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Research points to gut hormones as the key player in Type 2 diabetes remission after weight loss surgery

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Our scientists have discovered blood taken from people who have had weight loss surgery can help the pancreas to work properly again, shedding new light on why surgery can put Type 2 diabetes into remission.

Weight loss, or bariatric, surgery can be effective at putting Type 2 diabetes into remission in around 30-60% of people who have it. And the effects are often seen almost immediately after surgery, long before any significant weight loss kicks in. This indicates that something other than weight loss is at play which explains the link between surgery and Type 2 diabetes remission.

Getting to the gut of the matter

With our support, Dr Reshma Ramracheya at the University of Oxford, had previously discovered that a gut hormone, called PYY, was found at higher levels in the blood after bariatric surgery. Our scientists explored this further by studying cells from the pancreas of rodents, and found that long-term treatment with PYY could help these cells to work properly again. This pointed to PYY as a major player underpinning remission of Type 2 diabetes following bariatric surgery.

In their latest study, Dr Ramracheya and her team have looked for the first time at the relationship between PYY and the function of pancreatic cells in people. The researchers exposed donated human cells to blood taken from people before and after their bariatric surgery.

They found that the post-surgery blood improved the function of cells from the pancreas – helping beta cells to produce insulin (the hormone that lowers blood sugar) in response to high sugar levels and alpha cells to make glucagon (the hormone that raises blood sugar when it falls too low). This didn’t happen with the cells exposed to the pre-surgery blood. Read the full research paper, published in EBiomedicine, here.

The scientists also examined which factors altered by bariatric surgery are behind the increase in PYY. They found that the level of a particular protein, called IL-22, was higher in post-surgery blood samples and was shown to have a direct impact on PYY levels.

Future treatments could mimic bariatric surgery

This work helps us further untangle the biology of how bariatric surgery puts Type 2 diabetes remission and opens us exciting new avenues of research. By revealing the potential benefits of treating cells from our pancreas with PYY, it takes us one step closer toward developing drugs that boost this gut hormone to give the benefits of surgery without the need for an invasive procedure. 

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