Top

Published in:

01-06-2021 | Obesity | 2020 SAGES Oral

Low visceral adipose tissue regulatory T cells are associated with higher comorbidity severity in patients undergoing bariatric surgery

Authors: Anahita Jalilvand, Alecia Blaszczak, David Bradley, Joey Liu, Valerie Wright, Bradley Needleman, Willa Hsueh, Sabrena Noria

Published in: Surgical Endoscopy | Issue 6/2021

Abstract

Background

Adipose tissue (AT) inflammation is linked to the development of type 2 diabetes (T2DM) and atherosclerosis in murine models of obesity. Reduced AT regulatory T cells (Tregs), which are anti-inflammatory immune cells, play an important part in this pathogenesis, and we have shown that AT-Tregs are inversely correlated to increasing body-mass-index. The purpose of this study was to evaluate the association between AT-Treg abundance and comorbidity status in patients undergoing bariatric surgery (BS).

Methods

Visceral (intra-abdominal) AT was harvested at that time of primary BS (n = 80) and collagenase digested. AT-Treg abundance (CD4+/CD25+/FOXP3+) was characterized using flow cytometry from the AT stromal vascular fraction. The median AT-Treg abundance (3.03%) was utilized to define high (High-Tregs, n = 39) and low AT-Treg (low-Tregs, n = 38) abundance within this cohort. These two groups were compared in terms of baseline demographic data, preoperative obesity-related comorbidities, glycemic parameters, including insulin resistance (HOMA-IR).

Results

Age, excess body weight, and sex were not different between groups. Prevalence of hypertension, hyperlipidemia, or T2DM preoperatively were not different between groups. Compared to High-Tregs, patients with low-Tregs were more likely to have insulin-dependent type 2 diabetes (12.5% vs 2.9%, p = 0.04). Within patients with T2DM, low-Treg patients had higher plasma insulin levels compared to high-Tregs (31.8 (28.4–56.5) vs 15.5 (10.1–23.1), p = 0.04) and trended towards higher insulin resistance (HOMA-IR) (9.0 (5.3–18.3) vs 3.5 (2.2–7.7), p = 0.08). Within those diagnosed with hyperlipidemia, preoperative statin use was higher in Low-Treg patients compared to the control cohort (91% vs 50%, p = 0.056). Low-Treg patients with hypertension were more likely to need 2 + anti-hypertensive agents preoperatively compared to their counterparts (71% vs 44%, p = 0.058).

Conclusion

Within bariatric candidates, lower visceral AT-Treg abundance was associated with increased baseline medication requirements for type 2 diabetes, hypertension, and hyperlipidemia. This suggests that reduced AT-Tregs may be associated with higher obesity-related comorbidity severity.

Deng T et al (2013) Class II major histocompatibility complex plays an essential role in obesity-induced adipose inflammation. Cell Metab 17(3):411–422. https://doi.org/10.1016/j.cmet.2013.02.009CrossRefPubMedPubMedCentral

Kintscher U et al (2008) T-lymphocyte infiltration in visceral adipose tissue: a primary event in adipose tissue inflammation and the development of obesity-mediated insulin resistance. Arterioscler Thromb Vasc Biol 28(7):1304–1310. https://doi.org/10.1161/ATVBAHA.108.165100CrossRefPubMed

Lee B-C, Lee J (2014) Cellular and molecular players in adipose tissue inflammation in the development of obesity-induced insulin resistance. Biochim Biophys Acta 1842(3):446–462. https://doi.org/10.1016/j.bbadis.2013.05.017CrossRefPubMed

Cancello R et al (2005) Reduction of macrophage infiltration and chemoattractant gene expression changes in white adipose tissue of morbidly obese subjects after surgery-induced weight loss. Diabetes 54(8):2277–2286CrossRef

Deng T et al (2017) Adipocyte adaptive immunity mediates diet-induced adipose inflammation and insulin resistance by decreasing adipose Treg cells. Nat Commun 8:15725. https://doi.org/10.1038/ncomms15725CrossRefPubMedCentral

Eller K et al (2011) Potential role of regulatory T cells in reversing obesity-linked insulin resistance and diabetic nephropathy. Diabetes 60(11):2954–2962. https://doi.org/10.2337/db11-0358CrossRefPubMedPubMedCentral

Berger S et al (2017) Lipodystrophy and obesity are associated with decreased number of T cells with regulatory function and pro-inflammatory macrophage phenotype. Int J Obes 41(11):1676–1684. https://doi.org/10.1038/ijo.2017.163CrossRef

Feuerer M et al (2009) Lean, but not obese, fat is enriched for a unique population of regulatory T cells that affect metabolic parameters. Nat Med 15(8):930–939. https://doi.org/10.1038/nm.2002CrossRefPubMedPubMedCentral

Bradley D (2020) Adipose T regulatory cells decline in association with increased adipocyte MHCII activity in human obesity.

10.

Grandl G, Wolfrum C (2018) Hemostasis, endothelial stress, inflammation, and the metabolic syndrome. Semin Immunopathol 40(2):215–224. https://doi.org/10.1007/s00281-017-0666-5CrossRefPubMed

11.

McCracken E, Monaghan M, Sreenivasan S (2018) Pathophysiology of the metabolic syndrome. Clin Dermatol 36(1):14–20. https://doi.org/10.1016/j.clindermatol.2017.09.004CrossRefPubMed

12.

Eckel RH, Grundy SM, Zimmet PZ (2005) The metabolic syndrome. Lancet Lond Engl 365(9468):1415–1428. https://doi.org/10.1016/S0140-6736(05)66378-7CrossRef

13.

Catrysse L, van Loo G (2017) Inflammation and the metabolic syndrome: the tissue-specific functions of NF-κB. Trends Cell Biol 27(6):417–429. https://doi.org/10.1016/j.tcb.2017.01.006CrossRefPubMed

14.

Blaszczak AM et al (2019) Loss of antigen presentation in adipose tissue macrophages or in adipocytes, but not both, improves glucose metabolism. J Immunol Baltim Md 202(8):2451–2459. https://doi.org/10.4049/jimmunol.1801470CrossRef

15.

Zeng Q, Sun X, Xiao L, Xie Z, Bettini M, Deng T (2018) A unique population: adipose-resident regulatory T cells. Front Immunol 9:2075. https://doi.org/10.3389/fimmu.2018.02075CrossRefPubMedPubMedCentral

16.

Alberti KGMM, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation. Diabet Med 15(7):539–553CrossRef

17.

Expert Panel on Detection (2001) Evaluation, and treatment of high blood cholesterol in adults, “executive summary of the third report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)”. JAMA 285(19):2486–2497. https://doi.org/10.1001/jama.285.19.2486CrossRef

18.

Ryo M et al (2004) Adiponectin as a biomarker of the metabolic syndrome. Circ J 68(11):975–981. https://doi.org/10.1253/circj.68.975CrossRefPubMed

Title: Low visceral adipose tissue regulatory T cells are associated with higher comorbidity severity in patients undergoing bariatric surgery
Authors: Anahita Jalilvand
Alecia Blaszczak
David Bradley
Joey Liu
Valerie Wright
Bradley Needleman
Willa Hsueh
Sabrena Noria
Publication date: 01-06-2021
Publisher: Springer US
Keywords: Obesity
Obesity
Bariatric Surgery
Bariatric Surgery
Insulins
Hypertension
Insulins
Hypertension
Published in: Surgical Endoscopy / Issue 6/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07751-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Low visceral adipose tissue regulatory T cells are associated with higher comorbidity severity in patients undergoing bariatric surgery

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2021

Underwater endoscopic mucosal resection for colorectal lesions: a meta-analysis

A knowledge gap unmasked: viral transmission in surgical smoke: a systematic review

Robotic-assisted approaches to GERD following sleeve gastrectomy

Enhanced recovery program versus conventional care after colorectal surgery in the geriatric population: a systematic review and meta-analysis

Total extraperitoneal laparoscopic inguinal hernia repair with adductor tenotomy: a 10-year experience in the treatment of athletic pubalgia

What delays your case start? Exploring operating room inefficiencies