Visfatin concentration is decreased in women with gestational diabetes mellitus in the third trimester

Novel Biomolecules in the Pathogenesis of Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is one of the most common metabolic diseases in pregnant women. Its early diagnosis seems to have a significant impact on the developing fetus, the course of delivery, and the neonatal period. It may also affect the later stages of child development and subsequent complications in the mother. Therefore, the crux of the matter is to find a biopredictor capable of singling out women at risk of developing GDM as early as the very start of pregnancy. Apart from the well-known molecules with a proven and clear-cut role in the pathogenesis of GDM, e.g., adiponectin and leptin, a potential role of newer biomolecules is also emphasized. Less popular and less known factors with different mechanisms of action include: galectins, growth differentiation factor-15, chemerin, omentin-1, osteocalcin, resistin, visfatin, vaspin, irisin, apelin, fatty acid-binding protein 4 (FABP4), fibroblast growth factor 21, and lipocalin-2. The aim of this review is to present the potential and significance of these 13 less known biomolecules in the pathogenesis of GDM. It seems that high levels of FABP4, low levels of irisin, and high levels of under-carboxylated osteocalcin in the serum of pregnant women can be used as predictive markers in the diagnosis of GDM. Hopefully, future clinical trials will be able to determine which biomolecules have the most potential to predict GDM.

Visfatin level and gestational diabetes mellitus: a systematic review and meta-analysis

It is reported that elevated visfatin level is associated with gestational diabetes mellitus (GDM). However, the relationship between visfatin level and GDM remains controversial. The aim of our study was to systematically review available literature linking visfatin to GDM for a comprehensive understanding of the relationship between circulating visfatin level and GDM in human. PubMed, The Cochrane Library and Web of Science were searched for studies published up to July 2020. Standard mean difference with 95% confidence interval was calculated to evaluate the relationship between visfatin level and GDM using the Review Manager 5.3 and Stata 12.0. The evidence indicated that no significant difference was observed in the level of circulating visfatin between the women with GDM and normal glucose tolerance, suggesting circulating visfatin level is not independently related to GDM. Nevertheless, visfatin is involved in the development of GDM in obese women.

The Role of the Adipokines in the Most Common Gestational Complications

Adipocytokines are hormonally active molecules that are believed to play a key role in the regulation of crucial biological processes in the human body. Numerous experimental studies established significant alterations in the adipokine secretion patterns throughout pregnancy. The exact etiology of various gestational complications, such as gestational diabetes, preeclampsia, and fetal growth abnormalities, needs to be fully elucidated. The discovery of adipokines raised questions about their potential contribution to the molecular pathophysiology of those diseases. Multiple studies analyzed their local mRNA expression and circulating protein levels. However, most studies report conflicting results. Several adipokines such as leptin, resistin, irisin, apelin, chemerin, and omentin were proposed as potential novel early markers of heterogeneous gestational complications. The inclusion of the adipokines in the standard predictive multifactorial models could improve their prognostic values. Nonetheless, their independent diagnostic value is mostly insufficient to be implemented into standard clinical practice. Routine assessments of adipokine levels during pregnancy are not recommended in the management of both normal and complicated pregnancies. Based on the animal models (e.g., apelin and its receptors in the rodent preeclampsia models), future implementation of adipokines and their receptors as new therapeutic targets appears promising but requires further validation in humans.

Can adipokine visfatin be a novel marker of pregnancy-related disorders in women with obesity?

Overweight and obesity have become a dangerous disease requiring multiple interventions, treatment and preventions. In women of reproductive age, obesity is one of the most common medical conditions. Among others, obese state is characterized by low-grade systemic inflammation and enhanced oxidative stress. Increased maternal body mass index might amplify inflammation and reactive oxygen species production, which is associated with unfavourable clinical outcomes that affect both mother and child. Intrauterine growth retardation, preeclampsia, or gestational diabetes mellitus are examples of the hampered maternal and foetoplacental unit interactions. Visfatin is the obesity-related adipokine produced mainly by the visceral adipose tissue. Visfatin affects glucose homeostasis, as well as the regulation of genes related to oxidative stress and inflammatory response. Here, we review visfatin interactions in pregnancy-related disorders linked to obesity. We highlight the possible predictive and prognostic value of visfatin in diagnostic strategies on gravidas with obesity.

A clinical research study on the respective relationships between visfatin and human fetuin A and pregnancy outcomes in gestational diabetes mellitus

OBJECTIVE

The aim was to determine the role of visfatin (VF) and human fetuin A (AHSG) in the development of gestational diabetes mellitus (GDM) and to explore the association between these variables and adverse outcomes.

MATERIALS AND METHODS

We carried out our study on 68 cases of GDM pregnant women and 42 cases of healthy pregnant women, including 56 cases with diet control and 12 cases with insulin treatment. Enzyme-linked immunoassay (ELISA) was used to test the expression levels of VF and AHSG in maternal and umbilical cord serum. Immunohistochemistry (ICH) was used to test the expression level of the VF protein in placental tissue.

RESULTS

The expression levels of VF and AHSG in maternal and umbilical cord serum and the expression level of VF in placental tissue in GDM pregnant women were higher than those in healthy pregnant women. The incidence of adverse outcomes in the GDM pregnant women was higher than that in healthy pregnant women, and these differences were statistically significant (P < 0.05). Those who had higher expression levels of VF or AHSG had a higher incidence of adverse outcomes (P < 0.05).

CONCLUSION

The expression of VF and AHSG may participate in the development of GDM. A test of VF and AHSG in GDM pregnant women may have some predictive value for the occurrence of adverse outcomes.

Placental expressions and serum levels of adiponectin, visfatin, and omentin in GDM

AIMS

Adiponectin, visfatin, and omentin have been shown to be associated with insulin sensitivity and might have a role in the pathophysiology of gestational diabetes mellitus (GDM). This study aimed to (1) compare adiponectin, visfatin, and omentin mRNA expressions in placenta and their serum levels between normal pregnancy (NP) and GDM class A1 (GDMA1) pregnancy and (2) determine correlations between placental gene expressions as well as serum levels with maternal and neonatal clinical parameters in all, NP, and GDM subjects.

METHODS

NP subjects (n = 37), who had normal medical history during their pregnancies without diagnosis of any abnormalities and GDMA1 subjects (n = 37), who were diagnosed since they had antenatal care, were recruited when they were in labor with a gestational age of at least 34 weeks. Clinical parameters and serum adiponectin, visfatin, and omentin levels were measured in the delivery room.

RESULTS

GDMA1 subjects had higher serum visfatin and plasma glucose levels, but lower serum omentin levels (p  < 0.05 all) compared to controls, with comparable levels of placental adiponectin, visfatin, and omentin expressions, plasma insulin, and indices of insulin sensitivity and insulin resistance. Serum visfatin was negatively correlated with neonatal weight and length in the GDM group (p  < 0.05 all). Serum omentin was negatively correlated with pre-pregnancy body mass index and waist circumference only in the NP group (p  < 0.05 all). Serum adiponectin was negatively correlated with maternal age and HOMA-IR in the NP group (p  < 0.05 all) and with placental weight and serum omentin in the GDM group (p  < 0.05 all).

CONCLUSIONS

In conclusion, in GDMA1, increased serum visfatin, which has insulin-mimetic effect, might be associated with a compensatory mechanism that improves the impaired insulin function. Decreased serum omentin in GDMA1, which is normally found in visceral obesity, might lead to insulin resistance and contribute to the pathophysiology of GDM.

Involvement of Novel Adipokines, Chemerin, Visfatin, Resistin and Apelin in Reproductive Functions in Normal and Pathological Conditions in Humans and Animal Models

It is well known that adipokines are endocrine factors that are mainly secreted by white adipose tissue. Their central role in energy metabolism is currently accepted. More recently, their involvement in fertility regulation and the development of some reproductive disorders has been suggested. Data concerning the role of leptin and adiponectin, the two most studied adipokines, in the control of the reproductive axis are consistent. In recent years, interest has grown about some novel adipokines, chemerin, visfatin, resistin and apelin, which have been found to be strongly associated with obesity and insulin-resistance. Here, we will review their expression and role in male and female reproduction in humans and animal models. According to accumulating evidence, they could regulate the secretion of GnRH (Gonadotropin-Releasing Hormone), gonadotropins and steroids. Furthermore, their expression and that of their receptors (if known), has been demonstrated in the human and animal hypothalamo-pituitary-gonadal axis. Like leptin and adiponectin, these novel adipokines could thus represent metabolic sensors that are able to regulate reproductive functions according to energy balance changes. Therefore, after investigating their role in normal fertility, we will also discuss their possible involvement in some reproductive troubles known to be associated with features of metabolic syndrome, such as polycystic ovary syndrome, gestational diabetes mellitus, preeclampsia and intra-uterine growth retardation in women, and sperm abnormalities and testicular pathologies in men.

The role of adipokines in the pathogenesis of gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is a complex condition whose physiopathology to date has not been completely clarified. Two major metabolic disorders, insulin resistance and β-cells dysfunction, play currently major role in pathogenesis of GDM. These elements are influenced by the amount of adipose tissue present before and/or during the pregnancy. Consequently, adipokines (adiponectin (APN), leptin (LPT), adipocyte fatty acid-binding protein, resistin, visfatin, omentin, vaspin, apelin, chemerin) secreted by adipose tissue, may contribute directly and/or indirectly, through the enhancement of chronic inflammation, aggravating insulin resistance and promoting GDM onset. This review aims to outline the potential physiopathological and prognostic role in GDM of adipokines, mainly APN and LPT.

Circulating visfatin levels in the second and third trimester of pregnancies with gestational diabetes: a systematic review

INTRODUCTION

There are multiple published conflicting associations of the adipocytokine visfatin with gestational diabetes. In this study, we attempted to investigate this relationship via a systematic review of the published literature.

EVIDENCE ACQUISITION

Literature retrieval using PubMed, Google Scholar, Scopus and Hydi databases followed by article selection and data extraction were conducted. Relevant studies published up to June 2018 were included. In total, 29 cohorts that were published in 27 articles were analyzed. Three studies carried out in early pregnancy were excluded. A total of 2365 individuals, with 1069 gestational diabetes (GDM) cases and 1296 controls from studies describing visfatin in the second or third trimester of gestation were included.

EVIDENCE SYNTHESIS

The difference in visfatin levels between women with GDM and the controls in the second and third trimester was measured by weighted mean difference (WMD) and 95% confidence intervals (CI). Heterogeneity was inspected by using both subgroup and meta-regression analysis. Analysis was restricted to studies describing singleton pregnancies. The quality of included studies was assessed by the Newcastle-Ottawa Scale.

CONCLUSIONS

No significant difference in circulating visfatin levels in GDM during the second trimester of pregnancy (WMD -0.30 ng/mL, 95% CI: -2.06, 1.45, SE=0.895, P=0.733) was detected. Meta-analysis of the studies in the third trimester revealed a significant negative effect, that was however driven by only one study. This finding limits the meaningful interpretation of the pooled analysis. Significant heterogeneity was identified between studies, and meta-regression analysis showed that homeostatic model assessment for insulin resistance contributes significantly to heterogeneity. In conclusion, our findings suggest that peripheral blood visfatin concentration cannot be robustly associated with gestational diabetes status in the second and third trimesters of pregnancy.

Serum levels of adipokines in gestational diabetes: a systematic review

OBJECTIVE

To determine the difference of serum levels of 10 adipokines (apelin, chemerin, fatty acid-binding protein-4, fibroblast growth factor-21, monocyte chemoattractant protein-1, nesfatin-1, omentin-1, resistin, vaspin, and visfatin) among women with gestational diabetes and healthy pregnant controls.

MATERIALS AND METHODS

Literature search was conducted using the Medline (1966-2018), Scopus (2004-2018), Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2018), Clinicaltrials.gov (2008-2018) and Google Scholar (2004-2018) databases, along with the reference list of the included studies.

RESULTS

Ninety-one studies were included in the present review, with a total number of 11,074 pregnant women. A meta-analysis was not conducted due to the high inter-study heterogeneity. Current evidence suggests that fatty acid-binding protein-4 levels are significantly increased in pregnancies complicated with gestational diabetes, while no association of serum apelin and monocyte chemoattractant protein-1 with the disease can be supported. Data regarding the rest adipokines are conflicting, since the available studies did not unanimously indicate a significant change of their levels in gestational diabetes.

CONCLUSIONS

The findings of the present systematic review suggest the promising role of fatty acid-binding protein-4 in the prediction of gestational diabetes, while inconsistent evidence exists regarding the rest novel adipokines. Future cohorts are needed to assess their predictive efficacy and fully elucidate their contribution in the disease.

Association between circulating visfatin and gestational diabetes mellitus: a systematic review and meta-analysis

AIMS

Gestational diabetes mellitus (GDM) is a medical complication of any degree of glucose intolerance with onset or first recognition during pregnancy. Although visfatin is commonly considered to be related to GDM, studies revealed inconsistent results. This study aimed to clarify the relationship between visfatin and GDM.

METHODS

The protocol for this study was registered in PROSPERO (No. CRD42018086204) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed and Embase databases were used to search for relevant studies published up to September 30, 2017. The difference of visfatin levels between women with GDM and the controls was measured by standardised mean difference (SMD) and 95% confidence interval (CI).

RESULTS

Twenty-six studies that were published in 24 articles met the inclusion criteria, in which 2305 participants (1033 with GDM, mean age 31.39 years and 1272 controls, and mean age 29.99 years) were included. The quantitative meta-analysis revealed no significant difference in circulating visfatin levels between women with GDM and the controls (SMD = 0.249, 95% CI = - 0.079 to 0.576, P = 0.137). Subgroup analyses were performed referring to body mass index (BMI) where inconsistent results have been observed between cases and controls groups. For the ten studies, in which the level of BMI in women with GDM was higher than that in the control group, the pooled result showed that circulating visfatin was significantly higher among women with GDM than the controls (SMD = 0.367, 95% CI = 0.06 to 0.728, P = 0.046). Of other 16 studies BMI-matched, the pooled SMD illustrated no difference of visfatin.

CONCLUSIONS

Our study elucidates that visfatin is not independently associated with GDM. Visfatin is linked to GDM through maternal overweight/obesity, which is one of the major factors leading to the development of GDM.

Are adipokines associated with gestational diabetes mellitus?

OBJECTIVE

To investigate the association of maternal serum levels of chemerin, retinol binding protein-4 (RBP-4), and visfatin with gestational diabetes mellitus (GDM).

MATERIAL AND METHODS

158 pregnant women were screened between 24 and 28 weeks of gestation. They were divided into two groups: GDM group (n=76) and control group (n=82). Maternal serum concentrations of chemerin, RBP-4, visfatin, insulin, and homeostasis model assessment-insulin resistance (HOMA-IR) were assessed.

RESULTS

There were no differences in age and gestational age between the GDM group and the control group (p=0.058 and p=0.820, respectively). Body mass index (BMI) at 24 to 28 weeks of gestation was higher in the GDM group (p<0.001). The serum concentrations of RBP-4, chemerin, and visfatin did not demonstrate significant differences between the GDM and control groups (p=0.871, p=0.100, and p=0.886, respectively). Significant differences in serum level of insulin and HOMA-IR were found between the GDM and control groups (14.94 vs 9.87, p<0.001 and 3.73 vs 1.77, p<0.001, respectively). Correlation analyses of chemerin, RBP-4, visfatin, insulin, and HOMA-IR in both groups revealed a weak degree of positive correlation between RBP-4 and chemerin (Spearman r=0.251, p=0.026) and a strong positive correlation between maternal insulin and HOMA (Spearman r=0.868, p<0.001).

CONCLUSION

No differences were found in serum chemerin, RBP-4, and visfatin between pregnant women with GDM and healthy pregnant women. Further prospective studies will be essential to elucidate the contribution of adipokines to GDM and the positive correlation between maternal RBP-4 and chemerin.

The potential role of biomarkers in predicting gestational diabetes

Gestational diabetes (GD) is a frequent complication during pregnancy and is associated with maternal and neonatal complications. It is suggested that a disturbing environment for the foetus, such as impaired glucose metabolism during intrauterine life, may result in enduring epigenetic changes leading to increased disease risk in adult life. Hence, early prediction of GD is vital. Current risk prediction models are based on maternal and clinical parameters, lacking a strong predictive value. Adipokines are mainly produced by adipocytes and suggested to be a link between obesity and its cardiovascular complications. Various adipokines, including adiponectin, leptin and TNF&, have shown to be dysregulated in GD. This review aims to outline biomarkers potentially associated with the pathophysiology of GD and discuss the role of integrating predictive biomarkers in current clinical risk prediction models, in order to enhance the identification of those at risk.

Correlations of serum visfatin and metabolisms of glucose and lipid in women with gestational diabetes mellitus

Aims/Introduction

Visfatin is a newly discovered adipocytokine hormone, which exerts an insulin‐like effect by binding to the insulin receptor‐1. However, the role of visfatin in human gestational diabetes mellitus (GDM) remains controversial. The purpose of the present study was to investigate the correlation between serum visfatin and metabolism of glucose and lipid in GDM.

Materials and Methods

This was a prospective study. A total of 38 GDM patients and 35 age‐ and body mass index‐matched controls were studied between January 2012 and October 2013. Fasting serum levels of visfatin, fasting plasma glucose, hemoglobin A1c and lipid profile were measured. Two‐tailed t‐tests and Pearson's correlation coefficient were used to analyze the data.

Results

Perinatal visfatin levels were negatively correlated with fasting plasma glucose, insulin resistance index and triglycerides in controls (r = −0.47, −0.51, −0.57, respectively; P < 0.05), and positively correlated with high‐density lipoprotein cholesterol (r = 0.32, P < 0.05). A positive correlation with visfatin level only appeared in weight gain and body mass index in women with GDM (r = 0.36, 0.45, respectively; P < 0.05).

Conclusions

Visfatin appears to be involved in glucose and lipid metabolism regulation and insulin resistance, suggesting a role in GDM pathogenesis.

Potential mechanisms of exercise in gestational diabetes

Gestational diabetes mellitus (GDM) is defined as glucose intolerance first diagnosed during pregnancy. This condition shares same array of underlying abnormalities as occurs in diabetes outside of pregnancy, for example, genetic and environmental causes. However, the role of a sedentary lifestyle and/or excess energy intake is more prominent in GDM. Physically active women are less likely to develop GDM and other pregnancy-related diseases. Weight gain in pregnancy causes increased release of adipokines from adipose tissue; many adipokines increase oxidative stress and insulin resistance. Increased intramyocellular lipids also increase cellular oxidative stress with subsequent generation of reactive oxygen species. A well-planned program of exercise is an important component of a healthy lifestyle and, in spite of old myths, is also recommended during pregnancy. This paper briefly reviews the role of adipokines in gestational diabetes and attempts to shed some light on the mechanisms by which exercise can be beneficial as an adjuvant therapy in GDM. In this regard, we discuss the mechanisms by which exercise increases insulin sensitivity, changes adipokine profile levels, and boosts antioxidant mechanisms.

Expression and regulation of nampt in human islets

Nicotinamide phosphoribosyltransferase (Nampt) is a rate-limiting enzyme in the mammalian NAD+ biosynthesis of a salvage pathway and exists in 2 known forms, intracellular Nampt (iNampt) and a secreted form, extracellular Nampt (eNampt). eNampt can generate an intermediate product, nicotinamide mononucleotide (NMN), which has been reported to support insulin secretion in pancreatic islets. Nampt has been reported to be expressed in the pancreas but islet specific expression has not been adequately defined. The aim of this study was to characterize Nampt expression, secretion and regulation by glucose in human islets. Gene and protein expression of Nampt was assessed in human pancreatic tissue and isolated islets by qRT-PCR and immunofluorescence/confocal imaging respectively. Variable amounts of Nampt mRNA were detected in pancreatic tissue and isolated islets. Immunofluorescence staining for Nampt was found in the exocrine and endocrine tissue of fetal pancreas. However, in adulthood, Nampt expression was localized predominantly in beta cells. Isolated human islets secreted increasing amounts of eNampt in response to high glucose (20 mM) in a static glucose-stimulated insulin secretion assay (GSIS). In addition to an increase in eNampt secretion, exposure to 20 mM glucose also increased Nampt mRNA levels but not protein content. The secretion of eNampt was attenuated by the addition of membrane depolarization inhibitors, diazoxide and nifedipine. Islet-secreted eNampt showed enzymatic activity in a reaction with increasing production of NAD+/NADH over time. In summary, we show that Nampt is expressed in both exocrine and endocrine tissue early in life but in adulthood expression is localized to endocrine tissue. Enzymatically active eNampt is secreted by human islets, is regulated by glucose and requires membrane depolarization.

Adipocytokines and insulin resistance across various degrees of glucose tolerance in pregnancy

OBJECTIVE

Gestational diabetes mellitus is characterized by progressive insulin resistance. Adipocytokines are thought to be associated with insulin resistance. This cross-sectional study evaluated the associations between serum concentrations of several adipocytokines and insulin resistance at different stages of glucose tolerance in pregnancy, using the homeostasis model assessment of insulin resistance (HOMA-IR) as a reference.

METHODS

According to oral glucose tolerance test results, 74 pregnant women were divided into three groups: normal glucose tolerance (n = 25); intermediate glucose tolerance (n = 19); gestational diabetes mellitus (n = 30). Adiponectin, leptin, resistin, visfatin and retinol-binding protein 4 (RBP4) concentrations were measured using enzyme-linked immuno sorbent assays.

RESULTS

Groups were comparable regarding age, week of gestation and body mass index before gestation. There were statistically significant between-group differences in HOMA-IR, but no significant differences regarding serum adipocytokine concentrations.

CONCLUSIONS

Adipo nectin, leptin, resistin, visfatin and RBP4 were not associated with the degree of glucose tolerance in pregnancy. Concentrations of these adipocytokines are not sufficiently sensitive to replace HOMA- IR in pregnancy.

Changes in visfatin levels after oral glucose tolerance test in women with gestational diabetes mellitus

Visfatin levels increased following an oral glucose tolerance test (OGTT) in normal pregnancy, and this increase correlated with metabolic indexes such as blood glucose, blood fat, and insulin resistance. Conversely, visfatin levels in women with gestational diabetes mellitus (GDM) increased to lesser extent than in normal pregnancy, which suggests a disorder in the relationship between visfatin, blood glucose and insulin.

Role of adipokines and other inflammatory mediators in gestational diabetes mellitus and previous gestational diabetes mellitus

Previous Gestational Diabetes Mellitus (pGDM) is a common condition and has been associated with future development of Type 2 Diabetes Mellitus (T2DM) and Metabolic Syndrome (MS) in women affected. The pathogenesis and risk factors implicated in the development of these conditions later in the lives of women with pGDM are not as yet fully understood. Research has recently focused on a group of substances produced mainly by adipose tissue called adipokines, this group including, among others, adiponectin, leptin, Retinol-Binding Protein-4 (RBP-4), and resistin. These substances as well as other inflammatory mediators (CRP, IL-6, PAI-1, TNF-α) seem to play an important role in glucose tolerance and insulin sensitivity dysregulation in women with pGDM. We summarize the data available on the role of these molecules.

The role of visfatin in diabetic nephropathy

As a result of the energy overload in obesity, insulin resistance, type 2 diabetes, dyslipidemia, hypertension, and atherosclerosis develop, which together comprise the metabolic syndrome. Although the kidney becomes a victim of hyperglycemia in diabetes mellitus, recent work has shown that the abnormalities of lipid and glucose metabolism in the kidney are similarly important to those in adipose tissue. Interestingly, obesity triggers the release of adipokines such as leptin, resistin, and visfatin, and these can then be associated with the progression of diabetic nephropathy and other vascular complications. These adipokines, which are also synthesized in the kidney, appear to have an important role in renal injury associated with insulin resistance. Our studies found that visfatin is not only a surrogate marker of systemic inflammation in type 2 diabetic patients but is also up-regulated in diabetic kidney through the uptake of glucose into renal cells, which leads to the activation of the intracellular insulin signaling pathway and pro-inflammatory mechanisms. However, we also observed a beneficial effect of visfatin administration to type 2 diabetic mice. Visfatin injection improved diabetic nephropathy in vivo, in contrast to our previous in vitro study of cultured renal mesangial cells. These results suggest the possibility of multiple cross-talk between adipose tissue and kidney in the metabolic syndrome, particularly in diabetic nephropathy. Further study should be undertaken to understand the role of adipose tissue and kidney as major organs in the metabolic syndrome.

Maternal serum visfatin at 11-13 weeks of gestation in gestational diabetes mellitus

BACKGROUND

Visfatin and adiponectin are produced by adipose tissue and have opposite effects on insulin resistance. Circulating concentrations of these biomarkers are altered in type 2 diabetes mellitus. We sought to examine the potential value of maternal serum visfatin and adiponectin concentrations in early pregnancy as potential biomarkers in the prediction of gestational diabetes mellitus (GDM).

METHODS

This work was a case-control study of 100 women who developed GDM and 300 nondiabetic controls. Maternal serum visfatin and adiponectin were measured between 11 and 13 weeks of gestation. Regression analysis in the nondiabetic group was performed to examine the maternal characteristics affecting the serum concentrations of visfatin and adiponectin. Likelihood ratios for GDM were calculated for visfatin and adiponectin, and performance of screening was assessed by using ROC curve analysis.

RESULTS

In the GDM group compared with the nondiabetic group, the median maternal serum visfatin concentration was increased (1.34 multiples of the median [MoM], interquartile range [IQR] 0.70-2.87, vs 1.00 MoM, IQR: 0.53-1.92; P = 0.004) and serum adiponectin was decreased (0.66 MoM, IQR 0.50-0.92, vs 1.01, IQR 0.70-1.29; P < 0.0001). In screening for GDM by a combination of maternal factors and serum adiponectin and visfatin, the estimated detection rate was 68.0% (95% CI 58.3-76.3%), at a false-positive rate of 10%.

CONCLUSIONS

At 11-13 weeks in pregnancies that develop GDM, the serum concentration of adiponectin is decreased and visfatin is increased, and these biomarkers can be combined with maternal factors to provide effective early screening for GDM.

The role of visfatin in the pathogenesis of gestational diabetes mellitus

AIM

The objective of the present study was to evaluate the role of visfatin in gestational diabetes mellitus.

MATERIALS AND METHODS

Forty-five pregnant women at 24 to 28 weeks' gestation were assigned to consume an initial screening test using a 1-h 50-g glucose load, and then a 3-h 100-g glucose load. The study group consisted of 23 patients who were diagnosed with gestational diabetes mellitus and the control group consisted of 22 healthy pregnant women. We studied the levels of visfatin and the other parameters of inflammation, glucose and lipid metabolism between the 24th and 28th week of gestation and also between the 6th and 10th week after delivery.

RESULTS

Plasma visfatin and glucose levels at 60 min after a 50-g and a 100-g glucose load between the 24th and 28th week of gestation were significantly higher in the gestational diabetes group than in the control group. There were no statistical differences in visfatin levels between the groups at 6-10 weeks post-partum.

CONCLUSION

Visfatin levels were significantly elevated in women with gestational diabetes mellitus and during the course of pregnancy and increased visfatin concentrations were reduced within 6 to 10 weeks after delivery.

Nicotinamide Phosphoribosyltransferase in Human Diseases

Nicotinamide phosphoribosyltransferase (NAMPT) was first reported as a pre-B-cell colony enhancing factor in 1994 with little notice, but it has received increasing attention in recent years due to accumulating evidence indicating that NAMPT is a pleiotropic protein such as a growth factor, a cytokine, an enzyme and a visfatin. Now, NAMPT has been accepted as an official name of this protein. Because of NAMPT's multiple functions in a variety of physiological processes, their dysregulations have been implicated in the pathogenesis of a number of human diseases or conditions such as acute lung injury, aging, atherosclerosis, cancer, diabetes, rheumatoid arthritis and sepsis. This review will cover the current understanding of NAMPT's structure and functions with an emphasis on recent progress of nicotinamide phosphoribosyltransferase's pathological roles in various human diseases and conditions. Future directions on exploring its Terra incognita will be offered in the end.

Maternal and neonatal circulating visfatin concentrations in patients with pre-eclampsia and a small-for-gestational age neonate

OBJECTIVE

Maternal circulating visfatin concentrations are higher in patients with a small-for-gestational-age (SGA) neonate than in those who delivered an appropriate-for-gestational age (AGA) neonate or in those with pre-eclampsia. It has been proposed that enhanced transfer of visfatin from the foetal to maternal circulation may account for the high concentrations of maternal visfatin observed in patients with an SGA neonate. The aims of this study were: (1) to determine whether cord blood visfatin concentrations differ between normal neonates, SGA neonates and newborns of pre-eclamptic mothers; and (2) to assess the relationship between maternal and foetal circulating visfatin concentrations in patients with an SGA neonate and those with pre-eclampsia.

STUDY DESIGN

This cross-sectional study included 88 pregnant women and their neonates, as well as 22 preterm neonates in the following groups: (1) 44 normal pregnant women at term and their AGA neonates; (2) 22 normotensive pregnant women and their SGA neonates; (3) 22 women with pre-eclampsia and their neonates; and (4) 22 preterm neonates delivered following spontaneous preterm labour without funisitis or histologic chorioamnionitis, matched for gestational age with infants of pre-eclamptic mothers. Maternal plasma and cord blood visfatin concentrations were determined by ELISA. Non-parametric statistics were used for analyses.

RESULTS

(1) The median visfatin concentration was lower in umbilical cord blood than in maternal circulation, in normal pregnancy, SGA and pre-eclampsia groups (p<0.001 for all comparisons); (2) the median cord blood visfatin concentrations did not differ significantly between term AGA or SGA neonates, infants of mothers with pre-eclampsia and their gestational-age-matched preterm AGA neonates; (3) maternal and cord blood visfatin concentrations correlated only in the normal term group (r=0.48, p=0.04).

CONCLUSION

Circulating visfatin concentrations are lower in the foetal than in the maternal circulation and did not significantly differ between the study groups. Thus, it is unlikely that the foetal circulation is the source of the high maternal visfatin concentrations reported in patients with an SGA neonate.

Circulating and local visfatin/Nampt/PBEF levels in spontaneously hypertensive rats, stroke-prone spontaneously hypertensive rats and Wistar-Kyoto rats

Visfatin (also known as nicotinamide phosphoribosyltransferase and pre-B cell colony-enhancing factor) is a multifunctional protein. Visfatin has been reported to be involved in several biological processes in the cardiovascular system, . However, the role of visfatin in hypertension is still unclear. In this study, we examined the circulating and local adipose visfatin levels in spontaneously hypertensive rats (SHR), stroke-prone spontaneously hypertensive rats (SHR-SP), and in their normotensive control Wistar-Kyoto (WKY). SHR and SHR-SP rats exhibited lower body weight, lower fat tissue and hypolipidemia. No differences of serum visfatin levels were observed in SHR/SHR-SP and WKY. Serum visfatin levels did not correlate to serum glucose, lipids, insulin, and fat pad weights, but significantly correlated to weights of skeletal muscle. Visfatin expression in visceral fat tissue was slightly lower in SHR-SP compared with that in WKY. Moreover, there were no significant differences of visfatin expression in skeletal muscles among WKY, SHR and SHR-SP. Finally, visfatin protein was detected in L6 rat skeletal muscle cell culture medium, indicating that visfatin was secreted from skeletal muscle cells. Thus, our results may provide useful information for understanding the characteristic of visfatin in hypertensive models, and support the view that visfatin may be a myokine.

Could alterations in maternal plasma visfatin concentration participate in the phenotype definition of preeclampsia and SGA?

OBJECTIVE

Women with preeclampsia and those who delivered a small-for-gestational-age (SGA) neonate share several mechanisms of disease, including chronic uteroplacental ischemia and failure of physiologic transformation of the spiral arteries. However, the clinical manifestation of these obstetrical syndromes is remarkably different. It has been proposed that an altered maternal metabolic state, as well as a unique circulating cytokines milieu, predispose women to develop either preeclampsia or SGA. Compelling evidence suggests that adipose tissue orchestrates both metabolic pathways and immunological responses via the production of adipokines. Visfatin is a novel adipocytokine with metabolic and immunomodulating properties. The objective of this study was to determine whether preeclampsia and SGA are associated with alterations in maternal circulating visfatin concentrations.

METHODS

This cross-sectional study included pregnant women in the following groups: (1) normal pregnancy (n = 158); (2) patients with preeclampsia (n = 43) of which 32 had an AGA and 11 had an SGA neonate; (3) patients without preeclampsia who delivered an SGA neonate (n = 55). Maternal plasma visfatin concentrations were measured by ELISA. Nonparametric tests and multiple linear regression analysis were used.

RESULTS

(1) Women who delivered an SGA neonate had a higher median maternal plasma visfatin concentration than those with a normal pregnancy (20.0 ng/ml, interquartile range: 17.2-24.6 vs. 15.2 ng/ml, 12.1-19.2, respectively; P < 0.001) and than those with preeclampsia (14.5 ng/ml, 12.5-18.7; P < 0.001); (2) the median maternal plasma visfatin concentration did not differ significantly between patients with preeclampsia and those with a normal pregnancy (P = 0.8); (3) among patients with preeclampsia, there was no significant difference in the median maternal plasma visfatin concentration between those with or without an SGA neonate (P = 0.5); (4) in a linear regression model, delivery of an SGA neonate and pregestational body mass index were independently associated with increased visfatin concentration after adjustment for confounding factors (maternal age, smoking, gestational age at blood collection and the presence of preeclampsia or SGA).

CONCLUSION

(1) Patients with SGA, but not those with preeclampsia, had a higher maternal plasma visfatin concentration than those with a normal pregnancy; (2) this finding suggests differential involvement of visfatin in SGA and preeclampsia; (3) we propose that changes in circulating maternal visfatin concentration may be implicated in the phenotypic definitions and distinction of preeclampsia and SGA.

Evidence for differential regulation of the adipokine visfatin in the maternal and fetal compartments in normal spontaneous labor at term

OBJECTIVE

Visfatin, a novel adipokine with metabolic and immunoregulatory properties, has been implicated in the regulation of fetal growth, as well as in preterm labor. A gap in knowledge is whether spontaneous labor at term is associated with changes in the maternal and fetal concentrations of visfatin. The aim of this study was to determine if the presence of labor at term is associated with alterations in maternal and neonatal plasma visfatin concentrations.

STUDY DESIGN

This cross-sectional study included 50 normal pregnant women at term and their appropriate-for-gestational age (AGA) neonates in the following groups: 1) 25 mother-neonate pairs delivered by elective cesarean section without spontaneous labor, and 2) 25 mother-neonate pairs who delivered vaginally following spontaneous labor. Maternal plasma and cord blood visfatin concentrations were determined by ELISA. Non-parametric statistics were used for analyses.

RESULTS

1) The median visfatin concentration was higher in umbilical cord plasma of neonates born following a spontaneous labor at term than that of those who were born by an elective cesarean section (P=0.02); 2) in contrast, the median maternal plasma visfatin concentration did not differ significantly between patients with and without labor (P=0.44); and 3) there was a significant correlation between umbilical cord plasma concentration of visfatin and both maternal visfatin concentration (r=0.54, P=0.005) and gestational age (GA) at delivery (r=0.58; P=0.002) only in the absence of labor.

CONCLUSION

Term labor is associated with increased fetal, but not maternal, circulating visfatin concentrations. Previous reports indicate that preterm labor leading to preterm delivery is characterized by an increase in maternal plasma concentrations of visfatin. The observations reported herein support the view that there are fundamental differences in the endocrine and metabolic adaptations in normal labor at term and preterm labor.

Maternal plasma concentration of the pro-inflammatory adipokine pre-B-cell-enhancing factor (PBEF)/visfatin is elevated in pregnant patients with acute pyelonephritis

PROBLEM

Visfatin/pre-B-cell-enhancing factor (PBEF) has been implicated in the regulation of the innate immune system, as well as in glucose metabolism. Specifically, visfatin plays a requisite role in delayed neutrophil apoptosis in patients with sepsis. The aim of this study was to determine whether pyelonephritis during pregnancy is associated with changes in maternal plasma visfatin concentration in normal weight and overweight/obese patients.

METHOD OF STUDY

This cross-sectional study included the following groups: (1) normal pregnant women (n = 200) and (2) pregnant women with pyelonephritis (n = 40). Maternal plasma visfatin concentrations were determined by ELISA. Non-parametric statistics was used for analyses.

RESULTS

(1) The median maternal plasma visfatin concentration was significantly higher in patients with pyelonephritis than in those with a normal pregnancy; (2) among overweight/obese pregnant women, those with pyelonephritis had a significantly higher median plasma visfatin concentration than women with a normal pregnancy; and (3) pyelonephritis was independently associated with higher maternal plasma visfatin concentrations after adjustment for maternal age, pre-gestational body mass index, smoking status, gestational age at sampling, and birthweight.

CONCLUSION

Acute pyelonephritis during pregnancy is associated with a high circulating maternal visfatin concentration. These findings suggest that visfatin/PBEF may play a role in the regulation of the complex and dynamic crosstalk between inflammation and metabolism during pregnancy.

Plasma visfatin levels in preeclamptic and normal pregnancies

OBJECTIVE

Increasing evidences support the participation of adipokines in the pathogenesis of preeclampsia (PE). Visfatin is a novel adipokine secreted by fat tissue and macrophages and is involved in the regulation of glucose homeostasis. Our aim is to investigate visfatin levels in women with PE, women with the third trimester of normal pregnancy and healthy non-pregnant women.

PATIENTS AND METHODS

We included 32 preeclamptic patients who received antenatal and obstetric care at Perinatology Clinic. A total of 32 pregnant women with normal ongoing pregnancies and 32 non-pregnant women were taken as the control groups. Plasma levels of visfatin were quantified by ELISA.

RESULTS

Plasma levels of visfatin were 63.8 +/- 4.9 ng/ml in women with PE, 43.6 +/- 7.8 ng/ml in pregnant control and 31.6 +/- 4.2 ng/ml in the non-pregnant control, respectively (P < 0.001). Visfatin level was significantly higher in PE compared with non-pregnant control (P < 0.001) and pregnant control (P < 0.001); also, plasma level of visfatin was significantly higher in severe PE (75.3 +/- 4.6 ng/ml) than mild PE (41.8 +/- 5.2 ng/ml) (P < 0.001).

CONCLUSION

The results of the present study indicate that women with PE had significantly increased visfatin concentrations in the third trimester. Furthermore, visfatin levels were significantly higher in severe PE group.

Reviews: adipocytokines in normal and complicated pregnancies

Human pregnancy is characterized by insulin resistance, traditionally attributed to the effects of placental hormones. Normal pregnancy-induced insulin resistance is further enhanced in pregnancy complications, associated with disturbed placental function, such as gestational diabetes mellitus, preeclampsia, and intrauterine growth restriction. Compelling evidence suggests that these pregnancy disorders are associated with future development of maternal metabolic syndrome. However, the pathogenetic mechanisms underlying the association between abnormal placental development, insulin resistance, and maternal metabolic syndrome are not fully understood. A large body of evidence has recently supported the role of adipose tissue in the regulation of insulin resistance in both nonpregnant and pregnant participants. In this respect, adipocytokines, which are adipocyte-derived hormones, have been implicated in the regulation of maternal metabolism and gestational insulin resistance. Adipocytokines, including leptin, adiponectin, tumor necrosis factor alpha, interleukin 6, as well as the newly discovered resistin, visfatin, and apelin, are also known to be produced within the intrauterine environment. However, data concerning the pattern of adipocytokines secretion in normal and complicated pregnancies are still limited and partially contradictory. Given the importance of adipose tissue and its hormones in terms of adequate metabolic control and energy homeostasis, we present a review of published data related to the role of adipocytokines in pregnancy, especially in relation to pregnancy complications. Focus will be placed on the functions and other potential roles of the novel adipocytokines resistin, visfatin, and apelin.