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PMID: 28189172 20 A case report: subacute combined degeneration of the spinal cord and pernicious anemia caused by autoimmune gastritis

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Under conditions of chronic stress or systemic inflammation, enzymes such as indoleamine 2,3-dioxygenase (IDO) and tryptophan 2,3-dioxygenase (TDO) are upregulated, diverting TRP metabolism away from 5-HT synthesis toward KYN production, with profound consequences for both peripheral physiology and central nervous system (CNS) function