EFFECTS OF PHYSICAL EXERCISE ON THE KYNURENINE PATHWAY IN REGARD TO MODULATION OF DEPRESSION: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.18554/acbiobras.v8i2.8308Keywords:
Physical Training, Mental Health, Metabolism, TryptophanAbstract
Introduction: Depression represents one of the most common mental disorders, affecting more than 300 million people of all ages worldwide, and is now the leading cause of global disability. Thus, despite the availability of effective psychological and pharmacological treatments, it is necessary to understand the influence of physical exercise as an adjuvant treatment for depressive disorder. Objective: To carry out a systematic review on the effects of physical exercise on the kynurenine pathway in modulating depression. Methodology: This is a systematic review of the literature, carried out through searches in several databases, including VHL, Cochrane Library, Cochrane Central, Scielo, Medline, PubMed and Psyinfo. The selected descriptors were "exercise", "kynurenine pathway" and "depression", combined using the Boolean operators AND OR to cover the search. The article selection period ranged from 2019 to 2024. Inclusion and exclusion criteria were applied to ensure the relevance and quality of the selected studies, considering works in Portuguese, English and Spanish. Results: Physical exercise influences the different stages of the kynurenine metabolic pathway, modulating the production of neuroactive and neuroprotective metabolites. Specifically, exercise promotes changes in the activity of enzymes responsible for converting tryptophan into kynurenine, influencing the balance between the neuroprotective and neurotoxic branches of this metabolic pathway. In this sense, the significant effects on the regulation of neuroinflammatory balance promote a reduction in the inflammatory response associated with depression. Conclusion: Regular exercise contributes to reducing the production of pro-inflammatory mediators, diverting tryptophan metabolism to alternative pathways, such as the serotonin pathway. Thus, physical exercise acts positively in reducing depressive symptoms, providing significant benefits in the mood, energy and motivation of affected individuals.
References
1. Trivedi MH. Major depressive disorder in primary care: Strategies for identification. Journal of Clinical Psychiatry. 2020; 81(2): UT17042BR1C. https://doi:10.4088/JCP.UT17042BR1C.
2. Nardi AE, da Silva AG, Quevedo J. Tratado de Psiquiatria da Associação Brasileira de Psiquiatria. Porto Alegre: Editora Artmed; 2022.
3. Chirino TW, López ER, Angulo AL, Mora PC, Solis CL, Cruz MAS, Bello AFC, Pérez PR, Martínez JR, Chapul LS. Crosstalk between Exercise-Derived Endocannabinoidome and Kynurenines: Potential Target Therapies for Obesity and Depression Symptoms. Pharmaceuticals. 2023; 16(10): 1421. https://doi.org/10.3390/ph16101421.
4. Farup PG, Hamarsland H, Mølmen KS, Ellefsen S, Hestad K. The Kynurenine Pathway in Healthy Subjects and Subjects with Obesity, Depression and Chronic Obstructive Pulmonary Disease. Pharmaceuticals. 2023; 16(3): 351. https://doi.org/10.3390/ph16030351.
5. Tanaka M, Tóth F, Polyák H, Szabó Á, Mándi Y, Vécsei L. Immune Influencers in Action: Metabolites and Enzymes of the Tryptophan-Kynurenine Metabolic Pathway. Biomedicines. 2021; 9(7): 734. https://doi.org/10.3390/biomedicines9070734.
6. Allison DJ, Nederveen JP, Snijders T, Bell KE, Kumbhare D, Phillips SM et al. Exercise training impacts skeletal muscle gene expression related to the kynurenine pathway. American Journal of Physiology-Cell Physiology. 2019; 316(3): C444-C448. https://doi:10.1152/ajpcell.00448.2018.
7. Joisten N, Kummerhoff F, Koliamitra C, Schenk A, Walzik D, Hardt L, Knoop A, Thevis M, Kiesl D, Metcalfe AJ, Bloch W, Zimmer P. Exercise and the Kynurenine pathway: Current state of knowledge and results from a randomized cross-over study comparing acute effects of endurance and resistance training. Exercise Immunology Review. 2020; 26: 24-42. https://doi.org/10.3390/metabo11010004.
8. Savitz J. The kynurenine pathway: a finger in every pie. Mol Psychiatry. 2020; 25(1):131–147. https://doi.org/10.1038/s41380-019-0414-4.
9. Ren JC, Xiao H. Exercise for Mental Well-Being: Exploring Neurobiological Advances and Intervention Effects in Depression. Life. 2023; 13(7): 1505. https://doi.org/10.3390/life13071505.
10. Kanumuri M, Khan A, Neshat A, Alapati G, Mulaka GSR, Nisar N, Batool S, Arti F. Comparison of risk of stroke in patients with and without depression: A Systematic Review and Meta-Analysis. Cureus. 2024; 16(1): e53057. https://doi:10.7759/cureus.53057.
11. Dawood Hristova JJ, Pérez-Jover V. Psychotherapy with psilocybin for depression: systematic review. Behavioral Sciences. 2023; 13(4): 297. https://doi:10.3390/bs13040297.
12. Organização Pan-Americana da Saúde (OPAS). Uma em cada 100 mortes ocorre por suicídio, revelam estatísticas da OMS. 2021. https://www.paho.org/pt/noticias/17-6-2021-uma-em-cada-100-mortes-ocorre-por-suicidio-revelam-estatisticas-da-oms.
13. Brockbank J, Krause T, Moss E, Pedersen AM, Mørup MF, Ahdesmäki O, Vaughan J, Brodtkorb TH. Health state utility values in major depressive disorder treated with pharmacological interventions: a systematic literature review. Health Qual Life Outcomes. 2021; 19(1): 94. https://doi:10.1186/s12955-021-01723-x.
14. De Jesús-Romero R, Holder-Dixon AR, Buss JF, Lorenzo-Luaces L. Race, ethnicity, and other cultural background factors in trials of internet-based cognitive behavioral therapy for depression: systematic review. Journal of Medical Internet Research. 2024; 26: e50780. https://doi:10.2196/50780.
15. Köhler CA, Evangelou E, Stubbs B, Solmi M, Veronese N, Belbasis L, Bortolato B, Melo MCA, Coelho CA, Fernandes BS, Olfson M, Ioannidis JPA, Carvalho AF. Mapping risk factors for depression across the lifespan: An umbrella review of evidence from meta-analyses and Mendelian randomization studies. Journal of Psychiatric Research. 2018; 103: 189–207. https://doi:10.1016/j.jpsychires.2018.05.020.
16. Sharan P, Vellapandian C. Hypothalamic-Pituitary-Adrenal (HPA) Axis: Unveiling the Potential Mechanisms Involved in Stress-Induced Alzheimer’s Disease and Depression. Cureus. 2024; 16(8): e67595. https://doi:10.7759/cureus.67595.
17. Jiang Y, Zou D, Li Y, Gu S, Dong J, Ma X, Xu S, Wang F, Huang JH. Monoamine Neurotransmitters Control Basic Emotions and Affect Major Depressive Disorders. Pharmaceuticals (Basel). 2022; 15(10):1203. https://doi.org/10.3390/ph15101203.
18. Tran KH, Luki J, Hanstock S, Hanstock CC, Seres P, Aitchison K, Shandro T, Le Melledo JM. Decreased GABA+ Levels in the Medial Prefrontal Cortex of Perimenopausal Women: A 3T 1H-MRS Study. The International Journal of Neuropsychopharmacology. 2023; 26(1): 32–41. https://doi.org/10.1093/ijnp/pyac066.
19. Modoux M, Rolhion N, Mani S, Sokol H. Tryptophan Metabolism as a Pharmacological Target. Trends in Pharmacological Sciences. 2021; 42(1): 60–73. https://doi.org/10.1016/j.tips.2020.11.006.
20. Craig CF, Filippone RT, Stavely R, Bornstein JC, Apostolopoulos V, Nurgali K. Neuroinflammation as an etiological trigger for depression comorbid with inflammatory bowel disease. Journal of Neuroinflammation. 2022 Jan 4; 19(1): 4. https://doi.org/10.1186/s12974-021-02354-1.
21. Chen LM, Bao CH, Wu Y, Liang SH, Wang D, Wu LY, Huang Y, Liu HR, Wu HG. Tryptophan-kynurenine metabolism: a link between the gut and brain for depression in inflammatory bowel disease. Journal of Neuroinflammation. 2021; 18: 135. https://doi.org/10.1186/s12974-021-02175-2.
22. Hunt C, Macedo e Cordeiro T, Suchting R, de Dios C, Cuellar Leal VA, Soares JC, Dantzer R, Teixeira AL, Selvaraj S. Effect of immune activation on the kynurenine pathway and depression symptoms – A systematic review and meta-analysis. Neuroscience Biobehavioral Review. 2020; 118: 514–523. https://doi.org/10.1016/j.neubiorev.2020.08.010.
23. Jones K, Hawke F, Newman J, Miller JA, Burns J, Jakovljevic DG, Gorman G, Turnbull DM, Ramdharry G. Interventions for promoting physical activity in people with neuromuscular disease. The Cochrane Library. 2021; (5): CD013544.pub2. https://doi.org/10.1002/14651858.CD013544.pub2.
24. Freak-Poli RLA, Cumpston M, Albarqouni L, Clemes SA, Peeters A. Workplace pedometer interventions for increasing physical activity. Cochrane Database of Systematic Reviews. 2020; (7): CD009209.pub3. https://doi.org/10.1002/14651858.CD009209.pub3.
25. Lu L, Mao L, Feng Y, Ainsworth BE, Liu Y, Chen N. Effects of different exercise training modes on muscle strength and physical performance in older people with sarcopenia: a systematic review and meta-analysis. BMC Geriatrics. 2021; 21(1): 708. https://doi.org/10.1186/s12877-021-02642-8.
26. Lim A, Harijanto C, Vogrin S, Guillemin G, Duque G. Does Exercise influence kynurenine/tryptophan metabolism and psychological outcomes in persons with age-related diseases? A Systematic Review. International Journal of Tryptophan Research. 2021; 14: 117864692199111. https://doi.org/10.1177/1178646921991119.