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Melanocortin-4 receptor gene and complications after gastric banding
Ralph Peterli1, Thomas Peters, Markus von Flüe
1Surgical Clinic, St. Claraspital, Basel, Switzerland. ralph.peterli@claraspital.ch
Background:
Mutations of the melanocortin-4 receptor (MC4R) gene are associated with up to 5.8% of monogenetic causes of obesity. Correlations between defects in MC4R and complications after laparoscopic adjustable gastric banding (LAGB) have recently been reported. The aim of this study was to investigate whether in our patient population band-associated complications can be correlated with MC4R defects, which in turn could be a contraindication for gastric banding.
Methods:
Of 370 morbidly obese patients operated between Dec 1996 and May 2004 with LAGB, 37 required re-operation, by re-banding or biliopancreatic diversion/duodenal switch for band-associated complications. Genomic DNA was extracted from leucocytes of these 37 patients using standard methods. The entire MC4R-gene was amplified by PCR and sequenced on an ABI Prism 3100 automated DNA sequencer. Any detected mutation or polymorphism was verified utilizing a high-fidelity proofreading polymerase.
Results:
No mutation was seen in 35 patients (95%). The polymorphism Ile251Leu (A1144C) which was found in one patient is known not to be associated with obesity. A silent mutation Ile198Ile (C594T) was found in another patient. Based on published data, approximately 12 patients of the 37 would have been expected to carry one of the known obesity-associated MC4R mutations, but none of these was found.
Conclusion:
In our patient material, we could not confirm the observation previously published that MC4R defects are associated with a higher complication rate following LAGB. Thus, we do not recommend routine general screening for MC4R defects before LAGB.
Insights
Melanocortin-4 receptor (MC4R) gene mutations are linked to obesity. This study found no association between MC4R defects and complications after laparoscopic adjustable gastric banding (LAGB) in their patient group.
Area of Science:
- Genetics and Molecular Biology
- Bariatric Surgery
- Obesity Research
Background:
- Melanocortin-4 receptor (MC4R) gene mutations are a significant cause of monogenic obesity.
- Recent studies suggest a link between MC4R defects and complications following laparoscopic adjustable gastric banding (LAGB).
Purpose of the Study:
- To investigate the correlation between MC4R gene defects and band-associated complications in patients who underwent LAGB.
- To determine if MC4R defects could be a contraindication for gastric banding procedures.
Main Methods:
- Genomic DNA was extracted from 37 morbidly obese patients who experienced complications after LAGB.
- The entire MC4R gene was amplified by PCR and sequenced.
- Detected mutations and polymorphisms were verified using high-fidelity proofreading polymerase.
Main Results:
- No known obesity-associated MC4R mutations were found in any of the 37 patients.
- The study expected to find approximately 12 patients with known MC4R mutations based on published data, but none were identified.
- Known polymorphisms and a silent mutation were identified in two patients, but these are not associated with obesity.
Conclusions:
- The study could not confirm a previously reported association between MC4R defects and increased complication rates after LAGB.
- Routine screening for MC4R defects prior to LAGB is not recommended based on these findings.
