Effect of Endoscopic Gastroplication on the Genome-Wide Transcriptome in the Upper Gastrointestinal Tract.
Bariatric surgery is an effective intervention strategy in obesity, resulting in sustained weight loss and a reduction of comorbidities. Gastroplication, using the articulating circular endoscopic stapler, was recently introduced as a transoral bariatric technique. This procedure reduces gastric volume and induced 34.9 % of excess weight loss in the first year (Paulus et al. Gastrointest Endosc. 81(2):312-20, 3). The aim of the present study was to gain insight in the long-term effects and underlying mechanisms of gastroplication by investigating differences in the genome-wide gastric and duodenal transcriptome before and 1 year after intervention.



Ten morbidly obese patients (BMI 39.8 ± 0.9 kg/m2(mean ± SEM)) underwent gastroplication. Previous to the procedure and after 1 year, blood samples were taken, and mucosal biopsies were collected from the fundus, antrum and duodenum. Gene expression was measured using microarray analysis. Plasma adiponectin, HbA1c, IL-1β, IL-6, IL-7, TNF-α, IFN-γ, MCP-1, IL-8, TGF-1 and CRP levels were determined.



Downregulation of inflammatory genes and gene sets was observed in the fundus and duodenum 1 year after surgery. Gene expression of ghrelin and its activating enzyme GOAT were downregulated in the upper gastrointestinal tract. Patients showed a reduction in plasma HbA1c levels (from 6.17 ± 0.51 to 5.32 ± 0.14 %, p = 0.004) and an increase of plasma adiponectin (from 16.87 ± 3.67 to 27.67 ± 5.92 μg/ml, p = 0.002).



Individuals undergoing gastroplication displayed a downregulation of inflammatory tone in the stomach and duodenum, which coincided with improved HbA1c and adiponectin levels. The reduction of inflammatory tone in the upper gastrointestinal tract may be a consequence of an improved metabolic health status or alternatively caused by the procedure itself.
Top Institute Food and Nutrition, Wageningen, The Netherlands.|Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
Nikkie
N
van der Wielen
Department of General Surgery, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands.
Givan
G
Paulus
Top Institute Food and Nutrition, Wageningen, The Netherlands.|Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM, Maastricht, University Medical Center, Maastricht, The Netherlands.
Mark
M
van Avesaat
Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM, Maastricht, University Medical Center, Maastricht, The Netherlands.
Ad
A
Masclee
Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands. jocelijn.meijerink@wur.nl.
Jocelijn
J
Meijerink
Department of General Surgery, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands.
Nicole
N
Bouvy
D052242:Adiponectin / Q000097:blood; D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery / Q000379:methods; D015415:Biomarkers / Q000097:blood; D015536:Down-Regulation; D004386:Duodenum / Q000378:metabolism*; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism*; D015391:Gastroplasty / Q000379:methods*; D055106:Genome-Wide Association Study; D054439:Ghrelin / Q000097:blood; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000235:genetics* / Q000378:metabolism / Q000601:surgery*; D011184:Postoperative Period; D059467:Transcriptome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult
C499918:ADIPOQ protein, human; D052242:Adiponectin; D015415:Biomarkers; D054439:Ghrelin; D018836:Inflammation Mediators; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha
Adiponectin; Duodenum; Gastric tissue; Gastroplication; Gene expression; HbA1c; Immunity; Inflammation; Transcriptome