{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T13:13:15Z","timestamp":1750943595766,"version":"3.40.5"},"reference-count":22,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,10,8]],"date-time":"2021-10-08T00:00:00Z","timestamp":1633651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["390874280"],"award-info":[{"award-number":["390874280"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether the metabolites of Kynurenine pathway (KP) could serve as biomarkers for distinguishing between viral CNS infections and autoimmune neuroinflammatory diseases, especially anti\u2010N\u2010methyl\u2010D\u2010aspartate receptor encephalitis (NMDARE) and herpes virus encephalitis (HSE).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study enrolled CSF samples from 76 patients with viral CNS infections, autoimmune neuroinflammatory, and non\u2010inflammatory neurological diseases. We measured cerebrospinal fluid (CSF) concentrations of tryptophan (Trp) and kynurenine (Kyn) by ELISA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Kyn concentrations and Kyn\/Trp ratios were highly increased (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, viral vs. autoimmune) in viral CNS infections, whereas patients with autoimmune neuroinflammatory and non\u2010inflammatory diseases exhibited low concentrations. Furthermore, Kyn concentrations and Kyn\/Trp ratio turned out to be excellent biomarkers to distinguish between herpes simplex encephalitis (HSE) and NMDARE (AUC 0.920 and AUC 0.906), whereas Trp concentrations were similar in all three groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>The results suggest that elevated CSF Kyn concentrations and Kyn\/Trp ratio may serve as biomarkers for distinguishing viral CNS infections from autoimmune neuroinflammatory diseases. In particular, the distinction between HSE and NMDARE is of great clinical relevance. Further studies are warranted to investigate the potential of CSF Kyn levels and Kyn\/Trp ratio as routine parameters in patients with CNS diseases.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.51383","type":"journal-article","created":{"date-parts":[[2021,10,9]],"date-time":"2021-10-09T08:10:28Z","timestamp":1633767028000},"page":"2228-2234","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Differentiation of viral and autoimmune central nervous system inflammation by kynurenine pathway"],"prefix":"10.1002","volume":"8","author":[{"given":"Yi","family":"Luo","sequence":"first","affiliation":[{"name":"Clinical Neuroimmunology and Neurochemistry Department of Neurology Hannover Medical School Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nora","family":"M\u00f6hn","sequence":"additional","affiliation":[{"name":"Clinical Neuroimmunology and Neurochemistry Department of Neurology Hannover Medical School Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Skripuletz","sequence":"additional","affiliation":[{"name":"Clinical Neuroimmunology and Neurochemistry Department of Neurology Hannover Medical School Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makbule","family":"Senel","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Ulm Ulm Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hayrettin","family":"Tumani","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Ulm Ulm Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Pe\u00dfler","sequence":"additional","affiliation":[{"name":"Research Group Biomarkers for Infectious Diseases Helmholtz Centre for Infection Research Braunschweig Germany"},{"name":"TWINCORE Centre for Experimental and Clinical Infection Research Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kurt\u2010Wolfram","family":"S\u00fchs","sequence":"additional","affiliation":[{"name":"Clinical Neuroimmunology and Neurochemistry Department of Neurology Hannover Medical School Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2504-5398","authenticated-orcid":false,"given":"Martin","family":"Stangel","sequence":"additional","affiliation":[{"name":"Clinical Neuroimmunology and Neurochemistry Department of Neurology Hannover Medical School Hannover 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