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In brain, most L-tryptophan is metabolized to indoleamines, whereas in systemic tissues
L-tryptophan is catabolized to kynurenine pathway metabolites. Among these latter
compounds are: quinolinic acid, an N-methyl-D-aspartate receptor agonist; kynurenic
acid, an antagonist of excitatory amino acid receptors that also reduces quinolinic
acid-mediated neurotoxicity; and L-kynurenine, a possible convulsant. Because the
metabolism of L-tryptophan through the kynurenine pathway is dependent upon adequate
nutrition, we sought to determine whether the impaired nutrition characteristic of
eating-disordered patients might be associated with specific disturbances in this
metabolic pathway. Cerebrospinal fluid levels of L-tryptophan, quinolinic acid, kynurenic
acid, L-kynurenine, and 5-hydroxyindoleacetic acid were measured in medication-free
female patients meeting DSM-III-R criteria for either anorexia nervosa (n = 10) or normal-weight bulimia nervosa (n = 22), studied at varying stages of nutritional recovery. Eight healthy, normal-weight
females served as a comparison group. Cerebrospinal fluid levels of kynurenic acid
were significantly reduced in underweight anorectics, compared to normal females,
but returned to normal values with restoration of normal body weight. Although cerebrospinal
fluid quinolinic acid levels were not different from controls, the ratio of quinolinic
acid to kynurenic acid was significantly increased during the underweight phase of
anorexia nervosa. Furthermore, in the eating-disordered patients, kynurenic acid levels
in cerebrospinal fluid correlated positively with percent-of-population average body
weight. Cerebrospinal fluid 5-hydroxyindoleacetic acid levels were reduced in underweight
patients with anorexia nervosa. These results indicate that perturbations in kynurenine
metabolism occur in patients with anorexia nervosa, possibly as a consequence of the
nutritional compromise associated with the underweight phase of the illness
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Article info
Publication history
Received in revised form:
May 25,
1994
Received:
August 23,
1993
Identification
Copyright
© 1995 Society of Biological Psychiatry. Published by Elsevier Inc.
