Kynurenine pathway metabolism and immune activation: Peripheral measurements in psychiatric and co-morbid conditions.

Immune activation is inextricably linked with dysregulation of the tryptophan metabolism, shifting catabolic routes towards oxidative breakdown along the kynurenine axis. Several enzymes are able to metabolize tryptophan, but activity of inducible indoleamine 2,3-dioxygenase (IDO-1) plays a major role under pro-inflammatory, interferon-γ (IFN-γ) dominated settings. Accelerated breakdown of tryptophan into kynurenine, dysregulation of further downstream metabolism and impaired enzymatic activities due to the absence of oxidation sensitive cofactors are associated with a broad variety of primary disorders and co-morbidities. Deprivation of the essential amino acid tryptophan suppresses growth of pathogens or tumor cells but also restricts T cell proliferation, which favors immunosuppression. In addition, diminished levels of tryptophan lead to lower synthesis of neurotransmitter serotonin, this being probably the most important biochemical cause of psychiatric co-morbidities associated with a broad variety of chronic inflammatory disorders. Also other frequent co-occurring symptoms and conditions such as anemia or cachexia may be at least partially caused by the lowered levels of the essential growth factor tryptophan. Tissue and cell specific expression of kynurenine downstream processing enzymes and their defective regulation may contribute to symptom diversification. Several kynurenine downstream metabolites show potent bioactivities, thus leading to the defects in a variety of affected target pathways. Measuring peripheral tryptophan breakdown, which is usually done by estimating the kynurenine to tryptophan ratio, in parallel to determination of other immune activation markers to confirm the involvement of IDO-1 activity in deregulated breakdown, is a reliable tool to monitor status and progression of a variety of disorders and has great potential to be applied to monitor treatments and to predict e.g. the necessity of psychiatric interventions before aggravation of symptoms, thus in helping to personalize therapeutic strategies. This article is part of the Special Issue entitled 'The Kynurenine Pathway in Health and Disease'. Copyright Â