Marambio A, Watkins G, Castro F, Riffo A, Zúñiga R, Jans J, Villanueva ME, Díaz G. Changes in iron transporter divalent metal transporter 1 in proximal jejunum after gastric bypass. World J Gastroenterol 2014; 20(21): 6534-6540 [PMID: 24914374 DOI: 10.3748/wjg.v20.i21.6534]
Corresponding Author of This Article
Dr. Andrés Marambio, Department of Surgery, University of Chile Clinical Hospital, Santos Dumont 999, Independencia, Santiago 8380456, Chile. amarambio@med.uchile.cl
Research Domain of This Article
Surgery
Article-Type of This Article
Research Report
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World J Gastroenterol. Jun 7, 2014; 20(21): 6534-6540 Published online Jun 7, 2014. doi: 10.3748/wjg.v20.i21.6534
Changes in iron transporter divalent metal transporter 1 in proximal jejunum after gastric bypass
Andrés Marambio, Guillermo Watkins, Fabiola Castro, Andrea Riffo, Roberta Zúñiga, Jaime Jans, María E Villanueva, Guillermo Díaz
Andrés Marambio, Guillermo Watkins, Andrea Riffo, Jaime Jans, Department of Surgery, University of Chile Clinical Hospital, Santiago 8380456, Chile
Fabiola Castro, Department of Gastroenterology, Chilean Air Force Clinical Hospital, Santiago 7560171, Chile
Roberta Zúñiga, Guillermo Díaz, Department of Pharmacological and Toxicological Chemistry, University of Chile Chemistry and Pharmacy Faculty, Santiago 8380492, Chile
María E Villanueva, Pathology Service, University of Chile Clinical Hospital, Santiago 8380456, Chile
Author contributions: Marambio A participated in the conception and design of the study, acquisition, analysis and interpretation of data, and drafting the article and finally approving it; Watkins G participated in the conception and design of the study, revising the article critically and finally approving it; Castro F participated in the conception and design of the study, revising the article critically and finally approving it; Riffo A participated in the acquisition of data, revising the article critically and finally approving it; Zúñiga R participated in the acquisition, analysis and interpretation of data and drafting the article and finally approving it; Jans J participated in the acquisition of data, drafting the article and finally approving it; Villanueva ME participated in the analysis and interpretation of data, revising the article critically and finally approving it; and Díaz G participated in the conception and design of the study, analysis and interpretation of data, revising the article critically and finally approving it.
Supported by “2009 Clinical and Basic Clinical Research Contest” of the Bureau for Clinical Research Support from the University of Chile Clinical Hospital
Correspondence to: Dr. Andrés Marambio, Department of Surgery, University of Chile Clinical Hospital, Santos Dumont 999, Independencia, Santiago 8380456, Chile. amarambio@med.uchile.cl
Telephone: +56-2-29788329 Fax: +56-2-27370844
Received: September 15, 2013 Revised: December 5, 2013 Accepted: January 8, 2014 Published online: June 7, 2014
Abstract
AIM: To describe the variation that divalent metal transporter 1 (DMT1) shows in patients after Roux-en-Y gastric bypass (RYGB) surgery.
METHODS: Prospective and analytical study of DMT1 level at the brush border of proximal jejunum in patients having undergone RYGB surgery. The mucosa of proximal jejunum forming the gastrojejunal anastomosis was biopsied during surgery and after 6 mo later with an endoscopic biopsy. All the patients received precise instructions regarding feeding and nutritional supplementation. Both samples were processed at the same time by immunohistochemistry and western blot. Samples were analysed by a pathologist. For statistical analysis, the χ2 and Wilcoxon tests were used.
RESULTS: Sixteen patients were recruited, 13 of whom completed the study. Twelve were women. Average age and body mass index (BMI) were 44.1 and 40.4, respectively. Both body weight and BMI decreased significantly during the study period, with an average percent excess weight loss (%EWL) of 60% ± 13.3% and an average percent excess BMI loss (%EBMIL) of 79.6% ± 21.6%. Only two patients presented with mild anaemia 6 mo after surgery, but their ferritin levels stayed within normal ranges. Staining for DMT1 showed a significant increase in the cytoplasm of enterocytes located at the tips of the villi (χ2 = 6.03; P = 0.049). Nevertheless, the total quantity of DMT1 decreased significantly (Z = 2.04; P = 0.04). Associated with these results, we observed a significant increase in goblet cells in the villi 6 mo postoperatively (Z = -2.47; P = 0.013).
CONCLUSION: Six months after RYGB surgery, patients exhibit an increase in DMT1 expression in the enterocytes of the tips of the villi at the proximal jejunum.
Core tip: Anaemia after Roux-en-Y gastric bypass surgery is one of the most common nutritional deficiencies. Different nutritional supplementation strategies have been developed to prevent this complication, but a subset of patients still develop it. This study brings readers the first report on the molecular changes that occur in the physiology of iron absorption in these patients.
