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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Do different bariatric surgical procedures influence plasma levels of matrix metalloproteinase-2, -7, and -9 among patients with type 2 diabetes mellitus?
Wen-Chi Wu, Wei-Jei Lee, Tzong-His Lee, Shu-Chun Chen, Chih-Yen Chen
Wen-Chi Wu, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
Wei-Jei Lee, Department of Surgery, Min-Sheng General Hospital, Taoyuan 330, Taiwan
Wei-Jei Lee, Taiwan Society for Metabolic and Bariatric Surgery, Taipei 11031, Taiwan
Tzong-His Lee, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
Shu-Chun Chen, Department of Nursing, Chang-Gung Institute of Technology, Guishan, Taoyuan 333, Taiwan
Chih-Yen Chen, Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
Chih-Yen Chen, Faculty of Medicine and Institute of Emergency and Critical Medicine, National Yang-Ming University School of Medicine, Taipei 11221, Taiwan
Chih-Yen Chen, Association for the Study of Small Intestinal Diseases, Guishan, Taoyuan 33305, Taiwan
Chih-Yen Chen, Chinese Taipei Society for the Study of Obesity, Taipei 110, Taiwan
Author contributions: Wu WC and Lee TH contributed equally to this work and should be regarded as co-first authors. Chen CY conceived and designed the study and did data-analysis and patient data collection; Lee WJ performed bariatric surgery and collected the data of the patients; Wu WC reviewed the literature and wrote the original draft of the manuscript; Chen CY, Lee WJ, Lee TH, Chen SC, and Wu WC made critical revisions and approved the final version of the manuscript.
Supported by grants from Min-Sheng General Hospital, Taoyuan, and Far Eastern Memorial Hospital-National Yang-Ming University Joint Research Program, No. 105DN15, No. 106DN15, and No. 107DN14 to Lee TH and Chen CY.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of National Yang-Ming University.
Clinical trial registration statement: This is a clinical observation, not a clinical trial.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors have no potential conflicts of interest to declare.
Data sharing statement: The statistical code and dataset are available from the corresponding author at chency@vghtpe.gov.tw.
CONSORT 2010 statement: This is a clinical observation, not a clinical trial. This manuscript was exempted from the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Chih-Yen Chen, AGAF, MD, PhD, Attending Doctor, Professor, Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan. chency@vghtpe.gov.tw
Received: December 31, 2019
Peer-review started: December 31, 2019
First decision: March 24, 2020
Revised: April 9, 2020
Accepted: April 24, 2020
Article in press: April 24, 2020
Published online: June 15, 2020
Processing time: 153 Days and 23.4 Hours
BACKGROUND
Bariatric surgery is an efficient strategy for body weight and type 2 diabetes mellitus (T2DM) management. Abnormal lipid deposition in visceral organs, especially the pancreas and liver, might cause beta-cell dysfunction and insulin resistance. Extracellular matrix (ECM) remodeling allows adipose expansion, and matrix metalloproteinases (MMPs) play essential roles in ECM construction. MMP-2 and MMP-9 are the substrates of MMP-7. Different studies have reported that MMP-2, -7, and -9 increase in patients with obesity and metabolic syndromes or T2DM and are considered biomarkers in obesity and hyperglycemia patients.
AIM
To prospectively investigate whether MMP-2, MMP-7, and MMP-9 differ after two bariatric surgeries: Gastric bypass (GB) and sleeve gastrectomy (SG).
METHODS
We performed GB in 23 and SG in 19 obese patients with T2DM. We measured body weight, waist circumference, body mass index (BMI), and serum concentrations of total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting blood sugar (FBS), hemoglobin A1c (HbA1c), C-peptide, homeostasis model assessments of insulin resistance, and MMP-2, MMP-7, and MMP-9 levels at baseline and at 3, 12, and 24 mo post-operation.
RESULTS
Twenty-three patients aged 44.7 ± 9.7 years underwent GB, and 19 patients aged 40.1 ± 9.1 years underwent SG. In the GB group, BMI decreased from 30.3 ± 3.4 to 24.4 ± 2.4 kg/m2, HbA1c decreased from 9.2% ± 1.5% to 6.7% ± 1.4%, and FBS decreased from 171.6 ± 65.0 mg/dL to 117.7 ± 37.5 mg/dL 2 years post-operation (P < 0.001). However, the MMP-2, MMP-7, and MMP-9 levels pre- and post-GB were similar even 2 years post-operation (P = 0.107, 0.258, and 0.466, respectively). The SG group revealed similar results: BMI decreased from 36.2 ± 5.1 to 26.9 ± 4.7 kg/m2, HbA1c decreased from 7.9% ± 1.7% to 5.8% ± 0.6%, and FBS decreased from 138.3 ± 55.6 mg/dL to 95.1 ± 3.1 mg/dL (P < 0.001). The serum MMP-2, -7, and -9 levels pre- and post-SG were not different (P = 0.083, 0.869, and 0.1, respectively).
CONCLUSION
Improvements in obesity and T2DM induced by bariatric surgery might be the result of MMP-2, -7, or -9 independent pathways.
Core tip: Bariatric surgery is a very effective strategy for managing obesity patients and those with type 2 diabetes mellitus. Matrix metalloproteinases play roles in extracellular matrix remodeling which consequently results in insulin resistance. Some authors reported higher levels of matrix metalloproteinases (MMP)-2, -7, and -9 in obese or diabetic patients. We measured plasma MMP-2, -7, and -9 concentrations in obese patients before and after bariatric surgeries; however, we did not identify any statistical differences in the MMP levels. We suggested that bariatric surgery reduces obesity and diabetes through MMP-2, -7, or -9 independent pathways.
