Metabolic shift precedes the resolution of inflammation in a cohort of patients undergoing bariatric and metabolic surgery

Abstract

Bariatric and metabolic surgery has shown to promote weight loss and reduce systemic inflammation. However, the sequence and timing of events regarding metabolic improvement and inflammation resolution has been rarely explored. Furthermore, data on inflammatory markers of Th17 and Th1 cell responses after bariatric surgery is scarce. We conducted a prospective study in subjects with obesity that underwent bariatric and metabolic surgery, with follow-ups at 3 and 6 months. Anthropometric and metabolic markers such as insulin levels, HOMA-IR, and lipid parameters declined significantly 3 months after surgery; while hs-CRP, TNF-α, IL-1β, IL-6, and IL-8 serum concentrations decreased 6 months after the procedure. Concentrations of Th1 signature and driver cytokines, particularly IFN-γ, IL-12, and IL-18, and of Th17 driver IL-23 also decreased significantly after 6 months. Significant positive correlations between triglyceride levels and hs-CRP, IL-1β, and IFN-γ concentrations, and between Apo B and IFN-γ levels were observed 6 months after bariatric and metabolic surgery. In addition, BMI was associated with hs-CRP and TNF-α concentrations. Fat mass correlated with hs-CRP, TNF-α, and IL-12. Analysis of the temporality of metabolic and inflammatory events suggests that improvement in the metabolic status occurs before resolution of systemic inflammation and may be a requisite for the later event.

Increased inflammatory low-density neutrophils in severe obesity and effect of bariatric surgery: Results from case-control and prospective cohort studies

“…Seventy-two percent (26/36) of patients at 3 months achieved an excess weight loss (EBWL) ≥ 25% and 47% (17/36) succeeded ≥ 45% EBWL at 6 months ( Table 1 ). As bariatric surgery has shown an important impact on different inflammatory markers, 4 , 5 , 6 we also determined if bariatric surgery affected the accumulation of LDN in circulation as an indicator of improvement of inflammation. For this, we tested the effect of bariatric surgery on LDN in the peripheral blood of MOP in a prospective longitudinal study.…”

“… 3 Also, recent studies have shown that bariatric surgery significantly reduces several inflammatory mediators such as cytokines, hormones, and acute phase reactants, 4 , 5 most likely as a result of the resolution of metabolic disturbances. 6 However, much less is known about inflammatory cells. Prior research has shown that different stages of adiposity (overweight, obesity, and severe obesity) favor the accumulation of myeloid cells including macrophages, 7 and neutrophils.…”

Macrophages, Low-Grade Inflammation, Insulin Resistance and Hyperinsulinemia: A Mutual Ambiguous Relationship in the Development of Metabolic Diseases

“…Similarly, metabolic parameters improved after bariatric surgery already after three months, whereas it took six months in the same cohort of patients to achieve a significant improvement in the body mass index and a reduction in the circulating pro-inflammatory cytokine levels, among others TNFα, IL-1β and IL-6 [ 157 ]. Notably, circulating MCP1 levels did not significantly decrease during the observation period in this study.…”

An Explanation for the Adiponectin Paradox

“…Overnutritioninduced adipocyte hypertrophy thereby promotes the development of insulin resistance, chronic inflammation, macrophage infiltration into the adipose tissue, mitochondrial dysfunction and ultimately adipocyte death [8,9]. These negative consequences of overnutrition are reversed by drastic reduction in food intake [6,10], as well as by bariatric surgery [8,[11][12][13][14], and are accompanied by a normalization of serum adiponectin levels [7,[10][11][12][13]. Consequently, hypoadiponectinemia is considered both a risk factor [15,16] and a biomarker [17][18][19] of type 2 diabetes.…”