Thermogenesis and reduced lipid synthesis: one-anastomosis gastric bypass bariatric surgery 6-mo follow-ups in adipose tissue health context for type 2 diabetes

One-anastomosis gastric bypass (OAGB) represents a novel less invasive bariatric surgery technique that can significantly improve systemic metabolism and adipose tissue health in patients with type 2 diabetes mellitus (T2DM). Previously, we demonstrated that T2DM impairs proliferation and differentiation of adipose tissue progenitors. Obese patients with T2DM (<i>n</i> = 10) underwent clinical examination and subcutaneous fat biopsy during bariatric surgery and in 6 mo. Adipose-derived stem cells (ADSCs) were isolated by enzymatic method. Cell proliferation was analyzed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay and immunocytochemistry. Adipogenesis and thermogenesis were assessed by confocal microscopy. Adipocyte metabolism was estimated by radioisotope tracing. Western blotting was used to quantify protein expression. Median weight loss after OAGB was 40 kg. OAGB resolved hyperinsulinemia and stimulated insulin sensitivity with changes in homeostatic model assessment of insulin resistance and M-index up to twofold. Bariatric surgery significantly influenced properties of ADSC adipocytes: there were an increase in ADSC proliferation, decrease in white adipogenesis, activation of white and beige adipocyte lipid droplet fragmentation, activation of thermogenesis, and inhibition of lipogenesis. OAGB promotes weight loss and insulin sensitivity and changes regenerative potential of ADSC. Enhanced ability of ADSC to proliferate and differentiate into thermogenic adipocytes with reduced activity of lipogenesis may prevent weight gain after bariatric surgery.<b>NEW & NOTEWORTHY</b> Today, bariatric surgery remains the most effective instrument for weight loss, glycemic control, and type 2 diabetes combat. Bariatric surgery causes mild stimulation of ADSC proliferation and suppresses white adipogenesis. ADSC-derived adipocytes exhibited lipid droplet fragmentation, activation of thermogenesis, and inhibition of lipogenesis. Thus, enhanced ability of ADSC to proliferate and differentiate into thermogenic adipocytes with reduced activity of lipogenesis may support energy expenditure and prevent weight gain after bariatric surgery.