Tryptophan and indolic tryptophan metabolites in chronic renal failure

Tryptophan and indolic tryptophan metabolites were measured in the serum of normal subjects and chronic renal failure patients. The tryptophan free/total ratio was 0.07 in the normal serum, but the other tryptophan metabolite values were below detectable levels. The free/total ratio was 0.66 in patients with chronic renal failure, and both increase of free tryptophan and decrease of total tryptophan were observed. At the same time, 5-hydroxyindoleacetic acid, indole acetic acid, 5-hydroxytryptophol, and N-acetyltryptophan also increased in the serum of chronic renal failure patients, existing not only in free form but in protein-bound form. In the serum samples, following hemodialysis the indolic tryptophan metabolites showed a tendency to decrease, and the tryptophan free/total ratio of 0.42 a approached the normal value. When indolic tryptophan metabolites were added to normal serum in vitro, the free tryptophan level rose, and competition for binding to albumin between tryptophan and indolic tryptophan metabolites was observed. These findings suggested that the cause of the decrease in protein-bound tryptophan in uremic serum may be an accumulation of indolic tryptophan metabolites which complete for binding to albumin in uremia.