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Internal Medicine

Garrod’s tetrad

In medicine, Garrod’s tetrad is a term named for British physician Sir Archibald Garrod, who introduced the phrase “inborn errors of metabolism” in a lecture in 1908.

In medicine, Garrod’s tetrad is a term named for British physician Sir Archibald Garrod, who introduced the phrase “inborn errors of metabolism” in a lecture in 1908.

  1. Albinism: Tyrosine deficiency
  2. Alkaptonuria: Hemogentisate oxigenase deficiency
  3. Pentosuria: L-xylulose dehydrogenase deficiency
  4. Cystinuria: Aminoaciduria of basic (positively0charged) amino acids: cystine, ornithine, lysine, arginine (COLA)

History:

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Sir Archibald Edward Garrod KCMG FRS (1857 – 1936) was an English physician who pioneered the field of inborn errors of metabolism. He also discovered alkaptonuria, understanding its inheritance. He served as Regius Professor of Medicine at the University of Oxford from 1920 to 1927.

Although Mendel experimented with varieties of peas, his laws have been shown to apply to the inheritance of many kinds of characters in almost all organisms. In 1902 Mendelian inheritance was demonstrated in poultry (by English geneticists William Bateson and Reginald Punnett) and in mice. The following year, albinism became the first human trait shown to be a Mendelian recessive, with pigmented skin the corresponding dominant. 

In 1902 and 1909, English physician Sir Archibald Garrod initiated the analysis of inborn errors of metabolism in humans in terms of biochemical genetics. Alkaptonuria, inherited as a recessive, is characterized by excretion in the urine of large amounts of the substance called alkapton, or homogentisic acid, which renders the urine black on exposure to air. In normal (i.e., nonalkaptonuric) persons the homogentisic acid is changed to acetoacetic acid, the reaction being facilitated by an enzyme, homogentisic acid oxidase. Garrod advanced the hypothesis that this enzyme is absent or inactive in homozygous carriers of the defective recessive alkaptonuria gene; hence, the homogentisic acid accumulates and is excreted in the urine. Mendelian inheritance of numerous traits in humans has been studied since then.

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