Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China,
Obes Surg. 2013 Dec;23(12):2033-41. doi: 10.1007/s11695-013-0997-9.
BACKGROUND: Previous studies showed that early after Roux-en-Y gastric bypass (RYGB), there is a remarkable improvement in type 2 diabetes, which is characterized by insulin resistance. This study aims to gain insight into the underlying mechanisms of this effect. We determined the acute effects of RYGB on hepatic and peripheral insulin sensitivity. METHODS: A rat model of type 2 diabetes was established using high-fat diet combined with streptozotocin (30 mg/kg, ip). Animals were divided into four groups: diabetic, diabetic RYGB, diabetic RYGB sham, and control rats. Hyperinsulinemic-euglycemic clamps with tracer infusion were completed at 2 weeks postoperatively to assess insulin sensitivity. Triglyceride concentration in liver and muscle tissues was determined. Protein kinase C (PKC) membrane translocation, protein expression of phospho-c-Jun NH2-terminal kinase (JNK), and phospho-IκB kinase β (IKKβ) were assessed with western blot. Malondialdehyde (MDA) and superoxide dismutase (SOD) activities in the liver were also measured. RESULTS: RYGB surgery significantly improved hepatic insulin sensitivity index and decreased hepatic triglyceride concentration (P < 0.05), without an improvement in peripheral insulin sensitivity. Membrane translocation of PKC-ε, PKC-δ, and PKC-θ; the ratio of MDA to SOD; and the expression of p-JNK and p-IKKβ in the liver were lower in the diabetic RYGB group than in the diabetic group. CONCLUSIONS: Diabetes remission was induced at short term after RYGB. The improvement of hepatic tissue lipotoxicity decreased the activation of certain PKC isoforms, the activity of JNK and IKK inflammatory signaling pathways, and the degree of oxidative stress. Furthermore, the hepatic insulin sensitivity was ameliorated, which is possibly a mechanism for early diabetes remission.
背景:先前的研究表明,在 Roux-en-Y 胃旁路手术后(RYGB)早期,2 型糖尿病患者的胰岛素抵抗显著改善。本研究旨在深入了解这种效应的潜在机制。我们测定了 RYGB 对肝和外周胰岛素敏感性的急性影响。
方法:采用高脂肪饮食联合链脲佐菌素(30mg/kg,ip)建立 2 型糖尿病大鼠模型。动物分为 4 组:糖尿病组、糖尿病 RYGB 组、糖尿病 RYGB 假手术组和对照组大鼠。术后 2 周行高胰岛素-正葡萄糖钳夹实验,并用示踪剂输注评估胰岛素敏感性。测定肝和肌肉组织中的甘油三酯浓度。用 Western blot 测定蛋白激酶 C(PKC)膜易位、磷酸化 c-Jun NH2-末端激酶(JNK)和磷酸化 IκB 激酶β(IKKβ)的蛋白表达。还测定了肝组织中的丙二醛(MDA)和超氧化物歧化酶(SOD)活性。
结果:RYGB 手术显著改善了肝胰岛素敏感指数,降低了肝甘油三酯浓度(P<0.05),但外周胰岛素敏感性没有改善。PKC-ε、PKC-δ和 PKC-θ的膜易位;MDA/SOD 比值;以及肝组织中 p-JNK 和 p-IKKβ 的表达在糖尿病 RYGB 组均低于糖尿病组。
结论:RYGB 术后短期内诱导糖尿病缓解。肝组织脂毒性的改善降低了某些 PKC 同工型、JNK 和 IKK 炎症信号通路的活性以及氧化应激程度。此外,肝胰岛素敏感性得到改善,这可能是早期糖尿病缓解的机制之一。
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