GLP-1 RA-Exacerbated Gut Microbiome Dysbiosis in Obesity Mediates Post-Cessation Weight Regain

GLP-1 receptor agonists (GLP-1 RAs) effectively reduce weight in obesity, although significant weight regain typically follows discontinuation. Here, in a randomized clinical trial (ChiCTR2200066014), we found that GLP-1 RA (semaglutide) and a high-fibre diet achieved similar 12-week weight reduction, but semaglutide recipients exhibited significantly higher weight rebound at the 14th week after intervention cessation. Shotgun metagenomic sequencing revealed that semaglutide aggravated the proinflammatory signature in the gut microbiome, which contrasted with high-fibre diet intervention. The microbiota transplanted from semaglutide-treated subjects to germ-free mice induced gut barrier dysfunction, systemic inflammation and an increase in the bacterial antigen load in the liver and adipose tissue, which activated the NF-{kappa}B pathway to drive lipid accumulation. Using a diet-induced obesity mouse model, we found that semaglutide exacerbated gut microbiome dysbiosis by weakening host immune surveillance of the gut microbiota through downregulating IFN-{gamma} to reduce antimicrobial peptides expression and delaying gut transit time to shift microbial metabolism from saccharolysis towards proteolysis. Crucially, combining semaglutide with dietary fibre in mice mitigated microbiome dysbiosis and attenuated weight regain post-cessation. These findings suggest that GLP-1 RA-exacerbated gut microbiome dysbiosis in obesity as a key mediator of post-treatment weight rebound and propose adjunctive fibre supplementation as a strategy to sustain weight loss.