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Chen W, Huang J, Xiao J, Xu Q, Liu W, He X. Ileum excision partially reverses improvement of glucose metabolism in diabetic rats after biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis 2024:S1550-7289(24)00158-8. [PMID: 38782612 DOI: 10.1016/j.soard.2024.04.011] [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: 10/21/2023] [Revised: 03/03/2024] [Accepted: 04/07/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Bile acids can stimulate the secretion of glucagon-like peptide-1 (GLP-1) and be mostly reabsorbed in the ileum. OBJECTIVES We aimed to investigate whether ileum excision could reverse the glucose improvement after biliopancreatic diversion with duodenal switch (BPD/DS). SETTING Peking Union Medical College Hospital. METHODS Thirty diabetic rats were randomly divided into the BPD/DS group, BPD/DS plus ileectomy (BDI) group, and control group. The fasting blood glucose, bile acids, and glucagon-like peptide-1(GLP-1) levels in plasma samples were analyzed. RESULTS In postoperative week 20, the fasting blood glucose level in the BDI group was significantly higher than that in the BPD/DS group (11.5 ± 1.4 mmol/L versus 7.6 ± 1.0 mmol/L, P < .001), and the AUCOGTT value was also significantly higher than that in the BPD/DS group (2186.1 ± 237.2 mmol/L·min versus 1551.2 ± 136.9 mmol/L·min, P < .001). The plasma level of bile acids in the BDI group was lower than that in the BPD/DS group (P = .012) and was not significantly different from that in the control group (P = .629). The plasma level of GLP-1 in the BDI group was lower than that in the BPD/DS group (P = .009) and was not significantly different from that in the control group (P = .530). Moreover, the intestinal TGR5 expression in the BDI group was significantly lower than that in the BPD/DS group (P < .001). CONCLUSIONS The results show that excision of the ileum can partially reverse the improvement in glucose metabolism after BPD/DS.
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Affiliation(s)
- Weijie Chen
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Jianhao Huang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Jianchun Xiao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Qiang Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Wei Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Xiaodong He
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China.
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2
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Chen W, Zhou S, Xiao J, Liu W, Qu Q, He X. Farnesoid X receptor is inhibited after ileum transposition in diabetic rats: its hypoglycemic effect. Int J Med Sci 2023; 20:595-605. [PMID: 37082732 PMCID: PMC10110471 DOI: 10.7150/ijms.80563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 03/25/2023] [Indexed: 04/22/2023] Open
Abstract
Background: Aim to investigate bile acid profile changes and the Farnesoid X receptor (FXR) status after ileotransposition (IT), and reveal its possible hypoglycemic mechanism. Methods: Twenty male diabetic rats were randomly assigned into the IT group and the sham IT (SH) group. Bile acid profiles were measured using an ultra-performance liquid chromatography-tandem mass spectrometry. Glucose metabolism was monitored after oral administration of FXR inhibitor and agonist. And the expression of key FXR target genes were measured. Results: The levels of β-muricholic acid (P = 0.047), tauro-α-muricholic acid and tauro-β-muricholic acid (P < 0.001) in plasma in the IT group were higher than those in the SH group, and the levels of taurocholic acid (P = 0.049) and turoursodeoxycholic acid (P = 0.030) were lower than those in the SH group. After inhibition of intestinal FXR, the glucose metabolism in the SH group was improved. When FXR agonist was given, the blood glucose level was increased in both groups. After sacrifice, the levels of glycoursodeoxycholic acid, tauro-α-muricholic acid and tauro-β-muricholic acid in liver and ileum tissues were higher than those in the SH group (P < 0.05), the level of α- muricholic acid (P < 0.001) in liver tissues were lower than that in the SH group. Moreover, the expression of CYP7A1 mRNA (P < 0.001) and FGF15 mRNA (P = 0.001) in the IT group was significantly higher, and the expression of PEPCK mRNA (P = 0.004), SREPB1c mRNA (P = 0.005) and SRB1 mRNA (P = 0.001) were significantly lower than that in the SH group. Conclusions: We demonstrate a remarkable heterogeneity of BA profiles after IT, FXR activation might has a detrimental effect on glucose metabolism.
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Affiliation(s)
| | | | | | | | | | - Xiaodong He
- ✉ Corresponding author: Xiaodong He, Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing 100730, P. R. China Tel: 0086 13521624987; Fax: 0086 01069156002
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3
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Cheng ZQ, Liu TM, Ren PF, Chen C, Wang YL, Dai Y, Zhang X. Duodenal-jejunal bypass reduces serum ceramides via inhibiting intestinal bile acid-farnesoid X receptor pathway. World J Gastroenterol 2022; 28:4328-4337. [PMID: 36159007 PMCID: PMC9453759 DOI: 10.3748/wjg.v28.i31.4328] [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] [Received: 03/11/2022] [Revised: 05/12/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bile acids play an important role in the amelioration of type 2 diabetes following duodenal-jejunal bypass (DJB). Serum bile acids are elevated postoperatively. However, the clinical relevance is not known. Bile acids in the peripheral circulation reflect the amount of bile acids in the gut. Therefore, a further investigation of luminal bile acids following DJB is of great significance.
AIM To investigate changes of luminal bile acids following DJB.
METHODS Salicylhydroxamic acid (SHAM), DJB, and DJB with oral chenodeoxycholic acid (CDCA) supplementation were performed in a high-fat-diet/streptozotocin-induced diabetic rat model. Body weight, energy intake, oral glucose tolerance test, luminal bile acids, serum ceramides and intestinal ceramide synthesis were analyzed at week 12 postoperatively.
RESULTS Compared to SHAM, DJB achieved rapid and durable improvement in glucose tolerance and led to increased total luminal bile acid concentrations with preferentially increased proportion of farnesoid X receptor (FXR) - inhibitory bile acids within the common limb. Intestinal ceramide synthesis was repressed with decreased serum ceramides, and this phenomenon could be partially antagonized by luminal supplementation of FXR activating bile acid CDCA.
CONCLUSION DJB significantly changes luminal bile acid composition with increased proportion FXR-inhibitory bile acids and reduces serum ceramide levels. There observations suggest a novel mechanism of bile acids in metabolic regulation after DJB.
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Affiliation(s)
- Zhi-Qiang Cheng
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Tong-Ming Liu
- Department of Colorectal and Anal Surgery, Feicheng Hospital Affiliated to Shandong First Medical University, Feicheng 271600, Shandong Province, China
| | - Peng-Fei Ren
- Department of General Surgery, Lincheng People’s Hospital, Dezhou 253500, Shandong Province, China
| | - Chang Chen
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Yan-Lei Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Yong Dai
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Xiang Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
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4
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Abstract
Metabolomics emerged as an important tool to gain insights on how the body responds to therapeutic interventions. Bariatric surgery is the most effective treatment for severe obesity and obesity-related co-morbidities. Our aim was to conduct a systematic review of the available data on metabolomics profiles that characterize patients submitted to different bariatric surgery procedures, which could be useful to predict clinical outcomes including weight loss and type 2 diabetes remission. For that, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA guidelines were followed. Data from forty-seven original study reports addressing metabolomics profiles induced by bariatric surgery that met eligibility criteria were compiled and summarized. Amino acids, lipids, energy-related and gut microbiota-related were the metabolite classes most influenced by bariatric surgery. Among these, higher pre-operative levels of specific lipids including phospholipids, long-chain fatty acids and bile acids were associated with post-operative T2D remission. As conclusion, metabolite profiling could become a useful tool to predict long term response to different bariatric surgery procedures, allowing more personalized interventions and improved healthcare resources allocation.
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Affiliation(s)
- Matilde Vaz
- Endocrine & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
- Department of Anatomy, School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
| | - Sofia S Pereira
- Endocrine & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
- Department of Anatomy, School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
| | - Mariana P Monteiro
- Endocrine & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal.
- Department of Anatomy, School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal.
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5
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Guyot E, Dougkas A, Nazare JA, Bagot S, Disse E, Iceta S. A systematic review and meta-analyses of food preference modifications after bariatric surgery. Obes Rev 2021; 22:e13315. [PMID: 34312976 DOI: 10.1111/obr.13315] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 12/12/2022]
Abstract
This systematic review and meta-analyses aimed to synthesize evidence of the link between bariatric surgery and changes in food preferences, considering the method of assessment. MEDLINE, Cochrane Library, Web of Science, Cinahl, PsychINFO, ProQuest, and Open grey were searched incorporating two blocks of terms ("Intervention" and "Food Preferences"). Interventional or observational studies involving patients (BMI ≥ 35 kg m-2 ) with sleeve gastrectomy (SG) or Roux-en-Y Gastric Bypass (RYGB) and a control group were included. Meta-analyses were performed comparing the standardized daily mean percentage energy from proteins, carbohydrates, and lipids between preoperative and postoperative patients. Fifty-seven studies concerning 2,271 patients with RYGB and 903 patients with SG met the inclusion criteria, of which 24 were eligible for meta-analysis. Despite a total reduction in macronutrient intakes, the meta-analyses revealed a postoperative increase in percentage energy from proteins at 12 months (0.24, 95% CI: 0.03, 0.46, {I2 } = 73%) and a decrease in percentage energy from fat at 1 month (-0.47, 95% CI: 0.86, 0.09, {I2 } = 72%), up to 24 months (-0.20, 95% CI: -0.31, 0.08, {I2 } = 0%). In conclusion, the present systematic review and meta-analyses showed changes of food preferences in terms of macronutrient, food selection and, overall food appreciation up to 5 years following bariatric surgery.
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Affiliation(s)
- Erika Guyot
- Centre Européen Nutrition et Santé (CENS), Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Pierre-Bénite, France.,Institut Paul Bocuse Research Center, Ecully, France
| | | | - Julie-Anne Nazare
- Centre Européen Nutrition et Santé (CENS), Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Pierre-Bénite, France.,Laboratoire CarMeN, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Sarah Bagot
- Centre Européen Nutrition et Santé (CENS), Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Pierre-Bénite, France.,Institut Paul Bocuse Research Center, Ecully, France
| | - Emmanuel Disse
- Centre Européen Nutrition et Santé (CENS), Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Pierre-Bénite, France.,Laboratoire CarMeN, Université Claude Bernard Lyon 1, Pierre-Bénite, France.,Department of Endocrinology, Diabetes and Nutrition, Integrated Center for Obesity, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Sylvain Iceta
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, Quebec, Canada
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6
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Albaugh VL, Kindel TL, Nissen SE, Aminian A. Cardiovascular Risk Reduction Following Metabolic and Bariatric Surgery. Surg Clin North Am 2021; 101:269-294. [PMID: 33743969 DOI: 10.1016/j.suc.2020.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in developed countries, with worsening pandemics of type 2 diabetes mellitus and obesity as major cardiovascular (CV) risk factors. Clinical trials of nonsurgical obesity treatments have not shown benefits in CVD, although recent diabetes trials have demonstrated major CV benefits. In many retrospective and prospective cohort studies, however, metabolic (bariatric) surgery is associated with substantial and reproducible CVD benefits. Despite a lack of prospective, randomized clinical trials, data suggest metabolic surgery may be the most effective modality for CVD risk reduction, likely through weight loss and weight loss-independent mechanisms.
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Affiliation(s)
- Vance L Albaugh
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH 44195, USA.
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7
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Dai C, Wang M, Zhao L, Xu C, Huang J, Fan Z. Liver gene transfection by retrograde intrabiliary infusion facilitated by temporary biliary obstruction. J Gene Med 2019; 22:e3144. [PMID: 31742830 DOI: 10.1002/jgm.3144] [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: 06/22/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The hepatobiliary tract may be a valuable administration site for gene delivery. We demonstrated the role of temporary biliary obstruction for gene transfection by retrograde intrabiliary infusion. METHODS Male Sprague-Dawley rats received intrabiliary infusion of luciferase plasmid via an artificial common bile duct, with temporary biliary obstruction for 0 minutes (NO group), 30 minutes (30 min group) and 24 hours (24 h group), respectively (n = 4 for each group). Gene expression levels were evaluated by luciferase bioluminescence on postoperative days (POD) 1, 2 and 7. Serum and livers were collected on POD 1 and 14 for liver biochemistry, hematoxylin and eosin staining, and immunohistochemistry. RESULTS On POD 1, luciferase chemoluminescence was significantly higher in the 24 h group than in the NO group (p = 0.002) and the 30 min group (p = 0.002). However, it decreased rapidly after reversal of the obstruction in the 24 h group (POD 1 versus POD 2, p = 0.002; POD 1 versus POD 7, p = 0.002). Liver biochemistry was changed on POD 1, but no significant differences were detected after 14 days of recovery (p > 0.05). Similar histological changes were found in the three groups, with no unwanted proliferation of biliary epithelial cells. The obstruction did not cause serious liver damage. CONCLUSIONS Temporary biliary obstruction for 24 hours facilitated the safe, feasible and effective transfection of plasmid DNA into the liver via the hepatobiliary tract. In the future, endoscopic retrograde cholangiopancreatography and its dilation balloon could be used to create biliary obstruction and allow the direct gene delivery into the liver. More research is necessary for achieving stable gene expression, as well as in terms of weighing its benefits against potential complications.
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Affiliation(s)
- Chenguang Dai
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Digestive Endoscopy Department, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Min Wang
- Digestive Endoscopy Department, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lili Zhao
- Digestive Endoscopy Department, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Chunfang Xu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jin Huang
- Department of Gastroenterology, The Changzhou Second People's Hospital, Changzhou, China.,Division of Digestive Diseases, the People's Hospital of Ma Anshan, Ma Anshan, China
| | - Zhining Fan
- Digestive Endoscopy Department, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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8
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Barataud A, Vily-Petit J, Goncalves D, Zitoun C, Duchampt A, Philippe E, Gautier-Stein A, Mithieux G. Metabolic benefits of gastric bypass surgery in the mouse: The role of fecal losses. Mol Metab 2019; 31:14-23. [PMID: 31918916 PMCID: PMC6880100 DOI: 10.1016/j.molmet.2019.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 12/27/2022] Open
Abstract
Objective Roux-en-Y gastric surgery (RYGB) promotes a rapid and sustained weight loss and amelioration of glucose control in obese patients. A high number of molecular hypotheses were previously tested using duodenal-jejunal bypass (DJB) performed in various genetic models of mice with knockouts for various hormones or receptors. The data were globally negative or inconsistent. Therefore, the mechanisms remained elusive. Intestinal gluconeogenesis is a gut function that has been suggested to contribute to the metabolic benefits of RYGB in obese patients. Methods We studied the effects of DJB on body weight and glucose control in obese mice fed a high fat-high sucrose diet. Wild type mice and mice with a genetic suppression of intestinal gluconeogenesis were studied in parallel using glucose- and insulin-tolerance tests. Fecal losses, including excretion of lipids, were studied from the feces recovered in metabolic cages. Results DJB induced a dramatic decrease in body weight and improvement in glucose control (glucose- and insulin-tolerance) in obese wild type mice fed a high calorie diet, for 25 days after the surgery. The DJB-induced decrease in food intake was transient and resumed to normal in 7–8 days, suggesting that decreased food intake could not account for the benefits. Total fecal losses were about 5 times and lipid losses 7 times higher in DJB-mice than in control (sham-operated and pair-fed) mice, and could account for the weight loss of mice. The results were comparable in mice with suppression of intestinal gluconeogenesis. There was no effect of DJB on food intake, body weight or fecal loss in lean mice fed a normal chow diet. Conclusions DJB in obese mice fed a high calorie diet promotes dramatic fecal loss, which could account for the dramatic weight loss and metabolic benefits observed. This could dominate the effects of the mouse genotype/phenotype. Thus, fecal energy loss should be considered as an essential process contributing to the metabolic benefits of DJB in obese mice. Duodenal-jejunal bypass (DJB) promotes weight loss in mice fed a high calorie diet. DJB induces dramatic fecal energy losses in mice fed a high calorie diet. DJB has no effect in mice fed a control (starch-based) diet. There is no fecal losses in DJB-mice fed a control diet. Fecal energy loss is a cause of body weight loss in DJB-mice fed high calorie diet.
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Affiliation(s)
- Aude Barataud
- Institut National de la Santé et de la Recherche Médicale, U1213, Lyon, F-69008, France; Université de Lyon, Lyon, F-69008, France; Université Lyon 1, Villeurbanne, F-69622, France
| | - Justine Vily-Petit
- Institut National de la Santé et de la Recherche Médicale, U1213, Lyon, F-69008, France; Université de Lyon, Lyon, F-69008, France; Université Lyon 1, Villeurbanne, F-69622, France
| | - Daisy Goncalves
- Institut National de la Santé et de la Recherche Médicale, U1213, Lyon, F-69008, France; Université de Lyon, Lyon, F-69008, France; Université Lyon 1, Villeurbanne, F-69622, France
| | - Carine Zitoun
- Institut National de la Santé et de la Recherche Médicale, U1213, Lyon, F-69008, France; Université de Lyon, Lyon, F-69008, France; Université Lyon 1, Villeurbanne, F-69622, France
| | - Adeline Duchampt
- Institut National de la Santé et de la Recherche Médicale, U1213, Lyon, F-69008, France; Université de Lyon, Lyon, F-69008, France; Université Lyon 1, Villeurbanne, F-69622, France
| | - Erwann Philippe
- Institut National de la Santé et de la Recherche Médicale, U1213, Lyon, F-69008, France; Université de Lyon, Lyon, F-69008, France; Université Lyon 1, Villeurbanne, F-69622, France
| | - Amandine Gautier-Stein
- Institut National de la Santé et de la Recherche Médicale, U1213, Lyon, F-69008, France; Université de Lyon, Lyon, F-69008, France; Université Lyon 1, Villeurbanne, F-69622, France
| | - Gilles Mithieux
- Institut National de la Santé et de la Recherche Médicale, U1213, Lyon, F-69008, France; Université de Lyon, Lyon, F-69008, France; Université Lyon 1, Villeurbanne, F-69622, France.
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9
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Tsuchiya T, Naitoh T, Nagao M, Tanaka N, Watanabe K, Imoto H, Miyachi T, Motoi F, Unno M. Increased Bile Acid Signals After Duodenal-Jejunal Bypass Improve Non-alcoholic Steatohepatitis (NASH) in a Rodent Model of Diet-Induced NASH. Obes Surg 2019; 28:1643-1652. [PMID: 29235014 DOI: 10.1007/s11695-017-3065-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The increasing incidence of non-alcoholic steatohepatitis (NASH) has resulted in it becoming a common cause of liver-related mortality; however, no efficient treatment has been established. It has been reported that bariatric surgery improves metabolic comorbidities, such as diabetes mellitus and NASH. Although the mechanism is unclear, it is thought that the changes in bile acid (BA) signaling via its nuclear receptor, farnesoid X receptor (FXR), produce various metabolic effects. We sought to investigate the effects and mechanisms of bariatric surgery on NASH improvement. METHODS Male Sprague-Dawley rats were fed by a high-fat and high-fructose diet, which results in obesity, insulin resistance, and NASH. Rats underwent duodenal-jejunal bypass (DJB), which is a main component of bariatric procedures. The liver pathological findings and the expression level of mRNA of FXR were investigated. The plasma BA level was measured in peripheral and portal vein blood. RESULTS DJB suppressed weight gain, improved insulin resistance, and ameliorated NASH mainly in a point of inflammation. The plasma BA level along with the expression of FXR and its target transcriptional factor, small heterodimer partner (SHP), in the liver were elevated. CONCLUSIONS DJB has a direct effect on NASH improvement, and there is a possibility that an anti-inflammatory effect is functioning as a part of the mechanism. The increase of plasma bile acid level followed by the stimulation of FXR signaling may contribute to this phenomenon.
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Affiliation(s)
- Takahiro Tsuchiya
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takeshi Naitoh
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Munenori Nagao
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Naoki Tanaka
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kazuhiro Watanabe
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Hirofumi Imoto
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Tomohiro Miyachi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Fuyuhiko Motoi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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10
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Ahlin S, Cefalo C, Bondia-Pons I, Capristo E, Marini L, Gastaldelli A, Mingrone G, Nolan JJ. Bile acid changes after metabolic surgery are linked to improvement in insulin sensitivity. Br J Surg 2019; 106:1178-1186. [PMID: 31216062 PMCID: PMC6771783 DOI: 10.1002/bjs.11208] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/21/2018] [Accepted: 03/16/2019] [Indexed: 12/21/2022]
Abstract
Background Metabolic surgery is associated with a prompt improvement in insulin resistance, although the mechanism of action remains unknown. The literature on bile acid changes after metabolic surgery is conflicting, and insulin sensitivity is generally assessed by indirect methods. The aim of this study was to investigate the relationship between improvement in insulin sensitivity and concentration of circulating bile acids after biliopancreatic diversion (BPD) and Roux‐en‐Y gastric bypass (RYGB). Methods This was a prospective observational study of nine patients who underwent BPD and six who had RYGB. Inclusion criteria for participation were a BMI in excess of 40 kg/m2, no previous diagnosis of type 2 diabetes and willingness to participate. Exclusion criteria were major endocrine diseases, malignancies and liver cirrhosis. Follow‐up visits were carried out after a mean(s.d.) of 185·3(72·9) days. Fasting plasma bile acids were assessed by ultra‐high‐performance liquid chromatography coupled with a triple quadrupole mass spectrometer, and insulin sensitivity was measured by means of a hyperinsulinaemic–euglycaemic clamp. Results A significant increase in all bile acids, as well as an amelioration of insulin sensitivity, was observed after metabolic surgery. An increase in conjugated secondary bile acids was significantly associated with an increase in insulin sensitivity. Only the increase in glycodeoxycholic acid was significantly associated with an increase in insulin sensitivity in analysis of individual conjugated secondary bile acids. Conclusion Glycodeoxycholic acid might drive the improved insulin sensitivity after metabolic surgery.
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Affiliation(s)
- S Ahlin
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Fondazione Policlinico Universitario A. Gemelli Instituto di Ricovero e Cura a Carattere Scientifico and Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Cefalo
- Fondazione Policlinico Universitario A. Gemelli Instituto di Ricovero e Cura a Carattere Scientifico and Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - E Capristo
- Fondazione Policlinico Universitario A. Gemelli Instituto di Ricovero e Cura a Carattere Scientifico and Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Marini
- Fondazione Policlinico Universitario A. Gemelli Instituto di Ricovero e Cura a Carattere Scientifico and Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Gastaldelli
- Cardiometabolic Risk Laboratory, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - G Mingrone
- Fondazione Policlinico Universitario A. Gemelli Instituto di Ricovero e Cura a Carattere Scientifico and Università Cattolica del Sacro Cuore, Rome, Italy.,Steno Diabetes Centre, Gentofte, Denmark.,Department of Diabetes, King's College, London, UK
| | - J J Nolan
- Steno Diabetes Centre, Gentofte, Denmark.,School of Medicine, Trinity College Dublin, Ireland
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11
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Pierre JF, Li Y, Gomes CK, Rao P, Chang EB, Ping Yin D. Bile Diversion Improves Metabolic Phenotype Dependent on Farnesoid X Receptor (FXR). Obesity (Silver Spring) 2019; 27:803-812. [PMID: 30933435 PMCID: PMC6788773 DOI: 10.1002/oby.22440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/19/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The current study investigated whether bile diversion (BD) improves metabolic phenotype under farnesoid X receptor (FXR) deficiency. METHODS BD was performed in high-fat diet (HFD)-fed FXR knockout (FXRko) and wild-type (WT) animals. Metabolic phenotypes, circulating enteroendocrine hormones, total bile acids (BAs) and BA composition, and cecal gut microbiota were analyzed. RESULTS FXR-deficient mice were resistant to HFD-induced obesity; however, FXR-deficient mice also developed hyperglycemia and exhibited increased liver weight, liver steatosis, and circulating triglycerides. BD increased circulating total BAs and taurine-b-muricholic acid, which were in line with normalized hyperglycemia and improved glucose tolerance in HFD-fed WT mice. FXR deficiency also increased total BAs and taurine-b-muricholic acid, but these animals remained hyperglycemic. While BD improved metabolic phenotype in HFD-fed FXRko mice, these improvements were not as effective as in WT mice. BD increased liver expression of fibroblast growth factor 21 and peroxisome proliferator-activated receptor γ coactivator-1β and elevated circulating glucagon-like peptide-1 levels in WT mice but not in FXRko mice. FXR deficiency altered gut microbiota composition with a specific increase in phylum Proteobacteria that may act as a possible microbial signature of some diseases. These cellular and molecular changes in FXRko mice may contribute to resistance toward improved metabolism. CONCLUSIONS FXR signaling plays a pivotal role in improved metabolic phenotype following BD surgery.
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Affiliation(s)
- Joseph F. Pierre
- Department of Medicine, the University of Chicago, Chicago, IL, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yuxin Li
- Department of Surgery,the University of Chicago, Chicago, IL, USA
| | - Charles K. Gomes
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Prahlad Rao
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Eugene B. Chang
- Department of Medicine, the University of Chicago, Chicago, IL, USA
| | - Deng Ping Yin
- Department of Surgery,the University of Chicago, Chicago, IL, USA
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12
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Wang W, Cheng Z, Wang Y, Dai Y, Zhang X, Hu S. Role of Bile Acids in Bariatric Surgery. Front Physiol 2019; 10:374. [PMID: 31001146 PMCID: PMC6454391 DOI: 10.3389/fphys.2019.00374] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 03/18/2019] [Indexed: 12/11/2022] Open
Abstract
Bariatric surgery has been proved to be effective and sustainable in the long-term weight-loss and remission of metabolic disorders. However, the underlying mechanisms are still far from fully elucidated. After bariatric surgery, the gastrointestinal tract is manipulated, either anatomically or functionally, leading to changed bile acid metabolism. Accumulating evidence has shown that bile acids play a role in metabolic regulation as signaling molecules other than digestive juice. And most of the metabolism-beneficial effects are mediated through nuclear receptor FXR and membrane receptor TGR5, as well as reciprocal influence on gut microbiota. Bile diversion procedure is also performed on animals to recapitulate the benefits of bariatric surgery. It appears that bile acid alteration is an important component of bariatric surgery, and represents a promising target for the management of metabolic disorders.
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Affiliation(s)
- Wenting Wang
- Department of Obstetrics and Gynecology, The Second Hospital of Shandong University, Jinan, China
| | - Zhiqiang Cheng
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yanlei Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yong Dai
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xiang Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
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13
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Additional effects of duodenojejunal bypass on glucose metabolism in a rat model of sleeve gastrectomy. Surg Today 2019; 49:637-644. [DOI: 10.1007/s00595-019-1772-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/12/2019] [Indexed: 02/07/2023]
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14
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Importance of the gastrointestinal tract in type 2 diabetes. Metabolic surgery is more than just incretin effect. Cir Esp 2018; 96:537-545. [PMID: 30337047 DOI: 10.1016/j.ciresp.2018.09.004] [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: 10/18/2017] [Revised: 07/25/2018] [Accepted: 09/10/2018] [Indexed: 11/23/2022]
Abstract
Bariatric and metabolic surgery is creating new concepts about how the intestine assimilates food. Recent studies highlight the role of the gastrointestinal tract in the genesis and evolution of type 2 diabetes. This article has been written to answer frequent questions about metabolic surgery results and the mechanisms of action. For this purpose, a non-systematic search of different databases was carried out, identifying articles published in the last decade referring to the mechanisms of action of metabolic techniques. Understanding these mechanisms will help grasp why some surgeries are more effective than others and why the results can be so disparate among patients undergoing the same surgical approach.
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15
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Jirapinyo P, Thompson AC, Kröner PT, Chan WW, Thompson CC. Metabolic Effect of Foregut Exclusion Demonstrated by the Impact of Gastrogastric Fistula on Recurrence of Diabetes. J Am Coll Surg 2018; 226:259-266.e1. [PMID: 29274838 PMCID: PMC5826850 DOI: 10.1016/j.jamcollsurg.2017.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) resolves in >80% of patients after Roux-en-Y gastric bypass (RYGB). It has been hypothesized that foregut exclusion is mechanistically important to this observation. This study aimed to determine whether gastrogastric (GG) fistula, with a loss of foregut exclusion, is associated with T2DM relapse, and to assess whether closure of GG fistula is associated with T2DM resolution. STUDY DESIGN A matched cohort study of patients who experienced T2DM remission after RYGB. Cases (patients with GG fistula) were matched to controls (patients without GG fistula) based on age, BMI, weight regain, and duration from RYGB. Primary end point was T2DM relapse. Time-to-event analysis was performed to identify an association between GG fistula and time to T2DM resolution. RESULTS One hundred and twenty-six patients (42 cases and 84 controls) were included. Cases experienced a higher rate of T2DM relapse than controls (48% vs 13%; odds ratio 18; p < 0.0001). On multivariable analysis, GG fistula remained a significant predictor of T2DM relapse after controlling for sex and insulin use (odds ratio 6.3; p = 0.02). Of the 42 cases, 20 experienced T2DM relapse, with 1 spontaneous resolution. Of 19, thirteen underwent fistula revision and experienced a higher rate of T2DM resolution than the nonrevision group (69% vs 0%; odds ratio 27; p = 0.036). Time to T2DM resolution was shorter in the revision group compared with the nonrevision group (p = 0.006). CONCLUSIONS The RYGB patients with GG fistula have a higher rate of T2DM relapse, compared with those without GG fistula with similar BMI and weight regain. Successful fistula revision is associated with resolution of T2DM.
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Affiliation(s)
- Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Andrew C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Paul T Kröner
- Department of Medicine, Mount Sinai St. Luke's, Mount Sinai West Hospitals, New York, NY
| | - Walter W Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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16
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Seyfried F, Miras AD, Rotzinger L, Nordbeck A, Corteville C, Li JV, Schlegel N, Hankir M, Fenske W, Otto C, Jurowich C. Gastric Bypass-Related Effects on Glucose Control, β Cell Function and Morphology in the Obese Zucker Rat. Obes Surg 2018; 26:1228-36. [PMID: 26377340 DOI: 10.1007/s11695-015-1882-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) may improve beta cell function by mechanisms other than caloric restriction and body weight loss. We aimed to assess the impact of anatomical and hormonal alterations specific to RYGB on glucose homeostasis, β cell function and morphology. METHODS Male Zucker(fa/fa) rats underwent either RYGB (n = 11) or sham surgeries (n = 10). Five of the shams were then food restricted and body weight matched (BWM) to the RYGB rats. Six male Zucker(fa/+) rats underwent sham surgery and served as additional lean controls. Twenty-seven days after surgery, an oral glucose tolerance test (OGTT) was performed and plasma levels of glucose, insulin and glucagon-like peptide-1 (GLP-1) were measured. Immunohistological analysis of pancreatic islets was performed, and GLP-1 receptor and PDX-1 mRNA content were quantified. RESULTS Shams consumed more food and gained more weight compared to both RYGB and BWM (p < 0.001). Hyperglycaemia was evident in ad libitum-fed shams, whilst postprandial glucose levels were lower in RYGB compared to the BWM sham group (p < 0.05). During the OGTT, RYGB rats responded with >2.5-fold increase of GLP-1. Histology revealed signs of islet degeneration in ad libitum-fed shams, but not in RYGB and sham BWM controls (p < 0.001). GLP-1 receptor and PDX-1 mRNA content was similar between the RYGB and BWM shams but higher compared to ad libitum shams (p < 0.05). CONCLUSIONS Combined molecular, cellular and histological analyses of pancreatic function suggest that weight loss alone, and not the enhancement of GLP-1 responses, is predominant for the short-term β cell protective effects of RYGB.
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Affiliation(s)
- Florian Seyfried
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6 97080, Wuerzburg, Germany.
| | - Alexander D Miras
- Department of Investigative Medicine, Imperial College London, London, UK
| | - Laura Rotzinger
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6 97080, Wuerzburg, Germany
| | - Arno Nordbeck
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6 97080, Wuerzburg, Germany
| | - Caroline Corteville
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6 97080, Wuerzburg, Germany
| | - Jia V Li
- Division of Computational and Systems Medicine, Imperial College London, London, UK
- Centre for Digestive and Gut Health, Department of Surgery and Cancer, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Nicolas Schlegel
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6 97080, Wuerzburg, Germany
| | - Mohammed Hankir
- Department of Medicine, Integrated Research and Treatment Centre for Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Wiebke Fenske
- Department of Medicine, Integrated Research and Treatment Centre for Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Christoph Otto
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6 97080, Wuerzburg, Germany
| | - Christian Jurowich
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6 97080, Wuerzburg, Germany
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17
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Shapiro H, Kolodziejczyk AA, Halstuch D, Elinav E. Bile acids in glucose metabolism in health and disease. J Exp Med 2018; 215:383-396. [PMID: 29339445 PMCID: PMC5789421 DOI: 10.1084/jem.20171965] [Citation(s) in RCA: 270] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/11/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022] Open
Abstract
Bile acids (BAs) are cholesterol-derived metabolites that facilitate the intestinal absorption and transport of dietary lipids. Recently, BAs also emerged as pivotal signaling molecules controlling glucose, lipid, and energy metabolism by binding to the nuclear hormone farnesoid X receptor (FXR) and Takeda G protein receptor 5 (TGR5) in multiple organs, leading to regulation of intestinal incretin secretion, hepatic gluconeogenesis, glycogen synthesis, energy expenditure, inflammation, and gut microbiome configuration. Alterations in BA metabolism and signaling are associated with obesity and type 2 diabetes mellitus (T2DM), whereas treatment of T2DM patients with BA sequestrants, or bariatric surgery in morbidly obese patients, results in a significant improvement in glycemic response that is associated with changes in the BA profile and signaling. Herein, we review the roles of BAs in glucose metabolism in health and disease; highlight the limitations, unknowns, and challenges in understanding the impact of BAs on the glycemic response; and discuss how this knowledge may be harnessed to develop innovative therapeutic approaches for the treatment of hyperglycemia and diabetes.
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Affiliation(s)
- Hagit Shapiro
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | | | - Daniel Halstuch
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Eran Elinav
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
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18
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Albaugh VL, Banan B, Ajouz H, Abumrad NN, Flynn CR. Bile acids and bariatric surgery. Mol Aspects Med 2017; 56:75-89. [PMID: 28390813 PMCID: PMC5603298 DOI: 10.1016/j.mam.2017.04.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/27/2017] [Accepted: 04/04/2017] [Indexed: 12/12/2022]
Abstract
Bariatric surgery, specifically Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG), are the most effective and durable treatments for morbid obesity and potentially a viable treatment for type 2 diabetes (T2D). The resolution rate of T2D following these procedures is between 40 and 80% and far surpasses that achieved by medical management alone. The molecular basis for this improvement is not entirely understood, but has been attributed in part to the altered enterohepatic circulation of bile acids. In this review we highlight how bile acids potentially contribute to improved lipid and glucose homeostasis, insulin sensitivity and energy expenditure after these procedures. The impact of altered bile acid levels in enterohepatic circulation is also associated with changes in gut microflora, which may further contribute to some of these beneficial effects. We highlight the beneficial effects of experimental surgical procedures in rodents that alter bile secretory flow without gastric restriction or altering nutrient flow. This information suggests a role for bile acids beyond dietary fat emulsification in altering whole body glucose and lipid metabolism strongly, and also suggests emerging roles for the activation of the bile acid receptors farnesoid x receptor (FXR) and G-protein coupled bile acid receptor (TGR5) in these improvements. The limitations of rodent studies and the current state of our understanding is reviewed and the potential effects of bile acids mediating the short- and long-term metabolic improvements after bariatric surgery is critically examined.
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MESH Headings
- Animals
- Bile Acids and Salts/metabolism
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/microbiology
- Diabetes Mellitus, Type 2/pathology
- Diabetes Mellitus, Type 2/surgery
- Enterohepatic Circulation
- Gastrectomy
- Gastric Bypass
- Gastrointestinal Microbiome/physiology
- Gene Expression Regulation
- Glucose/metabolism
- Homeostasis/physiology
- Humans
- Insulin Resistance
- Obesity, Morbid/metabolism
- Obesity, Morbid/microbiology
- Obesity, Morbid/pathology
- Obesity, Morbid/surgery
- Receptors, Cytoplasmic and Nuclear/genetics
- Receptors, Cytoplasmic and Nuclear/metabolism
- Receptors, G-Protein-Coupled/genetics
- Receptors, G-Protein-Coupled/metabolism
- Rodentia
- Signal Transduction
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Affiliation(s)
- Vance L Albaugh
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Babak Banan
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Hana Ajouz
- American University of Beirut, Beirut, Lebanon
| | - Naji N Abumrad
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Charles R Flynn
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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19
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Chávez-Talavera O, Tailleux A, Lefebvre P, Staels B. Bile Acid Control of Metabolism and Inflammation in Obesity, Type 2 Diabetes, Dyslipidemia, and Nonalcoholic Fatty Liver Disease. Gastroenterology 2017; 152:1679-1694.e3. [PMID: 28214524 DOI: 10.1053/j.gastro.2017.01.055] [Citation(s) in RCA: 575] [Impact Index Per Article: 82.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 02/06/2023]
Abstract
Bile acids are signaling molecules that coordinately regulate metabolism and inflammation via the nuclear farnesoid X receptor (FXR) and the Takeda G protein-coupled receptor 5 (TGR5). These receptors activate transcriptional networks and signaling cascades controlling the expression and activity of genes involved in bile acid, lipid and carbohydrate metabolism, energy expenditure, and inflammation by acting predominantly in enterohepatic tissues, but also in peripheral organs. In this review, we discuss the most recent findings on the inter-organ signaling and interplay with the gut microbiota of bile acids and their receptors in meta-inflammation, with a focus on their pathophysiologic roles in obesity, type 2 diabetes, dyslipidemia, and nonalcoholic steatohepatitis, and their potential therapeutic applications.
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Affiliation(s)
- Oscar Chávez-Talavera
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - Anne Tailleux
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - Philippe Lefebvre
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - Bart Staels
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France.
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20
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Velmurugan G, Ramprasath T, Swaminathan K, Mithieux G, Rajendhran J, Dhivakar M, Parthasarathy A, Babu DDV, Thumburaj LJ, Freddy AJ, Dinakaran V, Puhari SSM, Rekha B, Christy YJ, Anusha S, Divya G, Suganya K, Meganathan B, Kalyanaraman N, Vasudevan V, Kamaraj R, Karthik M, Jeyakumar B, Abhishek A, Paul E, Pushpanathan M, Rajmohan RK, Velayutham K, Lyon AR, Ramasamy S. Gut microbial degradation of organophosphate insecticides-induces glucose intolerance via gluconeogenesis. Genome Biol 2017; 18:8. [PMID: 28115022 PMCID: PMC5260025 DOI: 10.1186/s13059-016-1134-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/14/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Organophosphates are the most frequently and largely applied insecticide in the world due to their biodegradable nature. Gut microbes were shown to degrade organophosphates and cause intestinal dysfunction. The diabetogenic nature of organophosphates was recently reported but the underlying molecular mechanism is unclear. We aimed to understand the role of gut microbiota in organophosphate-induced hyperglycemia and to unravel the molecular mechanism behind this process. RESULTS Here we demonstrate a high prevalence of diabetes among people directly exposed to organophosphates in rural India (n = 3080). Correlation and linear regression analysis reveal a strong association between plasma organophosphate residues and HbA1c but no association with acetylcholine esterase was noticed. Chronic treatment of mice with organophosphate for 180 days confirms the induction of glucose intolerance with no significant change in acetylcholine esterase. Further fecal transplantation and culture transplantation experiments confirm the involvement of gut microbiota in organophosphate-induced glucose intolerance. Intestinal metatranscriptomic and host metabolomic analyses reveal that gut microbial organophosphate degradation produces short chain fatty acids like acetic acid, which induces gluconeogenesis and thereby accounts for glucose intolerance. Plasma organophosphate residues are positively correlated with fecal esterase activity and acetate level of human diabetes. CONCLUSION Collectively, our results implicate gluconeogenesis as the key mechanism behind organophosphate-induced hyperglycemia, mediated by the organophosphate-degrading potential of gut microbiota. This study reveals the gut microbiome-mediated diabetogenic nature of organophosphates and hence that the usage of these insecticides should be reconsidered.
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Affiliation(s)
- Ganesan Velmurugan
- Department of Molecular Biology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India.
| | - Tharmarajan Ramprasath
- Center for Molecular and Translational Medicine, Research Science Center, Georgia State University, Atlanta, GA, 30303, USA
| | - Krishnan Swaminathan
- KMCH Research Foundation, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, 641014, India
| | - Gilles Mithieux
- Institut National de la Santé et de la Recherche Médicale, U1213, Lyon, 69372, France
| | - Jeyaprakash Rajendhran
- Department of Genetics, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Mani Dhivakar
- Department of Immunology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Ayothi Parthasarathy
- Department of Molecular Biology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - D D Venkatesh Babu
- Department of Molecular Biology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Leishman John Thumburaj
- Department of Immunology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Allen J Freddy
- Deparment of Zoology, Madras Christian College, Chennai, Tamil Nadu, 600059, India
| | - Vasudevan Dinakaran
- Department of Genetics, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Shanavas Syed Mohamed Puhari
- Department of Biochemistry, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Balakrishnan Rekha
- Department of Molecular Biology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Yacob Jenifer Christy
- Department of Molecular Biology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Sivakumar Anusha
- Department of Molecular Biology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Ganesan Divya
- Department of Biochemistry, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Kannan Suganya
- Department of Microbial Technology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Boominathan Meganathan
- Department of Molecular Biology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Narayanan Kalyanaraman
- Department of Immunology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Varadaraj Vasudevan
- Department of Biochemistry, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Raju Kamaraj
- Department of Immunology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Maruthan Karthik
- Department of Molecular Biology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Balakrishnan Jeyakumar
- Department of Molecular Biology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Albert Abhishek
- Department of Biochemistry, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Eldho Paul
- Department of Biochemistry, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Muthuirulan Pushpanathan
- Laboratory of Gene Regulation and Development, Program in Cellular Regulation and Development, National Institute of Child Health and Human Development, NIH, Bethesda, MD, 20892, USA
| | - Rajamani Koushick Rajmohan
- Department of Molecular Biology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India
| | - Kumaravel Velayutham
- Institute of Diabetes & Endocrinology, Alpha Hospital and Research Centre, Madurai, Tamil Nadu, 625009, India
| | - Alexander R Lyon
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College, London, UK
| | - Subbiah Ramasamy
- Department of Molecular Biology, Centre for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, 625021, India.
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21
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Abstract
In addition to their well-known function as dietary lipid detergents, bile acids have emerged as important signalling molecules that regulate energy homeostasis. Recent studies have highlighted that disrupted bile acid metabolism is associated with metabolism disorders such as dyslipidaemia, intestinal chronic inflammatory diseases and obesity. In particular, type 2 diabetes (T2D) is associated with quantitative and qualitative modifications in bile acid metabolism. Bile acids bind and modulate the activity of transmembrane and nuclear receptors (NR). Among these receptors, the G-protein-coupled bile acid receptor 1 (TGR5) and the NR farnesoid X receptor (FXR) are implicated in the regulation of bile acid, lipid, glucose and energy homeostasis. The role of these receptors in the intestine in energy metabolism regulation has been recently highlighted. More precisely, recent studies have shown that FXR is important for glucose homeostasis in particular in metabolic disorders such as T2D and obesity. This review highlights the growing importance of the bile acid receptors TGR5 and FXR in the intestine as key regulators of glucose metabolism and their potential as therapeutic targets.
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22
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Pierre JF, Martinez KB, Ye H, Nadimpalli A, Morton TC, Yang J, Wang Q, Patno N, Chang EB, Yin DP. Activation of bile acid signaling improves metabolic phenotypes in high-fat diet-induced obese mice. Am J Physiol Gastrointest Liver Physiol 2016; 311:G286-304. [PMID: 27340128 PMCID: PMC5007288 DOI: 10.1152/ajpgi.00202.2016] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/15/2016] [Indexed: 01/31/2023]
Abstract
The metabolic benefits induced by gastric bypass, currently the most effective treatment for morbid obesity, are associated with bile acid (BA) delivery to the distal intestine. However, mechanistic insights into BA signaling in the mediation of metabolic benefits remain an area of study. The bile diversion () mouse model, in which the gallbladder is anastomosed to the distal jejunum, was used to test the specific role of BA in the regulation of glucose and lipid homeostasis. Metabolic phenotype, including body weight and composition, glucose tolerance, energy expenditure, thermogenesis genes, total BA and BA composition in the circulation and portal vein, and gut microbiota were examined. BD improves the metabolic phenotype, which is in accord with increased circulating primary BAs and regulation of enterohormones. BD-induced hypertrophy of the proximal intestine in the absence of BA was reversed by BA oral gavage, but without influencing BD metabolic benefits. BD-enhanced energy expenditure was associated with elevated TGR5, D2, and thermogenic genes, including UCP1, PRDM16, PGC-1α, PGC-1β, and PDGFRα in epididymal white adipose tissue (WAT) and inguinal WAT, but not in brown adipose tissue. BD resulted in an altered gut microbiota profile (i.e., Firmicutes bacteria were decreased, Bacteroidetes were increased, and Akkermansia was positively correlated with higher levels of circulating primary BAs). Our study demonstrates that enhancement of BA signaling regulates glucose and lipid homeostasis, promotes thermogenesis, and modulates the gut microbiota, which collectively resulted in an improved metabolic phenotype.
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Affiliation(s)
- Joseph F. Pierre
- 1Department of Medicine, University of Chicago, Chicago, Illinois;
| | | | - Honggang Ye
- 1Department of Medicine, University of Chicago, Chicago, Illinois;
| | | | - Timothy C. Morton
- 3Department of Ecology and Evolution, University of Chicago, Chicago, Illinois
| | - Jinghui Yang
- 2Department of Surgery, University of Chicago, Chicago, Illinois; and
| | - Qiang Wang
- 2Department of Surgery, University of Chicago, Chicago, Illinois; and
| | - Noelle Patno
- 1Department of Medicine, University of Chicago, Chicago, Illinois;
| | - Eugene B. Chang
- 1Department of Medicine, University of Chicago, Chicago, Illinois;
| | - Deng Ping Yin
- Department of Surgery, University of Chicago, Chicago, Illinois; and
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23
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Baud G, Raverdy V, Bonner C, Daoudi M, Caiazzo R, Pattou F. Sodium glucose transport modulation in type 2 diabetes and gastric bypass surgery. Surg Obes Relat Dis 2016; 12:1206-12. [DOI: 10.1016/j.soard.2016.04.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 01/07/2023]
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24
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Abstract
Obesity and its associated medical conditions continue to increase and add significant burden to patients, as well as health-care systems, worldwide. Bariatric surgery is the most effective treatment for severe obesity and its comorbidities, and resolution of diabetes is weight loss-independent in the case of some operations. Although these weight-independent effects are frequently described clinically, the mechanisms behind them are not well understood and remain an intense area of focus in the growing field of metabolic and bariatric surgery. Perceptions of the mechanisms responsible for the beneficial metabolic effects of metabolic/bariatric operations have shifted from being mostly restrictive and malabsorption over the last 10 to 15 years to being more neuro-hormonal in origin. In this review, we describe recent basic and clinical findings of the major clinical procedures (adjustable gastric banding, vertical sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion) as well as other experimental procedures (ileal interposition and bile diversion) that recapitulate many of the metabolic effects of these complex operations in a simpler fashion. As the role of bile acids and the gut microbiome on metabolism is becoming increasingly well described, their potential roles in these improvements following metabolic surgery are becoming better appreciated. Bile acid and gut microbiome changes, in light of recent developments, are discussed in the context of these surgical procedures, as well as their implications for future study.
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Affiliation(s)
- Vance L Albaugh
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, 37232, USA
| | - C Robb Flynn
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, 37232, USA
| | - Robyn A Tamboli
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, 37232, USA
| | - Naji N Abumrad
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, 37232, USA
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25
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Spinelli V, Chávez-Talavera O, Tailleux A, Staels B. Metabolic effects of bile acid sequestration: impact on cardiovascular risk factors. Curr Opin Endocrinol Diabetes Obes 2016; 23:138-44. [PMID: 26859552 DOI: 10.1097/med.0000000000000235] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This article discusses the impact of bile acid sequestrants (BAS) on cardiovascular risk factors (CVRFs), on the basis of recent (pre)clinical studies assessing the metabolic impact of modulation of enterohepatic bile acid signaling via the bile acid receptors farnesoid X receptor (FXR) and Takeda G-protein-coupled receptor 5 (TGR5). RECENT FINDINGS BAS decrease low-density lipoprotein-cholesterol by stimulating de novo hepatic bile acid synthesis and lowering intestinal lipid absorption, and improve glucose homeostasis in type 2 diabetes mellitus, at least in part by increasing GLP-1 production, via intestinal TGR5- and FXR-dependent mechanisms. Intestinal and peripheral FXR and TGR5 modulation also affects peripheral tissues, which can contribute to the reduction of CVRFs. SUMMARY Bile acids are regulators of metabolism acting in an integrated interorgan manner via FXR and TGR5. Modulation of the bile acid pool size and composition, and selective interference with their receptors could, therefore, be a therapeutic approach to decrease CVRFs. Even though clinical cardiovascular outcome studies using BAS are still lacking, the existing data point to BAS as an efficacious pharmacological approach to reduce CVRFs.
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Affiliation(s)
- Valeria Spinelli
- aUniv Lille, UMR1011, EGID bInserm, UMR1011 cCHU Lille dInstitut Pasteur de Lille, U1011, Lille, France *Valeria Spinelli and Oscar Chávez-Talavera have contributed equally to the writing of this article
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26
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Spinelli V, Lalloyer F, Baud G, Osto E, Kouach M, Daoudi M, Vallez E, Raverdy V, Goossens JF, Descat A, Doytcheva P, Hubert T, Lutz TA, Lestavel S, Staels B, Pattou F, Tailleux A. Influence of Roux-en-Y gastric bypass on plasma bile acid profiles: a comparative study between rats, pigs and humans. Int J Obes (Lond) 2016; 40:1260-7. [PMID: 27089995 DOI: 10.1038/ijo.2016.46] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 02/03/2016] [Accepted: 02/21/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGBP) is the most widely used bariatric surgery procedure, which induces profound metabolic and physiological effects, such as substantial improvements in obesity, type 2 diabetes and their comorbidities. Increasing evidence identifies bile acids (BAs) as signaling molecules that contribute to the metabolic improvement after RYGBP. However, how and to what extent BAs mediate the metabolic effects of RYGBP still remains unclear and requires mechanism of action studies using preclinical models. In this study, we compared plasma BA profiles before and after RYGBP in two animal models, rats and pigs, with humans to evaluate their translational potential. METHODS Plasma BAs were profiled in rats, pigs and humans by liquid chromatography coupled with tandem mass spectrometry before and after RYGBP. RESULTS RYGBP increased baseline plasma total BA concentrations in humans and in the two animal models to a similar extent (∼3-fold increase), despite differences in presurgery BA levels and profiles between the models. However, qualitatively, RYGBP differently affected individual plasma BA species, with similar increases in some free species (cholic acid (CA), chenodeoxycholic acid (CDCA) and deoxycholic acid (DCA)), different increases in glyco-conjugated species depending on the model and globally no increase in tauro-conjugated species whatever the model. CONCLUSIONS The tested animal models share similar quantitative RYGBP-induced increases in peripheral blood BAs as humans, which render them useful for mechanistic studies. However, they also present qualitative differences in BA profiles, which may result in different signaling responses. Such differences need to be taken into account when translating results to humans.
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Affiliation(s)
- V Spinelli
- Université Lille, U1011, EGID, Lille, France.,Inserm, U1011, Lille, France.,CHU Lille, Lille, France.,Institut Pasteur de Lille, U1011, Lille, France
| | - F Lalloyer
- Université Lille, U1011, EGID, Lille, France.,Inserm, U1011, Lille, France.,CHU Lille, Lille, France.,Institut Pasteur de Lille, U1011, Lille, France
| | - G Baud
- Université Lille, Inserm, UMR1190, EGID, Lille, France
| | - E Osto
- Swiss Federal Institute of Technology, ETH Zürich, Institute of Food Nutrition and Health, Zurich, Switzerland.,Department of Cardiology, Center for Molecular Cardiology, University of Zurich and University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - M Kouach
- Centre Universitaire de Mesures et d'Analyses, Université Lille, Lille, France
| | - M Daoudi
- Université Lille, Inserm, UMR1190, EGID, Lille, France
| | - E Vallez
- Université Lille, U1011, EGID, Lille, France.,Inserm, U1011, Lille, France.,CHU Lille, Lille, France.,Institut Pasteur de Lille, U1011, Lille, France
| | - V Raverdy
- CHU Lille, Lille, France.,Université Lille, Inserm, UMR1190, EGID, Lille, France
| | - J-F Goossens
- Centre Universitaire de Mesures et d'Analyses, Université Lille, Lille, France
| | - A Descat
- Centre Universitaire de Mesures et d'Analyses, Université Lille, Lille, France
| | - P Doytcheva
- Department of Cardiology, Center for Molecular Cardiology, University of Zurich and University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Institute of Veterinary Physiology, Vetsuisse Faculty, Center of Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - T Hubert
- Université Lille, Inserm, UMR1190, EGID, Lille, France
| | - T A Lutz
- Institute of Veterinary Physiology, Vetsuisse Faculty, Center of Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - S Lestavel
- Université Lille, U1011, EGID, Lille, France.,Inserm, U1011, Lille, France.,CHU Lille, Lille, France.,Institut Pasteur de Lille, U1011, Lille, France
| | - B Staels
- Université Lille, U1011, EGID, Lille, France.,Inserm, U1011, Lille, France.,CHU Lille, Lille, France.,Institut Pasteur de Lille, U1011, Lille, France
| | - F Pattou
- CHU Lille, Lille, France.,Université Lille, Inserm, UMR1190, EGID, Lille, France
| | - A Tailleux
- Université Lille, U1011, EGID, Lille, France.,Inserm, U1011, Lille, France.,CHU Lille, Lille, France.,Institut Pasteur de Lille, U1011, Lille, France
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27
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Baud G, Daoudi M, Hubert T, Raverdy V, Pigeyre M, Hervieux E, Devienne M, Ghunaim M, Bonner C, Quenon A, Pigny P, Klein A, Kerr-Conte J, Gmyr V, Caiazzo R, Pattou F. Bile Diversion in Roux-en-Y Gastric Bypass Modulates Sodium-Dependent Glucose Intestinal Uptake. Cell Metab 2016; 23:547-53. [PMID: 26924216 DOI: 10.1016/j.cmet.2016.01.018] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/29/2015] [Accepted: 01/27/2016] [Indexed: 12/22/2022]
Abstract
Gastro-intestinal exclusion by Roux-en-Y gastric bypass (RYGB) improves glucose metabolism, independent of weight loss. Although changes in intestinal bile trafficking have been shown to play a role, the underlying mechanisms are unclear. We performed RYGB in minipigs and showed that the intestinal uptake of ingested glucose is blunted in the bile-deprived alimentary limb (AL). Glucose uptake in the AL was restored by the addition of bile, and this effect was abolished when active glucose intestinal transport was blocked with phlorizin. Sodium-glucose cotransporter 1 remained expressed in the AL, while intraluminal sodium content was markedly decreased. Adding sodium to the AL had the same effect as bile on glucose uptake. It also increased postprandial blood glucose response in conscious minipigs following RYGB. The decrease in intestinal uptake of glucose after RYGB was confirmed in humans. Our results demonstrate that bile diversion affects postprandial glucose metabolism by modulating sodium-glucose intestinal cotransport.
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Affiliation(s)
- Gregory Baud
- University Lille, Inserm, CHU Lille, U1190 Translational research for diabetes, 59000 Lille, France; European Genomic Institute for Diabetes, EGID, 59000 Lille, France
| | - Mehdi Daoudi
- University Lille, Inserm, CHU Lille, U1190 Translational research for diabetes, 59000 Lille, France
| | - Thomas Hubert
- University Lille, Inserm, CHU Lille, U1190 Translational research for diabetes, 59000 Lille, France; European Genomic Institute for Diabetes, EGID, 59000 Lille, France
| | - Violeta Raverdy
- University Lille, Inserm, CHU Lille, U1190 Translational research for diabetes, 59000 Lille, France; European Genomic Institute for Diabetes, EGID, 59000 Lille, France
| | - Marie Pigeyre
- University Lille, Inserm, CHU Lille, U1190 Translational research for diabetes, 59000 Lille, France; European Genomic Institute for Diabetes, EGID, 59000 Lille, France
| | - Erik Hervieux
- University Lille, Inserm, CHU Lille, U1190 Translational research for diabetes, 59000 Lille, France; European Genomic Institute for Diabetes, EGID, 59000 Lille, France
| | - Magalie Devienne
- University Lille, Inserm, CHU Lille, U1190 Translational research for diabetes, 59000 Lille, France; European Genomic Institute for Diabetes, EGID, 59000 Lille, France
| | - Mohamed Ghunaim
- University Lille, Inserm, CHU Lille, U1190 Translational research for diabetes, 59000 Lille, France; European Genomic Institute for Diabetes, EGID, 59000 Lille, France
| | - Caroline Bonner
- University Lille, Inserm, CHU Lille, U1190 Translational research for diabetes, 59000 Lille, France; European Genomic Institute for Diabetes, EGID, 59000 Lille, France
| | - Audrey Quenon
- University Lille, Inserm, CHU Lille, U1190 Translational research for diabetes, 59000 Lille, France; European Genomic Institute for Diabetes, EGID, 59000 Lille, France
| | - Pascal Pigny
- University Lille, Inserm, CHU Lille, U1172 Jean-Pierre Aubert Research Center, 59000 Lille, France
| | - André Klein
- CHU Lille, Metabolism and Glycosylation Diseases, Biology Pathology Center, 59000 Lille, France
| | - Julie Kerr-Conte
- University Lille, Inserm, CHU Lille, U1190 Translational research for diabetes, 59000 Lille, France; European Genomic Institute for Diabetes, EGID, 59000 Lille, France
| | - Valery Gmyr
- University Lille, Inserm, CHU Lille, U1190 Translational research for diabetes, 59000 Lille, France; European Genomic Institute for Diabetes, EGID, 59000 Lille, France
| | - Robert Caiazzo
- University Lille, Inserm, CHU Lille, U1190 Translational research for diabetes, 59000 Lille, France; European Genomic Institute for Diabetes, EGID, 59000 Lille, France
| | - François Pattou
- University Lille, Inserm, CHU Lille, U1190 Translational research for diabetes, 59000 Lille, France; European Genomic Institute for Diabetes, EGID, 59000 Lille, France.
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28
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Reconfiguration of the small intestine and diabetes remitting effects of Roux-en-Y gastric bypass surgery. Curr Opin Gastroenterol 2016; 32:61-6. [PMID: 26839962 DOI: 10.1097/mog.0000000000000241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Alterations in small intestinal physiology are proposed to play a causative role in the beneficial impact of Roux-en-Y gastric bypass on type 2 diabetes mellitus. The present article describes the key proposed mechanisms implicated with an emphasis on some of the newer findings in the field. RECENT FINDINGS Augmented incretin and diminished anti-incretin effects postsurgery are explored and a model proposed that reconciles the hindgut and foregut hypotheses of improved glycaemic control as being complementary rather than mutually exclusive. Synthesis of recent findings on postbypass changes in intestinal glucose handling then follows. Finally an updated view of the role of distal bile diversion and changes in the microbiota on enteroendocrine signalling is presented. SUMMARY A series of nonmutually exclusive changes in small intestinal physiology likely make a significant contribution to improved glycaemic control postgastric bypass. Longitudinal data indicate that these effects do not translate into a long-term cure. A number of surgery-induced changes, however, are amenable to device-based and pharmacology-based mimicry, and this is an area for prioritization of future research focus.
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29
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Cole AJ, Teigen LM, Jahansouz C, Earthman CP, Sibley SD. The Influence of Bariatric Surgery on Serum Bile Acids in Humans and Potential Metabolic and Hormonal Implications: a Systematic Review. Curr Obes Rep 2015; 4:441-50. [PMID: 26335653 DOI: 10.1007/s13679-015-0171-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recent research suggests a mechanistic role for bile acids (BA) in the metabolic improvement following bariatric surgery. It is believed that the hormonal and metabolic effects associated with changes in systemic BAs may be related to the farnesoid X receptor (FXR) and a G-protein coupled receptor (TGR5). This systematic review examines changes in systemic BAs following bariatric procedures. Studies were included if they reported the measurement of systemic BAs in humans at at least one time point after bariatric surgery. Eleven papers were identified that met the inclusion criteria. Seven studies reported the effect of Roux-en-Y gastric bypass (RYGB) on fasting BAs. The majority (6/7) reported that fasting BAs increased after RYGB. Data regarding fasting BAs after vertical sleeve gastrectomy (VSG) and laparoscopic gastric banding (LAGB) are inconsistent. Data regarding post-prandial BA changes after RYGB, VSG, and LAGB are also inconsistent. More research is needed to investigate the connection between BAs and the metabolic improvement seen after bariatric surgery.
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Affiliation(s)
- Abigail J Cole
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, 1334 Eckles Avenue, Saint Paul, MN, 55108, USA.
| | - Levi M Teigen
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, 1334 Eckles Avenue, Saint Paul, MN, 55108, USA.
| | - Cyrus Jahansouz
- Medical School, Department of Surgery, University of Minnesota-Twin Cities, 420 Delaware Street SE, Minneapolis, MN, 55404, USA.
| | - Carrie P Earthman
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, 1334 Eckles Avenue, Saint Paul, MN, 55108, USA.
| | - Shalamar D Sibley
- Department of Medicine, Division of Endocrinology, University of Minnesota-Twin Cities, 516 Delaware St. SE, Minneapolis, MN, 55455, USA.
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30
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Metabolic consequences of the incorporation of a Roux limb in an omega loop (mini) gastric bypass: evaluation by a glucose tolerance test at mid-term follow-up. Surg Endosc 2015; 30:2935-45. [DOI: 10.1007/s00464-015-4581-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/19/2015] [Indexed: 01/08/2023]
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31
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Santoro S, de Aquino CGG. Transforming a Biliopancreatic Derivation in an Ileal Interposition with a Single Anastomosis. Obes Surg 2015; 25:1547-9. [PMID: 26084252 DOI: 10.1007/s11695-015-1768-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The biliopancreatic derivation (BPD) is the most powerful bariatric procedure. However, it never became a very popular procedure, except for Italy, because of the high rate of nutritional problems, intense flatulence, and diarrhea. Here, we describe an extremely simple way (just one anastomosis) to revise the BPD, transforming it into an ileal interposition with duodenal exclusion, solving these described problems.
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Affiliation(s)
- Sergio Santoro
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Bloco A1 sala 223, São Paulo, 05652-900, Brazil,
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32
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Grams J, Garvey WT. Weight Loss and the Prevention and Treatment of Type 2 Diabetes Using Lifestyle Therapy, Pharmacotherapy, and Bariatric Surgery: Mechanisms of Action. Curr Obes Rep 2015; 4:287-302. [PMID: 26627223 DOI: 10.1007/s13679-015-0155-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Weight loss, whether achieved by lifestyle intervention, pharmacotherapy, or bariatric surgery, is highly effective as a primary interventional strategy in both the prevention and treatment of type 2 diabetes. In high-risk patients with prediabetes and/or metabolic syndrome, weight loss effectively prevents progression to type 2 diabetes mellitus (T2DM) and improves cardiovascular risk factors. These benefits are the result of improvements in insulin resistance, which is central to the pathophysiology of cardiometabolic disease. In patients with T2DM, weight loss improves glycemia, while reducing the need for conventional glucose-lowering medicines, by affecting all three processes that produce and sustain the hyperglycemic state, namely via increments in peripheral insulin sensitivity with improvements in insulin signal transduction at the cellular level, more robust insulin secretory responses, and reduced rates of hepatic glucose production. In both nondiabetic and diabetic subjects, hypocaloric feeding (e.g., treatment with very low-calorie diet or bariatric surgery) produces a rapid improvement in insulin sensitivity due to mobilization of fat from the intramyocellular, intrahepatocellular, and intra-abdominal compartments, and via a more long-term mechanism that correlates with the loss of total body fat. In diabetes, by improving glycemia, weight loss also enhances glucose homeostasis by reversing the defects in insulin action and secretion attributable to glucose toxicity. Regardless of the therapeutic approach, weight loss of ∼ 10 % maximally prevents future diabetes in patients with prediabetes or metabolic syndrome. In T2DM, greater degrees of weight loss lead to progressive improvements in glucose homeostasis. Therefore, when accompanied by greater weight loss, the metabolic benefits following bariatric surgery are generally more pronounced than those achieved following lifestyle and medical treatment. In addition, the mechanisms by which bariatric operations improve diabetes may include both weight-dependent and weight-independent mechanisms, and the latter may involve changes in gut hormones, bile acids, or gut microflora.
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Affiliation(s)
- J Grams
- Department of Surgery, University of Alabama at Birmingham and the Birmingham VA Medical Center, KB401, 1720 2nd Ave S, Birmingham, AL, 35294-0016, USA.
| | - W Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham and the Birmingham VA Medical Center, 1675 University Boulevard, Birmingham, AL, 35294-3360, USA.
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