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| - Background Obesity represents a global health threat, and is associated not only with exponentially increased cardiometabolic morbidity and mortality, but with adverse clinical outcomes in patients infected with SARS-CoV-2 as well. Enzymatic attachment of complex oligosaccharides to proteins (glycosylation) is highly responsive to numerous (patho)physiological conditions and ageing, which is perhaps best exemplified on IgG. The prospect of immune age reduction, by reverting induced glycosylation changes through metabolic intervention, opens many possibilities. Herein, we have investigated whether weight loss interventions affect inflammation- and ageing-related glycosylation alterations, in a longitudinal cohort of bariatric-surgery patients. To support potential findings, BMI-related glycosylation changes were monitored in a longitudinal TwinsUK cohort. Methods IgG and plasma N-glycans were chromatographically profiled in 37 obese patients, subjected to low-calorie diet and then to bariatric surgery, across multiple timepoints. Similarly, plasma glycome was analysed in 1,680 TwinsUK participants and longitudinally monitored during a 20-year follow-up. Findings Low-calorie diet induced marked increase in low branched and significant decrease in highly branched, more complex plasma N-glycans - the change opposite to the one typically observed in inflammatory conditions. Bariatric surgery resulted in extensive, gradual alterations in IgG glycome, that accompanied progressive weight loss during one year follow-up. We observed significant increase in digalactosylated and sialylated, and substantial decrease in agalactosylated and core fucosylated IgG glycans. In general, such IgG glycan profile is associated with a younger biological age and reflects enhanced anti-inflammatory IgG potential. The TwinsUK cohort replicated weight loss-associated agalactosylation decrease and digalactosylation increase, estimated through BMI decrease over a 20-year period. Interpretation Altogether, these findings highlight that weight loss substantially affects both plasma and IgG N-glycosylation, resulting in improved biological and immune age.
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