title: Combined serum proteomic and metabonomic profiling after laparoscopic sleeve gastrectomy in children and adolescents.
abstract: OBJECTIVE
  The consequences of bariatric surgery on important metabolic and signaling pathways are still poorly understood. The aim of our study was to unravel the network of metabolic changes and obesity-related protein biomarkers in morbidly obese children and adolescents undergoing laparoscopic sleeve gastrectomy (LSG).
  
  
  METHODS
  In a prospective study, 6 children with morbid obesity who had failed a well-established conservative weight loss therapy underwent LSG. Pre- and 6 months postoperatively, a metabonomic profiling of 163 metabolites by mass spectrometry and protein profiling by ELISA (clusterin [CLU], pigment epithelium-derived factor [PEDF], retinol binding protein 4 [RBP4], paraoxonase 1 [PON1]) was performed to identify biomarkers of important pathways.
  
  
  RESULTS
  At referral for surgery, the mean age was 14.5 years (range 8-17), mean body mass index (BMI in kg/m(2)) was 48.13 (range 41.1-56.3). All patients showed various metabolic comorbidities. LSG was uneventful in all of them. At 6 months postsurgery, the mean BMI has dropped to 37.1 (range 28.4-40.6). Targeted serum metabonomics resulted in 7 metabolites, which were significantly affected by LSG. Among those, the amino acid phenylalanine was increased, and methionine decreased. The glycero-phospatidylcholine PCaaC38:5 were upregulated, and PCaaC40:2 and PCaaC42:1 were down regulated after 6 months compared with baseline. Further, sphingomyoline (SM) C26:0 and SM C26:1 were decreased after 6 months. The obesity-related biomarkers CLU, PEDF, and RBP4 were decreased, whereas PON1 levels were increased.
  
  
  CONCLUSIONS
  LSG leads to changes in amino acids and in lipid metabolism indicated by glycerol-phosphatidylcholines and SM. The pattern of protein biomarkers and metabolites might provide measures for the induced physiological changes and for therapy monitoring.
authors.affiliation: Department of Pediatric Surgery, University Hospital of Leipzig, Leipzig, Germany. andreas.oberbach@medizin.uni-leipzig.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Oberbach
authors.forename: Martin
authors.initials: M
authors.lastname: von Bergen
authors.forename: Susann
authors.initials: S
authors.lastname: Blüher
authors.forename: Stefanie
authors.initials: S
authors.lastname: Lehmann
authors.forename: Holger
authors.initials: H
authors.lastname: Till
mesh_terms: D000293:Adolescent; D000596:Amino Acids / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002648:Child; D005260:Female; D005743:Gastrectomy; D020404:Glycerophospholipids / Q000097:blood; D006801:Humans; D010535:Laparoscopy; D050356:Lipid Metabolism; D008297:Male; D055432:Metabolomics; D009767:Obesity, Morbid / Q000097:blood* / Q000601:surgery*; D011446:Prospective Studies; D040901:Proteomics; D012189:Retrospective Studies
chemical_list: D000596:Amino Acids; D015415:Biomarkers; D020404:Glycerophospholipids