The putative metabolic role of d-chiro inositol phosphoglycan in human pregnancy and preeclampsia

Immunological alterations, systemic inflammation, endothelial dysfunction, and insulin resistance are prominent features of preeclampsia, although the reciprocal relationship between them is poorly understood. The metabolic syndrome that occurs during preeclampsia can be exacerbated by the systemic inflammation and linked to placental metabolism/development and endothelial dysfunction. Under healthy conditions, insulin and insulin-like growth factor-integrated pathways not only promote cell metabolism and proliferation, but also regulate endothelial synthesis and release of vasodilators (e.g., nitric oxide, NO) and opposing vasoconstrictors (e.g., endothelin-1) to maintain vascular homeostasis. d-chiro inositol phosphoglycans (DCI), second messengers of insulin, are increased during preeclampsia and contribute directly to insulin resistance. The dynamic balanced control of vascular function may be altered by excessive DCI that impairs the PI3-kinase-dependent pathway and may result in reduced bioavailability of NO, contributing to elevated peripheral vascular resistance and hypertension. © 2013 Elsevier Ireland Ltd.