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Erschienen in: Obesity Surgery 12/2013

01.12.2013 | Original Contributions

Amelioration in Hepatic Insulin Sensitivity by Reduced Hepatic Lipid Accumulation at Short-Term After Roux-en-Y Gastric Bypass Surgery in Type 2 Diabetic Rats

verfasst von: Bing He, Dongxu Piao, Chong Yu, Yong Wang, Ping Han

Erschienen in: Obesity Surgery | Ausgabe 12/2013

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Abstract

Background

Previous studies showed that early after Roux-en-Y gastric bypass (RYGB), there is a remarkable improvement in type 2 diabetes, which is characterized by insulin resistance. This study aims to gain insight into the underlying mechanisms of this effect. We determined the acute effects of RYGB on hepatic and peripheral insulin sensitivity.

Methods

A rat model of type 2 diabetes was established using high-fat diet combined with streptozotocin (30 mg/kg, ip). Animals were divided into four groups: diabetic, diabetic RYGB, diabetic RYGB sham, and control rats. Hyperinsulinemic-euglycemic clamps with tracer infusion were completed at 2 weeks postoperatively to assess insulin sensitivity. Triglyceride concentration in liver and muscle tissues was determined. Protein kinase C (PKC) membrane translocation, protein expression of phospho-c-Jun NH2-terminal kinase (JNK), and phospho-IκB kinase β (IKKβ) were assessed with western blot. Malondialdehyde (MDA) and superoxide dismutase (SOD) activities in the liver were also measured.

Results

RYGB surgery significantly improved hepatic insulin sensitivity index and decreased hepatic triglyceride concentration (P < 0.05), without an improvement in peripheral insulin sensitivity. Membrane translocation of PKC-ε, PKC-δ, and PKC-θ; the ratio of MDA to SOD; and the expression of p-JNK and p-IKKβ in the liver were lower in the diabetic RYGB group than in the diabetic group.

Conclusions

Diabetes remission was induced at short term after RYGB. The improvement of hepatic tissue lipotoxicity decreased the activation of certain PKC isoforms, the activity of JNK and IKK inflammatory signaling pathways, and the degree of oxidative stress. Furthermore, the hepatic insulin sensitivity was ameliorated, which is possibly a mechanism for early diabetes remission.
Literatur
1.
Zurück zum Zitat Danaei G, Finucane MM, Lu Y, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systemic analysis of health examination surveys and epidemiological studies with 370 county-years and 2.7 million participants. Lancet. 2011;378(9785):31–40.PubMedCrossRef Danaei G, Finucane MM, Lu Y, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systemic analysis of health examination surveys and epidemiological studies with 370 county-years and 2.7 million participants. Lancet. 2011;378(9785):31–40.PubMedCrossRef
2.
Zurück zum Zitat Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56.PubMedCrossRef Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56.PubMedCrossRef
3.
Zurück zum Zitat Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316–23.PubMedCrossRef Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316–23.PubMedCrossRef
4.
Zurück zum Zitat Greco AV, Mingrone G, Giancaterini A, et al. Insulin resistance in morbid obesity: reversal with intramyocellular fat depletion. Diabetes. 2002;51(1):144–51.PubMedCrossRef Greco AV, Mingrone G, Giancaterini A, et al. Insulin resistance in morbid obesity: reversal with intramyocellular fat depletion. Diabetes. 2002;51(1):144–51.PubMedCrossRef
5.
Zurück zum Zitat Burstein R, Epstein Y, Charuzi I, et al. Glucose utilization in morbidly obese subjects before and after weight loss by gastric bypass operation. Int J Obes Relat Metab Disord. 1995;19(8):558–61.PubMed Burstein R, Epstein Y, Charuzi I, et al. Glucose utilization in morbidly obese subjects before and after weight loss by gastric bypass operation. Int J Obes Relat Metab Disord. 1995;19(8):558–61.PubMed
6.
Zurück zum Zitat Gastaldi G, Russell A, Golay A, et al. Upregulation of peroxisome proliferator-activated receptor gamma coactivator gene (PGC1A) during weight loss is related to insulin sensitivity but not to energy expenditure. Diabetologia. 2007;50(11):2348–55.PubMedCrossRef Gastaldi G, Russell A, Golay A, et al. Upregulation of peroxisome proliferator-activated receptor gamma coactivator gene (PGC1A) during weight loss is related to insulin sensitivity but not to energy expenditure. Diabetologia. 2007;50(11):2348–55.PubMedCrossRef
7.
Zurück zum Zitat Camastra S, Gastaldelli A, Mari A, et al. Early and longer term effects of gastric bypass surgery on tissue-specific insulin sensitivity and beta cell function in morbidly obese patients with and without type 2 diabetes. Diabetologia. 2011;54(8):2093–102.PubMedCrossRef Camastra S, Gastaldelli A, Mari A, et al. Early and longer term effects of gastric bypass surgery on tissue-specific insulin sensitivity and beta cell function in morbidly obese patients with and without type 2 diabetes. Diabetologia. 2011;54(8):2093–102.PubMedCrossRef
8.
Zurück zum Zitat Fabbrini E, Tamboli RA, Magkos F, et al. Surgical removal of omental fat does not improve insulin sensitivity and cardiovascular risk factors in obese adults. Gastroenterology. 2010;139(2):448–55.PubMedCrossRef Fabbrini E, Tamboli RA, Magkos F, et al. Surgical removal of omental fat does not improve insulin sensitivity and cardiovascular risk factors in obese adults. Gastroenterology. 2010;139(2):448–55.PubMedCrossRef
9.
Zurück zum Zitat Gregor MF, Yang L, Fabbrini E, et al. Endoplasmic reticulum stress is reduced in tissues of obese subjects after weight loss. Diabetes. 2009;58(3):693–700.PubMedCrossRef Gregor MF, Yang L, Fabbrini E, et al. Endoplasmic reticulum stress is reduced in tissues of obese subjects after weight loss. Diabetes. 2009;58(3):693–700.PubMedCrossRef
10.
Zurück zum Zitat Lima MM, Pareja JC, Alegre SM, et al. Acute effect of Roux-en-Y gastric bypass on whole-body insulin sensitivity: a study with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95(8):3871–5.PubMedCrossRef Lima MM, Pareja JC, Alegre SM, et al. Acute effect of Roux-en-Y gastric bypass on whole-body insulin sensitivity: a study with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95(8):3871–5.PubMedCrossRef
11.
Zurück zum Zitat Campos GM, Rabl C, Peeva S, et al. Improvement in peripheral glucose uptake after gastric bypass surgery is observed only after substantial weight loss has occurred and correlates with the magnitude of weight lost. J Gastrointest Surg. 2010;14(1):15–23.PubMedCrossRef Campos GM, Rabl C, Peeva S, et al. Improvement in peripheral glucose uptake after gastric bypass surgery is observed only after substantial weight loss has occurred and correlates with the magnitude of weight lost. J Gastrointest Surg. 2010;14(1):15–23.PubMedCrossRef
12.
Zurück zum Zitat Srinivasan K, Viswanad B, Asrat L, et al. Combination of high-fat diet-fed and low-dose streptozotocin-treated rat: a model for type 2 diabetes and pharmacological screening. Pharmacol Res. 2005;52(4):313–20.PubMedCrossRef Srinivasan K, Viswanad B, Asrat L, et al. Combination of high-fat diet-fed and low-dose streptozotocin-treated rat: a model for type 2 diabetes and pharmacological screening. Pharmacol Res. 2005;52(4):313–20.PubMedCrossRef
13.
Zurück zum Zitat Lam TK, Yoshii H, Haber CA, et al. Free fatty acid-induced hepatic insulin resistance: a potential role for protein kinase C-delta. Am J Physiol Endocrinol Metab. 2002;283(4):E682–91.PubMed Lam TK, Yoshii H, Haber CA, et al. Free fatty acid-induced hepatic insulin resistance: a potential role for protein kinase C-delta. Am J Physiol Endocrinol Metab. 2002;283(4):E682–91.PubMed
14.
Zurück zum Zitat Shearer J, Duggan G, Weljie A, et al. Metabolomic profiling of dietary-induced insulin resistance in the high fat-fed C57BL/6J mouse. Diabetes Obes Metab. 2008;10(10):950–8.PubMedCrossRef Shearer J, Duggan G, Weljie A, et al. Metabolomic profiling of dietary-induced insulin resistance in the high fat-fed C57BL/6J mouse. Diabetes Obes Metab. 2008;10(10):950–8.PubMedCrossRef
15.
Zurück zum Zitat Koopman R, Schaart G, Hesselink MK. Optimisation of oil red O staining permits combination with immunofluorescence and automated quantification of lipids. Histochem Cell Biol. 2001;116(1):63–8.PubMed Koopman R, Schaart G, Hesselink MK. Optimisation of oil red O staining permits combination with immunofluorescence and automated quantification of lipids. Histochem Cell Biol. 2001;116(1):63–8.PubMed
16.
Zurück zum Zitat Yu C, Chen Y, Cline GW, et al. Mechanism by which fatty acids inhibit insulin activation of insulin receptor substrate-1 (IRS-1)-associated phosphatidylinositol 3-kinase activity in muscle. J Biol Chem. 2002;277(52):50230–6.PubMedCrossRef Yu C, Chen Y, Cline GW, et al. Mechanism by which fatty acids inhibit insulin activation of insulin receptor substrate-1 (IRS-1)-associated phosphatidylinositol 3-kinase activity in muscle. J Biol Chem. 2002;277(52):50230–6.PubMedCrossRef
17.
Zurück zum Zitat Qu X, Seale JP, Donnelly R. Tissue and isoform-selective activation of protein kinase C in insulin-resistant obese Zucker rats-effects of feeding. J Endocrinol. 1999;162(2):207–14.PubMedCrossRef Qu X, Seale JP, Donnelly R. Tissue and isoform-selective activation of protein kinase C in insulin-resistant obese Zucker rats-effects of feeding. J Endocrinol. 1999;162(2):207–14.PubMedCrossRef
18.
Zurück zum Zitat Ohkawa H, Ohishi N, Yagi K. Assay for lipid peroxides in animal tissues by thiobarbituric acid reaction. Anal Biochem. 1979;95(2):351–8.PubMedCrossRef Ohkawa H, Ohishi N, Yagi K. Assay for lipid peroxides in animal tissues by thiobarbituric acid reaction. Anal Biochem. 1979;95(2):351–8.PubMedCrossRef
19.
Zurück zum Zitat Marklund S, Marklund G. Involvement of the superoxide anion radical in the autoxidation of pyrogallol and a convenient assay for superoxide dismutase. Eur J Biochem. 1974;47(3):469–74.PubMedCrossRef Marklund S, Marklund G. Involvement of the superoxide anion radical in the autoxidation of pyrogallol and a convenient assay for superoxide dismutase. Eur J Biochem. 1974;47(3):469–74.PubMedCrossRef
20.
Zurück zum Zitat Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care. 1999;22(9):1462–70.PubMedCrossRef Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care. 1999;22(9):1462–70.PubMedCrossRef
21.
Zurück zum Zitat Schmitz-Peiffer C, Browne CL, Oakes ND, et al. Alterations in the expression and cellular localization of protein kinase C isozymes epsilon and theta are associated with insulin resistance in skeletal muscle of the high-fat-fed rat. Diabetes. 1997;46(2):169–78.PubMedCrossRef Schmitz-Peiffer C, Browne CL, Oakes ND, et al. Alterations in the expression and cellular localization of protein kinase C isozymes epsilon and theta are associated with insulin resistance in skeletal muscle of the high-fat-fed rat. Diabetes. 1997;46(2):169–78.PubMedCrossRef
22.
Zurück zum Zitat American Diabetes Association. Standards of medical care in diabetes 2011. Diabetes Care. 2011;34(5):e53.CrossRef American Diabetes Association. Standards of medical care in diabetes 2011. Diabetes Care. 2011;34(5):e53.CrossRef
23.
Zurück zum Zitat Liu Y, Zhou Y, Wang Y, et al. Rouxen-Y gastric bypass-induced improvement of glucose tolerance and insulin resistance in type 2 diabetic rats are mediated by glucagon-like peptide-1. Obes Surg. 2011;21(9):1424–31.PubMedCrossRef Liu Y, Zhou Y, Wang Y, et al. Rouxen-Y gastric bypass-induced improvement of glucose tolerance and insulin resistance in type 2 diabetic rats are mediated by glucagon-like peptide-1. Obes Surg. 2011;21(9):1424–31.PubMedCrossRef
24.
Zurück zum Zitat Chambers AP, Jessen L, Ryan KK, et al. Weight-independent changes in blood glucose homeostasis after gastric bypass or vertical sleeve gastrectomy in rats. Gastroenterology. 2011;141(3):950–8.PubMedCrossRef Chambers AP, Jessen L, Ryan KK, et al. Weight-independent changes in blood glucose homeostasis after gastric bypass or vertical sleeve gastrectomy in rats. Gastroenterology. 2011;141(3):950–8.PubMedCrossRef
25.
Zurück zum Zitat Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244(5):741–9.PubMedCrossRef Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244(5):741–9.PubMedCrossRef
26.
Zurück zum Zitat Rizza RA, Mandarino LJ, Gerich JE. Dose–response characteristics for effects of insulin on production and utilization of glucose in man. Am J Physiol. 1981;240(6):E630–9.PubMed Rizza RA, Mandarino LJ, Gerich JE. Dose–response characteristics for effects of insulin on production and utilization of glucose in man. Am J Physiol. 1981;240(6):E630–9.PubMed
27.
Zurück zum Zitat Dunn JP, Abumrad NN, Breitman I, et al. Hepatic and peripheral insulin sensitivity and diabetes remission at 1 month after Roux-en-Y gastric bypass surgery in patients randomized to omentectomy. Diabetes Care. 2012;35(1):137–42.PubMedCrossRef Dunn JP, Abumrad NN, Breitman I, et al. Hepatic and peripheral insulin sensitivity and diabetes remission at 1 month after Roux-en-Y gastric bypass surgery in patients randomized to omentectomy. Diabetes Care. 2012;35(1):137–42.PubMedCrossRef
28.
Zurück zum Zitat Colucci RA. Bariatric surgery in patients with type 2 diabetes: a viable option. Postgrad Med. 2011;123(1):24–33.PubMedCrossRef Colucci RA. Bariatric surgery in patients with type 2 diabetes: a viable option. Postgrad Med. 2011;123(1):24–33.PubMedCrossRef
29.
Zurück zum Zitat Lewis GF, Carpentier A, Adeli K, et al. Disordered fat storage and mobilization in the pathogenesis of insulin resistance and type 2 diabetes. Endocr Rev. 2002;23(2):201–29.PubMedCrossRef Lewis GF, Carpentier A, Adeli K, et al. Disordered fat storage and mobilization in the pathogenesis of insulin resistance and type 2 diabetes. Endocr Rev. 2002;23(2):201–29.PubMedCrossRef
30.
Zurück zum Zitat Delarue J, Magnan C. Free fatty acids and insulin resistance. Curr Opin Clin Nutr Metab Care. 2007;10(2):142–8.PubMedCrossRef Delarue J, Magnan C. Free fatty acids and insulin resistance. Curr Opin Clin Nutr Metab Care. 2007;10(2):142–8.PubMedCrossRef
31.
Zurück zum Zitat Morino K, Petersen KF, Shulman GI. Molecular mechanisms of insulin resistance in humans and their potential links with mitochondrial dysfunction. Diabetes. 2006;55 Suppl 2:S9–S15.PubMedCrossRef Morino K, Petersen KF, Shulman GI. Molecular mechanisms of insulin resistance in humans and their potential links with mitochondrial dysfunction. Diabetes. 2006;55 Suppl 2:S9–S15.PubMedCrossRef
32.
Zurück zum Zitat Copps KD, White MF. Regulation of insulin sensitivity by serine/threonine phosphorylation of insulin receptor substrate proteins IRS1 and IRS2. Diabetologia. 2012;55(10):2565–82.PubMedCrossRef Copps KD, White MF. Regulation of insulin sensitivity by serine/threonine phosphorylation of insulin receptor substrate proteins IRS1 and IRS2. Diabetologia. 2012;55(10):2565–82.PubMedCrossRef
33.
Zurück zum Zitat Gao Z, Zhang X, Zuberi A, et al. Inhibition of insulin sensitivity by free fatty acids requires activation of multiple serine kinases in 3T3–L1 adipocytes. Mol Endocrinol. 2004;18(8):2024–34.PubMedCrossRef Gao Z, Zhang X, Zuberi A, et al. Inhibition of insulin sensitivity by free fatty acids requires activation of multiple serine kinases in 3T3–L1 adipocytes. Mol Endocrinol. 2004;18(8):2024–34.PubMedCrossRef
34.
Zurück zum Zitat Ferrante Jr AW. Biomedicine. Improving metabolism by throwing out all the JNK. Science. 2013;339(6116):147–8.PubMedCrossRef Ferrante Jr AW. Biomedicine. Improving metabolism by throwing out all the JNK. Science. 2013;339(6116):147–8.PubMedCrossRef
35.
Zurück zum Zitat Nakatani Y, Kaneto H, Kawamori D, et al. Modulation of the JNK pathway in liver affects insulin resistance status. J Biol Chem. 2004;279(44):45803–9.PubMedCrossRef Nakatani Y, Kaneto H, Kawamori D, et al. Modulation of the JNK pathway in liver affects insulin resistance status. J Biol Chem. 2004;279(44):45803–9.PubMedCrossRef
36.
Zurück zum Zitat Ghosh S, Hayden MS. Celebrating 25 years of NF-κB research. Immunol Rev. 2012;246(1):5–13.PubMedCrossRef Ghosh S, Hayden MS. Celebrating 25 years of NF-κB research. Immunol Rev. 2012;246(1):5–13.PubMedCrossRef
37.
Zurück zum Zitat Tsai J, Zhang R, Qiu W, et al. Inflammatory NF-kappaB activation promotes hepatic apolipoprotein B100 secretion: evidence for a link between hepatic inflammation and lipoproteinproduction. Am J Physiol Gastrointest Liver Physiol. 2009;296(6):G1287–98.PubMedCrossRef Tsai J, Zhang R, Qiu W, et al. Inflammatory NF-kappaB activation promotes hepatic apolipoprotein B100 secretion: evidence for a link between hepatic inflammation and lipoproteinproduction. Am J Physiol Gastrointest Liver Physiol. 2009;296(6):G1287–98.PubMedCrossRef
38.
Zurück zum Zitat Houstis N, Rosen ED, Lander ES. Reactive oxygen species have a causal role in multiple forms of insulin resistance. Nature. 2006;440(7086):944–8.PubMedCrossRef Houstis N, Rosen ED, Lander ES. Reactive oxygen species have a causal role in multiple forms of insulin resistance. Nature. 2006;440(7086):944–8.PubMedCrossRef
39.
Zurück zum Zitat Styskal J, Van Remmen H, Richardson A, et al. Oxidative stress and diabetes: what can we learn about insulin resistance from antioxidant mutant mouse models? Free Radic Biol Med. 2012;52(1):46–58.PubMedCrossRef Styskal J, Van Remmen H, Richardson A, et al. Oxidative stress and diabetes: what can we learn about insulin resistance from antioxidant mutant mouse models? Free Radic Biol Med. 2012;52(1):46–58.PubMedCrossRef
40.
Zurück zum Zitat Fu S, Watkins SM, Gohan S. The role of endoplasmic reticulum in hepatic lipid homeostasis and stress signaling. Cell Metab. 2012;15(5):623–34.PubMedCrossRef Fu S, Watkins SM, Gohan S. The role of endoplasmic reticulum in hepatic lipid homeostasis and stress signaling. Cell Metab. 2012;15(5):623–34.PubMedCrossRef
41.
Zurück zum Zitat Bikman BT, Jessen L, Ryan KK, et al. Mechanism for improved insulin sensitivity after gastric bypass surgery. J Clin Endocrinol Metab. 2008;93(12):4656–63.PubMedCrossRef Bikman BT, Jessen L, Ryan KK, et al. Mechanism for improved insulin sensitivity after gastric bypass surgery. J Clin Endocrinol Metab. 2008;93(12):4656–63.PubMedCrossRef
42.
Zurück zum Zitat Wilding JP. The importance of free fatty acids in the development of type 2 diabetes. Diabet Med. 2007;24(9):934–45.PubMedCrossRef Wilding JP. The importance of free fatty acids in the development of type 2 diabetes. Diabet Med. 2007;24(9):934–45.PubMedCrossRef
Metadaten
Titel
Amelioration in Hepatic Insulin Sensitivity by Reduced Hepatic Lipid Accumulation at Short-Term After Roux-en-Y Gastric Bypass Surgery in Type 2 Diabetic Rats
verfasst von
Bing He
Dongxu Piao
Chong Yu
Yong Wang
Ping Han
Publikationsdatum
01.12.2013
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 12/2013
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-013-0997-9

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