# Biliopancreatic diversion with duodenal switch improve polycystic ovary syndrome with decreased serum ceramides

## TL;DR

This study shows that a specific weight-loss surgery improves PCOS symptoms in rats by reducing insulin resistance and altering bile acid and ceramide levels.

## Contribution

The study demonstrates that BPD/DS surgery improves PCOS through reduced serum ceramides and increased bile acids, with reversal upon bile acid sequestration.

## Key findings

- BPD/DS surgery significantly improved insulin resistance and reproductive disorders in PCOS rat models.
- Bile acid levels increased and ceramide levels decreased in the BPD/DS group compared to the sham group.
- Bile acid sequestration reversed the improvement in insulin resistance and increased ceramide levels.

## Abstract

Polycystic ovary syndrome (PCOS) is characterized primarily by insulin resistance and reproductive disorders. Biliopancreatic diversion with duodenal switch (BPD/DS) could significantly improve insulin sensitivity with significantly elevated level of bile acids. We aimed to explore changes in PCOS manifestations after BPD/DS and the possible mechanisms.

Twenty PCOS rat models were assigned into the BPD/DS group and the sham BD (S-BPD) group randomly. The fasting blood glucose, bile acids, and ceramides levels in serum samples were assessed.

The reproductive disorders of BPD/DS group were almost completely restored 8 weeks after surgery, and the AUCOGTT value and the AUCITT value were statistically less than those of the S-BPD group (P =0.001). The concentration of serum testosterone, luteinizing hormone, and follicle-stimulating hormone of the BPD/DS group was statistically less than that of the S-BPD group (P <0.05). Moreover, high level of bile acids and low level of ceramides were observed in the BPD/DS group (P <0.001). Bile acid sequestrant was given to the BPD/DS group rats for 1 week, the level of bile acids decreased and ceramides increased, the insulin resistance worsened. The AUCOGTT value increased from 818.3 ± 297.3 mmol/L·min to 1147.9 ± 167.9 mmol/L·min (P =0.007) and the AUCITT value increased from 525.6 ± 52.3 mmol/L·min to 577.7 ± 102.9 mmol/L·min (P =0.023).

Our study showed the improvement of insulin resistance in PCOS models after BPD/DS with decreased serum ceramides. The sequestrant of bile acid reversed the improvement of insulin resistance with higher ceramides level.