Pyrrole, Kryptopyrrole, Pyrrole Disorder, Pyrrole Condition, Pyrroluria, Kryptopyrole, Pyrole, Pyrrole syndrome:

These are all names applying to a chemical found in the urine which has been clinically shown to be associated with mental health and number of chronic health issues. Please note the current correct term is High or Elevated Urinary Pyrroles. Research in Australia, not yet ready for publication, has proven Urinary Pyrroles as a reliable Bio Marker of severity of oxidative stress. It is not a diagnosis.

No research has been conducted to show it is a condition, syndrome or disorder or autoimmune disease or genetic. It is not a diagnosis, but a measure of oxidative stress which must be managed for long term reduction of symptoms. Work has also shown, as Urinary Pyrroles are a waste product, therefore unstable, it is essential that collection and transportation of urine is done under strict standardized conditions to maximize reliability of results. Poor collection and handling can result in false readings and poor patient outcomes.

What is important is the focus on the urine measure as a biomarker of oxidative stress which directs patient care to identifying and managing the underlying oxidative stress. A doctor trained by Bio Balance Health will know how to do this and manage the process which is individualised to each patient.

The identification of High Urinary Pyrroles has changed many lives as reduction of the pyrrole measure commonly correlates with reduction of symptoms. The understanding that very High Urinary Pyrrole is also often associated with some forms of mental ill health has reduced the stigma and the loss of hope felt by many with a mental health diagnosis. The processes to reduce high pyrroles enhances current chronic health management.

Symptoms associated with high pyrrole vary as the underlying stress varies. This explains why there are so many symptoms and how each person with high pyrroles manifest different responses. It is important your practitioner lists all of your symptoms so treatment response can be observed. Pyrroles are only found in certain types of mental health.

In 2018 Applied Analytical Laboratories became the first to have selectivity in their assay which enables the distinction between chemical species pyrrole from urobilinogen, and provide separate measures for both, as well as the CORRECT scientific measure of Specific Gravity (SG). Urobilinogen is a by-product of normal gut function as opposed to oxidative stress and is co-measured in the assay. Separation of these urine components allows for identification of additional pathologies (e.g. obstructed bile duct, haemolytic anaemia, or hepatitis) and is critical for correct interpretation. The distinction allows a more accurate identification of the composition of the sample as treatment plans based on false results can exacerbate symptoms and/or lead to vitamin B6 toxicity. The laboratory report will give clear reference ranges.

AAL recommends you use Bio Balance Health trained doctors who have experience in managing the process. Self-diagnosis and self-medication is fraught with difficulties and will not achieve optimal results.
Applied Analytical Laboratories Pty Ltd (AAL) is the only dedicated Pyrrole testing laboratory in Australia. AAL are the leaders in investigating the origin of elevated urinary pyrroles, both in their own processes and quality control and through active research collaboration with University researchers.
SOME MORE SCIENCE
For those who want a bit more science.
The Pyrrole moieties that are measured are labile (reactive) intermediate fragments produced by the attack of reactive oxygen species on regulatory haem. This system has been suggested as a ”last resort” anti-oxidant system of the body (bilirubin, for example, is a powerful anti-oxidant yet is physiologically toxic (we have some references for this).
The coordination, or reaction, between pyridoxine/pyridoxal and any pyrroles, or indoles, does NOT occur (if there was reaction of this nature all muscle contraction of every species on earth would not occur).
No research has been performed or published to show Pyrrole is genetic or a disorder. Conversely, we suggest that it is a condition manifested by excess oxidative stress.
Kryptopyrrole is 3-ethyl-2,4-dimethyl pyrrole and is used in one of the calibration references used for AAL’s assay. It is NOT the active measured in the assay. It also has found successful application in our laboratory as a research chemical (where it has been used to produce HPL (the pyrroline-one form) and associated analogues for study. This work has made major inroads into elucidation of the mechanisms of the photo-oxidation (oxidation with reactive oxygen species or oxygen radicals).
Hydroxyhemepyrrolenone (aka HPL) is generated as an artifact during the testing process and is not the actual form of the analyte. HPL is also unstable (and rapidly disassociates) under the typically employed chromatographic conditions (which is why it is difficult to measure with current HPLC-MS technology.
Urobilinogen is a by-product of normal gut function, and levels can fluctuate greatly from morning to evening under normal circumstances, or times of adrenal stimulation/relaxation (through anxiety). It is not directly related to oxidative stress. Separate measure of UB can demonstrate other underlying issues which may present as mental distress, for example, bilary obstruction or renal failure. These do find these in our testing process. This makes this test very useful.

Urine Collection Process for Pyrrole Analysis “Where do I get a Urine Pyrrole Test ?”

Get a Urinary Pyrrole Test Request Form

If your Doctor has provided you with an Applied Analytical Laboratories Urinary Pyrrole Test request form, click to find your nearest collection agency.
If you are a new practitioner looking to refer a patient, please email to request an AAL Urinary Pyrrole Test request form.

Cease Supplements?

First time test? Patients must have not started zinc supplements or cease supplements 72 hours prior to tests (to establish a base-line).
Follow up test? Do NOT cease Zinc if it is a follow-up test.

Note: Medications

Medications used with Rheumatoid Arthritis and/and Urinary Tract Infections can interfere with the test, as does Rifampicin which changes the urine to a red/mauve colour. If you are taking these medications consult your physician as you will need to complete the course and/or abstain for a wash out period of 4 weeks prior to collecting a sample. For some, this is not possible.

Time of Collection?

Any time of the day is possible. Early in the day is preferable.
It is important that the time of collection needs to be noted on the form in order to help account for obtained Urobilinogen levels. Very high levels of urinary bilirubin DO also interfere. However this is rare and you will be informed if this is the case.

Blood does NOT affect the test result, so spotting at the beginning or end of menstrual cycle will not interfere with the result. It is NOT recommended to collect during peak menstruation.

Use Applied Analytical Specimen Jar

Urine is to be collected only in the AAL specimen jar containing medical grade preservative and immediately covered with foil which protects it from light and heat and from incidental high energy electromagnetic radiation (EMR). Any other jar will not have the required preservative inside the jar.

Flash Freeze

The sample is to be frozen immediately to -30’C and kept covered and frozen from the time of collection, during transport, and until the time of testing in the laboratory.

Transport (Collection Agency)

Samples are transported in dry ice to keep the relative temperature below freezing (at -30oC). Your results will be sent back to your doctor.

Pyrrole Results very high or very low?

According to NPAAC guidelines, we will notify the practitioner when the urinary pyrrole result is greater than 400ug/dL, urobilinogen is greater than 16µmol/L, or other parameters are detected (such as, bilirubin, blood, ketones, protein, nitrites and leucocytes). These can illuminate if a patient has liver/kidney function issues, diabetes, infection or other protein dysregulation factors. Applied Analytical Laboratories (AAL) is the only facility to meet this requirement and successfully participate in RCPA conducted proficiency programs for this system as an extra level of assurance. YOUR DOCTOR WILL BE NOTIFIED IMMEDIATELY OF RESULTS NEEDING URGENT ATTENTION.

Payment Process

The Urinary Pyrrole Request Form the doctor gives you to take to the collection agency will have a section to fill out your credit card details for the test. The test cannot occur until this is filled out.
Your collection agency will charge you separately for collection and handling fee.

Some practitioners in the Brisbane and Gold Coast area have an arrangement where the sample is collected on behalf of AAL and this reduced handling fee is included in their request form.

As a result of our regulatory review and further research, what has changed is:

Accuracy

Improvement in the sensitivity of the testing process is the only change in this test since AAL started in 2009. The accuracy of the figure for pyrrole is determined by careful collection, storage, and transport process. Clinical handling is standardized. Figures for comparison with pre-pyrrole separation results are on the results page.

Validated Reference Ranges

Since 2018 AAL Reference ranges are now specific to adult Australians. They have been set through statistical analysis of results of population and schizophrenic studies, discussions with clinicians, populated by research and finalised by consultation with NATA, and the RCPA. Previous ranges were USA and only applied to children. AAL results give Pyrrole, Urobilinogen, and give reference ranges to allow you to compare across the patient history and highlight any other biochemistry which may indicate differing diagnosis. AAL are required, by regulation, to contact the practitioner immediately there are any extreme reference ranges which may require a rapid response from the practitioner.

Distinction

Since 2018 AAL have reported the distinct separation of pyrrole and urobilinogen, and the reporting of both. Previous results are also tied in with current results (and comparisons made) so pre-2018 results have validity.

References

Australian University based researchers have many papers in the pipeline. Our involvement in research has allowed us to populate our laboratory process and reporting with the latest findings.

Biomark Res. 2015 Feb 6;3:3. doi: 10.1186/s40364-015-0028-1. eCollection 2015.
Biomarkers of a five-domain translational substrate for schizophrenia and schizoaffective psychosis. Fryar-Williams S1, Strobel JE.
Biomark Res. 2016 Nov 9;7:172. eCollection 2016.
Fundamental Role of Methylenetetrahydrofolate Reductase 677 C → T Genotype and Flavin Compounds in Biochemical Phenotypes for Schizophrenia and Schizoaffective Psychosis. Fryar-Williams S.
Front Psychiatry. 2016 Apr 14;7:48. doi: 10.3389/fpsyt.2016.00048. eCollection 2016.
Biomarker Case-Detection and Prediction with Potential for Functional Psychosis Screening: Development and Validation of a Model Related to Biochemistry, Sensory Neural Timing and End Organ Performance. Fryar-Williams S1, Strobel JE.
Clinical Psychological Science, 2016. Vol. 4(1), 144-162,
Nutritional interventions in clinical depression. Rechenberg, K. (2015)
Psychiatr. Pol 2014; 48(1): 75-88,
Does the usual dietary intake of patients with depression require vitamin mineral supplementation?
Stefańska E, Wendołowicz A, Kowzan U, Konarzewska B, Szulc A, Ostrowska L.
ACNEM Journal, Vol 29 No.3, 2010
“The Effectiveness of Targeted Nutrient Therapy In Treatment of Mental Illness – A Pilot Study”; Richard Stuckey, William Walsh, Brett Lambert.
Journal of Child & Adolescent Psychopharmacology, 2017 Nov; 27(9): 823-832;
Micronutrient Therapy for Violent and Aggressive Male Youth: An Open Label Trial; Hambly, J., Francis, K., Khan, S., Gibbons, K., Walsh, W., Lambert, B., Testa, C., & Haywood, A., doi: 10.1089/cap.2016.0199. Epub 2017 May 8.

, Urine Pyrrole Test Collection Process

We’re here for you

Applied Analytical Laboratories

Informed by research – committed to excellence

Contact Us

Shop 6, 11 Logandowns Drive,
Meadowbrook, QLD 4131

(07) 3133 1615