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Heme oxygenase inhibitors and inducers act on the enzymes that break down heme into biliverdin. The reaction also releases iron and carbon monoxide, and biliverdin is then reduced to bilirubin. In 1968 microsomal heme oxygenase was shown to convert heme to bilirubin enzymatically. In 1986 two forms of the enzyme were distinguished in rat liver, and only one of them, heme oxygenase 1 (HO-1), was inducible. Tin mesoporphyrin and zinc protoporphyrin are metalloporphyrins that compete with heme for the enzyme. HO-1-IN-1 is a further HO-1 inhibitor, whereas hemin and coniferaldehyde induce HO-1 expression in cells.
