Xu X Julia, Apovian Caroline, Hess Donald, Carmine Brian, Saha Asish, Ruderman Neil
Diabetes and Metabolism Unit, Section of Endocrinology, Department of Medicine, Boston University School of Medicine, Boston, MA
Diabetes and Metabolism Unit, Section of Endocrinology, Department of Medicine, Boston University School of Medicine, Boston, MA Nutrition and Weight Management Center, Boston University School of Medicine, Boston, MA.
Diabetes. 2015 Sep;64(9):3155-9. doi: 10.2337/db14-1765. Epub 2015 May 22.
Morbidly obese individuals are predisposed to a wide range of disorders, including type 2 diabetes, atherosclerotic cardiovascular disease, fatty liver disease, and certain cancers. Remarkably, all of these disorders can be improved or prevented by Roux-en-Y gastric bypass (RYGB) surgery. We have reported that decreased AMPK activity, together with increased oxidative stress and inflammation in adipose tissue, is associated with insulin resistance in morbidly obese bariatric surgery patients. In the current study, we assessed how these parameters are affected by RYGB surgery. Eleven patients (average age of 46 ± 4 years) were studied immediately prior to surgery and 3 months postoperatively. We measured subcutaneous adipose tissue AMPK phosphorylation (threonine 172, an index of its activation), malonyl-CoA content, protein carbonylation (a marker of oxidative stress), plasma adiponectin, and mRNA expression of several inflammatory cytokines. After surgery, AMPK activity increased 3.5-fold and oxidative stress decreased by 50% in subcutaneous adipose tissue. In addition, malonyl-CoA levels were reduced by 80%. Furthermore, patients had improvements in their BMI and insulin sensitivity (HOMA) and had increased circulating high-molecular weight adiponectin and decreased fasting plasma insulin levels. In contrast, the expression of inflammatory markers in subcutaneous adipose tissue was unchanged postoperatively, although plasma CRP was diminished by 50%.
病态肥胖个体易患多种疾病,包括2型糖尿病、动脉粥样硬化性心血管疾病、脂肪肝病和某些癌症。值得注意的是,所有这些疾病都可以通过Roux-en-Y胃旁路术(RYGB)得到改善或预防。我们曾报道,在病态肥胖的减肥手术患者中,AMPK活性降低,同时脂肪组织中的氧化应激和炎症增加,与胰岛素抵抗有关。在本研究中,我们评估了RYGB手术对这些参数的影响。对11名患者(平均年龄46±4岁)在手术前和术后3个月进行了研究。我们测量了皮下脂肪组织中AMPK的磷酸化(苏氨酸172,其激活指标)、丙二酰辅酶A含量、蛋白质羰基化(氧化应激标志物)、血浆脂联素以及几种炎性细胞因子的mRNA表达。手术后,皮下脂肪组织中AMPK活性增加了3.5倍,氧化应激降低了50%。此外,丙二酰辅酶A水平降低了80%。此外,患者的体重指数(BMI)和胰岛素敏感性(HOMA)有所改善循环中的高分子量脂联素增加,空腹血浆胰岛素水平降低。相比之下,皮下脂肪组织中炎症标志物的表达在术后没有变化,尽管血浆CRP降低了50%。