Dysregulation of gene expression within the peroxisome proliferator activated receptor pathway in morbidly obese patients

Document Type

Journal Article

Publication Date



Surgical Endoscopy








Bariatric; Obesity


Background: The causes of obesity are multifactorial but may include dysregulation of a family of related genes, such as the peroxisome proliferator activated receptor γ (PPARγ). When activated, the PPARγ pathway promotes lipid metabolism. This study used microarray technology to evaluate differential gene expression profiles in obese patients undergoing bariatric surgery. Methods: The study enrolled six morbidly obese patients with a body mass index (BMI) exceeding 35 and four nonobese individuals. Blood samples were stabilized in PaxGene tubes (PreAnalytiX), and total RNA was extracted. Next, 100 ng of total RNA was amplified and labeled using the Ovation RNA Amplification System V2 with the Ovation whole-blood reagent (NuGen) before it was hybridized to an Affymetrix (Santa Clara, CA) focus array containing more than 8,500 verified genes. The data were analyzed using an analysis of variance (ANOVA) (p<0.05) in the GeneSpring program, and potential pathways were identified with the Ingenuity program. Realtime quantitative reverse transcriptase-polymerase chain reaction was used to validate the array data. Results: A total of 97 upregulated genes and 125 downregulated genes were identified. More than a 1.5-fold change was identified between the morbidly obese patients and the control subjects for a cluster of dysregulated genes involving pathways regulating cell metabolism and lipid formation. Specifically, the PPARγ pathway showed a plethora of dysregulated genes including tumor necrosis factor-alpha (TNFα). In morbidly obese patients, TNFα expression was increased (upregulated) 1.6-fold. These findings were confirmed using quantitative polymerase chain reaction with a 2.8-fold change. Conclusions: Microarrays are a powerful tool for identifying biomarkers indicating morbid obesity by analyzing differential gene expression profiles. This study confirms the association of PPARγ with morbid obesity. Also, these findings in blood support previous work documented in tissue (omentum, liver, and stomach). Based on these findings in blood, the authors plan to explore postoperative changes in gene expression by analyzing blood samples after bariatric surgery. Ultimately, these findings may promote the development of therapeutic agents targeted to specific dysfunctional genes. © Springer Science+Business Media, LLC 2008.