Faculty Opinions recommendation of Jejunal nutrient sensing is required for duodenal-jejunal bypass surgery to rapidly lower glucose concentrations in uncontrolled diabetes.

Background: Epigenomic changes occurring during surgery have been neglected in research; diabetes and hypertension can affect the epigenome but little is known about the epigenetics of skeletal muscle (SKM). Methods: DNA methylation was profiled via Illumina MethylationEPIC arrays in SKM samples obtained at the beginning and end of heart surgery with cardiopulmonary bypass. Results: Methylation in patients with hypertension and diabetes was significantly different, more so for uncontrolled diabetes; hypertension alone produced minimal effect. The affected pathways involved IL-1, IL-12, IL-18, TNF-α, IFNγ, VEGF, NF-κB and Wnt signaling, apoptosis and DNA damage response. Significant changes occurred during surgery and included loci in the Hippo–YAP/TAZ pathway. Conclusion: Cardiopulmonary bypass surgery affects the SKM methylome, and the combination of hypertension and diabetes induces changes in the SKM epigenome in contrast to hypertension alone.

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Deactivation of the NLRP3 inflammasome in infiltrating macrophages by duodenal-jejunal bypass surgery mediates improvement of beta cell function in type 2 diabetes

Metabolism ◽

10.1016/j.metabol.2017.10.015 ◽

2018 ◽

Vol 81 ◽

pp. 1-12 ◽

Cited By ~ 9

Author(s):

Dong Wu ◽

Zhi-bo Yan ◽

Yu-gang Cheng ◽

Ming-wei Zhong ◽

Shao-zhuang Liu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Beta Cell ◽

Nlrp3 Inflammasome ◽

Beta Cell Function ◽

Bypass Surgery ◽

Cell Function ◽

Jejunal Bypass

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Exclusion of the Distal Ileum Cannot Reverse the Anti-Diabetic Effects of Duodenal-Jejunal Bypass Surgery

Obesity Surgery ◽

10.1007/s11695-015-1745-0 ◽

2015 ◽

Vol 26 (2) ◽

pp. 261-268 ◽

Cited By ~ 7

Author(s):

Jie Chai ◽

Guangyong Zhang ◽

Shaozhuang Liu ◽

Chunxiao Hu ◽

Haifeng Han ◽

...

Keyword(s):

Bypass Surgery ◽

Distal Ileum ◽

Jejunal Bypass

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Glycemic control after stomach-sparing duodenal-jejunal bypass surgery in diabetic patients with low body mass index

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2012.01.017 ◽

2012 ◽

Vol 8 (4) ◽

pp. 375-380 ◽

Cited By ~ 31

Author(s):

Ricardo Cohen ◽

Pedro Paulo Caravatto ◽

Jose Luis Correa ◽

Patricia Noujaim ◽

Tarissa Zanata Petry ◽

...

Keyword(s):

Body Mass Index ◽

Glycemic Control ◽

Body Mass ◽

Bypass Surgery ◽

Diabetic Patients ◽

Low Body Mass Index ◽

Jejunal Bypass

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The EndoBarrier: Duodenal-Jejunal Bypass Liner for Diabetes and Weight Loss

Gastroenterology Research and Practice ◽

10.1155/2018/7823182 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 15

Author(s):

Aruchuna Ruban ◽

Hutan Ashrafian ◽

Julian P. Teare

Keyword(s):

Weight Loss ◽

Bypass Surgery ◽

Clinical Evidence ◽

Gastric Bypass Surgery ◽

Rapid Rise ◽

Mortality And Morbidity ◽

Increased Risk ◽

Global Threat ◽

Jejunal Bypass

The rapid rise of obesity and type 2 diabetes poses a global threat to healthcare and is a major cause of mortality and morbidity. Bariatric surgery has revolutionised the treatment of both these conditions but is invasive and associated with an increased risk of complications. The EndoBarrier is a device placed endoscopically in the duodenum, which is designed to mimic the effects of gastric bypass surgery with the aim of inducing weight loss and improving glycaemic control. This review outlines the current clinical evidence of the device, its efficacy, potential mechanisms of action, and utility in clinical practice.

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Intestinal adaptation and Reg gene expression induced by antidiabetic duodenal-jejunal bypass surgery in Zucker fatty rats

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00275.2012 ◽

2013 ◽

Vol 304 (7) ◽

pp. G635-G645 ◽

Cited By ~ 20

Author(s):

Bing Li ◽

Yarong Lu ◽

Coimbatore B. Srikant ◽

Zu-Hua Gao ◽

Jun-Li Liu

Keyword(s):

Intestinal Mucosa ◽

Bypass Surgery ◽

Intestinal Adaptation ◽

Morbidly Obese ◽

Epithelial Proliferation ◽

Significant Weight Loss ◽

Specific Expression ◽

Growth And Survival ◽

Starting Point ◽

Jejunal Bypass

The antidiabetic mechanism of bariatric surgery includes specific changes in the secretion of incretins. To identify additional players originating from the gut, we evaluated the effects of duodenal-jejunal bypass (DJB) in morbidly obese Zucker fatty rats. A fast relief of hyperglycemia and hyperinsulinemia was achieved even before a significant weight loss occurred. Fourteen days after DJB, we characterized the changes in intestinal histochemistry in the bypassed duodenum and shortcut jejunum that was reanastomosed directly to the starting point of the duodenum and compared with the corresponding regions of sham-operated rats. The bypassed duodenum exhibited mucosal atrophy and apoptosis and decreased proliferative renewal. In shortcut jejunum, DJB resulted in 40% significantly enlarged intestinal circumference and increased epithelial proliferation, especially in putative transit-amplifying (TA) cells and the crypt. Because Reg family proteins promote cell growth and survival, we explored their expression in the intestine. With the use of immunohistochemistry, Reg1, -3α, and -3β were normally expressed in intestinal mucosa. After DJB, the level of Reg1 protein was reduced, whereas Reg3α and -3β were not changed in bypassed duodenum. Downstream in shortcut jejunum, the levels of Reg1 and -3β were greatly induced and especially concentrated in the putative TA cells. Our results revealed significant changes in the integrity and proliferation of the intestinal mucosa as a consequence of DJB, and in cell- and isoform-specific expression of Reg proteins within the replicating mucosal epithelium, and provide evidence indicating that the activation of Reg proteins may contribute to intestinal compensation against increased load and/or to improving insulin sensitivity.

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High Iron Feeding Modulates Glucose Metabolism in Duodenal-Jejunal Bypass Surgery but Not in Vertical Sleeve Gastrectomy in Mice

Diabetes ◽

10.2337/db18-2023-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 2023-P

Author(s):

JINGJING NIU ◽

JONATHAN D. DOUROS ◽

JONATHAN CAMPBELL ◽

MEGAN CAPOZZI ◽

SARAH M. GRAY ◽

...

Keyword(s):

Sleeve Gastrectomy ◽

Glucose Metabolism ◽

Bypass Surgery ◽

Vertical Sleeve Gastrectomy ◽

High Iron ◽

Jejunal Bypass

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Effects of Obesity and Gastric Bypass Surgery on Nutrient Sensors, Endocrine Cells, and Mucosal Innervation of the Mouse Colon

Nutrients ◽

10.3390/nu10101529 ◽

2018 ◽

Vol 10 (10) ◽

pp. 1529 ◽

Cited By ~ 10

Author(s):

Madusha Peiris ◽

Rubina Aktar ◽

Sarah Raynel ◽

Zheng Hao ◽

Michael Mumphrey ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Calorie Restriction ◽

Cell Activation ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Nerve Fibers ◽

Nutrient Sensing ◽

Ec Cells ◽

Mucosal Innervation

Background: Nutrient-sensing receptors located on enteroendocrine (EEC) cells modulate appetite via detection of luminal contents. Colonic ‘tasting’ of luminal contents may influence changes to appetite observed in obesity and after weight loss induced by bariatric surgery. We assessed the effects of obesity and gastric bypass-induced weight loss on expression of nutrient-sensing G-protein coupled receptors (GPCRs), EEC and enterochromaffin (EC) cells and mucosal innervation. Methods: qPCR and immunohistochemistry were used to study colonic tissue from (a) chow-fed/lean, (b) high-fat fed/obese, (c) Roux-en-Y gastric bypass surgery (RYGB), and (d) calorie restriction-induced weight loss mice. Results: Expression of GPR41, GPR43, GPR40, GPR120, GPR84, GPR119, GPR93 and T1R3 was increased in obese mice. Obesity-induced overexpression of GPR41, 40, 84, and 119 further increased after RYGB whereas GPR120 and T1R3 decreased. RYGB increased TGR5 expression. L-cells, but not EC cells, were increased after RYGB. No differences in mucosal innervation by protein gene product (PGP) 9.5 and GLP-1R-positive nerve fibers were observed. Stimulation of colonic mucosa with GPR41, GPR40, GPR85, GPR119, and TGR5 agonists increased cell activation marker expression. Conclusions: Several nutrient-sensing receptors induced activation of colonic EEC. Profound adaptive changes to the expression of these receptors occur in response to diet and weight loss induced by RYGB or calorie restriction.

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