Abnormalities in the cerebrospinal fluid levels of endocannabinoids in multiple sclerosis.
OBJECTIVE
Endocannabinoids (eCBs) play a role in the modulation of neuroinflammation, and experimental findings suggest that they may be directly involved in the pathogenesis of multiple sclerosis (MS). The objective of our study was to measure eCB levels in the cerebrospinal fluid (CSF) of patients with MS.


METHODS
Arachidonoylethanolamine (anandamide, AEA), palmotylethanolamide (PEA), 2-arachidonoylglycerol (2-AG) and oleoylethanolamide (OEA) levels were measured in the CSF of 50 patients with MS and 20 control subjects by isotope dilution gas-chromatography/mass-spectrometry. Patients included 35 patients with MS in the relapsing-remitting (RR) form of the disease, 20 in a stable clinical phase and 15 during a relapse, and 15 patients with MS in the secondary progressive (SP) form.


RESULTS
Significantly reduced levels of all the tested eCBs were found in the CSF of patients with MS compared to control subjects, with lower values detected in the SP MS group. Higher levels of AEA and PEA, although below those of controls, were found in the CSF of RR MS patients during a relapse. Higher levels of AEA, 2-AG and OEA were found in patients with MRI gadolinium-enhancing (Gd+) lesions.


CONCLUSIONS
The present findings suggest the presence of an impaired eCB system in MS. Increased CSF levels of AEA during relapses or in RR patients with Gd+ lesions suggest its potential role in limiting the ongoing inflammatory process with potential neuroprotective implications. These findings provide further support for the development of drugs targeting eCBs as a potential pharmacological strategy to reduce the symptoms and slow disease progression in MS.
Centre for Study of Demyelinating Diseases, Department of Medical and Surgical Specialities and Public Health, Ospedale S Maria della Misericordia, University of Perugia, Perugia, Italy.
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Sarchielli
D000328:Adult; D001095:Arachidonic Acids / Q000134:cerebrospinal fluid; D001921:Brain / Q000473:pathology; D063385:Cannabinoid Receptor Modulators / Q000134:cerebrospinal fluid*; D004185:Disability Evaluation; D018450:Disease Progression; D063388:Endocannabinoids; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D005989:Glycerides / Q000134:cerebrospinal fluid; D006801:Humans; D007249:Inflammation / Q000134:cerebrospinal fluid; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D009829:Oleic Acids / Q000134:cerebrospinal fluid; D053284:Polyunsaturated Alkamides / Q000134:cerebrospinal fluid; D012720:Severity of Illness Index
D001095:Arachidonic Acids; D063385:Cannabinoid Receptor Modulators; D063388:Endocannabinoids; D005989:Glycerides; D009829:Oleic Acids; D053284:Polyunsaturated Alkamides; C488250:oleoylethanolamide; C094503:glyceryl 2-arachidonate; C078814:anandamide