title: Duodenal-jejunal bypass attenuates progressive failure of pancreatic islets in streptozotocin-induced diabetic rats.
abstract: BACKGROUND
  Preservation of pancreatic beta cell function has been increasingly appealing in the treatment of type 2 diabetes. Evidence is still limited on how bariatric surgery affects pancreatic beta cell apoptosis.
  
  
  METHODS
  University medical center.
  
  
  OBJECTIVE
  The study aimed to investigate the effect of a major component of Roux-en-Y gastric bypass, duodenal-jejunal bypass, on protecting pancreatic beta cells from progressive loss.
  
  
  METHODS
  Forty-five normal Sprague-Dawley rats were randomly assigned into 3 groups: duodenal-jejunal bypass (DJB) group (n = 16) and sham (S) group (n = 17), based upon the procedure received, and a control (C) group (n = 12) without any procedure performed, to eliminate potential traumatic effects from surgery. Ten days after surgery, streptozotocin (STZ, 45 mg/kg weight) was injected intraperitoneally into each animal, including the control animals, to selectively induce pancreatic beta cell apoptosis. Weight, food intake, plasma glucose level, and the results of an oral glucose tolerance test were measured before surgery, pre-STZ injection, and up to 4 weeks after STZ injection. Plasma insulin and glucagon-like peptide-1 levels were also assayed during oral glucose tolerance test. At the end, pancreatic tissues were sliced and stained for beta cell analysis.
  
  
  RESULTS
  There were no significant differences in weight among all groups at any time points measured, despite rats in the S and C groups consuming more food than those in the DJB group as measured on day 10 (P<.05) and day 20 (P<.01) after STZ injection. Animals undergoing DJB did not experience symptoms typical of uncompensated diabetes, including hyperphagia and progressive weight loss. After STZ injection, fasting plasma glucose levels in the DJB group were significantly lower than those in the C and S groups (P<.001). When challenged by glucose load, DJB rats also had a better glycemic excursion (P<.01) and incretin response compared with C and S rats (P<.05). In addition, pancreatic beta cell size and mass was better preserved in DJB rats (P< .001).
  
  
  CONCLUSIONS
  DJB is able to protect pancreatic beta cells from apoptosis, which leads to better glycemic control and delayed onset of diabetes. These results imply the necessity of including a DJB component when designing bariatric procedure to achieve a better long-term outcome.
authors.affiliation: Center for Metabolic and Bariatric Surgery, Fudan University Pudong Medical Center, Shanghai, China.
authors.forename: Tingfeng
authors.initials: T
authors.lastname: Wang
authors.affiliation: Center for Metabolic and Bariatric Surgery, Fudan University Pudong Medical Center, Shanghai, China; Center for Medical Research and Innovation, Fudan University Pudong Medical Center, Shanghai, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Center for Metabolic and Bariatric Surgery, Fudan University Pudong Medical Center, Shanghai, China.
authors.forename: Xiong
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Center for Medical Research and Innovation, Fudan University Pudong Medical Center, Shanghai, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Cao
authors.affiliation: Center for Metabolic and Bariatric Surgery, Fudan University Pudong Medical Center, Shanghai, China; Division of Minimally Invasive Surgery, Department of Surgery, Shanghai Changhai Hospital, Shanghai, China.
authors.forename: Chengzhu
authors.initials: C
authors.lastname: Zheng
authors.affiliation: Center for Metabolic and Bariatric Surgery, Fudan University Pudong Medical Center, Shanghai, China. Electronic address: tfwang2013@163.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
mesh_terms: D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D017209:Apoptosis / Q000187:drug effects; D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight / Q000502:physiology; D003921:Diabetes Mellitus, Experimental / Q000473:pathology / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control / Q000601:surgery; D004386:Duodenum / Q000601:surgery*; D004435:Eating; D005215:Fasting / Q000097:blood; D015390:Gastric Bypass / Q000379:methods*; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism; D005951:Glucose Tolerance Test; D054795:Incretins / Q000378:metabolism; D007274:Injections, Intraperitoneal; D007328:Insulin / Q000378:metabolism; D007515:Islets of Langerhans / Q000187:drug effects / Q000502:physiology*; D007583:Jejunum / Q000601:surgery*; D008297:Male; D011897:Random Allocation; D017207:Rats, Sprague-Dawley; D013311:Streptozocin / Q000008:administration & dosage / Q000494:pharmacology
chemical_list: D001786:Blood Glucose; D054795:Incretins; D007328:Insulin; D013311:Streptozocin; D052216:Glucagon-Like Peptide 1
keywords: Apoptosis; Duodenal-jejunal bypass (DJB); Pancreatic beta cell; Streptozotocin; Type 2 diabetes