Cardiovascular, Renal and Metabolic Diseases, MedImmune LLC, Gaithersburg, MD, USA.
Pennington Biomedical Research Center, Baton Rouge, LA, USA.
Mol Metab. 2019 Jul;25:64-72. doi: 10.1016/j.molmet.2019.05.004. Epub 2019 May 9.
Understanding the mechanisms underlying the remarkable beneficial effects of gastric bypass surgery is important for the development of non-surgical therapies or less invasive surgeries in the fight against obesity and metabolic disease. Although the intestinal L-cell hormones glucagon-like peptide-1 (GLP-1) and peptide tyrosine-tyrosine (PYY) have attracted the most attention, direct tests in humans and rodents with pharmacological blockade or genetic deletion of either the GLP1-receptor (GLP1R) or the Y2-receptor (Y2R) were unable to confirm their critical roles in the beneficial effects gastric bypass surgery on body weight and glucose homeostasis. However, new awareness of the power of combinatorial therapies in the treatment of metabolic disease would suggest that combined blockade of more than one signaling pathway may be necessary to reverse the beneficial effects of bariatric surgery.
The metabolic effects of high-fat diet and the ability of Roux-en-Y gastric bypass surgery to lower food intake and body weight, as well as improve glucose handling, was tested in GLP1R and Y2R-double knockout (GLP1RKO/Y2RKO) and C57BL6J wildtype (WT) mice.
GLP1RKO/Y2RKO and WT mice responded similarly for up to 20 weeks on high-fat diet and 16 weeks after RYGB. There were no significant differences in loss of body and liver weight, fat mass, reduced food intake, relative increase in energy expenditure, improved fasting insulin, glucose tolerance, and insulin tolerance between WT and GLP1RKO/Y2RKO mice after RYGB.
Combined loss of GLP1R and Y2R-signaling was not able to negate or attenuate the beneficial effects of RYGB on body weight and glucose homeostasis in mice, suggesting that a larger number of signaling pathways is involved or that the critical pathway has not yet been identified.
了解胃旁路手术显著有益效果的机制对于开发非手术治疗或较少侵入性手术以对抗肥胖和代谢性疾病非常重要。尽管肠 L 细胞激素胰高血糖素样肽 1(GLP-1)和肽酪氨酸-酪氨酸(PYY)引起了最多的关注,但在人类和啮齿动物中进行的药理学阻断或 GLP1 受体(GLP1R)或 Y2 受体(Y2R)的基因缺失的直接测试无法证实它们在胃旁路手术对体重和葡萄糖稳态的有益作用中的关键作用。然而,人们对代谢性疾病联合治疗的作用有了新的认识,这表明可能需要联合阻断多种信号通路才能逆转减肥手术的有益作用。
高脂肪饮食的代谢作用以及 Roux-en-Y 胃旁路手术降低食物摄入量和体重以及改善葡萄糖处理的能力,在 GLP1R 和 Y2R 双重敲除(GLP1RKO/Y2RKO)和 C57BL6J 野生型(WT)小鼠中进行了测试。
GLP1RKO/Y2RKO 和 WT 小鼠在高脂肪饮食上最多可维持 20 周,RYGB 后可维持 16 周。RYGB 后,WT 和 GLP1RKO/Y2RKO 小鼠之间在体重和肝重、脂肪量、食物摄入量减少、相对能量消耗增加、空腹胰岛素、葡萄糖耐量和胰岛素耐量改善方面没有显着差异。
联合丧失 GLP1R 和 Y2R 信号传导不能否定或减弱 RYGB 对小鼠体重和葡萄糖稳态的有益作用,这表明涉及更多的信号通路,或者尚未确定关键通路。