Abstract
Objectives The aim was to investigate neutrophil gelatinase-associated lipocalin (NGAL) levels in the serum and term placentas and its potential role in gestational diabetes mellitus (GDM). Methods A total of 49 GDM subjects and 39 age-matched women with normal pregnancies were recruited. We examined serum concentrations of NGAL and tumor necrosis factor-α (TNF-α) in maternal blood and cord blood and their expression levels in the term placentas and umbilical cord. Results Serum NGAL levels were significantly higher in GDM patients than in normal pregnant controls both in the maternal blood (4.80 ± 1.99 vs. 3.66 ± 1.13, P=0.001) and the cord blood (4.70 ± 2.08 vs. 3.85 ± 1.44, P=0.027). Moreover, serum NGAL levels exhibited a positive correlation with various parameters of insulin resistance. Maternal serum NGAL levels positively correlated with the NGAL levels found in the cord blood of the control (r = 0.399, P=0.012) and the GDM subjects (r = 0.349, P=0.014). Finally, the expression of NGAL protein levels in the placenta (1.22 ± 0.39 vs. 0.65 ± 0.23, P < 0.001) and umbilical cord (0.65 ± 0.23 vs. 0.25 ± 0.10, P < 0.001) were higher in GDM women than those noted in the control subjects. In the GDM group, maternal serum NGAL levels exhibited a positive correlation with placental NGAL mRNA and protein levels (r = 0.848, P=0.008; r = 0.636, P=0.011, respectively). Conclusions NGAL may be an important adipokine involved in GDM and fetal development. The oversecretion of NGAL from the placenta may contribute to the elevated levels of serum NGAL in gestational diabetes mellitus.
Highlights
Gestational diabetes mellitus (GDM) is defined as any degree of carbohydrate intolerance with an onset during pregnancy [1, 2]
Previous clinical studies have demonstrated that the serum neutrophil gelatinase-associated lipocalin (NGAL) levels of patients with type 2 diabetes mellitus (T2DM) were significantly increased and that they exhibited a positive correlation with several indices of insulin resistance, such as fasting blood glucose [9, 10]. is suggested that NGAL played a biological role in addition to its involvement in diabetes mellitus
Mahfouz et al [9] demonstrated that serum NGAL levels were significantly elevated in patients with T2DM, and that NGAL exhibited a positive correlation with insulin resistance status, specific insulin resistance markers and diabetes progression
Summary
Gestational diabetes mellitus (GDM) is defined as any degree of carbohydrate intolerance with an onset during pregnancy [1, 2]. Recent studies have shown that the levels of NGAL are closely associated with the development of hyperglycemia and insulin resistance [6,7,8]. Previous clinical studies have demonstrated that the serum NGAL levels of patients with type 2 diabetes mellitus (T2DM) were significantly increased and that they exhibited a positive correlation with several indices of insulin resistance, such as fasting blood glucose [9, 10]. A previous study has shown that the expression levels of NGAL protein in the placental tissues of patients with preeclampsia were higher than those in control subjects, suggesting that NGAL in the International Journal of Endocrinology placenta may exert a compensatory response to the development of preeclampsia [13]. TNF-α can induce the expression of NGAL in placenta [16]
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