Bariatric Surgery-induced High-density Lipoprotein Functionality Enhancement Is Associated With Reduced Inflammation

Safwaan Adam, Jan H Ho, Yifen Liu, Tarza Siahmansur, Kirk Siddals, Zohaib Iqbal, Shazli Azmi, Siba Senapati, John New, Maria Jeziorska, Basil J Ammori, Akheel A Syed, Rachelle Donn, Rayaz A Malik, Paul N Durrington, Handrean Soran

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Emerging evidence suggests an association between impaired high-density lipoprotein (HDL) functionality and cardiovascular disease (CVD). HDL is essential for reverse cholesterol transport (RCT) and reduces inflammation and oxidative stress principally via paraoxonase-1 (PON1). RCT depends on HDL's capacity to accept cholesterol (cholesterol efflux capacity [CEC]) and active transport through ATP-binding cassette (ABC) A1, G1, and scavenger receptor-B1 (SR-B1). We have studied the impact of Roux-en-Y gastric bypass (RYGB) in morbidly obese subjects on RCT and HDL functionality.

METHODS: Biomarkers associated with increased CVD risk including tumour necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hsCRP), myeloperoxidase mass (MPO), PON1 activity, and CEC in vitro were measured in 44 patients before and 6 and 12 months after RYGB. Overweight but otherwise healthy (mean body mass index [BMI] 28 kg/m2) subjects acted as controls. Twelve participants also underwent gluteal subcutaneous adipose tissue biopsies before and 6 months after RYGB for targeted gene expression (ABCA1, ABCG1, SR-B1, TNF-α) and histological analysis (adipocyte size, macrophage density, TNF-α immunostaining).

RESULTS: Significant (P < 0.05) improvements in BMI, HDL-cholesterol, hsCRP, TNF-α, MPO mass, PON1 activity, and CEC in vitro were observed after RYGB. ABCG1 (fold-change, 2.24; P = 0.005) and ABCA1 gene expression increased significantly (fold-change, 1.34; P = 0.05). Gluteal fat adipocyte size (P < 0.0001), macrophage density (P = 0.0067), and TNF-α immunostaining (P = 0.0425) were reduced after RYBG and ABCG1 expression correlated inversely with TNF-α immunostaining (r = -0.71; P = 0.03).

CONCLUSION: RYGB enhances HDL functionality in association with a reduction in adipose tissue and systemic inflammation.

Original languageEnglish
Pages (from-to)2182-2194
Number of pages13
JournalThe Journal of Clinical Endocrinology and Metabolism
Issue number8
Early online date27 May 2022
Publication statusPublished - 14 Jul 2022


  • ABCG1
  • HDL functionality
  • bariatric surgery
  • cardiovascular disease
  • cholesterol efflux capacity
  • inflammation
  • obesity


Dive into the research topics of 'Bariatric Surgery-induced High-density Lipoprotein Functionality Enhancement Is Associated With Reduced Inflammation'. Together they form a unique fingerprint.

Cite this