Heme synthesis occurs through a series of steps that take place in both the mitochondria and cytoplasm. The initial process and final step occur in the mitochondria, while intermediate steps happen in the cytoplasm. Key enzymes in this process include ALA synthase, ALA dehydratase, and ferrochelatase. Inhibition of ALA dehydratase by heavy metals like lead can increase ALA levels in the blood and urine, indicating lead poisoning which is toxic to the brain and nervous system.