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The kynurenine pathway (KP), a major route of tryptophan catabolism, may be associated with the pathophysiology of depressive disorders. KP is responsible for ca. 99% of brain tryptophan metabolism via its degradation to kynurenine (KYN) catalyzed by indoleamine 2,3-dioxygenase (IDO). Some cytokines, such as interferon-γ (IFN-γ) and interleukin (IL)-6 are potent inducers of IDO. KYN is further converted by kynurenine aminotransferase (KAT) to the more neuroprotective kynurenic acid or by kynurenine 3-monooxygenase (KMO) to neurotoxic 3-hydroxykynurenine. The aim of the present study was to delineate whether the administration of imipramine (IMI) to rats subjected to chronic mild stress (CMS) may reverse behavioral changes induced by CMS in association with changes in immune-inflammatory markers and KP. We confirmed that the CMS procedure modeled one of the main symptoms of depression, i.e. anhedonia, and administration of IMI for 5 weeks resulted in a significant reduction in anhedonia in a majority of animals (CMS IMI-R animals), whereas 20% of animals did not respond to IMI treatment (CMS IMI-NR animals). We established that CMS procedure increased IFN-γ and IDO mRNA and decreased KAT II mRNA expression in the rat cortex. In the cortex and hippocampus, IMI treatment and non-responsiveness to IMI (in CMS IMI-NR animals) were associated with increased IL-6 mRNA expression. In the spleen, CMS increased production of IFN-γ and IL-6 proteins, while these cytokines were decreased by IMI in CMS IMI-R animals. Chronic IMI administration to CMS rats decreased IDO and KMO mRNA and protein expression and increased KAT II/KMO mRNA and protein ratio in IMI responders (CMS IMI-R) in comparison to CMS rats. In CMS IMI-NR rats, a significant increase in IDO mRNA expression and protein level in comparison with IMI responders was observed. Our findings indicate that resistance to therapeutic action of IMI could be explained by a deficiency of the inhibitory properties of IMI on IDO, KMO and KYN synthesis in the cortex. We conclude that the antidepressant activity of IMI may, at least in part, be explained by modulatory activities on the KAT II/KMO ratio in brain areas.

Brain glia possess the rate limiting enzyme indoleamine 2, 3-dioxygenase (IDO) which catalyses the conversion of tryptophan to kynurenine. Microglia also express kynurenine monooxygenase (KMO) and kynureninase (KYNU) which lead to the production of the free radical producing metabolites, 3-hydroxykynurenine and 3-hydroxyanthranillic acid respectively and subsequently production of the NMDA receptor agonist quinolinic acid. The aim of this study was to examine the effect of IFNγ-stimulated kynurenine pathway (KP) induction in microglia on neurite outgrowth and complexity, and to determine whether alterations could be abrogated using pharmacological inhibitors of the KP. BV-2 microglia were treated with IFNγ (5ng/ml) for 24h and conditioned media (CM) was placed on primary cortical neurons 3 days in vitro (DIV) for 48h. Neurons were fixed and neurite outgrowth and complexity was assessed using fluorescent immunocytochemistry followed by Sholl analysis. Results show increased mRNA expression of IDO, KMO and KYNU, and increased concentrations of tryptophan, kynurenine, and 3-hydroxykynurenine in the CM of IFNγ-stimulated BV-2 microglia. The IFNγ-stimulated BV-2 microglial CM reduced neurite outgrowth and complexity with reductions in various parameters of neurite outgrowth prevented when BV-2 microglia were pre-treated with either the IDO inhibitor, 1-methyltryptophan (1-MT) (L) (0.5mM; 30min), the KMO inhibitor, Ro 61-8048 (1μM; 30min), the synthetic glucocorticoid, dexamethasone (1μM; 2h) -which suppresses IFNγ-induced IDO - and the N-methyl-D-aspartate (NMDA) receptor antagonist, MK801 (0.1μM; 30min). Overall this study indicates that inhibition of the KP in microglia may be targeted to protect against reactive microglial-associated neuronal atrophy.

The role of hepatic tryptophan 2,3 dioxygenase (TDO) was assessed in the provocation of stress-induced depression-related behaviour in the rat. TDO drives tryptophan metabolism via the kynurenine pathway (KP) and leads to the production of neuroactive metabolites including kynurenine. A single 2 h period of restraint stress in adult male Sprague-Dawley rats provoked an increase in circulating concentrations of the glucocorticoid corticosterone and induction of hepatic TDO expression and activity. Repeated exposure to stress (10 d of 2 h restraint each day) provoked an increase in immobility in the forced swimming test (FST) indicative of depression-related behaviour. Immobility was accompanied by an increase in the circulating corticosterone concentrations, expression and activity of hepatic TDO and increase in the expression of TDO in the cerebral cortex. Increased TDO activity was associated with raised circulating kynurenine concentrations and a reduction in circulating tryptophan concentrations indicative of KP activation. Co-treatment with the TDO inhibitor allopurinol (20 mg/kg, i.p.), attenuated the chronic stress-related increase in immobility in the FST and the accompanying increase in circulating kynurenine concentrations. These findings indicate that stress-induced corticosterone and consequent activation of hepatic TDO, tryptophan metabolism and production of kynurenine provoke a depression-related behavioural phenotype. Inhibition of stress-related hepatic TDO activity promotes antidepressant activity. TDO may therefore represent a promising target for the treatment of depression associated with stress-related disorders in which there is evidence for KP activation.

Dysregulation of the GC system permitting excessive inflammation in the presence of elevated GCs occurs in depression, and is thought to be due to impaired GC signalling. We propose FKBP5, which acts to reduce GR activation, has a role in GC dysregulation. Glucocorticoid induced leucine zipper (GILZ) is a GC-inducible gene that is used as a readout of GR activation. The current objective was to examine the ability of IFN-α, IL-6, TNF-α, and IL-1β to impact GC sensitivity in microglia. These cytokines were chosen due to their implication in depression. The ability of these cytokines to alter mRNA expression of GR, FKBP5 and GILZ under basal conditions and in response to dexamethasone (DEX) in BV2 microglia was examined. Both IL-6 and IFN-α attenuated DEX-induced increases of GILZ, indicating the presence of GC resistance. IFN-α increased basal expression of FKBP5 and consistent with its negative feedback function attenuated DEX-induced FKBP5 expression. IL-6 did not alter basal expression of GR, FKBP5 or GILZ, but did attenuate the DEX-induced increases of FKBP5 and GILZ. Immunofluorescent staining shows that IFN-αand IL-6 reduce the degree of DEX-induced GR translocation and that IFN-α increased the co-localisation of GR and FKBP5. Taken together, IFN-α and IL-6 induce GC resistance in microglia and we hypothesise that IFN-α-induced increases in FKBP5 result in GR being held in the cytosol thereby preventing GC signalling.

The kynurenine pathway (KP) is the main pathway by which tryptophan is metabolized. Its rate limiting enzyme indolamine 2, 3-dioxygenase (IDO) catalyses the production of kynurenine, which in turn is metabolised by either kynurenine 3-hydroxylase (KMO) which leads to the production of quinolinic acid (neurotoxic), or by kynurenine aminotransferase (KAT II) which yields kynurenic acid (neuroprotective). These enzymes are localised in microglia and astrocytes respectively. The present studies demonstrated that IFN-γ induces expression of IDO, KMO and kynase along with the production of neurotoxic molecules from BV-2 microglia. This was determined using a cell culture system whereby microglia were activated with IFN-γ and this conditioned medium was then placed on primary cortical neurons. Inhibition of the kynurenine pathway with 1-(D)-methyl-tryptophan (IDO inhibitor) and Ro 61-8048 (KMO inhibitor) completely attenuated this microglial-mediated neurotoxicity, as did the NMDA antagonist MK-801. Furthermore the anti-depressant fluoxetine partially attenuated this neurotoxicity and IFN-γ induced increases in IDO and kynase mRNA expression. Inhibition of classical neurotoxic factors released from microglia i.e. iNOS and the enzyme NADPH oxidase had no effect on this microglial mediated neurotoxicity, and neither did the anti-inflammatory agent dexamethasone. These results propose IFN-γ activated microglia induce neurotoxicity by activating the KP, and this can be attenuated using fluoxetine, suggesting a possible role for anti-depressants in ameliorating neuronal damage and in influencing the KP balance.

LEARNING OUTCOME: Evaluate and improve the effectiveness or nutrition screening and assess timeliness of Medical Nutrition Therapy (MNT) for oncology patients receiving outpatient chemotherapy With a growing trend toward outpatient Treatment for oncology patients, it is likely that oncology patients will not be identified at nutritional risk through the traditional inpatient nutrition screening process. The nutrition and oncology clinic staff collaborated to develop a nutrition screening process for chemotherapy outpatients. To establish baseline performance, records of 15 patients receiving initial chemotherapy in June-July of 1995 were reviewed and weight status tracked. Initial findings showed 20% of the patients were at nutrition risk due to severe weight loss, however only 33% received MNT. A one page nutrition screening tool was developed using the Guidelines for Patient Generated Subjective Global Assessment and standard nutrition screening criteria. This screening was administered by nursing staff at cycle one, three and six and forwarded to the dietitian for assessment. After implementation for 10 months, the data was reviewed. One hundred percent of patients identified as being at nutrition risk received consults for MNT. Of those receiving consultation requests, 83% received MNT and 53% received MNT in a timely manner (within two weeks). Ninety one percent of patients were screened at cycle one, however, the percent of patient screened during cycles three and six could not be determined since these patients were not routinely tracked. The team decided to make the following changes: added nutrition morning to patient Hematology / Oncology Flow Sheet to ensure that it was completed, provided inservices for nutrition clinic and nursing personnel on the screening process, and established additional guidelines for screening patients receiving greater than six cycles. The new screening process will facilitate tailoring of MNT protocols based on risk category as well as set the stage for accurately measuring outcomes of MNT.