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Kember I, Sanajou S, Kilicarslan B, Girgin G, Baydar T. Evaluation of neopterin levels and kynurenine pathway in patients with acute coronary syndrome. Acute Crit Care 2023; 38:325-332. [PMID: 37652862 PMCID: PMC10497888 DOI: 10.4266/acc.2023.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/05/2023] [Accepted: 06/30/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Coronary atherosclerosis is the leading cause of coronary artery disease. Several investigations have indicated that tear-sensitive plaques contain macrophages and T cells. Neopterin is an essential cellular immune response biomarker. The main goal of this study was to see if there were any changes in biomarkers like unconjugated pteridines, neopterin, and biopterin, as well as kynurenine pathway enzymes like indoleamine 2,3-dioxygenase (IDO), which catalyzes the rate-limiting step in tryptophan degradation, in patients with the acute coronary syndrome (ACS) caused by angiographic atherosclerosis. METHODS High-performance liquid chromatography was used to determine the amounts of neopterin, biopterin, and creatinine in urine samples, as well as tryptophan and kynurenine in serum samples. The enzyme-linked immunosorbent assay was used to assess the amounts of neopterin in serum samples. The measured parameters were evaluated between ACS patients and controls. RESULTS The measured levels of neopterin, biopterin and the kynurenine to tryptophan ratio reflecting IDO activity, and the specifically known biomarkers such as cardiac troponin, creatine kinase, myoglobin, and natriuretic peptides are statistically higher in ACS patients compared to control subjects. On the other hand, the measured parameters are inadequate to classify the conventional kinds of ACS, ST-elevation- and non-ST-elevation- myocardial infarction. CONCLUSIONS The study found that determining and using neopterin and IDO parameters as biomarkers in individuals with the ACS can support traditional biomarkers. However, it can be concluded that evaluating pteridine biomarkers solely have no privilege to clinical findings in ACS diagnosis and classification.
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Affiliation(s)
- Ibrahim Kember
- Department of Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara, Türkiye
- Department of Emergency Medicine, Tuzla Devlet Hastanesi, Istanbul, Türkiye
| | - Sonia Sanajou
- Department of Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara, Türkiye
| | - Bilge Kilicarslan
- Department of Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara, Türkiye
| | - Gözde Girgin
- Department of Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara, Türkiye
| | - Terken Baydar
- Department of Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara, Türkiye
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2
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Battaglia MR, Di Fazio C, Battaglia S. Activated Tryptophan-Kynurenine metabolic system in the human brain is associated with learned fear. Front Mol Neurosci 2023; 16:1217090. [PMID: 37575966 PMCID: PMC10416643 DOI: 10.3389/fnmol.2023.1217090] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- Maria Rita Battaglia
- Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Chiara Di Fazio
- Department of Psychology, Center for Studies and Research in Cognitive Neuroscience, University of Bologna, Bologna, Italy
| | - Simone Battaglia
- Department of Psychology, Center for Studies and Research in Cognitive Neuroscience, University of Bologna, Bologna, Italy
- Department of Psychology, University of Turin, Turin, Italy
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3
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Serafini G, Costanza A, Aguglia A, Amerio A, Trabucco A, Escelsior A, Sher L, Amore M. The Role of Inflammation in the Pathophysiology of Depression and Suicidal Behavior: Implications for Treatment. Med Clin North Am 2023; 107:1-29. [PMID: 36402492 DOI: 10.1016/j.mcna.2022.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Depression and suicidal behavior are 2 complex psychiatric conditions of significant public health concerns due to their debilitating nature. The need to enhance contemporary treatments and preventative approaches for these illnesses not only calls for distillation of current views on their pathogenesis but also provides an impetus for further elucidation of their novel etiological determinants. In this regard, inflammation has recently been recognized as a potentially important contributor to the development of depression and suicidal behavior. This review highlights key evidence that supports the presence of dysregulated neurometabolic and immunologic signaling and abnormal interaction with microbial species as putative etiological hallmarks of inflammation in depression as well as their contribution to the development of suicidal behavior. Furthermore, therapeutic insights addressing candidate mechanisms of pathological inflammation in these disorders are proposed.
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Affiliation(s)
- Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa 16132, Italy.
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland, Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland; Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI), Lugano, Switzerland
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa 16132, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa 16132, Italy
| | - Alice Trabucco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Andrea Escelsior
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa 16132, Italy
| | - Leo Sher
- James J. Peters VA Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychiatry, New York, NY, USA
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa 16132, Italy
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4
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Guo Y, Chen X, Gong P, Li Z, Wu Y, Zhang J, Wang J, Yao W, Yang W, Chen F. Advances in the mechanisms of polysaccharides in alleviating depression and its complications. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 109:154566. [PMID: 36610126 DOI: 10.1016/j.phymed.2022.154566] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/04/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Depression is one of the most serious mental illnesses worldwide that endangers the health of people. The pathogenesis of depression is complex and is associated with abnormal neurotransmitter levels, activation of the hypothalamic-pituitary-adrenal (HPA) axis, inflammation, and gut flora-related disorders. However, most of the current pharmacological therapies used to manage depression are inconsistent and are associated with side effects. Owing to their low toxicity and wide availability in nature, polysaccharides are gradually attracting attention and are being discovered to exert direct or indirect antidepressant effects. PURPOSE In this review, we have summarized the classification, dosage, and experimental models to study polysaccharides with antidepressant effects obtained from different sources. We have also reviewed the protective effects and underlying mechanisms of these polysaccharides in depression by modulating inflammation, the HPA axis, and intestinal flora. METHODS We searched the PubMed, Web of Science, and Google scholar databases and included studies that reported the use of polysaccharides in treating depression. RESULTS The unique benefits of natural polysaccharides as antidepressants lie in their potential to modulate inflammation, regulate the HPA axis, and regulate intestinal flora, giving full play to their antidepressant effects via multiple pathways and targets. CONCLUSION Natural polysaccharides may be a promising resource for use as adjuvant antidepressant therapy. Our study might therefore provide evidence for the development of polysaccharide resources as antidepressants.
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Affiliation(s)
- Yuxi Guo
- School of Food and Biological Engineering, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Xuefeng Chen
- School of Food and Biological Engineering, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Pin Gong
- School of Food and Biological Engineering, Shaanxi University of Science and Technology, Xi'an 710021, China.
| | - Zixuan Li
- Guangdong Engineering Research Center of Chinese Medicine & Disease Susceptibility, Jinan University, Guangzhou 510632, China
| | - Yanping Wu
- Guangdong Engineering Research Center of Chinese Medicine & Disease Susceptibility, Jinan University, Guangzhou 510632, China.
| | - Jie Zhang
- Department of Psychosomatic Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510000, China
| | - Jiating Wang
- School of Food and Biological Engineering, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Wenbo Yao
- School of Food and Biological Engineering, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Wenjuan Yang
- School of Food and Biological Engineering, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Fuxin Chen
- School of Chemistry and Chemical Engineering, Xi'an University of Science and Technology, Xi'an 710054, China
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5
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Krasieva K, Clair C, Gencer B, Carballo D, Klingenberg R, Räber L, Windecker S, Rodondi N, Matter CM, Lüscher TF, Mach F, Muller O, Nanchen D. Smoking cessation and depression after acute coronary syndrome. Prev Med 2022; 163:107177. [PMID: 35901973 DOI: 10.1016/j.ypmed.2022.107177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022]
Abstract
Smoking and depression are risk factors for acute coronary syndrome (ACS) that often co-exist. We investigated the evolution of depression according to smoking cessation one-year after ACS. Data from 1822 ACS patients of the Swiss multicenter SPUM-ACS cohort study were analyzed over a one-year follow-up. Participants were classified in three groups based on smoking status one-year post-ACS - continuous smokers, smokers who quit within the year, and non-smokers. Depression status at baseline and one-year was assessed with the Center for Epidemiologic Studies Depression scale (CES-D) and antidepressant drug use. A CES-D score ≥ 16 defined depression. A multivariate-adjusted logistic regression model was used to calculate odds ratios (OR) between groups. The study sample mean age was 62.4 years and females represented 20.8%. At baseline, 22.6% were depressed, 40.9% were smokers, and 47.5% of these quit smoking over the year post-ACS. In comparison to depressed continuous smokers, depressed smokers who quit had an adjusted OR 2.59 (95% confidence interval (CI) 1.27-5.25) of going below a CES-D score of 16 or not using antidepressants. New depression at one-year was found in 24.4% of non-depressed smokers who quit, and in 27.1% of non-depressed continuous smokers, with an adjusted OR 0.85 (95% CI 0.55-1.29) of moving to a CES-D score of ≥16 or using antidepressants. In conclusion, smokers with depression at time of ACS who quit smoking improved their depression more frequently compared to continuous smokers. The incidence of new depression among smokers who quit after ACS was similar compared to continuous smokers.
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Affiliation(s)
- Kristina Krasieva
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Carole Clair
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Baris Gencer
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - David Carballo
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lorenz Räber
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thomas F Lüscher
- Royal Brompton & Harefield Hospital Trust and Imperial College, London SW3 6NP, UK
| | - François Mach
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Nanchen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
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6
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Gong X, Chang R, Zou J, Tan S, Huang Z. The role and mechanism of tryptophan - kynurenine metabolic pathway in depression. Rev Neurosci 2022; 34:313-324. [PMID: 36054612 DOI: 10.1515/revneuro-2022-0047] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/13/2022] [Indexed: 12/22/2022]
Abstract
Major depressive disorder (MDD) is a common mental illness characterized by persistent low mood and anhedonia, normally accompanied with cognitive impairment. Due to its rising incidence and high rate of recurrence and disability, MDD poses a substantial threat to patients' physical and mental health, as well as a significant economic cost to society. However, the etiology and pathogenesis of MDD are still unclear. Chronic inflammation may cause indoleamine-2,3-dioxygenase (IDO) to become overactive throughout the body and brain, resulting in excess quinolinic acid (QUIN) and less kynuric acid (KYNA) in the brain. QUIN's neurotoxicity damages glial cells and neurons, accelerates neuronal apoptosis, hinders neuroplasticity, and causes depression due to inflammation. Therefore, abnormal TRP-KYN metabolic pathway and its metabolites have been closely related to MDD, suggesting changes in the TRP-KYN metabolic pathway might contribute to MDD. In addition, targeting TRP-KYN with traditional Chinese medicine showed promising treatment effects for MDD. This review summarizes the recent studies on the TRP-KYN metabolic pathway and its metabolites in depression, which would provide a theoretical basis for exploring the etiology and pathogenesis of depression.
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Affiliation(s)
- Xiaoli Gong
- Department of Clinical Laboratory, Fifth Affiliated Hospital, Southern Medical University, Guangzhou 510900, China
| | - Rui Chang
- Department of Histology and Embryology, School of Basic Medicine, Hengyang Medical School, University of South China, 28 W. Chang Sheng Road, Hengyang 421001, Hunan, China
| | - Ju Zou
- Department of Histology and Embryology, School of Basic Medicine, Hengyang Medical School, University of South China, 28 W. Chang Sheng Road, Hengyang 421001, Hunan, China
| | - Sijie Tan
- Department of Histology and Embryology, School of Basic Medicine, Hengyang Medical School, University of South China, 28 W. Chang Sheng Road, Hengyang 421001, Hunan, China
| | - Zeyi Huang
- Department of Clinical Laboratory, Fifth Affiliated Hospital, Southern Medical University, Guangzhou 510900, China.,Department of Histology and Embryology, School of Basic Medicine, Hengyang Medical School, University of South China, 28 W. Chang Sheng Road, Hengyang 421001, Hunan, China
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7
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Sandri BJ, Kim J, Lubach GR, Lock EF, Guerrero C, Higgins L, Markowski TW, Kling PJ, Georgieff MK, Coe CL, Rao RB. Multiomic Profiling of Iron Deficient Infant Monkeys Reveals Alterations in Neurologically Important Biochemicals in Serum and CSF Prior to the Onset of Anemia. Am J Physiol Regul Integr Comp Physiol 2022; 322:R486-R500. [PMID: 35271351 DOI: 10.1152/ajpregu.00235.2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The effects of iron deficiency (ID) during infancy extend beyond the hematologic compartment and include short- and long-term adverse effects on many tissues including the brain. However, sensitive biomarkers of iron-dependent brain health are lacking in humans. OBJECTIVE To determine whether serum and CSF biomarkers of ID-induced metabolic dysfunction are concordant in the pre/early anemic stage of ID prior to anemia in a nonhuman primate model of infantile IDA. METHODS Paired serum and CSF specimens were collected from iron-sufficient (IS; n = 12) and ID (n = 7) rhesus infants at 4-months (pre-anemic period) and 6-months of age (anemic). Hematological, metabolomic, and proteomic profiles were generated via HPLC/MS at both time points to discriminate serum bio markers of ID-induced brain metabolic dysfunction. RESULTS We identified 227 metabolites and 205 proteins in serum. Abnormalities indicating altered liver function, lipid dysregulation, and increased acute phase reactants were present in ID. In CSF, we measured 210 metabolites and 1,560 proteins with changes in ID infants indicative of metabolomic and proteomic differences indexing disrupted synaptogenesis. Systemic and CSF proteomic and metabolomic changes were present and concurrent in the pre-anemic and anemic periods. CONCLUSIONS Multiomic serum and CSF profiling uncovered pathways disrupted by ID in both the pre-anemic and anemic stages of infantile IDA, including evidence for hepatic dysfunction and activation of acute phase response. Parallel changes observed in serum and CSF potentially provide measurable serum biomarkers of ID that reflect at-risk brain processes prior to progression to clinical anemia.
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Affiliation(s)
- Brian J Sandri
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States.,Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Jonathan Kim
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Gabriele R Lubach
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, United States
| | - Eric F Lock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Candace Guerrero
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN, United States
| | - LeeAnn Higgins
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN, United States
| | - Todd W Markowski
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN, United States
| | - Pamela J Kling
- Division of Neonatology, Department of Pediatrics, University of Wisconsin, Madison, WI, United States
| | - Michael K Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States.,Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Christopher L Coe
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, United States
| | - Raghavendra B Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States.,Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
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8
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Nguyen MM, Perlman G, Kim N, Wu CY, Daher V, Zhou A, Mathers EH, Anita NZ, Lanctôt KL, Herrmann N, Pakosh M, Swardfager W. Depression in type 2 diabetes: A systematic review and meta-analysis of blood inflammatory markers. Psychoneuroendocrinology 2021; 134:105448. [PMID: 34687965 DOI: 10.1016/j.psyneuen.2021.105448] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 12/22/2022]
Abstract
The prevalence of depression is higher among people with type 2 diabetes (T2DM). Individually, both conditions are associated with systemic inflammation. This study aimed to summarize the clinical data comparing peripheral inflammatory markers in blood between people with T2DM, with and without comorbid depression. From 2187 records, we identified 20 original peer-reviewed articles from which blood inflammatory marker concentrations could be combined and compared between people with T2DM and comorbid depression (D) vs. no depression (ND) as standardized mean differences (SMD) in random effects meta-analysis. Concentrations of C-reactive protein (CRP; ND/NND = 1742/15244, SMD = 0.31 95% confidence interval [0.16, 0.45], Z16 = 4.03, p < 0.01; I2 = 84.0%) and interleukin-6 (IL-6; ND/NND = 677/4349, SMD = 0.17 [0.04, 0.30], Z4 = 2.58, p = 0.01; I2 = 48.1%), were higher, and concentrations of brain derived neurotrophic factor (BDNF; ND/NND = 358/1512, SMD = -0.37 95% confidence interval [-0.64,-0.10], Z2 = -2.68, p = 0.01; I2 = 61.2%) were lower, among those with depression. Depression in T2DM was associated with systemic inflammation and lower peripheral blood BDNF concentrations. Inconsistency between studies suggests the need to explore further population heterogeneity and pathophysiological elements. PROSPERO (CRD42020188509).
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Affiliation(s)
- Michelle M Nguyen
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada; Sleep and Cardiopulmonary Program, University Health Network - Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto M4G 2V6, Canada
| | - George Perlman
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada; Sleep and Cardiopulmonary Program, University Health Network - Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto M4G 2V6, Canada
| | - Nakyung Kim
- Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada
| | - Che-Yuan Wu
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada
| | - Valerie Daher
- Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada
| | - Angela Zhou
- Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada
| | - Emily H Mathers
- Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada
| | - Natasha Z Anita
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada; Sleep and Cardiopulmonary Program, University Health Network - Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto M4G 2V6, Canada
| | - Krista L Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada; Sleep and Cardiopulmonary Program, University Health Network - Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto M4G 2V6, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network - Toronto Rehabilitation Institute, Toronto M5G 2A2, Canada
| | - Walter Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada; Sleep and Cardiopulmonary Program, University Health Network - Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto M4G 2V6, Canada.
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9
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Wagner-Skacel J, Mörkl S, Dalkner N, Fellendorf F, Fitz W, Brix B, Neshev R, Wedenig S, Mächler P, Dorr A, Picha R, Rudlof ME, Bartel TO, Tatschl JM, Gostner JM, Bengesser SA, Reininghaus EZ, Jenewein J, Goswami N. The Impact of Cardiovascular Rehabilitation on Psychophysiological Stress, Personality and Tryptophan Metabolism: A Randomized Pilot Feasibility Study. Antioxidants (Basel) 2021; 10:antiox10091425. [PMID: 34573057 PMCID: PMC8467958 DOI: 10.3390/antiox10091425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 01/17/2023] Open
Abstract
Multicomponent cardiac rehabilitation (CR) is a secondary prevention strategy for cardiac patients to tackle stress and psychosocial wellbeing. However, there is a lack of data on its psychoneuroimmunological effects and of biomarkers to determine individual risk and to develop treatment strategies. We conducted a pilot randomized controlled trial (RCT) to investigate the feasibility of deriving psychophysiological stress markers in patients with cardiovascular diseases. Thirty individuals with cardiovascular disease (mean age 58.8 years; 23.3% female) were enrolled and randomized into three treatment groups: standard rehabilitation, yoga, or transcendental meditation (TM). Depression, anxiety, sleep, stress perception, personality functioning, hair cortisol, serum tryptophan, kynurenine and neopterin concentrations were estimated at baseline and after a four-week intervention. Hair cortisol levels decreased significantly after rehabilitation in all groups (F = 15.98, p < 0.001). In addition, personality functioning improved in all patients over time. Participants with impairments in personality functioning showed a positive correlation with baseline neopterin that did not remain significant after Bonferroni correction. Concentrations of serum tryptophan and its metabolite kynurenine did not change significantly. This pilot RCT provides preliminary evidence of multicomponent CR leading to stabilization of hair cortisol levels and improved psychophysiological wellbeing and personality functioning. Impairments in personality functioning were correlated with neopterin levels, which may impact the symptomatology and outcome.
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Affiliation(s)
- Jolana Wagner-Skacel
- Department of Medical Psychology and Psychotherapy, Medical University Graz, 8036 Graz, Austria; (J.W.-S.); (J.J.)
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
- Correspondence: ; Tel.: +43-316-3858-1743
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Frederike Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Werner Fitz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Bianca Brix
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
| | - Ruslan Neshev
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
| | - Sarah Wedenig
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Petra Mächler
- Rehabilitation Center for Cardiovascular Disease, 8061 St. Radegund, Austria; (P.M.); (A.D.); (R.P.)
| | - Andreas Dorr
- Rehabilitation Center for Cardiovascular Disease, 8061 St. Radegund, Austria; (P.M.); (A.D.); (R.P.)
| | - Rainer Picha
- Rehabilitation Center for Cardiovascular Disease, 8061 St. Radegund, Austria; (P.M.); (A.D.); (R.P.)
| | - Maximilian E. Rudlof
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
| | - Till O. Bartel
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
| | - Josef M. Tatschl
- Health Psychology Unit, Institute of Psychology, Karl-Franzens University of Graz, 8010 Graz, Austria;
| | - Johanna M. Gostner
- Biochemical Immunotoxicology Group, Institute of Medical Biochemistry, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Susanne A. Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Eva Z. Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Josef Jenewein
- Department of Medical Psychology and Psychotherapy, Medical University Graz, 8036 Graz, Austria; (J.W.-S.); (J.J.)
| | - Nandu Goswami
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
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10
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Ketelhuth DFJ. The immunometabolic role of indoleamine 2,3-dioxygenase in atherosclerotic cardiovascular disease: immune homeostatic mechanisms in the artery wall. Cardiovasc Res 2020; 115:1408-1415. [PMID: 30847484 DOI: 10.1093/cvr/cvz067] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/30/2019] [Accepted: 03/05/2019] [Indexed: 01/05/2023] Open
Abstract
Coronary heart disease and stroke, the two most common cardiovascular diseases worldwide, are triggered by complications of atherosclerosis. Atherosclerotic plaques are initiated by a maladaptive immune response triggered by accumulation of lipids in the artery wall. Hence, disease is influenced by several non-modifiable and modifiable risk factors, including dyslipidaemia, hypertension, smoking, and diabetes. Indoleamine 2,3-dioxygenase (IDO), the rate-limiting enzyme in the kynurenine pathway of tryptophan (Trp) degradation, is modulated by inflammation and regarded as a key molecule driving immunotolerance and immunosuppressive mechanisms. A large body of evidence indicates that IDO-mediated Trp metabolism is involved directly or indirectly in atherogenesis. This review summarizes evidence from basic and clinical research showing that IDO is a major regulatory enzyme involved in the maintenance of immunohomeostasis in the vascular wall, as well as current knowledge about promising targets for the development of new anti-atherosclerotic drugs.
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Affiliation(s)
- Daniel F J Ketelhuth
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.,Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, Univ. of Southern Denmark, J. B. Winsløws Vej 21(3), Odense C, Denmark
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11
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Troubat R, Barone P, Leman S, Desmidt T, Cressant A, Atanasova B, Brizard B, El Hage W, Surget A, Belzung C, Camus V. Neuroinflammation and depression: A review. Eur J Neurosci 2020; 53:151-171. [DOI: 10.1111/ejn.14720] [Citation(s) in RCA: 225] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 02/20/2020] [Accepted: 03/03/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | - Pascal Barone
- UMR 1253 iBrain Université de Tours Inserm Tours France
| | - Samuel Leman
- UMR 1253 iBrain Université de Tours Inserm Tours France
| | - Thomas Desmidt
- UMR 1253 iBrain Université de Tours Inserm Tours France
- CHRU de Tours Tours France
| | | | | | - Bruno Brizard
- UMR 1253 iBrain Université de Tours Inserm Tours France
| | - Wissam El Hage
- UMR 1253 iBrain Université de Tours Inserm Tours France
- CHRU de Tours Tours France
| | | | | | - Vincent Camus
- UMR 1253 iBrain Université de Tours Inserm Tours France
- CHRU de Tours Tours France
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12
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Zhang MD, Tao X, Pan RL, Wang LS, Li CC, Zhou YF, Liao YH, Chen SG, Chang Q, Liu XM. Antidepressant-like effects of cajaninstilbene acid and its related mechanisms in mice. Fitoterapia 2020; 141:104450. [DOI: 10.1016/j.fitote.2019.104450] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 12/23/2022]
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13
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Abstract
PURPOSE OF REVIEW This article reviews the relationship of the microbiome, the gut-brain axis, and depression. It also will review factors which can influence this relationship, such as chronic stress, medications, and the Western diet typically consumed by adolescents. RECENT FINDINGS Changes in the gut microbiome increase the release of microbial lipopolysaccharides (LPS) which activate a gut inflammatory response. Gut pro-inflammatory cytokines stimulate the afferent vagal nerve which in turn impacts the hypothalamic-pituitary-adrenal (HPA) axis inducing symptoms associated with depression. Recent research suggests that gut inflammation can induce neuroinflammation which, in turn, stimulates microglia activation and the kynurenine pathway and can activate systemic inflammation-inducing depressive symptoms. Promoting a healthy diet and lifestyle changes, limiting exposure to pesticides, limiting medications that affect the microbiome and the use of such things pre/probiotics and other interventions may complement existing efforts to curb the rise in depression. Alternative and complementary therapies may serve as effective treatments in adolescents with depression.
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Affiliation(s)
- Deborah R Simkin
- Department of Psychiatry, Emory School of Medicine, 4641 Gulfstarr Dr., Suite 106, Destin, FL, 32541, USA.
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14
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How acute and chronic physical disease may influence mental health - An Analysis of neurotransmitter precursor amino acid levels. Psychoneuroendocrinology 2019; 106:95-101. [PMID: 30959235 DOI: 10.1016/j.psyneuen.2019.03.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/12/2019] [Accepted: 03/27/2019] [Indexed: 11/20/2022]
Abstract
Patients with somatic diseases are more likely to develop depression than physically healthy individuals, and comorbid depression has been shown to incrementally worsen patients´ health. Physical conditions are known to influence neurotransmitter precursor amino acids, changes in which are associated with depressive symptoms. In this prospective study we investigated neurotransmitter precursor amino acids levels in patients with acute and chronic physical disease and evaluated their association with depressive symptoms. 177 subjects with and without chronic medical comorbidity (factor: chronic physical disease) admitted to the trauma and orthopaedic surgery ward for a surgical intervention (factor: acute physical disease) were included in the analysis. Chronic medical comorbidity was scored using Charlson Index and depressive and anxiety symptoms using the Hospital Anxiety and Depression Scale (HADS, factor: mental health). The effect of covariates was also evaluated. C-reactive protein (CRP), neopterin, kynurenine/tryptophan (KYN/TRP) and phenylalanine/tyrosine (PHE/TYR) were analysed by HPLC or ELISA prior to surgery and at discharge. Mixed Model as well as correlation analyses were performed. CRP and neopterin levels were influenced by the factors "acute physical disease" (both p < 0.001) and "chronic physical disease" (p = 0.024, p = 0.001 respectively). PHE/TYR, an index of the catecholamine pathway) was related to the factors "acute physical disease" (p < 0.001) and "mental health-depression" (p = 0.012), while KYN/TRP (an index of the kynurenine pathway affecting also serotonin) was associated with "chronic physical disease" (p = 0.005). No significant effect of "mental health-anxiety" was found. The effect of "mental health-depression" on PHE/TYR was more pronounced in females (gender p = 0.003). Differences in HADS depression values correlated with changes in PHE/TYR and both correlated with CRP values. In conclusion, inflammatory reactions related to acute or chronic physical conditions can influence the availability of neurotransmitter precursor amino acids l and these changes are associated with mental health.
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15
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Zhang B, Wang PP, Hu KL, Li LN, Yu X, Lu Y, Chang HS. Antidepressant-Like Effect and Mechanism of Action of Honokiol on the Mouse Lipopolysaccharide (LPS) Depression Model. Molecules 2019; 24:molecules24112035. [PMID: 31141940 PMCID: PMC6600641 DOI: 10.3390/molecules24112035] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 12/22/2022] Open
Abstract
There is growing evidence that neuroinflammation is closely linked to depression. Honokiol, a biologically active substance extracted from Magnolia officinalis, which is widely used in traditional Chinese medicine, has been shown to exert significant anti-inflammatory effects and improve depression-like behavior caused by inflammation. However, the specific mechanism of action of this activity is still unclear. In this study, the lipopolysaccharide (LPS) mouse model was used to study the effect of honokiol on depression-like behavior induced by LPS in mice and its potential mechanism. A single administration of LPS (1 mg/kg, intraperitoneal injection) increased the immobility time in the forced swimming test (FST) and tail suspension test (TST), without affecting autonomous activity. Pretreatment with honokiol (10 mg/kg, oral administration) for 11 consecutive days significantly improved the immobility time of depressed mice in the FST and TST experiments. Moreover, honokiol ameliorated LPS-induced NF-κB activation in the hippocampus and significantly reduced the levels of the pro-inflammatory cytokines; tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and interferon γ (IFN-γ). In addition, honokiol inhibited LPS-induced indoleamine 2,3-dioxygenase (IDO) activation and quinolinic acid (a toxic product) increase and reduced the level of free calcium in brain tissue, thereby inhibiting calcium overload. In summary, our results indicate that the anti-depressant-like effects of honokiol are mediated by its anti-inflammatory effects. Honokiol may inhibit the LPS-induced neuroinflammatory response through the NF-κB signaling pathway, reducing the levels of related pro-inflammatory cytokines, and furthermore, this may affect tryptophan metabolism and increase neuroprotective metabolites.
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Affiliation(s)
- Bo Zhang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
| | - Ping-Ping Wang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
| | - Kai-Li Hu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
| | - Li-Na Li
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China.
| | - Xue Yu
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China.
| | - Yi Lu
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China.
| | - Hong-Sheng Chang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
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16
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Swardfager W, Hennebelle M, Yu D, Hammock BD, Levitt AJ, Hashimoto K, Taha AY. Metabolic/inflammatory/vascular comorbidity in psychiatric disorders; soluble epoxide hydrolase (sEH) as a possible new target. Neurosci Biobehav Rev 2018; 87:56-66. [PMID: 29407524 DOI: 10.1016/j.neubiorev.2018.01.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/17/2018] [Accepted: 01/21/2018] [Indexed: 02/06/2023]
Abstract
The common and severe psychiatric disorders, including major depressive disorder (MDD) and bipolar disorder (BD), are associated with inflammation, oxidative stress and changes in peripheral and brain lipid metabolism. Those pathways are implicated in the premature development of vascular and metabolic comorbidities, which account for considerable morbidity and mortality, including increased dementia risk. During endoplasmic reticulum stress, the soluble epoxide hydrolase (sEH) enzyme converts anti-inflammatory fatty acid epoxides generated by cytochrome p450 enzymes into their corresponding and generally less anti-inflammatory, or even pro-inflammatory, diols, slowing the resolution of inflammation. The sEH enzyme and its oxylipin products are elevated post-mortem in MDD, BD and schizophrenia. Preliminary clinical data suggest that oxylipins increase with symptoms in seasonal MDD and anorexia nervosa, requiring confirmation in larger studies and other cohorts. In rats, a soluble sEH inhibitor mitigated the development of depressive-like behaviors. We discuss sEH inhibitors under development for cardiovascular diseases, post-ischemic brain injury, neuropathic pain and diabetes, suggesting new possibilities to address the mood and cognitive symptoms of psychiatric disorders, and their most common comorbidities.
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Affiliation(s)
- W Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Pharmacology & Toxicology, Faculty of Medicine, University of Toronto, Toronto, Canada; Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada; University Health Network Toronto Rehabilitation Institute, Toronto, Canada.
| | - M Hennebelle
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA
| | - D Yu
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Pharmacology & Toxicology, Faculty of Medicine, University of Toronto, Toronto, Canada; Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
| | - B D Hammock
- Department of Entomology and Nematology and Comprehensive Cancer Center UCDMC, University of California, Davis, CA, USA
| | - A J Levitt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - K Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - A Y Taha
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA
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17
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Haverkamp GL, Loosman WL, Franssen CF, Kema IP, van Diepen M, Dekker FW, Honig A, Siegert CE. The role of tryptophan degradation in the association between inflammatory markers and depressive symptoms in chronic dialysis patients. Nephrol Dial Transplant 2018; 32:1040-1047. [PMID: 27220752 DOI: 10.1093/ndt/gfw212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/09/2016] [Indexed: 01/08/2023] Open
Abstract
Background Among chronic dialysis patients, associations have been found between inflammatory markers and depressive symptoms. In this population, no studies have examined the mechanism linking the association between inflammatory markers and depressive symptoms. We examined whether the association between inflammatory markers and depressive symptoms is mediated by tryptophan (TRP) degradation along the kynurenine (KYN) pathway. Methods The data are part of an observational, prospective cohort study in five urban dialysis centres in The Netherlands. Depressive symptoms were determined with the Beck Depression Inventory. Peripheral blood was collected before dialysis to measure inflammatory markers [high sensitivity C-reactive protein (HsCRP), interleukin (IL)-1β, IL-6, IL-10 and tumour necrosis factor-α (TNF-α)], TRP, KYN and 3-hydroxykynurenine. The KYN/TRP ratio was used as a measure of TRP degradation. The association between inflammatory markers and depressive symptoms was determined using linear regression analysis and adjusted for the KYN/TRP ratio. Results In total, 490 chronic dialysis patients were included. HsCRP [ β = 3.8; confidence interval (CI): 1.0-6.6], IL-6 ( β = 9.1; CI: 4.0-14.1) and TNF-α ( β = 1.3; CI: 0.9-1.7) were associated with the KYN/TRP ratio. We found significant associations between HsCRP ( β = 0.8; CI: 0.3-1.3) and IL-6 ( β = 1.2; CI: 0.3-2.2) levels and depressive symptoms. However, this association was not attenuated after adjustment for the KYN/TRP ratio. Also, no significant associations were found between the KYN/TRP ratio and depressive symptoms. Conclusion The association between inflammatory markers and depressive symptoms in chronic dialysis patients was not mediated by TRP degradation along the KYN pathway.
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Affiliation(s)
- Gertrud L Haverkamp
- Department of Nephrology, OLVG west, Amsterdam, The Netherlands.,Department of Psychiatry, OLVG west, Amsterdam, The Netherlands
| | - Wim L Loosman
- Department of Nephrology, OLVG west, Amsterdam, The Netherlands.,Department of Psychiatry, OLVG west, Amsterdam, The Netherlands
| | - Casper F Franssen
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ido P Kema
- Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG west, Amsterdam, The Netherlands.,Department of Psychiatry, VU Medical Centre, Amsterdam, The Netherlands
| | - Carl E Siegert
- Department of Nephrology, OLVG west, Amsterdam, The Netherlands
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18
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Chaves Filho AJM, Lima CNC, Vasconcelos SMM, de Lucena DF, Maes M, Macedo D. IDO chronic immune activation and tryptophan metabolic pathway: A potential pathophysiological link between depression and obesity. Prog Neuropsychopharmacol Biol Psychiatry 2018; 80:234-249. [PMID: 28595944 DOI: 10.1016/j.pnpbp.2017.04.035] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 04/03/2017] [Accepted: 04/10/2017] [Indexed: 12/12/2022]
Abstract
Obesity and depression are among the most pressing health problems in the contemporary world. Obesity and depression share a bidirectional relationship, whereby each condition increases the risk of the other. By inference, shared pathways may underpin the comorbidity between obesity and depression. Activation of cell-mediated immunity (CMI) is a key factor in the pathophysiology of depression. CMI cytokines, including IFN-γ, TNFα and IL-1β, induce the catabolism of tryptophan (TRY) by stimulating indoleamine 2,3-dioxygenase (IDO) resulting in the synthesis of kynurenine (KYN) and other tryptophan catabolites (TRYCATs). In the CNS, TRYCATs have been related to oxidative damage, inflammation, mitochondrial dysfunction, cytotoxicity, excitotoxicity, neurotoxicity and lowered neuroplasticity. The pathophysiology of obesity is also associated with a state of aberrant inflammation that activates aryl hydrocarbon receptor (AHR), a pathway involved in the detection of intracellular or environmental changes as well as with increases in the production of TRYCATs, being KYN an agonists of AHR. Both AHR and TRYCATS are involved in obesity and related metabolic disorders. These changes in the TRYCAT pathway may contribute to the onset of neuropsychiatric symptoms in obesity. This paper reviews the role of immune activation, IDO stimulation and increased TRYCAT production in the pathophysiology of depression and obesity. Here we suggest that increased synthesis of detrimental TRYCATs is implicated in comorbid obesity and depression and is a new drug target to treat both diseases.
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Affiliation(s)
- Adriano José Maia Chaves Filho
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil; Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Camila Nayane Carvalho Lima
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil; Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Silvânia Maria Mendes Vasconcelos
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil; Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - David Freitas de Lucena
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil; Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Michael Maes
- Impact Strategic Research Center, Deakin University, Geelong, Australia; Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina, Brazil
| | - Danielle Macedo
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil; Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil.
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19
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Baumgartner R, Forteza MJ, Ketelhuth DFJ. The interplay between cytokines and the Kynurenine pathway in inflammation and atherosclerosis. Cytokine 2017; 122:154148. [PMID: 28899580 DOI: 10.1016/j.cyto.2017.09.004] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/01/2017] [Accepted: 09/02/2017] [Indexed: 12/20/2022]
Abstract
The kynurenine pathway (KP) is the major metabolic route of tryptophan (Trp) metabolism. Indoleamine 2,3-dioxygenase (IDO1), the enzyme responsible for the first and rate-limiting step in the pathway, as well as other enzymes in the pathway, have been shown to be highly regulated by cytokines. Hence, the KP has been implicated in several pathologic conditions, including infectious diseases, psychiatric disorders, malignancies, and autoimmune and chronic inflammatory diseases. Additionally, recent studies have linked the KP with atherosclerosis, suggesting that Trp metabolism could play an essential role in the maintenance of immune homeostasis in the vascular wall. This review summarizes experimental and clinical evidence of the interplay between cytokines and the KP and the potential role of the KP in cardiovascular diseases.
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Affiliation(s)
- Roland Baumgartner
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institute and Karolinska University Hospital, SE-17176 Stockholm, Sweden.
| | - Maria J Forteza
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institute and Karolinska University Hospital, SE-17176 Stockholm, Sweden
| | - Daniel F J Ketelhuth
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institute and Karolinska University Hospital, SE-17176 Stockholm, Sweden
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20
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Mapping inflammation onto mood: Inflammatory mediators of anhedonia. Neurosci Biobehav Rev 2016; 64:148-66. [PMID: 26915929 DOI: 10.1016/j.neubiorev.2016.02.017] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/30/2015] [Accepted: 02/18/2016] [Indexed: 12/20/2022]
Abstract
Evidence supports inflammatory involvement in mood and cognitive symptoms across psychiatric, neurological and medical disorders; however, inflammation is not a sensitive or specific characteristic of these diagnoses. The National Institute of Mental Health Research Domain Criteria (RDoC) ask for a shift away from symptom-based diagnoses toward a transdiagnostic neurobiological focus in the study of brain illnesses. The RDoC matrix may provide a useful framework for integrating the effects of inflammation on brain function. Based on preclinical and clinical findings, relevant relationships span negative and positive valence systems, cognitive systems, systems for social processes and arousal/regulatory systems. As an exemplar, we consider the psychopathological domain of anhedonia, conceptualizing the relevance of inflammation (e.g., cellular immunity) and downstream processes (e.g., indoleamine 2,3-dioxygenase activation and oxidative inactivation of tetrahydrobiopterin) across RDoC units of analysis (e.g., catecholamine neurotransmitter molecules, nucleus accumbens medium spiny neuronal cells, dopaminergic mesolimbic and mesocortical reward circuits, animal paradigms, etc.). We discuss implications across illnesses affecting the brain, including infection, major depressive disorder, stroke, Alzheimer's disease and type 2 diabetes.
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21
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Acute Psychological Stress Modulates the Expression of Enzymes Involved in the Kynurenine Pathway throughout Corticolimbic Circuits in Adult Male Rats. Neural Plast 2015; 2016:7215684. [PMID: 26819772 PMCID: PMC4706967 DOI: 10.1155/2016/7215684] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/26/2015] [Accepted: 09/02/2015] [Indexed: 11/17/2022] Open
Abstract
Tryptophan is an essential dietary amino acid that is necessary for protein synthesis, but also serves as the precursor for serotonin. However, in addition to these biological functions, tryptophan also serves as a precursor for the kynurenine pathway, which has neurotoxic (quinolinic acid) and neuroprotective (kynurenic acid) metabolites. Glucocorticoid hormones and inflammatory mediators, both of which are increased by stress, have been shown to bias tryptophan along the kynurenine pathway and away from serotonin synthesis; however, to date, there is no published data regarding the effects of stress on enzymes regulating the kynurenine pathway in a regional manner throughout the brain. Herein, we examined the effects of an acute psychological stress (120 min restraint) on gene expression patterns of enzymes along the kynurenine pathway over a protracted time-course (1–24 h post-stress termination) within the amygdala, hippocampus, hypothalamus, and medial prefrontal cortex. Time-dependent changes in differential enzymes along the kynurenine metabolism pathway, particularly those involved in the production of quinolinic acid, were found within the amygdala, hypothalamus, and medial prefrontal cortex, with no changes seen in the hippocampus. These regional differences acutely may provide mechanistic insight into processes that become dysregulated chronically in stress-associated disorders.
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22
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Hüfner K, Oberguggenberger A, Kohl C, Geisler S, Gamper E, Meraner V, Egeter J, Hubalek M, Beer B, Fuchs D, Sperner-Unterweger B. Levels in neurotransmitter precursor amino acids correlate with mental health in patients with breast cancer. Psychoneuroendocrinology 2015; 60:28-38. [PMID: 26112459 DOI: 10.1016/j.psyneuen.2015.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/01/2015] [Accepted: 06/01/2015] [Indexed: 12/19/2022]
Abstract
Breast cancer is the most common cancer among females. Approximately 30% of cancer patients develop depression or depressive adaptation disorder within 5 years post diagnosis. Low grade inflammation and subsequent changes in neurotransmitter levels could be the pathophysiological link. In the current study we investigated the association of neurotransmitter precursor amino acids with a diagnosis of depression or state anxiety in 154 subjects suffering from breast cancer (BCA(+)), depression (DPR(+)), both or neither. Sociodemographic parameters, severity of depressive symptoms, and state anxiety (ANX) were recorded. Neopterin, kynurenine/tryptophan and phenylalanine/tyrosine were analysed by HPLC or ELISA. Significantly higher serum neopterin values were found in DPR(+) patients (p = 0.034) and in ANX(+) subjects (p = 0.008), as a marker of Th1-related inflammation. The phenylalanine/tyrosine ratio (index of the catecholamine pathway) was associated with the factors "breast cancer" and "depression" and their interaction (all p < 0.001); it was highest in the DPR(+)BCA(+) group. The kynurenine/tryptophan ratio (index of the serotonin pathway) was significantly associated with the factors "breast cancer" and "state anxiety" and their interaction (p < 0.001, p = 0.026, p = 0.02, respectively); it was highest in the ANX(+)BCA(+) group. In BCA(+) patients kynurenine/tryptophan ratios correlated with severity of state anxiety (r = 0.226, p = 0.048, uncorrected) and phenylalanine/tyrosine ratios with severity of depressive symptoms (r = 0.376, p < 0.05, corrected). In conclusion, levels of neurotransmitter precursor amino acids correlate with mental health, an effect which was much more pronounced in BCA(+) patients than in BCA(-) subjects. Aside from identifying underlying pathophysiological mechanisms, these results could be the basis for future treatment studies: in BCA(+) patients with depression the use of serotonin-noradrenaline reuptake inhibitors might be recommended while in those with predominant anxiety selective serotonin reuptake inhibitors might be the treatment of choice.
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Affiliation(s)
- K Hüfner
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - A Oberguggenberger
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - C Kohl
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - S Geisler
- Division of Biological Chemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - E Gamper
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - V Meraner
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - J Egeter
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - M Hubalek
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - B Beer
- Institute of Legal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - D Fuchs
- Division of Biological Chemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - B Sperner-Unterweger
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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Réus GZ, Jansen K, Titus S, Carvalho AF, Gabbay V, Quevedo J. Kynurenine pathway dysfunction in the pathophysiology and treatment of depression: Evidences from animal and human studies. J Psychiatr Res 2015; 68:316-28. [PMID: 26028548 PMCID: PMC4955923 DOI: 10.1016/j.jpsychires.2015.05.007] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/29/2015] [Accepted: 05/07/2015] [Indexed: 12/16/2022]
Abstract
Treatment-resistant depression affects up to 20% of individuals suffering from major depressive disorder (MDD). The medications currently available to treat depression, including serotonin re-uptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs), fail to produce adequate remission of depressive symptoms for a large number of patients. The monoamine hypothesis upon which these medications are predicated should be expanded and revised as research elucidates alternative mechanisms of depression and effective methods to treat the underlying pathologic consequences. Research into the role of tryptophan degradation and the kynurenine pathway in the setting of inflammation has brought new insight into potential etiologies of MDD. Further investigation into the connection between inflammatory mediators, tryptophan degradation, and MDD can provide many targets for novel antidepressant therapies. Thus, this review will highlight the role of the kynurenine pathway in the pathophysiology of depression, as well as a novel therapeutic target to classic and new modulators to treat depression based on findings from preclinical and clinical studies.
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Affiliation(s)
- Gislaine Z. Réus
- Center for Translational Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA,Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil,Corresponding author: Gislaine Z. Réus, PhD, Center for Experimental Models in Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, 1941 East Road, Houston, TX 77054, USA. , Phone: +1 (713) 486 2653, Fax: +1 (713) 486 2553
| | - Karen Jansen
- Center for Translational Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA,Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Stephanie Titus
- Center for Translational Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
| | - André F. Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Vilma Gabbay
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - João Quevedo
- Center for Translational Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA,Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil
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Does tryptophan degradation along the kynurenine pathway mediate the association between pro-inflammatory immune activity and depressive symptoms? Psychoneuroendocrinology 2014; 45:202-10. [PMID: 24845191 DOI: 10.1016/j.psyneuen.2014.03.013] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 03/19/2014] [Accepted: 03/24/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Several studies have suggested that induced tryptophan (TRP) degradation through the kynurenine (KYN) pathway by the enzyme indoleamine 2,3-dioxygenase (IDO) is implicated in the relation between depression and inflammation. We investigated the role of tryptophan degradation in the relationship between inflammatory markers and depressive symptoms in the Netherlands Study of Depression and Anxiety (NESDA) and hypothesized that tryptophan degradation would mediate (part of) this association. METHODS 2812 Participants of NESDA were included in this study including 1042 persons with current major depressive disorder (MDD). Assessments of C-reactive protein (CRP), interleukin (IL)-6, tumor-necrosis factor (TNF)-α, KYN and TRP were obtained from fasting blood samples at the baseline assessment. Tryptophan degradation was estimated by calculating the ratio [KYN/TRP]. Depressive symptoms were measured with the Inventory of Depressive Symptomatology. RESULTS Significant associations between inflammation and depressive symptoms were found for CRP and IL-6, for the total group and the subgroup of patients with current MDD. Adjustment for KYN/TRP did not attenuate these associations. There were no significant indirect effects for CRP on depressive symptoms mediated by KYN/TRP for the whole group (B=-0.032; 95% CI: -0.103 to 0.028) and for the subgroup of patients with current MDD (B=0.059; 95% CI: -0.037 to 0.165). Also IL-6 did not indirectly affect depressive symptoms through KYN/TRP in the total group (B=-0.023; 95% CI: -0.093 to 0.045) and in the MDD subgroup B=0.052; 95% CI: -0.019 to 0.144). Finally, no significant relation between depressive symptoms and KYN/TRP was found in the whole group (β=-0.019, p=0.311) nor in the subgroup with MDD (β=0.025, p=0.424). CONCLUSIONS We did not find indications for tryptophan degradation, measured by KYN/TRP, to mediate the relationship between inflammation and depressive symptoms.
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Is there a role for glutamate-mediated excitotoxicity in inflammation-induced depression? J Neural Transm (Vienna) 2014; 121:925-32. [PMID: 24633997 DOI: 10.1007/s00702-014-1187-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/26/2014] [Indexed: 12/20/2022]
Abstract
Chronic inflammation in physically ill patients is often associated with the development of symptoms of depression. The mechanisms that are responsible for inflammation-associated depression have been elucidated over the last few years. Kynurenine produced from tryptophan in a reaction catabolized by indoleamine 2,3 dioxygenase is transported into the brain where it is metabolized by microglial enzymes into a number of neurotropic compounds including quinolinic acid, an agonist of N-methyl-D-aspartate receptors. Quinolinic acid can synergize with glutamate released by activated microglia. This chain of events opens the possibility to treat inflammation-induced depression using therapies that target the transport of kynurenine through the blood-brain barrier, the production of quinolinic acid and glutamate by activated microglia, or the efflux of glutamate from the brain to the blood.
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Mo X, Pi L, Yang J, Xiang Z, Tang A. Serum indoleamine 2,3-dioxygenase and kynurenine aminotransferase enzyme activity in patients with ischemic stroke. J Clin Neurosci 2014; 21:482-6. [DOI: 10.1016/j.jocn.2013.08.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/07/2013] [Accepted: 08/10/2013] [Indexed: 12/31/2022]
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Ling W, Zhang J, Yuan Z, Ren G, Zhang L, Chen X, Rabson AB, Roberts AI, Wang Y, Shi Y. Mesenchymal stem cells use IDO to regulate immunity in tumor microenvironment. Cancer Res 2014; 74:1576-87. [PMID: 24452999 DOI: 10.1158/0008-5472.can-13-1656] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Mesenchymal stem cells (MSC) are present in most, if not all, tissues and are believed to contribute to tissue regeneration and the tissue immune microenvironment. Murine MSCs exert immunosuppressive effects through production of inducible nitric oxide synthase (iNOS), whereas human MSCs use indoleamine 2,3-dioxygenase (IDO). Thus, studies of MSC-mediated immunomodulation in mice may not be informative in the setting of human disease, although this critical difference has been mainly ignored. To address this issue, we established a novel humanized system to model human MSCs, using murine iNOS(-/-) MSCs that constitutively or inducibly express an ectopic human IDO gene. In this system, inducible IDO expression is driven by a mouse iNOS promoter that can be activated by inflammatory cytokine stimulation in a similar fashion as the human IDO promoter. These IDO-expressing humanized MSCs (MSC-IDO) were capable of suppressing T-lymphocyte proliferation in vitro. In melanoma and lymphoma tumor models, MSC-IDO promoted tumor growth in vivo, an effect that was reversed by the IDO inhibitor 1-methyl-tryptophan. We found that MSC-IDO dramatically reduced both tumor-infiltrating CD8(+) T cells and B cells. Our findings offer an important new line of evidence that interventional targeting of IDO activity could be used to restore tumor immunity in humans, by relieving IDO-mediated immune suppression of MSCs in the tumor microenvironment as well as in tumor cells themselves.
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MESH Headings
- Animals
- B-Lymphocytes/immunology
- B-Lymphocytes/metabolism
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- Cell Proliferation
- Cells, Cultured
- Humans
- Indoleamine-Pyrrole 2,3,-Dioxygenase/genetics
- Indoleamine-Pyrrole 2,3,-Dioxygenase/immunology
- Indoleamine-Pyrrole 2,3,-Dioxygenase/metabolism
- Mesenchymal Stem Cells/immunology
- Mesenchymal Stem Cells/metabolism
- Mice
- Mice, Inbred C57BL
- Nitric Oxide Synthase Type II/genetics
- Nitric Oxide Synthase Type II/immunology
- Nitric Oxide Synthase Type II/metabolism
- Promoter Regions, Genetic/genetics
- Promoter Regions, Genetic/immunology
- Tumor Microenvironment/genetics
- Tumor Microenvironment/immunology
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Affiliation(s)
- Weifang Ling
- Authors' Affiliations: Child Health Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey; and Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences/Shanghai Jiao Tong University School of Medicine, Shanghai, China
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A review of peripheral biomarkers in major depression: the potential of inflammatory and oxidative stress biomarkers. Prog Neuropsychopharmacol Biol Psychiatry 2014; 48:102-11. [PMID: 24104186 DOI: 10.1016/j.pnpbp.2013.09.017] [Citation(s) in RCA: 241] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 09/11/2013] [Accepted: 09/26/2013] [Indexed: 11/21/2022]
Abstract
Biomarkers are regularly used in medicine to provide objective indicators of normal biological processes, pathogenic processes or pharmacological responses to therapeutic interventions, and have proved invaluable in expanding our understanding and treatment of medical diseases. In the field of psychiatry, assessment and treatment has, however, primarily relied on patient interviews and questionnaires for diagnostic and treatment purposes. Biomarkers in psychiatry present a promising addition to advance the diagnosis, treatment and prevention of psychiatric diseases. This review provides a summary on the potential of peripheral biomarkers in major depression with a specific emphasis on those related to inflammatory/immune and oxidative stress/antioxidant defences. The complexities associated with biomarker assessment are reviewed specifically around their collection, analysis and interpretation. Focus is placed on the potential of peripheral biomarkers to aid diagnosis, predict treatment response, enhance treatment-matching, and prevent the onset or relapse of major depression.
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Bensimon K, Herrmann N, Swardfager W, Yi H, Black SE, Gao FQ, Snaiderman A, Lanctôt KL. Kynurenine and depressive symptoms in a poststroke population. Neuropsychiatr Dis Treat 2014; 10:1827-35. [PMID: 25285006 PMCID: PMC4181733 DOI: 10.2147/ndt.s65740] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Depression is a commonly occurring and persistent sequel of stroke affecting approximately 29% of patients. An immunological hypothesis has been put forward, and synthesis of kynurenine from tryptophan has been proposed to link inflammatory activity with neurotoxicity and neurotransmitter dysfunction. This study assessed the relationship between peripheral blood kynurenine and poststroke depressive symptoms. PATIENTS AND METHODS This was a multisite cross-sectional observational cohort study of patients with ischemic stroke. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression (CES-D) scale and divided into high, medium, and low depressive symptom tertiles. Concentrations of kynurenine and tryptophan were assayed from fasting serum samples, and the kynurenine/tryptophan ratio was compared between tertiles. Serum cytokine concentrations were assayed in a subgroup of patients, and the ratio of proinflammatory (IL-6, IL-18, IFNγ, TNF, IL-1β) to anti-inflammatory (IL-10) cytokines compared. NLM IDENTIFIER NCT00254020. RESULTS In these patients (n=86, 52.3% male, mean age 71.7±14.2 years), there were no differences in kynurenine/tryptophan ratios between CES-D scale tertiles (F 2,76=0.04, P=0.96) controlling for relevant covariates. For cytokines (n=53), serum IL-1β concentrations (F 2,52=3.55, P=0.037) and serum ratios of IL-18/IL-10 (F 2,52=3.30, P=0.046), IFNγ/IL-10 (F 2,52=4.02, P=0.025), and IL-1β/IL-10 (F 2,52=4.34, P=0.019) were elevated in the middle CES-D tertile. Post hoc analyses suggested that serum ratios of IL-18/IL-10 (ρ=0.28, P=0.04), and IL-1β/IL-10 (ρ=0.43, P=0.001), as well as IL-1β (ρ=0.29, P=0.04), were significantly associated with fatigue. CONCLUSION Peripheral kynurenine/tryptophan ratios were not associated with depressive symptoms in a poststroke population. However, in exploratory analyses a proinflammatory bias was identified specifically in patients with mild depressive symptoms and associated with poststroke fatigue, suggesting an avenue for future research.
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Affiliation(s)
- Kira Bensimon
- Sunnybrook Research Institute, Toronto, ON, Canada ; Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nathan Herrmann
- Sunnybrook Research Institute, Toronto, ON, Canada ; Faculty of Medicine, University of Toronto, Toronto, ON, Canada ; Canadian Partnership for Stroke Recovery, Heart and Stroke Foundation, Ottawa, ON, Canada
| | - Walter Swardfager
- Sunnybrook Research Institute, Toronto, ON, Canada ; Faculty of Medicine, University of Toronto, Toronto, ON, Canada ; Toronto Rehabilitations Institute,Toronto, ON, Canada ; Canadian Partnership for Stroke Recovery, Heart and Stroke Foundation, Ottawa, ON, Canada
| | - Hao Yi
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Sandra E Black
- Sunnybrook Research Institute, Toronto, ON, Canada ; Faculty of Medicine, University of Toronto, Toronto, ON, Canada ; Toronto Rehabilitations Institute,Toronto, ON, Canada ; Canadian Partnership for Stroke Recovery, Heart and Stroke Foundation, Ottawa, ON, Canada
| | - Fu-Qiang Gao
- Sunnybrook Research Institute, Toronto, ON, Canada ; Canadian Partnership for Stroke Recovery, Heart and Stroke Foundation, Ottawa, ON, Canada
| | - Abraham Snaiderman
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada ; Toronto Rehabilitations Institute,Toronto, ON, Canada
| | - Krista L Lanctôt
- Sunnybrook Research Institute, Toronto, ON, Canada ; Faculty of Medicine, University of Toronto, Toronto, ON, Canada ; Toronto Rehabilitations Institute,Toronto, ON, Canada ; Canadian Partnership for Stroke Recovery, Heart and Stroke Foundation, Ottawa, ON, Canada
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Mazereeuw G, Herrmann N, Bennett SAL, Swardfager W, Xu H, Valenzuela N, Fai S, Lanctôt KL. Platelet activating factors in depression and coronary artery disease: a potential biomarker related to inflammatory mechanisms and neurodegeneration. Neurosci Biobehav Rev 2013; 37:1611-21. [PMID: 23800745 DOI: 10.1016/j.neubiorev.2013.06.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 05/07/2013] [Accepted: 06/13/2013] [Indexed: 02/02/2023]
Abstract
The persistence of a depressive episode in coronary artery disease (CAD) patients not only heightens the risk of acute ischemic events, but it is also associated with accelerated cognitive decline. Antidepressant interventions for depression in CAD have only modest effects and novel approaches are limited by a poor understanding of etiological mechanisms. This review proposes that the platelet activating factor (PAF) family of lipids might be associated with the persistence of a depressive episode and related neurodegenerative pathology in CAD due to their association with leading etiological mechanisms for depression in CAD such as inflammation, oxidative and nitrosative stress, vascular endothelial dysfunction, and platelet reactivity. The evidence implicating PAFs in CAD, vascular pathology, and neurodegenerative processes is also presented. We also propose future directions for the investigation of PAFs as mediators of persistent depression. In summary, PAFs are implicated in leading mechanisms associated with depression in CAD. PAFs may therefore be associated with the persistence of depression in CAD and related to neurodegenerative and cognitive sequelae.
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Affiliation(s)
- Graham Mazereeuw
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Neural Regeneration Laboratory, Ottawa Institute of Systems Biology, Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada; CIHR Training Program in Neurodegenerative Lipidomics, Canada
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Ristagno G, Fries M, Brunelli L, Fumagalli F, Bagnati R, Russo I, Staszewsky L, Masson S, Li Volti G, Zappalà A, Derwall M, Brücken A, Pastorelli R, Latini R. Early kynurenine pathway activation following cardiac arrest in rats, pigs, and humans. Resuscitation 2013; 84:1604-10. [PMID: 23774325 DOI: 10.1016/j.resuscitation.2013.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/22/2013] [Accepted: 06/06/2013] [Indexed: 12/28/2022]
Abstract
AIM OF THE STUDY Kynurenine pathway (KP) is a major route of the tryptophan (TRP) catabolism. In the present study, TRP and KP metabolites concentrations were measured in plasma from rats, pigs and humans after cardiac arrest (CA) in order to assess KP activation and its potential role in post-resuscitation outcome. METHODS Plasma was obtained from: (A) 24 rats, subjected to 6 min CA and 6 min of cardiopulmonary resuscitation (CPR); (B) 10 pigs, subjected to 10 min CA and 5 min CPR; and (C) 3 healthy human volunteers and 5 patients resuscitated from CA. KP metabolites were quantified by liquid chromatography multiple reaction monitoring mass spectrometry. Assessments were available at baseline, and 1-4h, and 3-5 days post-CA. RESULTS KP was activated after CA in rats, pigs, and humans. Decreases in TRP occurred during the post-resuscitation period and were accompanied by significant increases in its major metabolites, 3-hydroxyanthranilic acid (3-HAA) and kynurenic acid in each species, that persisted up to 3-5 days post-CA (p<0.01). In rats, changes in KP metabolites reflected changes in post-resuscitation myocardial function. In pigs, changes in TRP and increases in 3-HAA were significanlty related to the severity of cerebral histopathogical injuries. In humans, KP activation was observed, together with systemic inflammation. Post-CA increases in 3-HAA were greater in patients that did not survive. CONCLUSION In this fully translational investigation, the KP was activated early following resuscitation from CA in rats, pigs, and humans, and might have contributed to post-resuscitation outcome.
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Affiliation(s)
- Giuseppe Ristagno
- Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
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Swardfager W, Herrmann N, McIntyre RS, Mazereeuw G, Goldberger K, Cha DS, Schwartz Y, Lanctôt KL. Potential roles of zinc in the pathophysiology and treatment of major depressive disorder. Neurosci Biobehav Rev 2013; 37:911-29. [PMID: 23567517 DOI: 10.1016/j.neubiorev.2013.03.018] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 03/19/2013] [Accepted: 03/27/2013] [Indexed: 12/17/2022]
Abstract
Incomplete response to monoaminergic antidepressants in major depressive disorder (MDD), and the phenomenon of neuroprogression, suggests a need for additional pathophysiological markers and pharmacological targets. Neuronal zinc is concentrated exclusively within glutamatergic neurons, acting as an allosteric modulator of the N-methyl D-aspartate and other receptors that regulate excitatory neurotransmission and neuroplasticity. Zinc-containing neurons form extensive associational circuitry throughout the cortex, amygdala and hippocampus, which subserve mood regulation and cognitive functions. In animal models of depression, zinc is reduced in these circuits, zinc treatment has antidepressant-like effects and dietary zinc insufficiency induces depressive behaviors. Clinically, serum zinc is lower in MDD, which may constitute a state-marker of illness and a risk factor for treatment-resistance. Marginal zinc deficiency in MDD may relate to multiple putative mechanisms underlying core symptomatology and neuroprogression (e.g. immune dysfunction, monoamine metabolism, stress response dysregulation, oxidative/nitrosative stress, neurotrophic deficits, transcriptional/epigenetic regulation of neural networks). Initial randomized trials suggest a benefit of zinc supplementation. In summary, molecular and animal behavioral data support the clinical significance of zinc in the setting of MDD.
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Affiliation(s)
- Walter Swardfager
- Neuropharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
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Shanmugasegaram S, Russell KL, Kovacs AH, Stewart DE, Grace SL. Gender and sex differences in prevalence of major depression in coronary artery disease patients: a meta-analysis. Maturitas 2012; 73:305-11. [PMID: 23026020 DOI: 10.1016/j.maturitas.2012.09.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 06/25/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Depression is related to increased morbidity and mortality in the general population and among patients with coronary artery disease (CAD). The prevalence of major depression is two-times higher in women than men in the general population, but whether this pattern holds true in the CAD population has not been established. OBJECTIVE To test, through quantitative synthesis, whether women with CAD have a greater prevalence of major depression than men. METHOD MEDLINE, EMBASE, and PsycINFO electronic databases were searched. Authors of key articles were contacted to identify other relevant publications. The titles and abstracts were screened by the first author and the selected full-text articles were independently screened by the first and second authors based on pre-defined inclusion criteria. Major depression had to be diagnosed through structured clinical interviews during cardiac-related hospitalization or post-CAD hospitalization. Meta-analysis was undertaken using the Review Manager 5 software program. All pooled analyses were based on random-effects models. RESULTS Eight eligible cohort and cross-sectional studies reporting data for 2072 participants (509 [24.6%] women) were included. Overall, major depression was observed in 95 (18.7%) women and 187 (12.0%) men. In the pooled analysis, prevalence of major depression was significantly greater in women compared to men (odds ratio=1.77, 95% confidence interval=1.21-2.58, p<.01). Heterogeneity was considered low to moderate (I(2)=36.0%). CONCLUSION Consistent with the general population, the prevalence of major depression is two-times greater in women than men with CAD. Women with CAD may warrant greater emphasis in efforts to identify and treat depression.
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Leonard B, Maes M. Mechanistic explanations how cell-mediated immune activation, inflammation and oxidative and nitrosative stress pathways and their sequels and concomitants play a role in the pathophysiology of unipolar depression. Neurosci Biobehav Rev 2011; 36:764-85. [PMID: 22197082 DOI: 10.1016/j.neubiorev.2011.12.005] [Citation(s) in RCA: 595] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 11/24/2011] [Accepted: 12/10/2011] [Indexed: 12/17/2022]
Abstract
This paper reviews that cell-mediated-immune (CMI) activation and inflammation contribute to depressive symptoms, including anhedonia; anxiety-like behaviors; fatigue and somatic symptoms, e.g. illness behavior or malaise; and mild cognitive impairment (MCI). These effects are in part mediated by increased levels of pro-inflammatory cytokines (PICs), e.g. interleukin-1 (IL-1), IL-6 and tumor necrosis factor (TNF)α, and Th-1-derived cytokines, such as IL-2 and interferon (IFN)γ. Moreover, new pathways, i.e. concomitants and sequels of CMI activation and inflammation, were detected in depression: (1) Induction of indoleamine 2,3-dioxygenase (IDO) by IFNγ and some PICs is associated with depleted plasma tryptophan, which may interfere with brain 5-HT synthesis, and increased production of anxiogenic and depressogenic tryptophan catabolites. (2) Increased bacterial translocation may cause depression-like behaviors by activating the cytokine network, oxidative and nitrosative stress (O&NS) pathways and IDO. (3) Induction of O&NS causes damage to membrane ω3 PUFAs, functional proteins, DNA and mitochondria, and autoimmune responses directed against intracellular molecules that may cause dysfunctions in intracellular signaling. (4) Decreased levels of ω3 PUFAs and antioxidants, such as coenzyme Q10, glutathione peroxidase or zinc, are associated with an increased inflammatory potential; more oxidative damage; the onset of specific symptoms; and changes in the expression or functions of brain 5-HT and N-methyl-d-aspartate receptors. (5) All abovementioned factors cause neuroprogression, that is a combination of neurodegeneration, neuronal apoptosis, and lowered neurogenesis and neuroplasticity. It is concluded that depression may be the consequence of a complex interplay between CMI activation and inflammation and their sequels/concomitants which all together cause neuroprogression that further shapes the depression phenotype. Future research should employ high throughput technologies to collect genetic and gene expression and protein data from patients with depression and analyze these data by means of systems biology methods to define the dynamic interactions between the different cell signaling networks and O&NS pathways that cause depression.
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Affiliation(s)
- Brian Leonard
- Pharmacology Department, National University of Ireland, Galway, Ireland
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Elovainio M, Hurme M, Jokela M, Pulkki-Råback L, Kivimäki M, Hintsanen M, Hintsa T, Lehtimäki T, Viikari J, Raitakari OT, Keltikangas-Järvinen L. Moderating effect of indoleamine 2,3-dioxygenase (IDO) activation in the association between depressive symptoms and carotid atherosclerosis: evidence from the Young Finns study. J Affect Disord 2011; 133:611-4. [PMID: 21600662 DOI: 10.1016/j.jad.2011.04.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 04/21/2011] [Accepted: 04/21/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depression and inflammation have been suggested to be involved in the atherosclerotic processes, but empirical evidence is mixed. We tested the hypothesis that depressive symptoms are associated with atherosclerosis only when combined with other risk factors, such as inflammation indicated by indoleamine 2,3-dioxygenase (IDO) activation. METHODS Participants were 544 women and 442 men (aged 24-39 years) who participated in the Young Finns Study medical examinations in 2001 and 2007. At baseline (in 2001), IDO activity (tryptophan and kynurenine ratio) and other biological and behavioral risk factors were assessed and depressive symptoms were determined using a modified 21-item Beck Depression Inventory. Carotid atherosclerosis was measured on the basis of carotid intimamedia thickness (IMT) at baseline and again in 2007. RESULTS In women, IDO activity moderated the association between depressive symptoms and IMT (p=0.02), so that a longitudinal association between depressive symptoms and IMT was found only in combination with high IDO activity (B=0.21, p=0.009). This association was robust to adjustment for other risk factors except body mass index and lipids which largely removed the association. LIMITATIONS The results of this study need to be confirmed using larger data sets and studies using clinical cut-off point for depression. CONCLUSIONS These data suggest that depressive symptoms are associated with preclinical y carotid atherosclerosis only if they are linked to inflammation, and that this association is present only in women. Underlying mechanisms are unknown but probably relate to adiposity.
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Affiliation(s)
- Marko Elovainio
- Institute of Behavioural Sciences, P.O. Box 9, 00014 University of Helsinki, Finland.
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Maes M, Leonard BE, Myint AM, Kubera M, Verkerk R. The new '5-HT' hypothesis of depression: cell-mediated immune activation induces indoleamine 2,3-dioxygenase, which leads to lower plasma tryptophan and an increased synthesis of detrimental tryptophan catabolites (TRYCATs), both of which contribute to the onset of depression. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:702-21. [PMID: 21185346 DOI: 10.1016/j.pnpbp.2010.12.017] [Citation(s) in RCA: 468] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 12/07/2010] [Accepted: 12/16/2010] [Indexed: 02/07/2023]
Abstract
This paper reviews the body of evidence that not only tryptophan and consequent 5-HT depletion, but also induction of indoleamine 2,3-dioxygenase (IDO) and the detrimental effects of tryptophan catabolites (TRYCATs) play a role in the pathophysiology of depression. IDO is induced by interferon (IFN)γ, interleukin-6 and tumor necrosis factor-α, lipopolysaccharides and oxidative stress, factors that play a role in the pathophysiology of depression. TRYCATs, like kynurenine and quinolinic acid, are depressogenic and anxiogenic; activate oxidative pathways; cause mitochondrial dysfunctions; and have neuroexcitatory and neurotoxic effects that may lead to neurodegeneration. The TRYCAT pathway is also activated following induction of tryptophan 2,3-dioxygenase (TDO) by glucocorticoids, which are elevated in depression. There is evidence that activation of IDO reduces plasma tryptophan and increases TRYCAT synthesis in depressive states and that TDO activation may play a role as well. The development of depressive symptoms during IFNα-based immunotherapy is strongly associated with IDO activation, increased production of detrimental TRYCATs and lowered levels of tryptophan. Women show greater IDO activation and TRYCAT production following immune challenge than men. In the early puerperium, IDO activation and TRYCAT production are associated with the development of affective symptoms. Clinical depression is accompanied by lowered levels of neuroprotective TRYCATs or increased levels or neurotoxic TRYCATs, and lowered plasma tryptophan, which is associated with indices of immune activation and glucocorticoid hypersecretion. Lowered tryptophan and increased TRYCATs induce T cell unresponsiveness and therefore may exert a negative feedback on the primary inflammatory response in depression. It is concluded that activation of the TRYCAT pathway by IDO and TDO may be associated with the development of depressive symptoms through tryptophan depletion and the detrimental effects of TRYCATs. Therefore, the TRYCAT pathway should be a new drug target in depression. Direct inhibitors of IDO are less likely to be useful drugs than agents, such as kynurenine hydroxylase inhibitors; drugs which block the primary immune response; compounds that increase the protective effects of kynurenic acid; and specific antioxidants that target IDO activation, the immune and oxidative pathways, and 5-HT as well.
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Affiliation(s)
- M Maes
- Maes Clinics @ TRIA, Piyavate Hospital, 998 Rimklongsamsen Road, Bangkok 10310, Thailand.
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The relationship between indoleamine 2,3-dioxygenase activity and post-stroke cognitive impairment. J Neuroinflammation 2011; 8:17. [PMID: 21324164 PMCID: PMC3055827 DOI: 10.1186/1742-2094-8-17] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 02/16/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Activation of indoleamine 2,3-dioxygenase (IDO) and higher concentrations of several kynurenine metabolites have been observed post-stroke, where they have been associated with increased mortality. While lower tryptophan or a higher ratio of kynurenine/tryptophan (K/T) in peripheral blood have been associated with dementia and the severity of cognitive symptoms in Alzheimer's disease, the association between K/T ratios and post-stroke cognitive impairment (PSCI) has not been investigated. METHODS Patients were recruited from the acute stroke unit of a general hospital within 1 month post-stroke. Assessments included the Standardized Mini-Mental State Examination (sMMSE) for cognition, the National Institutes of Health Stroke Scale (NIHSS) for stroke severity, and the Center for Epidemiological Studies-Depression Scale (CES-D) for depressive symptoms. Tryptophan and kynurenine concentrations were determined by high-performance liquid chromatography. RESULTS A total of 41 patients with ischemic stroke ([mean ± SD] age 72.3 ± 12.2 years, 53.7% male, sMMSE 25.6 ± 4.1, NIHSS 7.27 ± 5.55) were recruited. Higher K/T ratios were associated with lower post-stroke global cognition (i.e. sMMSE scores; β = -.327, P = .037). A backward stepwise elimination linear regression (F1,40=6.15, P=.005, adjusted R2=.205) showed that the highest K/T ratio tertile (β = -.412, P = .006) predicted lower sMMSE scores, controlling for age (β = -.253, p = .081), with NIHSS (β = -.027, P = 0.859), and lesion volume (β = -.066, P = 0.659) removed from the model. In receiver operating characteristic analysis, a K/T ratio of 78.3 μmol/mmol (top tertile) predicted significant cognitive impairment (sMMSE score ≤ 24) with 67% sensitivity and 86% specificity (area under the curve = 0.730, p = .022). CONCLUSIONS These data suggest an inflammatory response characterized by IDO activation may be relevant to the development of PSCI. Since the neuroactivity of kynurenine metabolites may be amenable to pharmacotherapeutic intervention, the K/T ratio may be a clinically important biomarker.
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Kurz K, Schroecksnadel S, Weiss G, Fuchs D. Association between increased tryptophan degradation and depression in cancer patients. Curr Opin Clin Nutr Metab Care 2011; 14:49-56. [PMID: 21076293 DOI: 10.1097/mco.0b013e328340d849] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW A high percentage of patients with malignant disease develops mood disorders or even depression. This review provides an overview, how immune activation and tryptophan degradation might contribute to the development of depression. RECENT FINDINGS Neurobiochemical changes caused by immune activation are supposed to be involved in the development of mood disorders, especially depression, in cancer patients. Within Th1-type immune response the enzyme indoleamine 2,3-dioxygenase (IDO) is induced, which degrades the essential amino acid tryptophan to form kynurenine derivatives. Enhanced immune-mediated tryptophan degradation is reflected by decreased plasma tryptophan levels and increased kynurenine concentrations in parallel with elevated concentrations of Th1-type immune activation marker neopterin. IDO activation has been demonstrated in patients with various kinds of cancer, and it has also been shown to predict a worse outcome of patients. Recent data also indicate strongly, that immune-mediated tryptophan degradation is crucially involved in the development of depression: IDO activation leads to the accumulation of neurotoxic metabolites, which are supposed to induce depressive-like behaviour. Furthermore immune-mediated tryptophan deprivation might also impair serotonin synthesis, as tryptophan is the precursor of this important neurotransmitter. SUMMARY Immune-mediated tryptophan degradation appears to be crucially involved in the development of depression.
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Affiliation(s)
- Katharina Kurz
- Clinical Immunology and Infectious Diseases, Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
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Swardfager W, Lanctôt K, Rothenburg L, Wong A, Cappell J, Herrmann N. A meta-analysis of cytokines in Alzheimer's disease. Biol Psychiatry 2010; 68:930-41. [PMID: 20692646 DOI: 10.1016/j.biopsych.2010.06.012] [Citation(s) in RCA: 688] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 06/03/2010] [Accepted: 06/08/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND Studies suggest that inflammation is involved in the neurodegenerative cascade leading to Alzheimer's disease (AD) pathology and symptoms. This study sought to quantitatively summarize the clinical cytokine data. METHODS Original English language peer-reviewed studies measuring cytokine concentrations in AD and healthy control subjects were included. Mean (± standard deviation) cytokine concentrations for AD and control subjects were extracted. RESULTS Forty studies measuring peripheral blood cytokine concentrations and 14 measuring cerebrospinal fluid (CSF) cytokine concentrations were included. In peripheral blood, there were significantly higher concentrations (weighted mean difference [95% confidence interval]) of interleukin (IL)-6 (2.86 [1.68, 4.04] pg/mL, p < .00001, N[AD/control subjects] = 985/680, 14 studies), tumor necrosis factor (TNF)-α (3.25 [.76, 5.74] pg/mL, p = .01, N = 680/447, 14 studies), IL-1β (.55 [.32, .78] pg/mL, p < .00001, N = 574/370, 10 studies), transforming growth factor (TGF)-β (67.23 [28.62, 105.83] pg/mL, p = .0006, N = 190/158, 5 studies), IL-12 (7.60 [5.58, 9.62] pg/mL, p < .00001, N = 148/106, 5 studies), and IL-18 (15.82 [1.98, 29.66] pg/mL, p = .03, N = 131/94, 4 studies) but not of IL-4, IL-8, IL-10, interferon-γ, or C-reactive protein in AD subjects compared with control subjects. There were significantly higher concentrations of TGF-β (7.81 [2.27, 13.35] pg/mL, p =.006, N = 113/114, 5 studies) but not IL-6, TNF-α, and IL-1β in the CSF of AD subjects compared with control subjects. CONCLUSIONS These results strengthen the clinical evidence that AD is accompanied by an inflammatory response, particularly higher peripheral concentrations of IL-6, TNF-α, IL-1β, TGF-β, IL-12 and IL-18 and higher CSF concentrations of TGF-β.
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Affiliation(s)
- Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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Peripheral and cerebral metabolic abnormalities of the tryptophan-kynurenine pathway in a murine model of major depression. Behav Brain Res 2010; 210:84-91. [PMID: 20153778 DOI: 10.1016/j.bbr.2010.02.014] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 02/02/2010] [Accepted: 02/05/2010] [Indexed: 11/26/2022]
Abstract
Occurring both peripherally and centrally, the kynurenine pathway (KP) - an alternative pathway to 5-HT synthesis from tryptophan (TRP) - could be of particular value to better understand the link between peripheral changes of circulating levels of glucocorticoids (GC)/proinflammatory cytokines and altered neurotransmission observed in depressed patients. Indeed, it is activated by these mediators of stress and can produce several neuroactive compounds like quinolinic acid (QUIN) and kynurenic acid (KYNA) that can respectively increase and decrease glutamate concentration in brain. In order to characterize the role of both the peripheral and cerebral KP in the pathophysiology of depressive disorders, we used the Unpredictable Chronic Mild Stress (UCMS) to induce a depressive-like syndrome and we then measured the level of relevant TRP-KYN pathway metabolites: KYN, 3-hydroxykynurenine (3HK; precursor of QUIN) and KYNA. We also measured TRP-5HT pathway metabolites: TRP, 5-HT, 5-HIAA. We showed that UCMS increased TRP catabolism along the KP in the periphery. 5-HT and KYN were found to be strongly negatively correlated in all brain structures of control mice and of UCMS mice except in the hippocampus. More importantly we found that KYN was preferentially metabolized along the QUIN pathway at the subcortical level (amygdala/striatum) whereas, at the cortical level (cingulate cortex), the QUIN pathway was reduced. Considering the role of these metabolites on the glutamatergic neurotransmission, we propose that such KP alterations could participate to the cortical/subcortical glutamatergic alterations reported in depressed patients.
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