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Reininghaus EZ, Lenger M, Schönthaler EMD, Fellendorf FT, Stross T, Schwarz M, Moll N, Reininghaus B, Dalkner N. Changes in tryptophan breakdown associated with response to multimodal treatment in depression. Front Psychiatry 2024; 15:1380620. [PMID: 38974918 PMCID: PMC11224482 DOI: 10.3389/fpsyt.2024.1380620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/03/2024] [Indexed: 07/09/2024] Open
Abstract
Background Research on depression showed that dysregulations in tryptophan (TRP), kynurenine (KYN), and its KYN pathway metabolites are key aspects in the development and maintenance of depressive symptoms. In our previous reports, we described sex-specific changes in TRP breakdown as well as changes in KYN and KYN/TRP in association with treatment response and inflammatory and metabolic parameters. However, results of treatment effects on KYN pathway metabolites as well as how pathway changes are related to treatment response remain sparse. Objective We investigated potential changes of KYN and KYN pathway metabolites in association with therapeutic response of individuals with depression during a six-week multimodal psychiatric rehabilitation program. Methods 87 participants were divided into treatment responders and non-responders (48 responders, 39 non-responders; 38 male, 49 female; M age = 51.09; SD age = 7.70) using scores of psychological questionnaires. KYN pathway metabolites serum concentrations as well as their ratios were collected using high performance liquid chromatography. Changes over time (time of admission (t1) vs. time of discharge (t2)) were calculated using repeated measure analyses of (co)variance. Results Non-responders exhibited higher levels of 3-Hydroxyanthralinic acid (3-HAA), nicotinic acid (NA), and 3-HAA/KYN, independently of measurement time. NA levels decreased, while 3-HAA levels increased over time in both groups, independently of treatment response. 3-HK/KYN levels decreased, while KYN levels increased in non-responders, but not in responders over time. Discussion The results indicate that some compounds of the KYN pathway metabolites can be altered through multimodal long-term interventions in association with treatment response. Especially the pathway degrading KYN further down to 3-HAA and 3-HK/KYN might be decisive for treatment response in depression.
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Affiliation(s)
- Eva Z. Reininghaus
- Clinical Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Melanie Lenger
- Clinical Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Elena M. D. Schönthaler
- Clinical Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Frederike T. Fellendorf
- Clinical Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Tatjana Stross
- Clinical Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Markus Schwarz
- Institute of Laboratory Medicine, University Hospital, Ludwig-Maximilian University (LMU), Munich, Munich, Germany
| | - Natalie Moll
- Institute of Laboratory Medicine, University Hospital, Ludwig-Maximilian University (LMU), Munich, Munich, Germany
| | - Bernd Reininghaus
- Clinical Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Nina Dalkner
- Clinical Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Heylen A, Vermeiren Y, Kema IP, van Faassen M, van der Ley C, Van Dam D, De Deyn PP. Brain Kynurenine Pathway Metabolite Levels May Reflect Extent of Neuroinflammation in ALS, FTD and Early Onset AD. Pharmaceuticals (Basel) 2023; 16:ph16040615. [PMID: 37111372 PMCID: PMC10143579 DOI: 10.3390/ph16040615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/04/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES Despite distinct clinical profiles, amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) patients share a remarkable portion of pathological features, with a substantial percentage of patients displaying a mixed disease phenotype. Kynurenine metabolism seems to play a role in dementia-associated neuroinflammation and has been linked to both diseases. We aimed to explore dissimilarities in kynurenine pathway metabolites in these early onset neurodegenerative disorders in a brain-region-specific manner. METHODS Using liquid chromatography mass spectrometry (LC-MS/MS), kynurenine metabolite levels were determined in the brain samples of 98 healthy control subjects (n = 20) and patients with early onset Alzheimer's disease (EOAD) (n = 23), ALS (n = 20), FTD (n = 24) or a mixed FTD-ALS (n = 11) disease profile. RESULTS Overall, the kynurenine pathway metabolite levels were significantly lower in patients with ALS compared to FTD, EOAD and control subjects in the frontal cortex, substantia nigra, hippocampus and neostriatum. Anthranilic acid levels and kynurenine-to-tryptophan ratios were consistently lower in all investigated brain regions in ALS compared to the other diagnostic groups. CONCLUSIONS These results suggest that the contribution of kynurenine metabolism in neuroinflammation is lower in ALS than in FTD or EOAD and may also be traced back to differences in the age of onset between these disorders. Further research is necessary to confirm the potential of the kynurenine system as a therapeutic target in these early onset neurodegenerative disorders.
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Affiliation(s)
- Annelies Heylen
- Laboratory of Neurochemistry and Behavior, Experimental Neurobiology Unit, University of Antwerp, 2610 Antwerp, Belgium
| | - Yannick Vermeiren
- Division of Human Nutrition and Health, Chair Group of Nutritional Biology, Wageningen University and Research, 6708 Wageningen, The Netherlands
- Faculty of Medicine & Health Sciences, Translational Neurosciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Ido P Kema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, 9713 Groningen, The Netherlands
| | - Martijn van Faassen
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, 9713 Groningen, The Netherlands
| | - Claude van der Ley
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, 9713 Groningen, The Netherlands
| | - Debby Van Dam
- Laboratory of Neurochemistry and Behavior, Experimental Neurobiology Unit, University of Antwerp, 2610 Antwerp, Belgium
- Department of Neurology and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9713 Groningen, The Netherlands
| | - Peter P De Deyn
- Laboratory of Neurochemistry and Behavior, Experimental Neurobiology Unit, University of Antwerp, 2610 Antwerp, Belgium
- Department of Neurology and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9713 Groningen, The Netherlands
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Pais ML, Martins J, Castelo-Branco M, Gonçalves J. Sex Differences in Tryptophan Metabolism: A Systematic Review Focused on Neuropsychiatric Disorders. Int J Mol Sci 2023; 24:ijms24066010. [PMID: 36983084 PMCID: PMC10057939 DOI: 10.3390/ijms24066010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Tryptophan (Tryp) is an essential amino acid and the precursor of several neuroactive compounds within the central nervous system (CNS). Tryp metabolism, the common denominator linking serotonin (5-HT) dysfunctions and neuroinflammation, is involved in several neuropsychiatric conditions, including neurological, neurodevelopmental, neurodegenerative, and psychiatric diseases. Interestingly, most of those conditions occur and progress in a sex-specific manner. Here, we explore the most relevant observations about the influence of biological sex on Tryp metabolism and its possible relation to neuropsychiatric diseases. Consistent evidence suggests that women have a higher susceptibility than men to suffer serotoninergic alterations due to changes in the levels of its precursor Tryp. Indeed, female sex bias in neuropsychiatric diseases is involved in a reduced availability of this amino acid pool and 5-HT synthesis. These changes in Tryp metabolism could lead to sexual dimorphism on the prevalence and severity of some neuropsychiatric disorders. This review identifies gaps in the current state of the art, thus suggesting future research directions. Specifically, there is a need for further research on the impact of diet and sex steroids, both involved in this molecular mechanism as they have been poorly addressed for this topic.
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Affiliation(s)
- Mariana Lapo Pais
- Doctoral Program in Biomedical Engineering, Faculty of Sciences and Technology, University of Coimbra, 3000-548 Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, 3000-548 Coimbra, Portugal
- Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, 3000-548 Coimbra, Portugal
| | - João Martins
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, 3000-548 Coimbra, Portugal
- Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, 3000-548 Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, 3000-548 Coimbra, Portugal
- Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Joana Gonçalves
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, 3000-548 Coimbra, Portugal
- Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, 3000-548 Coimbra, Portugal
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4
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Verma K, Chandra M, Prasad DN, Debnath C, Mohanty H, Kohli E, Reddy MPK. Alteration in cerebral blood flow, kynurenines with respect to mood profile in freshly recruited armed forces personnel. J Psychiatr Res 2022; 149:155-161. [PMID: 35276632 DOI: 10.1016/j.jpsychires.2022.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/23/2022] [Accepted: 02/28/2022] [Indexed: 11/18/2022]
Abstract
The present study is conducted to understand the association of mood profile with the kynurenine pathway (KP) metabolites, and cerebral hemodynamics in freshly recruited central armed forces personnel. Profile of Mood States questionnaire was utilized to assess mood profile, and Total Mood Disturbance (TMD) score was calculated. Transcranial Doppler was used to record blood flow velocity bilaterally of the middle cerebral artery. Chromatographic profile of the kynurenine metabolites was obtained in serum. Further, personnel were stratified according to sociodemographic variables (gender, age and diet) to observe the changes in their KP metabolic status. An activation of the kynurenic acid branch of the KP and the reduction in the mean blood flow velocity, and an increase in Gosling pulsatility index (PI) were observed in females having high TMD score. On gender comparative analysis, kynurenine metabolites of quinolinic acid branch and serotonin were significantly high in males. In males, with increase in age, a significant increase in the quinolinic acid branch of the KP was observed. Furthermore, a significant difference in level metabolites of the KP among the vegetarian and non-vegetarian groups was also observed. In conclusion we observed that increased TMD score was associated with cerebral hypoperfusion and higher vascular resistance along with activation of the KP. Our findings highlighted the importance of multi-facet brain function to showcase the close interaction of various dimensionalities and true picture of the assessee.
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Affiliation(s)
- Kalyani Verma
- Department of Neurobiology, Defence Institute of Physiology and Allied Sciences, DRDO, Timarpur, Delhi, India
| | - Mukesh Chandra
- Department of Cardio-Respiratory Physiology, Defence Institute of Physiology and Allied Sciences, DRDO, Timarpur, Delhi, India
| | - Dipti N Prasad
- Department of Neurobiology, Defence Institute of Physiology and Allied Sciences, DRDO, Timarpur, Delhi, India
| | - Chandan Debnath
- Indo Tibetan Border Police, CGO Complex, Ministry of Home Affairs, Delhi, India
| | - Haribandu Mohanty
- Indo Tibetan Border Police, CGO Complex, Ministry of Home Affairs, Delhi, India
| | - Ekta Kohli
- Department of Neurobiology, Defence Institute of Physiology and Allied Sciences, DRDO, Timarpur, Delhi, India.
| | - M Prasanna K Reddy
- Department of Cardio-Respiratory Physiology, Defence Institute of Physiology and Allied Sciences, DRDO, Timarpur, Delhi, India
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Tryptophan modulation in individuals with attention deficit hyperactivity disorder: a systematic review. J Neural Transm (Vienna) 2022; 129:361-377. [PMID: 35286460 PMCID: PMC9007797 DOI: 10.1007/s00702-022-02478-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/11/2022] [Indexed: 12/28/2022]
Abstract
The serotonergic system is implicated in ADHD, but the impact of serotonin’s precursor molecule, tryptophan, on ADHD symptomology remains unclear. Systematic searches of randomised controlled trials with an experimental tryptophan intervention in children and adults with ADHD identified 14 studies measuring core and related symptoms of the condition. Risk of bias was assessed using the Cochrane Risk of Bias tool. The 14 studies all used acute tryptophan depletion procedures, and most did not investigate core ADHD symptoms (inattention, impulsivity, hyperactivity) as primary outcome measures. Only two studies examined attention and revealed mixed effects of tryptophan. Similar effects were found for impulsivity in a small number of studies. No studies investigated hyperactivity. Most studies focused on reactive aggression, but samples were heterogenous and small, rendering potential meta-analyses inconclusive or misleading. However, the narrative analysis indicates tryptophan interventions may impact reactive aggression. More research is needed on the effect of tryptophan modulation on core ADHD symptoms, especially in adults, using more diverse samples to determine potential as an intervention. From current data, tryptophan modulation appears to alter aggressive behaviour in ADHD; however, the available studies were insufficient for the planned meta-analysis.
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6
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Tryptophan Metabolism in Bipolar Disorder in a Longitudinal Setting. Antioxidants (Basel) 2021; 10:antiox10111795. [PMID: 34829665 PMCID: PMC8615217 DOI: 10.3390/antiox10111795] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Immune-mediated inflammatory processes and oxidative stress are involved in the aetiopathogenesis of bipolar disorder (BD) and weight-associated comorbidities. Tryptophan breakdown via indoleamine 2,3-dioxygenase-1 (IDO-1) along the kynurenine axis concomitant with a pro-inflammatory state was found to be more active in BD, and associated with overweight/obesity. This study aimed to investigate tryptophan metabolism in BD compared to controls (C), stratified by weight classes, in a longitudinal setting, dependent on the incidence of BD episodes. Peripheral tryptophan, kynurenine, and neopterin were assessed in the serum of 226 BD individuals and 142 C. Three samples in a longitudinal assessment were used for 75 BD individuals. Results showed a higher kynurenine/tryptophan in both BD compared to C and overweight compared to normal weight persons. Levels remained stable over time. In the longitudinal course, no differences were found between individuals who were constantly euthymic or not, or who had an illness episode or had none. Findings indicate that tryptophan, kynurenine, and IDO-1 activity may play a role in pathophysiology in BD but are not necessarily associated with clinical manifestations. Accelerated tryptophan breakdown along the kynurenine axis may be facilitated by being overweight. This may increase the risk of accumulation of neurotoxic metabolites, impacting BD symptomatology, cognition, and somatic comorbidities.
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7
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Hajishafiee M, Ullrich SS, Fitzgerald PC, Horowitz M, Lange K, Poppitt SD, Feinle-Bisset C. Suppression of Energy Intake by Intragastric l-Tryptophan in Lean and Obese Men: Relations with Appetite Perceptions and Circulating Cholecystokinin and Tryptophan. J Nutr 2021; 151:2932-2941. [PMID: 34255069 DOI: 10.1093/jn/nxab218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/16/2021] [Accepted: 06/11/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND l-Tryptophan reduces energy intake in healthy men. The underlying mechanisms, including appetite, plasma cholecystokinin (CCK), tryptophan (Trp), and the ratio of Trp to large neutral amino acids (Trp:LNAAs ratio), and whether responses differ in lean and obese individuals, are uncertain. OBJECTIVES We evaluated the effects of intragastric Trp on energy intake (primary outcome) and their potential mechanisms, pre- and postmeal, in lean men and those with obesity. METHODS Twelve lean men [mean ± SD age: 30 ± 3 y; BMI (in kg/m2): 23 ± 1] and 13 men with obesity (mean ± SD age: 31 ± 3 y; BMI: 33 ± 1) received, on 3 separate occasions, in double-blind, randomized order, 3 g ("Trp-3") or 1.5 g ("Trp-1.5") Trp, or control ("C"), intragastrically, 30 min before a buffet-meal. Energy intake from the buffet-meal, hunger, fullness, and plasma CCK and amino acid concentrations were measured in response to Trp alone and for 2 h postmeal. Data were analyzed using maximum likelihood mixed-effects models, with treatment, group, and treatment-by-group interaction as fixed effects. RESULTS Trp alone increased plasma CCK, Trp, and the Trp:LNAAs ratio (all P < 0.001), with no difference between groups. Trp suppressed energy intake (P < 0.001), with no difference between groups (lean, C: 1085 ± 102 kcal, Trp-1.5: 1009 ± 92 kcal, Trp-3: 868 ± 104 kcal; obese, C: 1249 ± 98 kcal, Trp-1.5: 1217 ± 90 kcal, Trp-3: 1012 ± 100 kcal). Postmeal, fullness was greater after Trp-3 than after C and Trp-1.5 (all P < 0.05), and in men with obesity than in lean men (P < 0.05). Plasma Trp and the Trp:LNAAs ratio were greater after Trp-3 and Trp-1.5 than after C (all P < 0.001), and tended to be less in men with obesity than in the lean (P = 0.07) (Trp:LNAAs ratio: lean, C: 1.5 ± 0.2, Trp-1.5: 6.9 ± 0.7, Trp-3: 10.7 ± 1.4; obese, C: 1.4 ± 0.1, Trp-1.5: 4.6 ± 0.7, Trp-3: 7.8 ± 1.3). There were inverse correlations of energy intake with plasma Trp and the Trp:LNAAs ratio in both groups (lean, both r = -0.50, P < 0.01; obese, both r = -0.40, P < 0.05). CONCLUSIONS Intragastric Trp has potent energy intake-suppressant effects, in both lean men and those with obesity, apparently related to the Trp:LNAAs ratio.
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Affiliation(s)
- Maryam Hajishafiee
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Penelope Ce Fitzgerald
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Horowitz
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kylie Lange
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Sally D Poppitt
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Christine Feinle-Bisset
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
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8
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Hüfner K, Giesinger JM, Gostner JM, Egeter J, Koudouovoh-Tripp P, Vill T, Fuchs D, Sperner-Unterweger B. Neurotransmitter Precursor Amino Acid Ratios Show Differential, Inverse Correlations with Depression Severity in the Low and High Depression Score Range. Int J Tryptophan Res 2021; 14:11786469211039220. [PMID: 34483668 PMCID: PMC8414612 DOI: 10.1177/11786469211039220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/20/2021] [Indexed: 12/28/2022] Open
Abstract
The immunomodulatory capacity of mental stress is one of the basic concepts of
psychoneuroimmunology. The current prospective longitudinal study was designed
to evaluate the effect of acute mental stress on neurotransmitter precursor
amino acid levels in individuals with depression at 2 time points. Ten
physically healthy patients with a diagnosis of major depressive episode and
Montgomery–Åsberg Depression Rating Scale scores (MADRAS) ⩾20 points at
inclusion were assessed on 2 study days (once with higher MADRAS scores, once
with lower MADRAS scores; median 34.5 days apart) and subjected to a
standardized acute mental stress test on each study day. Blood was collected at
4 time points: once prior to and at 3 time points (0, 30 minutes, 60 minutes)
following mental stress. Neurotransmitter precursor amino acid levels, that is
kynurenine/tryptophan (KYN/TRP) and phenylalanine/tyrosine (PHE/TYR), as well as
neopterin and nitrite were analyzed in a total of 80 individual blood samples.
Regression and correlation analyses were performed. Regression analyses of
PHE/TYR (R2 = .547) and KYN/TRP
(R2 = .440) in relation to MADRAS depression
severity showed a quadratic curve fit. This was reflected by a negative linear
correlation between MADRAS scores and PHE/TYR as well as KYN/TRP in the lower
score range (r = −.805, P < .001 and
r = −.586, P < .001 respectively) and a
positive correlation in the higher MADRAS score range
(r = .713, P < .001 and
r = .379, P = .016 respectively). No effect of
acute mental stress was found. This analysis exemplifies the implications of
sampling as well as data distributions on results. The crosstalk of biological
mechanisms that orchestrate metabolic and immunological signaling may vary
depending on depression severity resulting in non-linear associations that may
explain the heterogeneity of results found in the literature.
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Affiliation(s)
- Katharina Hüfner
- University Clinic for Psychiatry II,
Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of
Innsbruck, Austria
- Katharina Hüfner, University Clinic for
Psychiatry II, Department of Psychiatry, Psychotherapy and Psychosomatics,
Medical University of Innsbruck, Anichstr. 35, Innsbruck 6020, Austria.
| | - Johannes M Giesinger
- University Clinic for Psychiatry II,
Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of
Innsbruck, Austria
| | - Johanna M Gostner
- Institute of Medical Biochemistry,
Biocenter, Medical University of Innsbruck, Austria
| | - Jonas Egeter
- University Clinic for Psychiatry II,
Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of
Innsbruck, Austria
| | - Pia Koudouovoh-Tripp
- University Clinic for Psychiatry II,
Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of
Innsbruck, Austria
- Division of Psychiatry and
Psychotherapeutic Medicine, Hospital St. Vinzenz Zams, Austria
| | - Theresa Vill
- University Clinic for Psychiatry II,
Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of
Innsbruck, Austria
| | - Dietmar Fuchs
- Institute of Biological Chemistry,
Biocenter, Medical University of Innsbruck, Austria
| | - Barbara Sperner-Unterweger
- University Clinic for Psychiatry II,
Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of
Innsbruck, Austria
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9
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Kink P, Egger EM, Lanser L, Klaunzner M, Holzner B, Willenbacher W, Kasseroler MT, Fuchs D, Weiss G, Kurz K. Immune Activation and Anemia Are Associated with Decreased Quality of Life in Patients with Solid Tumors. J Clin Med 2020; 9:jcm9103248. [PMID: 33053619 PMCID: PMC7601852 DOI: 10.3390/jcm9103248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/29/2020] [Accepted: 10/09/2020] [Indexed: 12/02/2022] Open
Abstract
Anemia often coincides with depression and impaired quality of life (QoL) in cancer patients. Sustained immune activation can lead to the development of anemia. Furthermore, it also may go along with changes in tryptophan and phenylalanine metabolism. The aim of our pilot study was to study the relationship between anemia, immune-mediated changes in amino acid metabolism, and the QoL and mood of cancer patients. Questionnaires to measure QoL and depression were completed by 152 patients with solid tumors. Hemoglobin, parameters of immune activation as well as tryptophan and phenylalanine metabolism were determined in the patients’ sera. Anemic patients (51.7%) presented with higher inflammatory markers, and a higher tryptophan breakdown with lower tryptophan concentrations. They reported an impaired QoL and had higher depression scores. Patients with an impaired QoL (65.8%) also suffered from more fatigue and impaired physical, emotional, and social functioning. They, furthermore, presented with higher concentrations of inflammatory markers (C-reactive protein (CRP) and neopterin) as well as higher tryptophan degradation (in men) and higher phenylalanine concentrations (in women). Sixty-one patients (40.1%) had (mostly mild) depression. In these patients, a higher degree of Th1 immune activation was found. The results of our study suggest that cancer-related anemia goes along with an impaired QoL, which is also associated with immune-mediated disturbances of tryptophan and phenylalanine metabolism.
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Affiliation(s)
- Patricia Kink
- Department of Internal Medicine II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (P.K.); (E.M.E.); (L.L.); (G.W.)
| | - Eva Maria Egger
- Department of Internal Medicine II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (P.K.); (E.M.E.); (L.L.); (G.W.)
| | - Lukas Lanser
- Department of Internal Medicine II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (P.K.); (E.M.E.); (L.L.); (G.W.)
| | - Michaela Klaunzner
- Department of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.K.); (B.H.)
| | - Bernhard Holzner
- Department of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.K.); (B.H.)
| | - Wolfgang Willenbacher
- Department of Internal Medicine V, Medical University of Innsbruck, 6020 Innsbruck, Austria; (W.W.); (M.T.K.)
- Oncotyrol Center for Personalized Cancer Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Maria Theresia Kasseroler
- Department of Internal Medicine V, Medical University of Innsbruck, 6020 Innsbruck, Austria; (W.W.); (M.T.K.)
- Oncotyrol Center for Personalized Cancer Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Dietmar Fuchs
- Institute of Biological Chemistry, Biocenter, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (P.K.); (E.M.E.); (L.L.); (G.W.)
| | - Katharina Kurz
- Department of Internal Medicine II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (P.K.); (E.M.E.); (L.L.); (G.W.)
- Correspondence: ; Tel.: +43-512-504-23260
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10
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Li H, Liu T, Heinsberg LW, Lockwood MB, Wainwright DA, Jang MK, Doorenbos AZ. Systematic Review of the Kynurenine Pathway and Psychoneurological Symptoms Among Adult Cancer Survivors. Biol Res Nurs 2020; 22:472-484. [PMID: 32602357 PMCID: PMC7708728 DOI: 10.1177/1099800420938141] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The co-occurrence of multiple psychoneurological symptoms, including pain, sleep disturbance, fatigue, depression, anxiety, and cognitive disturbance among adult cancer survivors led us to question which common biological mechanisms are shared among these conditions. Variances in tryptophan (Trp) levels and downstream metabolites of the kynurenine (Kyn) metabolic pathway are known to affect immune response and psychoneurological symptoms. The objective of this systematic review was to help us (a) better understand the role of the Kyn pathway in psychoneurological symptoms among adult cancer survivors and (b) identify common significant biomarkers across psychoneurological symptoms as a guide for future research. Some evidence has shown that decreased Trp levels and increased Kyn, Trp/Kyn ratio, and kynurenic acid/Trp ratio in parallel with immune activation are correlated with some psychoneurological symptoms among people undergoing cancer treatment, although discrepancies exist between studies. Kyn pathway activation could also be associated with psychoneurological symptoms among adult cancer survivors, but further research is needed to confirm its exact etiological role with respect to psychoneurological symptoms.
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Affiliation(s)
- Hongjin Li
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Tingting Liu
- Eleanor Mann School of Nursing, University of Arkansas, Fayetteville, AR, USA
| | - Lacey W Heinsberg
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, PA, USA
| | - Mark B Lockwood
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois, Chicago, IL, USA
| | - Derek A Wainwright
- Department of Neurological Surgery, Medicine (Hematology and Oncology) and Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Min Kyeong Jang
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Ardith Z Doorenbos
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
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Vidal R, García-Marchena N, O'Shea E, Requena-Ocaña N, Flores-López M, Araos P, Serrano A, Suárez J, Rubio G, Rodríguez de Fonseca F, Colado MI, Pavón FJ. Plasma tryptophan and kynurenine pathway metabolites in abstinent patients with alcohol use disorder and high prevalence of psychiatric comorbidity. Prog Neuropsychopharmacol Biol Psychiatry 2020; 102:109958. [PMID: 32360814 DOI: 10.1016/j.pnpbp.2020.109958] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/18/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alterations in tryptophan (TRP) metabolism has been linked to drug exposure and mental disorders. However, most of studies have been performed without considering the co-occurrence of both disorders in the context of addiction. This cross-sectional study examines TRP metabolism through the serotonin (5-HT) and kynurenine (KYN) pathways in subjects with alcohol use disorders (AUD) and high prevalence of psychiatric comorbidity. METHODS For this purpose, male and female abstinent AUD patients (N = 130) and healthy controls (N = 80) were clinically evaluated for substance use and mental disorders, and blood samples were collected to determine plasma concentrations of TRP, 5-HT, KYN and kynurenic acid (KA) using high performance liquid chromatography. Clinical and biochemical variables were analyzed for potential associations considering AUD, psychiatric comorbidity and sex. RESULTS TRP concentrations were significantly associated with an interaction effect between AUD diagnosis and sex (p < .01): TRP concentrations were lower in male AUD patients but higher in female AUD patients compared with their controls. KYN and KA concentrations were significantly associated with AUD diagnosis (p < .01 and p < .05, respectively). Thus, AUD patients showed significantly higher KYN concentrations and lower KA concentrations than controls. Regarding 5-HT concentrations, there were sex differences in the alcohol group (p < .05) and female AUD patients showed lower 5-HT concentrations than male AUD patients. Moreover, there was a significant interaction effect between psychiatric comorbidity and sex on TRP concentrations in the alcohol group (p < .01). Whereas male patients with both comorbid substance use and mental disorders showed lower TRP concentrations than male non-comorbid patients, female patients with comorbid mental disorders showed higher TRP concentrations than female non-comorbid patients. CONCLUSION While alterations in the KYN pathway appear to be directly associated with a history of AUD, altered TRP concentrations are associated with the presence of comorbid psychiatric disorders. Finally, sex differences in TRP metabolism must be considered in future studies.
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Affiliation(s)
- Rebeca Vidal
- Departamento Farmacología, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Nuria García-Marchena
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain; Unidad de Adicciones, Servicio de Medicina Interna, Institut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Esther O'Shea
- Departamento Farmacología, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Nerea Requena-Ocaña
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - María Flores-López
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Pedro Araos
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain; Facultad de Psicología, Universidad de Málaga, Málaga, Spain
| | - Antonia Serrano
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Juan Suárez
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Gabriel Rubio
- Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Fernando Rodríguez de Fonseca
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - María Isabel Colado
- Departamento Farmacología, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
| | - Francisco Javier Pavón
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain; Unidad Gestión Clínica del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
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12
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RAS inhibition modulates kynurenine levels in a CKD population with and without type 2 diabetes mellitus. Int Urol Nephrol 2020; 52:1125-1133. [PMID: 32314169 DOI: 10.1007/s11255-020-02469-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
Kynurenine pathway of tryptophan metabolism is involved in the pathophysiology of chronic kidney disease (CKD) and diabetes mellitus, mainly through the inflammation-induced activity of indoleamine 2,3-dioxygenase (IDO), and few studies have investigated its potential link with proteinuria. Renin-angiotensin system inhibitors (RASis) are recommended in these patients to decrease proteinuria, slow CKD progression and reduce cardiovascular risk, but whether these drugs influence kynurenine levels in humans is unknown. We evaluated serum tryptophan and kynurenine in patients suffering from CKD with or without type 2 diabetes mellitus, their correlations with markers of reduced kidney function, and their relationship with RAS-inhibiting therapy. Of 72 adult patients enrolled, 55 were receiving RASis, whereas 17 were not. Tryptophan was assessed by HPLC (high-performance liquid chromatography); kynurenine was measured using an enzyme-linked immunosorbent assay kit; IDO activity (%) was calculated with the formula (kynurenine/tryptophan) × 100. Kynurenine levels were significantly lower in the group under RASis compared to the untreated group (1.56 ± 0.79 vs 2.16 ± 1.51 µmol/l; P = 0.0378). In patients not receiving RASis, kynurenine was inversely related to estimated glomerular filtration rate (eGFR) (r = - 0.4862; P = 0.0478) and directly related to both proteinuria (ρ = 0.493; P = 0.0444) and albuminuria (ρ = 0.542; P = 0.0247). IDO activity was higher in patients with history of cardiovascular disease compared to patients with no such history, and it negatively correlated with eGFR (ρ = - 0.554; P = 0.0210) in the same group. These findings may contribute to explain the well-known beneficial effects of RAS inhibition in CKD population, especially considering that kynurenine is emerging as a potential new biomarker of CKD.
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