Journal of Molecular Neuroscience

, Volume 54, Issue 2, pp 181–187 | Cite as

Activation of the Kynurenine Pathway in the Acute Phase of Stroke and its Role in Fatigue and Depression Following Stroke

  • Heidi Ormstad
  • Robert Verkerk
  • Karl-Friedrich Amthor
  • Leiv Sandvik


Many stroke survivors suffer from poststroke fatigue (PSF) and poststroke depression (PSD), indicating the importance of increasing the base of knowledge about the mechanisms underlying these sequelae. The primary aim of this study was to determine whether activation of the kynurenine (KYN) pathway predicts subsequent fatigue or depression in acute ischemic stroke (AIS) patients. Acute serum levels of 5-hydroxytryptamine (5-HT), tryptophan (TRP) catabolites (TRYCATs), and competing amino acids, as well as subsequent fatigue and depression, were measured in 45 stroke patients. TRP index [=100 × TRP / (tyrosine + valine + phenylalanine + leucine + isoleucine)] was significantly lower in patients with a Fatigue Severity Scale (FSS) score of ≥4 at 12 months than in those with an FSS score of <4 (p = 0.039). Furthermore, the serum level of kynurenic acid in the acute stroke phase was significantly higher in patients with an FSS of score ≥4 at 18 months than in those with an FSS score of <4 (p = 0.026). These findings indicate that stroke patients with PSF have a lower bioavailability of TRP for 5-HT synthesis in the brain in the acute stroke phase. However, they also appear to have greater neuroprotective potential in that phase. In contrast to PSF, no predictors of PSD were found. These findings together with those of previous studies suggest that the immune response and indoleamine 2,3-dioxygenase activation that follows AIS can predict PSF but not PSD.


Acute ischemic stroke Kynurenine pathway Cytokines Poststroke fatigue Poststroke depression 


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Heidi Ormstad
    • 1
    • 2
  • Robert Verkerk
    • 3
  • Karl-Friedrich Amthor
    • 4
  • Leiv Sandvik
    • 5
  1. 1.Faculty of Health SciencesBuskerud and Vestfold University CollegeDrammenNorway
  2. 2.Vestre Viken Hospital TrustBuskerudNorway
  3. 3.Laboratory of Medical BiochemistryUniversity of AntwerpAntwerpBelgium
  4. 4.Department of NeurologyVestre Viken Hospital TrustBuskerudNorway
  5. 5.Section of BiostatisticsOslo University HospitalOsloNorway

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