J Hepatol. 2023 May 23. pii: S0168-8278(23)00341-0. [Epub ahead of print]
Fanny Lalloyer,
Denis A Mogilenko,
Ann Verrijken,
Joel T Haas,
Antonin Lamazière,
Mostafa Kouach,
Amandine Descat,
Sandrine Caron,
Emmanuelle Vallez,
Bruno Derudas,
Céline Gheeraert,
Eric Baugé,
Gaëtan Despres,
Eveline Dirinck,
Anne Tailleux,
David Dombrowicz,
Luc Van Gaal,
Jerôme Eeckhoute,
Philippe Lefebvre,
Jean-François Goossens,
Sven Francque,
Bart Staels.
BACKGROUND & AIMS: Roux-en-Y gastric bypass (RYGB), the most weight-loss effective surgical procedure, decreases obesity and comorbidities, such as non-alcoholic fatty liver (NAFLD) and cardiovascular (CVD) diseases. Cholesterol is a major CVD risk factor and modulator of NAFLD development, and the liver tightly controls its metabolism. How RYGB surgery modulates systemic and hepatic cholesterol metabolism is still unclear.
METHODS: We studied the hepatic transcriptome of 26 non-diabetic obese patients undergoing RYGB before and one-year post-surgery. In parallel, we measured quantitative changes in plasma cholesterol metabolites and bile acids (BA).
RESULTS: RYGB surgery improved systemic cholesterol metabolism and increased plasma total and primary BA levels. Transcriptomic analysis revealed specific alterations in the liver after RYGB, with the down-regulation of a module of genes implicated in inflammation and the up-regulation of three modules, one associated with BA metabolism. A dedicated analysis of hepatic genes related to cholesterol homeostasis pointed towards increased biliary cholesterol elimination after RYGB, associated with enhancement of the alternate, but not the classical, BA synthesis pathway. In parallel, alterations in the expression of genes involved in cholesterol uptake and intracellular trafficking indicate improved hepatic free cholesterol handling. Finally, RYGB decreased plasma markers of cholesterol synthesis, which correlated with post-surgery liver disease status improvement.
CONCLUSIONS: Our results identify specific regulatory effects of RYGB on inflammation and cholesterol metabolism. RYGB alters the hepatic transcriptome signature, likely improving liver cholesterol homeostasis. These gene regulatory effects are reflected by systemic post-surgery changes of cholesterol-related metabolites, corroborating the beneficial effects of RYGB on both hepatic and systemic cholesterol homeostasis.
IMPACTS AND IMPLICATION: Roux-en-Y gastric bypass (RYGB) is a widely used bariatric surgery procedure with proven efficacy in body weight management, combatting cardiovascular disease (CVD) and non-alcoholic fatty liver disease (NAFLD). RYGB exerts many beneficial metabolic effects, by lowering plasma cholesterol and improving atherogenic dyslipidemia. Using a cohort of RYGB patients, studied before and one year after surgery, we analyzed how RYGB modulates hepatic and systemic cholesterol and bile acid metabolism. The results of our study provide important insights on the regulation of cholesterol homeostasis after RYGB and open avenues that could guide future monitoring and treatment strategies targeting CVD and NAFLD in obesity.
Keywords: Roux-en-Y gastric bypass; bile acid; cholesterol; liver; transcriptome