Abstract
To investigate the effect of duodenal-jejunal bypass (DJB) surgery on postoperative blood glucose in type 2 diabetic rats, and further explore possible mechanisms for the effect of surgical treatment of type 2 diabetes. Forty rats with type 2 diabetes were randomly assigned to 4 groups (n = 10 rats per group), which subsequently underwent DJB, new biliopancreatic diversion (NBPD) or duodenal-jejunal exclusion (DJE) surgery or a sham operation (SHAM). Fasting glucose, 2-h postprandial glucose and blood lipids were measured, and the mRNA in liver and intestinal tissue for bile acid receptor (FXR), as well as the FXR protein expression in the liver tissues were determined. Postprandial blood glucose and fasting TG and FFA in the DJB and NBPD groups were significantly lower than those in the SHAM group and preoperative (p < 0.05) at 8 weeks postoperation. Liver FXR protein was expressed at significantly higher in the DJB and NBPD groups than in the other two (p < 0.05), and the intestinal FXR mRNA in the DJE group were highest. DJB up-regulates the expression of bile acid receptors in the liver and down-regulates those receptors in the intestinal tract via biliopancreatic diversion. This process reduces TG levels, and subsequently any lipotoxicity to islet cells to produce a hypoglycemic effect.
Highlights
The number of people with type 2 diabetes mellitus (T2DM) has increased over the years, and medical treatment has been the main therapeutic approach for T2DM
To investigate the effects of intestinal exclusion alone and biliopancreatic diversion alone on blood glucose levels, changes in blood glucose, blood lipids, insulin resistance (IR), and islet cell apoptosis were examined after performing duodenal-jejunal bypass (DJB), new biliopancreatic diversion (NBPD), duodenaljejunal exclusion (DJE), and sham operations (Fig. 4)
While the fasting serum cholesterol levels in the DJB and NBPD groups were significantly lower than those in the sham operation (SHAM) and DJE groups at 8 weeks postoperation (p < 0.05), no significant difference in fasting serum cholesterol levels was found among the 4 groups at 24 weeks postoperation (Fig. 7C)
Summary
The number of people with type 2 diabetes mellitus (T2DM) has increased over the years, and medical treatment has been the main therapeutic approach for T2DM. Our previous study showed that new biliopancreatic diversion (NBPD, Fig. 2) alone could reduce blood glucose levels, and intestinal exclusion (duodenal-jejunal exclusion, DJE, Fig. 3) alone produced no hypoglycemic effect. The levels of fasting serum total bile acids and mRNA and protein expression for components in signaling pathways downstream of bile acid receptors in various organs were measured at 24 weeks postoperation. This was done to explore the role of bile acids and their pathways in the hypoglycemic mechanism of intestinal bypass, so as to further explore understand the hypoglycemic mechanism of DJB
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