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Garruti G, Baj J, Cignarelli A, Perrini S, Giorgino F. Hepatokines, bile acids and ketone bodies are novel Hormones regulating energy homeostasis. Front Endocrinol (Lausanne) 2023; 14:1154561. [PMID: 37274345 PMCID: PMC10236950 DOI: 10.3389/fendo.2023.1154561] [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: 01/30/2023] [Accepted: 04/07/2023] [Indexed: 06/06/2023] Open
Abstract
Current views show that an impaired balance partly explains the fat accumulation leading to obesity. Fetal malnutrition and early exposure to endocrine-disrupting compounds also contribute to obesity and impaired insulin secretion and/or sensitivity. The liver plays a major role in systemic glucose homeostasis through hepatokines secreted by hepatocytes. Hepatokines influence metabolism through autocrine, paracrine, and endocrine signaling and mediate the crosstalk between the liver, non-hepatic target tissues, and the brain. The liver also synthetizes bile acids (BAs) from cholesterol and secretes them into the bile. After food consumption, BAs mediate the digestion and absorption of fat-soluble vitamins and lipids in the duodenum. In recent studies, BAs act not simply as fat emulsifiers but represent endocrine molecules regulating key metabolic pathways. The liver is also the main site of the production of ketone bodies (KBs). In prolonged fasting, the brain utilizes KBs as an alternative to CHO. In the last few years, the ketogenic diet (KD) became a promising dietary intervention. Studies on subjects undergoing KD show that KBs are important mediators of inflammation and oxidative stress. The present review will focus on the role played by hepatokines, BAs, and KBs in obesity, and diabetes prevention and management and analyze the positive effects of BAs, KD, and hepatokine receptor analogs, which might justify their use as new therapeutic approaches for metabolic and aging-related diseases.
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Affiliation(s)
- Gabriella Garruti
- Unit of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Jacek Baj
- Department of Anatomy, Medical University of Lublin, Lublin, Poland
| | - Angelo Cignarelli
- Unit of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Sebastio Perrini
- Unit of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Giorgino
- Unit of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine, University of Bari Aldo Moro, Bari, Italy
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Xu TQ, Kindel TL. The role of weight control in the management of type 2 diabetes mellitus: Bariatric surgery. Diabetes Res Clin Pract 2023; 199:110667. [PMID: 37037264 PMCID: PMC10192054 DOI: 10.1016/j.diabres.2023.110667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/06/2023] [Indexed: 04/12/2023]
Abstract
Diabetes mellitus is one of the major epidemics in the United States. It is heavily associated with obesity and multiple metabolic derangements that lead to long term morbidity, mortality as well as financial burden. Although medical therapy has been the mainstay in the management of diabetes mellitus, there remains a large portion of this patient population which struggles to obtain adequate glycemic control and long-term weight control with medical management alone. Bariatric surgery is a powerful tool in combating diabetes mellitus and affects glucose homeostasis through a variety of pathways. While it does provide a durable pathway for weight loss, improvement in glucose homeostasis is not only affected by the weight loss seen after bariatric surgery. Changes in gut hormone secretion, insulin regulation, and gut microbial composition also affect how these operations improve glucose homeostasis. Through improvement in the management of diabetes mellitus, comorbidities including cardiovascular disease, in turn demonstrate improvement. In this article, we will discuss the role of bariatric (metabolic) surgery as it relates to long term weight loss and the impact that weight loss has on improvement in diabetes mellitus.
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Affiliation(s)
- Thomas Q Xu
- Division of Minimally Invasive and Gastrointestinal Surgery, The Medical College of Wisconsin, United States
| | - Tammy Lyn Kindel
- Division of Minimally Invasive and Gastrointestinal Surgery, The Medical College of Wisconsin, United States.
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Somogyi E, Hoornenborg CW, Bruggink JE, Nyakas C, van Beek AP, van Dijk G. Ileal transposition: A non-restrictive bariatric surgical procedure that reduces body fat and increases ingestion-related energy expenditure. Physiol Behav 2020; 219:112844. [PMID: 32081815 DOI: 10.1016/j.physbeh.2020.112844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ileal Transposition (IT) was developed as a model to study body weight reduction without the restrictive or malabsorptive aspects of other bariatric surgeries, but the exact mechanisms of the alterations in body weight after IT are not completely understood. OBJECTIVE To provide a detailed description of the surgical procedure of IT, and describe its effect on energy balance parameters. METHODS Adult male Lewis rats underwent either IT (IT+) or sham (IT-) surgery. Following surgery body weight and energy intake were monitored. After attaining weight stability (> 30 days), energy expenditure and its components were assessed using indirect calorimetry at a day of fasting, limited intake, and ad libitum intake. At the end of the study body composition analysis was performed. RESULTS IT+ resulted in transiently reduced energy intake, increased ingestion-related energy expenditure (IEE) and decreased body and adipose tissue weight when compared to IT-. At weight stability, neither energy budget (i.e., energy intake - energy expenditure), nor energy efficiency was different in IT+ rats compared to IT-. CONCLUSION Our data show that the primary cause of weight reduction following IT+ is a transient reduction in energy intake. If the increased IEE is related to a higher level of satiety, compensatory feeding to bridge body weight difference between IT+ and IT- rats is less likely to occur.
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Affiliation(s)
- E Somogyi
- School of Ph.D Studies, University of Physical Education, Budapest, Hungary; Department of Behavioral Neuroscience; Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands; Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - C W Hoornenborg
- Department of Behavioral Neuroscience; Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands; Department of Endocrinology, University Medical Center Groningen, Groningen, the Netherlands
| | - J E Bruggink
- Department of Behavioral Neuroscience; Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands
| | - C Nyakas
- School of Ph.D Studies, University of Physical Education, Budapest, Hungary; Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - A P van Beek
- Department of Endocrinology, University Medical Center Groningen, Groningen, the Netherlands
| | - G van Dijk
- Department of Behavioral Neuroscience; Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands.
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Ying LD, Breuer GA, Hubbard MO, Nadzam GS, Hwa J, Martin KA. Technical Feasibility of a Murine Model of Sleeve Gastrectomy with Ileal Transposition. Obes Surg 2019; 29:593-600. [PMID: 30353248 DOI: 10.1007/s11695-018-3555-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sleeve gastrectomy with ileal transposition has been shown to be superior to sleeve gastrectomy alone for promoting weight loss in rat and porcine models. The absence of a mouse model for this procedure has impeded efforts to understand the molecular physiology underlying its efficacy. This study demonstrates the long-term survivability of sleeve gastrectomy with ileal transposition in mice. MATERIALS AND METHODS In this study of technical feasibility, a sleeve gastrectomy with ileal transposition (SGIT), sleeve gastrectomy (SG), or sham surgery (SH) was performed on 7- to 8-week-old C57Bl/6J mice (n = 8 for each). To evaluate long-term survivability, mice were placed on an obesogenic diet and weighed weekly for 10 weeks. The intestinal identity of the transposed segment was assessed with gene expression analysis of duodenal-, jejunal-, and ileal-specific hormones using quantitative polymerase chain reaction. RESULTS Overall, SGIT better prevented weight gain than the SG or sham procedures (10-week post-operative weight: SH 45.3 ± 1.0 g, SG 41.25 ± 1.6 g, SGIT 35.4 ± 0.8 g). Gene expression pattern analysis of three markers of intestinal identity (gastrin, cholecystokinin, and peptide YY) suggests that the ileal identity of the transposed segment is maintained 10 weeks after transposition. CONCLUSIONS We demonstrate for the first time a reproducible mouse model of sleeve gastrectomy with ileal transposition. Future studies utilizing this model will expand our understanding of the molecular pathways through which the hindgut regulates satiety.
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Affiliation(s)
- Lee D Ying
- Yale University School of Medicine, New Haven, CT, 06511, USA.,Yale Cardiovascular Research Center, 300 George St, Room 759, New Haven, CT, 06511, USA
| | | | - Matthew O Hubbard
- Yale University School of Medicine, New Haven, CT, 06511, USA.,Department of Gastrointestinal Surgery, Yale New Haven Health, New Haven, CT, 06511, USA
| | - Geoffrey S Nadzam
- Yale University School of Medicine, New Haven, CT, 06511, USA.,Department of Gastrointestinal Surgery, Yale New Haven Health, New Haven, CT, 06511, USA
| | - John Hwa
- Yale University School of Medicine, New Haven, CT, 06511, USA.,Yale Cardiovascular Research Center, 300 George St, Room 759, New Haven, CT, 06511, USA
| | - Kathleen A Martin
- Yale University School of Medicine, New Haven, CT, 06511, USA. .,Yale Cardiovascular Research Center, 300 George St, Room 759, New Haven, CT, 06511, USA.
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Marfil PHM, Paulo BB, Alvim ID, Nicoletti VR. Production and characterization of palm oil microcapsules obtained by complex coacervation in gelatin/gum Arabic. J FOOD PROCESS ENG 2018. [DOI: 10.1111/jfpe.12673] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- P. H. M. Marfil
- Department of Food Engineering and Technology; São Paulo State University (UNESP); São José do Rio Preto São Paulo 15054-000 Brazil
- Department of Food Engineering; Federal University of Triângulo Mineiro (UFTM); Uberaba Minas Gerais 38064-200 Brazil
| | - B. B. Paulo
- Department of Food Engineering and Technology; São Paulo State University (UNESP); São José do Rio Preto São Paulo 15054-000 Brazil
| | - I. D. Alvim
- Cereal and Chocolate Technology Centre - Institute of Food Technology (ITAL); Campinas São Paulo 13070-178 Brazil
| | - V. R. Nicoletti
- Department of Food Engineering and Technology; São Paulo State University (UNESP); São José do Rio Preto São Paulo 15054-000 Brazil
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Guo Y, Huang ZP, Liu CQ, Qi L, Sheng Y, Zou DJ. Modulation of the gut microbiome: a systematic review of the effect of bariatric surgery. Eur J Endocrinol 2018; 178:43-56. [PMID: 28916564 DOI: 10.1530/eje-17-0403] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/14/2017] [Accepted: 09/15/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Bariatric surgery is recommended for patients with obesity and type 2 diabetes. Recent evidence suggested a strong connection between gut microbiota and bariatric surgery. DESIGN Systematic review. METHODS The PubMed and OVID EMBASE were used, and articles concerning bariatric surgery and gut microbiota were screened. The main outcome measures were alterations of gut microbiota after bariatric surgery and correlations between gut microbiota and host metabolism. We applied the system of evidence level to evaluate the alteration of microbiota. Modulation of short-chain fatty acid and gut genetic content was also investigated. RESULTS Totally 12 animal experiments and 9 clinical studies were included. Based on strong evidence, 4 phyla (Bacteroidetes, Fusobacteria, Verrucomicrobia and Proteobacteria) increased after surgery; within the phylum Firmicutes, Lactobacillales and Enterococcus increased; and within the phylum Proteobacteria, Gammaproteobacteria, Enterobacteriales Enterobacteriaceae and several genera and species increased. Decreased microbial groups were Firmicutes, Clostridiales, Clostridiaceae, Blautia and Dorea. However, the change in microbial diversity is still under debate. Faecalibacterium prausnitzii, Lactobacillus and Coprococcus comes are implicated in many of the outcomes, including body composition and glucose homeostasis. CONCLUSIONS There is strong evidence to support a considerable alteration of the gut microbiome after bariatric surgery. Deeper investigations are required to confirm the mechanisms that link the gut microbiome and metabolic alterations in human metabolism.
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Affiliation(s)
- Yan Guo
- Department of Endocrinology, Changhai Hospital, Shanghai, China
| | - Zhi-Ping Huang
- Third Department of Hepatic Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
- Department of General Surgery, Shangai Changhai Hospital, Shanghai, China
| | - Chao-Qian Liu
- Department of General Surgery, Shangai Changhai Hospital, Shanghai, China
| | - Lin Qi
- Department of Orthopaedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuan Sheng
- Department of General Surgery, Shangai Changhai Hospital, Shanghai, China
| | - Da-Jin Zou
- Department of Endocrinology, Changhai Hospital, Shanghai, China
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Garruti G, Di Ciaula A, Wang HH, Wang DQH, Portincasa P. Cross-Talk Between Bile Acids and Gastro-Intestinal and Thermogenic Hormones: Clues from Bariatric Surgery. Ann Hepatol 2017; 16:s68-s82. [PMID: 29080342 DOI: 10.5604/01.3001.0010.5499] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 02/05/2023]
Abstract
Obesity is rapidly increasing and has reached epidemic features worldwide. It´s linked to insulin resistance, systemic low-grade inflammation and common pathogenic pathways with a number of comorbidities (including cancer), leading to high mortality rates. Besides change of lifestyles (diet and physical exercise) and pharmacological therapy, bariatric surgery is able to rapidly improve several metabolic and morphologic features associated with excessive fat storage, and currently represents an in vivo model to study the pathogenic mechanisms underlying obesity and obesity-related complications. Studies on obese subjects undergoing bariatric surgery find that the effects of surgery are not simply secondary to gastric mechanical restriction and malabsorption which induce body weight loss. In fact, some surgical procedures positively modify key pathways involving the intestine, bile acids, receptor signaling, gut microbiota, hormones and thermogenesis, leading to systemic metabolic changes. Furthermore, bariatric surgery represents a suitable model to evaluate the gene-environment interaction and some epigenetic mechanisms linking obesity and insulin resistance to metabolic diseases.
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Affiliation(s)
- Gabriella Garruti
- Department of Emergency and Organ Transplants, Unit of Endocrinology, University of Bari Medical School, Bari, Italy
| | | | - Helen H Wang
- Department of Medicine, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David Q-H Wang
- Department of Medicine, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School, Bari, Italy
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Machytka E, Bužga M, Zonca P, Lautz DB, Ryou M, Simonson DC, Thompson CC. Partial jejunal diversion using an incisionless magnetic anastomosis system: 1-year interim results in patients with obesity and diabetes. Gastrointest Endosc 2017; 86:904-912. [PMID: 28716404 DOI: 10.1016/j.gie.2017.07.009] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/06/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Most patients with type 2 diabetes mellitus have obesity. Studies show that bariatric surgery is superior to medical treatment for remission of type 2 diabetes mellitus. Nevertheless, very few patients undergo surgery, and a less-invasive endoscopic alternative is desirable. METHODS This was a single-arm first-in-human pilot study designed to evaluate the technical feasibility, safety, and clinical performance of the incisionless magnetic anastomosis system (IMAS) to create a partial jejunal diversion (PJD). Ten patients with obesity and type 2 diabetes mellitus, prediabetes, or no diabetes were enrolled. A PJD to the ileum was attempted in all patients under general anesthesia. The IMAS was delivered through the working channel of a colonoscope, with laparoscopic supervision. The patients were not required to participate in an intensive lifestyle/diet management program. Endoscopic visualization of the anastomosis was obtained at 2, 6, and 12 months. Patient weight, glycemic profile, and metabolic panels were acquired at 0.5, 1, 2, 3, 6, 9, and 12 months. RESULTS A PJD was created in all patients with no device-related serious adverse events. The anastomosis remained widely patent in all patients at 1 year. Average total weight loss was 14.6% (40.2% excess weight loss at 12 months). A significant reduction in glycated hemoglobin level was observed in all diabetic (1.9%) and prediabetic (1.0%) patients, while reducing or eliminating the use of diabetes medications. CONCLUSIONS Permanent anastomosis for PJD was created in all patients with the IMAS. This resulted in improvement in measures of hyperglycemia and progressive weight loss. (Clinical trial registration number: NCT02839512.).
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Affiliation(s)
- Evžen Machytka
- Department of Surgical Studies, Faculty of Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Marek Bužga
- Department of Physiology and Pathophysiology, University of Ostrava Faculty of Medicine, Ostrava, Czech Republic
| | - Pavel Zonca
- Department of Surgical Studies, Faculty of Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - David B Lautz
- Emerson Hospital, Concord, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
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Cohen R, Caravatto PP, Petry TZ. Innovative metabolic operations. Surg Obes Relat Dis 2016; 12:1247-55. [DOI: 10.1016/j.soard.2016.02.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/23/2016] [Indexed: 02/07/2023]
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Lee SK, Kwon OJ, Jeon HM, Kim SJ. Long-term effects of duodenojejunal bypass on diabetes in Otsuka Long-Evans Tokushima Fatty rats. Asian J Surg 2016; 40:262-269. [PMID: 26787497 DOI: 10.1016/j.asjsur.2015.11.001] [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: 07/22/2015] [Revised: 10/20/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Previous studies have shown that duodenojejunal bypass (DJB) resolves type 2 diabetes. However, this finding has been contradicted by several experimental and human trials and therefore needs to be clarified. METHODS Otsuka Long-Evans Tokushima Fatty (OLETF) rats randomly underwent a sham operation or DJB. Thereafter, we measured daily body weight, serum levels of glucose and gut hormones such as glucagon-like peptide-1, insulin, and leptin. RESULTS There was no significant difference in weight loss between rats in the DJB and sham-operated groups. There were also no differences in the area under the curve of glucose tolerance between the DJB and sham-operated groups (32466 ± 2261 mg/dL·min vs. 26319 ± 427 mg/dL·min; p = 0.35). Duodenojejunal bypass did not affect plasma concentrations of various gut hormones such as glucagon-like peptide-1, insulin, and leptin. CONCLUSIONS We have shown that DJB alone does not improve glucose tolerance in obese, diabetic OLETF rats. Therefore, it may be that DJB alone is insufficient for diabetic control in obese diabetic rats. The addition of a restrictive component such as sleeve gastrectomy, or a new drug may be necessary for achieving diabetes reversal.
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Affiliation(s)
- Sang Kuon Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Daejeon, Republic of Korea
| | - Oh-Joo Kwon
- Department of Biochemistry, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Hae Myung Jeon
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Say-June Kim
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Daejeon, Republic of Korea.
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Chen W, Xu Q, Xiao Y, Zhou J, Zhang W, Lin G, Gong F. Blockade of Central GLP-1 Receptors Deteriorates the Improvement of Diabetes after Ileal Transposition. Int J Med Sci 2016; 13:955-962. [PMID: 27994501 PMCID: PMC5165689 DOI: 10.7150/ijms.17290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 10/07/2016] [Indexed: 01/09/2023] Open
Abstract
Background: The mechanism of improvement of type 2 diabetes mellitus induced by ileal transposition (IT) is undefined. Our aim was to investigate the possible role of central glucagon-like peptide 1 (GLP-1) after IT. Methods: Ninety male diabetic rats were randomly divided into the IT, sham IT (S-IT) and control group. The food intake, glucose metabolism and GLP-1 level were measured. Subsequently, we administered GLP-1 antagonist via lateral brain ventricle cannula to block central GLP-1 receptor, and verified whether the food intake, glucose metabolism changed. And the activated pro-opiomelanocortin (POMC) neurons in different groups were compared after sacrifice. Results: IT induced significant diabetic improvement with decreased maximum food intake and higher postprandial GLP-1 level. The GLP-1 level in cerebrospinal fluid increased in correlation with the plasma GLP-1 level. When the central GLP-1 receptor antagonist was given to the IT group rats, the improvement of the glucose level declined. The glucose level surged (169.9 ± 14.2) % during the oral glucose tolerance test, the range was larger than that before central blockade ((67.1 ± 14.2) %, P < 0.001). Moreover, the POMC neuron number in the arcuate nucleus of the hypothalamus were reduced (12.7 ± 6.1 at a magnification of 100×). The relative content level of POMC-derived peptides in the pituitary was lower (0.1 ± 0.05). Conclusions: The central GLP-1 might play an important role in the remission of diabetes after IT. POMC neurons in the hypothalamus may be activated by the enhanced level of GLP-1 after IT.
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Affiliation(s)
- Weijie Chen
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing 100730, P. R. China
| | - Qianqian Xu
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing 100730, P. R. China
| | - Yiding Xiao
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing 100730, P. R. China
| | - Jiaolin Zhou
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing 100730, P. R. China
| | - Weimin Zhang
- Clinical Laboratory of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing 100730, P. R. China
| | - Guole Lin
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing 100730, P. R. China
| | - Fengying Gong
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing 100730, P. R. China
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Abstract
A cure for type 2 diabetes was once a mere dream but has now become a tangible and achievable goal with the unforeseen success of bariatric surgery in the treatment of both obesity and type 2 diabetes. Popular bariatric procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy exhibit high rates of diabetes remission or marked improvement in glycemic control. However, the mechanism of diabetes remission following these procedures is still elusive and appears to be very complex and encompasses multiple anatomical and physiological changes. In this article, calorie restriction, improved β-cell function, improved insulin sensitivity, and alterations in gut physiology, bile acid metabolism, and gut microbiota are reviewed as potential mechanisms of diabetes remission after Roux-en-Y gastric bypass and sleeve gastrectomy.
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Affiliation(s)
- Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Maternal ileal interposition surgery confers metabolic improvements to offspring independent of effects on maternal body weight in UCD-T2DM rats. Obes Surg 2014; 23:2042-9. [PMID: 24036841 DOI: 10.1007/s11695-013-1076-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Increasing numbers of people are undergoing bariatric surgery, of which approximately half are women in their childbearing years. However, information on the long-term effects of maternal bariatric surgery in their children is lacking. Furthermore, since bariatric surgery is performed to reduce body weight, clinical studies have not been able to differentiate between benefits to the child due to maternal body weight loss versus other maternal postoperative metabolic changes. Therefore, we used the University of California, Davis, type 2 diabetes mellitus (UCD-T2DM) rat model to test the hypothesis that maternal ileal interposition (IT) surgery would confer beneficial metabolic effects in offspring, independent of effects on maternal body weight. METHODS IT surgery was performed on 2-month-old prediabetic female UCD-T2DM rats. Females were bred 3 weeks after surgery, and male pups were studied longitudinally. RESULTS Maternal IT surgery resulted in decreased body weight in offspring compared with sham offspring (P < 0.05). IT offspring exhibited improvements of glucose-stimulated insulin secretion and nutrient-stimulated glucagon-like peptide-2 (GLP-2) secretion (P < 0.05). Fasting plasma unconjugated bile acid concentrations were 4-fold lower in IT offspring compared with sham offspring at two months of age (P < 0.001). CONCLUSIONS Overall, maternal IT surgery confers modest improvements of body weight and improves insulin secretion and nutrient-stimulated GLP-2 secretion in offspring in the UCD-T2DM rat model of type 2 diabetes, indicating that this is a useful model for investigating the weight-independent metabolic effects of maternal bariatric surgery.
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O'Brien CS, Wang G, McGinty J, Agénor KK, Dutia R, Colarusso A, Park K, Koshy N, Laferrère B. Effects of gastrogastric fistula repair on weight loss and gut hormone levels. Obes Surg 2014; 23:1294-301. [PMID: 23549962 DOI: 10.1007/s11695-013-0917-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Weight regain after gastric bypass (GBP) can be associated with a gastrogastric fistula (GGF), in which a channel forms between the gastric pouch and gastric remnant, allowing nutrients to pass through the "old route" rather than bypassing the duodenum. To further understand the mechanisms by which GGF may lead to weight regain, we investigated gut hormone levels in GBP patients with a GGF, before and after repair. MATERIALS AND METHODS Seven post-GBP subjects diagnosed with GGF were studied before and 4 months after GGF repair. Another cohort of 22 GBP control subjects without GGF complication were studied before and 1 year post-GBP. All subjects underwent a 50-g oral glucose tolerance test and blood was collected from 0-120 min for glucose, insulin, ghrelin, PYY3-36, GIP, and GLP-1 levels. RESULTS Four months after GGF repair subjects lost 6.0 ± 3.9 kg and had significantly increased postprandial PYY3-36 levels. After GGF repair, fasting and postprandial ghrelin levels decreased and were strongly correlated with weight loss. The insulin response to glucose also tended to be increased after GGF repair, however no concomitant increase in GLP-1 was observed. Compared to the post-GBP group, GLP-1 and PYY3-36 levels were significantly lower before GGF repair; however, after GGF repair, PYY3-36 levels were no longer lower than the post-GBP group. CONCLUSIONS These data utilize the GGF model to highlight the possible role of duodenal shunting as a mechanism of sustained weight loss after GBP, and lend support to the potential link between blunted satiety peptide release and weight regain.
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Affiliation(s)
- Ciaran S O'Brien
- New York Obesity Nutrition Research Center, Department of Medicine, St Luke's Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025, USA
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15
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Salinari S, le Roux CW, Bertuzzi A, Rubino F, Mingrone G. Duodenal-jejunal bypass and jejunectomy improve insulin sensitivity in Goto-Kakizaki diabetic rats without changes in incretins or insulin secretion. Diabetes 2014; 63:1069-78. [PMID: 24241532 DOI: 10.2337/db13-0856] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Gastric bypass surgery can dramatically improve type 2 diabetes. It has been hypothesized that by excluding duodenum and jejunum from nutrient transit, this procedure may reduce putative signals from the proximal intestine that negatively influence insulin sensitivity (SI). To test this hypothesis, resection or bypass of different intestinal segments were performed in diabetic Goto-Kakizaki and Wistar rats. Rats were randomly assigned to five groups: duodenal-jejunal bypass (DJB), jejunal resection (jejunectomy), ileal resection (ileectomy), pair-fed sham-operated, and nonoperated controls. Oral glucose tolerance test was performed within 2 weeks after surgery. Baseline and poststimulation levels of glucose, insulin, glucagon-like peptide 1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) were measured. Minimal model analysis was used to assess SI. SI improved after DJB (SI = 1.14 ± 0.32 × 10(-4) min(-1) ⋅ pM(-1)) and jejunectomy (SI = 0.80 ± 0.14 × 10(-4) min(-1) ⋅ pM(-1)), but not after ileectomy or sham operation/pair feeding in diabetic rats. Both DJB and jejunal resection normalized SI in diabetic rats as shown by SI levels equivalent to those of Wistar rats (SI = 1.01 ± 0.06 × 10(-4) min(-1) ⋅ pM(-1); P = NS). Glucose effectiveness did not change after operations in any group. While ileectomy increased plasma GIP levels, no changes in GIP or GLP-1 were observed after DJB and jejunectomy. These findings support the hypothesis that anatomic alterations of the proximal small bowel may reduce factors associated with negative influence on SI, therefore contributing to the control of diabetes after gastric bypass surgery.
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Affiliation(s)
- Serenella Salinari
- Department of Computer, Control, and Management Engineering "Antonio Ruberti," University of Rome "Sapienza," Rome, Italy
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16
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Mencarelli A, Renga B, D’Amore C, Santorelli C, Graziosi L, Bruno A, Monti MC, Distrutti E, Cipriani S, Donini A, Fiorucci S. Dissociation of intestinal and hepatic activities of FXR and LXRα supports metabolic effects of terminal ileum interposition in rodents. Diabetes 2013; 62:3384-93. [PMID: 23835330 PMCID: PMC3781484 DOI: 10.2337/db13-0299] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The farnesoid X receptor (FXR) and the liver x receptors (LXRs) are bile acid-activated receptors that are highly expressed in the enterohepatic tissues. The mechanisms that support the beneficial effects of bariatric surgery are only partially defined. We have investigated the effects of ileal interposition (IT), a surgical relocation of the distal ileum into the proximal jejunum, on FXR and LXRs in rats. Seven months after surgery, blood concentrations of total bile acids, taurocholic acid, an FXR ligand, and taurohyocholic acid, an LXRα ligand, were significantly increased by IT (P < 0.05). In contrast, liver and intestinal concentrations of conjugated and nonconjugated bile acids were decreased (P < 0.05). These changes were associated with a robust induction of FXR and FXR-regulated genes in the intestine, including Fgf15, a negative regulator of bile acid synthesis. IT repressed the liver expression of glucose-6-phosphatase (G6PC) and phosphoenolpyruvate carboxykinase (Pepck), two gluconeogenetic genes, along with the expression of LXRα and its target genes sterol regulatory element-binding protein (Srebp) 1c and fatty acid synthase (Fas) in the liver. Treating IT rats with chenodeoxycholic acid ameliorated insulin signaling in the liver. Whether confirmed in human settings, these results support the association of pharmacological therapies with bariatric surgeries to exploit the selective activation of intestinal nuclear receptors.
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Affiliation(s)
- Andrea Mencarelli
- Department of Experimental and Clinical Medicine, University of Perugia, Perugia, Italy
| | - Barbara Renga
- Department of Experimental and Clinical Medicine, University of Perugia, Perugia, Italy
- Corresponding author: Barbara Renga,
| | - Claudio D’Amore
- Department of Experimental and Clinical Medicine, University of Perugia, Perugia, Italy
| | - Chiara Santorelli
- Department of Surgical, Radiological and Odontostomatological Sciences, University of Perugia, Perugia, Italy
| | - Luigina Graziosi
- Department of Surgical, Radiological and Odontostomatological Sciences, University of Perugia, Perugia, Italy
| | - Angela Bruno
- Department of Experimental and Clinical Medicine, University of Perugia, Perugia, Italy
| | - Maria Chiara Monti
- Department of Biomedical and Pharmaceutical Sciences, University of Salerno, Salerno, Italy
| | | | - Sabrina Cipriani
- Department of Experimental and Clinical Medicine, University of Perugia, Perugia, Italy
| | - Annibale Donini
- Department of Surgical, Radiological and Odontostomatological Sciences, University of Perugia, Perugia, Italy
| | - Stefano Fiorucci
- Department of Experimental and Clinical Medicine, University of Perugia, Perugia, Italy
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Hansen CF, Bueter M, Theis N, Lutz T, Paulsen S, Dalbøge LS, Vrang N, Jelsing J. Hypertrophy dependent doubling of L-cells in Roux-en-Y gastric bypass operated rats. PLoS One 2013; 8:e65696. [PMID: 23776529 PMCID: PMC3679162 DOI: 10.1371/journal.pone.0065696] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 04/29/2013] [Indexed: 12/31/2022] Open
Abstract
Background and Aims Roux-en-Y gastric bypass (RYGB) leads to a rapid remission of type 2 diabetes mellitus (T2DM), but the underlying mode of action remains incompletely understood. L-cell derived gut hormones such as glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) are thought to play a central role in the anti-diabetic effects of RYGB; therefore, an improved understanding of intestinal endocrine L-cell adaptability is considered pivotal. Methods The full rostrocaudal extension of the gut was analyzed in rats after RYGB and in sham-operated controls ad libitum fed or food restricted to match the body weight of RYGB rats. Total number of L-cells, as well as regional numbers, densities and mucosa volumes were quantified using stereological methods. Preproglucagon and PYY mRNA transcripts were quantified by qPCR to reflect the total and relative hormone production capacity of the L-cells. Results RYGB surgery induced hypertrophy of the gut mucosa in the food exposed regions of the small intestine coupled with a doubling in the total number of L-cells. No changes in L-cell density were observed in any region regardless of surgery or food restriction. The total gene expression capacity of the entire gut revealed a near 200% increase in both PYY and preproglucagon mRNA levels in RYGB rats associated with both increased L-cell number as well as region-specific increased transcription per cell. Conclusions Collectively, these findings indicate that RYGB in rats is associated with gut hypertrophy, an increase in L-cell number, but not density, and increased PYY and preproglucagon gene expression. This could explain the enhanced gut hormone dynamics seen after RYGB.
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Affiliation(s)
- Carl Frederik Hansen
- Department of Histology, Gubra, Hørsholm, Denmark
- Department of Human Nutrition, University of Copenhagen, Frederiksberg, Denmark
| | - Marco Bueter
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
- Center of Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Nadine Theis
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Thomas Lutz
- Center of Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | | | - Niels Vrang
- Department of Histology, Gubra, Hørsholm, Denmark
| | - Jacob Jelsing
- Department of Histology, Gubra, Hørsholm, Denmark
- * E-mail:
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18
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Cohen R, Caravatto PP, Petry T. Surgery for Diabetes. CURRENT SURGERY REPORTS 2013. [DOI: 10.1007/s40137-013-0023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Ebihara K, Tachibe M, Kaneko N, Kishida T. Hydroxypropylation of high-amylose maize starch changes digestion and fermentation-dependent parameters in rats. J Nutr Sci 2013; 2:e17. [PMID: 25191565 PMCID: PMC4153341 DOI: 10.1017/jns.2013.5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 01/03/2013] [Accepted: 01/04/2013] [Indexed: 01/14/2023] Open
Abstract
It was examined whether the physiological effects of high-amylose maize starch (HAMS) are influenced by hydroxypropylation. Rats were fed one of the following three diets: an AIN-93-based diet with waxy maize starch (WMS) as a starch source, or this diet with 150 g of WMS replaced by either HAMS or hydroxypropylated HAMS (HP-HAMS). The activities of amylase in bile-pancreatic juice and sucrose, maltase and isomaltase of the jejunum and ileum were not affected by diet, but the digestibility of HAMS was decreased by hydroxypropylation. The amounts of SCFA in caecal content and H2 excreted in the breath and flatus for HAMS were decreased by hydroxypropylation. Plasma glucagon-like peptide-1 (GLP-1), glucose and insulin concentrations were not affected by diet. On the basis of PCR-denaturing gradient gel electrophoresis (DGGE) profiles, the similarity in caecal bacteria population of the HP-HAMS group and HAMS group was low, but that of the HP-HAMS and WMS groups was high. The amount of caecal IgA was not affected by hydroxypropylation, but those in the HAMS and HP-HAMS groups were greater than that in the WMS group. Plasma and liver concentrations of TAG and cholesterol for HAMS were not affected by hydroxypropylation. These results show that the small intestinal digestibility and fermentation-dependent parameters such as caecal SCFA and H2 productions and caecal bacterial profile of HAMS were affected by hydroxypropylation, but parameters of glucose metabolism such as GLP-1 and insulin, those of lipid metabolism such as plasma TAG and cholesterol and the amount of caecal IgA were not.
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Affiliation(s)
- Kiyoshi Ebihara
- Department of Biological Resources, Faculty of
Agriculture, Ehime University, 3-5-7
Tarumi, Matsuyama 790-8566, Japan
| | - Makoto Tachibe
- Matsutani Chemical Industry Co.,
Ltd., Research Laboratory, 5-3 Kitaitami, Itami
664-8508, Japan
| | - Natsumi Kaneko
- Department of Biological Resources, Faculty of
Agriculture, Ehime University, 3-5-7
Tarumi, Matsuyama 790-8566, Japan
| | - Taro Kishida
- Department of Biological Resources, Faculty of
Agriculture, Ehime University, 3-5-7
Tarumi, Matsuyama 790-8566, Japan
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20
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Goktas Z, Moustaid-Moussa N, Shen CL, Boylan M, Mo H, Wang S. Effects of bariatric surgery on adipokine-induced inflammation and insulin resistance. Front Endocrinol (Lausanne) 2013; 4:69. [PMID: 23772224 PMCID: PMC3677351 DOI: 10.3389/fendo.2013.00069] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 05/23/2013] [Indexed: 12/31/2022] Open
Abstract
Over a third of the US population is obese and at high risk for developing type 2 diabetes, insulin resistance, and other metabolic disorders. Obesity is considered a chronic low-grade inflammatory condition that is primarily attributed to expansion and inflammation of adipose tissues. Indeed, adipocytes produce and secrete numerous proinflammatory and anti-inflammatory cytokines known as adipokines. When the balance of these adipokines is shifted toward higher production of proinflammatory factors, local inflammation within adipose tissues and subsequently systemic inflammation occur. These adipokines including leptin, visfatin, resistin, apelin, vaspin, and retinol binding protein-4 can regulate inflammatory responses and contribute to the pathogenesis of diabetes. These effects are mediated by key inflammatory signaling molecules including activated serine kinases such as c-Jun N-terminal kinase and serine kinases inhibitor κB kinase and insulin signaling molecules including insulin receptor substrates, protein kinase B (PKB, also known as Akt), and nuclear factor kappa B. Bariatric surgery can decrease body weight and improve insulin resistance in morbidly obese subjects. However, despite reports suggesting reduced inflammation and weight-independent effects of bariatric surgery on glucose metabolism, mechanisms behind such improvements are not yet well understood. This review article focuses on some of these novel adipokines and discusses their changes after bariatric surgery and their relationship to insulin resistance, fat mass, inflammation, and glucose homeostasis.
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Affiliation(s)
- Zeynep Goktas
- Nutritional Sciences Program, College of Human Science, Texas Tech University, Lubbock, TX, USA
| | - Naima Moustaid-Moussa
- Nutritional Sciences Program, College of Human Science, Texas Tech University, Lubbock, TX, USA
| | - Chwan-Li Shen
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Mallory Boylan
- Nutritional Sciences Program, College of Human Science, Texas Tech University, Lubbock, TX, USA
| | - Huanbiao Mo
- Department of Nutrition and Food Sciences, Texas Woman’s University, Denton, TX, USA
| | - Shu Wang
- Nutritional Sciences Program, College of Human Science, Texas Tech University, Lubbock, TX, USA
- *Correspondence: Shu Wang, Nutritional Science Program, College of Human Science, Texas Tech University, P.O. Box: 41240, Lubbock, TX 79409-1240, USA e-mail:
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Cummings BP, Bettaieb A, Graham JL, Kim J, Ma F, Shibata N, Stanhope KL, Giulivi C, Hansen F, Jelsing J, Vrang N, Kowala M, Chouinard ML, Haj FG, Havel PJ. Bile-acid-mediated decrease in endoplasmic reticulum stress: a potential contributor to the metabolic benefits of ileal interposition surgery in UCD-T2DM rats. Dis Model Mech 2012; 6:443-56. [PMID: 23264565 PMCID: PMC3597026 DOI: 10.1242/dmm.010421] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Post-operative increases in circulating bile acids have been suggested to contribute to the metabolic benefits of bariatric surgery; however, their mechanistic contributions remain undefined. We have previously reported that ileal interposition (IT) surgery delays the onset of type 2 diabetes in UCD-T2DM rats and increases circulating bile acids, independently of effects on energy intake or body weight. Therefore, we investigated potential mechanisms by which post-operative increases in circulating bile acids improve glucose homeostasis after IT surgery. IT, sham or no surgery was performed on 2-month-old weight-matched male UCD-T2DM rats. Animals underwent an oral fat tolerance test (OFTT) and serial oral glucose tolerance tests (OGTT). Tissues were collected at 1.5 and 4.5 months after surgery. Cell culture models were used to investigate interactions between bile acids and ER stress. IT-operated animals exhibited marked improvements in glucose and lipid metabolism, with concurrent increases in postprandial glucagon-like peptide-1 (GLP-1) secretion during the OFTT and OGTTs, independently of food intake and body weight. Measurement of circulating bile acid profiles revealed increases in circulating total bile acids in IT-operated animals, with a preferential increase in circulating cholic acid concentrations. Gut microbial populations were assessed as potential contributors to the increases in circulating bile acid concentrations, which revealed proportional increases in Gammaproteobacteria in IT-operated animals. Furthermore, IT surgery decreased all three sub-arms of ER stress signaling in liver, adipose and pancreas tissues. Amelioration of ER stress coincided with improved insulin signaling and preservation of β-cell mass in IT-operated animals. Incubation of hepatocyte, adipocyte and β-cell lines with cholic acid decreased ER stress. These results suggest that postoperative increases in circulating cholic acid concentration contribute to improvements in glucose homeostasis after IT surgery by ameliorating ER stress.
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Affiliation(s)
- Bethany P Cummings
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA.
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Kota SK, Ugale S, Gupta N, Naik V, Kumar KVSH, Modi KD. Ileal interposition with sleeve gastrectomy for treatment of type 2 diabetes mellitus. Indian J Endocrinol Metab 2012; 16:589-98. [PMID: 22837922 PMCID: PMC3401762 DOI: 10.4103/2230-8210.98017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AIM Combination of laparoscopic ileal interposition (II) with sleeve gastrectomy (SG) is an upcoming procedure, which offers good metabolic improvement and weight reduction without causing significant malabsorption. The objective of this study was to evaluate the results of this novel procedure for control of type 2 diabetes, obesity, hypertension, and related metabolic abnormalities. MATERIALS AND METHODS The II and SG was performed in 43 patients (M:F = 25:18) from February 2008. Participants had a mean age of 47.2 ± 8.2 years (range 29-66 years), mean duration of diabetes of 10.1 ± 9.2 years (range 1-32 years), and mean preoperative body mass index (BMI) of 33.2 ± 7.8 kg/m2. All patients had poorly controlled type 2 diabetes mellitus (DM) [mean glycated hemoglobin (HbA1C) 9.6 ± 2.1%] despite use of oral hypoglycemic agents (OHAs) and/or insulin. Thirty (70%) patients had hypertension, 20 (46%) had dyslipidemia, and 18 (42%) had significant microalbuminuria. The primary outcome was remission of diabetes (HbA1C < 6.5% without OHAs/insulin) and the secondary outcomes were reduction in antidiabetic agent requirement and components of metabolic syndrome. RESULTS Mean follow-up was for 20.2 ± 8.6 months (range 4-40 months). Postoperatively, glycemic parameters (fasting and post-lunch blood sugar, HbA1C improved in all patients (P < 0.05) at all intervals. Twenty (47%) patients had remission in diabetes and the remaining patients showed significantly decreased OHA requirement. All patients had weight loss between 15 and 30% (P < 0.05). Twenty-seven (90%) patients had remission in hypertension. At 3 years, the mean fall in HbA1C (34%) was more than reduction in BMI (25%). There was a declining trend in lipids and microalbuminuria postoperatively, though it was significant for microalbuminuria only. CONCLUSIONS The laparoscopic II with SG seems to be a promising procedure for control of type 2 DM, hypertension, weight reduction, and associated metabolic abnormalities. A multicenter study with larger number of patients and a longer follow-up period is needed to substantiate our preliminary findings.
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Affiliation(s)
- Sunil Kumar Kota
- Department of Endocrinology, Medwin Hospitals, Hyderabad, Andhra Pradesh, India
| | - Surendra Ugale
- Department of Laparoscopic Surgery, Kirloskar Hospital, Hyderabad, Andhra Pradesh, India
| | - Neeraj Gupta
- Department of Laparoscopic Surgery, Kirloskar Hospital, Hyderabad, Andhra Pradesh, India
| | - Vishwas Naik
- Department of Laparoscopic Surgery, Kirloskar Hospital, Hyderabad, Andhra Pradesh, India
| | - K. V. S. Hari Kumar
- Department of Endocrinology, Command Hospital, Lucknow, Uttar Pradesh, India
| | - Kirtikumar D. Modi
- Department of Endocrinology, Medwin Hospitals, Hyderabad, Andhra Pradesh, India
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23
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Laferrère B. Gut feelings about diabetes. ACTA ACUST UNITED AC 2012; 59:254-60. [PMID: 22386248 DOI: 10.1016/j.endonu.2012.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 01/09/2012] [Indexed: 01/14/2023]
Abstract
Studies of patients going into diabetes remission after gastric bypass surgery have demonstrated the important role of the gut in glucose control. The improvement of type 2 diabetes after gastric bypass surgery occurs via weight dependent and weight independent mechanisms. The rapid improvement of glucose levels within days after the surgery, in relation to change of meal pattern, rapid nutrient transit, enhanced incretin release and improved incretin effect on insulin secretion, suggest mechanisms independent of weight loss. Alternatively, insulin sensitivity improves over time as a function of weight loss. The role of bile acids and microbiome in the metabolic improvement after bariatric surgery remains to be determined. While most patients after bariatric surgery experienced sustained weight loss and improved metabolism, small scale studies have shown weight regain and diabetes relapse, the mechanisms of which remain unknown.
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Affiliation(s)
- Blandine Laferrère
- Obesity Nutrition Research Center, St. Luke's/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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Tinoco A, El-Kadre L, Aquiar L, Tinoco R, Savassi-Rocha P. Short-term and mid-term control of type 2 diabetes mellitus by laparoscopic sleeve gastrectomy with ileal interposition. World J Surg 2012; 35:2238-44. [PMID: 21744166 DOI: 10.1007/s00268-011-1188-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Standard surgical procedures used for the treatment of morbid obesity constitute optional treatments for type 2 diabetes mellitus (T2DM). The aim of the present study was to evaluate the short- and mid-term effects of laparoscopic sleeve gastrectomy (SG) with ileal interposition (II) in T2DM patients (n = 30). METHODS The variables investigated were the feasibility of the procedure, remission/alleviation of the disease, morbidity, mortality, and weight loss. Patients were followed during a period of 6-18 months after surgery. RESULTS The average time required for the surgical procedure was 181.47 ± 53.23 min, and the mean duration of postoperative hospital stay was 3.17 ± 0.79 days. There were no intraoperative complications, and none of the patients required conversion to open surgery. Postoperatively, all patients experienced a significant weight loss: i.e., the mean body mass index (BMI) values prior to and following surgery were significantly different (P = 0.0001). Postoperative levels of glycosylated hemoglobin, fasting glucose, and fructosamine were significantly reduced (P = 0.0001, 0.0001, and 0.0004, respectively) from those detected prior to surgery. Remission of T2DM was observed in 80% of the patients over the follow-up period, and these subjects no longer required treatment with hypoglycemic drugs or diet. The remaining 20% of patients presented significant improvement in their condition but needed an oral hypoglycemic medication. CONCLUSIONS Adequate glycemic control, adjustable weight loss, and absence of nutritional deficiencies were the main benefits offered by the surgical intervention. The results indicate that SG/II treatment could be a promising alternative for patients with T2DM.
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Affiliation(s)
- Augusto Tinoco
- São Jose do Avai Hospital, Rua Cel. Luiz Ferraz, 397, Itaperuna, RJ, Brazil.
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25
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Effects of sleeve gastrectomy surgery with modified jejunoileal bypass on body weight, food intake and metabolic hormone levels of rats. ACTA ACUST UNITED AC 2011; 31:784-788. [DOI: 10.1007/s11596-011-0677-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Indexed: 10/14/2022]
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Metcalf SA, Washington MC, Brown TAL, Williams CS, Strader AD, Sayegh AI. Ileal interposition attenuates the satiety responses evoked by cholecystokinin-8 and -33. Peptides 2011; 32:1296-302. [PMID: 21557974 DOI: 10.1016/j.peptides.2011.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 04/23/2011] [Accepted: 04/24/2011] [Indexed: 02/07/2023]
Abstract
One of the possible mechanisms by which the weight-reducing surgical procedure ileal interposition (II) works is by increasing circulating levels of lower gut peptides that reduce food intake, such as glucagon like peptide-1 and peptide YY. However, since this surgery involves both lower and upper gut segments, we tested the hypothesis that II alters the satiety responses evoked by the classic upper gut peptide cholecystokinin (CCK). To test this hypothesis, we determined meal size (MS), intermeal interval (IMI) and satiety ratio (SR) evoked by CCK-8 and -33 (0, 1, 3, 5nmol/kg, i.p.) in two groups of rats, II and sham-operated. CCK-8 and -33 reduced MS more in the sham group than in the II group; CCK-33 prolonged IMI in the sham group and increased SR in both groups. Reduction of cumulative food intake by CCK-8 in II rats was blocked by devazepide, a CCK(1) receptor antagonist. In addition, as previously reported, we found that II resulted in a slight reduction in body weight compared to sham-operated rats. Based on these observations, we conclude that ileal interposition attenuates the satiety responses of CCK. Therefore, it is unlikely that this peptide plays a significant role in reduction of body weight by this surgery.
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Affiliation(s)
- Shannon A Metcalf
- Gastroenterology Laboratory, Department of Biomedical Sciences, College of Veterinary Medicine, Tuskegee University, Tuskegee, AL 36088, USA
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Scott WR, Batterham RL. Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: understanding weight loss and improvements in type 2 diabetes after bariatric surgery. Am J Physiol Regul Integr Comp Physiol 2011; 301:R15-27. [PMID: 21474429 DOI: 10.1152/ajpregu.00038.2011] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Obesity increases the likelihood of diseases like type 2 diabetes (T2D), heart disease, and cancer, and is one of the most serious public health problems of this century. In contrast to ineffectual prevention strategies, lifestyle modifications, and pharmacological therapies, bariatric surgery is a very effective treatment for morbid obesity and also markedly improves associated comorbidities like T2D. However, weight loss and resolution of T2D after bariatric surgery is heterogeneous and specific to type of bariatric procedure performed. Conventional mechanisms like intestinal malabsorption and gastric restriction do not fully explain this, and potent changes in appetite and the enteroinsular axis, as a result of anatomical reorganization and altered hormonal, neuronal, and nutrient signaling, are the portended cause. Uniquely these signaling changes appear to override vigorous homeostatic defenses of stable body weight and compelling self-gratifying motivations to eat and to reverse defects in beta-cell function and insulin sensitivity. Here we review mechanisms of weight loss and T2D resolution after Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy bariatric surgery, two markedly different procedures with robust clinical outcomes.
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Affiliation(s)
- William R Scott
- Centre for Obesity Research, Dept. of Medicine, Rayne Institute, University College London, WC1E 6JJ, UK
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Kohli R, Kirby M, Setchell KDR, Jha P, Klustaitis K, Woollett LA, Pfluger PT, Balistreri WF, Tso P, Jandacek RJ, Woods SC, Heubi JE, Tschoep MH, D'Alessio DA, Shroyer NF, Seeley RJ. Intestinal adaptation after ileal interposition surgery increases bile acid recycling and protects against obesity-related comorbidities. Am J Physiol Gastrointest Liver Physiol 2010; 299:G652-60. [PMID: 20595624 PMCID: PMC2950688 DOI: 10.1152/ajpgi.00221.2010] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Surgical interposition of distal ileum into the proximal jejunum is a bariatric procedure that improves the metabolic syndrome. Changes in intestinal and hepatic physiology after ileal interposition (transposition) surgery (IIS) are not well understood. Our aim was to elucidate the adaptation of the interposed ileum, which we hypothesized, would lead to early bile acid reabsorption in the interposed ileum, thus short circuiting enterohepatic bile acid recycling to more proximal bowel segments. Rats with diet-induced obesity were randomized to IIS, with 10 cm of ileum repositioned distal to the duodenum, or sham surgery. A subgroup of sham rats was pair-fed to IIS rats. Physiological parameters were measured until 6 wk postsurgery. IIS rats ate less and lost more weight for the first 2 wk postsurgery. At study completion, body weights were not different, but IIS rats had reversed components of the metabolic syndrome. The interposed ileal segment adapted to a more jejunum-like villi length, mucosal surface area, and GATA4/ILBP mRNA. The interposed segment retained capacity for bile acid reabsorption and anorectic hormone secretion with the presence of ASBT and glucagon-like-peptide-1-positive cells in the villi. IIS rats had reduced primary bile acid levels in the proximal intestinal tract and higher primary bile acid levels in the serum, suggesting an early and efficient reabsorption of primary bile acids. IIS rats also had increased taurine and glycine-conjugated serum bile acids and reduced fecal bile acid loss. There was decreased hepatic Cyp27A1 mRNA with no changes in hepatic FXR, SHP, or NTCP expression. IIS protects against the metabolic syndrome through short-circuiting enterohepatic bile acid recycling. There is early reabsorption of primary bile acids despite selective "jejunization" of the interposed ileal segment. Changes in serum bile acids or bile acid enterohepatic recycling may mediate the metabolic benefits seen after bariatric surgery.
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Affiliation(s)
- Rohit Kohli
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Ohio, USA.
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Cummings BP, Strader AD, Stanhope KL, Graham JL, Lee J, Raybould HE, Baskin DG, Havel PJ. Ileal interposition surgery improves glucose and lipid metabolism and delays diabetes onset in the UCD-T2DM rat. Gastroenterology 2010; 138:2437-46, 2446.e1. [PMID: 20226188 PMCID: PMC2883638 DOI: 10.1053/j.gastro.2010.03.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 02/01/2010] [Accepted: 03/04/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Bariatric surgery has been shown to reverse type 2 diabetes; however, mechanisms by which this occurs remain undefined. Ileal interposition (IT) is a surgical model that isolates the effects of increasing delivery of unabsorbed nutrients to the lower gastrointestinal tract. In this study we investigated effects of IT surgery on glucose tolerance and diabetes onset in UCD-T2DM (University of California at Davis type 2 diabetes mellitus) rats, a polygenic obese animal model of type 2 diabetes. METHODS IT or sham surgery was performed on 4-month-old male UCD-T2DM rats. All animals underwent oral glucose tolerance testing (OGTT). A subset was killed 2 months after surgery for tissue analyses. The remainder was followed until diabetes onset and underwent oral fat tolerance testing (OFTT). RESULTS IT surgery delayed diabetes onset by 120 +/- 49 days compared with sham surgery (P < .05) without a difference in body weight. During OGTT, IT-operated animals exhibited lower plasma glucose excursions (P < .05), improved early insulin secretion (P < .01), and 3-fold larger plasma glucagon-like peptide-1(7-36) (GLP-1(7-36)) excursions (P < .001), and no difference in glucose-dependent insulinotropic polypeptide responses compared with sham-operated animals. Total plasma peptide YY (PYY) excursions during OFTT were 3-fold larger in IT-operated animals (P < .01). IT-operated animals exhibited lower adiposity (P < .05), smaller adipocyte size (P < .05), 25% less ectopic lipid deposition, lower circulating lipids, and greater pancreatic insulin content compared with sham-operated animals (P < .05). CONCLUSIONS IT surgery delays the onset of diabetes in UCD-T2DM rats which may be related to increased nutrient-stimulated secretion of GLP-1(7-36) and PYY and improvements of insulin sensitivity, beta-cell function, and lipid metabolism.
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Affiliation(s)
- Bethany P. Cummings
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis; Davis, California.,Department of Nutrition, University of California, Davis; Davis, California
| | - April D. Strader
- Department of Physiology, Southern Illinois University School of Medicine; Carbondale, Illinois
| | - Kimber L. Stanhope
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis; Davis, California.,Department of Nutrition, University of California, Davis; Davis, California
| | - James L. Graham
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis; Davis, California.,Department of Nutrition, University of California, Davis; Davis, California
| | - Jennifer Lee
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine; University of California, Davis; Davis, California
| | - Helen E. Raybould
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine; University of California, Davis; Davis, California
| | - Denis G. Baskin
- Research and Development Service, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, and Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA
| | - Peter J. Havel
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis; Davis, California.,Department of Nutrition, University of California, Davis; Davis, California
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Abstract
AIMS Our studies were designed to understand the role of the gut hormones incretins GLP-1 and GIP on diabetes remission after gastric bypass surgery (GBP). METHODS Morbidly obese patients with type 2 diabetes (T2DM) were studied before and 1, 6, 12, 24 and 36 months after GBP. A matched group of patients were studied before and after a diet-induced 10 kg weight loss, equivalent to the weight loss 1 month after GBP. All patients underwent an oral glucose tolerance test and an isoglycaemic glucose intravenous challenge to measure the incretin effect. RESULTS Post-prandial GLP-1 and GIP levels increase after GBP and the incretin effect on insulin secretion normalizes to the level of non diabetic controls. In addition, the pattern of insulin secretion in response to oral glucose changes after GBP, with recovery of the early phase, and post-prandial glucose levels decrease significantly. These changes were not seen after an equivalent weight loss by diet. The changes in incretin levels and effect observed at 1 month are long lasting and persist up to 3 years after the surgery. The improved insulin release and glucose tolerance after GBP were shown by others to be blocked by the administration of a GLP-1 antagonist in rodents, demonstrating that these metabolic changes are, in part, GLP-1 dependent. CONCLUSION Although sustained and significant weight loss is likely to be the key mediator of diabetes remission after GBP, the changes of incretins improve the early phase of insulin secretion and post-prandial glucose levels, and contribute to the better glucose tolerance.
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Scheen AJ, De Flines J, De Roover A, Paquot N. Bariatric surgery in patients with type 2 diabetes: benefits, risks, indications and perspectives. DIABETES & METABOLISM 2010; 35:537-43. [PMID: 20152741 DOI: 10.1016/s1262-3636(09)73463-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Obesity plays a key role in the pathophysiology of type 2 diabetes (T2DM), and weight loss is a major objective, although difficult to achieve with medical treatments. Bariatric surgery has proven its efficacy in obtaining marked and sustained weight loss, and is also associated with a significant improvement in glucose control and even diabetes remission. Roux-en-Y gastric bypass appears to be more effective in diabetic patients than the restrictive gastroplasty procedure. This may be explained not only by greater weight reduction, but also by specific hormonal changes. Indeed, increased levels of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) may lead to improved beta-cell function and insulin secretion as well as reduced insulin resistance associated with weight loss. The presence of T2DM in obese individuals is a further argument to propose bariatric surgery, and even more so when diabetes is difficult to manage by medical means and other weight-related complications may occur. Bariatric surgery is associated with a better cardiovascular prognosis and reduced mortality, even though acute and long-term complications are present. The observation that surgical rerouting of nutrients triggers changes in the release of incretin hormones that, in turn, ameliorate the diabetic state in the absence of weight loss has led to the recent development of innovative surgical procedures. Thus, bariatric surgery may be said to be progressing towards so-called 'metabolic surgery', which merits further evaluation in patients with T2DM within a multidisciplinary approach that involves both surgeons and endocrinologists.
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Affiliation(s)
- A-J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Sart Tilman, University of Liège, Liège, Belgium.
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Herbella FA, Tineli AC, Wilson JL, Del Grande JC. Duodenal bypass does not decrease glucose levels of lean individuals with gastric cancer submitted to partial or total gastrectomy. ARQUIVOS DE GASTROENTEROLOGIA 2010; 46:230-2. [PMID: 19918692 DOI: 10.1590/s0004-28032009000300017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 01/16/2009] [Indexed: 11/22/2022]
Abstract
Change in glucose metabolism after bariatric operations may be credited to duodenal bypass. This study aims to evaluate the effect of duodenal bypass on glucose levels in lean individuals submitted to gastrectomy for gastric cancer. We reviewed 56 non-diabetic and 6 diabetic patients submitted to gastrectomy and Roux-en-Y for gastric cancer (partial gastrectomy in 66%/total gastrectomy in 34%). Glucose levels were not significantly altered after operation (P = 0.5). Diabetes control was improved in one patient with oral medication. In conclusion, duodenal bypass do not decrease glucose levels in lean individuals treated for gastric cancer.
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Affiliation(s)
- Fernando A Herbella
- Department of Surgery, Division of Esophagus and Stomach, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Maljaars PWJ, Peters HPF, Mela DJ, Masclee AAM. Ileal brake: a sensible food target for appetite control. A review. Physiol Behav 2008; 95:271-81. [PMID: 18692080 DOI: 10.1016/j.physbeh.2008.07.018] [Citation(s) in RCA: 288] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 07/10/2008] [Accepted: 07/14/2008] [Indexed: 12/14/2022]
Abstract
With the rising prevalence of obesity and related health problems increases, there is increased interest in the gastrointestinal system as a possible target for pharmacological or food-based approaches to weight management. Recent studies have shown that under normal physiological situations undigested nutrients can reach the ileum, and induce activation of the so-called "ileal brake", a combination of effects influencing digestive process and ingestive behaviour. The relevance of the ileal brake as a potential target for weight management is based on several findings: First, activation of the ileal brake has been shown to reduce food intake and increase satiety levels. Second, surgical procedures that increase exposure of the ileum to nutrients produce weight loss and improved glycaemic control. Third, the appetite-reducing effect of chronic ileal brake activation appears to be maintained over time. Together, this evidence suggests that activation of the ileal brake is an excellent long-term target to achieve sustainable reductions in food intake. This review addresses the role of the ileal brake in gut function, and considers the possible involvement of several peptide hormone mediators. Attention is given to the ability of macronutrients to activate the ileal brake, and particularly variation attributable to the physicochemical properties of fats. The emphasis is on implications of ileal brake stimulation on food intake and satiety, accompanied by evidence of effects on glycaemic control and weight loss.
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Affiliation(s)
- P W J Maljaars
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, University Hospital Maastricht, PO box 5800 6202 AZ Maastricht, The Netherlands.
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