Shani Shenhar-Tsarfaty1, Shiri Sherf-Dagan2,3,4, Galia Berman5, Muriel Webb2, Asnat Raziel3, Andrei Keidar3,6, David Goitein3,4,7, Nasser Sakran3,8, Eti Zwang5, Itzhak Shapira5, David Zeltser5, Shlomo Berliner5, Ori Rogowski5, Oren Shibolet2,4, Shira Zelber-Sagi2,9. 1. Department of Internal Medicine "C", "D" &"E", Tel Aviv Sourasky Medical Center, Tel Aviv, Affiliated to the Faculty of Medicine, the Tel Aviv University, Israel. shanis@tlvmc.gov.il. 2. Department of Gastroenterology, Tel-Aviv Medical Center, Tel-Aviv, Israel. 3. Assuta Medical Center, Tel Aviv, Israel. 4. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 5. Department of Internal Medicine "C", "D" &"E", Tel Aviv Sourasky Medical Center, Tel Aviv, Affiliated to the Faculty of Medicine, the Tel Aviv University, Israel. 6. Department of General Surgery, Assuta Ashdod Public Hospital, Ben-Gurion University, Beer-Sheba, Israel. 7. Department of Surgery C, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. 8. Department of Surgery A, Emek Medical Center Afula, Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel. 9. School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
Abstract
BACKGROUND: Impaired sympathetic/parasympathetic response, expressed by elevated Acetylcholinesterase (AChE) is associated with obesity, metabolic syndrome and inflammation. However, the association between morbid obesity and AChE and the changes in cholinergic tone following bariatric laparoscopic sleeve gastrectomy (LSG) surgery-induced weight reduction were never analyzed. METHODS: Two studies are presented; the first (the "apparently healthy cohort") was a cross-sectional study and the second (the "LSG cohort") was a prospective-cohort study with 12 months of follow-up. The "apparently healthy cohort" included 1450 apparently healthy participants who volunteered to the Tel-Aviv Medical Center Inflammation Survey (TAMCIS) during a routine annual checkup visit. The "LSG cohort" included 77 morbid obese patients before and at 3, 6, and 12 months following LSG surgery. Main outcomes included anthropometric measurements, Hemoglobin A1c (HbA1C), serum AChE, insulin test and Homeostasis Model Assessment (HOMA). RESULTS: Among the TAMCIS participants, serum AChE activity increased with BMI in a dose-dependent manner until it reached a peak level at BMI of 30-35 kg/m², followed by a plateau. Following LSG, a significant decrease in AChE activity between baseline and 12 months post-surgery was found for men, but not for women (-122.2 ± 135.3, P < 0.001 vs. -21.8 ± 120.5, P = 0.258 nmol substrate hydrolyzed/min per ml, respectively). The reduction in AChE activity was negatively correlated with %excess weight loss (EWL) and positively correlated with %body fat reduction at 12 months post-surgery among women (r = -0.329, P = 0.034 and r = 0.350, P = 0.023, respectively). In men, AChE activity reduction was positively correlated with the HOMA reduction (r = 0.358, P = 0.048). CONCLUSIONS: Obesity-related AChE resistance phenotype may be reversed following LSG and correlates with metabolic outcomes. Further long-term studies will be needed to validate and evaluate the beneficial effect of AChE reduction post bariatric surgery.
BACKGROUND: Impaired sympathetic/parasympathetic response, expressed by elevated Acetylcholinesterase (AChE) is associated with obesity, metabolic syndrome and inflammation. However, the association between morbid obesity and AChE and the changes in cholinergic tone following bariatric laparoscopic sleeve gastrectomy (LSG) surgery-induced weight reduction were never analyzed. METHODS: Two studies are presented; the first (the "apparently healthy cohort") was a cross-sectional study and the second (the "LSG cohort") was a prospective-cohort study with 12 months of follow-up. The "apparently healthy cohort" included 1450 apparently healthy participants who volunteered to the Tel-Aviv Medical Center Inflammation Survey (TAMCIS) during a routine annual checkup visit. The "LSG cohort" included 77 morbid obese patients before and at 3, 6, and 12 months following LSG surgery. Main outcomes included anthropometric measurements, Hemoglobin A1c (HbA1C), serum AChE, insulin test and Homeostasis Model Assessment (HOMA). RESULTS: Among the TAMCIS participants, serum AChE activity increased with BMI in a dose-dependent manner until it reached a peak level at BMI of 30-35 kg/m², followed by a plateau. Following LSG, a significant decrease in AChE activity between baseline and 12 months post-surgery was found for men, but not for women (-122.2 ± 135.3, P < 0.001 vs. -21.8 ± 120.5, P = 0.258 nmol substrate hydrolyzed/min per ml, respectively). The reduction in AChE activity was negatively correlated with %excess weight loss (EWL) and positively correlated with %body fat reduction at 12 months post-surgery among women (r = -0.329, P = 0.034 and r = 0.350, P = 0.023, respectively). In men, AChE activity reduction was positively correlated with the HOMA reduction (r = 0.358, P = 0.048). CONCLUSIONS: Obesity-related AChE resistance phenotype may be reversed following LSG and correlates with metabolic outcomes. Further long-term studies will be needed to validate and evaluate the beneficial effect of AChE reduction post bariatric surgery.
Authors: David Benaiges; Antonio Más-Lorenzo; Albert Goday; José M Ramon; Juan J Chillarón; Juan Pedro-Botet; Juana A Flores-Le Roux Journal: World J Gastroenterol Date: 2015-11-07 Impact factor: 5.742
Authors: Pedro González-Muniesa; Miguel-Angel Mártinez-González; Frank B Hu; Jean-Pierre Després; Yuji Matsuzawa; Ruth J F Loos; Luis A Moreno; George A Bray; J Alfredo Martinez Journal: Nat Rev Dis Primers Date: 2017-06-15 Impact factor: 52.329