Abstract
Severe obese patients with type 2 diabetes mellitus (T2DM) submitted to Roux-en-Y gastric bypass (RYGB) show significant improvement in glucose control after surgery upon discharge from the hospital, even before a considerable weight loss, with suppression of hypoglycemic drugs. Experimentally, the anatomical changes induced by RYGB can change genes expression in gastrointestinal tissue related to glucose control determinants to T2DM reversal. However, there aren't clinical studies that prove these findings in humans. We will study 20 severely obese patients with T2DM candidates for RYGB. Before and 3 months after surgery, biopsies will be collected from the gastric body, gastric fundus, duodenum, jejunum and ileum by double balloon enteroscopy, used to verify changes in mRNA expression by microarray technique. Altered gene expressed will be validated by RT-qPCR and protein expression by mass spectrometry. The plasma glucose, incretins, insulin, C-peptide and glycosylated hemoglobin will also be evaluated before and after surgery. Metabolic pathways involving genes reportedly regulated after RYGB will be identified and proposed as a potential therapeutic target for T2DM. The composition of intestinal microbiota in obese patients with T2DM has been suggested as key element in glucose control. Accordingly, in parallel, we evaluate the preoperative and postoperative changes in the composition of fecal microbiota in our patients. (AU)
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