Avaliação das incretinas GLP-1 e PYY em pacientes com Diabetes Mellitus 2 submetidos a Duodenal Swicth Parcial

Abstract

The Type 2 Diabetes Mellitus, as well as the metabolic syndrome (MS), is a multifactorial and metabolic disorder that now presents itself as a worldwide pandemic with effects on morbidity and mortality, possibly as a result of the mismatch between biological and cultural evolution of man. Was the object of research of this study to analyze the tissue expression of incretin hormones glucagon Pepitide Like-1 (GLP1) and Pepitide YY (PYY3-36), to identify and quantify L cells along the gastrointestinal tract in patients with DM2 subjected to adaptative gastroenteromentectomia with intestinal bipartition (Partial Duodenal Switch - DSP). The study was approved by the Ethics Committee of UEPG and patients informed and educated about the research objectives. The volunteer group consisted of 7 patients aged between 35 and 65 years, body mass index> 25 kg/m2 with T2DM on dietary treatment and medication for a minimum of 2 years and with difficulty on glycemic control and hypertriglyceridemia associated. Samples were obtained from the intestinal mucosa (jejunum and ileum) of DSP in patients undergoing preoperative and postoperative condition of fasting for 12 hours (three and twelve months respectively), through incisional biopsy. These biopsies were designed to test immunohistochemistry, qRT-PCR (Quantitative Real Time PCR) and Western Blott. The results were consistent and indicate a very significant differential expression between the state of pre-and postoperative tests for qRT-PCR (p = 0.1669) and Western Blot (p = 0.1569). Immunohistochemistry also showed low significance (p = 0.0043) of immune marked L cells for the same patients under the same conditions. These data can be interpreted in light of the fast imposed on patients. In addition the results are unprecedented for the immunostaining of L-cells of the human gastrointestinal tract, the data indicate that these cells have basal secretion for GLP-1, even after 12 hours without feed stimulation. In addition, the patients showed normalization of blood glucose levels in the post-surgery, suggesting metabolic improvement. It was also found that the number of L cells marked increases in density along the gastrointestinal tract toward the distal portion of the ileum (p = 0.0409). With these results it was possible to identify, locate and investigate different levels of expression and secretion from intestinal L cells in patients with DM2 and subjected to surgical control.