BACKGROUND Colorectal cancer(CRC)has a high incidence and mortality.Recent studies have shown that indole derivatives involved in gut microbiota metabolism can impact the tumorigenesis,progression,and metastasis of CR...BACKGROUND Colorectal cancer(CRC)has a high incidence and mortality.Recent studies have shown that indole derivatives involved in gut microbiota metabolism can impact the tumorigenesis,progression,and metastasis of CRC.AIM To investigate the effect of indole-3-acetaldehyde(IAAD)on CRC.METHODS The effect of IAAD was evaluated in a syngeneic mouse model of CRC and CRC cell lines(HCT116 and DLD-1).Cell proliferation was assessed by Ki-67 fluorescence staining and cytotoxicity tests.Cell apoptosis was analysed by flow cytometry after staining with Annexin V-fluorescein isothiocyanate and propidium iodide.Invasiveness was investigated using the transwell assay.Western blotting and real-time fluorescence quantitative polymerase chain reaction were performed to evaluate the expression of epithelial-mesenchymal transition related genes and aryl hydrocarbon receptor(AhR)downstream genes.The PharmMapper,SEA,and SWISS databases were used to screen for potential target proteins of IAAD,and the core proteins were identified through the String database.RESULTS IAAD reduced tumorigenesis in a syngeneic mouse model.In CRC cell lines HCT116 and DLD1,IAAD exhibited cytotoxicity starting at 24 h of treatment,while it reduced Ki67 expression in the nucleus.The results of flow cytometry showed that IAAD induced apoptosis in HCT116 cells but had no effect on DLD1 cells,which may be related to the activation of AhR.IAAD can also increase the invasiveness and epithelial-mesenchymal transition of HCT116 and DLD1 cells.At low concentrations(<12.5μmol/L),IAAD only exhibited cytotoxic effects without promoting cell invasion.In addition,predictions based on online databases,protein-protein interaction analysis,and molecular docking showed that IAAD can bind to matrix metalloproteinase-9(MMP9),angiotensin converting enzyme(ACE),poly(ADP-ribose)polymerase-1(PARP1),matrix metalloproteinase-2(MMP2),and myeloperoxidase(MPO).CONCLUSION Indole-3-aldehyde can induce cell apoptosis and inhibit cell proliferation to prevent the occurrence of CRC;however,at high concentrations(≥25μmol/L),it can also promote epithelial-mesenchymal transition and invasion in CRC cells.IAAD activates AhR and directly binds MMP9,ACE,PARP1,MMP2,and MPO,which partly reveals why it has a bidirectional effect.展开更多
Background Pectin is a heteropolysaccharide that acts as an intestinal immunomodulator,promoting intestinal development and regulating intestinal flora in the gut.However,the relevant mechanisms remain obscure.In this...Background Pectin is a heteropolysaccharide that acts as an intestinal immunomodulator,promoting intestinal development and regulating intestinal flora in the gut.However,the relevant mechanisms remain obscure.In this study,pigs were fed a corn-soybean meal-based diet supplemented with either 5%microcrystalline cellulose(MCC)or 5%pectin for 3 weeks,to investigate the metabolites and anti-inflammatory properties of the jejunum.Result The results showed that dietary pectin supplementation improved intestinal integrity(Claudin-1,Occludin)and inflammatory response[interleukin(IL)-10],and the expression of proinflammatory cytokines(IL-1β,IL-6,IL-8,TNF-α)was down-regulated in the jejunum.Moreover,pectin supplementation altered the jejunal microbiome and tryptophan-related metabolites in piglets.Pectin specifically increased the abundance of Lactococcus,Enterococcus,and the microbiota-derived metabolites(skatole(ST),3-indoleacetic acid(IAA),3-indolepropionic acid(IPA),5-hydroxyindole-3-acetic acid(HIAA),and tryptamine(Tpm)),which activated the aryl hydrocarbon receptor(AhR)pathway.AhR activation modulates IL-22 and its downstream pathways.Correlation analysis revealed the potential relationship between metabolites and intestinal morphology,intestinal gene expression,and cytokine levels.Conclusion In conclusion,these results indicated that pectin inhibits the inflammatory response by enhancing the AhR-IL22-signal transducer and activator of transcription 3 signaling pathway,which is activated through tryptophan metabolites.展开更多
Several studies have shown that the immune system is highly regulated by tryptophan metabolism,which serves as an immunomodulatory factor.The indoleamine 2,3-dioxygenase 1(IDO1),as an intracellular enzyme that partici...Several studies have shown that the immune system is highly regulated by tryptophan metabolism,which serves as an immunomodulatory factor.The indoleamine 2,3-dioxygenase 1(IDO1),as an intracellular enzyme that participates in metabolism of the essential amino acid tryptophan in the kynurenine pathway,is an independent prognostic marker for pancreatic cancer(PC).First,overexpression of IDO1 inhibits the maturation of dendritic cells and T-cell proliferation in the liver and spleen.Second,the high expression of kynurenine induces and activates the aryl hydrocarbon receptor,resulting in upregulated programmed cell death protein 1 expression.Third,the induction of IDO1 can lead to loss of the T helper 17 cell/regulatory T cell balance,mediated by the proximal tryptophan catabolite from IDO metabolism.In our study,we found that overexpression of IDO1 upregulated CD8+T cells and reduced natural killer T cells in pancreatic carcinoma in mice.Hence,it may be essential to pay more attention to tryptophan metabolism in patients,especially those who are tolerant to immunotherapy for PC.展开更多
Background Ochratoxin A(OTA)is a mycotoxin widely present in raw food and feed materials and is mainly pro-duced by Aspergillus ochraceus and Penicillium verrucosum.Our previous study showed that OTA principally induc...Background Ochratoxin A(OTA)is a mycotoxin widely present in raw food and feed materials and is mainly pro-duced by Aspergillus ochraceus and Penicillium verrucosum.Our previous study showed that OTA principally induces liver inflammation by causing intestinal flora disorder,especially Bacteroides plebeius(B.plebeius)overgrowth.However,whether OTA or B.plebeius alteration leads to abnormal tryptophan-related metabolism in the intestine and liver is largely unknown.This study aimed to elucidate the metabolic changes in the intestine and liver induced by OTA and the tryptophan-related metabolic pathway in the liver.Materials and methods A total of 30 healthy 1-day-old male Cherry Valley ducks were randomly divided into 2 groups.The control group was given 0.1 mol/L NaHCO3 solution,and the OTA group was given 235μg/kg body weight OTA for 14 consecutive days.Tryptophan metabolites were determined by intestinal chyme metabolomics and liver tryptophan-targeted metabolomics.AMPK-related signaling pathway factors were analyzed by Western blot-ting and mRNA expression.Results Metabolomic analysis of the intestinal chyme showed that OTA treatment resulted in a decrease in intesti-nal nicotinuric acid levels,the downstream product of tryptophan metabolism,which were significantly negatively correlated with B.plebeius abundance.In contrast,OTA induced a significant increase in indole-3-acetamide levels,which were positively correlated with B.plebeius abundance.Simultaneously,OTA decreased the levels of ATP,NAD+and dipeptidase in the liver.Liver tryptophan metabolomics analysis showed that OTA inhibited the kynurenine metabolic pathway and reduced the levels of kynurenine,anthranilic acid and nicotinic acid.Moreover,OTA increased the phosphorylation of AMPK protein and decreased the phosphorylation of mTOR protein.Conclusion OTA decreased the level of nicotinuric acid in the intestinal tract,which was negatively correlated with B.plebeius abundance.The abnormal metabolism of tryptophan led to a deficiency of NAD+and ATP in the liver,which in turn activated the AMPK signaling pathway.Our results provide new insights into the toxic mechanism of OTA,and tryptophan metabolism might be a target for prevention and treatment.展开更多
Background: Tryptophan metabolites such as serotonin, kynurenine, or kynurenic acids are considered to be the most important metabolites of gut microbiota. We wanted to know about changes in tryptophan metabolites in ...Background: Tryptophan metabolites such as serotonin, kynurenine, or kynurenic acids are considered to be the most important metabolites of gut microbiota. We wanted to know about changes in tryptophan metabolites in various diseases in which the etiology gut microbiota are considered to participate. Methods: Ultra-high speed liquid chromatography/mass spectroscopy (LC/MS) has been used to analyze simultaneously all the tryptophan metabolites, which we have explored for the first time in the world. Results: We analyzed plasma levels of tryptophan metabolites in patients with depression, autism, diabetes mellitus ‘DM’), and acute coronary syndrome (ACS). Of all the metabolites serotonin and kynurenine levels of these patients were higher than those of controls. Conclusion: Measurements of tryptophan metabolites in plasma of various diseases are important to know roles of gut microbiota in etiology, further therapeutic measures.展开更多
目的探究N-乙酰半胱氨酸对支气管哮喘大鼠CXC趋化因子配体(CXCL)8-CXC趋化因子受体(CXCR)1/2及瞬时受体电位通道蛋白(TRP)V1神经元敏感性的影响。方法选取80只SPF级SD雄性大鼠,随机分为正常(NO)组、模型(MO)组、N-乙酰半胱氨酸(NAC)组...目的探究N-乙酰半胱氨酸对支气管哮喘大鼠CXC趋化因子配体(CXCL)8-CXC趋化因子受体(CXCR)1/2及瞬时受体电位通道蛋白(TRP)V1神经元敏感性的影响。方法选取80只SPF级SD雄性大鼠,随机分为正常(NO)组、模型(MO)组、N-乙酰半胱氨酸(NAC)组、急支糖浆(ES)组,每组20只,对MO组、NAC组、ES组进行支气管哮喘建模,建模成功后,NAC组、ES组每天分别于腹腔内注射2 ml N-乙酰半胱氨酸注射液、急支糖浆灌胃10 g/kg剂量,NO组、MO组同期灌胃同体积生理盐水,通过苏木素-伊红(HE)染色法检测肺组织病理形态、酶联免疫吸附试验(ELISA)、实时荧光定量聚合酶链反应(RT-PCR)、Western印迹检测血清及肺组织中CXCL8、CXCR1、CXCR2、TRPV1含量、mRNA及蛋白表达,并分析N-乙酰半胱氨酸对支气管哮喘大鼠CXCL8-CXCR1/2及TRPV1神经元敏感性。结果与NO组相比,MO组咳嗽次数明显增加(P<0.05),而NAC组、ES组与MO组相比,其咳嗽次数明显降低(P<0.05),且NAC组比ES组降低明显(P<0.05);与NO组相比,MO组细支气管管腔、肺泡腔内可见渗出液、脱落的上皮细胞等,远端肺泡可见局部肺不张及周围肺大泡,且肺间质明显增厚,炎性细胞浸润明显,而与MO组比较,ES组、NAC组症状明显减少,部分肺间质的组织结构趋向正常,部分肺泡轻度扩张,且NAC组比ES组明显降低(P<0.05);与NO组对比,MO组CXCL8、CXCR1、CXCR2、TRPV1含量、mRNA及蛋白表达均明显升高(P<0.05),NAC组、ES组与MO组相比均显著降低(P<0.05),且NAC组比ES组明显降低(P<0.05)。结论N-乙酰半胱氨酸可以显著降低咳嗽次数,减少支气管哮喘症状,可使CXCL8-CXCR1/2及TRPV1神经元敏感性显著降低。展开更多
Serotonin deficiency in major depressive disorder(MDD)has formed the basis of antidepressant drug development and was originally attributed to induction of the major tryptophan(Trp)-degrading enzyme,liver Trp 2,3-diox...Serotonin deficiency in major depressive disorder(MDD)has formed the basis of antidepressant drug development and was originally attributed to induction of the major tryptophan(Trp)-degrading enzyme,liver Trp 2,3-dioxygenase(TDO),by cortisol,leading to decreased Trp availability to the brain for serotonin synthesis.Subsequently,the serotonin deficiency was proposed to involve induction of the extrahepatic Trp-degrading enzyme indoleamine 2,3-dioxygenase(IDO)by proinflammatory cytokines,with inflammation being the underlying cause.Recent evidence,however,challenges this latter concept,as not all MDD patients are immune-activated and,when present,inflammation is mild and/or transient.A wide range of antidepressant drugs inhibit the activity of liver TDO and bind specifically to the enzyme,but not to IDO.IDO induction is not a major event in MDD,but,when it occurs,its metabolic consequences may be masked and overridden by upregulation of kynurenine monooxygenase(KMO),the gateway to production of modulators of immune and neuronal functions.KMO appears to be activated in MDD by certain proinflammatory cytokines and antidepressants with anti-inflammatory properties may block this activation.We demonstrate the ability of the antidepressant ketamine to dock(bind)to KMO.The pathophysiology of MDD may be underpinned by both the serotonin deficiency and glutamatergic activation mediated respectively by TDO induction and N-methyl-D-aspartate receptor activation.Inhibition of TDO and KMO should be the focus of MDD pharmacotherapy.展开更多
基金Supported by Zhejiang Provincial Natural Science Foundation of China,No.LTGD23C040008,No.LBY23H200006,and No.LQ22H030004.
文摘BACKGROUND Colorectal cancer(CRC)has a high incidence and mortality.Recent studies have shown that indole derivatives involved in gut microbiota metabolism can impact the tumorigenesis,progression,and metastasis of CRC.AIM To investigate the effect of indole-3-acetaldehyde(IAAD)on CRC.METHODS The effect of IAAD was evaluated in a syngeneic mouse model of CRC and CRC cell lines(HCT116 and DLD-1).Cell proliferation was assessed by Ki-67 fluorescence staining and cytotoxicity tests.Cell apoptosis was analysed by flow cytometry after staining with Annexin V-fluorescein isothiocyanate and propidium iodide.Invasiveness was investigated using the transwell assay.Western blotting and real-time fluorescence quantitative polymerase chain reaction were performed to evaluate the expression of epithelial-mesenchymal transition related genes and aryl hydrocarbon receptor(AhR)downstream genes.The PharmMapper,SEA,and SWISS databases were used to screen for potential target proteins of IAAD,and the core proteins were identified through the String database.RESULTS IAAD reduced tumorigenesis in a syngeneic mouse model.In CRC cell lines HCT116 and DLD1,IAAD exhibited cytotoxicity starting at 24 h of treatment,while it reduced Ki67 expression in the nucleus.The results of flow cytometry showed that IAAD induced apoptosis in HCT116 cells but had no effect on DLD1 cells,which may be related to the activation of AhR.IAAD can also increase the invasiveness and epithelial-mesenchymal transition of HCT116 and DLD1 cells.At low concentrations(<12.5μmol/L),IAAD only exhibited cytotoxic effects without promoting cell invasion.In addition,predictions based on online databases,protein-protein interaction analysis,and molecular docking showed that IAAD can bind to matrix metalloproteinase-9(MMP9),angiotensin converting enzyme(ACE),poly(ADP-ribose)polymerase-1(PARP1),matrix metalloproteinase-2(MMP2),and myeloperoxidase(MPO).CONCLUSION Indole-3-aldehyde can induce cell apoptosis and inhibit cell proliferation to prevent the occurrence of CRC;however,at high concentrations(≥25μmol/L),it can also promote epithelial-mesenchymal transition and invasion in CRC cells.IAAD activates AhR and directly binds MMP9,ACE,PARP1,MMP2,and MPO,which partly reveals why it has a bidirectional effect.
基金supported by National Natural Science Foundation of China(NSFC)(31802072)China Scholarship Council(CSC NO.202103250006)+1 种基金the Central Public-interest Scientific Institution Basal Research Fund(No.Y2022GH02&PJ01618301)State Key Laboratory of Animal Nutrition(2004DA125184G2102)。
文摘Background Pectin is a heteropolysaccharide that acts as an intestinal immunomodulator,promoting intestinal development and regulating intestinal flora in the gut.However,the relevant mechanisms remain obscure.In this study,pigs were fed a corn-soybean meal-based diet supplemented with either 5%microcrystalline cellulose(MCC)or 5%pectin for 3 weeks,to investigate the metabolites and anti-inflammatory properties of the jejunum.Result The results showed that dietary pectin supplementation improved intestinal integrity(Claudin-1,Occludin)and inflammatory response[interleukin(IL)-10],and the expression of proinflammatory cytokines(IL-1β,IL-6,IL-8,TNF-α)was down-regulated in the jejunum.Moreover,pectin supplementation altered the jejunal microbiome and tryptophan-related metabolites in piglets.Pectin specifically increased the abundance of Lactococcus,Enterococcus,and the microbiota-derived metabolites(skatole(ST),3-indoleacetic acid(IAA),3-indolepropionic acid(IPA),5-hydroxyindole-3-acetic acid(HIAA),and tryptamine(Tpm)),which activated the aryl hydrocarbon receptor(AhR)pathway.AhR activation modulates IL-22 and its downstream pathways.Correlation analysis revealed the potential relationship between metabolites and intestinal morphology,intestinal gene expression,and cytokine levels.Conclusion In conclusion,these results indicated that pectin inhibits the inflammatory response by enhancing the AhR-IL22-signal transducer and activator of transcription 3 signaling pathway,which is activated through tryptophan metabolites.
基金National Natural Science Foundation of China,No.82200695。
文摘Several studies have shown that the immune system is highly regulated by tryptophan metabolism,which serves as an immunomodulatory factor.The indoleamine 2,3-dioxygenase 1(IDO1),as an intracellular enzyme that participates in metabolism of the essential amino acid tryptophan in the kynurenine pathway,is an independent prognostic marker for pancreatic cancer(PC).First,overexpression of IDO1 inhibits the maturation of dendritic cells and T-cell proliferation in the liver and spleen.Second,the high expression of kynurenine induces and activates the aryl hydrocarbon receptor,resulting in upregulated programmed cell death protein 1 expression.Third,the induction of IDO1 can lead to loss of the T helper 17 cell/regulatory T cell balance,mediated by the proximal tryptophan catabolite from IDO metabolism.In our study,we found that overexpression of IDO1 upregulated CD8+T cells and reduced natural killer T cells in pancreatic carcinoma in mice.Hence,it may be essential to pay more attention to tryptophan metabolism in patients,especially those who are tolerant to immunotherapy for PC.
基金Guangdong Province Natural Science Funds for Distinguished Young Scholar(2022B1515020016)the National Science Fund for Outstanding Young Scholars(32222080)+5 种基金National Key Research Program(2021YFD1300404)National Science Fund Project of China(32072751)Guangdong Basic and Applied Basic Research Foundation(2022B1515130003)China Agriculture Research System(CARS-42-15)Modern Agricultural Industrial Technology System Innovation Team of Guangdong Province(2022KJ137)Natural Science Foundation of Guangdong Province(2019B1515210012).
文摘Background Ochratoxin A(OTA)is a mycotoxin widely present in raw food and feed materials and is mainly pro-duced by Aspergillus ochraceus and Penicillium verrucosum.Our previous study showed that OTA principally induces liver inflammation by causing intestinal flora disorder,especially Bacteroides plebeius(B.plebeius)overgrowth.However,whether OTA or B.plebeius alteration leads to abnormal tryptophan-related metabolism in the intestine and liver is largely unknown.This study aimed to elucidate the metabolic changes in the intestine and liver induced by OTA and the tryptophan-related metabolic pathway in the liver.Materials and methods A total of 30 healthy 1-day-old male Cherry Valley ducks were randomly divided into 2 groups.The control group was given 0.1 mol/L NaHCO3 solution,and the OTA group was given 235μg/kg body weight OTA for 14 consecutive days.Tryptophan metabolites were determined by intestinal chyme metabolomics and liver tryptophan-targeted metabolomics.AMPK-related signaling pathway factors were analyzed by Western blot-ting and mRNA expression.Results Metabolomic analysis of the intestinal chyme showed that OTA treatment resulted in a decrease in intesti-nal nicotinuric acid levels,the downstream product of tryptophan metabolism,which were significantly negatively correlated with B.plebeius abundance.In contrast,OTA induced a significant increase in indole-3-acetamide levels,which were positively correlated with B.plebeius abundance.Simultaneously,OTA decreased the levels of ATP,NAD+and dipeptidase in the liver.Liver tryptophan metabolomics analysis showed that OTA inhibited the kynurenine metabolic pathway and reduced the levels of kynurenine,anthranilic acid and nicotinic acid.Moreover,OTA increased the phosphorylation of AMPK protein and decreased the phosphorylation of mTOR protein.Conclusion OTA decreased the level of nicotinuric acid in the intestinal tract,which was negatively correlated with B.plebeius abundance.The abnormal metabolism of tryptophan led to a deficiency of NAD+and ATP in the liver,which in turn activated the AMPK signaling pathway.Our results provide new insights into the toxic mechanism of OTA,and tryptophan metabolism might be a target for prevention and treatment.
文摘Background: Tryptophan metabolites such as serotonin, kynurenine, or kynurenic acids are considered to be the most important metabolites of gut microbiota. We wanted to know about changes in tryptophan metabolites in various diseases in which the etiology gut microbiota are considered to participate. Methods: Ultra-high speed liquid chromatography/mass spectroscopy (LC/MS) has been used to analyze simultaneously all the tryptophan metabolites, which we have explored for the first time in the world. Results: We analyzed plasma levels of tryptophan metabolites in patients with depression, autism, diabetes mellitus ‘DM’), and acute coronary syndrome (ACS). Of all the metabolites serotonin and kynurenine levels of these patients were higher than those of controls. Conclusion: Measurements of tryptophan metabolites in plasma of various diseases are important to know roles of gut microbiota in etiology, further therapeutic measures.
文摘目的探究N-乙酰半胱氨酸对支气管哮喘大鼠CXC趋化因子配体(CXCL)8-CXC趋化因子受体(CXCR)1/2及瞬时受体电位通道蛋白(TRP)V1神经元敏感性的影响。方法选取80只SPF级SD雄性大鼠,随机分为正常(NO)组、模型(MO)组、N-乙酰半胱氨酸(NAC)组、急支糖浆(ES)组,每组20只,对MO组、NAC组、ES组进行支气管哮喘建模,建模成功后,NAC组、ES组每天分别于腹腔内注射2 ml N-乙酰半胱氨酸注射液、急支糖浆灌胃10 g/kg剂量,NO组、MO组同期灌胃同体积生理盐水,通过苏木素-伊红(HE)染色法检测肺组织病理形态、酶联免疫吸附试验(ELISA)、实时荧光定量聚合酶链反应(RT-PCR)、Western印迹检测血清及肺组织中CXCL8、CXCR1、CXCR2、TRPV1含量、mRNA及蛋白表达,并分析N-乙酰半胱氨酸对支气管哮喘大鼠CXCL8-CXCR1/2及TRPV1神经元敏感性。结果与NO组相比,MO组咳嗽次数明显增加(P<0.05),而NAC组、ES组与MO组相比,其咳嗽次数明显降低(P<0.05),且NAC组比ES组降低明显(P<0.05);与NO组相比,MO组细支气管管腔、肺泡腔内可见渗出液、脱落的上皮细胞等,远端肺泡可见局部肺不张及周围肺大泡,且肺间质明显增厚,炎性细胞浸润明显,而与MO组比较,ES组、NAC组症状明显减少,部分肺间质的组织结构趋向正常,部分肺泡轻度扩张,且NAC组比ES组明显降低(P<0.05);与NO组对比,MO组CXCL8、CXCR1、CXCR2、TRPV1含量、mRNA及蛋白表达均明显升高(P<0.05),NAC组、ES组与MO组相比均显著降低(P<0.05),且NAC组比ES组明显降低(P<0.05)。结论N-乙酰半胱氨酸可以显著降低咳嗽次数,减少支气管哮喘症状,可使CXCL8-CXCR1/2及TRPV1神经元敏感性显著降低。
文摘Serotonin deficiency in major depressive disorder(MDD)has formed the basis of antidepressant drug development and was originally attributed to induction of the major tryptophan(Trp)-degrading enzyme,liver Trp 2,3-dioxygenase(TDO),by cortisol,leading to decreased Trp availability to the brain for serotonin synthesis.Subsequently,the serotonin deficiency was proposed to involve induction of the extrahepatic Trp-degrading enzyme indoleamine 2,3-dioxygenase(IDO)by proinflammatory cytokines,with inflammation being the underlying cause.Recent evidence,however,challenges this latter concept,as not all MDD patients are immune-activated and,when present,inflammation is mild and/or transient.A wide range of antidepressant drugs inhibit the activity of liver TDO and bind specifically to the enzyme,but not to IDO.IDO induction is not a major event in MDD,but,when it occurs,its metabolic consequences may be masked and overridden by upregulation of kynurenine monooxygenase(KMO),the gateway to production of modulators of immune and neuronal functions.KMO appears to be activated in MDD by certain proinflammatory cytokines and antidepressants with anti-inflammatory properties may block this activation.We demonstrate the ability of the antidepressant ketamine to dock(bind)to KMO.The pathophysiology of MDD may be underpinned by both the serotonin deficiency and glutamatergic activation mediated respectively by TDO induction and N-methyl-D-aspartate receptor activation.Inhibition of TDO and KMO should be the focus of MDD pharmacotherapy.