Small intestinal metabolism is central to whole-body insulin resistance

被引:27
作者
Angelini, Giulia [1 ,2 ]
Salinari, Serenella [3 ]
Castagneto-Gissey, Lidia [4 ]
Bertuzzi, Alessandro [5 ]
Casella-Mariolo, James [6 ]
Ahlin, Sofie [7 ]
Boskoski, Ivo [1 ,2 ]
Gaggini, Melania [8 ]
Raffaelli, Marco [1 ,2 ]
Costamagna, Guido [1 ,2 ]
Casella, Giovanni [4 ]
Marini, Pier Luigi [6 ]
Gastaldelli, Amalia [8 ]
Bornstein, Stefan [9 ,10 ]
Mingrone, Geltrude [1 ,2 ,3 ,9 ]
机构
[1] Fdn Policlin Univ A Gemelli IRCCS, Rome, Italy
[2] Univ Cattolica Sacro Cuore, Rome, Italy
[3] Univ Rome Sapienza, Dept Comp Control & Management Engn Antonio Ruber, Rome, Italy
[4] Sapienza Univ Rome, Dept Surg Sci, Rome, Italy
[5] CNR, Inst Syst Anal & Comp Sci IASI, Rome, Italy
[6] Azienda Osped S Camillo Forlanini, Dept Surg, Rome, Italy
[7] Univ Gothenburg, Dept Mol & Clin Med, Inst Med, Sahlgrenska Acad, Gothenburg, Sweden
[8] CNR, Inst Clin Physiol, Cardiometabol Risk Lab, Pisa, Italy
[9] Kings Coll London, Fac Life Sci & Med, Div Diabet & Nutr Sci, London, England
[10] Univ Dresden, Univ Klinikum Carl Gustav Carus Tech, Dept Med 3, Dresden, Germany
关键词
Y GASTRIC BYPASS; BETA-CELL FUNCTION; VERTICAL SLEEVE GASTRECTOMY; INTENSIVE MEDICAL THERAPY; DUODENAL-JEJUNAL BYPASS; BARIATRIC SURGERY; GLUCOSE-HOMEOSTASIS; GLP-1; SECRETION; OBESE-PATIENTS; BLOOD-GLUCOSE;
D O I
10.1136/gutjnl-2020-322073
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objective To assess the role of jejunum in insulin resistance in humans and in experimental animals. Design Twenty-four subjects undergoing biliopancreatic diversion (BPD) or Roux-en-Y gastric bypass (RYGB) were enrolled. Insulin sensitivity was measured at baseline and at 1 week after surgery using oral glucose minimal model. We excluded the jejunum from intestinal continuity in pigs and created a jejunal loop with its vascular and nerve supply intact accessible from two cutaneous stomas, and reconnected the bowel with an end-to-end anastomosis. Glucose stable isotopes were given in the stomach or in the jejunal loop. In vitro studies using primary porcine and human hepatocytes or myoblasts tested the effects of plasma on gluconeogenesis or glucose uptake and insulin signalling. Results Whole-body insulin sensitivity (S I.10(4): 0.54 +/- 0.12 before vs 0.82 +/- 0.11 after BPD, p=0.024 and 0.41 +/- 0.09 before vs 0.65 +/- 0.09/pM/min after RYGB, p=not significant) and Glucose Disposition Index increased only after BPD. In pigs, insulin sensitivity was significantly lower when glucose was administered in the jejunal loop than in the stomach (glucose rate of disappearance (R-d) area under the curve (AUC)/insulin AUC.10: 1.82 +/- 0.31 vs 2.96 +/- 0.33 mmol/pM/min, p=0.0017). Metabolomics showed a similar pattern before surgery and during jejunal-loop stimulation, pointing to a higher expression of gluconeogenetic substrates, a metabolic signature of impaired insulin sensitivity. A greater hepatocyte phosphoenolpyruvate-carboxykinase and glucose-6-phosphatase gene expression was elicited with plasma from porcine jejunal loop or before surgery compared with plasma from jejunectomy in pigs or jejunal bypass in humans. Stimulation of myoblasts with plasma from porcine jejunal loop or before surgery reduced glucose uptake, Ser473-Akt phosphorylation and GLUT4 expression compared with plasma obtained during gastric glucose administration after jejunectomy in pigs or after jejunal bypass in humans. Conclusion Proximal gut plays a crucial role in controlling insulin sensitivity through a distinctive metabolic signature involving hepatic gluconeogenesis and muscle insulin resistance. Bypassing the jejunum is beneficial in terms of insulin-mediated glucose disposal in obesity.
引用
收藏
页码:1098 / 1109
页数:12
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