Pages (from-to)734-738
JournalJournal of Hepatology
Issue number3
Publication statusPublished - Mar 2015


  • Acute intermittent porphyria
  • Variegate porphyria
  • Hepatocellular carcinoma
  • Tumor suppressor

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