title: Bariatric surgery rapidly improves mitochondrial respiration in morbidly obese patients.
abstract: BACKGROUND
  Obesity and its attendant comorbidities are an emerging epidemic. Chronic metabolic inflammation (metainflammation) is thought to precipitate obesity-associated morbidities; however, its mechanistic progression is poorly understood. Moreover, although interventions such as diet, exercise, and bariatric surgery can control body weight, their effects on metainflammation are also poorly understood. Recently, metainflammation and the pathobiology of obesity have been linked to mitochondrial dysfunction. Herein we examined the effects of bariatric surgery on mitochondrial respiration as an index of resolving metainflammation in morbidly obese patients.
  
  
  METHODS
  This institutional review board-approved study involved morbidly obese patients (body mass index > 35 kg/m(2)) undergoing sleeve gastrectomy or Roux-en-Y gastric bypass. Mitochondrial respiration was assessed in peripheral blood monocytes and in skeletal muscle samples before surgery and at 12 weeks after surgery. Patient biometrics, homeostasis model assessment-estimated insulin resistance (HOMA-IR) score, C-reactive protein, and lipid profile were analyzed.
  
  
  RESULTS
  Twenty patients were enrolled and showed an average percent excess body weight loss of 30.3% weight loss at 12 weeks after surgery. Average HOMA-IR score decreased from 3.0 to 1.2 in insulin-resistant patients. C-reactive protein, an index of metainflammation, showed a modest decrease. Lipid profile remained stable. Intriguingly, mitochondrial basal and maximal respiration rates in peripheral blood monocytes increased after surgery. Basal rates of skeletal muscle mitochondrial respiration were unchanged, but the maximal respiration rate trended toward an increase after surgery.
  
  
  CONCLUSIONS
  Cellular and tissue mitochondrial respiration increased in a morbidly obese patient cohort after laparoscopic bariatric surgery. These changes were consistent in patients with postsurgical weight loss. Importantly, no significant changes or improvements occurred in canonical indices used to assess recovery after bariatric surgery over this short time course. Thus, increased mitochondrial respiration may represent a novel biomarker of early improvement and positive outcome after surgery in morbidly obese patients.
authors: Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, 36688, USA, sheetalnijhawan@gmail.com.
authors: Sheetal
authors: S
authors: Nijhawan
authors: William
authors: W
authors: Richards
authors: Martha F
authors: MF
authors: O'Hea
authors: Jonathon P
authors: JP
authors: Audia
authors: Diego F
authors: DF
authors: Alvarez
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000592:standards / Q000639:trends*; D015992:Body Mass Index; D019069:Cell Respiration; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D008931:Mitochondria, Muscle / Q000378:metabolism*; D028361:Mitochondrial Diseases / Q000209:etiology* / Q000378:metabolism; D009767:Obesity, Morbid / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000378:metabolism*; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*
references: Nature. 2012 Jan 18;481(7381):278-86
references: 22258606
references: Infect Disord Drug Targets. 2012 Apr;12(2):161-78
references: 22420514
references: Cell Metab. 2013 Apr 2;17(4):491-506
references: 23562075
references: Diabetes Care. 2001 Apr;24(4):683-9
references: 11315831
references: Lancet. 2011 Aug 27;378(9793):815-25
references: 21872750
references: Anal Biochem. 1994 May 1;218(2):338-42
references: 8074290
references: Am J Physiol. 1996 Dec;271(6 Pt 1):C2053-61
references: 8997208
references: Nature. 2012 Feb 01;482(7384):179-85
references: 22297845
references: J Biol Chem. 2007 Dec 14;282(50):36321-9
references: 17959595
references: Nat Immunol. 2012 Mar 19;13(4):321-4
references: 22430784
references: Circulation. 2004 Sep 21;110(12):1564-71
references: 15364812
references: J Clin Endocrinol Metab. 2011 Apr;96(4):E606-13
references: 21289263