Use this URL to cite or link to this record in EThOS:
Title: Understanding and evaluating cardio-metabolic benefits imposed by surgery, medication and adipose tissue metabolism
Author: Azharian, Sahar
ISNI:       0000 0004 8497 8427
Awarding Body: University of Warwick
Current Institution: University of Warwick
Date of Award: 2018
Availability of Full Text:
Access from EThOS:
Access from Institution:
Obesity is the single most important risk factor for the development of cardio-metabolic disease. As white adipose tissue dysfunction plays an essential role in inflammation and metabolic health, it would be beneficial to therefore investigate the influence of surgery, endocrine hormones, and medication that mitigate adipose tissue inflammation and as a result improve cardio-metabolic disease. As such subcutaneous adipose tissue (SAT) biopsies and anthropometric and biochemical data were collected from obese-diabetic women before and after bariatric surgery. Inflammatory markers, endotoxin, cardio-metabolic markers, fibroblast growth factor (FGF)-19 and FGF-21, AGT protein expression and insulin sensitivity, were assessed by utilizing ELISA, western blot, anthropometric and biochemical data analysis. Collectively the findings of this study identified that combination (restrictive and malabsorptive) type of bariatric surgery compared to restrictive procedures, lead to the persistence of an inflammatory status, with less improvements in cardio-metabolic components, lower disease resolution and lack of significant improvement in FGF-19 and FGF-21 endocrine hormones, at 6 months post surgery. Therefore despite the significant weight loss with the combination type of surgery, it may still place patients at risk of cardiovascular disease at 6 months post surgery. In regards to medications that may affect adipose tissue inflammation, effects of liraglutide on adipose tissue specific angiotensinogen (AGT) was analysed to assess the possible antihypertensive qualities of this medication. The findings of this study indicated that liraglutide can down-regulate AGT in a time and dose depended manner in obese mature adipocytes. Furthermore liraglutide appeared to reduce cell proliferation, and improve insulin sensitivity. Finally, recognising the likelihood of improvement in Type 2 diabetes mellitus (T2DM) status post bariatric surgery is not only beneficial in supporting the preoperative weight loss criteria, but it will also identify individuals that may need more support post operatively to maintain improved cardio-metabolic outcomes. Therefore having a convenient, non-invasive, and cost effective detection and predictive test for T2DM, in such a circumstance can be useful. Urinary volatile organic compounds (VOC) have been used for the detection of many diseases such as different types of cancers, therefore the potential of VOCs for detecting T2DM was analysed. Urine from the same bariatric cohort was collected and tested by field asymmetric ion mobility spectrometry. The findings indicated that VOCs have the capability of distinguishing pre from post operation urine, in addition to post-operative T2DM status was predicted with the use of pre-operative VOCs. Therefore VOCs have the potential of being used as a screening and detection test for T2DM, and as a predictive test for the outcome of T2DM status post-bariatric surgery.
Supervisor: Not available Sponsor: European Foundation for the Study of Diabetes
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RC Internal medicine