title: Duodenal-jejunal exclusion improves insulin resistance in type 2 diabetic rats by upregulating the hepatic insulin signaling pathway.
abstract: OBJECTIVE
  Previous studies have shown duodenal-jejunal exclusion (DJE) results in the rapid resolution of type 2 diabetes; however, the underlying mechanism is unknown. This study aimed to measure the hepatic expression of insulin receptor substrate-2 (IRS-2) and glucose transporter-2 (GLUT-2) in type 2 diabetic rats post-DJE, and to investigate their roles in improved hepatic insulin resistance and glucose intolerance.
  
  
  METHODS
  Type 2 diabetic Sprague-Dawley (SD) rats were randomly divided into DJE operation (DO) and control (DC) groups. Normal SD rats were also divided into DJE operation and control groups. Fasting plasma glucose and insulin concentrations were measured, and the quantitative insulin sensitivity check index (QUICKI) and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) were calculated. Eight weeks postoperation, the hepatic IRS-2 and GLUT-2 protein and mRNA levels were measured using western blotting and reverse transcription polymerase chain reaction, respectively.
  
  
  RESULTS
  The fasting blood glucose in the DO group decreased from a preoperative level of 20.21 ± 2.14 mmol/L to 8.50 ± 2.19 mmol/L (P < 0.05) 8 wk post-DJE. A change in the QUICKI revealed a dramatic increase, and HOMA-IR showed a significant decrease in the DO group (P < 0.05). Additionally, the IRS-2 and GLUT-2 protein and mRNA levels at 8 wk postoperation were significantly increased in the DO group compared with the DC group.
  
  
  CONCLUSIONS
  DJE led to upregulated hepatic IRS-2 and GLUT-2 expression in the hepatic insulin signaling pathway and improved insulin sensitivity in type 2 diabetic rats.
authors.affiliation: Department of General Surgery, Affiliated Hospital of Xuzhou Medical College, JiangSu, China.
authors.forename: Ze-Qiang
authors.initials: ZQ
authors.lastname: Ren
authors.affiliation: Department of General Surgery, Affiliated Hospital of Xuzhou Medical College, JiangSu, China. Electronic address: zpb_ok@126.com.
authors.forename: Peng-Bo
authors.initials: PB
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Affiliated Hospital of Xuzhou Medical College, JiangSu, China.
authors.forename: Xiu-Zhong
authors.initials: XZ
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Affiliated Hospital of Xuzhou Medical College, JiangSu, China.
authors.forename: Shou-Kun
authors.initials: SK
authors.lastname: Chen
authors.affiliation: Operating Room, Affiliated Hospital of Xuzhou Medical College, JiangSu, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Affiliated Hospital of Xuzhou Medical College, JiangSu, China.
authors.forename: Dun-Tao
authors.initials: DT
authors.lastname: Lv
authors.affiliation: Department of General Surgery, Affiliated Hospital of Xuzhou Medical College, JiangSu, China.
authors.forename: Bu-Qiang
authors.initials: BQ
authors.lastname: Zhuang
authors.affiliation: College of Nursing, Xuzhou Medical College, JiangSu, China.
authors.forename: Yu-Qing
authors.initials: YQ
authors.lastname: Wen
authors.affiliation: College of Nursing, Xuzhou Medical College, JiangSu, China.
authors.forename: Hui-Hui
authors.initials: HH
authors.lastname: Hu
authors.affiliation: Department of General Surgery, Affiliated Hospital of Xuzhou Medical College, JiangSu, China.
authors.forename: Wei-Chao
authors.initials: WC
authors.lastname: Ding
authors.affiliation: Department of General Surgery, Affiliated Hospital of Xuzhou Medical College, JiangSu, China.
authors.forename: Chong
authors.initials: C
authors.lastname: Zhang
mesh_terms: D000818:Animals; D001786:Blood Glucose / Q000032:analysis; D003921:Diabetes Mellitus, Experimental / Q000097:blood / Q000378:metabolism / Q000601:surgery*; D004195:Disease Models, Animal; D004386:Duodenum / Q000601:surgery*; D015390:Gastric Bypass / Q000379:methods*; D051273:Glucose Transporter Type 2 / Q000378:metabolism; D007328:Insulin / Q000097:blood; D055504:Insulin Receptor Substrate Proteins / Q000378:metabolism; D007333:Insulin Resistance; D007583:Jejunum / Q000601:surgery*; D008099:Liver / Q000378:metabolism*; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley; D015398:Signal Transduction; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D001786:Blood Glucose; D051273:Glucose Transporter Type 2; D007328:Insulin; D055504:Insulin Receptor Substrate Proteins
keywords: Duodenal-jejunal exclusion operation; Glucose transporter-2; Hepatic insulin signaling; Insulin receptor substrate-2; Type 2 diabetes mellitus