Reversal of imbalance between kynurenic acid and 3-hydroxykynurenine by antipsychotics in medication-naïve and medication-free schizophrenic patients

A. M. Myint, M. J. Schwarz, R. Verkerk, H. H. Mueller, J. Zach, S. Scharpé, H. W.M. Steinbusch, B. E. Leonard, Y. K. Kim

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97 Citations (Scopus)


The association between the pro-inflammatory state of schizophrenia and increased tryptophan degradation into kynurenine has been reported. However, the relationship between metabolites from subdivisions of the kynurenine pathway, kynurenic acid and 3-hydroxykynurenine, remains unknown. The present study tested the relationship between these kynurenine metabolites in the plasma of medication-naïve (n= 35) or medication-free (n= 18) patients with schizophrenia at admission and following 6-week antipsychotic treatment compared to healthy controls (n= 48). The plasma concentrations of kynurenic acid (nmol/l) were lower (difference = -8.44 (-13.22 to -3.65); p= 0.001) and of 3-hydroxykynurenine (nmol/l) were higher (difference = 11.24 (8.11-14.37); p< 0.001) in the patients compared with the healthy controls. The kynurenic acid/kynurenine (difference = -2.75 (-5.115 to -0.336); p= 0.026) and kynurenic acid/3-hydroxykynurenine (difference = -1.08 (-1.431 to -0.729); p< 0.001) ratios were also lower in the patients. After the 6-week treatment, the patients' plasma kynurenic acid levels (difference = 3.85 (-0.23 to 7.94); p= 0.064) showed a trend towards an increase, whereas plasma 3-hydroxykynurenine levels (difference = 22.41 (19.76-25.07); p< 0.001) decreased. As a consequence, the kynurenic acid/3-hydroxykynurenine ratio (difference = -4.41 (-5.51 to -3.3); p< 0.001) increased. Higher initial plasma kynurenic acid levels on admission or increased kynurenic acid/kynurenine ratio after treatment were associated with reduction of clinical symptoms scores upon discharge although higher kynurenic acid/kynurenine on admission may induce higher positive symptoms score. In contrast, higher 3-hydroxykynurenine is associated with lower positive symptoms score. These results indicate that there is an imbalance in the kynurenine pathway in schizophrenia. The 6-week antipsychotic treatment may partially reverse the imbalance in kynurenine metabolism and that in turn induces clinical response.

Original languageEnglish
Pages (from-to)1576-1581
Number of pages6
JournalBrain, Behavior, and Immunity
Issue number8
Publication statusPublished - 2011 Nov
Externally publishedYes

Bibliographical note

Funding Information:
This study was funded by Advanced Practical Diagnostics n.v., Belgium for the laboratory analyses and Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea ( A040042 ) for the clinical sample and data collection.


  • 3-Hydroxykynurenine
  • Antipsychotics
  • Kynurenic acid
  • Kynurenine
  • Schizophrenia

ASJC Scopus subject areas

  • Immunology
  • Endocrine and Autonomic Systems
  • Behavioral Neuroscience


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