Metabolism of polyunsaturated fatty acids and ketogenesis: an emerging connection

This paper summarizes the emerging literature indicating that at least two polyunsaturated fatty acids (PUFA; linoleate, alpha-linolenate) are moderately ketogenic and that via ketone bodies significant amounts of carbon are recycled from these fatty acids into de novo synthesis of lipids including cholesterol, palmitate, stearate and oleate. This pathway (PUFA carbon recycling) is particularly active in several tissues during the suckling period when, depending on the tissue, >200 fold more carbon from alpha-linolenate can be recycled into newly synthesized lipids than is used to make docosahexaenoate. At least in rats, PUFA carbon recycling also occurs in adults and even during extreme linoleate deficiency. Hence, this pathway should be considered an obligatory component of PUFA metabolism. It is still speculative but part of the clinical benefit of the very high fat ketogenic diet in intractable seizures may be achieved by raising plasma levels of PUFA that have anti-seizure effects, especially arachidonate and docosahexaenoate. Hence, in addition to some PUFA being ketogenic substrates, the state of ketosis involves potentially beneficial changes in PUFA homeostasis. Both the molecular controls on these pathways and their clinical significance still need elucidation.