Dehhaghi, Mona, Panahi, Hamed Kazemi Shariat, Kavyani, Bahar et al. · Aging and disease · 2022 · DOI
This review examines how tryptophan, an amino acid we get from food, is processed differently in people with ME/CFS. The body normally converts tryptophan into important substances like serotonin (which affects mood) and NAD+, an energy molecule. The authors propose that this conversion process may become overactive in ME/CFS, depleting NAD+ and making fatigue worse. They suggest that NAD+ supplements might help reduce fatigue and improve quality of life.
Understanding the biochemical mechanisms underlying ME/CFS is critical for developing targeted treatments. This review identifies a specific metabolic pathway that could explain multiple ME/CFS symptoms and proposes a testable therapeutic intervention. If NAD+ depletion is confirmed as a disease mechanism, supplementation strategies could offer patients a potential avenue to reduce fatigue and improve functioning.
This review does not prove that KP hyperactivation causes ME/CFS or that NAD+ supplementation will be effective in patients—it proposes these as hypotheses for future investigation. Correlation between altered tryptophan metabolism and ME/CFS symptoms does not establish causation. The review cannot establish whether KP changes are primary disease drivers or secondary compensatory responses. Clinical efficacy of NAD+ supplements in ME/CFS remains untested and unproven.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Dehhaghi, Mona, Panahi, Hamed Kazemi Shariat, Kavyani, Bahar, Heng, Benjamin, Tan, Vanessa, Braidy, Nady, et al. (2022). The Role of Kynurenine Pathway and NAD<sup>+</sup> Metabolism in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.. Aging and disease. https://doi.org/10.14336/AD.2021.0824
BibTeX
@article{mecfsatlas-dehhaghi-2022-role-kynurenine,
author = {Dehhaghi, Mona and Panahi, Hamed Kazemi Shariat and Kavyani, Bahar and Heng, Benjamin and Tan, Vanessa and Braidy, Nady and Guillemin, Gilles J},
title = {The Role of Kynurenine Pathway and NAD<sup>+</sup> Metabolism in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.},
journal = {Aging and disease},
year = {2022},
doi = {10.14336/AD.2021.0824},
note = {PubMed: 35656104},
url = {https://www.mecfsatlas.com/evidence/dehhaghi-2022-role-kynurenine},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/dehhaghi-2022-role-kynurenine
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