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In such a setting, low heme production and lower antioxidant bilirubin levels would be expected to lead to metabolic crisis and neuronal death (64), Amid such an oxidative-heme crisis, heme’s porphyrobilinogen side chain is perported to be decarboxylated and deaminated to form a labile hydroxylactam hemopyrrole fragment that corresponds to the hydroxyhaemopyrroline-2-one (HPL) molecule that is a biomarker in this study (4)