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dc.contributor.advisorBrekke, Ole-Lars
dc.contributor.authorStorjord, Elin
dc.date.accessioned2020-12-22T13:12:52Z
dc.date.available2020-12-22T13:12:52Z
dc.date.issued2021-01-22
dc.description.abstractAcute intermittent porphyria (AIP) is a rare autosomal dominant inherited metabolic disease with lowered function of the enzyme hydroxymethylbilan synthase due to mutation in this gene of the heme synthesis. The resulting excess of aminolevulinic acid and porphobilinogen can result in acute abdominal pain, paresis, fatigue, increased risk for kidney failure and hepatocellular carcinoma. Some drugs, fasting, infections and stress can trigger AIP attacks. Metabolic diseases like diabetes mellitus are associated with inflammation. Therefore we investigated if there was inflammation in AIP measured as elevated levels of plasma cytokines. Handling of blood samples can have effect on the cytokine levels, so we compared the use of plasma using four different anticoagulants with serum. The effects of storage temperature, freezing and thawing were also examined. We concluded that one should analyse cytokines in EDTA plasma samples stored at 4ºC for up to 4 hours before centrifugation. We established reference ranges for cytokines from 162 healthy persons. By using a multiplex assay, we found elevated cytokines in the 50 AIP cases as a sign of low-grade inflammation, compared to the 50 matched controls. The inflammation may be one of the explanations for the higher risk for HCC in AIP. We found lower levels of prealbumin and lower kidney function in symptomatic vs. asymptomatic AIP cases. The fasting C-peptide and insulin levels were lower in the symptomatic AIP cases compared to matched controls. Persons with AIP are recommended a high carbohydrate intake because glucose inhibits the first step in the heme synthesis. The cases and controls filled out a 7-days diet logbook, had their anthropometric measures done, filled out a questionnaire on lifestyle-factors and was interviewed by a physician. Blood was analysed for cytokines, vitamins, glucose metabolism measures and fats etc. Persons with AIP had a lower carbohydrate intake than recommended by guidelines.en_US
dc.description.doctoraltypeph.d.en_US
dc.description.popularabstractAcute intermittent porphyria (AIP) is a metabolic disease that can result in attacks with acute abdominal pain, paresis, fatigue and increased risk of kidney failure and liver cancer. In a case control study of 50 AIP cases and 50 matched controls we interviewed the participants, drew blood samples and obtained diet logbooks. Fasting, infections, medications and stress can trigger an AIP attack, and we found stress as the most common trigger. Plasma cytokines were elevated in the AIP cases compared to the matched controls as a sign of low-grade inflammation. We investigated how to handle blood samples to get the most correct level of cytokines, concluding that analysis of cytokines can be performed in EDTA plasma samples stored at 4ºC for up to 4 hours before centrifugation. A low carbohydrate intake may trigger AIP attacks. We found that persons with AIP had a lower carbohydrate intake than recommended, and that a lower insulin level was associated with higher AIP disease activity.en_US
dc.description.sponsorshipHelse Nord og Nordlandssykehuseten_US
dc.identifier.urihttps://hdl.handle.net/10037/20120
dc.language.isoengen_US
dc.publisherUiT The Arctic University of Norwayen_US
dc.publisherUiT Norges arktiske universiteten_US
dc.relation.haspart<p>Paper I: Storjord, E., Dahl, J.A., Landsem, A., Fure, H., Ludviksen, J.K., Goldbeck‐Wood, S., … O.‐L. (2017). Systemic inflammation in acute intermittent porphyria: a case–control study. <i>Clinical & Experimental Immunology, 187</i>, 466-479. Also available at <a href=https://doi.org/10.1111/cei.12899>https://doi.org/10.1111/cei.12899</a>. <p>Paper II: Storjord, E., Dahl, J.A., Landsem, A., Ludviksen, J.K., Karlsen, M.B., Karlsen, B.O. & Brekke, O.-L. (2019). Lifestyle factors including diet and biochemical biomarkers in acute intermittent porphyria: Results from a case-control study in northern Norway. <i>Molecular Genetics and Metabolism, 128</i>(3), 254–270. Also available in Munin at <a href=https://hdl.handle.net/10037/15306>https://hdl.handle.net/10037/15306</a>. <p>Paper III: Hennø, L.T., Storjord, E., Christiansen, D., Bergseth, G., Ludviksen, J.K., Fure, H., … Brekke, O.-L. (2017). Effect of the anticoagulant, storage time and temperature of blood samples on the concentrations of 27 multiplex assayed cytokines - Consequences for defining reference values in healthy humans. <i>Cytokine, 97</i>, 86-95. Also available at <a href=https://doi.org/10.1016/j.cyto.2017.05.014>https://doi.org/10.1016/j.cyto.2017.05.014</a>. Accepted manuscript available in Munin at <a href=https://hdl.handle.net/10037/13444>https://hdl.handle.net/10037/13444</a>.en_US
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2021 The Author(s)
dc.rights.urihttps://creativecommons.org/licenses/by-nc-sa/4.0en_US
dc.rightsAttribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)en_US
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750en_US
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750en_US
dc.titleAcute intermittent porphyria. Inflammation, diet and biomarkers in acute intermittent porphyriaen_US
dc.typeDoctoral thesisen_US
dc.typeDoktorgradsavhandlingen_US


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