C-peptide level as predictor of type 2 diabetes remission and body composition changes in non-diabetic and diabetic patients after Roux-en-Y gastric bypass

OBJECTIVES: Several predictors of type 2 diabetes mellitus (T2DM) remission after metabolic surgery have been proposed and used to develop predictive scores. These scores may not be reproducible in diverse geographic regions with different baseline characteristics. This study aimed to identify predictive factors associated with T2DM remission after Roux-en-Y gastric bypass (RYGB) in patients with severe obesity. We hypothesized that the body composition alterations induced by bariatric surgery could also contribute to diabetes remission. METHODS: We retrospectively evaluated 100 patients with severe obesity and T2DM who underwent RYGB between 2014 and 2016 for preoperative factors (age, diabetes duration, insulin use, HbA1c, C-peptide plasma level, and basal insulinemia) to identify predictors of T2DM remission (glycemia<126 mg/dL and/or HbA1c<6.5%) at 3 years postoperatively. The potential preoperative predictors were prospectively applied to 20 other patients with obesity and T2DM who underwent RYGB for validation. In addition, 81 patients with severe obesity (33 with T2DM) underwent body composition evaluations by bioelectrical impedance analysis (InBody 770®) 1 year after RYGB for comparison of body composition changes between patients with and those without T2DM. RESULTS: The retrospective analysis identified only a C-peptide level >3 ng/dL as a positive predictor of 3-year postoperative diabetes remission, which was validated in the prospective phase. There was a significant difference in the postoperative body composition changes between non-diabetic and diabetic patients only in trunk mass. CONCLUSION: Preoperative C-peptide levels can be useful for predicting T2DM remission after RYGB. Trunk mass is the most important difference in postoperative body composition changes between non-diabetic and diabetic patients

Effects of irradiated Bothropstoxin-1 and Bothrops jararacussu crude venom on the immune system

A radiação ionizante tem sido empregada com sucesso na modificação das propriedades imunológicas das biomoléculas e tem se mostrado uma potente ferramenta para destoxicar venenos de serpentes sem afetar e, muitas vezes, melhorando suas propriedades imunogênicas. Resultados promissores foram obtidos com o tratamento, tanto de veneno total quanto de frações isoladas, com a radiação gama de 60Co. No presente trabalho, foram avaliados os efeitos da Bothropstoxina-1 (Bthx-1) e do veneno total de Bothrops jararacussu sobre o sistema imune de camundongos B10.PL e BALB/c, visando caracterizar a resposta imune contra proteínas irradiadas. Modificações estruturais foram observadas por meio de técnicas eletroforéticas - SDS-PAGE. Para os ensaios imunológicos, camundongos de diferentes linhagens foram imunizados com ambas as formas da Bthx-1 e os anticorpos circulantes foram isotipados e titulados pelo método de ELISA. Os resultados mostraram que tanto o veneno total como a toxina isolada, mesmo após o processo de irradiação, se mostraram imunogênicos e os anticorpos produzidos reconheciam as formas nativas. Para a caracterização antigênica a técnica de Western Blot permitiu demonstrar que a Bthx-1 irradiada induziu à produção de anticorpos responsivos para ambas as formas da toxina isolada e do veneno total. Os resultados do ensaio de citotoxicidade mostram que a viabilidade dos macrófagos ensaiados com a Bthx-1 ou com o veneno total irradiados foi maior quando comparada com os resultados obtidos para as formas nativas. Analisando-se o resultado do ensaio de LDH, observou-se que a Bthx-1 irradiada promoveu menor dano muscular que a toxina nativa. Conclui-se que a irradiação de proteínas promove modificações estruturais significativas, mantendo, contudo, suas propriedades imunológicas originais, representando uma potencial ferramenta na melhoria do processo de imunização.Ionizing radiation has been successfully employed to modify the immunological properties of biomolecules and has been proven to be a powerful tool to attenuate snake venoms toxicity without affecting and even increasing their immunogenic properties. Very promising results were obtained when crude animal venoms, as well as isolated toxins, were treated with 60Co gamma rays, yielding toxoids with good immunogenicity, however, little is known about the modifications that irradiated molecules undergo and even less about the immunological response that such antigens elicit. At the present work, we have evaluated the effects on immune system of B10.PL and BALB/c mice of Bothrops jararacussu crude venom and isolated bothropstoxin-1 (Bthx-1), before and after gamma radiation exposition. According to our data, irradiation process promoted structural modifications on both isolated toxin and crude venom, characterized by higher molecular weight protein (aggregates and oligomers) formation. Irradiated samples were immunogenic and the antibodies elicited by them were able to recognize the native toxin in ELISA. These results indicate that irradiation of toxic proteins can promote significant modifications in their structures, but still retain many of the original antigenic and immunological properties. Also, our data indicate that the irradiated protein induced higher titers of IgG2b, suggesting that Th1 cells were predominantly involved. Results from Western blot assay showed that antibodies raised against irradiated bothropstoxin-1 recognize both native isolated toxin or crude venom. Citotoxicity assay showed that irradiated toxin and crude venom were less toxic than their native counterpart. Thus, the viability of the macrophages cultured in the presence of irradiated Bthx-1 or crude venom was higher if compared with their native forms. LDH Assay showed that irradiated Bthx-1 promotes less muscular damage than the native form. Our data confirm a potential use of ionizing radiation for immunization process improvement