title: IMMUNOLOGICAL EVALUATION OF PATIENTS WITH TYPE 2 DIABETES MELLITUS SUBMITTED TO METABOLIC SURGERY.
abstract: BACKGROUND
  Immunological and inflammatory mechanisms play a key role in the development and progression of type 2 diabetes mellitus.
  
  
  OBJECTIVE
  To raise the hypothesis that alterations in immunological parameters occur after duodenojejunal bypass surgery combined with ileal interposition without gastrectomy, and influences the insulin metabolism of betacells.
  
  
  METHODS
  Seventeen patients with type 2 diabetes mellitus under clinical management were submitted to surgery and blood samples were collected before and six months after surgery for evaluation of the serum profile of proinflammatory (IFN-γ, TNF-α, IL-17A) and anti-inflammatory cytokines (IL-4, IL-10). In addition, anthropometric measures, glucose levels and insulin use were evaluated in each patient.
  
  
  RESULTS
  No changes in the expression pattern of proinflammatory cytokines were observed before and after surgery. In contrast, there was a significant decrease in IL-10 expression, which coincided with a reduction in the daily insulin dose, glycemic index, and BMI of the patients. Early presentation of food to the ileum may have induced the production of incretins such as GLP-1 and PYY which, together with glycemic control, contributed to weight loss, diabetes remission and the consequent good surgical prognosis of these patients. In addition, the control of metabolic syndrome was responsible for the reduction of IL-10 expression in these patients.
  
  
  CONCLUSIONS
  These findings suggest the presence of low-grade inflammation in these patients during the postoperative period, certainly as a result of adequate glycemic control and absence of obesity, contributing to a good outcome of surgery.
authors.affiliation: Department of Surgery, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil.
authors.forename: Marisa de Carvalho
authors.initials: Mde C
authors.lastname: Borges
authors.affiliation: Department of Surgery, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil.
authors.forename: Guilherme Azevedo
authors.initials: GA
authors.lastname: Terra
authors.affiliation: Department of Surgery, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil.
authors.forename: Tharsus Dias
authors.initials: TD
authors.lastname: Takeuti
authors.affiliation: Department of Immunology.
authors.forename: Betânia Maria
authors.initials: BM
authors.lastname: Ribeiro
authors.affiliation: Department of Surgery, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil.
authors.forename: Alex Augusto
authors.initials: AA
authors.lastname: Silva
authors.affiliation: Department of Surgery, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil.
authors.forename: Júverson Alves
authors.initials: JA
authors.lastname: Terra-Júnior
authors.affiliation: Department of Immunology.
authors.forename: Virmondes
authors.initials: V
authors.lastname: Rodrigues-Júnior
authors.affiliation: Department of Surgery, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Crema
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000276:immunology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult