Plasma Zonulin Levels as a Non-Invasive Biomarker of Intestinal Permeability in Women with Gestational Diabetes Mellitus

Abstract

Objective: We aimed to compare the levels of plasma zonulin, a non-invasive biomarker of increased intestinal permeability, between pregnant subjects, with and without gestational diabetes mellitus (GDM), at 24–28 gestational weeks. The eighty-five consecutive pregnant subjects that presented to our hospital’s obstetrics outpatient clinic and were diagnosed with GDM, for the first time by an oral glucose tolerance test (OGTT), formed the GDM group; 90 consecutive subjects that were not diagnosed with GDM by OGTT, formed the control group. The diagnosis of GDM was made by an OGTT performed between the 24th and 28th weeks of gestation, and in compliance with the American Diabetes Association (ADA) criteria. Plasma zonulin levels were measured by the enzyme-linked immunosorbent assay (ELISA) methods. The Plasma zonulin level was significantly higher in the GDM group than the control group (p < 0.001). A correlation analysis showed that plasma zonulin level was positively correlated to body mass index (BMI), creatinine, fasting plasma glucose, baseline, first hour, and two hours glucose levels and the OGTT, hemoglobin A1C (HbA1C), homeostatic model assessment for insulin resistance (HOMA-IR), and alanine aminotransferase (ALT) levels. Our findings suggest that zonulin may be a non-invasive biomarker involved in the pathogenesis of GDM. Further large-scale studies are needed on this subject.

Could serum zonulin be an intestinal permeability marker in diabetes kidney disease?

“…In newly-diagnosed [ 20 ] and longstanding T2DM patients [ 26 ], zonulin levels were also elevated, when compared to healthy subjects. The zonulin increment may indicates a higher intestinal permeability in T2DM, since previous evidence describes zonulin as intestinal permeability marker in diabetes [ 29 ].…”

Gut Microbiota and Gestational Diabetes Mellitus: A Review of Host-Gut Microbiota Interactions and Their Therapeutic Potential

“…Zonulin is a physiological modulator of tight junctions and a potential biomarker to predict gut epithelial permeability. Recent evidence has shown that plasma zonulin levels were significantly elevated in women with GDM during their first trimester (Mokkala et al, 2017b;Bawah et al, 2019;Demir et al, 2019). A study in 2019 showed that obese pregnant women with elevated plasma zonulin levels had 109 times more risk of developing GDM compared to women with normal BMI (Bawah et al, 2019).…”

Markers of gastrointestinal permeability and dysbiosis in premenopausal women with PCOS: a case–control study

“…10 11 Studies have shown that zonulin levels are increased in obesity, type 2 diabetes, gestational diabetes mellitus and positively correlated with insulin resistance and levels of inflammatory markers such as interleukin-6. [12][13][14] Fatty acid-binding protein 2 (FABP2), also known as intestinal (I)-FABP, is an intracellular protein involved in the uptake and metabolism of fatty acids, and it is predominantly expressed in small intestinal enterocytes. FABP2 is released into the circulation following small intestinal mucosal injury, and elevated levels indicate intestinal epithelial cell damage.…”