AHP Is a Family Of
Rare And Debilitating
Genetic Diseases

Each type of porphyria involves a genetic defect in a heme biosynthesis pathway enzyme. They are classified as the following: acute hepatic porphyria (AHP)—which may present as a sudden neurovisceral acute attack—or photocutaneous porphyria.1-3

Using Major Clinical Manifestations for Classification of 8 Types of Porphyria3,4

ADP=aminolevulinic acid dehydratase-deficiency porphyria; AIP=acute intermittent porphyria; ALA=aminolevulinic acid; CEP=congenital erythropoietic porphyria; EPP=erythropoietic protoporphyria; HCP=hereditary coproporphyria; PBG=porphobilinogen; PCT=porphyria cutanea tarda; VP=variegate porphyria; XLDPP=X-linked dominant protoporphyria.

This site is dedicated to discussing AHP.  For information about all types of porphyria, including both AHP and photocutaneous porphyria, visit the American Porphyria Foundation website.

Causes of AHP

The types of porphyria are genetic metabolic disorders of the heme biosynthesis pathway. AHP, a subset of porphyria, often presents as a sudden acute attack requiring hospitalization and is triggered by excess ALA and PBG.2-5

Watch this Mechanism of Disease video to take a deeper look at the pathogenesis, signs and symptoms, and common methods used to inform a diagnosis of AHP:

AHP is caused by enzymatic defects that result in accumulation in the liver of toxic intermediates—aminolevulinic acid (ALA) and porphobilinogen (PBG). Upregulation of ALAS1 (aminolevulinate acid synthase 1) is a central pathophysiologic mechanism underlying AHP, and leads to this toxic accumulation. ALA and PBG then enter the circulatory system and are thought to cause neurologic lesions leading to dysfunction across the autonomic, central, and peripheral nervous systems. Dysfunction in these systems can cause patients to have severe, diffuse abdominal pain plus one or more of the following symptoms: anxiety, confusion, nausea, vomiting, limb weakness and pain. This can potentially result in irreversible neuropathies and long-term disease complications such as kidney disease and hepatocellular carcinoma. Elevated PBG is important as a highly specific diagnostic marker. ALA is believed to be the primary toxic intermediate responsible for causing acute attacks, ongoing symptoms between attacks, and prolonged or potentially permanent neuropathy in AHP. Acute attacks generally last 3 to 7 days, but the recovery period can be long and extend into residual chronic symptoms.1-9

Upregulation of ALAS1 leads to toxic accumulation of ALA and PBG

AHP Consists of 4 TYPES

There are 4 types of AHP, which stem from different enzyme deficiencies in the heme biosynthesis pathway in the liver. About 80% of cases are acute intermittent porphyria (AIP), followed by variegate porphyria (VP), hereditary coproporphyria (HCP), and the extremely rare ALA dehydratase-deficiency porphyria (ADP). The prevalence of AIP may be under-reported due to estimates based on patients with symptomatic disease only, rather than an enzyme mutation.2,4,5,10

Types of acute hepatic porphyria

Epidemiology of AHP

In the US, the overall prevalence of people diagnosed with symptomatic AHP is approximately 10 per 1 million people. It affects people of all races. The majority of cases occur in women of reproductive age, with most attacks occurring between the ages of 15 and 45. Importantly, the risk of long-term disease consequences, such as porphyria-related kidney disease or hepatocellular carcinoma, remains after menopause. Some patients experience debilitating and potentially life-threatening attacks.2-4,10-16

The majority of cases occur in women3,12,17†

The majority of acute hepatic porphyria cases occur in women

In one study including 108 patients.

Management Approaches for AHP

  • IV hemin8
    Intended for the amelioration
    of recurrent AIP attacks
  • Pain medications8,9
    Opioids and nonopioids are
    commonly prescribed
  • Liver transplantation8
    Rarely used. May be suitable only for severely affected patients where other management approaches have been unsuccessful
  • Trigger avoidance8
    Avoiding certain triggers that
    may exacerbate AHP symptoms
  • Glucose and carbohydrate loading8
    May downregulate the heme
    biosynthesis pathway
  • Hormone therapy (GnRH analogs)8
    For those experiencing acute attacks
    related to their menstrual cycles
  • Medications to treat symptoms8
    Medications are prescribed for specific symptoms of AHP (eg, beta-blockers for hypertension and tachycardia, and an antiemetic for nausea and vomiting)
  • RNA interference (RNAi) therapeutics18,19
    Leverage the naturally occurring RNAi process and target the disease pathway of AHP