Abstract
Roux-en-Y gastric bypass surgery (RYGB) is the most common and effective weight loss procedure for severe obesity. However, a significant increase in addictive behaviors and new-onset substance use disorder (SUD) are sometimes observed post-surgery. The endogenous opioid system is known to play a major role in motivated behavior and reward, as well as the abuse of substances, including alcohol, tobacco, opioids and highly palatable foods. Here, we examined the effects of RYGB on mu-opioid receptor levels in the brain. Male Sprague-Dawley rats were assigned to one of four groups: standard diet with sham surgery (control), ad libitum high-energy high-fat (HF) diet with sham surgery, calorie restricted HF diet with sham surgery (Sham-FR), or HF diet with RYGB surgery. Control and HF groups were fed their respective diets for 8 weeks, with surgery performed on the eighth week. After 9 weeks on their respective diets post-surgery, animals were sacrificed for mu-opioid receptor autoradiography using the [3H] [D-Ala2,N-Me-Phe4-Gly5-ol]- enkephalin (DAMGO) ligand. Rats with RYGB showed reduced DAMGO binding in the central amygdala compared to sham-operated HF diet controls, and in the hypothalamus compared to high-fat fed Sham-FR. Diet alone did not change [3H] DAMGO binding in any region. These findings show that RYGB surgery, independent of diet or caloric restriction, decreases mu opioid signaling in specific regions important for stress and energy regulation. Thus, RYGB surgery may lead to greater stress sensitivity via downregulated mu opioid signaling in the central amygdala, which may contribute to the observed increased risk in some subjects for addictive behavior.
Highlights
The results of this study show that Roux-en-Y gastric bypass surgery (RYGB) surgery resulted in a significant 31% reduction in binding in the hypothalamus compared to animals on a food restricted HF diet, and a 56% reduction in binding in the central medial amygdala compared to the HF group
It has been reported that mu opioid receptor (MOR) inhibition in the lateral hypothalamus, but not the nucleus accumbens or ventral tegmental area, reduces food intake in food-deprived mice, suggesting that opioid signaling in the hypothalamus mediates hunger rather than the rewarding aspect of food consumption [39]
Our laboratories previously reported that body weight significantly decreases in the 8 weeks following RYGB surgery [34] (Fig 3)
Summary
When a high-energy, high-fat/high sugar diet is restricted to match caloric intake of rats eating standard chow, there is no difference in MOR mRNA levels in the nucleus accumbens, suggesting increased calorie intake or obesity is necessary to induce changes in MOR availability, not the macronutrient composition of the diet [24]. The MOR agonist D-Ala2,N,Me-Phe, Gly-ol5-enkephalin (DAMGO) has been implicated in the increased preference for a high-fat diet [25] This effect is especially apparent in the nucleus accumbens, where stimulation with DAMGO triggers an increase in food intake even when sated [26]. We expect that a high-fat diet will increase mu opioid receptor expression in regions of the reward circuit, and that RYGB might reverse this effect
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