Visceral white adipose tissue and serum proteomic alternations in metabolically healthy obese patients undergoing bariatric surgery

Metabolically healthy obesity is characterized as a comorbidity-free obesity status, however the exact pathogenetic mechanisms implicated in its transition to unhealthy obesity have not yet been unveiled. Our aim was to investigate the effect of metabolic health on the proteomic profile both in serum and visceral fat of morbidly obese subjects. 28 patients undergoing bariatric surgery were prospectively enrolled. They were divided into two groups: metabolically healthy (MHO, n = 18) and unhealthy (MUO, n = 10) obese patients. 30 biomarkers were measured in serum and visceral adipose tissue with the use of targeted proteomic analysis (Luminex assays). TNF weak inducer of apoptosis (TWEAK) (p = 0.043), TNF related apoptosis inducing ligand (TRAIL) (p = 0.037), Growth differentiation factor-15 (GDF-15) (p = 0.04), Resistin (RETN) (p = 0.047), Matrix metalloproteinase-9 (MMP-9) (p = 0.011) and C-terminal telopeptide (ICTP) (p = 0.022) were up-regulated in the MUO group in the visceral white adipose tissue. Moreover, C-C motif ligand-3 (CCL-3) (p = 0.056), Interleukin-20 (IL-20) (p = 0.04), Prokineticin-1 (PROK-1) (p = 0.028) and TWEAK (p = 0.016) were found to be suppressed in the serum of MHO group. Significant correlations between serum and adipose tissue levels of certain cytokines were also observed, while 16 biomarkers were associated with BMI. Our results indicate metabolic health substantially attenuates the expression of TWEAK, TRAIL, GDF-15, RETN, MMP-9 and ICTP expression locally, in the visceral white adipose tissue, and the expression of CCL-3, IL-20, PROK-1 and TWEAK in the peripheral blood. Intriguingly, different cytokines except for TWEAK- are up-regulated in each site, suggesting that obesity is not a homogenous but a multi-dimensional disease.