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Stefater-Richards MA, Panciotti C, Feldman HA, Gourash WF, Shirley E, Hutchinson JN, Golick L, Park SW, Courcoulas AP, Stylopoulos N. Gut adaptation after gastric bypass in humans reveals metabolically significant shift in fuel metabolism. Obesity (Silver Spring) 2023; 31:49-61. [PMID: 36541157 PMCID: PMC10240542 DOI: 10.1002/oby.23585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/23/2022] [Accepted: 08/03/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Roux-en-Y gastric bypass surgery (RYGB) is among the most effective therapies for obesity and type 2 diabetes, and intestinal adaptation is a proposed mechanism for these effects. It was hypothesized that intestinal adaptation precedes and relates to metabolic improvement in humans after RYGB. METHODS This was a prospective, longitudinal, first-in-human study of gene expression (GE) in the "Roux limb" (RL) collected surgically/endoscopically from 19 patients with and without diabetes. GE was determined by microarray across six postoperative months, including at an early postoperative (1 month ± 15 days) time point. RESULTS RL GE demonstrated tissue remodeling and metabolic reprogramming, including increased glucose and amino acid use. RL GE signatures were established early, before maximal clinical response, and persisted. Distinct GE fingerprints predicted concurrent and future improvements in HbA1c and in weight. Human RL exhibited GE changes characterized by anabolic growth and shift in metabolic substrate use. Paradoxically, anabolic growth in RL appeared to contribute to the catabolic state elicited by RYGB. CONCLUSIONS These data support a role for a direct effect of intestinal energy metabolism to contribute to the beneficial clinical effects of RYGB, suggesting that related pathways might be potential targets of therapeutic interest for patients with obesity with or without type 2 diabetes.
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Affiliation(s)
- Margaret A. Stefater-Richards
- Center for Basic and Translational Obesity Research, Division of Endocrinology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Courtney Panciotti
- Center for Basic and Translational Obesity Research, Division of Endocrinology, Boston Children’s Hospital, Boston, MA
| | - Henry A. Feldman
- Harvard Medical School, Boston, MA
- Division of Endocrinology, Boston Children’s Hospital, Boston, MA
| | - William F. Gourash
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Eleanor Shirley
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John N. Hutchinson
- Harvard Medical School, Boston, MA
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | - Lena Golick
- Division of Endocrinology, Boston Children’s Hospital, Boston, MA
| | - Sang W. Park
- Harvard Medical School, Boston, MA
- Division of Endocrinology, Boston Children’s Hospital, Boston, MA
| | - Anita P. Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Nicholas Stylopoulos
- Center for Basic and Translational Obesity Research, Division of Endocrinology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Martinez EE, Panciotti C, Pereira LM, Kellogg MD, Stylopoulos N, Mehta NM. Gastrointestinal Hormone Profiles Associated With Enteral Nutrition Tolerance and Gastric Emptying in Pediatric Critical Illness: A Pilot Study. JPEN J Parenter Enteral Nutr 2019; 44:472-480. [PMID: 31304610 DOI: 10.1002/jpen.1678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 06/19/2019] [Accepted: 06/28/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Enteral nutrition (EN) intolerance and delayed gastric emptying are prevalent in pediatric critical illness and limit EN delivery. Gastrointestinal (GI) hormones may be associated with EN intolerance and delayed gastric emptying in this cohort. METHODS We determined GI hormone levels, time to achieve 50% of EN goal, and gastric emptying in critically ill children. Total amylin, active ghrelin, total glucagon-like peptide-1 (GLP-1), total gastric inhibitory polypeptide, glucagon, and total peptide-YY (PYY) were measured by multiplex assay and cholecystokinin by ELISA. Lower concentrations of acetaminophen at 1 hour (C1h, µg/mL) using the acetaminophen absorption test defined delayed gastric emptying. Correlation, regression analyses, and a principal component analysis were used to examine the association between GI hormones and time to 50% EN goal and C1h. RESULTS GI hormones were measured in 14 of 21 patients with gastric emptying testing; median age of 11.2 years (6.74-16.3) and 50% male. Increasing hormone levels from GI hormone profile 1 (GLP-1, glucagon, and amylin) correlated with greater time to reach 50% EN goal (R2 = 0.296, P = 0.04). Decreasing hormone levels from GI hormone profile 2 (PYY and ghrelin) correlated with lower C1h and slower gastric emptying (R2 = 0.342, P = 0.02). CONCLUSION GI hormone profiles are associated with time to achieve 50% of EN goal and gastric emptying in critically ill children. We have described a feasible model to study the role of GI hormones in this cohort, including the potential clinical applicability of GI hormone measurement in the management of delayed gastric emptying.
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Affiliation(s)
- Enid E Martinez
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Courtney Panciotti
- Department of Medicine, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Luis M Pereira
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Mark D Kellogg
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas Stylopoulos
- Department of Medicine, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nilesh M Mehta
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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3
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Meoli L, Ben-Zvi D, Panciotti C, Kvas S, Pizarro P, Munoz R, Stylopoulos N. Intestine-Specific Overexpression of LDLR Enhances Cholesterol Excretion and Induces Metabolic Changes in Male Mice. Endocrinology 2019; 160:744-758. [PMID: 30566603 PMCID: PMC6399722 DOI: 10.1210/en.2018-00098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 12/13/2018] [Indexed: 12/13/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) surgery is one of the most effective treatment options for severe obesity and related comorbidities, including hyperlipidemia, a well-established risk factor of cardiovascular diseases. Elucidating the molecular mechanisms underlying the beneficial effects of RYGB may facilitate development of equally effective, but less invasive, treatments. Recent studies have revealed that RYGB increases low-density lipoprotein receptor (LDLR) expression in the intestine of rodents. Therefore, in this study we first examined the effects of RYGB on intestinal cholesterol metabolism in human patients, and we show that they also exhibit profound changes and increased LDLR expression. We then hypothesized that the upregulation of intestinal LDLR may be sufficient to decrease circulating cholesterol levels. To this end, we generated and studied mice that overexpress human LDLR specifically in the intestine. This perturbation significantly affected intestinal metabolism, augmented fecal cholesterol excretion, and induced a reciprocal suppression of the machinery related to luminal cholesterol absorption and bile acid synthesis. Circulating cholesterol levels were significantly decreased and, remarkably, several other metabolic effects were similar to those observed in RYGB-treated rodents and patients, including improved glucose metabolism. These data highlight the importance of intestinal cholesterol metabolism for the beneficial metabolic effects of RYGB and for the treatment of hyperlipidemia.
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Affiliation(s)
- Luca Meoli
- Center for Basic and Translational Obesity Research, Boston Children’s Hospital, Boston, Massachusetts
- Division of Endocrinology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Danny Ben-Zvi
- Center for Basic and Translational Obesity Research, Boston Children’s Hospital, Boston, Massachusetts
- Division of Endocrinology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel–Canada, Hebrew University–Hadassah Medical School, Jerusalem, Israel
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts
| | - Courtney Panciotti
- Center for Basic and Translational Obesity Research, Boston Children’s Hospital, Boston, Massachusetts
- Division of Endocrinology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Stephanie Kvas
- Center for Basic and Translational Obesity Research, Boston Children’s Hospital, Boston, Massachusetts
- Division of Endocrinology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Palmenia Pizarro
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica, Santiago, Chile
| | - Rodrigo Munoz
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica, Santiago, Chile
| | - Nicholas Stylopoulos
- Center for Basic and Translational Obesity Research, Boston Children’s Hospital, Boston, Massachusetts
- Division of Endocrinology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Correspondence: Nicholas Stylopoulos, MD, Division of Endocrinology, CLS16066, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115.
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4
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Martinez E, Panciotti C, Stylopoulos N, Mehta N. 464. Crit Care Med 2019. [DOI: 10.1097/01.ccm.0000551216.99942.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Ben-Zvi D, Meoli L, Abidi WM, Nestoridi E, Panciotti C, Castillo E, Pizarro P, Shirley E, Gourash WF, Thompson CC, Munoz R, Clish CB, Anafi RC, Courcoulas AP, Stylopoulos N. Time-Dependent Molecular Responses Differ between Gastric Bypass and Dieting but Are Conserved Across Species. Cell Metab 2018; 28:310-323.e6. [PMID: 30043755 PMCID: PMC6628900 DOI: 10.1016/j.cmet.2018.06.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/19/2017] [Accepted: 06/04/2018] [Indexed: 12/22/2022]
Abstract
The effectiveness of Roux-en-Y gastric bypass (RYGB) against obesity and its comorbidities has generated excitement about developing new, less invasive treatments that use the same molecular mechanisms. Although controversial, RYGB-induced improvement of metabolic function may not depend entirely upon weight loss. To elucidate the differences between RYGB and dieting, we studied several individual organ molecular responses and generated an integrative, interorgan view of organismal physiology. We also compared murine and human molecular signatures. We show that, although dieting and RYGB can bring about the same degree of weight loss, post-RYGB physiology is very different. RYGB induces distinct, organ-specific adaptations in a temporal pattern that is characterized by energetically demanding processes, which may be coordinated by HIF1a activation and the systemic repression of growth hormone receptor signaling. Many of these responses are conserved in rodents and humans and may contribute to the remarkable ability of surgery to induce and sustain metabolic improvement.
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Affiliation(s)
- Danny Ben-Zvi
- Center for Basic and Translational Obesity Research, Division of Endocrinology, CLS16066, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel; Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA.
| | - Luca Meoli
- Center for Basic and Translational Obesity Research, Division of Endocrinology, CLS16066, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Wasif M Abidi
- Developmental Endoscopy Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Eirini Nestoridi
- Center for Basic and Translational Obesity Research, Division of Endocrinology, CLS16066, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Courtney Panciotti
- Center for Basic and Translational Obesity Research, Division of Endocrinology, CLS16066, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Erick Castillo
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica, Santiago 8331150, Chile
| | - Palmenia Pizarro
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica, Santiago 8331150, Chile
| | - Eleanor Shirley
- Division of Minimally Invasive and Metabolic Surgery, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - William F Gourash
- Division of Minimally Invasive and Metabolic Surgery, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Christopher C Thompson
- Developmental Endoscopy Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Rodrigo Munoz
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica, Santiago 8331150, Chile
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Ron C Anafi
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Anita P Courcoulas
- Division of Minimally Invasive and Metabolic Surgery, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Nicholas Stylopoulos
- Center for Basic and Translational Obesity Research, Division of Endocrinology, CLS16066, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.
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