Cerebrospinal Fluid Biomarkers in Bariatric Surgery

Columbia University

Status: Completed

Conditions: Obesity

Treatments: Behavioral: Very Low Calorie Diet (VLCD); Procedure: Roux-en-Y Gastric Bypass (RYGB); Procedure: Sleeve Gastrectomy (SG)

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT04350892

1R01DK124465 (U.S. NIH Grant/Contract)

AAAS8430

Details and patient eligibility

About

The goal of this project is to understand why bariatric surgery is such an effective treatment for obesity with a focus on brain mechanisms. Cerebrospinal fluid (CSF) neuropeptide, hormone and protein levels will be measured as a surrogate for changes in brain activity in participants before and after bariatric surgery as compared with participants before and after diet-induced weight loss. The investigators are studying neuropeptides and hormones that are know to be involved with the regulation of appetite and body weight to determine if some of the changes that are expected to occur after diet-induced weight loss do not occur after bariatric surgery. In addition, proteomic analysis will be used to uncover new protein biomarkers that are unique to surgical weight loss. The results of these studies will help explain why bariatric surgery is so effective in achieving long-term weight loss. Understanding how the central nervous system responds to bariatric surgery could help the development of alternative nonsurgical therapies for obesity and its metabolic complications.

Full description

Peripheral metabolic signals communicate levels of energy stores to the brain and elicit a host of neuronal responses that maintain energy balance; such regulatory mechanisms make it difficult to maintain diet-induced weight loss. The goal is to understand how these central regulatory mechanisms are circumvented following surgical alterations in the gut in subjects after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (SG) compared to carefully matched diet- induced weight loss controls who achieve weight loss on a low calorie liquid diet. Surgery participants will be patients who have already chosen to have a bariatric surgery procedure with their doctor. Diet participants will be provided with the low calorie liquid diet for approximately 3 months and will be monitored weekly throughout the study.

Surgery participants will be studied at 3 time-points:

1. Before the intervention
2. After surgery at 10-15% weight loss
3. At 12 months after surgery

Low calorie diet participants will be studied at 2 time-points:

1. Before intervention
2. At 10-15% weight loss (approximately 12 weeks on the diet)

At each time-point subjects will have a lumbar puncture (spinal tap) for cerebrospinal fluid (CSF) sampling and blood will be collected in the fasting state and in response to a liquid meal challenge. Body weight, waist and hip circumference will be measured.

Enrollment: 51 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• 18-65 years old
• BMI 35-55

Exclusion criteria

• No clinically significant medical conditions
• No use of tobacco
• No alcohol or drug abuse
• No recent weight change (+/-5%) within prior 6 months
• No medications that may affect body weight or blood glucose
• No diabetes medications, beta-blockers, opiates or glucocorticoids
• No pregnancy, breastfeeding, or planning to become pregnant during the study (diet group only)
• No lactose intolerance

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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51 participants in 3 patient groups

Roux-en-Y Gastric Bypass Surgery

Active Comparator group

Treatment:

Procedure: Roux-en-Y Gastric Bypass (RYGB)

Sleeve Gastrectomy Surgery

Active Comparator group

Treatment:

Procedure: Sleeve Gastrectomy (SG)

Very Low Calorie Diet

Active Comparator group

Treatment:

Behavioral: Very Low Calorie Diet (VLCD)