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Obesity-related acetylcholinesterase elevation is reversed following laparoscopic sleeve gastrectomy

International Journal of Obesity volume 43, pages 297–305 (2019)Cite this article

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Abstract

Background

Impaired sympathetic/parasympathetic response, expressed by elevated Acetylcholinesterase (AChE) is associated with obesity, metabolic syndrome and inflammation. However, the association between morbid obesity and AChE and the changes in cholinergic tone following bariatric laparoscopic sleeve gastrectomy (LSG) surgery-induced weight reduction were never analyzed.

Methods

Two studies are presented; the first (the “apparently healthy cohort”) was a cross-sectional study and the second (the “LSG cohort”) was a prospective-cohort study with 12 months of follow-up. The “apparently healthy cohort” included 1450 apparently healthy participants who volunteered to the Tel-Aviv Medical Center Inflammation Survey (TAMCIS) during a routine annual checkup visit. The “LSG cohort” included 77 morbid obese patients before and at 3, 6, and 12 months following LSG surgery. Main outcomes included anthropometric measurements, Hemoglobin A1c (HbA1C), serum AChE, insulin test and Homeostasis Model Assessment (HOMA).

Results

Among the TAMCIS participants, serum AChE activity increased with BMI in a dose-dependent manner until it reached a peak level at BMI of 30–35 kg/m², followed by a plateau. Following LSG, a significant decrease in AChE activity between baseline and 12 months post-surgery was found for men, but not for women (−122.2 ± 135.3, P < 0.001 vs. −21.8 ± 120.5, P = 0.258 nmol substrate hydrolyzed/min per ml, respectively). The reduction in AChE activity was negatively correlated with %excess weight loss (EWL) and positively correlated with %body fat reduction at 12 months post-surgery among women (r = −0.329, P = 0.034 and r = 0.350, P = 0.023, respectively). In men, AChE activity reduction was positively correlated with the HOMA reduction (r = 0.358, P = 0.048).

Conclusions

Obesity-related AChE resistance phenotype may be reversed following LSG and correlates with metabolic outcomes. Further long-term studies will be needed to validate and evaluate the beneficial effect of AChE reduction post bariatric surgery.

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Funding

Funding

This study was supported (in part) by grant no. 3–10470 from the Chief Scientist Office of the Ministry of Health, Israel.

Author information

Author notes

  1. Shani Shenhar-Tsarfaty and Shiri Sherf-Dagan contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine “C”, “D” &“E”, Tel Aviv Sourasky Medical Center, Tel Aviv, Affiliated to the Faculty of Medicine, the Tel Aviv University, Israel

    Shani Shenhar-Tsarfaty, Galia Berman, Eti Zwang, Itzhak Shapira, David Zeltser, Shlomo Berliner & Ori Rogowski

  2. Department of Gastroenterology, Tel-Aviv Medical Center, Tel-Aviv, Israel

    Shiri Sherf-Dagan, Muriel Webb, Oren Shibolet & Shira Zelber-Sagi

  3. Assuta Medical Center, Tel Aviv, Israel

    Shiri Sherf-Dagan, Asnat Raziel, Andrei Keidar, David Goitein & Nasser Sakran

  4. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Shiri Sherf-Dagan, David Goitein & Oren Shibolet

  5. Department of General Surgery, Assuta Ashdod Public Hospital, Ben-Gurion University, Beer-Sheba, Israel

    Andrei Keidar

  6. Department of Surgery C, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

    David Goitein

  7. Department of Surgery A, Emek Medical Center Afula, Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel

    Nasser Sakran

  8. School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel

    Shira Zelber-Sagi

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Correspondence to Shani Shenhar-Tsarfaty.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were approved by the institutional research committees in both participating hospitals and in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The LSG study was pre-registered in the NIH registration website (TRIAL no. NCT01922830).

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Informed consent was obtained from all individual participants included in the study.

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Shenhar-Tsarfaty, S., Sherf-Dagan, S., Berman, G. et al. Obesity-related acetylcholinesterase elevation is reversed following laparoscopic sleeve gastrectomy. Int J Obes 43, 297–305 (2019). https://doi.org/10.1038/s41366-018-0014-4

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