Simulation of gastric bypass effects on glucose metabolism and non-alcoholic fatty liver disease with the Sleeveballoon device

Figures

• 

  Fig. 1. Sleeveballoon device. The device consists in a gastric balloon traversed by a channel that permits the passage of a limited amount of food. The channel continues with a duodenal sleeve, which prevents the contact of food with the duodenal mucosa.

• 

  Fig. 2. Sleeveballoon induces sustained weight loss and reduction of visceral fat. Panel a: Body weight was significantly lower in rats with the Sleeveballoon than in sham-operated rats (614.4 ± 20.6 vs. 503.1 ± 8.9 g, P = .006 Mann-Whitney U test, corrected for multiple comparisons by the Bonferroni's inference method), while no difference was found in comparison with RYGB rats (490.0 ± 17.7 g, P = .60 Mann-Whitney U test, corrected for multiple comparisons by the Bonferroni's inference method). Panel b: Mesenteric and retroperitoneal fat (visceral fat) content was higher in sham-operated than in both Sleeveballoon and RYGB groups (38.1 ± 3.0 vs. 16.3 ± 1.9 g, P = .002 and 38.1 ± 3.0 vs. 13.3 ± 2.1 g, P = .0006 respectively, Mann-Whitney U test, corrected for multiple comparisons by the Bonferroni's inference method). Panels c,d: Time courses of blood glucose (c) and plasma insulin (d) after an oral glucose load (1 g/kgbw) in sham, RYGB and Sleevebaloon rats. Rats undergone RYGB or Sleevebaloon placement significantly reduced both blood glucose and plasma insulin concentrations (P < .04). Data are expressed as mean ± SEM. Panel e: Time course of GLP1 after an oral glucose load (1…

• 

  Fig. 3. Sleeveballoon delays gastric emptying. Panels a, b: Representative image of intestinal transit after 5 (a) and 120 (b) minutes from contrast medium administration in a rat with Sleevebaloon. Panels c, d: Representative image of intestinal transit after 5 (a) and 120 (b) minutes from contrast medium administration in RYGB rats. Panels e, f: Representative image of intestinal transit after 5 (a) and 120 (b) minutes from contrast medium administration in a sham-operated rat.

• 

  Fig. 4. Insulin signaling was significantly more efficient in the liver and skeletal muscle tissue of rodents with the Sleeveballon than in sham-operated rats. Panels a,b: Western blot analysis of Akt Ser473and GSK3αβ Ser21/9 in the liver. Akt Ser473 and GSK3αβ Ser21/9 phosphorylation was significantly higher in the liver of both Sleevebaloon and RYGB rats. Panels c,d: Western blot analysis of Akt Ser473and GSK3αβ Ser21/9 in the skeletal muscle. Akt Ser473 and GSK3αβ Ser21/9 phosphorylation was significantly higher in the skeletal muscle of both Sleevebaloon and RYGB rats. *P < .04, **P < .009, ***P < .0004 Mann-Whitney U test, corrected for multiple comparisons by the Bonferroni's inference method. Data are expressed as mean ± SEM.

• 

  Fig. 5. RYGB and Sleevebaloon markedly increased hepatic glycogen depots. Panels a,b,c,: Periodic acid-Schiff staining of liver biopsies from sham, RYGB and Sleevebaloon rats; both RYGB and Sleevebaloon have much larger hepatic glycogen depots. Panels d,e,f: Periodic acid-Schiff staining of skeletal muscle biopsies from sham, RYGB and Sleevebaloon rats; both RYGB and Sleevebaloon have much larger hepatic glycogen depots.

• 

  Fig. 6. Sleeveballoon drastically reduces fat accumulation and Plin2 protein expression in both liver and skeletal muscle. Panels a,b: Western blot analysis of Plin2 protein level, in liver and skeletal muscle biopsies of sham, RYGB and Sleevebaloon rats. Plin2 protein expression in both liver and skeletal muscle is significantly lower in rats with Sleevebaloon and RYGB than in sham-operated rats. Panels c,d,e: Oil Red O staining of liver biopsies from sham, RYGB and Sleevebaloon rats. RYGB and Sleevebaloon drastically reduced hepatic fat accumulation. Panels f,g,h: Oil Red O staining of skeletal muscle biopsies from sham, RYGB and Sleevebaloon rats. RYGB and Sleevebaloon drastically reduced skeletal muscle fat accumulation. ***P < .0005, *P < .03. Data are expressed as mean ± SEM, Mann-Whitney U test, corrected for multiple comparisons by the Bonferroni's inference method. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

• 

  Fig. 7. Sleeveballoon reduces myocytic fat accumulation and Plin2 levels and improves left ventricular contractility function. Panel a: Plin2 levels are much reduced in the heart of rats undergone sleeveballoon placement or RYGB. Panel b: Left ventricular ejection fraction (%) is significantly higher in the RYGB and Sleeveballoon groups than in sham-operated controls. Panels c,d,e: Fat accumulation is much lower in the heart sections of rats undergone Seeveballoon placement or RYGB. *P < .03, **P < .009. Data are expressed as mean ± SEM, Mann-Whitney U test, corrected for multiple comparisons by the Bonferroni's inference method.