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

American Journal of Physiology - Endocrinology and Metabolism. 2025. Vol. 329. No. 1. P. 86–101.

Stafeev I., Agareva M., Michurina S., Tomilova A., Shestakova E., Voznesenskaya A., Sineokaya M., Boldyreva M.

Background: One-anastomosis gastric bypass (OAGB) represents a novel less invasive bariatric surgery technique which can significantly improve systemic metabolism and adipose tissue health in type 2 diabetes mellitus (T2DM) patients. Previously, we demonstrated that T2DM impairs proliferation and differentiation of adipose tissue progenitors. Methods: Obese patients with T2DM (N=10) underwent clinical examination and subcutaneous fat biopsy during bariatric surgery and in 6-months. Adipose-derived stem cells (ADSC) were isolated by enzymatic method. Cell proliferation was analyzed using MTT assay and immunocytochemistry. Adipogenesis and thermogenesis were assessed by confocal microscopy. Adipocytes metabolism was estimated by radioisotope tracing. Western blotting was employed to quantify protein expression. Results: Median weight loss after OAGB was 40 kg. OAGB resolved hyperinsulinemia and stimulated insulin sensitivity with changes in HOMA-IR and M-index up to 2-fold. Bariatric surgery significantly influenced properties of ADSC adipocytes: there were an increase in ADSC proliferation, decrease in white adipogenesis, activation of white and beige adipocytes lipid droplet fragmentation, activation of thermogenesis and inhibition of lipogenesis. Conclusions: 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.

Keywords: obesity, mesenchymal stem cells, adipocytes, type 2 diabetes