Genetic reprogramming of remnant duodenum may contribute to type 2 diabetes improvement after Roux-en-Y gastric bypass

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 99-100; p. 111631
• Main Authors: Sala, Priscila, Machado, Natasha Mendonça, Torrinhas, Raquel Susana Matos de Miranda, Fonseca, Danielle C., Ferreira, Beatriz AM, Ishida, Robson Kiyoshi, Guarda, Ismael Francisco Mota Siqueira, de Moura, Eduardo Guimarães Hourneaux, Sakai, Paulo, Santo, Marco Aurélio, Heymsfield, Steven B., Corrêa-Giannella, Maria Lúcia, Waitzberg, Dan Linetzky
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2022; Elsevier Limited
• Subjects: Biochemical markers; Biopsy; Blood glucose; Body mass index; Cholesterol; Diabetes; Diabetes mellitus (non-insulin dependent); Disease control; Duodenum; Duodenum, LXR; Evaluation; Gastric bypass; Gastrointestinal surgery; Gene expression; Genes; Glucose; Glycemia; Hemoglobin; Homeostasis; Ileum; Insulin resistance; Intestinal adaptation; Intestine; Jejunum; Lipids; Markers; Metabolism; Obesity; Ontology; Pathophysiology; Patients; Peptides; Polymerase chain reaction; Remission; Retinoid X receptors; Reverse transcription; Small intestine; Software; Transcriptomes; Transcriptomics; Values; Weight control; United States > US; Obesity; Gene expression; Duodenum, LXR; Glycemia; Gastric bypass
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2022.111631

•In obese women with type 2 diabetes subjected to Roux-en-Y gastric bypass, intestinal adaptations to its new anatomy included changes in gene expression.•Some differentially expressed genes correlated with markers of glucose homeostasis in this population.•Transcriptomic findings in duodenum appeared to affect lipogenesis and cholesterol efflux in these women.•Duodenal transcriptomic changes correlated with remission of postoperative diabetes in this group.
Type 2 diabetes control occurs within a few days after Roux-en-Y gastric bypass (RYGB) and might be related to intestinal adaptation to the new anatomic arrangement. The aim of this study was to evaluate the intestinal transcriptome response to RYGB and its correlation with markers of glycemic homeostasis.
Global transcriptomic analyses performed by microarray technique were conducted in intestinal biopsies collected from adult women with obesity (N = 20) and T2D before and 3 mo after RYGB. Clinical and biochemical markers of glycemic homeostasis were also evaluated. At 1-y postoperative, patients were classified as responsive (R) or non-responsive (NR) to complete T2D remission according to the American Diabetes Association criteria. Intestinal differentially expressed genes (DEGs) were analyzed separately in the two groups, validated by reverse transcription quantitative polymerase chain reaction, and applied in functional enrichment and canonical pathway analysis. Spearman correlations between clinical and biochemical variables with DEGs were conducted. Twelve patients were classified as R and displayed 62 (duodenum), 241 (jejunum), and 63 (ileum) DEGs.
Eight of the patients with DEGs presented very strong or strong positive correlations with glycemia or glycated hemoglobin. Duodenal changes of genes involved in the LXR/RXR pathway were more likely to be associated with T2D.
In obese women, complete remission of T2D after RYGB might include intestinal transcriptomic changes that suggest a potential role of intracellular cholesterol and lipid homeostasis on glucose control.