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Introduction Carnosine is a histidine-containing dipeptide formed by beta-alanine (BA) and L-histidine that is abundant in human skeletal muscle ( + ) buffering ( + accumulation and can be improved by increasing buffering capacity ( Beta-alanine is a non-proteogenic amino acid and the limiting factor for carnosine formation in the skeletal muscle ( Muscle Carnosine Metabolism Carnosine homeostasis is dependent on its synthesis from, and degradation to, its constituent amino acids

Focus on what the patient cares about, which may be redness only or papules only, because treatment may be long-term and expensive

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Abbreviations 1MT: 1-methyl-tryptophan 3HAA: 3-hydroxyanthranilic acid 3HK: 3-hydroxykynurenine 5-HT: Serotonin 7nAChRs 7: nicotinic acetylcholine receptors AHR: Aryl hydrocarbon receptor AMPAR: -amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor BBB: Blood brain barrier BCG: Bacile Calmette-Gurin BDI-II: Beck Depression Inventory, 2nd edition BDNF: Brain-derived neurotrophic factor BSSI: Beck Scale for Suicidal Ideation CDRS-R: Childrens Depression Rating Scale-Revised CNS: Central nervous system ESBA: (S)-4-(ethylsulfonyl)benzoylalanine GBA: Gut-brain axis HAMD: Hamilton Depression Rating Scale HPA: Hypothalamic-pituitary-adrenal IDO: Indoleamine 2,3-dioxygenase KAT: Kynurenine aminotransferase KMO: Kynurenine 3-monooxygenase KP: Kynurenine pathway K-SADS-PL: Schedule for Affective Disorders and Schizophrenia for School-Age Children KYN: Kynurenine KYNA: Kynurenic acid LDH: Lactate dehydrogenase LPS: Lipopolysaccharide LSD: Lysergic acid diethylamide MDD: Major depressive disorder NMDAR: N-methyl-D-aspartate receptor NO: Nitric oxide PA: Picolinic acid QA: Quinolinic acid ROS: Reactive oxygen species SCFA: Short-chain fatty acids SSRI: Selective serotonin reuptake inhibitor TBI: Traumatic brain injury TDO : Tryptophan 2,3-dioxygenase TRP: Tryptophan UCMS: Unpredictable Chronic Mild Stress References Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, et al

34 The prognosis of MMNSTs is generally very poor, with significantly high rates of morbidity and mortality