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Cited by 143Bariatric Surgery and OutcomesAdipokines, Inflammation, and Metabolic DiseasesMinimally Invasive Surgical Techniques

Reduction in endotoxemia, oxidative and inflammatory stress, and insulin resistance after Roux-en-Y gastric bypass surgery in patients with morbid obesity and type 2 diabetes mellitus

Monte, Scott V., Caruana, Joseph A., Ghanim, Husam, Sia, Chang Ling, Korzeniewski, Kelly, Schentag, Jerome J., Dandona, Paresh·2012·Surgery
DOI 10.1016/j.surg.2011.09.038
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Abstract

Background Roux-en-Y gastric bypass (RYGB) results in profound weight loss and resolution of type 2 diabetes mellitus (T2DM). The mechanism of this remarkable transition remains poorly defined. It has been proposed that endotoxin (lipopolysaccharide [LPS]) sets inflammatory tone, triggers weight gain, and initiates T2DM. Because RYGB may diminish LPS from endogenous and exogenous sources, we hypothesized that LPS and the associated cascade of oxidative and inflammatory stress would diminish after RYGB.Methods Fifteen adults with morbid obesity and T2DM undergoing RYGB were studied. After an overnight fast, a baseline blood sample was collected the morning of surgery and at 180 days to assess changes in glycemia, insulin resistance, LPS, mononuclear cell nuclear factor (NF)-κB binding and mRNA expression of CD14, TLR-2, TLR-4, and markers of inflammatory stress.Results At 180 days after RYGB, subjects had a significant decrease in body mass index (52.1 ± 13.0 to 40.4 ± 11.1), plasma glucose (148 ± 8 to 101 ± 4 mg/dL), insulin (18.5 ± 2.2 mμU/mL to 8.6 ± 1.0 mμU/mL) and HOMA-IR (7.1 ± 1.1 to 2.1 ± 0.3). Plasma LPS significantly reduced by 20 ± 5% (0.567 ± 0.033 U/mL to 0.443 ± 0.022 E U/mL). NF-κB DNA binding decreased significantly by 21 ± 8%, whereas TLR-4, TLR-2, and CD-14 expression decreased significantly by 25 ± 9%, 42 ± 8%, and 27 ± 10%, respectively. Inflammatory mediators CRP, MMP-9, and MCP-1 decreased significantly by 47 ± 7% (10.7 ± 1.6 mg/L to 5.8 ± 1.0 mg/L), 15 ± 6% (492 ± 42 ng/mL to 356 ± 26 ng/mL) and 11 ± 4% (522 ± 35 ng/mL to 466 ± 35 ng/mL), respectively.Conclusion LPS, NF-κB DNA binding, TLR-4, TLR-2, and CD14 expression, CRP, MMP-9, and MCP-1 decreased significantly after RYGB. The mechanism underlying resolution of insulin resistance and T2DM after RYGB may be attributable, at least in part, to the reduction of endotoxemia and associated proinflammatory mediators.

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Authors
Monte, S. V., Caruana, J. A., Ghanim, H., Sia, C. L., Korzeniewski, K., Schentag, J. J., & Dandona, P.
Affiliations
  • University at Buffalo, State University of New York (US)
  • Sisters of Charity Hospital (US)
  • Kaleida Health (US)
Corresponding author
Monte, Scott V.
ORCID
Venue
Surgery
Publisher
Elsevier BV
Published
2012-04
Volume
151
Issue
4
Pages
587-593
ISSN
0039-6060 (ISSN-L)
DOI
10.1016/j.surg.2011.09.038
OpenAlex
W1985684171
Cited by
143
References
31
Citations by year
2026: 1 · 2025: 4 · 2024: 6 · 2023: 7 · 2022: 11 · 2021: 18 · 2020: 14 · 2019: 13 · 2018: 7 · 2017: 9 · 2016: 8 · 2015: 14 · 2014: 10 · 2013: 15 · 2012: 6
FWCI
10.14
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Surgery (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01dk069805-04)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01-DK069805, R01DK075877)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
  • Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
Keywords
Roux-en-Y gastric bypass, morbid obesity, type 2 diabetes, endotoxemia, lipopolysaccharide, insulin resistance, oxidative stress, inflammatory stress, NF-κB, Toll-like receptors, CD14, TLR4, TLR2, weight loss, bariatric surgery, C-reactive protein, MMP-9
MeSH terms
Adult, Anthropometry, Diabetes Mellitus, Type 2, Female, Humans, Inflammation, Insulin Resistance, Leukocytes, Mononuclear, Lipopolysaccharides, Male, Middle Aged, Obesity, Morbid, Gastric Bypass, NF-kappa B, Treatment Outcome, Oxidative Stress, Lipopolysaccharide Receptors, Endotoxemia, Toll-Like Receptor 4

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