Abstract
BackgroundLipids are a primary storage form of energy and the source of inflammatory and pain signaling molecules, yet knowledge of their importance in chronic migraine (CM) pathology is incomplete. We aim to determine if plasma and cerebrospinal fluid (CSF) lipid metabolism are associated with CM pathology.MethodsWe obtained plasma and CSF from healthy controls (CT, n = 10) or CM subjects (n = 15) diagnosed using the International Headache Society criteria. We measured unesterified fatty acid (UFA) and esterified fatty acids (EFAs) using gas chromatography-mass spectrometry. Glycerophospholipids (GP) and sphingolipid (SP) levels were determined using LC-MS/MS, and phospholipase A2 (PLA2) activity was determined using fluorescent substrates.ResultsUnesterified fatty acid levels were significantly higher in CM plasma but not in CSF. Unesterified levels of five saturated fatty acids (SAFAs), eight monounsaturated fatty acids (MUFAs), five ω-3 polyunsaturated fatty acids (PUFAs), and five ω-6 PUFAs are higher in CM plasma. Esterified levels of three SAFAs, eight MUFAs, five ω-3 PUFAs, and three ω-6 PUFAs, are higher in CM plasma. The ratios C20:4n-6/homo-γ-C20:3n-6 representative of delta-5-desaturases (D5D) and the elongase ratio are lower in esterified and unesterified CM plasma, respectively. In the CSF, the esterified D5D index is lower in CM. While PLA2 activity was similar, the plasma UFA to EFA ratio is higher in CM. Of all plasma GP/SPs detected, only ceramide levels are lower (p = 0.0003) in CM (0.26 ± 0.07%) compared to CT (0.48 ± 0.06%). The GP/SP proportion of platelet-activating factor (PAF) is significantly lower in CM CSF.ConclusionsPlasma and CSF lipid changes are consistent with abnormal lipid metabolism in CM. Since plasma UFAs correspond to diet or adipose tissue levels, higher plasma fatty acids and UFA/EFA ratios suggest enhanced adipose lipolysis in CM. Differences in plasma and CSF desaturases and elongases suggest altered lipid metabolism in CM. A lower plasma ceramide level suggests reduced de novo synthesis or reduced sphingomyelin hydrolysis. Changes in CSF PAF suggest differences in brain lipid signaling pathways in CM. Together, this pilot study shows lipid metabolic abnormality in CM corresponding to altered energy homeostasis. We propose that controlling plasma lipolysis, desaturases, elongases, and lipid signaling pathways may relieve CM symptoms.
Highlights
Chronic migraine (CM) is common (Lipton et al, 2016), disabling, challenging to treat (May and Schulte, 2016; SunEdelstein and Rapoport, 2016), and presently the focus of promising receptor-mediated signaling pathways studies (Cady et al, 2014)
With the studies above linking lipid metabolism with pain, inflammation, and receptor-mediated signaling pathways, we propose that lipid metabolism is different in CM than in healthy non-headache controls (CT)
To determine if specific groups of fatty acids (SAFA, monounsaturated fatty acid (MUFA), and polyunsaturated fatty acid (PUFA)) changed in CT compared with CM, we quantified unesterified and esterified saturated fatty acid (SAFA), MUFAs, and PUFAs in plasma and cerebrospinal fluid (CSF)
Summary
Chronic migraine (CM) is common (Lipton et al, 2016), disabling, challenging to treat (May and Schulte, 2016; SunEdelstein and Rapoport, 2016), and presently the focus of promising receptor-mediated signaling pathways studies (Cady et al, 2014). Lipids are sources of bioactive molecules associated with pain, inflammation, vascular activity, neuroplasticity, ion channel, and receptor functions (Mead and Dhopeshwarkar, 1971; Rouser et al, 1972; Piomelli and Sasso, 2014; Schroeder and Brunet, 2015). These properties are associated with headache pathophysiology, but the relationship of different fatty acids, glycerophospholipid (GP), and sphingolipid (SP) profiles with CM are not obvious. Lipids are a primary storage form of energy and the source of inflammatory and pain signaling molecules, yet knowledge of their importance in chronic migraine (CM) pathology is incomplete. We aim to determine if plasma and cerebrospinal fluid (CSF) lipid metabolism are associated with CM pathology
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