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Review

Altered Tryptophan-Kynurenine Pathway in Delirium: A Review of the Current Literature

by
Ang Hui Phing
1,
Suzana Makpol
2,
Muhammad Luqman Nasaruddin
2,
Wan Asyraf Wan Zaidi
3,
Nurul Saadah Ahmad
1 and
Hashim Embong
1,*
1
Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
2
Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
3
Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2023, 24(6), 5580; https://doi.org/10.3390/ijms24065580
Submission received: 20 February 2023 / Revised: 9 March 2023 / Accepted: 11 March 2023 / Published: 15 March 2023
(This article belongs to the Collection 21st Anniversary of IJMS: Advances in Molecular Endocrinology and Metabolism)
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Abstract

Delirium, a common form of acute brain dysfunction, is associated with increased morbidity and mortality, especially in older patients. The underlying pathophysiology of delirium is not clearly understood, but acute systemic inflammation is known to drive delirium in cases of acute illnesses, such as sepsis, trauma, and surgery. Based on psychomotor presentations, delirium has three main subtypes, such as hypoactive, hyperactive, and mixed subtype. There are similarities in the initial presentation of delirium with depression and dementia, especially in the hypoactive subtype. Hence, patients with hypoactive delirium are frequently misdiagnosed. The altered kynurenine pathway (KP) is a promising molecular pathway implicated in the pathogenesis of delirium. The KP is highly regulated in the immune system and influences neurological functions. The activation of indoleamine 2,3-dioxygenase, and specific KP neuroactive metabolites, such as quinolinic acid and kynurenic acid, could play a role in the event of delirium. Here, we collectively describe the roles of the KP and speculate on its relevance in delirium.
Keywords: acute brain dysfunction; delirium; inflammation; kynurenine pathway; neuroinflammation acute brain dysfunction; delirium; inflammation; kynurenine pathway; neuroinflammation
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MDPI and ACS Style

Phing, A.H.; Makpol, S.; Nasaruddin, M.L.; Wan Zaidi, W.A.; Ahmad, N.S.; Embong, H. Altered Tryptophan-Kynurenine Pathway in Delirium: A Review of the Current Literature. Int. J. Mol. Sci. 2023, 24, 5580. https://doi.org/10.3390/ijms24065580

AMA Style

Phing AH, Makpol S, Nasaruddin ML, Wan Zaidi WA, Ahmad NS, Embong H. Altered Tryptophan-Kynurenine Pathway in Delirium: A Review of the Current Literature. International Journal of Molecular Sciences. 2023; 24(6):5580. https://doi.org/10.3390/ijms24065580

Chicago/Turabian Style

Phing, Ang Hui, Suzana Makpol, Muhammad Luqman Nasaruddin, Wan Asyraf Wan Zaidi, Nurul Saadah Ahmad, and Hashim Embong. 2023. "Altered Tryptophan-Kynurenine Pathway in Delirium: A Review of the Current Literature" International Journal of Molecular Sciences 24, no. 6: 5580. https://doi.org/10.3390/ijms24065580

APA Style

Phing, A. H., Makpol, S., Nasaruddin, M. L., Wan Zaidi, W. A., Ahmad, N. S., & Embong, H. (2023). Altered Tryptophan-Kynurenine Pathway in Delirium: A Review of the Current Literature. International Journal of Molecular Sciences, 24(6), 5580. https://doi.org/10.3390/ijms24065580

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