Gut hormones: history, physiology and therapeutic opportunities
Dr Keval Chandarana
In recent decades, a great deal of investigation has been focused on the role of gut hormones in energy homeostasis. The gastrointestinal tract is the largest endocrine organ in the body producing hormones that have important sensing and signalling roles in regulating body weight and energy expenditure. Dietary modifications are the first-line treatment for obesity however dieting results in only moderate weight-loss and maintenance of weight-loss is poor. Compensatory gut hormone changes appear to contribute to the failure of weight-loss through dietary means. In contrast, bariatric surgery is an efficacious treatment modality for obesity, resulting in durable weight loss and amelioration of obesity-associated co-morbidities, particularly type 2 diabetes mellitus. Moreover, the metabolic benefits of bariatric surgery occur independently of weight loss. An increasing body of evidence suggests that alterations in circulating gut hormones mediate the weight-loss and metabolic benefits of bariatric surgery. Logically, strategies aimed at modulating circulating gut hormone concentrations or targeting their receptors are being developed as potential pharmacotherapies for obesity.