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Wu W, Zhu L, Dou Z, Hou Q, Wang S, Yuan Z, Li B. Ghrelin in Focus: Dissecting Its Critical Roles in Gastrointestinal Pathologies and Therapies. Curr Issues Mol Biol 2024; 46:948-964. [PMID: 38275675 PMCID: PMC10813987 DOI: 10.3390/cimb46010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
This review elucidates the critical role of ghrelin, a peptide hormone mainly synthesized in the stomach in various gastrointestinal (GI) diseases. Ghrelin participates in diverse biological functions ranging from appetite regulation to impacting autophagy and apoptosis. In sepsis, it reduces intestinal barrier damage by inhibiting inflammatory responses, enhancing GI blood flow, and modulating cellular processes like autophagy and apoptosis. Notably, in inflammatory bowel disease (IBD), serum ghrelin levels serve as markers for distinguishing between active and remission phases, underscoring its potential in IBD treatment. In gastric cancer, ghrelin acts as an early risk marker, and due to its significant role in increasing the proliferation and migration of gastric cancer cells, the ghrelin-GHS-R axis is poised to become a target for gastric cancer treatment. The role of ghrelin in colorectal cancer (CRC) remains controversial; however, ghrelin analogs have demonstrated substantial benefits in treating cachexia associated with CRC, highlighting the therapeutic potential of ghrelin. Nonetheless, the complex interplay between ghrelin's protective and potential tumorigenic effects necessitates a cautious approach to its therapeutic application. In post-GI surgery scenarios, ghrelin and its analogs could be instrumental in enhancing recovery and reducing complications. This article accentuates ghrelin's multifunctionality, shedding light on its influence on disease mechanisms, including inflammatory responses and cancer progression, and examines its therapeutic potential in GI surgeries and disorders, advocating for continued research in this evolving field.
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Affiliation(s)
- Wei Wu
- Department of Intensive Care Medicine, The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China; (W.W.); (Q.H.); (S.W.); (Z.Y.)
| | - Lei Zhu
- Department of Intensive Care Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, China; (L.Z.); (Z.D.)
| | - Zhimin Dou
- Department of Intensive Care Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, China; (L.Z.); (Z.D.)
| | - Qiliang Hou
- Department of Intensive Care Medicine, The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China; (W.W.); (Q.H.); (S.W.); (Z.Y.)
| | - Sen Wang
- Department of Intensive Care Medicine, The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China; (W.W.); (Q.H.); (S.W.); (Z.Y.)
| | - Ziqian Yuan
- Department of Intensive Care Medicine, The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China; (W.W.); (Q.H.); (S.W.); (Z.Y.)
| | - Bin Li
- Department of Intensive Care Medicine, The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China; (W.W.); (Q.H.); (S.W.); (Z.Y.)
- Department of Intensive Care Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, China; (L.Z.); (Z.D.)
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de Azevedo Muner Ferreira B, Fonseca DC, Sala P, Alves JTM, Prudêncio APA, Machado NM, Marques M, Barcelos S, Ishida RK, Guarda IFMS, De Moura EGH, Sakai P, Santo MA, de Miranda Torrinhas RSM, Waitzberg DL. Roux-en-Y gastric bypass affects the expression of genes related to the intestinal folate metabolism pathway in obese women. Nutrition 2023; 112:112054. [PMID: 37224573 DOI: 10.1016/j.nut.2023.112054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/10/2023] [Accepted: 04/03/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Roux-en-Y gastric bypass (RYGB) promotes sustained weight loss, and the resulting new gastrointestinal anatomy can contribute to nutritional depletions. Folate deficiency is one of the most frequently observed nutritional deficiencies after RYGB. The aim of this study was to assess whether RYGB affects the expression of genes related to the intestinal folate metabolism pathway as an additional molecular mechanism contributing to its postoperative deficiency. METHODS Biopsies from the duodenum, jejunum, and ileum of 20 obese women were collected before and 3 mo after RYGB. The expression of genes involved in intestinal folate metabolism was assessed by microarray and reverse transcriptase polymerase chain reaction (RT-qPCR). Folate intake (7-d food record) and plasma levels (electrochemiluminescence) also were measured. RESULTS Compared with the preoperative phase, transcriptomic alterations were observed in all intestinal segments studied after RYBG, mainly marked by decreased expression of genes encoding folate transporters/receptors and increased expression of genes involved in folate biosynthesis (P < 0.05). Reduced folate intake and plasma folate levels were also observed simultaneously (P < 0.05). Plasma folate concentrations correlated inversely with intestinal FOLR2 and SHMT2 genes (P < 0.001). CONCLUSION The present findings suggested that impaired expression of genes related to intestinal folate metabolism may contribute to the early systemic deficiency after RYGB and highlight a potential transcriptomic reprogramming of the intestine in response to RYGB to compensate for folate depletion induced by this surgical technique.
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Affiliation(s)
- Beatriz de Azevedo Muner Ferreira
- Laboratory of Nutrition and Metabolic Surgery of the Digestive Tract, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Danielle Cristina Fonseca
- Laboratory of Nutrition and Metabolic Surgery of the Digestive Tract, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Priscila Sala
- Laboratory of Nutrition and Metabolic Surgery of the Digestive Tract, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Departmento de Nutrição, Centro Universitário São Camilo, Sao Paulo, Brazil
| | - Juliana Tepedino Martins Alves
- Laboratory of Nutrition and Metabolic Surgery of the Digestive Tract, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Paula Aguiar Prudêncio
- Laboratory of Nutrition and Metabolic Surgery of the Digestive Tract, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Natasha Mendonça Machado
- Laboratory of Nutrition and Metabolic Surgery of the Digestive Tract, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mariane Marques
- Laboratory of Nutrition and Metabolic Surgery of the Digestive Tract, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Samira Barcelos
- Laboratory of Nutrition and Metabolic Surgery of the Digestive Tract, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Paulo Sakai
- Hospital das Clínicas, HCFMUSP, São Paulo, Brazil
| | | | - Raquel Susana Matos de Miranda Torrinhas
- Laboratory of Nutrition and Metabolic Surgery of the Digestive Tract, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Dan Linetzky Waitzberg
- Laboratory of Nutrition and Metabolic Surgery of the Digestive Tract, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Shoar S, Naderan M, Shoar N, Modukuru VR, Mahmoodzadeh H. Alteration Pattern of Taste Perception After Bariatric Surgery: a Systematic Review of Four Taste Domains. Obes Surg 2020; 29:1542-1550. [PMID: 30712168 DOI: 10.1007/s11695-019-03730-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Efforts continue to understand the underlying mechanism of weight loss after bariatric surgery. Taste perception has shown to be a contributing factor. However, the alteration pattern in different taste domains and among bariatric procedures has not been sufficiently investigated. OBJECTIVES To study the alteration pattern in the perception of four taste domains after different bariatric procedures. SETTINGS Private Research Institute, USA. METHODS A systematic review was conducted to pool available data in the literature on post-operative changes in the perception of sensitivity to four taste domains after Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and adjustable gastric banding (AGB). RESULTS Our study showed that bariatric surgery is associated with significant change in sensitivity to all four taste domains especially salt taste, sweetness, and sourness. LSG patients showed an increased sensitivity to all four taste domains. However, RYGB patients had a variable alteration pattern of taste perception but more commonly a decreased sensitivity to sweetness and an increased sensitivity to salt taste and sourness. Additionally, AGB patients had a decreased sensitivity to sweetness, salt taste, and sourness. CONCLUSION Bariatric surgery is associated with taste change in a way which results in less preference for high-calorie food and possibly reduced calorie intake. This may explain one of the mechanisms by which bariatric surgery produces weight loss. However, data are heterogeneous, the potential effect dilutes over time, and the alteration varies significantly between different procedures.
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Affiliation(s)
- Saeed Shoar
- Department of ScientificWriting, Division of Surgical Research, Shoar Research Institute, Houston, TX, USA. .,Cancer Institute, Imam Khomeini Hospital Complex, Division of Surgical Oncology, Department of Surgery, Tehran University of Medical Science, Tehran, Iran.
| | - Mohammad Naderan
- Cancer Institute, Imam Khomeini Hospital Complex, Division of Surgical Oncology, Department of Surgery, Tehran University of Medical Science, Tehran, Iran
| | - Nasrin Shoar
- Department of ScientificWriting, Division of Surgical Research, Shoar Research Institute, Houston, TX, USA.,Faculty of Medicine, Kashan University of Medical Science, Kashan, Iran
| | - Venkat R Modukuru
- Department of ScientificWriting, Division of Surgical Research, Shoar Research Institute, Houston, TX, USA.,Faculty Surgeon, Department of Surgery, NYMC at Metropolitan Hospital Program, New York City, NY, USA
| | - Habibollah Mahmoodzadeh
- Cancer Institute, Imam Khomeini Hospital Complex, Division of Surgical Oncology, Department of Surgery, Tehran University of Medical Science, Tehran, Iran
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Camacho-Ramírez A, Mayo-Ossorio MÁ, Pacheco-García JM, Almorza-Gomar D, Ribelles-García A, Belmonte-Núñez A, Prada-Oliveira JA, Pérez-Arana GM. Pancreas is a preeminent source of ghrelin after sleeve gastrectomy in Wistar rats. Histol Histopathol 2020; 35:801-809. [PMID: 31951010 DOI: 10.14670/hh-18-200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Many surgical techniques are employed in the treatment of severe obesity. A main consequence of these techniques is the improvement of type 2 Diabetes mellitus. Ghrelin is a gut hormone released in the gastric fundus and corpus, which has been related to diabetic improvement as mentioned in these papers. Sleeve gastrectomy and Roux-en Y Gastric Bypass are surgical techniques broadly employed in humans; both severely reduce the gastric surface. Paradoxically, the serum level of ghrelin in patients is preserved. We hypothesized about the role of embryonic pancreatic epsilon cells, which have the capacity to release ghrelin. We studied the changes in the epsilon cells and differentiation markers with immunostaining and ghrelin serum level and after surgery. We employed euglycemic male Wistar rats: two surgical groups (Sleeve gastrectomy and Roux-en Y Gastric Bypass) and two control groups. We reported a significant increase of ghrelin epsilon-cells in the pancreas and basal serum after Sleeve gastrectomy versus the control groups. The epsilon cellular increment was related to neogenesis, as the neurogenin-3 marker revealed. The Roux-en Y Gastric Bypass showed neither epsilon cell increase nor basal serum changes in ghrelin release. As a conclusion, we reported that the severe suppression of the fundus gastric produced the recovery of ghrelin released by the epsilon cells, which was indicative of an ontogenic embryonic pancreatic function.
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Affiliation(s)
- Alonso Camacho-Ramírez
- Surgery Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain.,Asociación Gaditana de Apoyo al Investigador AGAI, Cádiz, Spain
| | - María Ángeles Mayo-Ossorio
- Surgery Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain
| | - José Manuel Pacheco-García
- Surgery Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain
| | - David Almorza-Gomar
- Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain.,Department of Operative Statistic and Research, University of Cádiz, Cádiz, Spain
| | - Antonio Ribelles-García
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Cádiz, Cádiz, Spain.,Sustainable Social Development Research Institute (INDESS), University of Cádiz, Cádiz, Spain
| | - Ana Belmonte-Núñez
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Cádiz, Cádiz, Spain
| | - J Arturo Prada-Oliveira
- Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain.,Asociación Gaditana de Apoyo al Investigador AGAI, Cádiz, Spain.,Department of Human Anatomy and Embryology, Faculty of Medicine, University of Cádiz, Cádiz, Spain.
| | - Gonzalo M Pérez-Arana
- Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain.,Department of Human Anatomy and Embryology, Faculty of Medicine, University of Cádiz, Cádiz, Spain.,Asociación Gaditana de Apoyo al Investigador AGAI, Cádiz, Spain
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Courcoulas AP, Stefater MA, Shirley E, Gourash WF, Stylopoulos N. The Feasibility of Examining the Effects of Gastric Bypass Surgery on Intestinal Metabolism: Prospective, Longitudinal Mechanistic Clinical Trial. JMIR Res Protoc 2019; 8:e12459. [PMID: 30679147 PMCID: PMC6483060 DOI: 10.2196/12459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 01/01/2023] Open
Abstract
Background Bariatric surgery, especially Roux-en-Y gastric bypass (RYGB), is the best treatment for severe obesity and its complications including type 2 diabetes mellitus (T2DM). Understanding the mechanisms responsible for the beneficial metabolic effects will help to engineer ways to improve the procedure or produce these effects without surgery. Objective The aim is to present data on recruitment and feasibility of a translational study designed to collect intestinal samples before and after bariatric surgery. The goal of biobanking is to allow future studies to test the hypothesis that the mechanism of action of RYGB involves specific changes in the postsurgical short- and long-term metabolism and morphology of the jejunum (Roux limb). Specifically, to test whether the intestine enhances its metabolism and activity after RYGB and increases its fuel utilization, we designed a prospective, longitudinal study, which involved the recruitment of candidates for RYGB with and without T2DM. We describe the tissue bank that we have generated, and our experience, hoping to further facilitate the performance of longitudinal mechanistic studies in human patients undergoing bariatric surgery and especially those involving post-RYGB intestinal biology. Methods We conducted a trial to characterize the effects of RYGB on intestinal metabolism. Intestinal tissue samples were collected from the jejunum at surgery, 1, 6, and 12 months postoperatively for the analysis of intestinal gene expression and metabolomic and morphologic changes. The target number of patients who completed at least the 6-month follow-up was 26, and we included a 20% attrition rate, increasing the total number to 32. Results To enroll 26 patients, we had to approach 79 potential participants. A total of 37 agreed to participate and started the study; 33, 30, and 26 active participants completed their 1-month, 6-month, and 12-month studies, respectively. Three participants withdrew, and 30 participants are still active. Altruism and interest in research were the most common reasons for participation. Important factors for feasibility and successful retention included (1) large volume case flow, (2) inclusion and exclusion criteria broad enough to capture a large segment of the patient population but narrow enough to ensure the completion of study aims and protection of safety concerns, (3) accurate assessment of willingness and motivation to participate in a study, (4) seamless integration of the recruitment process into normal clinical flow, (5) financial reimbursement and nonfinancial rewards and gestures of appreciation, and (6) nonburdensome follow-up visits and measures and reasonable time allotted. Conclusions Human translational studies of the intestinal mechanisms of metabolic and weight changes after bariatric surgery are important and feasible. A tissue bank with unique samples has been established that could be used by investigators in many research fields, further enabling mechanistic studies on the effects of bariatric surgery. Trial Registration ClinicalTrials.gov NCT02710370; https://clinicaltrials.gov/ct2/show/NCT02710370 (Archived by WebCite at http://www.webcitation.org/75HrQT8Dl)
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Affiliation(s)
| | | | - Eleanor Shirley
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - William F Gourash
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Mohammadi Farsani T, Mohammadi Farsani G, Kabir A. Gene Expression Changings After Bariatric Surgery in Morbid Obese Patients and Type 2 Diabetes Remission. Obes Surg 2018; 29:649-650. [PMID: 30565099 DOI: 10.1007/s11695-018-03648-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Taiebeh Mohammadi Farsani
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Medical Biotechnology , Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Gholamreza Mohammadi Farsani
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Clinical Nutrition, School of Nutrition and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Sala P, Corrêa-Giannella ML, Waitzberg DL. Bariatric surgery and gene expression in the gut. Curr Opin Clin Nutr Metab Care 2018; 21:246-251. [PMID: 29697537 DOI: 10.1097/mco.0000000000000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The current review provides an overview of recent literature on new findings related to bariatric surgery and gut gene expression. RECENT FINDINGS Bariatric surgery modulates the expression of intestinal genes. Experimental and clinical investigations have demonstrated the association of gut rearrangement with changes in intestinal expression of genes related to glucose metabolism. Recent data suggest that bariatric surgery also affects expression of genes belonging to other pathways, including nutrient transporters and metabolism of vitamin B12, decreasing pathway-encoding genes that may contribute to vitamin B12 deficiency in the postoperative period. SUMMARY Bariatric surgery is an effective intervention strategy against severe obesity, resulting in sustained weight loss and reduction of comorbidities. Nutritional genomic changes appear in response to bariatric surgery, possibly due to adaptive gut response. Improved understanding of the molecular pathways modulated by this intervention may facilitate weight and comorbidities management.
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Affiliation(s)
- Priscila Sala
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM 35), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Programa de Pos-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brasil
| | - M L Corrêa-Giannella
- Programa de Pos-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brasil
- Laboratorio de Carboidratos e Radioimunoensaio (LIM-18), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Dan L Waitzberg
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM 35), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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