4.4 Article

Jejunal gluconeogenesis associated with insulin resistance level and its evolution after Roux-en-Y gastric bypass

Journal

SURGERY FOR OBESITY AND RELATED DISEASES
Volume 13, Issue 4, Pages 623-630

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.soard.2016.11.021

Keywords

Morbid obesity; Bariatric surgery; Type 2 diabetes; Insulin resistance; Metformin; Insulin; Leptin; Jejunum; Gluconeogenesis

Categories

Funding

  1. Institute de Salud Carlos III, Spain [PI12/00338]
  2. FEDER funds

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Background: Intestinal gluconeogenesis (GNG) may play an important role in glucose homeostasis, but there is little information about the condition in humans. Objectives: To study the relationship between intestinal GNG and insulin resistance, its association with the evolution of morbidly obese patients after bariatric surgery, and the effect of insulin and or leptin. Setting: Regional university hospital, Malaga (Spain). Methods: Jejunal mRNA expression of genes involved in GNG was analyzed in 3 groups of morbidly obese patients who underwent Roux-en-Y gastric bypass: with low insulin resistance (MO-low-IR), with high insulin resistance (MO-high-IR), and with type 2 diabetes treated with metformin (MO-metf-T2D). Also, intestinal epithelial cells (IEC) from MO-low-IR were incubated with different doses of insulin and or leptin. Results: In MO-high-IR, glutaminase, phosphoenolpyruvate carboxykinase (PEPCK), glucose 6-phosphatase (G6 Pase), peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1 alpha), and sterol regulatory element-binding proteins 1 c (SREBP-1 c) expressions were significantly higher than in MO-low-IR. In MO-metf-T2 D, only PEPCK was significantly lower than in MO-high-IR. In IEC, an incubation with a high glucose and insulin dose produced an increase of PEPCK and SREBP-1 c, and a decrease of glutaminase, fructose 1,6-bisphosphatase (FBPase), and PGC-1 alpha expression. At high doses of leptin, G6 Pase and FBPase were significantly increased. The improvement of insulin resistance 3 months after bariatric surgery was positively associated with high G6 Pase and FBPase expression. Conclusion: mRNA expression of genes involved in GNG is increased in the jejunum of MO-high-IR, and regulated by insulin and or leptin. High mRNA expression of genes involved in GNG is associated with a better evolution of insulin resistance after bariatric surgery. (C) 2017 American Society for Metabolic and Bariatric Surgery. All rights reserved.

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