Tryptophan malabsorption

Tryptophan malabsorption (blue diaper syndrome) Indigo blue and other indoles (amino acid excretion is normal) Tryptophan Hypercalcemia, retarded growth, febrile episodes, and irritability Chromatographic separation and detection of indole derivatives (H21, S36) (D16, R9, T3a)... 

A number of genetic diseases that result in defects of tryptophan metabolism are associated with the development of pellagra despite an apparently adequate intake of both tryptophan and niacin. Hartnup disease is a rare genetic condition in which there is a defect of the membrane transport mechanism for tryptophan, resulting in large losses due to intestinal malabsorption and failure of the renal resorption mechanism. In carcinoid syndrome there is metastasis of a primary liver tumor of enterochromaffin cells which synthesize 5-hydroxy-tryptamine. Overproduction of 5-hydroxytryptamine may account for as much as 60% of the body s tryptophan metabolism, causing pellagra because of the diversion away from NAD synthesis. 

Hartnup disorder Is a rare condition caused by impaired resorption of neutral amino acids (especially tryptophan, alanine, threonine, glutamine, and histidine) In the renal tubules and malabsorption In the Intestine, resulting from mutations that lead to defective function of a neutral amino acid transporter. 

Hartnup disease is an inherited autosomal recessive disease that manifests itself in malabsorption of neutral amino acids, including tryptophan, in the gastrointestinal tract and also in deficient reabsorption of these amino acids in the renal tubules. The deficient uptake of tryptophan can result in a pellagra-like condition, which may include mental manifestations such as... 

Acrodermatitis enteropathica is a metabolic disorder that results in the malabsorption of zinc. However, when patients afflicted with this disorder were treated with human milk, zinc absorption was enhanced (Lombeck et al. 1975). It was reported by Evans (1980) that patients with acrodermatitis enteropathica have an impaired tryptophan metabolic pathway. Picolinic acid, a chief metabolite of tryptophan, is also a constituent of human milk. Picolinic acid is secreted by the pancreas into the intestinal lumen. A study by Boosalis et al. (1983) demonstrated that patients with pancreatic insufficiency had difficulty absorbing zinc administered as zinc sulfate. However, when these pancreatic-insufficient patients were given zinc as zinc picolinate, the extent of zinc absorption was similar to that of healthy controls. Zinc absorption may depend on the bioavailability of picolinic acid. Such a mandatory role of picolinic acid in absorption has not been confirmed (Bonewitz et al. 1982). 

The neutral amino acids alanine, serine, threonine, asparagine, glutamine, valine, leucine, isoleucine, phenylalanine, tyrosine, tryptophan, histidine and citrulline share a common transporter at the luminal border of the epithelial cells in the renal tubuli and the epithelial cells in the small intestine [16]. In Hartnup disorder an impairment of this transporter leads to hyperexcretion of these neutral amino acids and to intestinal malabsorption. Excretion of tryptophan metabolites kynurenine and N-methyl-nico-tinamide is reduced. Plasma concentrations of the affected amino acids may be low normal or reduced. The inheritance is autosomal recessive. The hph2-deficient mouse has been postulated as a model for Hartnup disorder [17]. Affected persons may be asymptomatic, while some demonstrate pellagra-like photodermatitis or cerebellar ataxia due to a nicotinamide deficiency and respond well to the administration of nicotinamide [16]. 

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