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Loid P, Grönroos S, Hurme S, Salminen P, Mäkitie O. Rare gene variants and weight loss at 10 years after sleeve gastrectomy and gastric bypass - a randomized clinical trial. Surg Obes Relat Dis 2025; 21:628-636. [PMID: 39743445 DOI: 10.1016/j.soard.2024.11.021] [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: 07/02/2024] [Revised: 10/06/2024] [Accepted: 11/23/2024] [Indexed: 01/04/2025]
Abstract
BACKGROUND Genetic background of severe obesity is inadequately understood. The effect of genetic factors on weight loss after metabolic bariatric surgery (MBS) has shown inconclusive results. OBJECTIVES To determine the prevalence of rare obesity-associated gene variants in a secondary analysis of a randomized clinical trial (RCT) comparing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) for the treatment of severe obesity and examine their association with long-term weight loss at 10 years. SETTING University Hospital, Finland. METHODS Targeted sequencing panel was used to examine variants in 79 obesity-associated genes and 16p11.2 copy number variants. Weight loss was evaluated by percentage total weight loss (%TWL). RESULTS Out of 240 patients, 113 patients [mean body mass index 48.4 kg/m2, (6.8 standard deviation [SD]) kg/m2 and median age 49 (range 26-64) years, LSG n = 60, LRYGB n = 53] were available for this post-hoc study. We identified 7 rare heterozygous likely/suspected pathogenic (LP/SP) variants in SH2B1, PCSK1, DNMT3A, BDNF, and AFF4 in 6 patients (5.3%), 5 heterozygous variants of uncertain significance in PLXNA4, PLXNA2, NRP1, and SEMA3D in 5 patients (4.4%), heterozygous Bardet-Biedl syndrome variants in 3 patients (2.7%), and PCKS1 risk allele p.Asn221Asp in 9 patients (8.0%). The patients with LP/SP variants had earlier age of obesity onset (P = .0089) and higher %TWL (P = .0446) compared with patients without LP/SP variants. CONCLUSIONS There were LP/SP pathogenic variants in 5% of the patients supporting the potential benefits of genetic testing to optimize targeted therapies in the future. Despite deleterious gene defects the long-term MBS outcome can be favorable.
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Affiliation(s)
- Petra Loid
- Folkhälsan Research Center, Genetics Research Program, Helsinki, Finland; Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.
| | - Sofia Grönroos
- Department of Surgery, University of Turku, Turku, Finland; Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland; Department of Surgery, Satasairaala Central Hospital, Pori, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland; Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Outi Mäkitie
- Folkhälsan Research Center, Genetics Research Program, Helsinki, Finland; Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland; Department of Molecular Medicine and Surgery, Karolinska Institutet, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
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AlTarrah D, Al-Abdullah L, Alhusayan M, Canha D, Almazeedi S, Al-Serri A, Abulhasan M, Alsomly T, Almutawa N, Al-Onaizi M, Fagherazzi G, Alzaid F. Cross-sectional analysis of eating disorder risk and risk correlates in candidates for bariatric surgery from the BariPredict cohort. Sci Rep 2025; 15:11191. [PMID: 40169756 PMCID: PMC11961600 DOI: 10.1038/s41598-025-95614-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Accepted: 03/24/2025] [Indexed: 04/03/2025] Open
Abstract
Bariatric surgery is an effective intervention for managing obesity. Persons with obesity are a high-risk population for eating disorders (ED), and these can negatively impact perioperative and long-term outcomes of surgery. We aim to understand prevalence and correlates of ED in preintervention patients, identifying those needing psychological support. Baseline cross-sectional analysis of 275 patients of the BariPredict cohort (NCT06480058), a study to assess predictors of long-term surgery outcomes. Psychological assessments were conducted using SCOFF, KUAS, and BDI tools. Data were analyzed for prevalence of high ED risk and for associations of clinical, biological and demographic factors. Mean age was 38.5 years, mean BMI was 42.3 kg/m², with 62.5% being female. 65.8% of patients had a SCOFF score ≥ 2 indicating high ED risk. Class II obesity (p < 0.05), younger age (p < 0.01), and higher depression (p < 0.01) were associated with ED risk in a logistic regression adjusted for age, obesity class, diabetes, HbA1c, depression and anxiety scores. We report high preintervention prevalence of ED, with a risk profile corresponding to BMI of 35-39.9 Kg/m2 in younger adults with concurrent depression. This patient profile should be prioritized for psychological assessment and support to potentially improve outcomes of bariatric surgery.
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Affiliation(s)
- Dana AlTarrah
- Department of Social and Behavioral Science, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait
| | - Lulwa Al-Abdullah
- Dasman Diabetes Institute, Gulf Road intersecting Jassim Al Bahar St., Sharq, Block 3, Dasman, P.O. Box 1180, Kuwait City, Kuwait
| | - Mohammed Alhusayan
- Dasman Diabetes Institute, Gulf Road intersecting Jassim Al Bahar St., Sharq, Block 3, Dasman, P.O. Box 1180, Kuwait City, Kuwait
- Department of Cancer Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dulce Canha
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, 1445, Strassen, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | | | - Ahmad Al-Serri
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Maryam Abulhasan
- Kuwait Center for Mental Health, Ministry of Health, Kuwait City, Kuwait
| | - Talia Alsomly
- Department of Surgery, Jaber Al-Ahmed Hospital, Kuwait City, Kuwait
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Naif Almutawa
- Department of Community Medicine and Behavioral Science, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Mohammed Al-Onaizi
- Dasman Diabetes Institute, Gulf Road intersecting Jassim Al Bahar St., Sharq, Block 3, Dasman, P.O. Box 1180, Kuwait City, Kuwait
- Department of Anatomy, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, 1445, Strassen, Luxembourg
| | - Fawaz Alzaid
- Dasman Diabetes Institute, Gulf Road intersecting Jassim Al Bahar St., Sharq, Block 3, Dasman, P.O. Box 1180, Kuwait City, Kuwait.
- INSERM UMR-S1151, CNRS UMR-S8253, Université Paris Cité, Institut Necker Enfants Malades, Paris, France.
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Al-Serri A, Al-Janahi HA, Jamal MH, AlTarrah D, Ziyab AH, Al-Bustan SA. Influence of the Brain-Derived Neurotrophic Factor Gene Polymorphism on Weight Loss Following Intragastric Balloon Intervention: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2024; 17:4299-4306. [PMID: 39582783 PMCID: PMC11585270 DOI: 10.2147/dmso.s481547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 11/14/2024] [Indexed: 11/26/2024] Open
Abstract
Background and Aim There is noticeable heterogeneity in weight loss outcomes following intragastric balloon (IGB) treatment, with average weight loss ranging between 11% to 15% of total body weight. Genetic variations associated with obesity have been found to influence weight loss response, however such variations are limited. Therefore, the aim of this study is to investigate the impact of the obesity associated brain-derived neurotrophic factor (BDNF) gene polymorphism rs11030104 with weight loss outcomes following IGB treatment. Methods In this cross-sectional study, BDNF rs11030104 was analysed in 106 individuals who underwent intragastric balloon treatment. Weight loss metrics were evaluated at the three-month follow-up: percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and percentage of body mass index loss (%EBMIL). The effects of additive and dominant genetic models were evaluated. Both linear and logistic regression were applied to assess associations between rs11030104 genotypes and weight loss metrics. Results A total of 71 participants completed the 3-month follow-up assessment (loss to follow-up: 33%). This study found a significant association between the BDNF rs11030104 polymorphism and weight loss. A-allele carriers showed a better response to IGB treatment. Individuals carrying the AA genotype were found to have a greater %TWL than those carrying the GG genotype at 3 months post-IGB treatment (11.05% vs 5.09%, p=0.003). Conclusion Our results suggest that BDNF rs11030104 influences the response to weight loss after IGB treatment and therefore could be added to the growing list of genetic variants that predict greater weight loss response.
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Affiliation(s)
- Ahmad Al-Serri
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Hessa A Al-Janahi
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Mohammad H Jamal
- Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Dana AlTarrah
- Department of Social and Behavioral Science, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Suzanne A Al-Bustan
- Department of Biological Sciences, Faculty of Science, Kuwait University, Kuwait City, Kuwait
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Liu D, Liu Y, Lu CY, Wang Q, Bao Y, Yu Y, Wang Q, Peng W. Investigating genetic variants in early-onset obesity through exome sequencing: A retrospective cohort study. Obes Res Clin Pract 2024; 18:417-425. [PMID: 39667993 DOI: 10.1016/j.orcp.2024.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 11/27/2024] [Accepted: 12/04/2024] [Indexed: 12/14/2024]
Abstract
OBJECTIVE This study aimed to examine clinical data and analyze exome sequencing (ES) findings in children diagnosed with early-onset obesity. METHODS We screened children presenting with severe (body mass index-standard deviation score >3) and early-onset (<7 years) obesity using ES. Participants were categorized into either the "no variant identified" group or the "variant identified" group, facilitating the exploration of correlations between clinical-demographic characteristics and genetic mutations linked to early-onset obesity. The functional implications of identified variants were assessed through in silico analyses. RESULTS Of the patients, 32 (35.5 %) possessed one or more mutations in pathways associated with obesity, all of which were heterozygous and patients with more than two obesity-associated variants were more obese. This cohort included 29 novel mutations distinct to our study population, 7 previously reported pathogenic variants, two instances of uniparental disomy, and one mitochondrial hotspot mutation. Variants in the SH2B1 gene emerged as a prevalent genetic determinant of obesity within our group, accounting for 16.6 % of cases. Statistical evaluations showed no significant differences in demographic attributes between the two groups. CONCLUSION Exome sequencing proves to be an instrumental approach for uncovering new variants and broadening the spectrum of mutations in early-onset obesity among children. Concurrently, further functional studies, both in vitro and in vivo, are crucial to elucidate the contributions of these variants to obesity's pathogenesis.
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Affiliation(s)
- Deyun Liu
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.
| | - Yuxiang Liu
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Chen Yu Lu
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Qian Wang
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Yingying Bao
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Yue Yu
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Qiang Wang
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Wu Peng
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
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Abstract
Obesity is a multi-factorial disease that is influenced by genetic, epigenetic, and environmental factors. Precision medicine is a practice wherein prevention and treatment strategies take individual variability into account. It involves using a variety of factors including deep phenotyping using clinical, physiologic, and behavioral characteristics, 'omics assays (eg, genomics, epigenomics, transcriptomics, and microbiomics among others), and environmental factors to devise practices that are individualized to subsets of patients. Personalizing the therapeutic modality to the individual can lead to enhanced effectiveness and tolerability. The authors review advances in precision medicine made in the field of bariatrics and discuss future avenues and challenges.
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Affiliation(s)
- Khushboo Gala
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA. https://twitter.com/KhushbooSGala
| | - Wissam Ghusn
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA; Department of Internal Medicine, Boston University Medical Center, Harrison Avenue, Boston, MA 02111, USA. https://twitter.com/Wissam_Ghusn
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA.
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Qamar S, Mallik R, Makaronidis J. Setmelanotide: A Melanocortin-4 Receptor Agonist for the Treatment of Severe Obesity Due to Hypothalamic Dysfunction. TOUCHREVIEWS IN ENDOCRINOLOGY 2024; 20:62-71. [PMID: 39526054 PMCID: PMC11548362 DOI: 10.17925/ee.2024.20.2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/27/2023] [Indexed: 11/16/2024]
Abstract
Obesity is a silent global pandemic. It is a condition associated with multiple risk factors and adverse outcomes that arise from the intertwined relationship between environmental factors and genetics. The genetic factors that cause phenotypic expression are variable. Monogenic obesity is a severe early-onset and rarer form of obesity, which presents with co-morbidities such as abnormal feeding behaviour. Monogenic obesity causes impaired weight regulation in the hypothalamus due to defects in the leptin-melanocortin signalling pathway. The emergence of a new therapeutic treatment, the melanocortin-4 receptor agonist setmelanotide (originally RM-493), has represented a breakthrough in the management of monogenic obesity and has raised hope in managing complex obesity. This review provides an overview of the setmelanotide trials that have taken place, as well as its mechanism of action, side effects and weight loss outcomes that led to its approval in the treatment of pro-opiomelanocortin (POMC) deficiency and proprotein convertase subtilisin/kexin type 1 (PCSK1) deficiency. It also explores setmelanotide's role in other genetic forms of obesity, such as hypothalamic obesity, Prader-Willi syndrome, Alström syndrome and other rare genetic conditions that are being investigated. This review aims to help to understand the pathophysiology of genetic obesity and aid in future treatment options for people with severe, complex genetic obesity.
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Affiliation(s)
- Sulmaaz Qamar
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
- UCLH Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital, London, UK
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Ritwika Mallik
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
- UCLH Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital, London, UK
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Janine Makaronidis
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
- UCLH Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital, London, UK
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
- Department of Diabetes and Metabolism, Barts Health NHS Trust, London, UK
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7
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Zuccaro MV, LeDuc CA, Thaker VV. Updates on Rare Genetic Variants, Genetic Testing, and Gene Therapy in Individuals With Obesity. Curr Obes Rep 2024; 13:626-641. [PMID: 38822963 PMCID: PMC11694263 DOI: 10.1007/s13679-024-00567-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE OF REVIEW The goal of this paper is to aggregate information on monogenic contributions to obesity in the past five years and to provide guidance for genetic testing in clinical care. RECENT FINDINGS Advances in sequencing technologies, increasing awareness, access to testing, and new treatments have increased the utilization of genetics in clinical care. There is increasing recognition of the prevalence of rare genetic obesity from variants with mean allele frequency < 5% -new variants in known genes as well as identification of novel genes- causing monogenic obesity. While most of these genes are in the leptin melanocortin pathway, those in adipocytes may also contribute. Common variants may contribute either to higher lifetime tendency for weight gain or provide protection from monogenic obesity. While specific genetic mutations are rare, these segregate in individuals with early-onset severe obesity; thus, collectively genetic etiologies are not as rare. Some genetic conditions are amenable to targeted treatment. Research into the discovery of novel genetic causes as well as targeted treatment is growing over time. The utility of therapeutic strategies based on the genetic risk of obesity is an advancing frontier.
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Affiliation(s)
- Michael V Zuccaro
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, United States
| | - Charles A LeDuc
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Irving Medical Center, 1150, St. Nicholas Avenue, NY 10032, United States
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, United States
| | - Vidhu V Thaker
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Irving Medical Center, 1150, St. Nicholas Avenue, NY 10032, United States.
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, United States.
- Division of Pediatric Endocrinology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, 10032, United States.
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Zhang N, Wang H, Ran S, Wang Z, Zhou B, Wang S, Li Z, Liu B, Nie Y, Huang Y, Meng H. Mutations in the leptin-melanocortin pathway and weight loss after bariatric surgery: a systematic review and meta-analysis. Obesity (Silver Spring) 2024; 32:1047-1058. [PMID: 38577709 DOI: 10.1002/oby.24007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE The objective of this meta-analysis was to quantify the overall effects of gene mutations in the leptin-melanocortin pathway on short- and long-term weight loss after bariatric surgery. METHODS MEDLINE, PubMed, and Embase were searched, and data were analyzed using ReviewManager (RevMan) version 5.4. The datasets were divided into two subgroups based on postoperative time, and the outcome measure was the percentage of total weight loss. Meta-regression analysis was performed, and the outcome was presented as the weighed mean difference of percentage of total weight loss. RESULTS The results showed that patients with mutations in the leptin-melanocortin pathway experienced 3.03% lower total weight loss after bariatric surgery (mean difference, -3.03; 95% CI: -3.63 to -2.44), mainly reflected in lower long-term postoperative weight loss (mean difference, -3.43; 95% CI: -4.09 to -2.77), whereas mutation carriers exhibited a magnitude of short-term postoperative weight loss that was similar to patients without such mutations (total difference value, -1.13; 95% CI: -2.57 to 0.31). CONCLUSIONS Mutations in leptin-melanocortin pathway genes reduce long-term weight loss after bariatric surgery, whereas this effect may not be reflected during the period of rapid weight loss within 12 months. These genetic variants increase the difficulties in maintaining patients' long-term weight loss.
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Affiliation(s)
- Nianrong Zhang
- General Surgery Department & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Hao Wang
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Shuman Ran
- General Surgery Department & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Zhe Wang
- General Surgery Department & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Biao Zhou
- General Surgery Department & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Siqi Wang
- General Surgery Department & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Zhengqi Li
- General Surgery Department & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Baoyin Liu
- General Surgery Department & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Yuntao Nie
- General Surgery Department & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Yishan Huang
- General Surgery Department & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Hua Meng
- General Surgery Department & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
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Safari S, Parsaee M, Moradi M, Hakiminejad M, Koohsari P, Larti F. The effect of significant weight loss after bariatric surgery on echocardiographic indices: an observational study focusing on left ventricular deformation by 2D speckle echocardiography and right ventricular size. Egypt Heart J 2024; 76:44. [PMID: 38587759 PMCID: PMC11001804 DOI: 10.1186/s43044-024-00474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/29/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Obesity is a known risk factor for atherosclerosis and cardiac disease. HYPOTHESIS This study evaluated the effect of significant weight loss following bariatric surgery on myocardial deformation indices and right ventricular size (RV). This was a prospective cohort study. Morbid obese patients scheduled for bariatric surgery from July 2017 to February 2018 at Firoozgar Hospital were included in our study and referred for transthoracic echocardiography at Rajaie Cardiovascular Medical and Research Center. RESULTS Thirty-four patients entered the study. The absolute value of global longitudinal strain (GLS) at baseline, 3, and 6 months after surgery was 17.42 ± 2.94%, 18.24 ± 3.09%, and 19.52 ± 2.78%, respectively, with a statistically significant difference from baseline to after six months (P value < 0.001). The absolute value of global circumferential strain (GCS) at baseline, 3, and 6 months after surgery was 20.14 ± 4.22%, 23.32 ± 4.66%, and 24.53 ± 4.52%, respectively, with statistically significant changes (P value < 0.001) from baseline to three months and from baseline to six months and no significant difference from three months to six months. A significant decrease was reported in mechanical dispersion of circumferential strain (38.05 ± 23.81-23.37 ± 20.86 ms, P value = 0.006) 6 months after surgery. Right ventricular size three- and six-month post-surgery showed a significant decrease relative to baseline echocardiography. CONCLUSIONS Bariatric surgery could enhance cardiac function, as proven by 2D speckle echocardiography. Changes in RV size may be related to weight loss and should be considered when assessing patients who have undergone bariatric surgery.
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Affiliation(s)
- Saeed Safari
- General Surgery Department, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Parsaee
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Moradi
- General Surgery Department, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Hakiminejad
- General Surgery Department, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Parisa Koohsari
- Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Farnoosh Larti
- Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, Tehran, 1419733141, Iran.
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Ramasamy I. Physiological Appetite Regulation and Bariatric Surgery. J Clin Med 2024; 13:1347. [PMID: 38546831 PMCID: PMC10932430 DOI: 10.3390/jcm13051347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
Obesity remains a common metabolic disorder and a threat to health as it is associated with numerous complications. Lifestyle modifications and caloric restriction can achieve limited weight loss. Bariatric surgery is an effective way of achieving substantial weight loss as well as glycemic control secondary to weight-related type 2 diabetes mellitus. It has been suggested that an anorexigenic gut hormone response following bariatric surgery contributes to weight loss. Understanding the changes in gut hormones and their contribution to weight loss physiology can lead to new therapeutic treatments for weight loss. Two distinct types of neurons in the arcuate hypothalamic nuclei control food intake: proopiomelanocortin neurons activated by the anorexigenic (satiety) hormones and neurons activated by the orexigenic peptides that release neuropeptide Y and agouti-related peptide (hunger centre). The arcuate nucleus of the hypothalamus integrates hormonal inputs from the gut and adipose tissue (the anorexigenic hormones cholecystokinin, polypeptide YY, glucagon-like peptide-1, oxyntomodulin, leptin, and others) and orexigeneic peptides (ghrelin). Replicating the endocrine response to bariatric surgery through pharmacological mimicry holds promise for medical treatment. Obesity has genetic and environmental factors. New advances in genetic testing have identified both monogenic and polygenic obesity-related genes. Understanding the function of genes contributing to obesity will increase insights into the biology of obesity. This review includes the physiology of appetite control, the influence of genetics on obesity, and the changes that occur following bariatric surgery. This has the potential to lead to the development of more subtle, individualised, treatments for obesity.
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Affiliation(s)
- Indra Ramasamy
- Department of Blood Sciences, Conquest Hospital, Hastings TN37 7RD, UK
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11
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Concepción-Zavaleta MJ, Quiroz-Aldave JE, Durand-Vásquez MDC, Gamarra-Osorio ER, Valencia de la Cruz JDC, Barrueto-Callirgos CM, Puelles-León SL, Alvarado-León EDJ, Leiva-Cabrera F, Zavaleta-Gutiérrez FE, Concepción-Urteaga LA, Paz-Ibarra J. A comprehensive review of genetic causes of obesity. World J Pediatr 2024; 20:26-39. [PMID: 37725322 DOI: 10.1007/s12519-023-00757-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Obesity is a multifactorial chronic disease with a high, increasing worldwide prevalence. Genetic causes account for 7% of the cases in children with extreme obesity. DATA SOURCES This narrative review was conducted by searching for papers published in the PubMed/MEDLINE, Embase and SciELO databases and included 161 articles. The search used the following search terms: "obesity", "obesity and genetics", "leptin", "Prader-Willi syndrome", and "melanocortins". The types of studies included were systematic reviews, clinical trials, prospective cohort studies, cross-sectional and prospective studies, narrative reviews, and case reports. RESULTS The leptin-melanocortin pathway is primarily responsible for the regulation of appetite and body weight. However, several important aspects of the pathophysiology of obesity remain unknown. Genetic causes of obesity can be grouped into syndromic, monogenic, and polygenic causes and should be assessed in children with extreme obesity before the age of 5 years, hyperphagia, or a family history of extreme obesity. A microarray study, an analysis of the melanocortin type 4 receptor gene mutations and leptin levels should be performed for this purpose. There are three therapeutic levels: lifestyle modifications, pharmacological treatment, and bariatric surgery. CONCLUSIONS Genetic study technologies are in constant development; however, we are still far from having a personalized approach to genetic causes of obesity. A significant proportion of the affected individuals are associated with genetic causes; however, there are still barriers to its approach, as it continues to be underdiagnosed. Video Abstract (MP4 1041807 KB).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - José Paz-Ibarra
- Department of Medicine, School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
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12
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Samuels JM, Paddu NU, Rekulapeli A, Madhar A, Srivastava G. High Prevalence of Positive Genetic Obesity Variants in Postoperative Bariatric Surgery Patients with Weight Regain Presenting for Medical Obesity Intervention. Obes Surg 2024; 34:170-175. [PMID: 37996769 DOI: 10.1007/s11695-023-06952-1] [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: 10/08/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Genetic obesity susceptibility in postoperative bariatric surgery weight regain (PBSWR) remains largely unexplored. METHODS A retrospective case series of adult (N = 27) PBSWR patients who had undergone genetic obesity testing was conducted between Sept. 2020 and March 2022. PRIMARY OUTCOME frequency of genetic variants in patients experiencing weight regain following bariatric surgery. SECONDARY OUTCOMES prevalence of obesity-related comorbidities, nadir BMI achieved post-bariatric surgery, and percent total body weight loss (%TBWL) achieved with obesity pharmacotherapies. RESULTS Heterozygous mutations were identified in 22 (81%) patients, with the most prevalent mutations occurring in CEP290, RPGR1P1L, and LEPR genes (3 patients each). Median age was 56 years (interquartile range (IQR) 46.8-65.5), 88% female. Types of surgery were 67% RYGB, 19% SG, 4% gastric band, and 13% revisions. Median nadir BMI postoperatively was 34.0 kg/m2 (IQR 29.0-38.5). A high prevalence of metabolic derangements was noted; patients presented median 80 months (IQR 39-168.5) postoperative for medical weight management with 40% weight regain. BMI at initiation of anti-obesity medication (AOMs) was 41.7 kg/m2 (36.8-44.4). All received AOM and required at least 3 AOMs for weight regain. Semaglutide (N = 21), topiramate (N = 14), and metformin (N = 12) were most prescribed. Median %TBWL for the cohort at the first, second, and third visit was 1.7, 5.0, and 6.5 respectively. Fourteen (52%) achieved 5%TBWL, 10 (37%) achieved 10%TBWL, and 4 (15%) achieved 15%TBWL with combination AOMs and supervised medical intervention. CONCLUSION An unusually high prevalence of genetic obesity variants in PBSWR was found, warranting further research.
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Affiliation(s)
- Jason M Samuels
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, 37204, USA
- Vanderbilt Weight Loss Clinics, Vanderbilt University Medical Center, Nashville, TN, 37204, USA
| | - Nina U Paddu
- Vanderbilt Weight Loss Clinics, Vanderbilt University Medical Center, Nashville, TN, 37204, USA
- Department of Medicine, Division of Diabetes, Endocrinology & Metabolism, Vanderbilt University School of Medicine, Nashville, TN, 37204, USA
| | - Akhil Rekulapeli
- Department of Medicine, Division of Diabetes, Endocrinology & Metabolism, Vanderbilt University School of Medicine, Nashville, TN, 37204, USA
| | - Ayush Madhar
- Department of Medicine, Division of Diabetes, Endocrinology & Metabolism, Vanderbilt University School of Medicine, Nashville, TN, 37204, USA
| | - Gitanjali Srivastava
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, 37204, USA.
- Vanderbilt Weight Loss Clinics, Vanderbilt University Medical Center, Nashville, TN, 37204, USA.
- Department of Medicine, Division of Diabetes, Endocrinology & Metabolism, Vanderbilt University School of Medicine, Nashville, TN, 37204, USA.
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, 37204, USA.
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13
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Anazco D, Ghusn W, Campos A, Cifuentes L, Fansa S, Tama E, Bublitz JT, Gala K, Hurtado MD, Olson JE, Acosta A. Type 2 Diabetes Remission in Patients with Heterozygous Variants in the Leptin-Melanocortin Pathway after Roux-en-Y Gastric Bypass: A Matched Case-Control Study. Obes Surg 2023; 33:3502-3509. [PMID: 37798511 DOI: 10.1007/s11695-023-06859-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is associated with a high rate of type 2 diabetes (T2D) remission. Carriers of heterozygous variants in the leptin-melanocortin pathway (LMP) are more likely to experience weight recurrence after RYGB. Our aim was to investigate if carrier status and associated weight regain affects the rate of T2D remission after RYGB. METHODS Carriers of LMP variants with a diagnosis of T2D prior to RYGB (N = 16) were matched to non-carriers (N = 32) based on sex, age, and BMI. We assessed for post-operative T2D remission status post-surgery on a yearly basis, for up to 15 years. Our primary endpoint was the proportion of patients achieving T2D remission at 1 year. We conducted a survival analysis for all patients that achieved remission at least at one time-point to evaluate for maintenance of T2D remission by using a log-rank test. RESULTS Both carriers and non-carriers had similar baseline and procedural characteristics. The proopiomelanocortin gene in the LMP pathway had the most variants (n = 5, 31%). Carriers had a lower total body weight loss percentage at nadir (28.7% ± 6.9) than non-carriers (33.7% ± 8.8, p = 0.04). The proportion of patients achieving T2D remission at 1 year was 68.8% for carriers and 71.9% for non-carriers (p = 1.0). Survival curves for maintenance of first remission were similar for both groups (p = 0.73), with a median survival of 8 years for both carriers and non-carriers. CONCLUSIONS Despite inferior weight loss outcomes at nadir, carriers had similar T2D remission rates when compared to non-carriers. Weight-independent metabolic benefits of RYGB might contribute to this observation.
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Affiliation(s)
- Diego Anazco
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
| | - Wissam Ghusn
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
| | - Alejandro Campos
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
| | - Lizeth Cifuentes
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
| | - Sima Fansa
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
| | - Elif Tama
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Joshua T Bublitz
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55902, USA
| | - Khushboo Gala
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
| | - Maria D Hurtado
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Janet E Olson
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55902, USA
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA.
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14
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Gatta-Cherifi B, Laboye A, Gronnier C, Monsaingeon-Henry M, Meulebrouck S, Baron M, Bertin F, Pupier E, Cambos S, Poitou C, Beyec-Le Bihan JL, Bonnefond A. A novel pathogenic variant in MRAP2 in an obese patient with successful outcome of bariatric surgery. Eur J Endocrinol 2023; 189:K15-K18. [PMID: 37888144 DOI: 10.1093/ejendo/lvad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/20/2023] [Accepted: 08/10/2023] [Indexed: 10/28/2023]
Abstract
Mutations in genes encoding proteins located in the leptin/melanocortin pathway have been identified in the rare cases of genetic obesities. Heterozygous variants of MRAP2, encoding a G coupled-protein receptor accessory protein implicated in energy control notably via the melanocortin-4 receptor, have been recently identified. A 24-year-old patient with early-onset severe obesity (body mass index [BMI]: 64 kg/m2) associated with hypertension, respiratory complications, nonalcoholic fatty liver disease, and type 2 diabetes was referred to our department. Sleeve gastrectomy was successful. A new heterozygous variant in MRAP2 (NM_138409.4: c.154G>C/p.G52R) variant was identified in the patient DNA. Functional assessment confirmed that this new variant was pathogenic. We report a new pathogenic loss-of-function mutation in MRAP2 in a patient suffering from a severe multicomplicated obesity. This confirms the metabolic phenotype in patients with this monogenic form of obesity. Longer follow-up will be necessary. Our finding will allow a personalized medicine.
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Affiliation(s)
- Blandine Gatta-Cherifi
- CHU Bordeaux, Groupe Hospitalier Sud, Hopital Haut Lévêque Service Endocrinologie, Diabétologie, Nutrition, Avenue de Magellan, 33600 Pessac, France
- Neurocentre Magendie, Equipe "physiopathologie de la balance énergétique et obésité" INSERMU1215, 33000 Bordeaux, France
| | - Alexandre Laboye
- CHU Bordeaux, Groupe Hospitalier Sud, Hopital Haut Lévêque Service Endocrinologie, Diabétologie, Nutrition, Avenue de Magellan, 33600 Pessac, France
| | - Caroline Gronnier
- CHU Bordeaux, Groupe Hospitalier Sud, Hopital Haut Lévêque Service Chirurgie digestive et endocrinienne, Avenue de Magellan, 33600 Pessac, France
| | - Maud Monsaingeon-Henry
- CHU Bordeaux, Groupe Hospitalier Sud, Hopital Haut Lévêque Service Endocrinologie, Diabétologie, Nutrition, Avenue de Magellan, 33600 Pessac, France
| | - Sarah Meulebrouck
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, Lille University Hospital, 59000 Lille, France
- Université de Lille, 59000 Lille, France
| | - Morgane Baron
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, Lille University Hospital, 59000 Lille, France
- Université de Lille, 59000 Lille, France
| | - Françoise Bertin
- Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, UF Génétique de l'obésité et des Dyslipidémies, Service de Biochimie Endocrinienne et Oncologique, 75013 Paris, France
| | - Emilie Pupier
- CHU Bordeaux, Groupe Hospitalier Sud, Hopital Haut Lévêque Service Endocrinologie, Diabétologie, Nutrition, Avenue de Magellan, 33600 Pessac, France
| | - Sophie Cambos
- CHU Bordeaux, Groupe Hospitalier Sud, Hopital Haut Lévêque Service Endocrinologie, Diabétologie, Nutrition, Avenue de Magellan, 33600 Pessac, France
| | - Christine Poitou
- Sorbonne Université, 75013 Paris, France
- Nutrition Department, Assistance Publique Hôpitaux de Paris, Reference Center for Rare Diseases PRADORT, Pitié-Salpêtrière Hospital, 75013 Paris, France
- INSERM, Nutrition and Obesities: systemic approaches Research Unit (NutriOmics), 75013 Paris, France
| | - Johanne Le Beyec-Le Bihan
- Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, UF Génétique de l'obésité et des Dyslipidémies, Service de Biochimie Endocrinienne et Oncologique, 75013 Paris, France
- Sorbonne Université, 75013 Paris, France
- INSERM, UMR-S1149, Centre de recherche sur l'inflammation, 75013 Paris, France
| | - Amélie Bonnefond
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, Lille University Hospital, 59000 Lille, France
- Université de Lille, 59000 Lille, France
- Department of Metabolism, Imperial College London, London, United Kingdom
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15
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Gong Y, Wu Q, Huang S, Fu Z, Ye J, Liu R, Lin S, Guan W, Yang N, Li JZ, Liang H, Zhou H. Functional Characterization of MC4R Variants in Chinese Morbid Obese Patients and Weight Loss after Bariatric Surgery. Adv Biol (Weinh) 2023; 7:e2300007. [PMID: 37140139 DOI: 10.1002/adbi.202300007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/04/2023] [Indexed: 05/05/2023]
Abstract
Mutations in MC4R are the most common genetic cause of obesity. In the reported Chinese morbid obesity cohort, 10 out of 59 harbor six MC4R variants, including Y35C, T53I, V103I, R165W, G233S, and C277X, among which V103I has a relatively high frequency, while other five variants are rare in the population. The prevalence of MC4R carriers in Chinese morbid obese patients (body mass index ≥ 45 kg m-2 ) is detected as 16.9% in this study. R165W and C277X are loss-of-function variants. The patient with R165W achieves excess weight loss (%EWL) as high as 20.6% and 50.3% at 1 and 8 months after surgery, respectively. G233S is reported for the first time in Asia obese population. The patient harboring G233S has a %EWL as 23.3% one month postsurgery. It is concluded that morbid obese patients with rare MC4R variants can benefit from metabolic surgery. More importantly, the choice of surgery procedure and MC4R variant should be taken into consideration for personalized treatment. In the future, a larger size cohort, accompanied with regular and longer follow-up, would be helpful.
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Affiliation(s)
- Yingyun Gong
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qinyi Wu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Shushu Huang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Zhenzhen Fu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jingya Ye
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ruiping Liu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Shibo Lin
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wei Guan
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ningli Yang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - John Zhong Li
- The Key Laboratory of Rare Metabolic Diseases, The Key Laboratory of Human Functional Genomics of Jiangsu Province, Department of Biochemistry and Molecular Biology, Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, 211166, China
- Shanghai Qi Zhi Institute, Shanghai, 200232, China
| | - Hui Liang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Hongwen Zhou
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Shanghai Qi Zhi Institute, Shanghai, 200232, China
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16
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Novelli G, Cassadonte C, Sbraccia P, Biancolella M. Genetics: A Starting Point for the Prevention and the Treatment of Obesity. Nutrients 2023; 15:2782. [PMID: 37375686 DOI: 10.3390/nu15122782] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Obesity is a common, serious, and costly disease. More than 1 billion people worldwide are obese-650 million adults, 340 million adolescents, and 39 million children. The WHO estimates that, by 2025, approximately 167 million people-adults and children-will become less healthy because they are overweight or obese. Obesity-related conditions include heart disease, stroke, type 2 diabetes, and certain types of cancer. These are among the leading causes of preventable, premature death. The estimated annual medical cost of obesity in the United States was nearly $173 billion in 2019 dollars. Obesity is considered the result of a complex interaction between genes and the environment. Both genes and the environment change in different populations. In fact, the prevalence changes as the result of eating habits, lifestyle, and expression of genes coding for factors involved in the regulation of body weight, food intake, and satiety. Expression of these genes involves different epigenetic processes, such as DNA methylation, histone modification, or non-coding micro-RNA synthesis, as well as variations in the gene sequence, which results in functional alterations. Evolutionary and non-evolutionary (i.e., genetic drift, migration, and founder's effect) factors have shaped the genetic predisposition or protection from obesity in modern human populations. Understanding and knowing the pathogenesis of obesity will lead to prevention and treatment strategies not only for obesity, but also for other related diseases.
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Affiliation(s)
- Giuseppe Novelli
- Department of Biomedicine and Prevention, Medical School, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
- Italian Barometer Diabetes Observatory Foundation, IBDO, 00186 Rome, Italy
- Department of Pharmacology, School of Medicine, University of Nevada, Reno, NV 89557, USA
| | - Carmen Cassadonte
- Department of Biomedicine and Prevention, Medical School, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Paolo Sbraccia
- Italian Barometer Diabetes Observatory Foundation, IBDO, 00186 Rome, Italy
- Department of Systems Medicine, Medical School, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Michela Biancolella
- Department of Biology, Tor Vergata University of Rome, Via della Ricerca Scientifica 1, 00133 Rome, Italy
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17
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Luli M, Yeo G, Farrell E, Ogden J, Parretti H, Frew E, Bevan S, Brown A, Logue J, Menon V, Isack N, Lean M, McEwan C, Gately P, Williams S, Astbury N, Bryant M, Clare K, Dimitriadis GK, Finlayson G, Heslehurst N, Johnson B, Le Brocq S, Roberts A, McGinley P, Mueller J, O'Kane M, Batterham RL, Miras AD. The implications of defining obesity as a disease: a report from the Association for the Study of Obesity 2021 annual conference. EClinicalMedicine 2023; 58:101962. [PMID: 37090435 PMCID: PMC10119881 DOI: 10.1016/j.eclinm.2023.101962] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
Unlike various countries and organisations, including the World Health Organisation and the European Parliament, the United Kingdom does not formally recognise obesity as a disease. This report presents the discussion on the potential impact of defining obesity as a disease on the patient, the healthcare system, the economy, and the wider society. A group of speakers from a wide range of disciplines came together to debate the topic bringing their knowledge and expertise from backgrounds in medicine, psychology, economics, and politics as well as the experience of people living with obesity. The aim of their debate was not to decide whether obesity should be classified as a disease but rather to explore what the implications of doing so would be, what the gaps in the available data are, as well as to provide up-to-date information on the topic from experts in the field. There were four topics where speakers presented their viewpoints, each one including a question-and-answer section for debate. The first one focused on the impact that the recognition of obesity could have on people living with obesity regarding the change in their behaviour, either positive and empowering or more stigmatising. During the second one, the impact of defining obesity as a disease on the National Health Service and the wider economy was discussed. The primary outcome was the need for more robust data as the one available does not represent the actual cost of obesity. The third topic was related to the policy implications regarding treatment provision, focusing on the public's power to influence policy. Finally, the last issue discussed, included the implications of public health actions, highlighting the importance of the government's actions and private stakeholders. The speakers agreed that no matter where they stand on this debate, the goal is common: to provide a healthcare system that supports and protects the patients, strategies that protect the economy and broader society, and policies that reduce stigma and promote health equity. Many questions are left to be answered regarding how these goals can be achieved. However, this discussion has set a good foundation providing evidence that can be used by the public, clinicians, and policymakers to make that happen.
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Affiliation(s)
- Migena Luli
- Division of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Giles Yeo
- Department of Clinical Biochemistry, Institute of Metabolic Science, Cambridge University, Cambridge, United Kingdom
| | - Emma Farrell
- School of Education, University College Dublin, Dublin, Ireland
| | - Jane Ogden
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Surrey, United Kingdom
| | - Helen Parretti
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, United Kingdom
| | - Emma Frew
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Stephen Bevan
- HR Research Development, Institute for Employment, Brighton, United Kingdom
| | - Adrian Brown
- Department of Experimental and Translational Medicine, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Jennifer Logue
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Vinod Menon
- Department of Upper Gastrointestinal Team, University Hospitals and Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Nadya Isack
- Obesity Empowerment Network, London, United Kingdom
| | - Michael Lean
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, United Kingdom
| | | | - Paul Gately
- Obesity Institute, Leeds Beckett University, Leeds, United Kingdom
| | | | - Nerys Astbury
- Nuffield Department of Primary Care Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Maria Bryant
- Department of Health Sciences and the Hull York Medical School, University of York, York, United Kingdom
| | - Kenneth Clare
- European Coalition for People Living with Obesity, United Kingdom
| | - Georgios K. Dimitriadis
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Graham Finlayson
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Brett Johnson
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Audrey Roberts
- European Coalition for People Living with Obesity, United Kingdom
| | - Patrick McGinley
- Department of Finance, Maidstone & Tunbridge Wells NHS Trust, Kent, United Kingdom
| | - Julia Mueller
- Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Mary O'Kane
- Dietetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rachel L. Batterham
- School of Life and Medical Sciences, University College London, London, United Kingdom
| | - Alexander Dimitri Miras
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
- School of Medicine, Ulster University, United Kingdom
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18
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Raatz SJ, Pratt JSA. Metabolic and Bariatric Surgery for Pediatric Obesity. MANAGING PEDIATRIC OBESITY USING ADVANCED THERAPIES 2023:211-244. [DOI: 10.1007/978-3-031-37380-0_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Mierzwa M, Bik-Multanowski M, Ranke MB, Brandt S, Flehmig B, Małecka-Tendera E, Mazur A, Petriczko E, Wabitsch M, Wójcik M, Zachurzok A. Clinical, genetic, and epidemiological survey of Polish children and adolescents with severe obesity: A study protocol of the Polish-German study project on severe early-onset obesity. Front Endocrinol (Lausanne) 2022; 13:972174. [PMID: 36479220 PMCID: PMC9719973 DOI: 10.3389/fendo.2022.972174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
Severe early-onset obesity (SEOO) in children is a common feature of monogenic obesity. Nowadays, mutations in at least 50 genes are known to be related to monogenic obesity, and many others are tested. Part of them is involved in the leptin-proopiomelanocortin pathway. The aim of the project is to establish the Polish database of severely obese children and adolescents and to evaluate the prevalence of monogenic forms of obesity in this cohort, with a special focus on leptin-proopiomelanocortin pathway abnormalities. The secondary project aim is to identify new population-specific mutations in obesity-related genes in severely obese Polish children and adolescents. This is a prospective multi-center clinical study performed in four Polish centers. The estimated sample size is 500 patients aged 1-18 years, with severe obesity, hyperphagia, and food-seeking behaviors. In each patient, the medical history regarding the obesity duration in the patient and obesity and its complication existence in the family will be taken. Next, the questionnaire regarding the symptom characteristic of specific mutations, which we are going to test, will be performed. Hyperphagia will be assessed on the basis of age-specific questionnaires. The physical examination with anthropometric measurement, basic biochemical and hormonal tests, and leptin and biologically active leptin measurements will be performed. Finally, genetic analysis will be performed using next-generation sequencing with sequencing libraries prepared to include obesity-related genes. The genotyping findings will be confirmed with the use of classic sequencing (Sanger's method). In the future, the pathogenicity of new mutations in obesity-related genes identified in our cohort is planned to be confirmed by functional testing in vitro. Nowadays, there are no data regarding the prevalence of severe obesity or monogenic obesity in Polish children. This project has the potential to improve understanding of obesity etiology and may contribute to implementing attribute mutation-specific treatment. Moreover, it may lead to a finding of new, population-specific mutations related to SEOO.
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Affiliation(s)
- Magdalena Mierzwa
- Pediatric Endocrinology Ward, Independent Public Clinical Hospital No. 1, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Mirosław Bik-Multanowski
- Department of Medical Genetics, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | | | - Stephanie Brandt
- Center for Rare Endocrine Diseases, Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, Ulm, Germany
| | | | - Ewa Małecka-Tendera
- Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Artur Mazur
- Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - Elżbieta Petriczko
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Disorders and Cardiology of Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Martin Wabitsch
- Center for Rare Endocrine Diseases, Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, Ulm, Germany
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Pediatric Institute, Jagiellonian University Medical College, Cracow, Poland
| | - Agnieszka Zachurzok
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
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Handley D, Rafey MF, Almansoori S, Brazil JF, McCarthy A, Amin HA, O’Donnell M, Blakemore AI, Finucane FM. Higher Waist Hip Ratio Genetic Risk Score Is Associated with Reduced Weight Loss in Patients with Severe Obesity Completing a Meal Replacement Programme. J Pers Med 2022; 12:jpm12111881. [PMID: 36579607 PMCID: PMC9695448 DOI: 10.3390/jpm12111881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022] Open
Abstract
Background: A better understanding of the influence of genetic factors on the response to lifestyle interventions in people with obesity may allow the development of more personalised, effective and efficient therapeutic strategies. We sought to determine the influence of six obesity-related genetic risk scores on the magnitude of weight lost by patients with severe obesity who completed a dietary intervention. Methods: In this single-centre prospective cohort study, participants with severe and complicated obesity who completed a 24-week, milk-based meal replacement programme were genotyped to detect the frequency of common risk alleles for obesity and type 2 diabetes-related traits. Genetic risk scores (GRS) for six of these traits were derived. Participants with a potentially deleterious monogenic gene variant were excluded from the analysis. Results: In 93 patients completing the programme who were not carrying a known obesity-related gene mutation, 35.5% had diabetes, 53.8% were female, mean age was 51.4 ± 11 years, mean body mass index was 51.5 ± 8.7 and mean total weight loss percent at 24 weeks was 16 ± 6.3%. The waist-hip ratio (WHR) GRS was inversely associated with percentage total weight loss at 24 weeks (adjusted β for one standard deviation increase in WHR GRS -11.6 [-23.0, -0.3], p = 0.045), and patients in the lowest tertile of WHR GRS lost more weight. Conclusions: Patients with severe and complicated obesity with a genetic predisposition to central fat accumulation had less weight loss in a 24-week milk-based meal replacement programme, but there was no evidence for influence from the five other obesity-related genetic risk scores on the response to dietary restriction.
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Affiliation(s)
- Dale Handley
- College of Health, Medical and Life Sciences, Brunel University London, London UB8 3PH, UK
| | - Mohammed Faraz Rafey
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, H91 YR71 Galway, Ireland
- HRB Clinical Research Facility, University of Galway, H91 CF50 Galway, Ireland
- Department of Medicine, University of Galway, H91 CF50 Galway, Ireland
| | - Sumaya Almansoori
- College of Health, Medical and Life Sciences, Brunel University London, London UB8 3PH, UK
- Faculty of Medicine, Imperial College London, London SW7 2BX, UK
- International Centre for Forensic Science, General Department of Forensic Science and Criminology, Dubai Police, Dubai 00000, United Arab Emirates
| | - John F. Brazil
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, H91 YR71 Galway, Ireland
- HRB Clinical Research Facility, University of Galway, H91 CF50 Galway, Ireland
- Department of Medicine, University of Galway, H91 CF50 Galway, Ireland
| | - Aisling McCarthy
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, H91 YR71 Galway, Ireland
| | - Hasnat A. Amin
- College of Health, Medical and Life Sciences, Brunel University London, London UB8 3PH, UK
| | - Martin O’Donnell
- HRB Clinical Research Facility, University of Galway, H91 CF50 Galway, Ireland
- Department of Medicine, University of Galway, H91 CF50 Galway, Ireland
| | - Alexandra I. Blakemore
- College of Health, Medical and Life Sciences, Brunel University London, London UB8 3PH, UK
- Department of Medicine, University of Galway, H91 CF50 Galway, Ireland
- Faculty of Medicine, Imperial College London, London SW7 2BX, UK
| | - Francis M. Finucane
- College of Health, Medical and Life Sciences, Brunel University London, London UB8 3PH, UK
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, H91 YR71 Galway, Ireland
- HRB Clinical Research Facility, University of Galway, H91 CF50 Galway, Ireland
- Department of Medicine, University of Galway, H91 CF50 Galway, Ireland
- Correspondence: ; Tel.: +353-(39)-1893803
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Wang L, Xu G, Tian C, Sang Q, Yu C, Wuyun Q, Wang Z, Chen W, Amin B, Wang D, Chen G, Lian D, Zhang N. Combination of Single-Nucleotide Polymorphisms and Preoperative Body Mass Index to Predict Weight Loss After Laproscopic Sleeve Gastrectomy in Chinese Patients with Body Mass Index ≥ 32.5 kg/m2. Obes Surg 2022; 32:3951-3960. [PMID: 36279045 DOI: 10.1007/s11695-022-06330-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022]
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Nalbantoğlu Ö, Hazan F, Acar S, Gürsoy S, Özkan B. Screening of non-syndromic early-onset child and adolescent obese patients in terms of LEP, LEPR, MC4R and POMC gene variants by next-generation sequencing. J Pediatr Endocrinol Metab 2022; 35:1041-1050. [PMID: 35801948 DOI: 10.1515/jpem-2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/16/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Non-syndromic monogenic obesity is a rare cause of early-onset severe obesity in the childhood period. The aim of this study was to screen four obesity related genes (LEP, LEPR, MC4R and POMC) in children and adolescents who had severe, non-syndromic early onset obesity. METHODS Next-generation sequencing of all exons in LEP, LEPR, MC4R and POMC was performed in 154 children and adolescents with early onset severe obesity obesity. RESULTS Fifteen different variants in nineteen patients were identified with a variant detection rate of 12.3%. While six different heterozygous variants were observed in MC4R gene (10/154 patients; 6.5%), five different variants in POMC gene (four of them were heterozygous and one of them was homozygous) (6/154 patients; 3.9%) and four different homozygous variants in LEPR gene (3/154 patients; 1.9%) were described. However, no variants were detected in the LEP gene. The most common pathogenic variant was c.496G>A in MC4R gene, which was detected in four unrelated patients. Six novel variants (6/15 variants; 40%) were described in seven patients. Four of them including c.233C>A and c.752T>C in MC4R gene and c.761dup and c.1221dup in LEPR gene were evaluated as pathogenic or likely pathogenic. CONCLUSIONS In conclusion, MC4R variants are the most common genetic cause of monogenic early-onset obesity, consistent with the literature. The c.496G>A variant in MC4R gene is highly prevalent in early-onset obese patients.
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Affiliation(s)
- Özlem Nalbantoğlu
- Clinic of Pediatric Endocrinology, University of Health Sciences Turkey, Dr. BehçetUz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Filiz Hazan
- Clinic of Medical Genetics, University of Health Sciences Turkey, Dr. BehçetUz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Sezer Acar
- Clinic of Pediatric Endocrinology, University of Health Sciences Turkey, Dr. BehçetUz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Semra Gürsoy
- Clinic of Pediatric Genetics, University of Health Sciences Turkey, Dr. BehçetUz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Behzat Özkan
- Clinic of Pediatric Endocrinology, University of Health Sciences Turkey, Dr. BehçetUz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
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Campos A, Cifuentes L, Hashem A, Busebee B, Hurtado-Andrade MD, Ricardo-Silgado ML, McRae A, De la Rosa A, Feris F, Bublitz JT, Hensrud D, Camilleri M, Kellogg TA, Eckel-Passow JE, Olson J, Acosta A. Effects of Heterozygous Variants in the Leptin-Melanocortin Pathway on Roux-en-Y Gastric Bypass Outcomes: a 15-Year Case-Control Study. Obes Surg 2022; 32:2632-2640. [PMID: 35654930 PMCID: PMC9721531 DOI: 10.1007/s11695-022-06122-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Heterozygous variants in the leptin-melanocortin pathway are associated with obesity. However, their effect on the long-term outcomes after Roux-en-Y gastric bypass (RYGB) is still unknown. METHODS In this matched case-control study, 701 participants from the Mayo Clinic Biobank with a history of RYGB were genotyped. Sixty-three patients had a heterozygous variant in the leptin-melanocortin pathway. After excluding patients with potential confounders, carriers were randomly matched (on sex, age, body mass index [BMI], and years since surgery) with two non-carrier controls. The electronic medical record of carriers and matched non-carriers was reviewed for up to 15 years after RYGB. RESULTS A total of 50 carriers and 100 matched non-carriers with a history of RYGB were included in the study. Seven different genes (LEPR, PCSK1, POMC, SH2B1, SRC1, MC4R, and SIM1) in the leptin-melanocortin pathway were identified. At the time of surgery, the mean age was 50.8 ± 10.6 years, BMI 45.6 ± 7.3 kg/m2, and 79% women. There were no differences in postoperative years of follow-up, Roux limb length, or gastric pouch size between groups. Fifteen years after RYGB, the percentage of total body weight loss (%TBWL) in carriers was - 16.6 ± 10.7 compared with - 28.7 ± 12.9 in non-carriers (diff = 12.1%; 95% CI, 4.8 to 19.3) and the percentage of weight regain after maximum weight loss was 52.7 ± 29.7 in carriers compared with 29.8 ± 20.7 in non-carriers (diff = 22.9%; 95% CI, 5.3 to 40.5). The nadir %TBWL was lower - 32.1 ± 8.1 in carriers compared with - 36.8 ± 10.4 in non-carriers (diff = 4.8%; 95% CI 1.8 to 7.8). CONCLUSIONS Carriers of a heterozygous variant in the leptin-melanocortin pathway have a progressive and significant weight regain in the mid- and long-term after RYGB. Genotyping patients experiencing significant weight regain after RYGB could help implement multidisciplinary and individualized weight loss interventions to improve weight maintenance after surgery.
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Affiliation(s)
- Alejandro Campos
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Lizeth Cifuentes
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Anas Hashem
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Bradley Busebee
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Maria D Hurtado-Andrade
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Maria L Ricardo-Silgado
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Alison McRae
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Alan De la Rosa
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Fauzi Feris
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Joshua T Bublitz
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Donald Hensrud
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael Camilleri
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Todd A Kellogg
- Division of Endocrine & Metabolic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jeanette E Eckel-Passow
- Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Janet Olson
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA.
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Kırmızıbekmez H, Kendir Demirkol Y, Akgün Doğan Ö, Seymen G, İnan Balcı E, Atla P, Dursun F. Familial early-onset obesity in Turkish children: variants and polymorphisms in the melanocortin-4 receptor (MC4R) gene. J Pediatr Endocrinol Metab 2022; 35:657-662. [PMID: 35355494 DOI: 10.1515/jpem-2021-0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Genetic factors have a key role in childhood obesity with higher rates in children than adults. Among the monogenic types of non-syndromic obesity, melanocortin-4 receptor (MC4R) deficiency is the most frequent cause. Beside pathogenic variants, single-nucleotide polymorphisms in MC4R gene are also associated with lower energy expenditure. The aim of this study was to estimate the frequency of MC4R variants and polymorphisms in a cohort of Turkish children and adolescents with severe early-onset obesity, and to understand the clinical features of patients. METHODS Patients, 1-17 years of age, with the onset of obesity before 10 years of age and a body mass index (BMI) standard deviation score (SDS) of >2.3, and who had a family history of early-onset obesity in at least one of their first-degree relatives were included in the study. Beside routine blood tests genetic analyses for MC4R gene were performed. RESULTS Analyses of MC4R revealed previously known variations in three (3.5%) patients, and pathogenic polymorphisms related with obesity in four (4.7%) patients. BMI SDS values were between 2.8 and 5.5 SDS in the pathogenic variant carrier group, and 2.8-4.9 SDS in the polymorphism group. Mean BMI SDS in variant-negative group was 3.4 ± 0.82. CONCLUSIONS Investigation of the MC4R in individuals with early-onset obesity and presence of obesity first-degree relatives is important. Hypertension is a rare comorbidity compared to other causes. Contrary to studies reporting that insulin resistance was absent or very rare, we found it as a frequent finding in both pathogenic variants and polymorphisms of MC4R.
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Affiliation(s)
- Heves Kırmızıbekmez
- Department of Pediatric Endocrinology, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Yasemin Kendir Demirkol
- Department of Pediatric Genetics, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Özlem Akgün Doğan
- Department of Pediatric Genetics, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Gülcan Seymen
- Department of Pediatric Endocrinology, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Elif İnan Balcı
- Department of Pediatric Endocrinology, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Pınar Atla
- Department of Pediatric Endocrinology, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Fatma Dursun
- Department of Pediatric Endocrinology, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul, Turkey
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25
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Tao YX. Mutations in melanocortin-4 receptor: From fish to men. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2022; 189:215-257. [PMID: 35595350 DOI: 10.1016/bs.pmbts.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Melanocortin-4 receptor (MC4R), expressed abundantly in the hypothalamus, is a critical regulator of energy homeostasis, including both food intake and energy expenditure. Shortly after the publication in 1997 of the Mc4r knockout phenotypes in mice, including increased food intake and severe obesity, the first mutations in MC4R were reported in humans in 1998. Studies in the subsequent two decades have established MC4R mutation as the most common monogenic form of obesity, especially in early-onset severe obesity. Studies in animals, from fish to mammals, have established the conserved physiological roles of MC4R in all vertebrates in regulating energy balance. Drug targeting MC4R has been recently approved for treating morbid genetic obesity. How the MC4R can be exploited for animal production is highly worthy of active investigation.
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Affiliation(s)
- Ya-Xiong Tao
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States.
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26
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The Obesogenic and Glycemic Effect of Bariatric Surgery in a Family with a Melanocortin 4 Receptor Loss-of-Function Mutation. Metabolites 2022; 12:metabo12050430. [PMID: 35629934 PMCID: PMC9143288 DOI: 10.3390/metabo12050430] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 01/25/2023] Open
Abstract
We report the long-term response to bariatric surgery in a singular family of four adolescents with severe obesity (41–82 kg/m2), homozygous for the C271R loss-of-function mutation in the melanocortin 4 receptor (MC4R), and three adults heterozygous for the same mutation. All patients had similar sociodemographic backgrounds and were followed for an average of 7 years. Three of the four homozygous patients regained their full weight (42–77 kg/m2), while the fourth lost weight but remained obese with a body mass index of 60 kg/m2. Weight regain was associated with relapse of most comorbidities, yet hyperglycemia did not relapse or was delayed. A1c levels were reduced in homozygous and heterozygous patients. The long-term follow-up data on this very unique genetic setting show that weight loss and amelioration of obesity following bariatric surgery require active MC4R signaling, while the improvement in glycemia is in part independent of weight loss. The study validates animal models and demonstrates the importance of biological signaling in the regulation of weight, even after bariatric surgery.
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Gantz MG, Driscoll DJ, Miller JL, Duis JB, Butler MG, Gourash L, Forster J, Scheimann AO. Critical review of bariatric surgical outcomes in patients with Prader-Willi syndrome and other hyperphagic disorders. Obesity (Silver Spring) 2022; 30:973-981. [PMID: 35416416 DOI: 10.1002/oby.23385] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/26/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of this study was to review bariatric procedure outcomes among patients with Prader-Willi syndrome (PWS), melanocortin 4 receptor (MC4R) mutations, Bardet-Biedl syndrome, and hypothalamic obesity. METHODS Systematic published literature review used the following search terms: "Prader-Willi syndrome," "Bardet-Biedl syndrome," "hyperphagia," "bariatric surgery," "MC4R"/"melanocortin 4 receptor", "hypothalamic obesity," and "bariatric procedure." Information collected included demographics, genetics, anthropometry, procedure type, outcomes, and complications, with inclusion of case series and clinical reports given the rarity of the disorders. For PWS, postoperative weight-change percentage and BMI up to 14 years following surgery were analyzed using general linear mixed models, with descriptive outcomes for other conditions. RESULTS A total of 54 publications were identified, with variable follow-up periods for 202 patients (114 with PWS, 43 with MC4R mutations, 7 with Bardet-Biedl syndrome, and 38 with hypothalamic obesity) among bariatric procedures. Weight loss of patients with PWS was greatest within 1 year of surgery, with weight-change percentage not significantly different from 0 at 5 years. Long-term results in other conditions were variable and featured suboptimal weight loss and increased reoperation risk. CONCLUSIONS Bariatric procedures among hyperphagic individuals, including those with PWS, report variable results and outcomes. Benefits of bariatric surgery may be less durable in hyperphagic disorders in comparison with other patients with severe obesity.
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Affiliation(s)
- Marie G Gantz
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, North Carolina, USA
| | - Daniel J Driscoll
- Departments of Pediatrics and Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jennifer L Miller
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jessica B Duis
- Section of Genetics and Inherited Metabolic Disease, Department of Pediatrics, Colorado Children's Hospital, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Merlin G Butler
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, University of Kansas, Medical Center, Kansas City, Kansas, USA
| | - Linda Gourash
- Pittsburgh Partnership, Pittsburgh, Pennsylvania, USA
| | | | - Ann O Scheimann
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Mendonça F, Soares R, Carvalho D, Freitas P. The Impact of Bariatric Surgery on Bone Health: State of the Art and New Recognized Links. Horm Metab Res 2022; 54:131-144. [PMID: 35276738 DOI: 10.1055/a-1767-5581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Bariatric surgery (BS) is the most effective therapy for severe obesity, which improves several comorbidities (such as diabetes, hypertension, dyslipidemia, among others) and results in marked weight loss. Despite these consensual beneficial effects, sleeve gastrectomy and Roux-en-Y gastric bypass (the two main bariatric techniques) have also been associated with changes in bone metabolism and progressive bone loss. The objective of this literature review is to examine the impact of bariatric surgery on bone and its main metabolic links, and to analyze the latest findings regarding the risk of fracture among patients submitted to bariatric surgery.
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Affiliation(s)
- Fernando Mendonça
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Raquel Soares
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Antoine D, Guéant-Rodriguez RM, Chèvre JC, Hergalant S, Sharma T, Li Z, Rouyer P, Chery C, Halvick S, Bui C, Oussalah A, Ziegler O, Quilliot D, Brunaud L, Guéant JL, Meyre D. Low-frequency Coding Variants Associated With Body Mass Index Affect the Success of Bariatric Surgery. J Clin Endocrinol Metab 2022; 107:e1074-e1084. [PMID: 34718599 DOI: 10.1210/clinem/dgab774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT A recent study identified 14 low-frequency coding variants associated with body mass index (BMI) in 718 734 individuals predominantly of European ancestry. OBJECTIVE We investigated the association of 2 genetic scores (GS) with i) the risk of severe/morbid obesity, ii) BMI variation before weight-loss intervention, iii) BMI change in response to an 18-month lifestyle/behavioral intervention program, and iv) BMI change up to 24 months after bariatric surgery. METHODS The 14 low-frequency coding variants were genotyped or sequenced in 342 French adults with severe/morbid obesity and 574 French adult controls from the general population. We built risk and protective GS based on 6 BMI-increasing and 5 BMI-decreasing low-frequency coding variants that were polymorphic in our study. RESULTS While the risk GS was not associated with severe/morbid obesity status, BMI-decreasing low-frequency coding variants were significantly less frequent in patients with severe/morbid obesity than in French adults from the general population. Neither the risk nor the protective GS was associated with BMI before intervention in patients with severe/morbid obesity, nor did they affect BMI change in response to a lifestyle/behavioral modification program. The protective GS was associated with a greater BMI decrease following bariatric surgery. The risk and protective GS were associated with a higher and lower risk of BMI regain after bariatric surgery. CONCLUSION Our data indicate that in populations of European descent, low-frequency coding variants associated with BMI in the general population also affect the outcomes of bariatric surgery in patients with severe/morbid obesity.
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Affiliation(s)
- Darlène Antoine
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
| | - Rosa-Maria Guéant-Rodriguez
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
| | - Jean-Claude Chèvre
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
| | - Sébastien Hergalant
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
| | - Tanmay Sharma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Zhen Li
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
- Specialized Obesity Center and Endocrinology, Diabetology, department of Nutrition, Brabois Hospital, CHRU of Nancy, 54500 Vandoeuvre-Les-Nancy, France
| | - Pierre Rouyer
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
| | - Céline Chery
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
| | - Sarah Halvick
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
| | - Catherine Bui
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
| | - Abderrahim Oussalah
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
| | - Olivier Ziegler
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
- Specialized Obesity Center and Endocrinology, Diabetology, department of Nutrition, Brabois Hospital, CHRU of Nancy, 54500 Vandoeuvre-Les-Nancy, France
- Department of Surgery, Endocrine and metabolic surgery, Multidisciplinary unit for obesity surgery (CVMC), University Hospital Centre of Nancy, Brabois Hospital, 54500 Nancy, France
| | - Didier Quilliot
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
- Specialized Obesity Center and Endocrinology, Diabetology, department of Nutrition, Brabois Hospital, CHRU of Nancy, 54500 Vandoeuvre-Les-Nancy, France
- Department of Surgery, Endocrine and metabolic surgery, Multidisciplinary unit for obesity surgery (CVMC), University Hospital Centre of Nancy, Brabois Hospital, 54500 Nancy, France
| | - Laurent Brunaud
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
- Department of Surgery, Endocrine and metabolic surgery, Multidisciplinary unit for obesity surgery (CVMC), University Hospital Centre of Nancy, Brabois Hospital, 54500 Nancy, France
| | - Jean-Louis Guéant
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
| | - David Meyre
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, 54500 Nancy, France
- FHU ARRIMAGE, department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, 54500 Nancy, France
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 4L8, Canada
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30
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Parmar CD, Bosch K, Benhmida R, O'Connell N, Fong C, Batterham R. First Report of One Anastomosis Gastric Bypass Performed in Twins. Obes Surg 2022; 32:1757-1760. [PMID: 35064865 DOI: 10.1007/s11695-022-05906-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Chetan D Parmar
- Department of Surgery, Whittington Hospital, London, N19 5NF, UK.
| | | | | | | | | | - Rachel Batterham
- Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospitals NHS Trust, London, UK
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31
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Cooiman MI, Alsters SIM, Duquesnoy M, Hazebroek EJ, Meijers-Heijboer HJ, Chahal H, Le Beyec-Le Bihan J, Clément K, Soula H, Blakemore AI, Poitou C, van Haelst MM. Long-Term Weight Outcome After Bariatric Surgery in Patients with Melanocortin-4 Receptor Gene Variants: a Case-Control Study of 105 Patients. Obes Surg 2022; 32:837-844. [PMID: 34984630 DOI: 10.1007/s11695-021-05869-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Pathogenic heterozygous MC4R variants are associated with hyperphagia and variable degrees of obesity. Several research groups have reported short-term weight loss outcomes after bariatric surgery in a few patients with MC4R variants, but lack of longer-term data prevents evidence-based clinical decision-making. MATERIALS AND METHODS Bariatric surgery patients with heterozygous (likely) pathogenic MC4R variants, from three collaborating centers in the Netherlands, France, and the UK, were compared to matched controls (matched 2:1 for age, sex, preoperative BMI, surgical procedure, and diabetes mellitus, but without MC4R mutations). Weight loss and regain outcomes up to 6 years of follow-up were compared. RESULTS At 60 months of follow-up after RYGB, cases with MC4R variants showed weight regain with a mean of 12.8% (± 10.4 SD) total weight loss (TWL) from nadir, compared to 7.9% (± 10.5 SD) in the controls (p = 0.062). Among patients receiving SG, the cases with MC4R variants experienced inferior weight loss (22.6% TWL) during the first year of follow-up compared to the controls (29.9% TWL) (p = 0.010). CONCLUSIONS This multicenter study reveals inferior mid-term weight outcomes of cases with MC4R variants after SG, compared to RYGB. Since adequate weight loss outcomes were observed after RYGB, this procedure would appear to be an appropriate surgical approach for this group. However, the pattern of weight regain seen in cases with MC4R variants after both RYGB and SG highlights the need for pro-active lifelong management to prevent relapse, as well as careful expectation management.
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Affiliation(s)
- Mellody I Cooiman
- Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinic, Wagnerlaan 55, Arnhem, the Netherlands. .,Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Suzanne I M Alsters
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Maeva Duquesnoy
- Nutrition Department, Reference Center for Rare Diseases, Assistance Publique Hopitaux de Paris, Pitie-Salpetriere Hospital, Paris, France
| | - Eric J Hazebroek
- Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinic, Wagnerlaan 55, Arnhem, the Netherlands
| | - Hanne J Meijers-Heijboer
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Harvinder Chahal
- Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Johanne Le Beyec-Le Bihan
- Department of Biochemistry for Endocrinology and Oncology, Obesity and Dyslipidemia Genetics Unit, Assistance Publique-Hospitaux de Paris, Sorbonne Université, Pitie-Salpetriere Hospital, Paris, France
| | - Karine Clément
- Nutrition Department, Reference Center for Rare Diseases, Assistance Publique Hopitaux de Paris, Pitie-Salpetriere Hospital, Paris, France.,INSERM, Nutrition and Obesities, Systemic Approaches (NutriOmics) Research Unit, Sorbonne Université, Paris, France
| | - Hedi Soula
- INSERM, Nutrition and Obesities, Systemic Approaches (NutriOmics) Research Unit, Sorbonne Université, Paris, France
| | - Alex I Blakemore
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Department of Life Sciences, Brunel University London, London, UK
| | - Christine Poitou
- Nutrition Department, Reference Center for Rare Diseases, Assistance Publique Hopitaux de Paris, Pitie-Salpetriere Hospital, Paris, France.,INSERM, Nutrition and Obesities, Systemic Approaches (NutriOmics) Research Unit, Sorbonne Université, Paris, France
| | - Mieke M van Haelst
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. .,Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
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32
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Dubern B, Mosbah H, Pigeyre M, Clément K, Poitou C. Rare genetic causes of obesity: diagnosis and management in clinical care. ANNALES D'ENDOCRINOLOGIE 2021; 83:63-72. [PMID: 34953778 DOI: 10.1016/j.ando.2021.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rare genetic forms of obesity are linked to impaired energy balance (i.e., eating behaviour and energy expenditure) involving hypothalamic pathways. More than 60 genes coding for proteins located in the hypothalamic leptin/melanocortin pathway contribute to the development of these rare forms of obesity. The ambition of the French National Protocol for the Diagnosis and Care (PNDS) of Obesity of Rare Causes was to establish practical recommendations for assessment and management at all ages. This report is available on the website of the French Health Authority (HAS). In addition to severe obesity, patients often display obesity-related comorbidities and neuropsychological/psychiatric disorders. These complex conditions make clinical management particularly challenging. Early diagnosis is critical for the organization of coordinated specialized multidisciplinary care, with mandatory interaction between caregivers, social partners and families. Strategies to prevent aggravation of obesity consist in limiting access to food, establishing a reassuring daily eating environment, and the practice of sustained adapted supervised daily physical activity. The implementation of genetic diagnosis in clinical practice now enables a personalized medicine approach with access to new drug therapies, and improves the analysis of the risk/benefit ratio of bariatric surgery.
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Affiliation(s)
- Béatrice Dubern
- Paris Public Hospitals, PRADORT Competence Centre, Department of Paediatric Nutrition and Gastroenterology, CHU Trousseau, Paris, France; Sorbonne University/INSERM, Research Unit: Nutrition and Obesities; Systemic Approaches, NutriOmics, Paris, France
| | - Héléna Mosbah
- Paris Public Hospitals, Reference Centre for Rare Diseases PRADORT (PRADer-Willi Syndrome and other Rare Obesities with Eating Disorders), Nutrition Department, Pitié-Salpêtrière hospital, Paris, France
| | - Marie Pigeyre
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, ON, Canada; Department of Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
| | - Karine Clément
- Sorbonne University/INSERM, Research Unit: Nutrition and Obesities; Systemic Approaches, NutriOmics, Paris, France; Paris Public Hospitals, Reference Centre for Rare Diseases PRADORT (PRADer-Willi Syndrome and other Rare Obesities with Eating Disorders), Nutrition Department, Pitié-Salpêtrière hospital, Paris, France
| | - Christine Poitou
- Sorbonne University/INSERM, Research Unit: Nutrition and Obesities; Systemic Approaches, NutriOmics, Paris, France; Paris Public Hospitals, Reference Centre for Rare Diseases PRADORT (PRADer-Willi Syndrome and other Rare Obesities with Eating Disorders), Nutrition Department, Pitié-Salpêtrière hospital, Paris, France.
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33
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Blum K, Thanos PK, Wang GJ, Bowirrat A, Gomez LL, Baron D, Jalali R, Gondré-Lewis MC, Gold MS. Dopaminergic and other genes related to reward induced overeating, Bulimia, Anorexia Nervosa, and Binge eating. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2021. [DOI: 10.1080/23808993.2021.1994186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kenneth Blum
- Division of Addiction Research & Education, Center for Psychiatry, Medicine & Primary Care (Office of the Provost), Western University Health Sciences Graduate School of Biomedical Sciences, Pomona, CA, USA
- Department of Precision Behavioral Management, The Kenneth Blum Behavioral Neurogenetic Institute (Division of Ivitalize Inc.), Austin, TX, USA
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Department of Psychiatry, University of Vermont, Burlington, VM, USA
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology, Nonakuri, India
| | - Panayotis K. Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, University at Buffalo, Buffalo, NY, USA
| | - Gene -Jack Wang
- Laboratory of Neuroimaging, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Abdalla Bowirrat
- Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Luis Llanos Gomez
- Department of Precision Behavioral Management, The Kenneth Blum Behavioral Neurogenetic Institute (Division of Ivitalize Inc.), Austin, TX, USA
| | - David Baron
- Division of Addiction Research & Education, Center for Psychiatry, Medicine & Primary Care (Office of the Provost), Western University Health Sciences Graduate School of Biomedical Sciences, Pomona, CA, USA
| | - Rehan Jalali
- Department of Precision Behavioral Management, The Kenneth Blum Behavioral Neurogenetic Institute (Division of Ivitalize Inc.), Austin, TX, USA
| | - Marjorie C Gondré-Lewis
- Neuropsychopharmacology Laboratory, Department of Anatomy, Howard University College of Medicine, Washington, Washington, DC, USA
| | - Mark S Gold
- Department of Psychiatry, School of Medicine, Washington University, St. Louis, MO, USA
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34
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Courbage S, Poitou C, Le Beyec-Le Bihan J, Karsenty A, Lemale J, Pelloux V, Lacorte JM, Carel JC, Lecomte N, Storey C, De Filippo G, Coupaye M, Oppert JM, Tounian P, Clément K, Dubern B. Implication of Heterozygous Variants in Genes of the Leptin-Melanocortin Pathway in Severe Obesity. J Clin Endocrinol Metab 2021; 106:2991-3006. [PMID: 34097736 DOI: 10.1210/clinem/dgab404] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Unlike homozygous variants, the implication of heterozygous variants on the leptin-melanocortin pathway in severe obesity has not been established. OBJECTIVE To describe the frequency, the phenotype, and the genotype-phenotype relationship for heterozygous variants in LEP, LEPR, POMC, and PCSK1 in severe obesity. METHODS In this retrospective study, genotyping was performed on at least 1 of the LEP, LEPR, POMC, and PCSK1 genes in 1486 probands with severe obesity (600 children, 886 adults). The phenotype was collected in 60 subjects with heterozygous variants and 16 with homozygous variants. We analyzed variant frequency, body mass index (BMI), age of obesity onset, food impulsivity, and endocrine abnormalities. RESULTS The frequency of subjects with homozygous variants was 1.7% (n = 26), and 6.7% (n = 100) with heterozygous variants. Adults with homozygous variants had a higher BMI (66 vs 53 kg/m2, P = .015), an earlier onset of obesity (0.4 vs 5.4 years, P < .001), more often food impulsivity (83% vs 42%, P = .04), and endocrine abnormalities (75% vs 26%, P < .01). The BMI was higher for subjects with high-impact heterozygous variants (61 vs 50 kg/m², P = .045) and those with a second heterozygous variant on the pathway (65 vs 49 kg/m², P < .01). In children, no significant differences were found for the age of obesity onset and BMI. CONCLUSION Heterozygous variants in LEP, LEPR, POMC, and PCSK1 are frequent in severe obesity and sometimes associated with a phenotype close to that of homozygotes. These data suggest a systematic search for variants in severe early-onset obesity, to discuss therapy that targets this key pathway.
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Affiliation(s)
- Sophie Courbage
- Assistance Publique-Hôpitaux de Paris (AP-HP), Reference Centre for Rare Diseases (PRADORT, Prader-Willi Syndrome and other Rare Forms of Obesity with Eating Behavior Disorders), Pediatric Nutrition and Gastroenterology Department, Armand-Trousseau Hospital, Sorbonne University, Paris, France
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics) Research Unit, Paris, France
| | - Christine Poitou
- Assistance Publique-Hôpitaux de Paris (AP-HP), Reference Centre for Rare Diseases (PRADORT, Prader-Willi Syndrome and other Rare Forms of Obesity with Eating Behavior Disorders), Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics) Research Unit, Paris, France
| | - Johanne Le Beyec-Le Bihan
- Assistance Publique-Hôpitaux de Paris (AP-HP), Endocrine and Oncological Biochemistry Department, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Alexandra Karsenty
- Assistance Publique-Hôpitaux de Paris (AP-HP), Reference Centre for Rare Diseases (PRADORT, Prader-Willi Syndrome and other Rare Forms of Obesity with Eating Behavior Disorders), Pediatric Nutrition and Gastroenterology Department, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Julie Lemale
- Assistance Publique-Hôpitaux de Paris (AP-HP), Reference Centre for Rare Diseases (PRADORT, Prader-Willi Syndrome and other Rare Forms of Obesity with Eating Behavior Disorders), Pediatric Nutrition and Gastroenterology Department, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Véronique Pelloux
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics) Research Unit, Paris, France
| | - Jean-Marc Lacorte
- Assistance Publique-Hôpitaux de Paris (AP-HP), Endocrine and Oncological Biochemistry Department, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Jean-Claude Carel
- Université de Paris, F-75019, Paris, France; AP-HP.Nord Université de Paris. Hôpital Universitaire Robert-Debré, Service d'Endocrinologie Diabétologie Pédiatrique F-75019, Paris, France
| | - Nathalie Lecomte
- Université de Paris, F-75019, Paris, France; AP-HP.Nord Université de Paris. Hôpital Universitaire Robert-Debré, Service d'Endocrinologie Diabétologie Pédiatrique F-75019, Paris, France
| | - Caroline Storey
- Université de Paris, F-75019, Paris, France; AP-HP.Nord Université de Paris. Hôpital Universitaire Robert-Debré, Service d'Endocrinologie Diabétologie Pédiatrique F-75019, Paris, France
| | - Gianpaolo De Filippo
- Université de Paris, F-75019, Paris, France; AP-HP.Nord Université de Paris. Hôpital Universitaire Robert-Debré, Service d'Endocrinologie Diabétologie Pédiatrique F-75019, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Bicêtre Hospital, Medicine for Adolescents Department, Le Kremlin-Bicêtre, France
| | - Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris (AP-HP), Reference Centre for Rare Diseases (PRADORT, Prader-Willi Syndrome and other Rare Forms of Obesity with Eating Behavior Disorders), Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Explorations Fonctionnelles Department, Louis-Mourier Hospital, Centre Intégré Nord Francilien de l'Obésité (CINFO) and Université de Paris, Centre de Recherche sur l'Inflammation, Inserm UMRS 1149, Paris, France
| | - Jean-Michel Oppert
- Assistance Publique-Hôpitaux de Paris (AP-HP), Reference Centre for Rare Diseases (PRADORT, Prader-Willi Syndrome and other Rare Forms of Obesity with Eating Behavior Disorders), Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Patrick Tounian
- Assistance Publique-Hôpitaux de Paris (AP-HP), Reference Centre for Rare Diseases (PRADORT, Prader-Willi Syndrome and other Rare Forms of Obesity with Eating Behavior Disorders), Pediatric Nutrition and Gastroenterology Department, Armand-Trousseau Hospital, Sorbonne University, Paris, France
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics) Research Unit, Paris, France
| | - Karine Clément
- Assistance Publique-Hôpitaux de Paris (AP-HP), Reference Centre for Rare Diseases (PRADORT, Prader-Willi Syndrome and other Rare Forms of Obesity with Eating Behavior Disorders), Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics) Research Unit, Paris, France
| | - Béatrice Dubern
- Assistance Publique-Hôpitaux de Paris (AP-HP), Reference Centre for Rare Diseases (PRADORT, Prader-Willi Syndrome and other Rare Forms of Obesity with Eating Behavior Disorders), Pediatric Nutrition and Gastroenterology Department, Armand-Trousseau Hospital, Sorbonne University, Paris, France
- Sorbonne Université, INSERM, Nutrition and Obesities; Systemic Approaches (NutriOmics) Research Unit, Paris, France
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Gupta SR, Zhou Y, Wadden TA, Berkowitz RI, Chao AM. A Systematic Review of Genetic Correlates of Weight Loss After Bariatric Surgery. Obes Surg 2021; 31:4612-4623. [PMID: 34370160 DOI: 10.1007/s11695-021-05585-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
This systematic review synthesized research evaluating the relationship between genetic predictors and weight loss after bariatric surgery. Fifty-seven studies were identified that examined single genes or genetic risk scores. Uncoupling protein (UCP) rs660339 was associated with excess weight loss after surgery in 4 of 6 studies. The most commonly assessed genes were fat mass and obesity-associated (FTO) gene (n = 10) and melanocortin-4 receptor (MC4R) (n = 14). Both were inconsistently related to weight loss. Genetic risk scores predicted weight loss in 6 of 7 studies. This evidence suggests the potential of using genetic variants and genetic risk scores to predict the amount of weight loss anticipated after bariatric surgery and identify patients who may be at risk for suboptimal weight reduction.
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Affiliation(s)
- Sapana R Gupta
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Yingjie Zhou
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Thomas A Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert I Berkowitz
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ariana M Chao
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA. .,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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36
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Aasbrenn M, Svendstrup M, Schnurr TM, Lindqvist Hansen D, Worm D, Balslev-Harder M, Grarup N, Burgdorf KS, Vestergaard H, Pedersen O, Ängquist L, Fenger M, Sørensen TIA, Madsbad S, Hansen T. Genetic markers of abdominal obesity and weight loss after gastric bypass surgery. PLoS One 2021; 16:e0252525. [PMID: 34048505 PMCID: PMC8162622 DOI: 10.1371/journal.pone.0252525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Weight loss after bariatric surgery varies widely between individuals, partly due to genetic differences. In addition, genetic determinants of abdominal obesity have been shown to attenuate weight loss after dietary intervention with special attention paid to the rs1358980-T risk allele in the VEGFA locus. Here we aimed to test if updated genetic risk scores (GRSs) for adiposity measures and the rs1358980-T risk allele are linked with weight loss following gastric bypass surgery. Methods Five hundred seventy six patients with morbid obesity underwent Roux-en-Y gastric bypass. A GRS for BMI and a GRS for waist-hip-ratio adjusted for BMI (proxy for abdominal obesity), respectively, were constructed. All patients were genotyped for the rs1358980-T risk allele. Associations between the genetic determinants and weight loss after bariatric surgery were evaluated. Results The GRS for BMI was not associated with weight loss (β = -2.0 kg/100 risk alleles, 95% CI -7.5 to 3.3, p = 0.45). Even though the GRS for abdominal obesity was associated with an attenuated weight loss response adjusted for age, sex and center (β = -14.6 kg/100 risk alleles, 95% CI -25.4 to -3.8, p = 0.008), it was not significantly associated with weight loss after adjustment for baseline BMI (β = -7.9 kg/100 risk alleles, 95% CI -17.5 to 1.6, p = 0.11). Similarly, the rs1358980-T risk allele was not significantly associated with weight loss (β = -0.8 kg/risk allele, 95% CI -2.2 to 0.6, p = 0.25). Discussion GRSs for adiposity derived from large meta-analyses and the rs1358980-T risk allele in the VEGFA locus did not predict weight loss after gastric bypass surgery. The association between a GRS for abdominal obesity and the response to bariatric surgery may be dependent on the association between the GRS and baseline BMI.
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Affiliation(s)
- Martin Aasbrenn
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Geriatric Research Unit, Department of Geriatrics, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark
- * E-mail:
| | - Mathilde Svendstrup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Theresia M. Schnurr
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Dorte Worm
- Department of Medicine, Amager Hospital, Copenhagen, Denmark
| | - Marie Balslev-Harder
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Henrik Vestergaard
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Bornholms Hospital, Rønne, Denmark
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Ängquist
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mogens Fenger
- Department of Clinical Biochemistry, Hvidovre University Hospital, Copenhagen, Denmark
| | - Thorkild I. A. Sørensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Hvidovre University Hospital, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Poitou C, Puder L, Dubern B, Krabusch P, Genser L, Wiegand S, Verkindt H, Köhn A, von Schwartzenberg RJ, Flück C, Pattou F, Laville M, Kühnen P, Clément K. Long-term outcomes of bariatric surgery in patients with bi-allelic mutations in the POMC, LEPR, and MC4R genes. Surg Obes Relat Dis 2021; 17:1449-1456. [PMID: 34083135 DOI: 10.1016/j.soard.2021.04.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gene mutations in the leptin-melanocortin signaling cascade lead to hyperphagia and severe early onset obesity. In most cases, multimodal conservative treatment (increased physical activity, reduced caloric intake) is not successful to stabilize body weight and control hyperphagia. OBJECTIVES To examine bariatric surgery as a therapeutic option for patients with genetic obesity. SETTING Three major academic, specialized medical centers. METHODS In 3 clinical centers, we retrospectively analyzed the outcomes of bariatric surgery performed in 8 patients with monogenic forms of obesity with bi-allelic variants in the genes LEPR (n = 5), POMC (n = 2), and MC4R (n = 1). RESULTS In this group of patients with monogenic obesity, initial bariatric surgery was performed at a median age of 19 years (interquartile range [IQR], 16-23.8 yr). All patients initially experienced weight loss after each bariatric surgery, which was followed by substantial weight regain. In total, bariatric surgery led to a median maximum reduction of body weight of -21.5 kg (IQR, -36.3 to -2.9 kg), median percent excess weight loss (%EWL) of -47.5 %EWL (IQR, -57.6 to -28.9 %EWL). This body weight reduction was followed by median weight regain of 24.1 kg (IQR: 10.0 to 42.0 kg), leading to a final weight change of -24.2 % EWL (IQR: -37.6 to -5.4 %EWL) after a maximum duration of 19 years post surgery. In one patient, bariatric surgery was accompanied by significant complications, including vitamin deficiencies and hernia development. CONCLUSION The indication for bariatric surgery in patients with monogenic obesity based on bi-allelic gene mutations and its benefit/risk balance has to be evaluated very cautiously by specialized centers. Furthermore, to avoid an unsuccessful operation, preoperative genetic testing of patients with a history of early onset obesity might be essential, even more since novel pharmacological treatment options are expected.
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Affiliation(s)
- Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, CRNH Ile de France, F-CRIN/FORCE Network Paris, Paris, France; Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, F-CRIN/FORCE Network Paris, Paris, France
| | - Lia Puder
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin, Germany; Department for Pediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Beatrice Dubern
- Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, F-CRIN/FORCE Network Paris, Paris, France; Pediatric Nutrition and Gastroenterology Department, Assistance Publique-Hôpitaux de Paris, Trousseau Hospital, Paris, France
| | - Philipp Krabusch
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin, Germany; Department for Pediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Laurent Genser
- Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, F-CRIN/FORCE Network Paris, Paris, France; Department of Hepato-Biliary and Pancreatic Surgery, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Susanna Wiegand
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Center for Social-Pediatric Care/Pediatric Endocrinology and Diabetology, Berlin, Germany
| | - Hélène Verkindt
- CHU Lille, Endocrine and Metabolic Surgery, Integrated Center for Obesity, Lille, France
| | - Arvid Köhn
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Berlin, Germany
| | - Reiner Jumpertz von Schwartzenberg
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Berlin, Germany
| | - Christa Flück
- Paediatric Endocrinology, Diabetology and Metabolism, Department of Paediatrics and Department of BioMedical Research, Bern University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - François Pattou
- CHU Lille, Endocrine and Metabolic Surgery, Integrated Center for Obesity, Lille, France; University of Lille, Lille Pasteur Institute, Inserm U1190, European Genomic Institute for Diabetes, Lille, France; F-CRIN/FORCE Network, Pierre Bénite, Lyon, France
| | - Martine Laville
- F-CRIN/FORCE Network, Pierre Bénite, Lyon, France; Département Endocrinologie, Diabète et Nutrition, Hospices Civils de Lyon, Centre de Recherche en Nutrition Humaine Rhône-Alpes, Univ-Lyon, CarMeN Laboratory, Université Claude Bernard Lyon1, F-CRIN/FORCE Network, Pierre Bénite, Lyon, France
| | - Peter Kühnen
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin, Germany.
| | - Karine Clément
- Assistance Publique-Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, CRNH Ile de France, F-CRIN/FORCE Network Paris, Paris, France; Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, F-CRIN/FORCE Network Paris, Paris, France
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Jang HN, Kim SH, Cho YM, Park DJ. Bariatric Surgery for Cowden Syndrome with PTEN Mutation: a Case Report. Obes Surg 2021; 31:2316-2318. [PMID: 33481191 DOI: 10.1007/s11695-021-05231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Han Na Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sa Hong Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
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Gandotra C, Basam M, Mahajan A, Ngwa J, Ortega G, Tran D, Fullum TM, Sherif ZA. Characteristics and resolution of hypertension in obese African American bariatric cohort. Sci Rep 2021; 11:1683. [PMID: 33462353 PMCID: PMC7814052 DOI: 10.1038/s41598-021-81360-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 12/15/2020] [Indexed: 01/08/2023] Open
Abstract
Weight reduction continues to be first-line therapy in the treatment of hypertension (HTN). However, the long-term effect of bariatric malabsorptive surgical techniques such as Roux-en-Y Gastric Bypass (RYGB) surgery in the management of hypertension (HTN) is less clear. African Americans (AA) are disproportionately affected by obesity and hypertension and have inconsistent outcomes after bariatric surgery (BS). Despite a plethora of bariatric literature, data about characteristics of a predominantly AA bariatric hypertensive cohort including hypertension in obese (HIO) are scarce and underreported. The aims of this study were, (1) to describe the preoperative clinical characteristics of HIO with respect to HTN status and age, and (2) to identify predictors of HTN resolution one year after RYGB surgery in an AA bariatric cohort enrolled at the Howard University Center for Wellness and Weight Loss Surgery (HUCWWS). In the review of 169 AA bariatric patients, the average BMI was 48.50 kg/m2 and the average age was 43.86 years. Obese hypertensive patients were older (46 years vs. 37.89 years; p < .0001); had higher prevalence of diabetes mellitus (DM, 43.09% vs. 10.87%; p < .0001) and dyslipidemia (38.2% vs. 13.04%; p 0.002). Hypertensive AA who were taking ≥ 2 antihypertensive medications prior to RYGB were 18 times less likely to experience HTN resolution compared to hypertensive AA taking 0-1 medications, who showed full or partial response. Also, HIO was less likely to resolve after RYGB surgery in patients who needed ≥ 2 antihypertensive medications prior to surgical intervention.
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Affiliation(s)
- Charu Gandotra
- Department of Cardiology, Internal Medicine, Howard University Hospital, Washington, DC, USA
| | - Motahar Basam
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Ankit Mahajan
- Department of Cardiology, Hartford Healthcare, Putnam, CT, USA
| | - Julius Ngwa
- Department of Medicine, Howard University Hospital, Washington, DC, USA
| | - Gezzer Ortega
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Tran
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Terrence M Fullum
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Zaki A Sherif
- Department of Biochemistry and Molecular Biology, College of Medicine, Howard University, Washington, DC, 20059, USA.
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40
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Gandotra C, Basam M, Mahajan A, Ngwa J, Ortega G, Tran D, Fullum TM, Sherif ZA. Characteristics and resolution of hypertension in obese African American bariatric cohort. Sci Rep 2021; 11:1683. [PMID: 33462353 DOI: 10.1038/s41598-021-81360-y.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 12/15/2020] [Indexed: 08/28/2024] Open
Abstract
Weight reduction continues to be first-line therapy in the treatment of hypertension (HTN). However, the long-term effect of bariatric malabsorptive surgical techniques such as Roux-en-Y Gastric Bypass (RYGB) surgery in the management of hypertension (HTN) is less clear. African Americans (AA) are disproportionately affected by obesity and hypertension and have inconsistent outcomes after bariatric surgery (BS). Despite a plethora of bariatric literature, data about characteristics of a predominantly AA bariatric hypertensive cohort including hypertension in obese (HIO) are scarce and underreported. The aims of this study were, (1) to describe the preoperative clinical characteristics of HIO with respect to HTN status and age, and (2) to identify predictors of HTN resolution one year after RYGB surgery in an AA bariatric cohort enrolled at the Howard University Center for Wellness and Weight Loss Surgery (HUCWWS). In the review of 169 AA bariatric patients, the average BMI was 48.50 kg/m2 and the average age was 43.86 years. Obese hypertensive patients were older (46 years vs. 37.89 years; p < .0001); had higher prevalence of diabetes mellitus (DM, 43.09% vs. 10.87%; p < .0001) and dyslipidemia (38.2% vs. 13.04%; p 0.002). Hypertensive AA who were taking ≥ 2 antihypertensive medications prior to RYGB were 18 times less likely to experience HTN resolution compared to hypertensive AA taking 0-1 medications, who showed full or partial response. Also, HIO was less likely to resolve after RYGB surgery in patients who needed ≥ 2 antihypertensive medications prior to surgical intervention.
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Affiliation(s)
- Charu Gandotra
- Department of Cardiology, Internal Medicine, Howard University Hospital, Washington, DC, USA
| | - Motahar Basam
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Ankit Mahajan
- Department of Cardiology, Hartford Healthcare, Putnam, CT, USA
| | - Julius Ngwa
- Department of Medicine, Howard University Hospital, Washington, DC, USA
| | - Gezzer Ortega
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Tran
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Terrence M Fullum
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Zaki A Sherif
- Department of Biochemistry and Molecular Biology, College of Medicine, Howard University, Washington, DC, 20059, USA.
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41
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Rare genetic forms of obesity: From gene to therapy. Physiol Behav 2020; 227:113134. [DOI: 10.1016/j.physbeh.2020.113134] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 01/05/2023]
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Zorn S, von Schnurbein J, Kohlsdorf K, Denzer C, Wabitsch M. Diagnostic and therapeutic odyssey of two patients with compound heterozygous leptin receptor deficiency. Mol Cell Pediatr 2020; 7:15. [PMID: 33140236 PMCID: PMC7606406 DOI: 10.1186/s40348-020-00107-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rare genetic variations in the leptin-melanocortin signalling pathway can severely impair appetite regulation and cause extreme obesity in early childhood. CASE PRESENTATION Our case reports describe the diagnostic and therapeutic procedures in a girl as well as in a non-related boy of non-consanguineous, German parents with severe early-onset obesity, pronounced hyperphagia, and permanent food-seeking behaviour. Excessive weight gain within the first year of life initiated extensive diagnostics without finding a causal diagnosis. Furthermore, a wide range of intensive, interdisciplinary, and behavioural therapies for weight control were unsuccessful. Prior to bariatric surgery, the 18-year-old girl and the 14-year-old boy reached a BMI of 67.7 kg/m2 and 55.2 kg/m2, respectively. However, even surgical outcomes were unsatisfactory. A subsequently initiated genetic analysis including sequencing of the leptin receptor gene revealed compound heterozygous variants as a cause of the severe early-onset obesity in both patients (c.2598-3_2607delTAGAATGAAAAAG and c.2227 T>C; c.1874G>A and c.2051A>C). Both patients were enrolled in the clinical study RM-493-015 and treated with melanocortin receptor agonist setmelanotide. Currently, they are still on setmelanotide treatment in the extension trial RM-493-022. CONCLUSION Our case report illustrates the urgent necessity of early genetic diagnostics in children with severe early-onset obesity to avoid frustrating and potentially damaging therapies. Thus, genetic examination should precede bariatric surgery. In the future, several pharmacological therapies will be available for some forms of monogenetic obesity.
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Affiliation(s)
- Stefanie Zorn
- Center for Rare Endocrine Diseases, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, 89075, Ulm, Germany
| | - Julia von Schnurbein
- Center for Rare Endocrine Diseases, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, 89075, Ulm, Germany
| | - Katja Kohlsdorf
- Center for Rare Endocrine Diseases, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, 89075, Ulm, Germany
| | - Christian Denzer
- Center for Rare Endocrine Diseases, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, 89075, Ulm, Germany
| | - Martin Wabitsch
- Center for Rare Endocrine Diseases, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, 89075, Ulm, Germany.
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Abstract
PURPOSE OF REVIEW The prevalence of pediatric obesity and its associated complications is increasing around the world. Treatment of obesity is challenging and metabolic and bariatric surgery (MBS) is currently the most effective treatment for this condition. At this time, vertical sleeve gastrectomy (VSG) is the most commonly performed bariatric procedure in adolescents. However, knowledge regarding the efficacy, safety, and durability of VSG in adolescents is still evolving. This review summarizes the most recent updates in the field of MBS particularly VSG in adolescents. RECENT FINDINGS MBS is recommended to treat moderate to severe obesity, especially when complicated by comorbidities. The use of VSG for weight loss is increasing among adolescents and produces similar weight loss at five years in both adolescents and adults. The physiologic mechanisms causing weight loss after VSG are multifactorial and still being investigated. The complication rate after VSG ranges between 0 and 17.5%. SUMMARY VSG appears to be a well-tolerated and effective procedure in adolescents. However, it continues to be underutilized despite the increasing prevalence of moderate to severe obesity in adolescents. It is thus important to educate providers regarding its benefits and safety profile.
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Affiliation(s)
- Vibha Singhal
- Pediatric Endocrinology, Massachusetts General Hospital for Children
- Neuroendocrine Unit, Massachusetts General Hospital
- MGH Weight Center
| | | | - Madhusmita Misra
- Pediatric Endocrinology, Massachusetts General Hospital for Children
- Neuroendocrine Unit, Massachusetts General Hospital
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Vos N, Oussaada SM, Cooiman MI, Kleinendorst L, Ter Horst KW, Hazebroek EJ, Romijn JA, Serlie MJ, Mannens MMAM, van Haelst MM. Bariatric Surgery for Monogenic Non-syndromic and Syndromic Obesity Disorders. Curr Diab Rep 2020; 20:44. [PMID: 32729070 PMCID: PMC7391392 DOI: 10.1007/s11892-020-01327-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The global prevalence of obesity has increased rapidly over the last decades, posing a severe threat to human health. Currently, bariatric surgery is the most effective therapy for patients with morbid obesity. It is unknown whether this treatment is also suitable for patients with obesity due to a confirmed genetic defect (genetic obesity disorders). Therefore, this review aims to elucidate the role of bariatric surgery in the treatment of genetic obesity. RECENT FINDINGS In monogenic non-syndromic obesity, an underlying genetic defect seems to be the most important factor determining the efficacy of bariatric surgery. In syndromic obesity, bariatric surgery result data are scarce, and even though some promising follow-up results have been reported, caution is required as patients with more severe behavioral and developmental disorders might have poorer outcomes. There is limited evidence in support of bariatric surgery as a treatment option for genetic obesity disorders; hence, no strong statements can be made regarding the efficacy and safety of these procedures for these patients. However, considering that patients with genetic obesity often present with life-threatening obesity-related comorbidities, we believe that bariatric surgery could be considered a last-resort treatment option in selected patients.
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Affiliation(s)
- Niels Vos
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Sabrina M Oussaada
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mellody I Cooiman
- Department of Bariatric Surgery, Rijnstate Hospital and Vitalys Clinic, Arnhem, The Netherlands
| | - Lotte Kleinendorst
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Kasper W Ter Horst
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Eric J Hazebroek
- Department of Bariatric Surgery, Rijnstate Hospital and Vitalys Clinic, Arnhem, The Netherlands
| | - Johannes A Romijn
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mireille J Serlie
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marcel M A M Mannens
- Genome Diagnostics Laboratory, Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mieke M van Haelst
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
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Kleinendorst L, Abawi O, van der Voorn B, Jongejan MHTM, Brandsma AE, Visser JA, van Rossum EFC, van der Zwaag B, Alders M, Boon EMJ, van Haelst MM, van den Akker ELT. Identifying underlying medical causes of pediatric obesity: Results of a systematic diagnostic approach in a pediatric obesity center. PLoS One 2020; 15:e0232990. [PMID: 32384097 PMCID: PMC7209105 DOI: 10.1371/journal.pone.0232990] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background Underlying medical causes of obesity (endocrine disorders, genetic obesity disorders, cerebral or medication-induced obesities) are thought to be rare. Even in specialized pediatric endocrinology clinics, low diagnostic yield is reported, but evidence is limited. Identifying these causes is vital for patient-tailored treatment. Objectives To present the results of a systematic diagnostic workup in children and adolescents referred to a specialized pediatric obesity center. Methods This is a prospective observational study. Prevalence of underlying medical causes was determined after a multidisciplinary, systematic diagnostic workup including growth charts analysis, extensive biochemical and hormonal assessment and genetic testing in all patients. Results The diagnostic workup was completed in n = 282 patients. Median age was 10.8 years (IQR 7.7–14.1); median BMI +3.7SDS (IQR +3.3-+4.3). In 54 (19%) patients, a singular underlying medical cause was identified: in 37 patients genetic obesity, in 8 patients cerebral and in 9 patients medication-induced obesities. In total, thirteen different genetic obesity disorders were diagnosed. Obesity onset <5 years (p = 0.04) and hyperphagia (p = 0.001) were indicators of underlying genetic causes, but only in patients without intellectual disability (ID). Patients with genetic obesity with ID more often had a history of neonatal feeding problems (p = 0.003) and short stature (p = 0.005). BMI-SDS was not higher in patients with genetic obesity disorders (p = 0.52). Patients with cerebral and medication-induced obesities had lower height-SDS than the rest of the cohort. Conclusions To our knowledge, this is the first study to report the results of a systematic diagnostic workup aimed at identifying endocrine, genetic, cerebral or medication-induced causes of pediatric obesity. We found that a variety of singular underlying causes were identified in 19% of the patients with severe childhood obesity. Because of this heterogeneity, an extensive diagnostic approach is needed to establish the underlying medical causes and to facilitate disease-specific, patient-tailored treatment.
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Affiliation(s)
- Lotte Kleinendorst
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ozair Abawi
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bibian van der Voorn
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Division of Endocrinology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mieke H. T. M. Jongejan
- Department of Pediatrics, Obesity Center CGG, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Annelies E. Brandsma
- Department of Pediatrics, Obesity Center CGG, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Jenny A. Visser
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Division of Endocrinology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elisabeth F. C. van Rossum
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Division of Endocrinology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bert van der Zwaag
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mariëlle Alders
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Elles M. J. Boon
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mieke M. van Haelst
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Erica L. T. van den Akker
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- * E-mail:
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Wu S, Pan L, Liao H, Yao W, Shen N, Chen C, Liu D, Ge M. High-fat diet increased NADPH-oxidase-related oxidative stress and aggravated LPS-induced intestine injury. Life Sci 2020; 253:117539. [PMID: 32165213 DOI: 10.1016/j.lfs.2020.117539] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/04/2020] [Accepted: 03/08/2020] [Indexed: 02/07/2023]
Abstract
AIMS Lipopolysaccharide (LPS)-induced intestinal injury is a common clinical feature of sepsis. Aggravated inflammation and higher sensitivity to infection are associated with high-fat diet (HFD) in patients with type 2 diabetes and/or obesity. However, the mechanism by which HFD exacerbates LPS-induced intestinal injury has not been elucidated. This study aims to examine the effects of HFD on intestinal injury induced by LPS and the underlying mechanism. MAIN METHODS Mice were fed with HFD or regular chow for 12weeks and were then challenged with LPS. Vas2870 was administered to mice that received HFD before the initiation of the diet. The levels of tight junction protein expression, oxidative stress, organ injury, and nicotinamide adenine dinucleotide phosphate (NADPH)-associated proteins were assessed periodically. KEY FINDINGS LPS treatment resulted in severe intestinal pathological injury and increased oxidative stress, evidenced by significantly increased serum diamine oxidase, reactive oxygen species, malondialdehyde, and intestinal fatty acid binding protein contents. Additionally, a decrease in tight junction protein expression was observed, indicating a loss of tight junction integrity. LPS treatment induced the expression of Nox2 and Nox4. All the effects were more severe in HFD mice. Treatment with vas2870 conferred protection against LPS-induced intestinal injury in HFD-fed mice, partially reduced oxidative stress, and rescued the expression of tight junction proteins. CONCLUSION HFD aggravated LPS-induced intestine injury through exacerbating intestinal Nox-related oxidative stress, which led to a loss of the integrity of tight junctions and consequently increased intestinal permeability.
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Affiliation(s)
- Shan Wu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Lijie Pan
- Vaccine Research Institute of Sun Yat-sen University, Guangzhou 510630, China
| | - Haofeng Liao
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Weifeng Yao
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Ning Shen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Chaojin Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Dezhao Liu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
| | - Mian Ge
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
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Aykut A, Özen S, Gökşen D, Ata A, Onay H, Atik T, Darcan Ş, Özkinay F. Melanocortin 4 receptor (MC4R) gene variants in children and adolescents having familial early-onset obesity: genetic and clinical characteristics. Eur J Pediatr 2020; 179:1445-1452. [PMID: 32185475 PMCID: PMC7223532 DOI: 10.1007/s00431-020-03630-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 11/27/2022]
Abstract
Melanocortin 4 receptor gene plays an important role in food intake, energy balance, and weight control. The autosomal dominantly inherited MC4R variants cause obesity by causing hyperphagia and decreased sense of satiety. Homozygous variants are rarely reported, and they cause earlier/severe obesity. Our objective is to determine the MC4R gene variant frequency in children and adolescents with familial early-onset obesity. One hundred thirty-nine children and adolescents (57 girls/82 boys) whose weight increase started before the age of 5 years and who had early-onset obesity in at least one of their first-degree relatives were included in the study. Obesity is defined as body mass index (BMI) of ≥ 95th percentile, and as extreme obesity is defined if the BMI ≥ 120% of the 95th percentile or ≥ 35 kg/m2. Children having genetic syndromes associated with obesity and mental retardation or taking drugs that promote changes in eating behavior or weight were excluded from the study. Coding region of the MC4R gene was sequenced by using the Illumina MiSeq Next Generation Sequencing System. The mean age of the patients was 7.3 ± 3.7 years, and the mean BMI SDS was 3.7 ± 0.7. While 118 patients (85%) were prepubertal, 21 patients (15%) were pubertal. Seven different variants were identified in 12 patients by giving a variant detection rate of 8.6%, of these five were previously identified missense variants p.N274S, p.S136F, p.V166I, p.R165W, and p.I291SfsX10. One homozygous variant p.I291SfsX10 (c.870delG) was detected in a severely obese 2-year-old boy, and other variants were heterozygous. Two novel variants were found: p.M200del and p.S188L. By using the in silico analysis software, these novel variants were predicted to be disease causing.Conclusion: MC4R gene variants are quite common in childhood obesity in Turkish population. Screening the variants in MC4R gene is necessary in patients with severe childhood-onset obesity. In such patients, comorbidities of obesity can be seen from early years. What is known • The frequency of MC4R mutations in obese patients was approximately 0-6.3%. What is new • In obese Turkish pediatric population, unlike other European countries, MC4R gene variants are quite common as we found a variant rate of 8.6% • We believe it is necessary to screen the variants in MC4R gene in patients with severe childhood-onset obesity and who had early-onset obesity in at least one of their first-degree relatives in Turkish population.
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Affiliation(s)
- Ayça Aykut
- Department of Medical Genetics, Ege University School of Medicine, İzmir, Turkey
| | - Samim Özen
- Department of Pediatric Endocrinology, Ege University School of Medicine, İzmir, Turkey.
| | - Damla Gökşen
- Department of Pediatric Endocrinology, Ege University School of Medicine, İzmir, Turkey
| | - Aysun Ata
- Department of Pediatric Endocrinology, Ege University School of Medicine, İzmir, Turkey
| | - Hüseyin Onay
- Department of Medical Genetics, Ege University School of Medicine, İzmir, Turkey
| | - Tahir Atik
- Department of Pediatric Genetics, Ege University School of Medicine, İzmir, Turkey
| | - Şükran Darcan
- Department of Pediatric Endocrinology, Ege University School of Medicine, İzmir, Turkey
| | - Ferda Özkinay
- Department of Medical Genetics, Ege University School of Medicine, İzmir, Turkey ,Department of Pediatric Genetics, Ege University School of Medicine, İzmir, Turkey
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