Adm and SFLT-1 Expression in Placentas With Gestational Diabetes Mellitus

Abstract

Aim: In this study, we aimed to examine the expression levels of Adrenomedullin (ADM) and soluble fms-like tyrosine kinase-1 (sFlt-1), two novel proteins found to be involved in vascular regulation in gestational diabetes mellitus (GDM), to compare the expression levels of these proteins in the histopathology of the disease and to observe the correlation of the expression intensity of these proteins with the disease.
 Methods: In our study, 20 healthy and 20 GDM placenta samples were obtained. Histologic follow-up was performed. 5µm thick sections were taken from these tissues and stained with Hematoxylin-Eosin and Periodic Acid Schiff (PAS). Immunohistochemically, ADM and sFlt-1 antibodies were studied.
 Results: In the GDM group, vascular dilatation and congestion in stem villus, hyperplasic endothelial cells, and increased syncytial bridges in the external part of the villi, mononuclear cell infiltration, pyknotic nuclei and cytoplasm loss in some of the decidual cells in the maternal region were observed. In the immunohistochemical examination, cytotrophoblast and syncytiotrophoblast cells of villous and syncytial nodes showed negative ADM expression. ADM was positively expressed in some cytotrophoblast cells of small villi, vascular endothelial cells and decidual cells. In the GDM group, sFlt-1 expression was positive in endothelial cells, some Hofbauer cells of mesenchymal connective tissue, decidual cell nuclei and membranes. 
 Conclusion: ADM may be an important receptor in insulin metabolism to determine the glucose level because we found positive ADM expression in cytotrophoblasts and membranes of decidual cells. In addition, changes in endothelial cells of maternal and fetal regions and sFlt-1 expression in Hofbauer cells suggest that this molecule possibly plays a key role in the angiogenic effect.