Figure 8
From: New insight into the mechanisms of ectopic fat deposition improvement after bariatric surgery
Proposed mechanism of NAFLD and insulin resistance reversal after Sleeve Gastrectomy. Excessive caloric intake, associated with NAFLD and obesity, reduces AMPK activation, causing a decrease of Plin2 catabolism mediated by chaperone-mediated autophagy leading to ectopic fat deposition increase and simultaneously to hepatic insulin resistance. After SG, the energy imbalance due to reduced caloric intake causes an increase in AMPK phosphorylation, a crucial step in Plin2-LAMP2A binding, leading to an enhanced Plin2 autophagy that exposes LD triglycerides to intracellular lipases. In addition, AMPK increased phosphorylation improves insulin signaling and promotes glycogen synthesis.
