Background
Much ado has been made about obesity’s health impact, largely founded on simple patient weight and circulating adipose-derived mediator levels. Paradoxically, a “healthy obese” state exists, but substantial knowledge gaps also exist regarding human adipose-phenotype determinants. Surgical major amputation (AMP) patients are the “sickest-of-the-sick”. Conversely, elective knee-replacement (TKR) is reserved for patients who expect continued health and longevity. To delineate human adipose biology variability and clinical determinants, we studied fresh subcutaneous adipose from AMP patients, using TKR patients as controls. We hypothesized that AMP patients would display a pro-inflammatory adipokine signature, and that certain clinical conditions (diabetes, hypertension, hyperlipidemia, high BMI, uremia) would independently drive elevated adipose inflammation.
Methods
AMP (n=29) and TKR (n=20) adipose and clinical data were collected prospectively, and protein was isolated and analyzed for eight adipose-related mediators. Statistical analyses included Wilcoxon-rank sum, Fischer’s exact and multiple linear-regression modeling of clinical parameter predictors of mediator expression.
Results
IL-6, IL-8, leptin, resistin, and PAI-1 were differentially expressed (up to 200-fold) between AMP/TKR cohorts. Key clinical parameters which associated with protein levels of adipose-phenotype included age, sex, hypertension, hyperlipidemia, congestive heart failure, cerebrovascular disease, renal disease, and warfarin, statin, and insulin use, with simple BMI failing to be predictive.
Conclusions
AMP-patients display adiposopathy, with a pro-inflammatory adipose-phenotypic signature compared to TKR-controls. BMI fails to predict phenotype, yet other clinical conditions such as age, hyperlipidemia, and renal insufficiency do drive adipokine expression. Understanding human adipose-phenotypic determinants stands as a fundamental priority when future studies dissect the interplay between adipose biology and surgical diseases/outcomes.