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Zakeri R, Carnemolla A, Marvasti P, Mok J, Jassil F, Chaiyasoot K, Lichfield J, Alves M, Mansoor R, Omar R, Batterham R. O106 Maximising the benefits of bariatric surgery through targeting ghrelin: a randomised, double-blind, placebo-controlled crossover study in people with suboptimal weight loss after bariatric surgery. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction
One in 5 people have a suboptimal weight-loss (WL) response to bariatric surgery. The causes are unclear, but patients report resumed hunger and increased food intake, eating behaviours driven by the orexigenic hormone, ghrelin. This proof-of-concept study aimed to evaluate the impact of reducing circulating acyl-ghrelin, the biologically active isoform, on appetite and energy intake in people with suboptimal WL and aberrant ghrelin profile after bariatric surgery.
Methods
Thirty-five patients with <20%WL from 12 months after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) and aberrant circulating ghrelin profile underwent 10 days of treatment with a novel, highly-selective ghrelin o-acyltransferase inhibitor, GLWL-01, and placebo. The primary endpoint was within-person change in ad libitum energy intake during a test meal on day 10. Secondary endpoints assessed subjective appetite, food cravings, macronutrient intake, gut hormones, cardiometabolic profile and body composition. Ethical approval was obtained.
Results
Thirty-one participants (26 RYGB, 9 SG) completed both cycles. GLWL-01 produced a 58.9±27.2% decrease in fasting plasma acyl-ghrelin and 29.3±27.1% increase in desacyl-ghrelin after 10 days. Marked reduction in subjective hunger, food cravings and hedonic influence on appetite was observed with GLWL-01, however objective appetite measures – ad libitum and free-living energy intake – did not change. Circulating levels of cardiovascular risk-conferring lipoproteins significantly improved and no adverse impact on glycaemic control was observed.
Conclusion
Pharmacological modulation of the ghrelin system may be used as part of a personalised therapeutic approach to optimise clinical outcomes in patients with suboptimal WL after bariatric surgery.
Take-home message
This first-in-human mechanistic study shows that pharmacological modulation of the ghrelin system is a promising therapeutic strategy for maximising weight loss response to bariatric surgery.
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Affiliation(s)
- R Zakeri
- Centre for Obesity Research, University College London
- Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Foundation Trust
- National Institute of Health Research UCLH Biomedical Research Centre
| | - A Carnemolla
- Centre for Obesity Research, University College London
| | - P Marvasti
- Centre for Obesity Research, University College London
| | - J Mok
- Centre for Obesity Research, University College London
- Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Foundation Trust
| | - F Jassil
- Centre for Obesity Research, University College London
- Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Foundation Trust
| | - K Chaiyasoot
- Centre for Obesity Research, University College London
- Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Foundation Trust
| | - J Lichfield
- Centre for Obesity Research, University College London
| | - M Alves
- Unit for Multidisciplinary Research in Biomedicine, University of Porto
| | - R Mansoor
- Department of Statistical Science, University College London
| | - R Omar
- Department of Statistical Science, University College London
| | - R Batterham
- Centre for Obesity Research, University College London
- Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Foundation Trust
- National Institute of Health Research UCLH Biomedical Research Centre
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