Obesity Surgery

, Volume 27, Issue 3, pp 826–836

Mechanisms of Action of Surgical Interventions on Weight-Related Diseases: the Potential Role of Bile Acids

  • Mohsen Mazidi
  • Pedro Paulo P. de Caravatto
  • John R. Speakman
  • Ricardo V. Cohen
Review Article

DOI: 10.1007/s11695-017-2549-1

Cite this article as:
Mazidi, M., de Caravatto, P.P.P., Speakman, J.R. et al. OBES SURG (2017) 27: 826. doi:10.1007/s11695-017-2549-1

Abstract

Surgical interventions for weight-related diseases (SWRD) may have substantial and sustainable effect on weight reduction, also leading to a higher remission rate of type 2 diabetes (T2D) mellitus than any other medical treatment or lifestyle intervention. The resolution of T2D after Roux-en-Y gastric bypass (RYGB) typically occurs too quickly to be accounted for by weight loss alone, suggesting that these operations have a direct impact on glucose homeostasis. The mechanisms underlying these beneficial effects however remain unclear. Recent research suggests that changes in the concentrations of plasma bile acids might contribute to these metabolic changes after surgery. In this review, we aimed to outline the potential role of bile acids in SWRD. We systematically reviewed MEDLINE, SCOPUS, and Web of Science for articles reporting the effect of SWRD on outcomes published between 1969 and 2016. We found that changes in circulating bile acids after surgery may play a major role through activation of the farnesoid X receptor A (FXRA), the fibroblast growth factor 19 (FGF19), and the G protein-coupled bile acid receptor (TGR5). Bile acid concentration increased significantly after RYGB. Some studies suggest that a transitory decrease occurs at 1 week post-surgery, followed by a gradual increase. Most studies have shown the increase to be proportionate by all bile acid subtypes. Bile acids can regulate glucose metabolism through the expression of TGR5 receptor in L cells, resulting in a release of glucagon-like peptide 1 (GLP-1). It may also induce the synthesis and secretion of FGF19 in ileal cells, thereby improving insulin sensitivity and regulating glucose metabolism. All the present SWRD are involved with changes in food stimulation to the stomach. This implies that discovering and developing the antagonists to TGR5 and FXRA may effectively control metabolic syndrome and the elucidation of the mechanisms underlying the physiological effects related to weight loss and T2D remission after surgery may help to identify new drug targets.

Keywords

Surgery of weight-related diseasesRYGBBile acidsMechanisms of actionMetabolic surgery

Supplementary material

11695_2017_2549_MOESM1_ESM.docx (14 kb)
ESM 1(DOCX 14 kb)

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Mohsen Mazidi
    • 1
    • 2
  • Pedro Paulo P. de Caravatto
    • 3
  • John R. Speakman
    • 1
    • 4
  • Ricardo V. Cohen
    • 3
  1. 1.State Key Laboratory of Molecular Developmental BiologyInstitute of Genetics and Developmental Biology, Chinese Academy of SciencesChaoyangChina
  2. 2.University of the Chinese Academy of SciencesHuairouChina
  3. 3.The Center for Obesity and DiabetesOswaldo Cruz German HospitalSão PauloBrazil
  4. 4.Institute of Biological and Environmental ScienceUniversity of AberdeenAberdeenUK