Adipose tissue remodelling in pregnancy

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Adipose tissue remodelling in pregnancy

During pregnancy, a mother undergoes rapid and continuous metabolic adaptations to meet the nutritional needs of herself and her fetus. One such adaptation is a reduction in maternal insulin sensitivity, which increases glucose availability to the fetus; however, gestational diabetes mellitus (GDM) can occur if excessive insulin resistance occurs alongside insufficient insulin secretion. A study published in Science Translational Medicine now reports a signalling pathway linked with pregnancy-associated plasma A (PAPPA) that regulates adipose tissue expansion in pregnancy and protects against GDM.

First, Corvera and colleagues reanalysed their previously published gene expression dataset of adipose tissue biopsy samples from pregnant women with normoglycaemia who underwent a caesarean section and non-pregnant, non-diabetic control individuals who underwent gastric bypass surgery. They also obtained needle biopsy samples for histological analysis of subcutaneous adipose tissue from a separate cohort of weight-matched pregnant or non-pregnant women.

PAPPA, which circulates at progressively increasing levels as pregnancy advances, proteolyses IGFBP5 to release IGF1, thereby enabling the signalling function of IGF1. To test this hypothesis, the researchers used an in vitro assay that measures the expandability of small fragments of human adipose tissue. Of note, explants from pregnant women showed increased expandability compared with those from non-pregnant women. Furthermore, culturing explants from pregnant women with recombinant human PAPPA revealed a dose-dependent effect of PAPPA to increase the expandability of adipose tissue. In addition, adipose tissue expandability was critically dependent on IGF1 signalling.

The researchers retrospectively analysed circulating levels of PAPPA and blood concentrations of glucose from the medical records of a cohort of 6,361 pregnant women. Importantly, PAPPA values in this cohort were inversely correlated with glycaemia, glucose tolerance and risk of GDM. To test whether PAPPA regulates the expansion of adipose tissue in pregnancy, Corvera and colleagues investigated a mouse model that lacks Pappa (Pappa-KO). Compared with wild-type mice, Pappa-KO mice are 60% smaller but are viable and fertile. However, upon pregnancy, Pappa-KO mice did not show the normal adipose tissue remodelling that occurs upon pregnancy in wild-type mice. Finally, the researchers examined the metabolic consequences of abnormal adipose tissue remodelling during pregnancy in Pappa-KO mice. Notably, insulin sensitivity was decreased in Pappa-KO mice compared with wild-type mice. This difference was more pronounced in pregnant mice, suggesting that PAPPA ablation causes gestational insulin resistance.

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