Role of Gut Microbiome and Microbial Metabolites in Alleviating Insulin Resistance After Bariatric Surgery
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REVIEW
Role of Gut Microbiome and Microbial Metabolites in Alleviating Insulin Resistance After Bariatric Surgery Mingfei Wang 1 & Leping Li 1,2 & Yuezhi Chen 1,2 & Guodong Lian 1,2 & Jinshen Wang 1,2 & Jizhun Zhang 1,2 & Keshu Shan 1,2 & Liang Shang 1,2 & Feng Tian 1,2 & Changqing Jing 1,2 Received: 29 April 2020 / Revised: 5 September 2020 / Accepted: 11 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Insulin resistance (IR) is the most common pathophysiological change in patients with type 2 diabetes mellitus (T2DM). Several recent studies have suggested that the gut microbiome and microbial metabolites are involved in the pathogenesis of IR. Bariatric surgery, as an effective treatment for T2DM, can markedly alleviate IR through mechanisms that have not been elucidated. In this review, we summarize the current evidence on the changes in the gut microbiome and microbial metabolites (including lipopolysaccharide, short-chain fatty acids, branched-chain amino acids, aromatic amino acids, bile acids, methylamines, and indole derivatives) after bariatric surgery. Additionally, we discuss the mechanisms that correlate the changes in microbial metabolites with the postoperative alleviation of IR. Furthermore, we discuss the prospect of bariatric surgery as a treatment for T2DM. Keywords Gut microbiota . Microbial metabolite . Bariatric surgery . Insulin resistance . T2DM
Abbreviations IR Insulin resistance T2DM Type 2 diabetes mellitus GB Gastric banding RYGB Roux-en-Y gastric bypass SG Sleeve gastrectomy LPS Lipopolysaccharide SCFAs Short-chain fatty acids BCAAs Branched-chain amino acids AAAs Aromatic amino acids TMAO Trimethylamine N-oxide IPA Indole propionic acid BAs Bile acids Mingfei Wang, Leping Li and Yuezhi Chen contributed equally to this work. * Feng Tian [email protected] * Changqing Jing [email protected] 1
Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, China
2
Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
Introduction Insulin resistance (IR), a major predisposing factor for type 2 diabetes mellitus (T2DM), is a clinical condition associated with decreased responsiveness to normal circulating levels of insulin [1, 2]. Observational studies have suggested that bariatric or metabolic surgery can rapidly improve the clinical and laboratory manifestations of patients with T2DM, including IR [3, 4]. There are various types of bariatric surgery, such as gastric banding (GB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) [4]. Bariatric surgery involves anatomically adjusting the digestion order of food through gastric volume reduction and removal of duodenum, which affects the composition and diversity of gut microbiota. The human gut microbiota, whose total weight exceeds 1 kg, is a complex mutualistic system that comprises approximately 100 trillion bacteria [5
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