HARTNUP DISEASE

inborn metabolic disorder involving the amino acid tryptophan. Normally, one of the metabolic pathways of tryptophan leads to the synthesis of nicotinic acid, or niacin, a vitamin of the B group, a deficiency of which causes pellagra. In Hartnup disease, it is believed that the transport system in the kidney tubule that normally reabsorbs tryptophan into the body circulation is defective. As a result, the concentration of tryptophan increases in the urine and decreases in the blood, and there is less tryptophan available for the synthesis of niacin. Clinical features of Hartnup disease include episodic scaly red rashes over exposed areas of the body, identical in appearance with those of classical pellagra; thought processes and behaviour may also be abnormal. In addition to defective kidney transport, there also seems to be a delayed and incomplete absorption of dietary tryptophan through the intestinal tract. The pellagra-like symptoms can be controlled with supplementary doses of the amide of niacin (nicotinamide); affected persons generally respond well to a high-protein diet.