Interviews with Andrew Wheeler, MD, and Thomas Shin, MD, PhD
by Benjamin Clapp, MD, FACS, FASMBS; Tammy Kindel, MD, PhD, FACS, FASMBS; and Shaina R. Eckhouse, MD, FACS, FASMBS
Dr. Clapp is an Associate Clinical Professor of Surgery at Texas Tech School of Medicine at El Paso in El Paso, Texas. Dr. Kindel is Associate Professor of Surgery at the Medical College of Wisconsin in Milwaukee, Wisconsin. Dr. Eckhouse is an Associate Professor of Surgery at Washington University School of Medicine in St. Louis, Missouri.
Bariatric Times. 2023;20(7–12):22–23.
Andrew Wheeler, MD, was a recipient of the 2023 American Society for Metabolic and Bariatric Surgery (ASMBS) research grant, funded by the Treatment, Research and Education to end Obesity (TREO) Foundation for his study titled “Biometabolic Impact of Continuation of GLP-1 Agonists Following Bariatric Surgery: A Randomized Control Trial.” The grant amount was for $25,000. In this article, we aim to highlight Dr. Wheeler’s clinical and research career and the clinical implications of his study. Additionally, we will explore the vital role that the TREO Foundation grant will have in helping him build an extramurally funded research career.
Can you please share your current clinical practice and research background as a surgeon–scientist focusing on the hormonal and metabolic effects of bariatric surgery in the treatment of obesity?
Dr. Wheeler: My academic clinical practice focuses on comprehensive weight management. I have a particular clinical interest in maximizing the effectiveness of metabolic surgery using combined medical and surgical therapy before and after surgery. We study metabolic changes and determinants after metabolic surgery, including changes in gut microbiome and circulating metabolite changes after surgery to better understand the mechanisms of the beneficial effects of metabolic surgery, not only on obesity, but also on associated comorbid illnesses.
You were awarded an ASMBS research grant in 2023, funded by the TREO Foundation. Could you further explain the aims of this grant?
Dr. Wheeler: Our goal is to determine, both clinically and physiologically, the benefits or potential downfalls of the continuation of glucagon-like peptide-1 (GLP-1) agonists as pharmacologic management after metabolic surgery. We want to determine if continuation of these medications can improve outcomes after metabolic surgery or potentially lead to more side effects. We are going to measure changes in the gut microbiome, as well as circulating metabolites after surgery, to understand if the addition of GLP-1 agonists to metabolic surgery results in more changes than surgery alone.
What were the results of the ASMBS research grant funded by TREO Foundation? This may be early, so you can answer what you think the results will be.
Dr. Wheeler: We hypothesize that fewer patients will regain weight and overall weight loss will be improved when continuing GLP-1 agonists after surgery, but that there will likely be a number of patients who have to stop the medication postoperatively due to side effects.
Please explain what makes your grant interesting to the membership of the ASMBS.
Dr. Wheeler: Data from this work should help provide direction for medical weight loss physicians and bariatric surgeons to better advise patients and make recommendations on using GLP-1 agonists after surgery.
How have the findings from the study funded by TREO Foundation through the ASMBS research grant affected the daily practice of bariatric surgery?
Dr. Wheeler: This is pending, but we believe this work could potentially inform and impact clinical decision-making.
Thomas Shin, MD, PhD, was a recipient of the 2023 American Society for Metabolic and Bariatric Surgery (ASMBS) research grant, funded by the TREO Foundation for his study titled, “Spatial Transcriptomics Reveals Oncoprotective Effect of Bariatric Surgery Against Breast Cancer.” The grant amount was for $25,000. In this article, we aim to highlight Dr. Shin’s clinical and research career and the clinical implications of his study. Additionally, we will explore the vital role that the TREO Foundation grant will have in helping him build an extramurally funded research career.
Can you please share your current clinical practice and research background as a surgeon-scientist focusing on the hormonal and metabolic effects of bariatric surgery in the treatment of obesity?
Dr. Shin: I am the current minimally invasive surgery/bariatric surgery clinical fellow at Brigham and Women’s Hospital in Boston, Massachusetts. Our practice serves many patients with obesity, as well as patients who require repeat surgical interventions after previous bariatric surgeries and endoscopic procedures, such as revisions, conversions, and reversals. My scientific training stems from my graduate/PhD training in immunology with a focus on the role of inflammation in various processes, including bone metabolism and cancer development. Currently, my research and clinical interests intersect to focus on how hormonal and metabolic effects after bariatric surgery impact nongastrointestinal systems in the body, including inflammatory processes and immune system changes.
You were awarded an ASMBS research grant in 2023, funded by the TREO Foundation. Could you further explain the aims of this grant?
Dr. Shin: Various clinical studies have shown that bariatric surgery confers a protective effect against cancer development; however, the mechanism through which this happens is still poorly understood. This is of particular interest among cancers that are traditionally considered hormone-related, including breast cancer. Our project aims to answer two major questions: 1) how does bariatric surgery affect the breast tissue; and 2) how do those identified changes overlap with pathways already identified as associated with the development of breast cancer?
What were the results of the ASMBS research grant funded by TREO Foundation? This may be early, so you can answer what you think the results will be.
Dr. Shin: With support from the TREO Foundation, we are confident that our studies will reveal unappreciated gene expression patterns and molecular pathways that are changed within the breast tissue microenvironment after bariatric surgery. Many of these genes are likely to be involved not only in cancer development within the breast, but also the crosstalk between breast tissue and cancer cells that create a microenvironment conducive to cancer development. Revealing these molecular pathways might yield new therapeutic targets for breast cancer in patients with obesity.
Please explain what makes your grant interesting to the membership of the ASMBS.
Dr. Shin: As metabolic and bariatric surgeons, we are interested not only in the treatment of obesity itself, but also addressing the numerous conditions that are associated with obesity. It is increasingly apparent that obesity is a complex disease both in terms of its cause and in how it affects other organ systems and disease development. Though interest is strong, our field’s collective knowledge of the relationship between obesity, bariatric surgery, and oncology remains limited.
How have the findings from the study funded by TREO Foundation through the ASMBS research grant affected the daily practice of bariatric surgery?
Dr. Shin: The scope of bariatric surgery and obesity medicine continues to evolve and goes beyond strictly losing weight. Obesity is now a well-known risk factor for numerous other associated diagnoses, and this study aims to make a mechanistic argument for how obesity plays a role in breast cancer development. With success, the results of our study will reveal new approaches and innovations to how we can further tailor one of the leading cancer diagnoses in the United States among our bariatric patient population.
Category: Current Issue, Research Grant Report
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