Projection of Gut Microbiome Pre- and Post-Bariatric Surgery To Predict Surgery Outcome.

Meirav Ben Izhak,Eli Mavor,Avishai Alis,Ruti Cohen,Liora Madar-Shapiro,Nitsan Maharshak,Shimon Sapozhnikov,Edward Messick,Omry Koren,Hamutal Meiri,Chaim Wachtel,Adi Eshel,Aviel Meoded,Yoram Louzoun,Narisra Jongkam,Shai Meron Eldar,Ilanit Mahler,Conrad L Leung ,Subhi Abu‐Abeid

doi:10.1128/msystems.01367-20

Abstract

ABSTRACTBariatric surgery is often the preferred method to resolve obesity and diabetes, with ∼800,000 cases worldwide yearly and high outcome variability. The ability to predict the long-term body mass index (BMI) change following surgery has important implications for individuals and the health care system in general. Given the tight connection between eating habits, sugar consumption, BMI, and the gut microbiome, we tested whether the microbiome before any treatment is associated with different treatment outcomes, as well as other intakes (high-density lipoproteins [HDL], triglycerides, etc.). A projection of the gut microbiome composition of obese (sampled before and after bariatric surgery) and lean patients into principal components was performed, and the relation between this projection and surgery outcome was studied. The projection revealed three different microbiome profiles belonging to lean, obese, and obese individuals who underwent bariatric surgery, with the postsurgery microbiome more different from the lean microbiome than the obese microbiome. The same projection allowed for a prediction of BMI loss following bariatric surgery, using only the presurgery microbiome. The microbial changes following surgery were an increase in the relative abundance of Proteobacteria and Fusobacteria and a decrease in Firmicutes. The gut microbiome can be decomposed into main components depicting the patient's development and predicting in advance the outcome. Those may be translated into the better clinical management of obese individuals planning to undergo metabolic surgery.IMPORTANCE BMI and diabetes can affect the gut microbiome composition. Bariatric surgery has large variabilities in the outcome. The microbiome was previously shown to be a good predictor for multiple diseases. We analyzed here the gut microbiome before and after bariatric surgery and showed the following. (i) The microbiome before surgery can be used to predict surgery outcomes. (ii) The postsurgery microbiome drifts further away from the lean microbiome than the microbiome of the presurgery obese patients. These results can lead to a microbiome-based presurgery decision whether to perform surgery.

Highlights

Bariatric surgery is often the preferred method to resolve obesity and diabetes, with ~800,000 cases worldwide yearly and high outcome variability
When looking at which operational taxonomic units (OTU) are contributing to PC4 (Fig. 5A) we found Holdemania to be strongly correlated with future weight loss
Patients were enrolled in the obesity control/bariatric surgery clinics of four medical centers in Israel – Kaplan Medical Center (KMC), Rabin Medical Center (RMC), Tel Aviv Medical Center (TMC) and Poria Medical Center (PMC) during December 2015- November 2018

Summary

Introduction

Bariatric surgery is often the preferred method to resolve obesity and diabetes, with ~800,000 cases worldwide yearly and high outcome variability. Given the tight connection between eating habits, sugar consumption, BMI and the gut microbiome, we tested whether the microbiome before any treatment is associated with different treatment outcomes, as well as other intakes (HDL, Triglycerides, etc.). The microbiome is strongly associated with weight and sugar consumption, and as such it serves as a proxy for nutrition and life habits and may influence them. Such life habits may influence the total body mass and BMI in regular conditions, as well as after bariatric surgery. Experimental fecal transplants to mice demonstrated that transplantation of microbiome from obese individuals into slim mice turned them obese [6], showing the importance of the gut microbiome in regulating body weight. Opposite studies of turning obese mice into slim mice have not been successful but one study demonstrated that certain bacteria can prevent weight gain in mice [7]

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Results

Conclusion