<unk> P is caused by mutations in CPOX, which codes for the enzyme<unk> ogen oxidase. This enzyme is responsible for the sixth step in the heme biosynthetic pathway, converting<unk> ogen III to protoporphyrinogen IX. CPOX is located at 3q11.2-q12.1, has 6 introns and 7 exons and produces an mRNA strand that is 2675 bases in length. It is inherited in an autosomal dominant fashion, meaning that a deficiency of 50% of the normal enzyme activity is enough to cause symptoms. As reproductive fitness is not impacted, homozygous affected individuals have been reported. Along with other acute porphyrias<unk> P demonstrates reduced penetrance, meaning not all individuals who carry a disease-causing mutation will express symptoms. Individuals who are homozygous for a specific mutation (K404E) or compound heterozygous with a null allele in CPOX have a more severe erythropoietic porphyria, harderoporphyria, characterized by neonatal jaundice, hyperbilirubinemia, hepatosplenomegaly and skin lesions upon exposure to ultraviolet light.<unk> P is a rare disease, but the exact incidence is difficult to determine due to the reduced penetrance of the acute porphyrias. Overall, the incidence of all porphyrias is estimated at 1:20,000 in the United States. The incidence of harderoporphyria is even lower, with less than 10 cases reported worldwide.
Hereditary coproporphyria
Hartnup disease
Acromesomelic dysplasia
Van Gogh syndrome
Schnitzler syndrome
Imperforate anus
Wildervanck syndrome
Ackerman syndrome