Acylation stimulating protein reduction precedes insulin sensitization after BPD-DS bariatric surgery in severely obese women

Abstract

Objective:The mechanisms involved in early resolution of insulin resistance and type 2 diabetes mellitus after biliopancreatic diversion with duodenal switch (BPD-DS) surgery are still unknown. We evaluated early effects of BPD-DS on plasma acylation stimulating protein (ASP), an adipokine involved in lipid and glucose metabolism.Subjects:32 non-diabetic and 22 diabetic severely obese women (BMI⩾40 kg m−2) were evaluated for body composition and plasma parameters before, 24 h, 5 days, 6 and 12 months after surgery.Results:Within the early postoperative period (24 h), ASP decreased 25 and 30% in non-diabetic and diabetic women, respectively (P<0.001). Twenty-four hours after surgery, triglyceride, cholesterol, HDL-Chol, LDL-Chol and C3 also decreased, while glucose, insulin and high-sensitivity C-reactive protein (hsCRP) increased (all P<0.001). By 5 days, without significant weight loss, the decreases in ASP, cholesterol, HDL-Chol and LDL-Chol levels were all maintained. At this time, glucose, insulin and HOMA-IR also decreased 11 to 52% (all P<0.001). At 6 and 12 months, with pronounced weight loss and decreased per cent fat mass, there were further decreases in ASP (maximal −56% non-diabetic, −61% diabetic, P<0.001), as well as in glucose, insulin, HOMA-IR, triglyceride, cholesterol, LDL-Chol, HDL-Chol and hsCRP levels. Improved insulin resistance/diabetes at 5 days was predicted by 24 h changes as follows: per cent change ASP, HDL-Chol, hsCRP and total cholesterol predicted HOMA-IR (5 days) (r2=0.454, P<0.001), and per cent change ASP, HDL-Chol and hsCRP predicted change (5 days vs baseline) in HOMA-IR (r2=0.351, P<0.001).Conclusion:Acute postoperative decreases in ASP are associated with early improvement of insulin resistance/diabetes after BPD-DS surgery.

Biliopancreatic diversion with duodenal switch modifies plasma chemerin in early and late post‐operative periods

“…While restrictions were placed on the specific foods the BPD-DS subjects could consume there was no constraint on the number of calories. Elevated plasma glucose and insulin concentrations 24 h post-surgery in the BPD-DS subjects [Supporting Information Figure 1 and as previously published (30)] supports BPD-DS subjects were not in a fasted state at the time plasma chemerin declined. Accordingly, fasting is likely not responsible for the initial decrease in plasma total chemerin.…”

“…Blood samples were chelated with K 2 EDTA and plasma was separated and stored at 270 C until analysis. Additional subject characteristics and sample analysis procedures are described in the following publications (30)(31)(32)(33).…”

Cholinergic activation suppresses palmitate-induced macrophage activation and improves acylation stimulating protein resistance in co-cultured adipocytes

“…10 This study suggested that restoration of ASP sensitivity precedes physiological restitution of INS sensitivity. Interestingly, both C3KO mice receiving chronic recombinant ASP and C5L2KO mice fed a high fat or diabetogenic diet, both examples of induced ASP resistance, are accompanied by onset of INS resistance and inflammation.…”

Healthy Obese and Post Bariatric Patients - Metabolic and Vascular Patterns

“…Moreover, we noted that high presurgical hsCRP levels predicted an unfavourable postbariatric eff ect on insulin resistance. This is counterintuitive and needs further confi rmation, given that in the short run after bariatric surgery, hsCRP reduction predicts improved insulin sensitivity [ 34 ] . Furthermore, it would be interesting to include other adipocytokines into the equation of infl ammation, insulin resistance and eff ectivity of bariatric surgery, such as NAMPT [ 35 ] .…”