Molecular mechanisms of diabetes reversibility after bariatric surgery

Objective: Insulin resistance is a strong biological marker of both obesity and type 2 diabetes. Abnormal fat deposition within skeletal muscle has been identified as a mechanism of obesity-associated insulin resistance. Biliopancreatic diversion (BPD), inducing a massive lipid malabsorption, leads...

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Published in:	International Journal of Obesity Vol. 31; no. 9; pp. 1429 - 1436
Main Authors:	Rosa, G, Mingrone, G, Manco, M, Euthine, V, Gniuli, D, Calvani, R, Favuzzi, A.M.R, Castagneto, M, Vidal, H
Format:	Journal Article
Language:	English
Published:	Basingstoke Nature Publishing 01-09-2007 Nature Publishing Group
Subjects:	Bariatric Surgery biochemical pathways Biological and medical sciences Biopsy Blood Glucose - analysis Blood Glucose - metabolism complications Complications and side effects Diabetes Diabetes Mellitus, Type 2 - genetics Diabetes Mellitus, Type 2 - metabolism Diabetes. Impaired glucose tolerance Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Fatty acids Feeding. Feeding behavior Female free fatty acids Fundamental and applied biological sciences. Psychology Gastrointestinal surgery Gene expression Genetic aspects Glucose Humans Insulin - metabolism Insulin resistance insulin secretion lipid metabolism Lipids Male Medical sciences men messenger RNA Metabolic diseases Metabolism Metabolites Muscle, Skeletal - metabolism Musculoskeletal system noninsulin-dependent diabetes mellitus Nutrient availability Obesity Obesity, Morbid - metabolism Obesity, Morbid - surgery Oxidation patients physiological response Postoperative Period remission Risk factors skeletal muscle Surgery tissue analysis Type 2 diabetes Vertebrates: anatomy and physiology, studies on body, several organs or systems Weight Loss White people women Italy Rome Italy Endocrinopathy Type 2 diabetes Human Pancreatic hormone Bariatric surgery biliopancreatic diversion Gene expression Striated muscle Insulin Mechanism Sensitivity Insulin resistance Reversibility Morbid obesity Molecular biology
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Summary:	Objective: Insulin resistance is a strong biological marker of both obesity and type 2 diabetes. Abnormal fat deposition within skeletal muscle has been identified as a mechanism of obesity-associated insulin resistance. Biliopancreatic diversion (BPD), inducing a massive lipid malabsorption, leads to a reversion of type 2 diabetes. To elucidate the mechanisms of diabetes reversibility, the expression of genes involved in glucose and free fatty acids (FFAs) metabolism was investigated in skeletal muscle biopsies from obese, type 2 diabetic subjects. Peripheral insulin sensitivity and insulin secretion was also measured. Subjects: Eight Caucasian obese diabetic patients (BMI 52.1+/-1.85 kg/m2) were studied before and 3 years after BPD. Measurements: The mRNA levels were estimated by quantitative real-time reverse transcription polymerase chain reaction (RT-PCR), insulin sensitivity by the euglycemic-hyperinsulinemic clamp and insulin secretion using a model describing the relationship between insulin secretion and glucose concentration. Results: Whole-body glucose uptake (M), normalized by fat-free mass, significantly increased in post-obese subjects (P<0.0001). Total insulin output decreased (P<0.05) in association with a significant improvement of beta-cells glucose sensitivity (P<0.05). mRNA levels of FABP3 (P<0.05), FACL (P<0.05), ACC2 (P<0.05), HKII (P<0.05) and PDK4 (P<0.05) were significantly decreased, while SREBP1c mRNA increased (P<0.05) after BPD. Conclusion: Reversibility of type 2 diabetes after BPD is dependent on the improvement of skeletal muscle insulin sensitivity, mediated by changes in the expression of genes regulating glucose and fatty acid metabolism in response to nutrient availability.
Bibliography:	http://www.nature.com/ijo/ ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0307-0565 1476-5497
DOI:	10.1038/sj.ijo.0803630