HMBS

The HMBS gene provides instructions for making an enzyme known as hydroxymethylbilane synthase. This enzyme is involved in the production of a molecule called heme. Heme is vital for all of the body's organs, although it is most abundant in the blood, bone marrow, and liver. Heme is an essential component of iron-containing proteins called hemoproteins, including hemoglobin (the protein that carries oxygen in the blood).

The production of heme is a multi-step process that requires eight different enzymes. Hydroxymethylbilane synthase is responsible for the third step in this process, which combines four molecules of porphobilinogen (the product of the second step) to form a compound called hydroxymethylbilane. In subsequent steps, five other enzymes produce and modify compounds that ultimately lead to heme.

porphyria - caused by mutations in the HMBS gene

More than 300 mutations in the HMBS gene have been identified in people with a form of porphyria known as acute intermittent porphyria. Some of these mutations change single protein building blocks (amino acids) in hydroxymethylbilane synthase. Other mutations add or delete genetic material within the HMBS gene, which alters the structure and function of the enzyme.

Mutations in the HMBS gene reduce the activity of hydroxymethylbilane synthase, allowing compounds called porphyrins to build up in the liver and other organs. These compounds are formed during the normal process of heme production, but reduced activity of hydroxymethylbilane synthase allows them to accumulate to toxic levels. This buildup, in combination with nongenetic factors such as certain drugs, alcohol, smoking, and dieting, leads to attacks of severe abdominal pain and other symptoms in people with acute intermittent porphyria.