The Immunophenotyping Changes of Peripheral CD4+ T Lymphocytes and Inflammatory Markers of Class III Obesity Subjects After Laparoscopic Gastric Sleeve Surgery - A Follow-Up Study

Nasser M Rizk; Amina Fadel; Wasaif AlShammari; Noura Younes; Moataz Bashah

doi:10.2147/JIR.S282189

The Immunophenotyping Changes of Peripheral CD4+ T Lymphocytes and Inflammatory Markers of Class III Obesity Subjects After Laparoscopic Gastric Sleeve Surgery - A Follow-Up Study

J Inflamm Res. 2021 May 5:14:1743-1757. doi: 10.2147/JIR.S282189. eCollection 2021.

Authors

Nasser M Rizk^{1

2

3}, Amina Fadel¹, Wasaif AlShammari¹, Noura Younes⁴, Moataz Bashah⁵

Affiliations

¹ Biomedical Sciences Department-College of Health Sciences, QU Health-Qatar University.
² Biomedical Research Center, Qatar University.
³ Biomedical and Pharmaceutical Research Unit, QU Health-Qatar University.
⁴ Clinical Chemistry Lab, Hamad Medical Corporation, Doha, Qatar.
⁵ Metabolic Unit, Surgery Department, Hammed Medical Corporation (HMC), Doha, Qatar.

Abstract

Purpose: Obesity is a chronic disorder characterized by a low-grade inflammatory state and immune cell irregularities. The study aimed to follow up on the changes in the peripheral CD4+ T lymphocytes and the pro-inflammatory cytokines; IL-6, TNF-alpha, MCP-1, and IL-10 at baseline and 12 weeks post-surgical intervention by the laparoscopic gastric sleeve (LGS) in morbidly obese patients (class III obesity subjects).

Materials and methods: A prospective longitudinal research included 24 class III obesity subjects with a BMI > 40 kg/m². The subjects were enrolled from the Metabolic/Surgical Department at Hamad Medical Corporation (HMC)-Qatar. Fasting blood samples were collected at admission to LGS for weight loss and after 12 weeks of LGS. The immunophenotype of CD4+ T-cell populations; naïve (CD45RA⁺and CD27⁺), central memory T cells (CD45RO⁺ and CD27⁺), and effector memory (CD45RO⁺and CD27^-) and T-regulatory cell (CD4+CD25+ FoxP3+) were identified using flow cytometry. Plasma pro-inflammatory cytokines and adipokines were evaluated. A control group of lean subjects was used to compare changes of T-regulatory and inflammatory biomarkers with postoperative changes in obese patients.

Results: The means (SD) of age and BMI of class III obesity subjects was 32.32 (8.36) years and 49.02 (6.28) kg/m^2, respectively. LGS caused a significant reduction in BMI by 32%, p<0.0001. LGS intervention significantly decreased CD4+ T-lymphocytes and effector memory (TEM) cells but increased T-regulatory (Treg), naïve, and central memory (TCM) cells, with all p values < 0.05. The increase of Treg cells postoperative is significantly lower compared to lean subjects, p < 0.05. A significant reduction of plasma IL-6, TNF-α, and MCP-1, but IL-10 significantly increased after LGS, with all p<0.05. Adiponectin/leptin ratio improved after LGS by 2.9 folds, p<0.0001.

Conclusion: Weight loss by LGS accomplished a substantial rise of Treg and decreased EM T-lymphocytes with a shift from pro-inflammatory to the anti-inflammatory pattern.

Keywords: T-regulatory cells; class III obesity; follow up; immunity; laparoscope gastric sleeve surgery; peripheral CD4+ T-lymphocytes.