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Sang Q, Wang L, Wuyun Q, Zheng X, Wang D, Zhang N, Du D. Retrospective Comparison of SADI-S Versus RYGB in Chinese with Diabetes and BMI< 35kg/m 2: a Propensity Score Adjustment Analysis. Obes Surg 2021; 31:5166-5175. [PMID: 34591261 DOI: 10.1007/s11695-021-05708-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND As a modification of the duodenal switch (DS), single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) has recently become very popular and is successful for weight loss and T2DM remission. However, current studies have been mostly aimed at patients with severe obesity. OBJECTIVES In this study, we firstly compare primary SADI-S to the Roux-en-Y gastric bypass (RYGB) in Chinese with diabetes and BMI< 35 kg/m2. METHODS Using a propensity score (PS) matching analysis, we analyzed all patients with diabetes and BMI< 35 kg/m2 who underwent primary SADI-S or RYGB. All surgeries were conducted by a single surgeon at a Chinese center from June 2017 to January 2019. RESULTS Twenty-six patients who underwent SADI-S and 65 patients who underwent RYGB were included in our analysis. Of these, 26 (100%) of patients in the SADI-S group and 43 (66%) of patients in the RYGB group completed the 24-month follow-up. No severe perioperative complication was observed in either group. There was a statistically higher percentage of total weight loss with SADI-S at the 2-year follow-up when compared to RYGB (p = 0.017 after PS correction). After PS adjustment, 76.5% of patients in the SADI-S group and 82.4% of patients in the RYGB group achieved complete remission of T2DM (p = 1.000). Nutritional outcomes were similar in the two groups. CONCLUSION In Chinese with diabetes and BMI< 35 kg/m2, with comparable T2DM remission and nutritional outcomes, primary SADI-S allows for better weight loss than RYGB. Compared with RYGB, SADI-S is also a safe, effective, and feasible treatment for these patients.
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Affiliation(s)
- Qing Sang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China
| | - Liang Wang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China
| | - Qiqige Wuyun
- Surgery Centre of Diabetes Mellitus, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China
| | - Xuejing Zheng
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China
| | - Dezhong Wang
- Department of General Surgery, Aerospace Center Hospital, Beijing, 100049, China
| | - Nengwei Zhang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China.
| | - Dexiao Du
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China.
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Dolo PR, Yao L, Shao Y, Widjaja J, Li C, Zhu X. The effect of sleeve ablation of gastric mucosa on body weight and glucose homeostasis in Sprague-Dawley rat model. Surg Obes Relat Dis 2021; 17:1984-1994. [PMID: 34479813 DOI: 10.1016/j.soard.2021.07.025] [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: 02/05/2021] [Revised: 07/25/2021] [Accepted: 07/31/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The gastric mucosa is an important endocrine organ, most of which is resected in sleeve gastrectomy (SG). The effect of removing most of the gastric mucosa has not been studied. OBJECTIVE To assess the effect of ablating the gastric mucosa (an area proportional to that in SG), on obesity and diabetes in a rat model. SETTING The Affiliated Hospital of Xuzhou Medical University in Xuzhou Jiangsu, P. R. China. METHODS Among 34 fatty Sprague-Dawley rats, 26 randomly received low-dose streptozotocin (STZ) to induce diabetes and then were randomly assigned to gastric mucosa ablation (GMA, n = 10), sleeve gastrectomy (SG, n = 8), and sham (n = 8) groups. The remaining normal fatty rats were assigned to the non-diabetic gastric mucosa ablation (nGMA, n = 8) group. In the GMA groups, the gastric mucosa was thermally ablated using electrocautery. Rats were followed for 8 weeks postoperatively. Preoperative oral glucose tolerance test (OGTT), insulin tolerance test (ITT), and mixed meal tolerance test (MMTT) were repeated at designated time points postoperatively. Changes in body weight, food intake, and fasting blood glucose were also recorded. RESULTS Fasting ghrelin concentration and area under curve (AUC) decreased significantly (P < .05) in the GMA groups and the SG group after surgery. Gastrin concentration remained unchanged in SG but decreased significantly in the GMA groups after surgery. Significantly increased GLP-1 AUC was found in the GMA groups and the SG group postoperatively. The decrease in fasting blood glucose did not differ significantly between the diabetic GMA and SG groups after surgery. Glucose AUC during OGTT in both SG and diabetic GMA groups was decreased significantly from the preoperative level, but the decreased glucose AUC in the SG group was significantly greater (P < .05). The decrease in body weight and food intake in the SG group was significantly greater than in the GMA groups. CONCLUSION Ablation of most of the gastric mucosa along the greater curvature is effective in weight loss and glycemic control in a rodent model.
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Affiliation(s)
- Ponnie Robertlee Dolo
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, P. R. China; Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou Jiangsu, P. R. China
| | - Libin Yao
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, P. R. China; Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou Jiangsu, P. R. China
| | - Yong Shao
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, P. R. China; Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou Jiangsu, P. R. China
| | - Jason Widjaja
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, P. R. China; Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou Jiangsu, P. R. China
| | - Chao Li
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, P. R. China; Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou Jiangsu, P. R. China
| | - Xiaocheng Zhu
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, P. R. China; Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou Jiangsu, P. R. China.
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Koepsell H. Glucose transporters in the small intestine in health and disease. Pflugers Arch 2020; 472:1207-1248. [PMID: 32829466 PMCID: PMC7462918 DOI: 10.1007/s00424-020-02439-5] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 12/23/2022]
Abstract
Absorption of monosaccharides is mainly mediated by Na+-D-glucose cotransporter SGLT1 and the facititative transporters GLUT2 and GLUT5. SGLT1 and GLUT2 are relevant for absorption of D-glucose and D-galactose while GLUT5 is relevant for D-fructose absorption. SGLT1 and GLUT5 are constantly localized in the brush border membrane (BBM) of enterocytes, whereas GLUT2 is localized in the basolateral membrane (BLM) or the BBM plus BLM at low and high luminal D-glucose concentrations, respectively. At high luminal D-glucose, the abundance SGLT1 in the BBM is increased. Hence, D-glucose absorption at low luminal glucose is mediated via SGLT1 in the BBM and GLUT2 in the BLM whereas high-capacity D-glucose absorption at high luminal glucose is mediated by SGLT1 plus GLUT2 in the BBM and GLUT2 in the BLM. The review describes functions and regulations of SGLT1, GLUT2, and GLUT5 in the small intestine including diurnal variations and carbohydrate-dependent regulations. Also, the roles of SGLT1 and GLUT2 for secretion of enterohormones are discussed. Furthermore, diseases are described that are caused by malfunctions of small intestinal monosaccharide transporters, such as glucose-galactose malabsorption, Fanconi syndrome, and fructose intolerance. Moreover, it is reported how diabetes, small intestinal inflammation, parental nutrition, bariatric surgery, and metformin treatment affect expression of monosaccharide transporters in the small intestine. Finally, food components that decrease D-glucose absorption and drugs in development that inhibit or downregulate SGLT1 in the small intestine are compiled. Models for regulations and combined functions of glucose transporters, and for interplay between D-fructose transport and metabolism, are discussed.
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Affiliation(s)
- Hermann Koepsell
- Institute for Anatomy and Cell Biology, University of Würzburg, Koellikerstr 6, 97070, Würzburg, Germany.
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Xu K, Ma J, Liu Z, Wang X, Yan S, Liu Z, Sun F, Wang K. Effect of Sleeve Gastrectomy on Bone Metabolism and Serum 5-Hydroxytryptamine in Obese Rats. Med Sci Monit 2020; 26:e924097. [PMID: 32324718 PMCID: PMC7193245 DOI: 10.12659/msm.924097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Studies have shown that bariatric surgery, such as sleeve gastrectomy (SG), has an adverse effect on bone, including decreased bone mineral density (BMD) and bone metabolism. Peripheral 5-hydroxytryptamine (5-HT) has an adverse regulatory effect on bone formation. Here, we assessed changes in bone metabolism and whether 5-HT is involved in the effect of SG on bone metabolism. MATERIAL AND METHODS A rat model of obesity was established using Wistar rats. After successful modeling, rats were randomly assigned to 2 groups - the SG group and the Sham group - with 10 rats in each group. We then performed sleeve gastrectomy or sham operation. Bone metabolic markers and BMD of rats were measured at 2 and 16 weeks after the operation and the level of 5-HT in serum was determined. Rats were killed at 16 weeks after the operation, and bones of the hind limbs were harvested to measure 5-HT by immunofluorescence. RESULTS BMD was decreased and bone metabolism demonstrated a trend of bone destruction in the rats after SG. A significantly increasing trend in the level of serum 5-HT was found, and bone immunofluorescence showed increased expression of 5-HT. CONCLUSIONS BMD was decrease and bone metabolism demonstrated a trend of bone destruction after SG. SG can affect the level of 5-HT in serum or bone tissue and the 5-HT may be involved in the process through which SG affects bone metabolism.
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Affiliation(s)
- Kai Xu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland).,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
| | - Junxing Ma
- Gastrointestinal Surgery, Feicheng Hospital Affiliated to Shandong First Medical University, Feicheng People's Hospital, Feicheng, Shandong, China (mainland)
| | - Zhi Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Xiaoyang Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Shaohua Yan
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland).,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
| | - Zitian Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland).,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
| | - Fuyun Sun
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland).,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
| | - Kexin Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
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The Effects of Duodenojejunal Omega Switch in Combination with High-Fat Diet and Control Diet on Incretins, Body Weight, and Glucose Tolerance in Sprague-Dawley Rats. Obes Surg 2018; 28:748-759. [PMID: 28840471 PMCID: PMC5803292 DOI: 10.1007/s11695-017-2883-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Despite excellent results of bariatric surgery in the treatment of type 2 diabetes and weight loss in human subjects, some patients do not obtain desired results. One of the reasons for this is that not all patients follow caloric intake recommendations. Aim The aim of this study was to investigate the effect of duodenojejunal omega switch (DJOS) surgery on body weight, glucose tolerance, and incretins in rats. Methods DJOS and SHAM surgery were performed on rats maintained for 8 weeks on high-fat diet (HF) and control diet (CD), respectively. After surgery, four groups were kept on the same diet as before the surgery, and four groups had a changed diet (CD vs. HF and HF vs. CD) for the next 8 weeks. Glucose tolerance, insulin tolerance, glucose-stimulated insulin, glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide/glucose-dependent insulinotropic polypeptide (GIP) secretion, food intake, and body weight were measured. Results A change of diet after surgery resulted in reduced glucose tolerance. Plasma insulin levels were lowered between DJOS and SHAM surgeries for the HF/HF and CD/HF groups. DJOS surgery did not reduce body weight in the studied groups, irrespective of diet. In the HF/HF group, ΔGLP-1 was lower for DJOS surgery in comparison with other groups. Differences of weight changes were observed for groups HF/HF and HF/CD. After DJOS surgery, ΔGIP was lower in the CD/HF group compared with HF/HF. Conclusions Our results show that applications of different types of diets, before and after surgery, is a sensitive method for studies of mechanism of glucose intolerance after DJOS surgery.
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Dolo PR, Li C, Zhu X, Yao L, Meng S, Hong J. The effect of distal-ileal exclusion after Roux-en-Y gastric bypass on glucose tolerance and GLP-1 response in type-2 diabetes Sprague-Dawley rat model. Surg Obes Relat Dis 2018; 14:1552-1560. [PMID: 30122358 DOI: 10.1016/j.soard.2018.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/01/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND An increase in glucagon-like peptide-1 (GLP-1) mediating early diabetes remission after Roux-en-Y gastric bypass (RYGB) is believed to be associated with distal-ileal stimulation. OBJECTIVE To observe the effect of distal-ileal exclusion on glucose tolerance and GLP-1 response after RYGB. SETTING Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China. METHODS A type 2 diabetes model was created in 40 Sprague-Dawley rats that were randomly assigned to a RYGB group (n = 32) and a sham group (n = 8). Four weeks after surgery, the RYGB group was further divided into the RYGB control group (n = 8) and the distal-ileal exclusion group (RYGB-IEx, n = 24). Rats in the RYGB-IEx group underwent laparotomy, and the last 20 cm of ileum was excluded. An oral glucose tolerance test, insulin tolerance test, and mixed-meal tolerance test conducted preoperatively were repeated in all groups at 4 and 8 weeks postoperatively. RESULTS Compared with preoperative level, GLP-1 was significantly increased after RYGB. GLP-1 area under the curve recorded after oral gavage at week 4 postoperatively was significantly higher than the preoperative level (P < .05). GLP-1, insulin area under the curve, and improved glucose-excursion on oral glucose tolerance test 4 weeks after gastric bypass were not reversed at week 8 after distal-ileal exclusion in the RYGB-IEx group. Food intake increased significantly after distal-ileal exclusion in the RYGB-IEx group. CONCLUSION These findings suggest that distal-ileal stimulation might not be required for incretin response and diabetes remission after gastric bypass in the type 2 diabetes Sprague-Dawley rat model.
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Affiliation(s)
- Ponnie Robertlee Dolo
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, P. R. China
| | - Chao Li
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, P. R. China
| | - Xiaocheng Zhu
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, P. R. China.
| | - Libin Yao
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, P. R. China
| | - Song Meng
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, P. R. China
| | - Jian Hong
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, P. R. China
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Gao Z, Wang B, Gong X, Yao C, Ren D, Shao L, Pang Y, Liu J. Effect of gastric bypass combined with ileal transportation on type 2 diabetes mellitus. Exp Ther Med 2018; 15:4571-4577. [PMID: 29725390 DOI: 10.3892/etm.2018.5928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 12/08/2017] [Indexed: 01/14/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic progressive disease, which manifests as an endocrine disorder. Among the different methods of surgery available to treat patients with T2DM, Roux-en-Y gastric bypass (RYGBP) and ileal transposition (IT) are the most commonly performed. The aim of the present study was to investigate the effects of RYGBP combined with IT on rats with T2DM. A total of 8 healthy male rats were used as a control group and 40 GK rats were randomly divided into 5 groups: A diabetes mellitus (DM) group, a sham operative group (SO), a RYGBP group, an IT group and a RYGBP+IT group. The results demonstrated that fasting blood glucose, triglyceride, total cholesterol and gastric inhibitory polypeptide levels in all treatment groups were significantly lower than those of the SO and DM groups. Furthermore, levels TC and TG in the RYGBP+IT group were significantly lower than in the RYGBP and IT groups. Levels of phosphoenolpyruvate carboxykinase and glucose-6-phosphatase mRNA and IRS-2 protein in all treatment groups were also significantly lower than those of the SO group; and they were significantly lower in the RYGBP+IT group compared with the RYGBP and IT groups. The expression of phosphorylated Akt in the treatment groups was significantly higher than the SO group and was significantly higher in the RYGBP+IT group compared with the RYGBP and IT groups. These results indicate that RYGBP and IT surgical treatment can induce T2DM remission by mediating the expression of insulin-related factors to reverse insulin resistance. The current study also indicated that the effect of RYGBP combined with IT may be developed as a novel first-line method of treating T2DM.
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Affiliation(s)
- Zhaoxia Gao
- Department of General Surgery, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Bin Wang
- Department of Ear-Nose-Throat, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Xiaojun Gong
- Department of General Surgery, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Chun Yao
- Department of Endocrinology, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Defa Ren
- Department of General Surgery, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Liwei Shao
- Department of General Surgery, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Yan Pang
- Department of Clinical Laboratory, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Jinxiu Liu
- Department of General Surgery, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
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Ileal Transposition Decreases Plasma Lipopolysaccharide Levels in Association with Increased L Cell Secretion in Non-obese Non-diabetic Rats. Obes Surg 2018; 26:1287-95. [PMID: 26334758 DOI: 10.1007/s11695-015-1879-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic exposure to lipopolysaccharide (LPS) contributes to metabolic abnormalities, but there has been no study to evaluate plasma LPS levels after ileal transposition (IT). We examined the effect of IT on gut hormone secretion and plasma LPS levels and their correlation with metabolic parameters. METHODS Sprague-Dawley rats underwent either IT or sham operation. After 4 weeks, oral glucose tolerance tests (OGTT) were performed and fasting plasma LPS and gut histology were analyzed. RESULTS Compared with the sham group, food intake and body weight decreased, and insulin sensitivity increased in the IT group. During the OGTTs, glucagon, glucagon-like peptide-1 (GLP-1), GLP-2, and peptide YY (PYY) were significantly higher in the IT group than the sham group. The villi length, muscle thickness, and the density of GLP-1 and glucose-dependent insulinotropic polypeptide co-expressing cells (K/L-cells) increased in the transposed ileum compared with the ileum of the sham group. Fasting plasma LPS levels were lower in the IT group than the sham group (5.6 ± 0.2 vs. 6.8 ± 0.1 EU/ml, P = 0.002) and significantly correlated with insulin resistance (r = 0.755, P < 0.001). Plasma LPS levels were negatively correlated with PYY secretion (r = -0.710, P = 0.001), and GLP-2 secretion (r = -0.561, P = 0.019). CONCLUSIONS IT surgery decreased plasma LPS levels in a non-obese non-diabetic rat model, which was associated with improved insulin sensitivity and increased L-cell secretion.
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Liang Y, Wang Y, Qiao Z, Cao T, Feng Y, Zhang L, Zhang P. Duodenal-Jejunal Bypass Surgery Reverses Diabetic Phenotype and Reduces Obesity in db/db Mice. Curr Chem Genom Transl Med 2017; 11:41-49. [PMID: 29238655 PMCID: PMC5712635 DOI: 10.2174/2213988501711010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/08/2017] [Accepted: 10/18/2017] [Indexed: 11/22/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM), a complex metabolic disorder typically accompanying weight gain, is associated with progressive β-cell failure and insulin resistance. Bariatric surgery ameliorates glucose tolerance and provides a near-perfect treatment. Duodenal-jejunal bypass (DJB) is an experimental procedure and has been studied in several rat models, but its influence in db/db mice, a transgenic model of T2DM, remains unclear. To investigate the effectiveness of DJB in db/db mice, we performed the surgery and evaluated metabolism improvement. Results showed that mice in DJB group weighed remarkably less than sham group two weeks after surgery. Compared to the preoperative level, postoperative fasting blood glucose (FBG) was dramatically reduced. Statistical analysis revealed that changes in body weight and FBG were significantly correlated. Besides, DJB surgery altered plasma insulin level with approximate 40% reduction. Thus, for the first time we proved that DJB can achieve rapid therapeutic effect in transgenic db/db mice with severe T2DM as well as obesity. In addition, decreased insulin level reflected better insulin sensitivity induced by DJB. In conclusion, our study demonstrates that DJB surgery may be a potentially effective way to treat obesity-associated T2DM.
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Affiliation(s)
- Yongjun Liang
- Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, , P.R. China
| | - Yueqian Wang
- Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, , P.R. China
| | - Zhengdong Qiao
- Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, , P.R. China
| | - Ting Cao
- Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, , P.R. China
| | - Ying Feng
- Laboratory of Molecular Neuropharmacology, School of Pharmacy, East China University of Science and Technology, 130 Meilong Road, , P.R. China
| | - Lin Zhang
- Laboratory of Molecular Neuropharmacology, School of Pharmacy, East China University of Science and Technology, 130 Meilong Road, , P.R. China
| | - Peng Zhang
- Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, , P.R. China
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Wu Q, Zhang X, Zhong M, Han H, Liu S, Liu T, Wei M, Guo W, Xie H, Hu S, Zhang G. Effects of Bariatric Surgery on Serum Bile Acid Composition and Conjugation in a Diabetic Rat Model. Obes Surg 2017; 26:2384-92. [PMID: 26843082 DOI: 10.1007/s11695-016-2087-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Serum bile acids (BAs) are elevated following bariatric surgery and have emerged as a potential glucose-lowering beneficial factor. The change of BA components and its underlying mechanisms may be of great significance during bariatric surgery. The aim of this study is to investigate the effects of different bariatric procedures on serum BA composition and explore the potential mechanisms using a diabetic rat model. METHODS Duodenal-jejunal bypass (DJB), sleeve gastrectomy (SG), and sham operation were performed in diabetic rats induced by high-fat diet (HFD) and streptozotocin (STZ). Body weight, food intake, oral glucose tolerance test (OGTT), and insulin tolerance test (ITT) were measured at indicated time points. Serum BAs composition and the expression of cholesterol 7α hydroxylase (CYP7A1), bile acid: CoA synthase (BACS) and bile acid-CoA: amino acid N-acyltransferase (BAAT) at both transcriptional and protein levels in the liver were evaluated at 12 weeks postoperatively. RESULTS Compared with sham group, DJB and SG both achieved rapid and sustained improvements in glucose tolerance and insulin sensitivity. They also resulted in increased serum BAs, especially the taurine-conjugated BAs by elevated conjugation. No obvious difference was detected between DJB and SG except that SG achieved decreased weight gain and food intake. CONCLUSIONS The preferentially elevated serum taurine-conjugated BAs were similar after different bariatric surgeries, and the enhanced conjugation of BAs in the liver might account for the changed serum BAs profiles.
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Affiliation(s)
- Qunzheng Wu
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Xiang Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Mingwei Zhong
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Haifeng Han
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Shaozhuang Liu
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Teng Liu
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Meng Wei
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Wei Guo
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Haibin Xie
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Guangyong Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China.
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Effects of Laparoscopic Roux-en-Y Gastric Bypass on Chinese Type 2 Diabetes Mellitus Patients with Different Levels of Obesity: Outcomes After 3 Years’ Follow-Up. Obes Surg 2017; 28:702-711. [DOI: 10.1007/s11695-017-2903-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Bauer PV, Duca FA. Targeting the gastrointestinal tract to treat type 2 diabetes. J Endocrinol 2016; 230:R95-R113. [PMID: 27496374 DOI: 10.1530/joe-16-0056] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/20/2016] [Indexed: 12/12/2022]
Abstract
The rising global rates of type 2 diabetes and obesity present a significant economic and social burden, underscoring the importance for effective and safe therapeutic options. The success of glucagon-like-peptide-1 receptor agonists in the treatment of type 2 diabetes, along with the potent glucose-lowering effects of bariatric surgery, highlight the gastrointestinal tract as a potential target for diabetes treatment. Furthermore, recent evidence suggests that the gut plays a prominent role in the ability of metformin to lower glucose levels. As such, the current review highlights some of the current and potential pathways in the gut that could be targeted to improve glucose homeostasis, such as changes in nutrient sensing, gut peptides, gut microbiota and bile acids. A better understanding of these pathways will lay the groundwork for novel gut-targeted antidiabetic therapies, some of which have already shown initial promise.
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Affiliation(s)
- Paige V Bauer
- Toronto General Hospital Research Institute and Department of MedicineUHN, Toronto, ON, Canada Department of PhysiologyUniversity of Toronto, Toronto, ON, Canada
| | - Frank A Duca
- Toronto General Hospital Research Institute and Department of MedicineUHN, Toronto, ON, Canada
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Surgical cure for type 2 diabetes by foregut or hindgut operations: a myth or reality? A systematic review. Surg Endosc 2016; 31:25-37. [PMID: 27194257 DOI: 10.1007/s00464-016-4952-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/18/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bariatric surgery results in remission of type 2 diabetes mellitus in a significant proportion of patients. Animal research has proposed the foregut and hindgut hypotheses as possible mechanisms of remission of T2DM independent of weight loss. These hypotheses have formed the basis of investigational procedures designed to treat T2DM in non-obese (in addition to obese) patients. The aim of this study was to review the procedures that utilise the foregut and hindgut hypotheses to treat T2DM in humans. METHODS A systematic review was conducted to identify the investigational procedures performed in humans that are based on the foregut and hindgut hypotheses and then to assess their outcomes. RESULTS Twenty-four studies reported novel procedures to treat T2DM in humans; only ten utilised glycated haemoglobin A1c (HbA1c) in their definition of remission. Reported remission rates were 20-40 % for duodenal-jejunal bypass (DJB), 73-93 % for duodenal-jejunal bypass with sleeve gastrectomy (DJB-SG), 62.5-100 % for duodenal-jejunal bypass sleeve (DJBS) and 47-95.7 % for ileal interposition with sleeve gastrectomy (II-SG). When using a predetermined level of HbA1c to define remission, the remission rates were lower (27, 63, 0 and 65 %) for DJB, DJB-SG, DJBS and II-SG. CONCLUSIONS The outcomes of the foregut- and hindgut-based procedures are not better than the outcomes of just one of their components, namely sleeve gastrectomy. The complexity of these procedures in addition to their comparable outcomes to a simpler operation questions their utility.
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Expedited Biliopancreatic Juice Flow to the Distal Gut Benefits the Diabetes Control After Duodenal-Jejunal Bypass. Obes Surg 2016; 25:1802-9. [PMID: 25726319 DOI: 10.1007/s11695-015-1633-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Serum bile acids (BAs) are elevated after metabolic surgeries including Roux-en-Y gastric bypass (RYGB), ileal transposition (IT), and duodenal-jejunal bypass (DJB). Recently, BAs have emerged as a kind of signaling molecules, which can not only promote glucagon-like peptide-1 (GLP-1) secretion but can also regulate multiple enzymes involved in glucose metabolism. The aim of this study was to investigate whether expedited biliopancreatic juice flow to the distal gut contributes to the increased serum GLP-1 and BAs and benefits the diabetes control after DJB. METHODS DJB, long alimentary limb DJB (LDJB), duodenal-jejunal anastomosis (DJA), and sham operation were performed in diabetic rats induced by high-fat diet (HFD) and low dose of streptozotocin (STZ). Body weight, food intake, oral glucose tolerance, insulin tolerance, glucose-stimulated insulin and GLP-1 secretion, fasting serum total bile acids (TBAs), and lipid profiles were measured at indicated time points. RESULTS Compared with sham operation, DJA, DJB, and LDJB all achieved rapid and dramatic improvements in glucose tolerance and insulin sensitivity independently of food restriction and weight loss. DJB and LDJB-operated rats exhibited even better glucose tolerance, higher fasting serum TBAs, and higher glucose-stimulated GLP-1 secretion than the DJA group postoperatively. No difference was detected in insulin sensitivity and glucose-stimulated insulin secretion between DJA, DJB, and LDJB groups. CONCLUSIONS Expedited biliopancreatic juice flow to the distal gut was associated with augmented GLP-1 secretion and increased fasting serum TBA concentration, which may partly explain the metabolic benefits of DJB.
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Oh TJ, Ahn CH, Cho YM. Contribution of the distal small intestine to metabolic improvement after bariatric/metabolic surgery: Lessons from ileal transposition surgery. J Diabetes Investig 2016; 7 Suppl 1:94-101. [PMID: 27186363 PMCID: PMC4854512 DOI: 10.1111/jdi.12444] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/11/2015] [Indexed: 12/19/2022] Open
Abstract
Roux-en Y gastric bypass is a highly effective bariatric/metabolic surgical procedure that can induce robust weight loss and even remission of type 2 diabetes. One of the characteristic consequences of Roux-en Y gastric bypass is the expedited nutrient delivery to the distal small intestine, where L-cells are abundant and bile acid reabsorption occurs. To examine the role of the distal small intestine in isolation from other components of Roux-en Y gastric bypass, the ileal transposition (IT) surgery has been used in various rat models. IT relocates the distal ileal segment to the upper jejunum distal to the ligament of Treitz without any other alterations in the gastrointestinal anatomy. Therefore, IT exposes the distal ileal tissue to ingested nutrients after a meal faster than the normal condition. Although there is some inconsistency in the effect of IT according to different types of rat models and different types of surgical protocols, IT typically improved glucose tolerance, increased insulin sensitivity and induced weight loss, and the findings were more prominent in obese diabetic rats. Suggested mechanisms for the metabolic improvements after IT include increased L-cell secretion (e.g., glucagon-like peptides and peptide YY), altered bile acid metabolism, altered host-microbial interaction, attenuated metabolic endotoxemia and many others. Based on the effect of IT, we can conclude that the contribution of the distal small intestine to the metabolic benefits of bariatric/metabolic surgery is quite considerable. By unveiling the mechanism of action of IT, we might revolutionize the treatment for obesity and type 2 diabetes.
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Affiliation(s)
- Tae Jung Oh
- Department of Internal MedicineSeoul National University Bundang HospitalSeongnamKorea; Department of Internal MedicineSeoul National University College of MedicineSeoulKorea
| | - Chang Ho Ahn
- Department of Internal Medicine Seoul National University College of Medicine Seoul Korea
| | - Young Min Cho
- Department of Internal Medicine Seoul National University College of Medicine Seoul Korea
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Wang Y, Zhang X, Liu T, Zhong M, Wan H, Liu S, Zhang G, Kassab GS, Hu S. Jejunum-ileum circuit procedure improves glucose metabolism in diabetic rats independent of weight loss. Obesity (Silver Spring) 2016; 24:342-51. [PMID: 26709012 DOI: 10.1002/oby.21339] [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] [Received: 04/15/2015] [Revised: 07/15/2015] [Accepted: 08/22/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To introduce a lower-risk novel surgical procedure to achieve diabetes reversal along with associated hormonal changes. METHODS Diabetic rats were randomly assigned to jejunum-ileum circuit (JIC), sham-JIC, ileal interposition (IT), and sham-IT groups. The JIC group included two subgroups: short (JIC-S) and long (JIC-L), based on the length between anastomosis and Treitz ligament (LAT ). The body weight, food intake, blood glucose, glucose and insulin tolerance, and gut hormones were measured. The liver gene expression of glucose transporter 2 (GLUT2) and protein expression of glucose-6-phosphatase (G6P) and phosphoenolpyruvate carboxykinase (PKC) were also measured. Following a dye infusion, nutrient delivery was measured at termination day. RESULTS Compared to sham-JIC group, JIC-S group did not reduce body weight or food intake but significantly improved glucose tolerance and insulin resistance. With fast chyme transit, JIC-S not only promoted the secretion of insulin, glucagon-like peptide 1, and peptide YY and decreased leptin, but also upregulated hepatic GLUT2 and downregulated hepatic G6P and PKC. JIC-L group, however, failed to achieve remission of diabetes. CONCLUSION JIC-S relieves diabetes independent of weight loss, as it promotes the secretion of anti-diabetic hormones and inhibits hepatic glucose production. The prolonging of LAT , however, diminishes the hypoglycemic effect.
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Affiliation(s)
- Yanmin Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Correspondence: Sanyuan Hu
| | - Xiang Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Correspondence: Sanyuan Hu
| | - Teng Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Correspondence: Sanyuan Hu
| | - Mingwei Zhong
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Correspondence: Sanyuan Hu
| | - Houmin Wan
- Department of General Surgery, the Fourth Hospital of Jinan, Jinan, Shandong, China
| | - Shaozhuang Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Correspondence: Sanyuan Hu
| | - Guangyong Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Correspondence: Sanyuan Hu
| | - Ghassan S Kassab
- Department of Bioengineering, California Medical Innovations Institute, San Diego, California, USA
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Correspondence: Sanyuan Hu
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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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Wang Y, Zhang X, Zhong M, Liu T, Zhang G, Liu S, Guo W, Wei M, He Q, Sun D, Hu S. Improvements of Glucose and Lipid Metabolism After Jejuno-ileal Circuit Procedure in a Non-obese Diabetic Rat Model. Obes Surg 2015; 26:1768-76. [PMID: 26660687 DOI: 10.1007/s11695-015-1997-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In a recent study, we showed a jejuno-ileal circuit (JIC) procedure that effectively improved glucose homeostasis, but the intrinsic mechanism requires further studies. Furthermore, the role of JIC in lipid metabolism is also unknown. Given that adiposity aggravates insulin sensitivity, we hypothesize that the JIC procedure improves fat metabolism and thus further contributes to diabetic remission. The aim of this study was to investigate the effects of JIC surgery on lipid metabolism and glucose homeostasis in a non-obese diabetic rat model. METHODS Fourteen high-fat diet and low-dose streptozotocin-induced diabetic rats were randomly divided into JIC and sham-JIC groups. Body weight, food intake, glucose tolerance, insulin resistance, serum lipid parameters, glucagon-like peptide 1 (GLP-1), and adipose-derived hormones were measured. At 12 weeks postoperatively, the expressions of hepatic fatty acid synthase (FAS) and acetyl-CoA carboxylase (ACC) were measured by Western blot. The lipid content of liver was assessed by hematoxylin-eosin staining and Oil Red O staining. The enteroendocrine cells in the distal ileum were examined by immunohistochemical staining. RESULTS Relative to the sham group, the JIC rats exhibited significant improvements in glucose tolerance, insulin resistance, and dyslipidemia without weight loss, showing increased GLP-1 and adiponectin and decreased leptin. JIC also reduced the expression of FAS and ACC in the liver, exhibited improved hepatic fat content, and raised the levels of GLP-1 and chromogranin A in the distal gut. CONCLUSIONS JIC alleviated lipometabolic disorders in hyperglycemic rats, which may contribute to the amelioration of insulin sensitivity and glycemic control.
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Affiliation(s)
- Yanmin Wang
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Xiang Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Mingwei Zhong
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Teng Liu
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Guangyong Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Shaozhuang Liu
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Wei Guo
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Meng Wei
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Qingsi He
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Dong Sun
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China.
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Roux-en Y gastric bypass is superior to duodeno-jejunal bypass in improving glycaemic control in Zucker diabetic fatty rats. Obes Surg 2015; 24:1888-95. [PMID: 24927690 DOI: 10.1007/s11695-014-1301-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Whilst weight loss results in many beneficial metabolic consequences, the immediate improvement in glycaemia after Roux-en-Y Gastric bypass (RYGB) remains intriguing. Duodenal jejunal bypass (DJB) induces similar glycaemic effects, while not affecting calorie intake or weight loss. We studied diabetic ZDF(fa/fa) rats to compare the effects of DJB and RYGB operations on glycaemia. METHODS Male ZDF(fa/fa) rats, aged 12 weeks underwent RYGB, DJB or sham operations. Unoperated ZDF(fa/fa) and ZDF(fa/+w)ere used as controls. Body weight, food intake, fasting glucose, insulin and gut hormones were measured at baseline and on postoperative days 2, 10 and 35. An oral glucose tolerance test (OGTT) was performed on days 12 and 26. RESULTS DJB had similar food intake and body weight to sham-operated and unoperated control ZDF(fa/fa) rats (p = NS), but had lower fasting glucose (p < 0.05). RYGB had lower food intake, body weight and fasting glucose compared to all groups (p < 0.001). DJB prevented the progressive decline in fasting insulin observed in the sham-operated or unoperated ZDF(fa/fa) rats, while RYGB with normalized glycaemia reduced the physiological requirement for raised fasting insulin. CONCLUSIONS Bypassing the proximal small bowel with the DJB has mild to moderate body weight independent effects on glucose homeostasis and preservation of fasting insulin levels in the medium term. These effects might be further amplified by the additional anatomical and physiological changes after RYGB.
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Duodenal-jejunal bypass surgery suppresses hepatic de novo lipogenesis and alleviates liver fat accumulation in a diabetic rat model. Obes Surg 2015; 24:2152-60. [PMID: 24898720 DOI: 10.1007/s11695-014-1308-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Duodenal-jejunal bypass (DJB) surgery can induce rapid and durable remission of type 2 diabetes mellitus (T2DM), but the intrinsic mechanisms remain to be elucidated. Recent studies indicated that improved hepatic insulin resistance and insulin signaling transduction might contribute to the diabetic control after DJB. Given the important role of liver adiposity in hepatic insulin resistance, this study was aimed at investigating the effects of DJB on glucose homeostasis and liver fat accumulation in a T2DM rat model induced by high-fat diet (HFD) and small dose of streptozotocin (STZ). METHODS Forty adult male diabetic rats induced by HFD and small dose of STZ were randomly assigned to sham and DJB groups. Body weight, calorie intake, hormone levels, glucose, and lipid parameters were measured at indicated time points. Subsequently, hepatic triglycerides (TG) content and the protein levels of sterol regulatory element binding protein-1 (SREBP-1), carbohydrate response element binding protein (ChREBP), fatty acid synthase (FAS), and acetyl-CoA carboxylase (ACC) were evaluated at 2 and 8 weeks postoperatively. RESULTS Compared with sham group, DJB induced rapid and significant improvements in glucose homeostasis and insulin sensitivity independently of weight loss and calorie restriction. The DJB-operated rats exhibited lower liver TG content and decreased hepatic SREBP-1, ChREBP, ACC, and FAS at 8 weeks postoperatively. CONCLUSIONS DJB alleviated hepatic fat accumulation and downregulated the key transcriptional regulators and enzymes involved in hepatic de novo lipogenesis, which might contribute to improved hepatic insulin sensitivity and glucose homeostasis after DJB.
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Chai J, Zhang G, Liu S, Hu C, Han H, Hu S, Zhang Z. Exclusion of the Distal Ileum Cannot Reverse the Anti-Diabetic Effects of Duodenal-Jejunal Bypass Surgery. Obes Surg 2015; 26:261-8. [DOI: 10.1007/s11695-015-1745-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Jurowich CF, Otto C, Rikkala PR, Wagner N, Vrhovac I, Sabolić I, Germer CT, Koepsell H. Ileal Interposition in Rats with Experimental Type 2 Like Diabetes Improves Glycemic Control Independently of Glucose Absorption. J Diabetes Res 2015; 2015:490365. [PMID: 26185767 PMCID: PMC4491588 DOI: 10.1155/2015/490365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/05/2015] [Accepted: 06/07/2015] [Indexed: 02/08/2023] Open
Abstract
Bariatric operations in obese patients with type 2 diabetes often improve diabetes before weight loss is observed. In patients mainly Roux-en-Y-gastric bypass with partial stomach resection is performed. Duodenojejunal bypass (DJB) and ileal interposition (IIP) are employed in animal experiments. Due to increased glucose exposition of L-cells located in distal ileum, all bariatric surgery procedures lead to higher secretion of antidiabetic glucagon like peptide-1 (GLP-1) after glucose gavage. After DJB also downregulation of Na(+)-d-glucose cotransporter SGLT1 was observed. This suggested a direct contribution of decreased glucose absorption to the antidiabetic effect of bariatric surgery. To investigate whether glucose absorption is also decreased after IIP, we induced diabetes with decreased glucose tolerance and insulin sensitivity in male rats and investigated effects of IIP on diabetes and SGLT1. After IIP, we observed weight-independent improvement of glucose tolerance, increased insulin sensitivity, and increased plasma GLP-1 after glucose gavage. The interposed ileum was increased in diameter and showed increased length of villi, hyperplasia of the epithelial layer, and increased number of L-cells. The amount of SGLT1-mediated glucose uptake in interposed ileum was increased 2-fold reaching the same level as in jejunum. Thus, improvement of glycemic control by bariatric surgery does not require decreased glucose absorption.
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Affiliation(s)
- Christian Ferdinand Jurowich
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Christoph Otto
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Prashanth Reddy Rikkala
- Institute of Anatomy and Cell Biology, University of Würzburg, Koellikerstraße 6, 97070 Würzburg, Germany
| | - Nicole Wagner
- Institute of Anatomy and Cell Biology, University of Würzburg, Koellikerstraße 6, 97070 Würzburg, Germany
| | - Ivana Vrhovac
- Molecular Toxicology Unit, Institute for Medical Research & Occupational Health, Ksaverska Cesta 2, 10000 Zagreb, Croatia
| | - Ivan Sabolić
- Molecular Toxicology Unit, Institute for Medical Research & Occupational Health, Ksaverska Cesta 2, 10000 Zagreb, Croatia
| | - Christoph-Thomas Germer
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Hermann Koepsell
- Institute of Anatomy and Cell Biology, University of Würzburg, Koellikerstraße 6, 97070 Würzburg, Germany
- Department of Molecular Plant Physiology and Biophysics, Julius-von-Sachs-Institute, University of Würzburg, Julius-von-Sachs-Platz 2, 97082 Würzburg, Germany
- *Hermann Koepsell:
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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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Preserve common limb in duodenal-jejunal bypass surgery benefits rats with type 2-like diabetes. Obes Surg 2014; 24:405-11. [PMID: 24190437 DOI: 10.1007/s11695-013-1103-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND In order to understand the underlying mechanisms by which weight loss surgeries improve metabolic profiles in type 2 diabetes mellitus (T2DM) patients and to evaluate the relevance of the length of the common limb in modulating various aspects of metabolism, we performed regular duodenal-jejunal bypass (DJB) and long-limb DJB (LL-DJB) surgeries in Goto-Kakizaki (GK) rats and compared their effects on glycemic control. METHODS Male GK rats at 12 weeks of age were used for this study. Body weight, food intake, fasting glucose, glucagon-like peptide-1 (GLP-1) level, glucose tolerance, insulin sensitivity, cholesterol and triglycerides levels, and fecal energy content were monitored for 26 weeks after the two types of surgeries. RESULTS We performed systematic analyses on GK rats after DJB or long-limb surgeries. Both procedures prevented body weight gain, reduced blood glucose and lipid levels, increased GLP-1 levels, and led to better insulin sensitivity. In general, LL-DJB displayed better effects than DJB, except that both surgeries caused similar increase in GLP-1 levels. CONCLUSIONS Both DJB and LL-DJB surgeries triggered beneficial effects in GK rats. LL-DJB showed better outcomes than DJB, which may be due to reduced food intake and higher fecal energy content. This indicates that the length of the common limb could influence metabolic profiles of surgery recipients.
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Grong E, Arbo IB, Thu OKF, Kuhry E, Kulseng B, Mårvik R. The effect of duodenojejunostomy and sleeve gastrectomy on type 2 diabetes mellitus and gastrin secretion in Goto-Kakizaki rats. Surg Endosc 2014; 29:723-33. [PMID: 25106717 DOI: 10.1007/s00464-014-3732-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 07/08/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bariatric surgery is a highly effective treatment of type 2 diabetes in patients with morbid obesity. The weight-loss independent improvement of glycemic control observed after these procedures has led to the discussion whether bariatric surgery can be introduced as treatment for type 2 diabetes in patients with a body mass index < 35 kg/m(2). We have studied the effects of two bariatric procedures on type 2 diabetes and on gastrointestinal hormone secretion in a lean diabetic animal model. METHODS Male Goto-Kakizaki rats, 17-18 weeks old, were randomized into three groups: duodenojejunostomy (DJ), sleeve gastrectomy (SG), or sham operation. During 36 postoperative weeks we evaluated body weight, fasting blood glucose, glucose tolerance, insulin, HbA1c, glucagon-like peptide 1, cholesterol parameters, triglycerides, total ghrelin, and gastrin. RESULTS Oral glucose tolerance was significantly improved for both DJ and SG at four weeks after surgery (p < 0.05). At the 34th postoperative week, SG had significantly lower area under the curve during oral glucose tolerance test compared to sham (p = 0.007). SG had significantly lower HbA1c compared to sham at 12 weeks; (mean ± SEM) 4.3 ± 0.1 % versus 5.2 ± 0.3 % (p < 0.05) and compared to both DJ and sham 34 weeks after surgery [median (75 %;25 %)] 5.2 (6.0; 4.3) % versus 7.0 (7.5; 6.7) % and 7.3 (7.6; 6.7) % (p = 0.009). Serum gastrin levels were markedly elevated for SG compared to DJ and sham; 188.0 (318.0; 121.0) versus 77.5 (114.0; 58.0) and 68.0 (90.0; 59.5) pmol/L (p = 0.004) at six weeks and 192.0 (587.8; 110.8) versus 65.5 (77.0; 59.0) and 69.5 (113.0; 55.5) (p = 0.001) 36 weeks after surgery. CONCLUSION Sleeve gastrectomy induces hypergastrinemia, lowers HbA1c, and improves glycemic control in Goto-Kakizaki rats. Sleeve gastrectomy is superior to duodenojejunostomy as treatment of type 2 diabetes mellitus in this animal model.
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Affiliation(s)
- Eivind Grong
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), PB 8905, 7491, Trondheim, Norway,
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Buchwald H, Menchaca HJ, Michalek VN, Bertin NT. Ileal effect on blood glucose, HbA1c, and GLP-1 in Goto-Kakizaki rats. Obes Surg 2014; 24:1954-60. [PMID: 24908242 DOI: 10.1007/s11695-014-1307-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There have been enumerable studies on the effects of glucagon-like peptide-1 (GLP-1) on satiety and pancreatic islet function, stimulating the advocacy of surgical transposition of the ileum (rich in GLP-1-generating L-cells) higher in the gastrointestinal tract for earlier stimulation. In the Goto-Kakizaki rat with naturally occurring type 2 diabetes, we studied the influence of ileal exclusion (IE) and ileal resection (IR) on blood glucose, hemoglobin A1c (HbA1c), and GLP-1. METHODS In six control (Ctrl), 10 IE, and 10 IR rats, over 12 weeks of follow-up, we determined blood glucose, HbA1c, and GLP-1. RESULTS Two animals in the IE and IR groups did not survive to week 13. Both operated groups weighed more than the Ctrl group at baseline and at 13 weeks; thus, IE and IR did not retard weight gain (p < 0.05). All three groups were equally hyperglycemic at week 13: 255 ± 10.2 Ctrl, 262 ± 11.0 IE, 292 ± 17.8 IR (mg/dl ± SEM). The three groups had statistically identical markedly elevated HbA1c percentages at week 13: 14.7 ± 28 Ctrl, 11.7 ± 3.4 IE, 13.8 ± 3.5 IR (% ± SEM). The end-study GLP-1 values (pM ± SEM) were 5 ± 0.9 Ctrl, 33 ± 8.9 IE, and 25 ± 6.7 IR. P values for intergroup differences were IE vs. Ctrl 0.02, IR vs. Ctrl 0.02, and IE vs. IR 0.59. CONCLUSIONS Neither IE nor IR resulted in a decrease in the mean GLP-1 level. On the contrary, the exclusion or resection of the L-cell rich ileum raised GLP-1 levels 5- to 6-fold. This increase in the GLP-1 was not associated with the mitigation of hyperglycemia or elevated HbA1c levels.
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Affiliation(s)
- Henry Buchwald
- Department of Surgery, University of Minnesota, 420 Delaware St. SE, MMC 290, Minneapolis, MN, 55455, USA,
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Mid to distal small bowel resection with the preservation of the terminal ileum improves glucose homeostasis in diabetic rats by activating the hindgut-dependent mechanism. J Gastrointest Surg 2014; 18:1186-93. [PMID: 24687254 DOI: 10.1007/s11605-014-2507-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/16/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this study was to develop a novel surgical model to test the "hindgut hypothesis" and thereby study the role of the gut in glucose homeostasis and the mechanism of action of bariatric surgery. METHOD Sprague-Dawley rats were given a high-fat and high-sugar diet and treated with 25 mg/kg streptozotocin (STZ). The fat-sugar-fed/STZ-treated rats were randomized into mid to distal small bowel resection with the preservation of the terminal ileum (DBRPI) and sham operation (which had a formal celiotomy with bowel manipulation only) groups. Rats were observed for 12 weeks after the operation. The main outcome measures were weight, food intake, non-fasting glucose, an oral glucose tolerance test (OGTT), an insulin tolerance test (ITT), the levels of fasting and glucose-induced insulin, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), serum bile acids, and lipid profile. RESULT The DBRPI and sham groups exhibited no difference in weight and food intake after surgery. When compared to the sham controls, the DBRPI group displayed an improvement in non-fasting glucose, oral glucose tolerance, and insulin tolerance at 4 and 12 weeks postresection. DBRPI elicited an increased serum insulin, PYY and GLP-1 levels at 12 weeks postoperation; furthermore, DBRPI resulted in higher serum levels of triglyceride, total bile acids, total bilirubin, and direct bilirubin levels and lower free fatty acid level at 12 weeks. CONCLUSIONS This study provides strong evidences for the key role of hindgut in the amelioration of diabetes after bariatric surgery. Moreover, these findings confirm that DBRPI is a simple and effective surgical model for testing the "hindgut hypothesis" and focused study of biliary enterohepatic recycling in the context of bariatric operations.
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Hu C, Su Q, Li F, Zhang G, Sun D, Han H, Liu S, Hu S. Duodenal–Jejunal Bypass Improves Glucose Homeostasis in Association with Decreased Proinflammatory Response and Activation of JNK in the Liver and Adipose Tissue in a T2DM Rat Model. Obes Surg 2014; 24:1453-62. [DOI: 10.1007/s11695-014-1230-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Hu C, Zhang G, Sun D, Han H, Hu S. Duodenal-jejunal bypass improves glucose metabolism and adipokine expression independently of weight loss in a diabetic rat model. Obes Surg 2014; 23:1436-44. [PMID: 23636998 DOI: 10.1007/s11695-013-0976-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is accumulating evidence that adipokines lead to a proinflammatory state, which plays crucial roles in insulin resistance and development of type 2 diabetes mellitus (T2DM). Previous studies demonstrated that weight loss after bariatric surgery is accompanied by a suppression of the proinflammatory state. However, the effect of bariatric surgery on adipokine expression beyond weight loss is still elusive. The aim of this study was to investigate the effect of duodenal-jejunal bypass (DJB) on glucose homeostasis and adipokine expression independently of weight loss. METHODS A T2DM rat model was developed by a high-fat diet and low dose of streptozotocin. Twenty-one diabetic rats and 10 age-matched SD rats were randomly assigned to the DJB group, sham-DJB (S-DJB) group, and control group. For 12 weeks after surgery, their body weight, food intake, glucose homeostasis, lipid parameters, serum adipokine levels, and adipokine gene expression in the mesocolon adipose tissue were measured. RESULTS Compared to the S-DJB group, DJB induced significant and sustained glycemic control with improved insulin sensitivity and glucose tolerance independently of weight loss. DJB improved the lipid metabolism by decreasing fasting free fatty acids and triglycerides. Serum leptin and IL-6 significantly decreased 12 weeks after DJB, whereas adiponectin increased and TNF-α remained unchanged. The mRNA expression levels of leptin, TNF-α, and IL-6 decreased, whereas adiponectin increased in the mesocolon adipose tissue. CONCLUSION DJB reduced the proinflammatory adipokines and increased the anti-inflammatory adipokines independently of weight loss, which may contribute to the improvement of insulin sensitivity.
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Affiliation(s)
- Chunxiao Hu
- Department of General Surgery, Qilu Hospital of Shandong University, 107#, Wenhua Xi Road, Jinan 250012, Shandong, PR China
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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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Muñoz R, Escalona A. Duodenal-Jejunal Bypass Liner to Treat Type 2 Diabetes Mellitus in Morbidly Obese Patients. Curr Cardiol Rep 2014; 16:454. [DOI: 10.1007/s11886-013-0454-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Grueneberger JM, Karcz-Socha I, Sawczyn T, Kosmowski J, Stygar D, Goos M, Küsters S, Zwirska-Korczala K, Marjanovic G, Keck T, Hopt UT, Karcz WK. Systematic ileal transposition in Zucker rats shows advantage for long segment distal transposition. Surgery 2014; 155:165-72. [DOI: 10.1016/j.surg.2013.05.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 05/28/2013] [Indexed: 01/05/2023]
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Shimizu H, Eldar S, Heneghan HM, Schauer PR, Kirwan JP, Brethauer SA. The effect of selective gut stimulation on glucose metabolism after gastric bypass in the Zucker diabetic fatty rat model. Surg Obes Relat Dis 2014; 10:29-35. [PMID: 23507630 DOI: 10.1016/j.soard.2013.01.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Potential mechanisms underlying the antidiabetic effects of Roux-en-Y gastric bypass (RYGB) include altered nutrient exposure in the gut. The aim of this study was to evaluate the effects of selective gut stimulation on glucose metabolism in an obese diabetic rat model. METHODS Sixteen male Zucker diabetic fatty rats were randomly assigned to 1 of 2 groups: RYGB with gastrostomy tube (GT) insertion into the excluded stomach or a control group with GT insertion into the stomach. An insulin tolerance test (ITT), oral glucose tolerance test (OGTT), and mixed meal tolerance test (MMTT) were performed before and 14-28 days after surgery. A glucose tolerance test via GT (GTT-GT) and MMTT via GT were performed postoperatively. RESULTS Postoperatively, the RYGB group had significant decreases in weight and food intake. Both the ITT and OGTT tests revealed significantly improved glucose tolerance after RYGB. The GTT-GT showed a reversal of the improved glucose tolerance in the RYGB group. In response to meal stimulation, postoperatively, the RYGB group increased glucagon-like peptide 1 (GLP-1) secretion via the oral route and peptide YY secretion by both oral and GT routes. CONCLUSION When foregut exposure to nutrients was reversed after RYGB, the improvement in glucose metabolism was abrogated. This model can be extended to identify the role of gut in glucose homeostasis in type 2 diabetes.
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Affiliation(s)
- Hideharu Shimizu
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shai Eldar
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Helen M Heneghan
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - John P Kirwan
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Metabolic Translational Research Center, Endocrine and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
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Sub-sleeve gastrectomy achieves good diabetes control without weight loss in a non-obese diabetic rat model. Surg Endosc 2013; 28:1010-8. [PMID: 24190081 DOI: 10.1007/s00464-013-3272-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 10/06/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although weight loss has been implicated in anti-diabetic effects, sleeve gastrectomy (SG)-mediated anti-diabetic effects are induced through mechanisms beyond weight loss. Our aim was to investigate whether anti-diabetic effects can be achieved by surgically removing a smaller portion of the stomach instead of SG. METHODS Male 11-week-old Goto-Kakizaki rats (N = 50) were randomized into five groups: sub-sleeve gastrectomy (SSG, only the gastric fundus is removed), SG, sham-operated SSG, sham-operated SG, and control. Body weight, food intake, hormone secretion, and glucose metabolism were measured up to 24 weeks after surgery. RESULTS The data showed that (i) both SSG and SG surgeries significantly improved glucose homeostasis, with lower ghrelin levels and higher post-prandial glucagon-like peptide 1, peptide YY, and insulin levels; (ii) SG, but not SSG, produced sustained weight loss and significant reduction of food intake; and (iii) SG induced better long-term diabetic improvement than SSG. CONCLUSIONS The SSG that only removed the gastric fundus exhibited significant diabetic improvement without weight loss, but did not induce long-term diabetic improvement comparable to that of SG. Our study helps to understand the role of hormones and weight loss in maintaining long-term diabetes improvement after SG.
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Ramzy AR, Nausheen S, Chelikani PK. Ileal transposition surgery produces ileal length-dependent changes in food intake, body weight, gut hormones and glucose metabolism in rats. Int J Obes (Lond) 2013; 38:379-87. [PMID: 24166069 DOI: 10.1038/ijo.2013.201] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/23/2013] [Accepted: 10/06/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Enhanced stimulation of the lower gut is hypothesized to play a key role in the weight loss and resolution of diabetes following bariatric surgeries. Ileal transposition (IT) permits study of the effects of direct lower gut stimulation on body weight, glucose homeostasis and other metabolic adaptations without the confounds of gastric restriction or foregut exclusion. However, the underlying mechanisms and the length of the ileum sufficient to produce metabolic benefits following IT surgery remain largely unknown. OBJECTIVE To determine the effects of transposing varying lengths of the ileum to upper jejunum on food intake, body weight, glucose tolerance and lower gut hormones, and the expression of key markers of glucose and lipid metabolism in skeletal muscle and adipose tissue in rats. METHODS Adult male Sprague-Dawley rats (n=9/group) were subjected to IT surgery with translocation of 5, 10 or 20 cm of the ileal segment to proximal jejunum or sham manipulations. Daily food intake and body weight were recorded, and an intraperitoneal glucose tolerance test was performed. Blood samples were assayed for hormones and tissue samples for mRNA (RT-qPCR) and/or protein abundance (immunoblotting) of regulatory metabolic markers. RESULTS We demonstrate that IT surgery exerts ileal length-dependent effects on multiple parameters including: (1) decreased food intake and weight gain, (2) improved glucose tolerance, (3) increased tissue expression and plasma concentrations of glucagon-like peptide-1 (GLP-1) and peptide YY (PYY), and decreased leptin concentrations and (4) upregulation of key markers of glucose metabolism (glucose transporter-4 (GLUT-4), insulin receptor substrate 1 (IRS-1), adenosine monophosphate-activated protein kinase (AMPK), hexokinase (HK) and phosphofructokinase (PFK)) together with a downregulation of lipogenic markers (fatty acid synthase (FAS)) in muscle and adipose tissue. CONCLUSIONS Together, our data demonstrate that the reduction in food intake and weight gain, increase in lower gut hormones, glycemic improvements and associated changes in tissue metabolic markers following IT surgery are dependent on the length of the transposed ileum.
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Affiliation(s)
- A R Ramzy
- Department of Production Animal Health, Faculty of Veterinary Medicine, Alberta, Calgary, Canada
| | - S Nausheen
- Department of Production Animal Health, Faculty of Veterinary Medicine, Alberta, Calgary, Canada
| | - P K Chelikani
- 1] Department of Production Animal Health, Faculty of Veterinary Medicine, Alberta, Calgary, Canada [2] Gastrointestinal Research Group, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Alberta, Calgary, Canada
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Pezeshki A, Chelikani PK. Effects of Roux-en-Y gastric bypass and ileal transposition surgeries on glucose and lipid metabolism in skeletal muscle and liver. Surg Obes Relat Dis 2013; 10:217-28. [PMID: 24603111 DOI: 10.1016/j.soard.2013.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 08/29/2013] [Accepted: 09/27/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Roux-en Y gastric bypass (RYGB) and ileal transposition (IT) surgeries produce weight loss and improve diabetic control; however, the mechanisms of glycemic improvements are largely unknown. Because skeletal muscle and liver play a key role in glucose homeostasis, we compared the effects of RYGB and IT surgeries on key molecules of glucose and lipid metabolism in muscle and liver. METHODS Sprague-Dawley rats were subjected to RYGB, IT, or sham surgeries; sham-animals were ad-lib fed or pair-fed to RYGB rats (n = 7-9/group). At 8 weeks postoperatively, blood samples were collected for glucagon-like peptide-1 (GLP-1) and insulin analyses by ELISA. Leg muscle and liver tissues were analyzed for mRNA (RT-qPCR) and/or protein abundance (immuno blotting) of important molecules of glucose and lipid metabolism [glucose transporter-4 (GLUT-4), hexokinase, phosphofructokinase (PFK), adenosine monophosphate activated protein kinase-α (AMPKα), cytochrome C oxidase-IV (COX-IV), citrate synthase, carnitine palmitoyl transferase-1 (CPT-1), medium-chain acyl-CoA dehydrogenase (MCAD), peroxisome proliferator-activated receptor gamma co-activator 1 α (PGC-1 α), PGC-1-related coactivator (PRC), uncoupling protein-3 (UCP-3)]. RESULTS Plasma GLP-1 concentrations were increased comparably with RYGB and IT. RYGB and IT increased muscle GLUT-4 protein content, muscle hexokinase mRNA, and liver PFK mRNA. IT increased muscle AMPKα and COX-IV protein content and liver citrate synthase activity. IT increased muscle CPT-1, MCAD and PRC mRNA, whereas RYGB increased UCP-3 mRNA in muscle and liver, and PGC-1 α mRNA in liver. CONCLUSION The data suggest that RYGB and IT surgeries lead to enhanced GLP-1 secretion and produce similar stimulatory effects on important molecules of glucose metabolism but differential effects on key molecules of lipid oxidation in muscle and liver.
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Affiliation(s)
- Adel Pezeshki
- Department of Production Animal Health, Faculty of Veterinary Medicine, Gastrointestinal Research Group, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Prasanth K Chelikani
- Department of Production Animal Health, Faculty of Veterinary Medicine, Gastrointestinal Research Group, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada.
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Allen RE, Hughes TD, Ng JL, Ortiz RD, Ghantous MA, Bouhali O, Froguel P, Arredouani A. Mechanisms behind the immediate effects of Roux-en-Y gastric bypass surgery on type 2 diabetes. Theor Biol Med Model 2013; 10:45. [PMID: 23849268 PMCID: PMC3726422 DOI: 10.1186/1742-4682-10-45] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 07/10/2013] [Indexed: 02/08/2023] Open
Abstract
Background The most common bariatric surgery, Roux-en-Y gastric bypass, leads to glycemia normalization in most patients long before there is any appreciable weight loss. This effect is too large to be attributed purely to caloric restriction, so a number of other mechanisms have been proposed. The most popular hypothesis is enhanced production of an incretin, active glucagon-like peptide-1 (GLP-1), in the lower intestine. We therefore set out to test this hypothesis with a model which is simple enough to be robust and credible. Method Our method involves (1) setting up a set of time-dependent equations for the concentrations of the most relevant species, (2) considering an “adiabatic” (or quasi-equilibrium) state in which the concentrations are slowly varying compared to reaction rates (and which in the present case is a postprandial state), and (3) solving for the dependent concentrations (of e.g. insulin and glucose) as an independent concentration (of e.g. GLP-1) is varied. Results Even in the most favorable scenario, with maximal values for (i) the increase in active GLP-1 concentration and (ii) the effect of GLP-1 on insulin production, enhancement of GLP-1 alone cannot account for the observations. I.e., the largest possible decrease in glucose predicted by the model is smaller than reported decreases, and the model predicts no decrease whatsoever in glucose ×insulin, in contrast to large observed decreases in homeostatic model assessment insulin resistance (HOMA-IR). On the other hand, both effects can be accounted for if the surgery leads to a substantial increase in some substance that opens an alternative insulin-independent pathway for glucose transport into muscle cells, which perhaps uses the same intracellular pool of GLUT-4 that is employed in an established insulin-independent pathway stimulated by muscle contraction during exercise. Conclusions Glycemia normalization following Roux-en-Y gastric bypass is undoubtedly caused by a variety of mechanisms, which may include caloric restriction, enhanced GLP-1, and perhaps others proposed in earlier papers on this subject. However, the present results suggest that another possible mechanism should be added to the list of candidates: enhanced production in the lower intestine of a substance which opens an alternative insulin-independent pathway for glucose transport.
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Affiliation(s)
- Roland E Allen
- Department of Physics and Astronomy, Texas A&M University, College Station, TX 77843, USA.
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Sun D, Liu S, Zhang G, Chen W, Yan Z, Hu S. Type 2 diabetes control in a nonobese rat model using sleeve gastrectomy with duodenal-jejunal bypass (SGDJB). Obes Surg 2013; 22:1865-73. [PMID: 22911149 DOI: 10.1007/s11695-012-0744-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND As a new bariatric procedure, sleeve gastrectomy with duodenal-jejunal bypass (SGDJB) needs further assessment. We compared the diabetic control between SGDJB and sleeve gastrectomy (SG) in Goto-Kakizaki (GK) rats, a nonobese rat model of type 2 diabetes. Our aim is firstly to develop a nonobese diabetic rat model for SGDJB and secondly to investigate the feasibility and safety of SGDJB to induce diabetes remission. METHODS Fifty 11-week-old male GK rats were divided into five groups: sham-operated SG (SOSG), sham-operated SGDJB (SOSGDJB), control, SG, and SGDJB. Rats were observed for 16 weeks after surgery. The body weight, food intake, glycemic control outcomes, ghrelin, peptide YY (PYY), insulin, glucagon-like peptide 1 (GLP-1), and glucose-dependent insulinotropic peptide were measured. RESULTS The operated groups showed lower food intake since 4 weeks postoperation and significant weight loss since 6 weeks postoperation. SGDJB and SG surgeries induced a decreased fasting ghrelin level and increased levels of glucose-stimulated insulin, GLP-1, and PYY secretion at 2 and 16 weeks postoperation. Compared with the SG group, the SGDJB group showed higher glucose-stimulated GLP-1 levels. Both SGDJB and SG groups exhibited significant improvement in oral glucose tolerance and insulin tolerance compared with sham-operated and control groups, but there was no difference between the operated groups. CONCLUSIONS This nonobese diabetic rat model may be valuable in studying the effect of SGDJB on diabetic control. SGDJB shows similar improvement of glucose metabolism with SG. Our findings do not provide evidence for the foregut-mediated amelioration in glucose homeostasis.
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Affiliation(s)
- Dong Sun
- Department of General Surgery, Qilu Hospital of Shandong University, #107 Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
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Duodenal-Jejunal Bypass Improves Glycemia and Decreases SGLT1-Mediated Glucose Absorption in Rats With Streptozotocin-Induced Type 2 Diabetes. Ann Surg 2013; 258:89-97. [DOI: 10.1097/sla.0b013e3182890311] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Sun X, Song M, Bai R, Cheng S, Xing Y, Yuan H, Wang P, Zhou L. Ileal interposition surgery-induced improvement of hyperglycemia and insulin resistance in Goto-Kakizaki rats by upregulation of TCF7L2 expression. Exp Ther Med 2013; 5:1511-1515. [PMID: 23737909 PMCID: PMC3671895 DOI: 10.3892/etm.2013.998] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 03/05/2013] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to investigate the effects of ileal interposition (IT) on glucose and insulin resistance (IR) in type 2 diabetic mellitus (T2DM), and the role of T-cell factor 7-like 2 (TCF7L2), formerly known as TCF4, in the downregulation of hyperglycemia following IT. Goto-Kakizaki (GK) rats subjected to IT surgery (GK-IT group), GK rats subjected to sham surgery (GK-Sham group) and Wistar (WS) rats subjected to sham surgery (WS-Sham group) were investigated in this study. Fasting plasma glucose, body weight, food intake per 1 kg body weight, insulin and a homeostasis model assessment of insulin resistance (HOMA-IR) were measured pre- and post-surgery. The rats were euthanized 28 days post-surgery and the pancreas of each rat was dissected. The expression levels of TCF7L2 mRNA and protein were analyzed by quantitative RT-PCR and western blotting, respectively. Our results revealed that IT improved both fasting plasma glucose levels and IR in GK rats by upregulating the expression of the TCF7L2 protein. IT provides a valuable therapeutic option for patients with T2DM. Upregulation of TCF7L2 protein expression may be a possible mechanism underlying the improvement of T2DM following IT.
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Affiliation(s)
- Xu Sun
- Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
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Kim WS, Kim JW, Ahn CW, Choi SH. Resolution of type 2 diabetes after gastrectomy for gastric cancer with long limb Roux-en Y reconstruction: a prospective pilot study. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 84:88-93. [PMID: 23396643 PMCID: PMC3566474 DOI: 10.4174/jkss.2013.84.2.88] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 11/14/2012] [Accepted: 12/04/2012] [Indexed: 01/06/2023]
Abstract
PURPOSE It is unclear whether metabolic surgery is effective in non obese type 2 diabetes mellitus (T2DM) and the result after gastrectomy and conventional reconstruction for gastric cancer with non obese T2DM are not satisfactory for improvement of T2DM. Prospective single-arm pilot study with long limb Roux-en Y reconstruction after gastrectomy was evaluated on its safety and efficacy as a potential cure for T2DM in patients with non obese gastric cancer. METHODS Fifteen patients with non obese T2DM and gastric cancer were enrolled. After gastrectomy, the gastrointestinal tract was reconstructed by Roux-en Y gastrojejunostomy or esophagojejunostomy. The biliopancreatic and Roux limb were 100 to 120 cm long each. RESULTS There was no surgery-related mortality, but four cases experienced complications (26.7%). Before surgery, the mean body mass index was 25.2 ± 3.4 kg/m(2) and mean glycated hemoglobin (HbA1c) was 7.7 ± 1.4% with antidiabetic medications. The mean BMI decreased to 21.7 ± 3.1 kg/m(2) (P < 0.05) and the mean HbA1c decreased to 6.3 ± 0.8% (P < 0.05) 6 months after surgery. At the end of the study (follow-up duration, 12.5 ± 5.5 months), HbA1c decreased to <6% in 11 patients (78.6%) without any antidiabetic medications. There were no patients who had anemia, and/or malnutrition after surgery except one patient who died due to recurrence four months after surgery. CONCLUSION Long limb Roux-en Y reconstruction after gastrectomy is feasible and has the potential to cure T2DM in non obese gastric cancer patients. A randomized controlled trial is needed to confirm this result.
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Affiliation(s)
- Whan Sik Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Won Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Woo Ahn
- Department of Endocrinology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Ho Choi
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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The entire small intestine mediates the changes in glucose homeostasis after intestinal surgery in Goto-Kakizaki rats. Ann Surg 2013; 256:1049-58. [PMID: 23001083 DOI: 10.1097/sla.0b013e31826c3866] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the potential interaction between excluding foregut and interposing hindgut and the role of different portions of the small intestine in mediating changes in some glucoregulatory mechanisms and glucose homeostasis after intestinal surgery in Goto-Kakizaki (GK) rats. BACKGROUND Previous studies have revealed changes in glucoregulatory mechanisms and glucose homeostasis after excluding foregut and interposing hindgut alone and lead to the "foregut hypothesis" and "hindgut hypothesis." However, these hypotheses are not mutually exclusive. METHODS Duodenal-jejunal bypass (DJB), ileal interposition (IT), duodenal-jejunal bypass with ileal interposition (DJBIT), sub-ileal interposition (sIT), and sham operations were performed on GK rats. Main outcome measures were oral glucose tolerance (studied at 0, 2, 4, 8, and 24 weeks), insulin sensitivity, β-cell function, and postprandial levels of glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and glucose-dependent insulinotropic peptide(GIP) (evaluated at 2 and 24 weeks). RESULTS Global body weight in the control group was higher than in the operation groups at postoperative week 2, but it was similar among groups at postoperative week 24. The DJBIT procedure induced synergistic improvement in glucose tolerance and insulin sensitivity (P < 0.05). Generalized linear mixed-model analysis confirmed that glucose tolerance in nonsham operation groups improved over time (P < 0.001), with a significant time × treatment interaction (P < 0.001). Fasting C-peptide, postprandial insulin, GLP-1, and PYY levels increased after nonsham operations (P < 0.05); however, they were not significantly different among the DJBIT, DJB, and IT groups (P > 0.05). Compared with sub-IT, IT induced better glucose tolerance (P < 0.05) and higher postprandial insulin, GLP-1 and PYY levels (P < 0.05), and no significant difference in insulin sensitivity and fasting C-peptide was observed (P > 0.05). None of the surgical procedures affected glucose-stimulated GIP levels (P > 0.05). CONCLUSIONS This study provides experimental evidence that excluding foregut and interposing hindgut provided independent and synergistic changes in glucose homeostasis after intestinal surgery in GK rats and that glucose tolerance improved over time.
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Long segment ileal transposition leads to early amelioration of glucose control in the diabetic obese Zucker rat. Wideochir Inne Tech Maloinwazyjne 2013; 8:130-8. [PMID: 23837097 PMCID: PMC3699773 DOI: 10.5114/wiitm.2011.32925] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 09/01/2012] [Accepted: 09/18/2012] [Indexed: 01/01/2023] Open
Abstract
Introduction Fast delivery of food to the terminal ileum is thought to be pathophysiologically responsible for type 2 diabetes remission after obesity surgery. Imitating this effect, ileal transposition (IT) is designed as initiating diabetes remission for non-obese patients. Aim To date, it is not clear which length of the transposed segment achieves the best glucose lowering results. As previous rodent data mostly rely on a 10 cm IT, the current study evaluated a long segment IT (20 cm) in the diabetic obese Zucker rat. Material and methods Twenty male diabetic obese Zucker rats (Crl:ZUC-Leprfa) were randomly assigned to undergo either a long segment (20 cm; ∼ 50% of ileum) IT or sham surgery. Glucose control was determined by an oral glucose tolerance test (OGTT) on day −7, 0, 14 and 20. Analysis of the incretin hormones glucagon-like peptide 1 (GLP-1), peptide YY (PYY) and insulin was included in the first and third OGTT. Results Ileal transposition animals showed an early improvement of glucose control after 14 days (area under the curve: IT vs. baseline 314.7 ±229.0 mmol/l × min vs. 564.6 ±268.5 mmol/l × min; p < 0.05). Compared to sham animals, glucose-stimulated GLP-1 and PYY levels were raised (5.75 ±3.73 pmol/l vs. 18.52 ±14.22 pmol/l, p < 0.05; 129.7 ±64.62 pmol/l vs. 164.0 ±62.26 pmol/l, p < 0.05). Body weight gain from postoperative day 5 was greater for sham animals (50.22 ±20.93 γ vs. 16.4 ±25.93 g; p < 0.01). Conclusions Long segment IT shows a rapid rise in GLP-1 and PYY levels, thus leading to early amelioration of glucose control.
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Muñoz R, Carmody JS, Stylopoulos N, Davis P, Kaplan LM. Isolated duodenal exclusion increases energy expenditure and improves glucose homeostasis in diet-induced obese rats. Am J Physiol Regul Integr Comp Physiol 2012; 303:R985-93. [PMID: 22972837 DOI: 10.1152/ajpregu.00262.2012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) in rodent models reduces food intake (FI), increases resting energy expenditure (EE), and improves glycemic control. We have shown that mimicking the duodenal component of RYGB by implantation of a 10-cm endoluminal sleeve device (ELS-10) induces weight loss and improves glycemic control in diet-induced obese (DIO) rats. We sought to determine the mechanisms and structural requirements of these effects. We examined the effects of ELS-10 devices implanted in male DIO rats on body weight, food intake (FI), meal patterns, total and resting EE, and multiple parameters of glucose homeostasis, comparing them with sham-operated (SO) rats and with SO rats weight matched to the ELS-10-treated group. To determine the extent of duodenal exclusion required to influence metabolic outcomes, we compared the effects of implanting 10-, 4-, or 1-cm ELS devices. ELS-10 rats exhibited 13% higher total and 9% higher resting EE than SO controls. ELS-10 rats also exhibited enhanced postprandial GLP-1 secretion and improved glucose tolerance and insulin sensitivity out of proportion to the effects of weight loss alone. Implantation of 4- or 1-cm ELS devices had no effect on EE and limited effects on glucose homeostasis. Complete duodenal exclusion with ELS-10 induces weight loss by decreasing FI and increasing EE and improves glycemic control through weight loss-independent mechanisms. Thus signals originating in the proximal small intestine appear to exert a direct influence on the physiological regulation of EE and glucose homeostasis. Their selective manipulation could provide effective new therapies for obesity and diabetes that mimic the benefits of RYGB.
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Affiliation(s)
- Rodrigo Muñoz
- Obesity, Metabolism & Nutritional Institute and Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02129, USA
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Johannessen H, Kodama Y, Zhao CM, Sousa MML, Slupphaug G, Kulseng B, Chen D. Eating Behavior and Glucagon-Like Peptide-1-Producing Cells in Interposed Ileum and Pancreatic Islets in Rats Subjected to Ileal Interposition Associated with Sleeve Gastrectomy. Obes Surg 2012; 23:39-49. [DOI: 10.1007/s11695-012-0750-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jejunal nutrient sensing is required for duodenal-jejunal bypass surgery to rapidly lower glucose concentrations in uncontrolled diabetes. Nat Med 2012; 18:950-5. [PMID: 22610279 DOI: 10.1038/nm.2745] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 03/19/2012] [Indexed: 02/08/2023]
Abstract
Gastrointestinal bypass surgeries restore metabolic homeostasis in patients with type 2 diabetes and obesity(1), but the underlying mechanisms remain elusive. Duodenal-jejunal bypass surgery (DJB), an experimental surgical technique that excludes the duodenum and proximal jejunum from nutrient transit(1,2), lowers glucose concentrations in nonobese type 2 diabetic rats(2–5). Given that DJB redirects and enhances nutrient flow into the jejunum and that jejunal nutrient sensing affects feeding(6,7), the repositioned jejunum after DJB represents a junction at which nutrients could regulate glucose homeostasis. Here we found that intrajejunal nutrient administration lowered endogenous glucose production in normal rats through a gut-brain-liver network in the presence of basal plasma insulin concentrations. Inhibition of jejunal glucose uptake or formation of long chain fatty acyl-coA negated the metabolic effects of glucose or lipid, respectively, in normal rats, and altered the rapid (2 d) glucose-lowering effect induced by DJB in streptozotocin (STZ)-induced uncontrolled diabetic rats during refeeding. Lastly, in insulin-deficient autoimmune type 1 diabetic rats and STZ-induced diabetic rats, DJB lowered glucose concentrations in 2 d independently of changes in plasma insulin concentrations, food intake and body weight. These data unveil a glucoregulatory role of jejunal nutrient sensing and its relevance in the early improvement of glycemic control after DJB in rat models of uncontrolled diabetes.
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Toghaw P, Matone A, Lenbury Y, De Gaetano A. Bariatric surgery and T2DM improvement mechanisms: a mathematical model. Theor Biol Med Model 2012; 9:16. [PMID: 22587410 PMCID: PMC3586953 DOI: 10.1186/1742-4682-9-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 04/23/2012] [Indexed: 02/06/2023] Open
Abstract
Background Consensus exists that several bariatric surgery procedures produce a rapid improvement of glucose homeostasis in obese diabetic patients, improvement apparently uncorrelated with the degree of eventual weight loss after surgery. Several hypotheses have been suggested to account for these results: among these, the anti-incretin, the ghrelin and the lower-intestinal dumping hypotheses have been discussed in the literature. Since no clear-cut experimental results are so far available to confirm or disprove any of these hypotheses, in the present work a mathematical model of the glucose-insulin-incretin system has been built, capable of expressing these three postulated mechanisms. The model has been populated with critically evaluated parameter values from the literature, and simulations under the three scenarios have been compared. Results The modeling results seem to indicate that the suppression of ghrelin release is unlikely to determine major changes in short-term glucose control. The possible existence of an anti-incretin hormone would be supported if an experimental increase of GIP concentrations were evident post-surgery. Given that, on the contrary, collected evidence suggests that GIP concentrations decrease post-surgery, the lower-intestinal dumping hypothesis would seem to describe the mechanism most likely to produce the observed normalization of Type 2 Diabetes Mellitus (T2DM) after bariatric surgery. Conclusions The proposed model can help discriminate among competing hypotheses in a context where definitive data are not available and mechanisms are still not clear.
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Affiliation(s)
- Puntip Toghaw
- Department of Mathematics, Faculty of Science, Kasetsart University, Bangkok, Thailand
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Chacko SK, Haymond MW, Sun Y, Marini JC, Sauer PJJ, Ma X, Sunehag AL. Effect of ghrelin on glucose regulation in mice. Am J Physiol Endocrinol Metab 2012; 302:E1055-62. [PMID: 22338071 DOI: 10.1152/ajpendo.00445.2011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Improvement of glucose metabolism after bariatric surgery appears to be from the composite effect of the alterations in multiple circulating gut hormone concentrations. However, their individual effect on glucose metabolism during different conditions is not clear. The objective of this study was to determine whether ghrelin has an impact on glycogenolysis, gluconeogenesis, and insulin sensitivity (using a mice model). Rate of appearance of glucose, glycogenolysis, and gluconeogenesis were measured in wild-type (WT), ghrelin knockout (ghrelin(-/-)), and growth hormone secretagogue receptor knockout (Ghsr(-/-)) mice in the postabsorptive state. The physiological nature of the fasting condition was ascertained by a short-term fast commenced immediately at the end of the dark cycle. Concentrations of glucose and insulin were measured, and insulin resistance and hepatic insulin sensitivity were calculated. Glucose concentrations were not different among the groups during the food-deprived period. However, plasma insulin concentrations were lower in the ghrelin(-/-) and Ghsr(-/-) than WT mice. The rates of gluconeogenesis, glycogenolysis, and indexes of insulin sensitivity were higher in the ghrelin(-/-) and Ghsr(-/-) than WT mice during the postabsorptive state. Insulin receptor substrate 1 and glucose transporter 2 gene expressions in hepatic tissues of the ghrelin(-/-) and Ghsr(-/-) were higher compared with that in WT mice. This study demonstrates that gluconeogenesis and glycogenolysis are increased and insulin sensitivity is improved by the ablation of the ghrelin or growth hormone secretagogue receptor in mice.
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Affiliation(s)
- Shaji K Chacko
- Department of Pediatrics, Baylor College of Medicine Children’s Nutrition Research Center, United States Department of Agriculture/Agricultural Research Service, Houston, TX, USA
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Praveen Raj P, Kumaravel R, Chandramaliteeswaran C, Rajpandian S, Palanivelu C. Is laparoscopic duodenojejunal bypass with sleeve an effective alternative to Roux en Y gastric bypass in morbidly obese patients: preliminary results of a randomized trial. Obes Surg 2012; 22:422-6. [PMID: 21870050 DOI: 10.1007/s11695-011-0507-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The incidence of obesity and related metabolic disorders in India and that of stomach carcinoma is one of the highest in the world. Hence, one requires a procedure that allows postoperative surveillance of the stomach with the best outcomes in terms of weight control and resolution of co-morbidities. Here, we compare one such procedure, duodenojejunal bypass with sleeve against the standard Roux-en Y gastric bypass. METHODS Fifty-seven patients who were selected for a bypass procedure were randomized into two groups of laparoscopic duodenojejunal bypass with sleeve (DJB) and laparoscopic Roux en Y gastric bypass. The limb lengths were similar in both the groups, and the sleeve was done over a 36F bougie. RESULTS The mean body mass index and percent excess weight loss at the end of 3, 6, and 12 months between the groups were not statistically significant. The operating times were higher in the DJB group. The rate of resolution of diabetes, hypertension, and dyslipidemias were also similar with no statistical significance. There was 100% resolution of dyslipidemias in both groups. There was one patient in the DJB group who presented with internal herniation 1 month post-op and was managed surgically. There was no mortality in both the groups. CONCLUSION Laparoscopic duodenojejunal with sleeve gastrectomy, a procedure which combines the principles and advantages of sleeve gastrectomy and foregut hypothesis, is a safe and effective alternative to gastric bypass in weight reduction and resolution of co-morbidities especially for Asian countries. But, long-term follow-up is required.
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Affiliation(s)
- P Praveen Raj
- Department of Minimal Access Bariatric and Metabolic Surgery, Gem Hospital and Research Centre, 45 Pankaja Mill Road, Coimbatore, Tamil Nadu, 641045, India.
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