Metabolic shift precedes the resolution of inflammation in a cohort of patients undergoing bariatric and metabolic surgery

Figures

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  Figure 1. Changes in the levels of hs-CRP before and after bariatric surgery. n = 32; hs-CRP: high sensitivity C-reactive protein; **p-value < 0.01, ***p-value < 0.001, n.s.: non-significant; Friedman test with Nemenyi post-hoc pairwise comparison test. This figure was made with the help of Tidyverse and Hmisc packages in R software.

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  Figure 2. Metabolic normalization precedes resolution of systemic inflammation. (A) Comparison of the p-values of the metabolic and inflammatory markers at 3 and 6 months post-surgery versus preoperatory values. The dashed line represents the cut-off for statistical significance (p-value = 0.05). (B) Median values at each time point after normalization, represented as the magnitude of change in each variable. IFN: Interferon, IL: Interleukin, TNF: Tumor Necrosis Factor. HOMA-IR: Homeostatic Model Assessment for Insulin Resistance, Chol: Total cholesterol, hs-CRP: high sensitivity C-reactive protein. This figure was made with the help of Tidyverse and Hmisc packages in R software.

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  Figure 3. Correlation heatmaps: Inflammatory markers, anthropometric indicators, body composition parameters, and biochemical variables. n = 32. Spearman’s rho rank correlation coefficient is rounded to one decimal and shown in black and bold font for statistically significant findings (p-value < 0.05). Red squares represent positive values; Blue squares represent negative values. (a) Preoperative; (b) Postoperative 3-month follow-up; (c) Postoperative 6-month follow-up. Apo: Apolipoprotein, BMI: Body Mass Index, HDL-c: High Density Lipoprotein Cholesterol, HOMA-IR: Homeostatic Model Assessment for Insulin Resistance, LDL-c: Low Density Lipoprotein Cholesterol, hs-CRP: high sensitivity C-reactive protein, IFN: Interferon, IL: Interleukin, MCP: Monocyte Chemoattractant Protein, TNF: Tumor Necrosis Factor. This figure was made with the help of Complex Heatmaps Package in R software.

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  Figure 4. Mechanisms involved in the production of late-onset anti-inflammatory response as a result of early metabolic changes associated with bariatric and metabolic surgery. Green lines indicate pathway activation whereas red lines indicate pathway inhibition. Upper arrows indicate increase and down arrows indicate decrease. GLP-1: Glucagon-like peptide-1; CCK: Cholecystokinin; PYY: Y-Y Peptide; OXY: Oxyntomodulin; TG: Triglycerides; LDL-c: Low density lipoprotein cholesterol; VLDL-c: Very low density lipoprotein cholesterol; LPS: Lipopolysaccharide; FFA: Free fatty acids; TLR: Toll-like receptor; AGE’s: Advanced glycation end products; RAGE’s: Advanced glycation end product receptors; MCP-1: Monocyte chemotactic protein-1; Th1: Type 1 T-helper lymphocyte; Th17: Type 17 T-helper lymphocyte; DAMPS: Damage-associated molecular patterns; M1: M1 Macrophages; M2: M2 Macrophages; IFN-γ: Gamma interferon; TNF-α: Tumor necrosis factor alpha; IL: Interleukin; MHC-II: Mayor histocompatibility complex class II; NF-kB: Nuclear factor kappa-B; TCR: T-Cell receptor; CD: Cluster of differentiation; CLS: Crown-like structures. Figure made by Eder-Luna using Biorender drawing platform.