Published online May 28, 2020. doi: 10.3748/wjg.v26.i20.2599
Peer-review started: March 14, 2020
First decision: April 12, 2020
Revised: April 13, 2020
Accepted: May 15, 2020
Article in press: May 15, 2020
Published online: May 28, 2020
Although it is stated that bariatric surgeries are capable of preventing numerous types of cardiovascular diseases and cancer, the basic studies are still warranted to explain such roles by revealing the possible mechanisms. Herein, an attempt was made to answer these questions in an innovative way by investigating one of the important regulation systems in the body – the endothelin-1 (ET-1) axis.
Providing evidence for the lowered risk of cardiovascular disease and cancer will not only enlighten the multifunctional effects of sleeve gastrectomy (SG), which is deemed to be “metabolic”, but also broaden and deepen our understanding of related fields and help improve the acceptance of SG as well.
In the current study, an ameliorated status of the ET-1 axis was confirmed, indicating the improvement in endothelial function and decline in the risk of lung cancer. Plus, the latter was also identified by the decreased level of DNA damage. Collectively, these findings are bound to attract and inspire future researchers to look for the clues of the benefits brought by bariatric surgeries that extend beyond the known metabolic improvements.
SG and sham surgery were performed to clarify the effect induced on the ET-1 axis. In order to determine the real baseline of the parameters, healthy controls were also included. Moreover, the γ-H2AX foci assay was applied to provide stronger evidence of SG in preventing lung cancer, which was not an approach used commonly in previous research related to bariatric surgeries.
The results indicated that SG improved endothelial function and prevented lung cancer by normalizing the ET-1 axis, providing animal-based findings and suggesting new perspectives for the clinical field. The potential mechanisms of how SG effects the ET-1 axis and whether it is a direct impact or achieved by moderating metabolic disorder, however, need to be explored further.
Beyond reducing body weight and improving both glycometabolism and insulin sensitivity, SG improves endothelial function and exerts a protective role in preventing lung cancer by normalizing the ET-1 axis and lessening DNA damage. These findings may present a new theoretical basis for clinical implications of SG.
We believe that looking for more lines of evidence which expand our knowledge beyond the metabolic impact of bariatric surgeries is important, particularly because it will illuminate and illustrate the whole picture of the therapeutic effects of these procedures. Undoubtedly, factors that change under metabolic disorder and contribute to canceration, are the entry points and keys to the answer.