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Hepatic Vagotomy in Patients With Obesity Leads to Improvement of the Cholesterol to High-Density Lipoprotein Ratio

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Abstract

Introduction/Purpose

The obesity epidemic is rapidly growing, and visceral adiposity is associated with metabolic consequences secondary to peroxisome proliferator-activated receptor (PPAR)-induced inter-organ signaling pathways. PPARs are ligand-activated transcription factors that modulate vagal pathways which can improve blood pressure, arterial remodeling, cholesterol levels, and insulin sensitivity. However, an obesity-induced inflammatory milieu can interfere with the beneficial effects of PPAR activity, suggesting that a dysregulated PPAR-vagus pathway may play a role in the pathogenesis of obesity-related hypertension. Therefore, we hypothesized that hepatic vagotomy (HV) in patients with obesity would result in a significant reduction in blood pressure and/or the number of hypertension medications compared to control.

Methods

We conducted a retrospective chart review of 160 patients undergoing laparoscopic sleeve gastrectomy. Patients were divided into HV and control groups, and information was collected at each clinic visit.

Results

At six-months post-operation, the HV group was found to have significantly lower total cholesterol (TC)/high-density lipoprotein (HDL) ratios than the control group. The HV group also had a numerically better blood profile for TC, HDL, low-density lipoprotein (LDL), triglycerides, C-reactive protein, and LDL/HDL ratio. Hypertensive patients in the HV group showed numerically lower hypertension medication counts after six weeks when compared to control.

Conclusion

We present the first study to report clinically significant changes related to HV in human subjects. Our results did not support our initial hypothesis but did demonstrate an improvement of the TC/HDL ratio with HV in patients with obesity. Future studies should confirm these findings in a randomized control trial.

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References

  1. Uno K, Yamada T, Ishigaki Y, et al. Hepatic peroxisome proliferator-activated receptor-γ-fat-specific protein 27 pathway contributes to obesity-related hypertension via afferent vagal signals. Eur Heart J. 2012;33(10):1279–89. https://doi.org/10.1093/eurheartj/ehr265.

    Article  CAS  PubMed  Google Scholar 

  2. Moreno M, Lombardi A, Silvestri E, et al. PPARs: Nuclear Receptors Controlled by, and Controlling, Nutrient Handling through Nuclear and Cytosolic Signaling. PPAR Res. 2010;2010:435689. https://doi.org/10.1155/2010/435689

  3. Wilson JL, Duan R, El-Marakby A, et al. Peroxisome Proliferator Activated Receptor-α Agonist Slows the Progression of Hypertension, Attenuates Plasma Interleukin-6 Levels and Renal Inflammatory Markers in Angiotensin II Infused Mice. PPAR Res. 2012;2012:645969. https://doi.org/10.1155/2012/645969.

  4. Zarzuelo MJ, Jiménez R, Galindo P, et al. Antihypertensive effects of peroxisome proliferator-activated receptor-β activation in spontaneously hypertensive rats. Hypertension. 2011;58(4):733–43. https://doi.org/10.1161/HYPERTENSIONAHA.111.174490.

    Article  CAS  PubMed  Google Scholar 

  5. Botta M, Audano M, Sahebkar A, et al. PPAR Agonists and Metabolic Syndrome: An Established Role? Int J Mol Sci. 2018;19(4):1197. https://doi.org/10.3390/ijms19041197.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Usuda D, Kanda T. Peroxisome proliferator-activated receptors for hypertension. World J Cardiol. 2014;6(8):744–54. https://doi.org/10.4330/wjc.v6.i8.744.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Westerbacka J, Kolak M, Kiviluoto T, et al. Genes involved in fatty acid partitioning and binding, lipolysis, monocyte/macrophage recruitment, and inflammation are overexpressed in the human fatty liver of insulin-resistant subjects. Diabetes. 2007;56(11):2759–65. https://doi.org/10.2337/db07-0156.

    Article  CAS  PubMed  Google Scholar 

  8. Bernal-Mizrachi C, Xiaozhong L, Yin L, et al. An afferent vagal nerve pathway links hepatic PPARalpha activation to glucocorticoid-induced insulin resistance and hypertension. Cell Metab. 2007;5(2):91–102. https://doi.org/10.1016/j.cmet.2006.12.010.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Pham GS, Shimoura CG, Chaudhari S, et al. Chronic unilateral cervical vagotomy reduces renal inflammation, blood pressure, and renal injury in a mouse model of lupus. Am J Physiol Renal Physiol. 2020;319(2):F155-F161. https://doi.org/10.1152/ajprenal.00201.2020.

  10. Lubaczeuski C, Balbo SL, Ribeiro RA, et al. Vagotomy ameliorates islet morphofunction and body metabolic homeostasis in MSG-obese rats. Braz J Med Biol Res. 2015;48(5):447–57. https://doi.org/10.1590/1414-431X20144340.

  11. Souza-Mello V. Peroxisome proliferator-activated receptors as targets to treat non-alcoholic fatty liver disease. World J Hepatol. 2015;7(8):1012–9. https://doi.org/10.4254/wjh.v7.i8.1012.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Purdy M, Nykopp TK, Kainulainen S, et al. Division of the hepatic branch of the anterior vagus nerve in fundoplication: effects on gallbladder function. Surg Endosc. 2009;23(9):2143–6. https://doi.org/10.1007/s00464-008-0242-0.

    Article  PubMed  Google Scholar 

  13. Woodward ER. The history of vagotomy. Am J Surg. 1987;153(1):9–17. https://doi.org/10.1016/0002-9610(87)90195-4.

    Article  CAS  PubMed  Google Scholar 

  14. Rabben HL, Zhao CM, Hayakawa Y, et al. Vagotomy and Gastric Tumorigenesis. Curr Neuropharmacol. 2016;14(8):967–72. https://doi.org/10.2174/1570159x14666160121114854.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Seeras K, Qasawa RN, Prakash S. Truncal Vagotomy. Tampa, FL: StatPearls; 2021.

  16. Centers for Disease Control and Prevention. 2021 Sept 30. Adult Obesity Facts. Retrieved October 11, 2021 from https://www.cdc.gov/obesity/data/adult.html.

  17. Bocher V, Pineda-Torra I, Fruchart JC, et al. PPARs: transcription factors controlling lipid and lipoprotein metabolism. Ann N Y Acad Sci. 2002;967:7–18. https://doi.org/10.1111/j.1749-6632.2002.tb04258.x.

    Article  CAS  PubMed  Google Scholar 

  18. Chao L, Marcus-Samuels B, Mason MM, et al. Adipose tissue is required for the antidiabetic, but not for the hypolipidemic, effect of thiazolidinediones. J Clin Invest. 2000;106(10):1221–8. https://doi.org/10.1172/JCI11245.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Rahimian R, Masih-Khan E, Lo M, et al. Hepatic over-expression of peroxisome proliferator activated receptor gamma2 in the ob/ob mouse model of non-insulin dependent diabetes mellitus. Mol Cell Biochem. 2001;224(1–2):29–37. https://doi.org/10.1023/a:1011927113563.

    Article  CAS  PubMed  Google Scholar 

  20. Uno K, Katagiri H, Yamada T, et al. Neuronal pathway from the liver modulates energy expenditure and systemic insulin sensitivity. Science. 2006;312(5780):1656–9. https://doi.org/10.1126/science.1126010.

    Article  CAS  PubMed  Google Scholar 

  21. Ferrer-Márquez M, Belda-Lozano R, Ferrer-Ayza M. Technical Controversies in Laparoscopic Sleeve Gastrectomy. OBES SURG. 2012;22:182–7. https://doi.org/10.1007/s11695-011-0492-0.

    Article  PubMed  Google Scholar 

  22. Picone DS, Schultz MG, Otahal P, et al. Accuracy of Cuff-Measured Blood Pressure: Systematic Reviews and Meta-Analyses. J Am Coll Cardiol. 2017;70(5):572–86. https://doi.org/10.1016/j.jacc.2017.05.064.

    Article  PubMed  Google Scholar 

  23. Schiavon CA, Bersch-Ferreira AC, Santucci EV, et al. Effects of Bariatric Surgery in Obese Patients With Hypertension: The GATEWAY Randomized Trial (Gastric Bypass to Treat Obese Patients With Steady Hypertension). Circulation. 2018;137(11):1132–1142. https://doi.org/10.1161/CIRCULATIONAHA.117.032130. Erratum in: Circulation. 2019 Oct;140(14):e718.

  24. Wen J, Huang Y, Lu Y, et al. Associations of non-high-density lipoprotein cholesterol, triglycerides and the total cholesterol/HDL-c ratio with arterial stiffness independent of low-density lipoprotein cholesterol in a Chinese population. Hypertens Res. 2019;42(8):1223–1230. https://doi.org/10.1038/s41440-019-0251-5.

  25. Ingelsson E, Schaefer EJ, Contois JH, et al. Clinical utility of different lipid measures for prediction of coronary heart disease in men and women. JAMA. 2007;298(7):776–85. https://doi.org/10.1001/jama.298.7.776.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Dr. Frank Greenway at Pennington Biomedical Research Center (Baton Rouge, LA) for assisting us with the study design.

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Authors and Affiliations

  1. LSUHSC School of Medicine, 433 Bolivar St, New Orleans, LA, 70112, USA

    Anna M. Catinis & Ashlin J. Hinojosa

  2. LSUHSC School of Public Health, 2020 Gravier St, New Orleans, LA, 70112, USA

    Claudia Leonardi

  3. LSU Department of Surgery, School of Medicine, 433 Bolivar St, New Orleans, LA, 70112, USA

    Michael W. Cook

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  1. Anna M. Catinis
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  2. Ashlin J. Hinojosa
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  3. Claudia Leonardi
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  4. Michael W. Cook
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Correspondence to Michael W. Cook.

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Key Points

1. Hepatic vagotomy results in lower total cholesterol/high-density lipoprotein ratios.

2. Hepatic vagotomy may reverse obesity related dysregulation of hepatic PPAR activity.

3. Hepatic vagotomy enhances bariatric surgery's positive impact on CRP & TC/HDL.

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Supplementary file1 (DOCX 26 KB)

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Catinis, A.M., Hinojosa, A.J., Leonardi, C. et al. Hepatic Vagotomy in Patients With Obesity Leads to Improvement of the Cholesterol to High-Density Lipoprotein Ratio. OBES SURG 33, 3740–3745 (2023). https://doi.org/10.1007/s11695-023-06800-2

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  • DOI: https://doi.org/10.1007/s11695-023-06800-2

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