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肠道适应性在减重手术后的重要作用

发布日期:2015-2-13 11:34:45 文章来源:生物谷 作者次数:1133

              近日,来自美国密歇根大学的Randy J. Seeley在著名国际期刊cell metabolism在线发表了一篇综述性文章,就手术治疗肥胖和糖尿病与肠道适应性变化之间的关系进行了探讨和总结。

            在这篇文章里,Randy J. Seeley提到,例如垂直袖状胃切除术(VSG)和Roux-en-Y 胃旁路术(RYGB)这样的胃间隔手术是持续减轻体重改善血糖调节的最有效的治疗手段。传统意义上,普遍认为这些效应是由于手术过程导致的机械性变化产生的,比如对饮食的限制性和营养吸收不良,但是对进行了胃间隔手术的小鼠模型的大量研究发现,生理性变化也会对这些手术的治疗效果产生重要调节作用,特别是类似于肠道激素分泌,胆汁酸水平以及这两个过程之后的组成型变化。通过对胆汁酸受体(FXR)进行功能失活研究发现,FXR失活会大大降低VSG的手术效果。VSG和RYGB都与肠道菌群变化有重要关系,肠道菌群能够在一定程度上调节手术治疗的效果。

            Randy J. Seeley等人提出假设,手术导致的胃肠道改变导致肠道对营养物质的吸收和小肠内PH值变化,促进了这些生理效应。研究人员进一步探讨影响手术治疗效果的分子基础将为我们理解胃肠道与肥胖和糖尿病的关系提供新契机,同时也会促进对新治疗策略的研究,减少侵袭性方法的使用,达到手术治疗的效果。

            综上所述,Randy J. Seeley等人总结了手术治疗肥胖和糖尿病与肠道适应性变化之间的关系,并且为进一步研究胃肠道与肥胖糖尿病的相互作用提出了新的假设。


            doi:10.1016/j.cmet.2015.01.001


            The Role of Gut Adaptation in the Potent Effects of Multiple Bariatric Surgeries on Obesity and Diabetes


            Randy J. Seeley, Adam P. Chambers, Darleen A. Sandoval


            Bariatric surgical procedures such as vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) are the most potent treatments available to produce sustained reductions in body weight and improvements in glucose regulation. While traditionally these effects are attributed to mechanical aspects of these procedures, such as restriction and malabsorption, a growing body of evidence from mouse models of these procedures points to physiological changes that mediate the potent effects of these surgeries. In particular, there are similar changes in gut hormone secretion, bile acid levels, and composition after both of these procedures. Moreover, loss of function of the nuclear bile acid receptor (FXR) greatly diminishes the effects of VSG. Both VSG and RYGB are linked to profound changes in the gut microbiome that also mediate at least some of these surgical effects. We hypothesize that surgical rearrangement of the gastrointestinal tract results in enteroplasticity caused by the high rate of nutrient presentation and altered pH in the small intestine that contribute to these physiological effects. Identifying the molecular underpinnings of these procedures provides new opportunities to understand the relationship of the gastrointestinal tract to obesity and diabetes as well as new therapeutic strategies to harness the effectiveness of surgery with less-invasive approaches.

     

     

    作者:佚名

    来源:生物谷

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