Neprilysin in Pregnancy

A healthy pregnancy is accompanied by a number of physiological adaptations in the mother. Glucose metabolism and the cardiovascular system change, resulting in increased insensitivity to insulin and altered blood pressure regulation. Disturbances in glucose metabolism and blood pressure regulation can lead to gestational diabetes and to preeclampsia, a severe elevation of blood pressure during pregnancy. Both conditions are among the most common pregnancy complications. Neprilysin is a protease that degrades a number of physiologically relevant, bioactive peptides, thereby influencing various processes: neprilysin cleaves insulin and glucagon and is therefore involved in the regulation of blood glucose in a complex manner. In addition, neprilysin cleaves peptides that affect blood pressure, such as bradykinin and angiotensin. Anchored in the cell membrane, neprilysin sits on the cell surface of many cells. By cleavage, the enzymatically active part (sNEP) can be released from the cell surface and circulate and act in the bloodstream. This gives sNEP systemic relevance in addition to a potential role as a biomarker. Because of its substrate specificity, neprilysin may play a role in physiological adaptations in healthy pregnancy as well as in the development of pregnancy pathologies. To date, however, maternal sNEP has not been studied in pregnancy. In this study, sNEP will be measured during pregnancy in healthy women and in women who develop gestational diabetes or preeclampsia and will be associated with metabolism and blood pressure. The results will provide new information on the relationship between neprilysin, maternal metabolism, adaptation to pregnancy, and the development of pregnancy pathologies, and indicate whether sNEP could be considered as a biomarker for pregnancy pathologies.