Aarsland Tore Ivar Malmei, Instanes Johanne Telnes, Posserud Maj-Britt Rocio, Ulvik Arve, Kessler Ute, Haavik Jan
Department of Biomedicine, University of Bergen, 5020 Bergen, Norway.
Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway.
Pharmaceuticals (Basel). 2022 Nov 19;15(11):1439. doi: 10.3390/ph15111439.
The kynurenine pathway of tryptophan (Trp) metabolism generates multiple biologically active metabolites (kynurenines) that have been implicated in neuropsychiatric disorders. It has been suggested that modulation of kynurenine metabolism could be involved in the therapeutic effect of electroconvulsive therapy (ECT). We performed a systematic review with aims of summarizing changes in Trp and/or kynurenines after ECT and assessing methodological issues. The inclusion criterium was measures of Trp and/or kynurenines before and after ECT. Animal studies and studies using Trp administration or Trp depletion were excluded. Embase, MEDLINE, PsycInfo and PubMed were searched, most recently in July 2022. Outcomes were levels of Trp, kynurenines and ratios before and after ECT. Data on factors affecting Trp metabolism and ECT were collected for interpretation and discussion of the reported changes. We included 17 studies with repeated measures for a total of 386 patients and 27 controls. Synthesis using vote counting based on the direction of effect found no evidence of effect of ECT on any outcome variable. There were considerable variations in design, patient characteristics and reported items. We suggest that future studies should include larger samples, assess important covariates and determine between- and within-subject variability. PROSPERO (CRD42020187003).
色氨酸（Trp）代谢的犬尿氨酸途径产生多种具有生物活性的代谢产物（犬尿氨酸），这些代谢产物与神经精神疾病有关。有人提出，犬尿氨酸代谢的调节可能与电休克治疗（ECT）的治疗效果有关。我们进行了一项系统综述，旨在总结ECT后色氨酸和/或犬尿氨酸的变化，并评估方法学问题。纳入标准是ECT前后色氨酸和/或犬尿氨酸的测量值。动物研究以及使用色氨酸给药或色氨酸耗竭的研究被排除在外。检索了Embase、MEDLINE、PsycInfo和PubMed，最近一次检索时间为2022年7月。结果是ECT前后色氨酸、犬尿氨酸的水平及比值。收集了影响色氨酸代谢和ECT的因素的数据，用于解释和讨论所报告的变化。我们纳入了17项重复测量研究，共涉及386例患者和27名对照。基于效应方向的投票计数法进行的综合分析未发现ECT对任何结果变量有影响的证据。在设计、患者特征和报告项目方面存在相当大的差异。我们建议未来的研究应纳入更大的样本，评估重要的协变量，并确定受试者间和受试者内的变异性。国际前瞻性系统评价注册库（CRD42020187003）。
