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Roux-en-Y gastric bypass, but not sleeve gastrectomy, decreases plasma PCSK9 levels in morbidly obese patients.

Authors
  • Blanchard, C1
  • Ledoux, S2
  • Verhaegen, A3
  • Wargny, M4
  • Letessier, E5
  • Stepanian, A6
  • Huten, N7
  • Jacobi, D8
  • Krempf, M9
  • Le Bras, M10
  • Perrocheau Guillouche, M10
  • Arnaud, L11
  • Pichelin, M4
  • Van Gaal, L3
  • Cariou, B4
  • Le May, C12
  • 1 University of Nantes, CNRS, Inserm, Thorax Institute, 44000 Nantes, France; Clinical Department of Digestive and Endocrine Surgery, CHU of Nantes, Nantes, France. , (France)
  • 2 Department of Functional Explorations, North Francilien Integrated Obesity Centre (CINFO), Hôpital Louis Mourier (AP-HP.7), University of Paris, Paris, France. , (France)
  • 3 Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium. , (Belgium)
  • 4 University of Nantes, CNRS, Inserm, Thorax Institute, 44000 Nantes, France; Thorax Institute, Department of Endocrinology, CIC 1413 Inserm, CHU Nantes, Nantes, France. , (France)
  • 5 Clinical Department of Digestive and Endocrine Surgery, CHU of Nantes, Nantes, France. , (France)
  • 6 AP-HP, Hôpital Lariboisière, Department of Biological Haematology, Paris, France. , (France)
  • 7 Digestive, Endocrine, Oncology and Liver Transplantation Department, CHU of Tours, Tours, France. , (France)
  • 8 University of Nantes, CNRS, Inserm, Thorax Institute, 44000 Nantes, France; Digestive, Endocrine, Oncology and Liver Transplantation Department, CHU of Tours, Tours, France. , (France)
  • 9 Thorax Institute, Department of Endocrinology, CIC 1413 Inserm, CHU Nantes, Nantes, France; INRA, UMR 1280, Physiology of Nutritional Adaptations, CHU Hôtel-Dieu, 44000 Nantes, France. , (France)
  • 10 Thorax Institute, Department of Endocrinology, CIC 1413 Inserm, CHU Nantes, Nantes, France. , (France)
  • 11 University of Nantes, CNRS, Inserm, Thorax Institute, 44000 Nantes, France. , (France)
  • 12 University of Nantes, CNRS, Inserm, Thorax Institute, 44000 Nantes, France. Electronic address: [email protected] , (France)
Type
Published Article
Journal
Diabetes & metabolism
Publication Date
Nov 01, 2020
Volume
46
Issue
6
Pages
480–487
Identifiers
DOI: 10.1016/j.diabet.2020.01.003
PMID: 32032671
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a master regulator of low-density lipoprotein cholesterol (LDL-C) metabolism, acting as an endogenous inhibitor of the LDL receptor. While it has been shown that bariatric surgery differentially affects plasma LDL-C levels, little is known of its effects on plasma PCSK9 concentrations. Therefore, the present study aimed to: (i) investigate the effect of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on plasma PCSK9 concentrations; and (ii) correlate baseline or postoperative plasma PCSK9 concentration variations with anthropometric and metabolic parameters. Fasting plasma PCSK9 levels were measured by ELISA in morbidly obese patients before and 6 months after bariatric surgery. Patients were recruited from three prospective cohorts (in Nantes and Colombes in France, and Antwerp in Belgium). A total of 156 patients (34SG, 122RYGB) were included. Plasma PCSK9, LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) levels were significantly reduced after RYGB (-19.6%, -16.6% and -19.5%, respectively; P<0.0001), but not after SG. In all patients, postoperative PCSK9 change was positively correlated with fasting plasma glucose (FPG; r=0.22, P=0.007), HOMA-IR (r=0.24, P=0.005), total cholesterol (r=0.17, P=0.037) and non-HDL-C (r=0.17, P=0.038) variations, but not LDL-C. In contrast to what was observed for glucose parameters (FPG, HOMA-IR), correlation between PCSK9 and non-HDL-C changes after RYGB was independent of total weight loss. RYGB, but not SG, promotes a significant reduction in plasma PCSK9 levels, and such changes in circulating PCSK9 levels after RYGB appear to be more associated with glucose improvement than with lipid homoeostasis parameters. Copyright © 2020. Published by Elsevier Masson SAS.

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