title: Bariatric surgery improves the circulating numbers and biological activity of late outgrowth endothelial progenitor cells.
abstract: BACKGROUND
  Although the salutary effects of bariatric surgery as a treatment for excess weight and type 2 diabetes are established, there is scant evidence for effects on other contributors to cardiovascular diseases such as repair of endothelial dysfunction. This study evaluates outcomes of bariatric surgery on late outgrowth endothelial progenitor cells (LOEPCs), a cell phenotype essential for endothelial repair.
  
  
  METHODS
  Patients with a body mass index >35 kg/m(2) and type 2 diabetes were enrolled into either medical or bariatric surgical arms. Primary outcomes included analysis of isolated LOEPCs from peripheral blood for growth, function, and mitochondrial respiration. Plasma was used for metabolic profiling.
  
  
  RESULTS
  Medical arm patients showed no improvement in any of the parameters tested. Bariatric surgical arm patients showed a 24% reduction in body mass index as early as 3 months postintervention and resolution of type 2 diabetes at 24 months postintervention (HbA1c 31% reduction; fasting glucose 29% reduction). Bariatric surgery increased the numbers of LOEPCs 8-fold and increased LOEPC network formation 3-fold at 24 months postintervention. The increased numbers and activity of LOEPCs in the bariatric surgical arm correlated with improvements in body mass index, insulin, and triglyceride levels only at 24 month postintervention. LOEPC mitochondrial respiration displayed a trend toward improvement compared with baseline as evidenced by an increase (36%) at 24 months in the bariatric arm.
  
  
  CONCLUSIONS
  Bariatric surgery increases LOEPC levels and activity, which correlates with weight loss and improved metabolic profile at 24 months postintervention.
authors.affiliation: Department of Surgery, University of South Alabama College of Medicine, Mobile, Alabama.
authors.forename: William O
authors.initials: WO
authors.lastname: Richards
authors.affiliation: Department of Surgery, University of South Alabama College of Medicine, Mobile, Alabama.
authors.forename: Kelley Bose
authors.initials: KB
authors.lastname: Prutzman
authors.affiliation: Department of Surgery, University of South Alabama College of Medicine, Mobile, Alabama.
authors.forename: Martha F
authors.initials: MF
authors.lastname: O'Hea
authors.affiliation: Microbiology and Immunology, University of South Alabama College of Medicine, Mobile, Alabama; The Laboratory of Molecular Biology, University of South Alabama College of Medicine, Mobile, Alabama; The Center for Lung Biology, University of South Alabama College of Medicine, Mobile, Alabama. Electronic address: jaudia@southalabama.edu.
authors.forename: Jonathon P
authors.initials: JP
authors.lastname: Audia
authors.affiliation: The Center for Lung Biology, University of South Alabama College of Medicine, Mobile, Alabama; Internal Medicine, University of South Alabama College of Medicine, Mobile, Alabama; Pharmacology, University of South Alabama College of Medicine, Mobile, Alabama. Electronic address: dalvarez@southalabama.edu.
authors.forename: Diego F
authors.initials: DF
authors.lastname: Alvarez
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016022:Case-Control Studies; D049109:Cell Proliferation; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology / Q000601:surgery*; D066026:Endothelial Progenitor Cells / Q000473:pathology*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008928:Mitochondria / Q000502:physiology; D009765:Obesity / Q000473:pathology / Q000601:surgery*; D014280:Triglycerides / Q000378:metabolism; D015431:Weight Loss / Q000502:physiology
chemical_list: D014280:Triglycerides
keywords: Bariatric surgery; Endothelial progenitor cells; Late outgrowth EPCs; Mitochondrial respiration; Roux-en-Y gastric bypass; Sleeve gastrectomy