Vascular Risk Reduction in Obesity through Reduced Granulocyte Burden and Improved Angiogenic Monocyte Content following Bariatric Surgery

Summary Bariatric surgery, in addition to the benefit of sustained weight loss, can also reduce cardiometabolic risk and mortality. Lifelong vessel maintenance is integral to the prevention of cardiovascular disease. Using aldehyde dehydrogenase activity, an intracellular detoxifying enzyme present at high levels within pro-vascular progenitor cells, we observed an association between chronic obesity and “regenerative cell exhaustion” (RCE), a pathology whereby chronic assault on circulating regenerative cell types can result in adverse inflammation and diminished vessel repair. We also describe that, at 3 months following bariatric surgery, systemic inflammatory burden was reduced and pro-angiogenic macrophage precursor content was improved in subjects with severe obesity, suggesting the restoration of a microenvironment to support vessel homeostasis. These data suggest that bariatric surgery may reverse deleterious events that predispose patients with morbid obesity to cardiovascular risk.
Graphical Abstract
Highlights Obesity features a low frequency of ALDH and CD133 co-expressing cells Bariatric surgery results in lower granulocyte precursors expressing ALDH Macrophage balance favors M2 polarization following bariatric surgery Cellular changes after bariatric surgery give insight into reducing CV risk
In Hess et al., the quantification of circulating progenitor cells in individuals with obesity, before and 3 months after bariatric surgery, demonstrates reduced granulocyte precursors and increased pro-angiogenic monocytes with M2 polarization. These alterations are consistent with improved vessel homeostasis and recovered cardiovascular health observed following bariatric surgery.