In recent years, considerable interest has been developed in the effect of various diseases upon the metabolic pathway by which L-tryptophan is converted to nicotinic acid derivatives. As the list of diseases associated with abnormal tryptophan metabolism has grown, there has been mounting scepticism abc;ut the specificity and clinical significance of many of the observed changes. The aim of this article is to review some of the more recent developments which have taken place in the study of tryptophan metabolism in man, and to show that many of the reported abnormalities may have as their origin the influence of hormonal and nutritional factors upon the metabolic pathway. Recognition of these factors should help to distinguish between non-specific changes brought about by the metabolic response to the 'stress' of any severe illness, and abnormalities of tryptophan metabolism that are of pathological or clinical significance.Clinical research into tryptophan metabolism in man has been largely concerned with the levels of intermediate metabolites that are present in urine collected after the patient has received an oral dose of L-tryptophan. The techniques involved have been discussed by Price, Brown, and Yess (1965), and by Musajo and Benassi (1964), who also reviewed the published results obtained in a variety of diseases.
Biochemistry of Tryptophan Metabolism and the Effect of HormonesThe steps involved in the biosynthesis of nicotinic acid and 5-hydroxytryptamine from L-tryptophan are summarized in Figure 1. Some of these enzymatic reactions require pyridoxal 5-phosphate, the coenzyme derived from the various forms of vitamin B6, as a cofactor. Impaired function of this coenzyme results in an elevated urinary excretion ofkynurenine, 3-hydroxykynurenine, and xanthurenic acid, apparently because the kynureninase which is responsible for the conversion of 3-hydroxykynurenine