胃旁路术后微生物群谱早期变化与肠道炎性Toll样受体基因表达水平降低有相关性

　　Toll样受体（TLR）是与炎症相关的免疫调节受体，可被脂肪酸和内毒素激活，如TLR4和TLR7与慢性炎症相关，而TLR10则具有抗炎作用。Roux-en-Y胃旁路术（RYGB）后的患者通常会出现肠道菌群改变及炎症消退现象。

　　为此，巴西圣保罗大学、圣保罗联邦大学、圣保罗卡马戈医院、法国国家农业研究所、法国心脏代谢与营养研究所、法国沙普提厄医院、巴西独立日大学入组20例患有2型糖尿病、行RYGB术的肥胖妇女，分别在术前及术后3个月收集粪便标本及小肠活检标本。

　　结果发现，RYGB手术3个月后，全小肠段TLR4表达下降、空肠及回肠段TLR7表达下降，空肠TLR10表达增加，同时伴随双歧杆菌属增多（P＜0.05）。

　　因此，RYGB术后炎症消退且可能与TLR表达及肠道益生菌的改变有相关性。

JPEN J Parenter Enteral Nutr. 2017;41(2):284.

Early changes in microbiota profile, after Roux-en-Y gastric bypass, are associated with decreased expression levels of intestinal inflammatory Toll-like receptor genes.

Priscila Sala; Karina Al Assal; Raquel S. Torrinhas; Natasha M. Machado; Danielle C. Fonseca; Giliane Belarmino; Robson K. Ishida; Ismael F. M. S. Guarda; Eduardo G. H. Moura; Paulo Sakai; Marco Aurélio Santo; Ismael D. C. G. Silva; Carla Taddei; Andrew M. Thomas; Joel Doré; Karine Clément; Edi Prifti; Daniel Giannella-Neto; Dan L. Waitzberg.

University of São Paulo, São Paulo, Brazil; UNIFESP, São Paulo, Brazil; A. C. Camargo Hospital, São Paulo, Brazil; National Institute of Agricultural Research, Paris, France; Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Paris, France; Nove de Julho University, São Paulo, Brazil.

Purpose: Toll-like receptors (TLRs), well-characterized immune receptors involved in inflammation, are mainly activated by fatty acids and endotoxins. TLRs are present in inflammatory states, such as obesity and metabolic syndrome. For instance, TLR4 and TLR7 have been associated with chronic inflammation, decreased immune function, and types 1 and 2 diabetes mellitus (DM), whereas TLR10 is an anti-inflammatory pattern recognition receptor. After Roux-en-Y gastric bypass (RYGB), patients may present gut microbiota changes and decreased inflammation. Our aim was to examine selected TLRs in gastrointestinal tissue and changes in gut microbiota within 3 months after RYGB.

Methods: Fecal samples and intestinal biopsies (duodenum, jejunum, and ileum) were acquired from 20 obese women with type 2 DM (age, 46.9 ± 6.2 years; body mass index [BMI], 46.5 ± 5.3 kg/m²) before and 3 months after RYGB (BMI, 38.2 ± 4.2 kg/m²). Gut gene microarray analysis was performed with Affymetrix Human GeneChip 1.0 ST array. Fecal microbiota analysis was performed by next-generation 16S RNA sequencing on the MiSeq system.

Results: Three months after RYGB, expressions of genes encoding TLRs showed altered levels in the gut, including reduced TLR4 in all intestinal segments, reduced TLR7 in jejunum and ileum, and increased TLR10 in jejunum. There was a concomitant increase in Actonobacillus levels (Bifidobacterium genus) (P < .05).

Conclusions: Altered expression levels of genes encoding TLRs related to inflammation were associated with beneficial changes in the gut microbiota profile.

Financial support: Research supported by FAPESP 2011/09612-3 and Scholarship DD 2013/03246-0.

DOI: 10.1177/0148607116686023