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Tryptophan metabolic dysregulation plays a pivotal role in DM pathogenesis through three primary pathways, including the indole, kynurenine, and serotonin pathways (Gao et al., 2023)

The end products of purine metabolism, uric acid, a potent antioxidant, have been reported to be found in decreased levels in MDD 71,72,73 , while lower cerebro-spinal fluid (CSF) levels of hypoxanthine and xanthine, the two metabolites preceding uric acid, have previously been linked with depression 74

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Improvement in constipation symptoms was the primary outcome in most studies, and all the studies reported a significant improvement in the treated arm [106, 109, 110, 112, 113]

[DOI] [Google Scholar] 218.Nascimento N.P.d., Vinhal Borges .G.A., de Castro J.S., Nascimento C.P.d., Bitu L.A., de Sousa P.H.M., da Silva E.M.C