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The Effect of Vitamin Supplementation on the Urinary Excretion of Tryptophan Metabolites by Pregnant Women

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The Effect of Vitamin Supplementation on the Urinary Excretion of Tryptophan Metabolites by Pregnant Women THE EFFECT OF VITAMIN SUPPLEMENTATION ON THE URINARY EXCRETION OF TRYPTOPHAN METABOLITES BY PREGNANT WOMEN R. R. Brown, … , Madeline J. Thornton, J. M. Price J Clin Invest. 1961;40(4):617-623. https://doi.org/10.1172/JCI104292. Research Article Find the latest version: https://jci.me/104292/pdf THE EFFECT OF VITAMIN SUPPLEMENTATION ON THE URINARY EXCRETION OF TRYPTOPHAN METABO- LITES BY PREGNANT WOMEN * By R. R. BROWN, MADELINE J. THORNTON AND J. M. PRICE t (From the Cancer Research Hospital and the Departnent of Gynecology and Obstetrics, University of Wisconsin Medical School, Madison, Wis.) (Submitted for publication September 30, 1960; accepted October 28, 1960) The first demonstration by Lepkovsky, Roboz ports on the efficacy of pyridoxine in reducing the and Haagen-Smit (1) of the occurrence of xan- incidence of pre-eclampsia (20, 21), factors in ad- thurenic acid in urine of vitamin B6-deficient rats dition to vitamin B6 nutrition are probably in- has since been extended and confirmed in a num- volved. ber of species (2-4) including man (5, 6), and Since quantitative studies of urinary trypto- the measurement of xanthurenic acid in urine fol- phan metabolites have been chiefly concerned lowing a loading dose of tryptophan has been pro- with xanthurenic acid, the present study was un- posed as an index of vitamin B6 nutrition (7). dertaken to evaluate the quantity of this and other The role of this vitamin in tryptophan metabolism tryptophan metabolites excreted during preg- has been studied in intact rats by Dalgliesh (8), nancy, and to determine the effect, if any, of other and enzyme studies by a number of investigators vitamins in addition to vitamin B6 on the excre- (9-12) provide a reasonable explanation for the tion of tryptophan metabolites by normal preg- elevated excretion of tryptophan metabolites nant women. The results indicate that the ele- found in the urine of pvridoxine-deficient animals. vated levels of tryptophan metabolites found in Although xanthurenic acid sometimes occurs in the urine of normal pregnant subjects were low- elevated amounts in urine, it is not an abnormal ered by pyridoxine administration to near the tryptophan metabolite. since it can be detected in levels found in nonpregnant subjects, with the ex- normal human urine (13). ception of N-methyl-2-pyridone-5-carboxamide ex- The observations that pregnant women ex- cretion, which remained two or three times higher crete elevated amounts of xanthurenic acid (14- in pregnancy. Administration of other vitamins 16) and other metabolites of tryptophan (17) had no effect on the excretion of tryptophan me- have been interpreted as signifying a vitamin B6 tabolites. The pattern of urinary metabolites deficiency in pregnancy, inasmuch as supplemen- found suggests that other factors in addition to tation of the diet with pyridoxine restored the vitamin Be nutrition may be involved in regulating excretion of xanthurenic acid to control levels. the metabolism of tryptophan in pregnant subjects. Xanthurenic acid excretion was not elevated in pregnant swine (18). rats, guinea pigs, rabbits METHODS or dogs (19). However, dietary pyridoxine de- The effect of vitamin supplementation on the metabo- ficiency caused elevated xanthurenic acid excre- lism of tryptophan was studied in 14 pregnant subjects tion in most of these species. (ages 21 to 37) seen by one of us (M. T.) as outpatients It has been reported that pre-eclamptic and in the Department of Gynecology and Obstetrics. In eclamptic patients excreted more xanthurenic acid stage of pregnancy, 4 subjects were in the third tri- than normal pregnant or nonpregnant women mester, 9 were in the second trimester, and one was late (14). However, since there are differing re- in the first trimester. Prior to the first study, the sub- jects received no vitamin supplement for at least 2 weeks. * Supported in part by grants from the National In- After collection of a 24 hour basal urine, each subject stitute of Arthritis and Metabolic Diseases (no. A-1499), was given an oral test dose of 2 g of L-tryptophan and the American Cancer Society, and from the Wisconsin two more complete 24-hour urine collections were ob- Division of the American Cancer Society. tained. Thus, all urine was collected for 1 day before tAmerican Cancer Society, Charles S. Hayden Foun- and for 2 days after tryptophan administration (Group dation Professor of Surgery in Cancer Research. II, pregnant, no vitamins). The urine was preserved 617 618 R. R. BROWN, MADELINE J. THORNTON AND J. M. PRICE under toluene and refrigerated until analyzed. Follow- RESULTS ing this first study, each subject received a multivitamin preparation lacking only pyridoxine of the common vi- Table I outlines the metabolic relationships of tamins.' After ingestion of this vitamin preparation for the compounds measured, and shows the average 11 days, the 3-day tryptophan study was repeated (Group quantities excreted by the various groups of sub- III, pregnant, vitamins, no B6). The subjects were then jects before and after a loading dose of 2 g of given daily the same multivitamin preparation, containing means a in addition 6 mg of pyridoxine hydrochloride,2 for an- L-tryptophan. Statistical evaluation by of other 11 days when a third tryptophan study was obtained t test was made of the basal (pre-tryptophan) (Group IV, pregnant, vitamins with B,). The subjects levels of excretion between groups and also of the then continued to receive the complete multi-vitamin sup- yields of metabolites due to tryptophan loading plement until term. Of the 14 subjects on whom com- (post-tryptophan values minus basal values) be- plete studies were obtained during pregnancy, 9 were available for postpartum study (Group V). This 3-day tween groups (Table II). study was done 1 to 16 months post partum when the sub- The basal excretions of kynurenine, hydroxy- jects had stopped lactating, and had received no vitamin kynurenine, and xanthurenic acid were signifi- supplement for at least 2 weeks prior to study. cantly higher (p .0.05) in pregnancy (Group Mild anemia was the chief prenatal complication. All II) than in the control subjects (Group I), infants (7 males and 7 females) were delivered at term, whereas basal acid excretion was sig- two by Cesarean section, two by forceps and the re- kynurenic mainder spontaneously. Postpartum bleeding and a nificantly lower (p ' 0.02) in the pregnant sub- subsequent transfusion reaction in one subj ect were the jects. In comparing the basal levels of excretion only postpartum complications encountered. by pregnant subjects (Group II) with the same For comparison, the tryptophan metabolism of a group subjects post partum (Group V), it was found of 10 normal, nonpregnant women (ages 19 to 45) was that pregnant subjects excreted significantly ele- measured (Group I). Two of the controls were post- menopausal, the others were premenopausal. Four of vated levels of kynurenine, hydroxykynurenine the controls had had one or more pregnancies, 6 were nulliparous; no detectable difference in tryptophan me- TABLE I tabolism was observed between these subgroups. The average utrinary excretion of nietabolites of trypto- In addition, 7 normal nonpregnant women were given phan by various groups of woment the tryptophan load test just before menstruation, just TRYPTOPHAN after menstruation, and at the estimated time of ovula- .'A 1 B.6 tion, in an attempt to evaluate the influence on trypto- B6. KYN-HK phan metabolism of changes in hormonal levels during Iu~ . the menstrual cycle. Subjects with regular cycles were 11- oAH KA ACK XA chosen in order that it might be possible to accurately 110 CONTROL 0 22 IO 25 7 87 predict the time of ovulation and the start of menstru- 2 42 61 16 29 51 30 120 ation. 1 14 PREGNANT,NO -------21 9 13 25 56 10 98 29 183 306 254 207 The tryptophan metabolites measured were kynurenine, VITAMINS 2 34 82 0 21 8 13 28 63 acid (22), 3-hydroxy- ff14m VREGNANSVITAMINS - -- - - -_1 172* acetylkynurenine, o-aminohippuric 412 293* (23), kynurenic and xanthurenic acids (24), NO B6 2 31 74 23 172 315 kynurenine 0 9 12 and N-methyl-2-pyridone-5-carboxamide (pyridone) (25). 1PRETGNANS1, 23 16 25 56 163* _ WITH B6 2 32 42 20 60 116 94 319* Only the natural L-tryptophan was used in these studies 0 19 12 13 13 18 65 since previous reports (26) demonstrated that use of _ PARTUMPOST- 2 45 132 46 133 135 95_I 102 DL-tryptophan leads to the excretion of metabolites of D-tryptophan. t The units are in micromoles of metabolite per 24 hours except for the dose of L-tryptophan which is 2.0 g 1 Each daily dose contained 1.5 mg thiamine mono- (9,800 ,umoles). The abbreviations are: oAH, o-amino- nitrate, 3 mg riboflavin, 7.5 ,ug vitamin B,2, 100 mg ascor- hippuric acid; KA, kynurenic acid; ACK, acetylkynure- bic acid, 15 mg nicotinamide, 0.4 mg folic acid, 6,000 nine; KYN, kynurenine; HK, 3-hydroxykynurenine: USP units vitamin A, 75 mg ferrous sulfate, 6 mg race- HAA, 3-hydroxyanthranilic acid; XA, xanthurenic acid; mic calcium pantothenate and 1.87 g calcium carbonate. PYR, N-methyl-2-pyridone-5-carboxamide; B,, pyridoxal We are indebted to Dr. J. M. Maas and Mr. R. Glenn phosphate or pyridoxine hydrochloride. Weiss of Eli Lilly and Co., Indianapolis, Ind., for supply- * Pyridone values are elevated because of 15 mg (123 ing us with this preparation. tmoles) of niacinamide present in the multivitamin sup- 2 Compren Pulvules no. 25, Eli Lilly and Co., Indi- plement. The average increase in pyridone excretion anapolis, Ind., kindly supplied by Dr. J. M. Maas and after multivitamin supplementation was 69.5 ,moles, Mr.
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