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Pérez-Arana GM, Díaz-Gómez A, Bancalero-de los Reyes J, Gracia-Romero M, Ribelles-García A, Visiedo F, González-Domínguez Á, Almorza-Gomar D, Prada-Oliveira JA. The role of glucagon after bariatric/metabolic surgery: much more than an "anti-insulin" hormone. Front Endocrinol (Lausanne) 2023; 14:1236103. [PMID: 37635984 PMCID: PMC10451081 DOI: 10.3389/fendo.2023.1236103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
The biological activity of glucagon has recently been proposed to both stimulate hepatic glucose production and also include a paradoxical insulinotropic effect, which could suggest a new role of glucagon in the pathophysiology type 2 diabetes mellitus (T2DM). An insulinotropic role of glucagon has been observed after bariatric/metabolic surgery that is mediated through the GLP-1 receptor on pancreatic beta cells. This effect appears to be modulated by other members of the proglucagon family, playing a key role in the beneficial effects and complications of bariatric/metabolic surgery. Glucagon serves a dual role after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). In addition to maintaining blood glucose levels, glucagon exhibits an insulinotropic effect, suggesting that glucagon has a more complex function than simply an "anti-insulin hormone".
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Affiliation(s)
- Gonzalo-Martín Pérez-Arana
- Department of Human Anatomy and Embryology, University of Cadiz, Cádiz, Spain
- Institute for Biomedical Science Research and Innovation (INIBICA), University of Cadiz, Cádiz, Spain
| | | | | | | | | | - Francisco Visiedo
- Department of Human Anatomy and Embryology, University of Cadiz, Cádiz, Spain
- Institute for Biomedical Science Research and Innovation (INIBICA), University of Cadiz, Cádiz, Spain
| | - Álvaro González-Domínguez
- Institute for Biomedical Science Research and Innovation (INIBICA), University of Cadiz, Cádiz, Spain
| | - David Almorza-Gomar
- Institute for Biomedical Science Research and Innovation (INIBICA), University of Cadiz, Cádiz, Spain
- Operative Statistic and Research Department, University of Cádiz, Cádiz, Spain
| | - José-Arturo Prada-Oliveira
- Department of Human Anatomy and Embryology, University of Cadiz, Cádiz, Spain
- Institute for Biomedical Science Research and Innovation (INIBICA), University of Cadiz, Cádiz, Spain
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Liu FS, Wang S, Guo XS, Ye ZX, Zhang HY, Li Z. State of art on the mechanisms of laparoscopic sleeve gastrectomy in treating type 2 diabetes mellitus. World J Diabetes 2023; 14:632-655. [PMID: 37383590 PMCID: PMC10294061 DOI: 10.4239/wjd.v14.i6.632] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/01/2023] [Accepted: 04/24/2023] [Indexed: 06/14/2023] Open
Abstract
Obesity and type-2 diabetes mellitus (T2DM) are metabolic disorders. Obesity increases the risk of T2DM, and as obesity is becoming increasingly common, more individuals suffer from T2DM, which poses a considerable burden on health systems. Traditionally, pharmaceutical therapy together with lifestyle changes is used to treat obesity and T2DM to decrease the incidence of comorbidities and all-cause mortality and to increase life expectancy. Bariatric surgery is increasingly replacing other forms of treatment of morbid obesity, especially in patients with refractory obesity, owing to its many benefits including good long-term outcomes and almost no weight regain. The bariatric surgery options have markedly changed recently, and laparoscopic sleeve gastrectomy (LSG) is gradually gaining popularity. LSG has become an effective and safe treatment for type-2 diabetes and morbid obesity, with a high cost-benefit ratio. Here, we review the me-chanism associated with LSG treatment of T2DM, and we discuss clinical studies and animal experiments with regard to gastrointestinal hormones, gut microbiota, bile acids, and adipokines to clarify current treatment modalities for patients with obesity and T2DM.
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Affiliation(s)
- Fa-Shun Liu
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Song Wang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Xian-Shan Guo
- Department of Endocrinology, Xinxiang Central Hospital, Xinxiang 453000, Henan Province, China
| | - Zhen-Xiong Ye
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Hong-Ya Zhang
- Central Laboratory, Yangpu District Control and Prevention Center, Shanghai 200090, China
| | - Zhen Li
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
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Haran C, Lim YK, Aljanabi I, Bann S, Wickremesekera S. Bariatric surgery and the neurohormonal switch: Early insulin resistance recordings after laparoscopic sleeve gastrectomy. Medicine (Baltimore) 2022; 101:e29687. [PMID: 35905279 PMCID: PMC9333479 DOI: 10.1097/md.0000000000029687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Laparoscopic sleeve gastrectomy (LSG) is a bariatric operation with a safe risk profile. It has been proven to successfully reduce weight, decrease insulin resistance (IR), and ameliorate diabetes mellitus. The aim of this study was to determine if there is an early improvement in IR after LSG and its association with weight loss. This was a prospective observational study of 32 patients who underwent LSG at a single center over a 3-year period. Serum insulin and fasting glucose levels were recorded preoperatively, on day 1 postoperatively, and 3 weeks after LSG. IR levels were calculated using the Homeostasis Model Assessment 2 Version 2.23. IR levels were compared along with the overall weight loss, via body mass index. β-cell function was the secondary outcome. IR significantly improved the day after surgery with a statistically significant mean difference of 0.89 units (P = .043) and significantly more so 3 weeks postoperatively, with a mean difference of 4.32 units (P < .0005). β-cell function reduced 3 weeks postoperatively, with a mean difference of 23.95 %β (P = .025), while body mass index significantly reduced, with a mean difference of 4.32 kg/m2 (P < .0005). Early improvement of IR was observed on postoperative day 1 after LSG before any weight loss. This raises the possibility of an undetermined, underlying neurohormonal switch that improves IR. Further investigation is needed to determine this mechanism, as it may lead to an improvement in the medical management of diabetes mellitus.
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Affiliation(s)
- Cheyaanthan Haran
- Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand
- Wellington School of Medicine, Otago University, Wellington, New Zealand
- *Correspondence: Cheyaanthan Haran, Department of General Surgery, Wellington Regional Hospital, Riddiford Street, Newtown, Wellington 6021, New Zealand (e-mail: )
| | - Yu kai Lim
- Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand
| | - Imad Aljanabi
- Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand
| | - Simon Bann
- Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand
- Wellington School of Medicine, Otago University, Wellington, New Zealand
- Victoria University of Wellington, Wellington, New Zealand
| | - Susrutha Wickremesekera
- Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand
- Wellington School of Medicine, Otago University, Wellington, New Zealand
- Victoria University of Wellington, Wellington, New Zealand
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Ruze R, Xu Q, Liu G, Li Y, Chen W, Cheng Z, Xiong Y, Liu S, Zhang G, Hu S, Yan Z. Central GLP-1 contributes to improved cognitive function and brain glucose uptake after duodenum-jejunum bypass on obese and diabetic rats. Am J Physiol Endocrinol Metab 2021; 321:E392-E409. [PMID: 34370593 DOI: 10.1152/ajpendo.00126.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/29/2021] [Indexed: 12/19/2022]
Abstract
The improvement of cognitive function following bariatric surgery has been highlighted, yet its underlying mechanisms remain elusive. Finding the improved brain glucose uptake of patients after Roux-en-Y gastric bypass (RYGB), duodenum-jejunum bypass (DJB), and sham surgery (Sham) were performed on obese and diabetic Wistar rats, and intracerebroventricular (ICV) injection of glucagon-like peptide-1 (GLP-1) analog liraglutide (Lira), antagonist exendin-(9-39) (Exe-9), and the viral-mediated GLP-1 receptor (Glp-1r) knockdown (KD) were applied on both groups to elucidate the role of GLP-1 in mediating cognitive function and brain glucose uptake assessed with the Morris water maze (MWM) and positron emission tomography (PET). Insulin and GLP-1 in serum and cerebral spinal fluid (CSF) were measured, and the expression of glucose uptake-related proteins including glucose transporter 1 (GLUT-1), GLUT-4, phospho-Akt substrate of 160kDa (pAS160), AS160, Rab10, Myosin-Va as well as the c-fos marker in the brain were examined. Along with augmented glucose homeostasis following DJB, central GLP-1 was correlated with the improved cognitive function and ameliorated brain glucose uptake, which was further confirmed by the enhancive role of Lira on both groups whereas the Exe-9 and Glp-1r KD were opposite. Known to activate insulin-signaling pathways, central GLP-1 contributes to improved cognitive function and brain glucose uptake after DJB.NEW & NOTEWORTHY The improvement of cognitive function following bariatric surgery has been highlighted while its mechanisms remain elusive. The brain glucose uptake of patients was improved after RYGB, and the DJB and sham surgery performed on obese and diabetic Wistar rats revealed that the elevated central GLP-1 contributes to the dramatic improvement of cognitive function, brain glucose uptake, transport, glucose sensing, and neuronal activation.
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Affiliation(s)
- Rexiati Ruze
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qian Xu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, People's Republic of China
| | - Guoqin Liu
- Department of General Surgery, Jinan Central Hospital, Shandong University, Jinan, People's Republic of China
| | - Yuekai Li
- Department of Nuclear Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Weijie Chen
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhiqiang Cheng
- Department of Colorectal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Yacheng Xiong
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, People's Republic of China
| | - Shaozhuang Liu
- Department of Bariatric and Metabolic Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Guangyong Zhang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, People's Republic of China
| | - Sanyuan Hu
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, People's Republic of China
| | - Zhibo Yan
- Department of Colorectal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
- Key Laboratory Experimental Teratology of the Ministry of Education and Department of Physiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
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A safety study of laparoscopic single-anastomosis duodeno-ileal bypass with gastric plication (SADI-GP) in the management of morbid obesity. Langenbecks Arch Surg 2021; 407:845-860. [PMID: 34402959 PMCID: PMC8369141 DOI: 10.1007/s00423-021-02276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/13/2021] [Indexed: 12/02/2022]
Abstract
Background Bariatric surgery is more effective in the management of morbid obesity and related comorbidities than is conservative therapy. Pylorus-preserving single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-SG) is a modified duodenal switch technique. Gastric plication (GP) is an alternate to SG. Methods Morbidly obese (BMI of > 40, or > 35 in the presence of diabetes or prediabetes) patients were recruited and operated on to perform SADI with GP. Complications related to surgery were recorded to assess the feasibility of the procedure. Weight-loss outcomes were analysed to determine efficacy. Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was recorded after 1 year of follow-up, and test scales were used to describe physiological phenomena. Results Seventeen middle-aged (mean: 40 years) patients were involved in our study; 15 of them were females. The mean duration of surgery was 205 min. There were no complications of conversion, death, bleeding, VTE or 30-day readmission to hospital. We did experience CD4a (pulmonary insufficiency due to chronic lung disease) and a CD3b (anastomosis leakage treated laparoscopically) complications. Vomiting occurred in three cases (CD1). Obesity-related comorbidities showed favourable resolution rates (77.8% for hypertension, 81.2% for dyslipidaemia, 100% for diabetes at the 1-year follow-up). Weight-loss outcomes were favourable (53.20 EWL%, and 35.58 TWL% at 1-year follow-up). Greater weight loss caused significantly higher levels of Depression (t(13.958) = − 2.373; p = 0.00; p < 0.05) and Low Positive Emotions (t(13.301) = − 2.954; p = 0.00; p < 0.05) and Introversion/Low Positive Emotionality (t(13.408) = − 1.914; p = 0.02; p < 0.05) in MMPI-2 data. Conclusion According to our safety study, SADI-GP is a promising malabsorptive procedure, but a long-term high-volume case series or a randomised controlled trial is necessary to evaluate complication rates and weight-loss outcomes. Emotional dysregulation is common among bariatric surgery patients according to personality inventory data; therefore, psychological follow-up and psychotherapeutic support are necessary for weight-loss maintenance. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02276-9.
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Wang XF, Li ML, Fang QQ, Zhao WY, Lou D, Hu YY, Chen J, Wang XZ, Tan WQ. Flexible electrical stimulation device with Chitosan-Vaseline® dressing accelerates wound healing in diabetes. Bioact Mater 2021; 6:230-243. [PMID: 32913931 PMCID: PMC7451868 DOI: 10.1016/j.bioactmat.2020.08.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 12/16/2022] Open
Abstract
The healing process of diabetic wounds is typically disordered and prolonged and requires both angiogenesis and epithelialization. Disruptions of the endogenous electric fields (EFs) may lead to disordered cell migration. Electrical stimulation (ES) that mimics endogenous EFs is a promising method in treating diabetic wounds; however, a microenvironment that facilitates cell migration and a convenient means that can be used to apply ES are also required. Chitosan-Vaseline® gauze (CVG) has been identified to facilitate wound healing; it also promotes moisture retention and immune regulation and has antibacterial activity. For this study, we created a wound dressing using CVG together with a flexible ES device and further evaluated its potential as a treatment for diabetic wounds. We found that high voltage monophasic pulsed current (HVMPC) promoted healing of diabetic wounds in vivo. In studies carried out in vitro, we found that HVMPC promoted the proliferation and migration of human umbilical vein endothelial cells (HUVECs) by activating PI3K/Akt and ERK1/2 signaling. Overall, we determined that the flexible ES-chitosan dressing may promoted healing of diabetic wounds by accelerating angiogenesis, enhancing epithelialization, and inhibiting scar formation. These findings provide support for the ongoing development of this multidisciplinary product for the care and treatment of diabetic wounds.
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Affiliation(s)
- Xiao-Feng Wang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, PR China
| | - Meng-Lu Li
- Key Laboratory of Micro-Nano Electronic Devices and Smart Systems of Zhejiang Province, College of Information Science & Electronic Engineering, Zhejiang University, Hangzhou, 310027, Zhejiang Province, PR China
| | - Qing-Qing Fang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, PR China
| | - Wan-Yi Zhao
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, PR China
| | - Dong Lou
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, PR China
| | - Yan-Yan Hu
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, PR China
| | - Jun Chen
- Innovation Center for Signaling Network, College of Life Sciences, Zhejiang University, Hangzhou, 310058, Zhejiang Province, PR China
| | - Xiao-Zhi Wang
- Key Laboratory of Micro-Nano Electronic Devices and Smart Systems of Zhejiang Province, College of Information Science & Electronic Engineering, Zhejiang University, Hangzhou, 310027, Zhejiang Province, PR China
| | - Wei-Qiang Tan
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, PR China
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The obesity paradox: does it exist in the perioperative period? Int Anesthesiol Clin 2020; 58:14-20. [PMID: 32250998 DOI: 10.1097/aia.0000000000000278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang Y, Guo X, Lu X, Mattar S, Kassab G. Mechanisms of Weight Loss After Sleeve Gastrectomy and Adjustable Gastric Banding: Far More Than Just Restriction. Obesity (Silver Spring) 2019; 27:1776-1783. [PMID: 31545007 DOI: 10.1002/oby.22623] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 07/15/2019] [Indexed: 12/18/2022]
Abstract
Obesity has reached global epidemic proportions in recent decades. Bariatric surgery is currently accepted as most effective in alleviating morbid obesity and related disorders. Sleeve gastrectomy (SG) and adjustable gastric banding (AGB) have gained popularity since the beginning of this century because of their efficacy, safety, and simplicity. SG, in particular, has emerged as the most popular bariatric procedure because of its simpler concept and shorter operative time compared with gastric bypass. Caloric restriction, however, cannot account for the sustained weight loss and improved glucose metabolism seen following SG and AGB. Other mechanisms, including changes in gastrointestinal hormone secretion, rearrangement of hypothalamic and vagal control, alteration in energy expenditure, and re-regulation of bile acid metabolism and the intestinal flora environment, are thought to contribute to the postoperative benefits. This review focuses on clinical and experimental literature addressing the potential mechanisms for SG and AGB procedures in human and animal models. Understanding such mechanisms can provide important insight into how current gastric restrictive procedures work and how future treatments of obesity, both surgical and nonsurgical, can be developed.
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Affiliation(s)
- Yanmin Wang
- California Medical Innovations Institute, San Diego, California, USA
| | - Xiaomei Guo
- California Medical Innovations Institute, San Diego, California, USA
| | - Xiao Lu
- California Medical Innovations Institute, San Diego, California, USA
| | - Samer Mattar
- Swedish Weight Loss Services, Seattle, Washington, USA
| | - Ghassan Kassab
- California Medical Innovations Institute, San Diego, California, USA
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