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Banding hormone therapy

Banding more effective when combined with GLP-1

Research offers an opportunity to optimise bariatric surgery with adjunctive pharmacotherapy

Pharmacological activation of the receptor for glucagon-like peptide 1 (GLP-1) in conjunction with a laparoscopic adjustable gastric banding could offer a new “opportunity to optimise bariatric surgery with adjunctive pharmacotherapy,” according to researcher s from the University of Cincinnati and the Helmholtz Center in Munich, Germany.

The study, ‘GLP-1R Agonism Enhances Adjustable Gastric Banding In Diet-Induced Obese Rats’, which is published online in the journal Diabetes, demonstrated that banding plus GLP-1 therapy results in improved weight loss, compared to performing banding.

"To our knowledge, these are the first findings to show that pharmacological therapies can augment and improve surgical interventions in the treatment of obesity,” Dr Kirk Habegger, research assistant professor in the endocrinology, diabetes and metabolism division at the University of Cincinnati.

Study

The investigators hypothesised that GLP-1 receptor (GLP-1R) agonists would augment the effects of laparoscopic banding. Male Long Evans rats with diet-induced obesity underwent laparoscopic banding implantation or sham surgery.

GLP-1R agonism, cannabinoid receptor-1 (CB1-R) antagonism, or vehicle was combined with inflation to evaluate interaction between AGB and pharmacological treatments.

They reported that GLP1-R agonism reduced body weight in both sham and banding rats (left un-inflated), compared to vehicle-treated animals. Subsequent band inflation was ineffective in vehicle-treated rats, but enhanced weight loss stimulated by GLP1-R agonism.

In contrast, there were no additional body weight loss when CB1-R antagonism was given with banding.

They also found that band inflation triggered neural activation in areas of the nucleus of the solitary tract known to be targeted by GLP1-R agonism, offering potential mechanism for the interaction.

“These data show that GLP-1R agonism, but not CB1-R antagonism, improves weight loss achieved by AGB,” the researchers concluded. “And suggest an opportunity to optimise bariatric surgery with adjunctive pharmacotherapy.”

"Currently, surgical intervention is the best option out there for sustained weight loss,” said Habegger. "One of our long-term goals at the UC Metabolic Diseases Institute is to find out why these interventions work so well, and figure out ways to recreate their success in less invasive ways.”

C0-lead author of the study was Dr Matthias Tschöp, adjunct professor at University of Cincinnati and director of the Institute for Diabetes and Obesity at the Helmholtz Center.

Co-authors include Sarah Amburgy, Dr David D’Alessio, Kristy Heppner, Jenna Holland, Henriette Kirchner, Dr Radhakrishna Krishna, Dr Silvana Obici, Nickki Ottaway, Diego Perez-Tilve, Dr Christine Raver, Dr Randy Seeley and Dan Sweeney, all from the University of Cincinnati; Timo Muller, Paul Pfluger and Chun-Xia Yi, all from the Helmholz Center in Germany; and Richard DiMarchi, from Indiana University.

This research was supported by grants from the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases, the Netherlands Organization for Scientific Research Rubicon Program and Ethicon Endo-Surgery.

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