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. 2023 Oct 6:14:1243906.
doi: 10.3389/fendo.2023.1243906. eCollection 2023.

Bariatric surgery and calcifediol treatment, Gordian knot of severe-obesity-related comorbidities treatment

Aura D Herrera-Martínez  1   2 , Laura L S Castillo-Peinado  1   3   4   5 , María J Molina-Puerta  1   2 , Alfonso Calañas-Continente  1   2 , Antonio Membrives  1   6 , Juan Castilla  1   6 , Marta Camacho Cardenosa  1 , Antonio Casado-Díaz  1   5 , María A Gálvez-Moreno  1   2 , Manuel D Gahete  1   7   8 , José Manuel Quesada Gómez  1   2   7 , Roger Bouillon  9 , Feliciano Priego-Capote  1   3   4   5 , Raúl M Luque  1   7   8
Affiliations

Bariatric surgery and calcifediol treatment, Gordian knot of severe-obesity-related comorbidities treatment

Aura D Herrera-Martínez et al. Front Endocrinol (Lausanne). .

Abstract

Background: Obesity (OB) is a chronic metabolic disease with important associated comorbidities and mortality. Vitamin D supplementation is frequently administered after bariatric surgery (BS), so as to reduce OB-related complications, maybe including chronic inflammation.

Aim: This study aimed to explore relations between vitamin D metabolites and components of the inflammasome machinery in OB before and after BS and their relations with the improvement of metabolic comorbidities.

Patients and methods: Epidemiological/clinical/anthropometric/biochemical evaluation was performed in patients with OB at baseline and 6 months after BS. Evaluation of i) vitamin-D metabolites in plasma and ii) components of the inflammasome machinery and inflammatory-associated factors [NOD-like-receptors (NLRs), inflammasome-activation-components, cytokines and inflammation/apoptosis-related components, and cell-cycle and DNA-damage regulators] in peripheral blood mononuclear cells (PBMCs) was performed at baseline and 6 months after BS. Clinical and molecular correlations/associations were analyzed.

Results: Significant correlations between vitamin D metabolites and inflammasome-machinery components were observed at baseline, and these correlations were significantly reduced 6 months after BS in parallel to a decrease in inflammation markers, fat mass, and body weight. Treatment with calcifediol remarkably increased 25OHD levels, despite 24,25(OH)2D3 remained stable after BS. Several inflammasome-machinery components were associated with improvement in metabolic comorbidities, especially hypertension and dyslipidemia.

Conclusion: The beneficial effects of vitamin D on OB-related comorbidities after BS patients are associated with significant changes in the molecular expression of key inflammasome-machinery components. The expression profile of these inflammasome components can be dynamically modulated in PBMCs after BS and vitamin D supplementation, suggesting that this profile could likely serve as a sensor and early predictor of the reversal of OB-related complications after BS.

Keywords: bariatric surgery; comorbidities; inflammasome; obesity; vitamin D.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Change in serum levels of RCP and calcidiol using chemoluminiscence in patients before and 6 months after bariatric surgery (A). Change in vitamin D metabolites using SPE-LC-MD/MS in patients before and 6 months after bariatric surgery (B). Data represent the median ± interquartile range. Asterisks (***p<0.001) indicate significant changes between the clinical variables. ns, non-significant.
Figure 2
Figure 2
Clinical correlations between bioelectrical impedance, anthropometric measurements, and vitamin D metabolites in patients before (A) and 6 months after bariatric surgery (B). Only significant correlations (p<0.05) are presented.
Figure 3
Figure 3
Significant clinical–molecular associations between vitamin D metabolites and the presence of baseline hypertension, dyslipidemia, and metabolic comorbidities in patients with OB before surgery (A); clinical–molecular associations between vitamin D metabolites and improvement of hypertension and metabolic comorbidities 6 months after surgery (B). Clinical associations between anthropometric measurements and improvement of metabolic comorbidities at baseline (C) and 6 months after surgery (D). Data represent the median ± interquartile range. Asterisks (*p<0.05) indicate significant changes between the clinical variables.
Figure 4
Figure 4
Clinical correlations between bioelectrical impedance, anthropometric measurements, and the mRNA expression of some inflammasome components in patients before (A) and 6 months after bariatric surgery (B). Only significant correlations (p<0.05) are presented.
Figure 5
Figure 5
Significant clinical–molecular associations between the improvement of hypertension (6 months after surgery) and the mRNA expression of some inflammasome components at baseline (A) and 6 months after surgery (B). Data represent the median ± interquartile range. Asterisks (*p<0.05) indicate significant changes between the clinical variables.
Figure 6
Figure 6
Significant clinical–molecular associations between the improvement of metabolic comorbidities and the mRNA expression of inflammasome components at baseline (A) and 6 months after surgery (B). Data represent the median ± interquartile range. Asterisks (*p<0.05) indicate significant changes between the clinical variables.
Figure 7
Figure 7
Clinical correlations between vitamin D metabolites and some inflammasome components in patients before (A) and 6 months after bariatric surgery (B). Only significant correlations (p<0.05) are presented.
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