Published online Jun 15, 2020. doi: 10.4239/wjd.v11.i6.252
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
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.
To prospectively investigate whether MMP-2, MMP-7, and MMP-9 differ after two bariatric surgeries: Gastric bypass (GB) and sleeve gastrectomy (SG).
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.
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).
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.