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    Prediction of Possible Adverse Effects of Gestational Diabetes Mellitus on Maternal and Fetal Glomeruli by Urine and Amniotic Fluid Podocyte Degradation Products
    (Mdpi, 2024) Cagiran, Fatma Tanilir; Mavral, Nihal; Kali, Zercan; Kirici, Pinar
    Objectives: To compare the levels of podocyte damage markers nephrin and podocalyxin in urine samples taken at the time of gestational diabetes mellitus (GDM) diagnosis and at birth. Amniotic fluid podocalyxin (pdx) and nephrin levels were also analyzed to determine whether GDM had an impact on fetal glomeruli. Methods: A total of 50 patients, including 24 patients diagnosed with gestational diabetes and 26 healthy pregnant women whose gestational weeks were matched, were included in the study. GDM was diagnosed with a 75 g oral glucose tolerance test (OGTT). Fresh morning urine samples from patients diagnosed with GDM were collected. The second urine sample was collected with the help of a catheter during birth. Amniotic fluid samples were taken from patients who gave birth by cesarean section. The urinary podocalyxin and nephrin levels were measured via the quantitative sandwich enzyme immunoassay. Albumin-creatinine ratio (uACR) was also calculated in urine samples. Results: Urinary nephrin and pdx levels on the day of GDM diagnosis were similar in the GDM and control groups. Microalbuminuria was detected in only one patient from each group at the time of GDM diagnosis. In the urine samples taken from the time of birth, pdx and nephrin levels of the GDM group were significantly higher than the control group (p < 0.001 for each). While microalbuminuria was detected in five patients (20.8%) at the time of birth in the GDM group, it was detected in only two patients (7.7%) in the control group. In the GDM group, a significant increase was detected between the urine pdx and nephrin levels measured at diagnosis and those measured at birth. In the control group, measurements at baseline and at birth were similar. There was no significant difference between the GDM and control groups in terms of amniotic fluid pdx and nephrin levels. A positive and significant correlation was detected between urinary pdx, nephrin, SBP, and uACR. Conclusions: While GDM triggers podocyte damage in maternal glomeruli, it does not cause significant change in fetal glomeruli.
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    PTX3 as a key modulator of functional ovarian response in PCOS: evaluation alongside TSG-6 and ITI
    (Bmc, 2025) Kali, Zercan; Karabulut, Umran; Memur, Tuba; Cagiran, Fatma Tanilir; Mavral, Nihal; Kirici, Pinar
    ObjectiveTo investigate the relationship between follicular fluid pentraxin 3 (PTX-3) levels and ovarian response, embryo quality, and insulin resistance (IR) in patients with polycystic ovary syndrome (PCOS) undergoing IVF/ICSI.MethodsA total of 130 women were enrolled and categorized into three groups: lean PCOS (n = 43), overweight PCOS (n = 42), and unexplained infertility (UEI, n = 45). Patients with endocrine disorders, chronic inflammatory diseases, or recent hormonal therapy (within 3 months) were excluded. Follicular fluid (FF) and serum PTX-3 levels were measured using ELISA. Subgroup analyses were performed according to BMI and HOMA-IR status. Correlations between FF PTX-3 and clinical, hormonal, and embryological parameters were assessed. ROC curve analysis and multivariate linear regression were used to evaluate the diagnostic and predictive value of FF biomarkers for follicular output rate (FORT).ResultsFF PTX-3 levels were significantly higher in both lean (23.31 +/- 1.33 ng/mL) and overweight PCOS patients (12.54 +/- 1.05 ng/mL) compared to UEI controls (7.01 +/- 0.54 ng/mL; p = 0.029). Notably, PTX-3 remained elevated in lean PCOS despite a lower BMI, supporting its role in intrinsic ovarian inflammation. FF PTX-3 showed significant positive correlations with total testosterone (r = 0.580), AFC (r = 0.598), and oocyte count (r = 0.532), but was inversely associated with high-quality embryo number (r = - 0.482), 2PN count (r = - 0.312), and FORT (r = - 0.418). ROC analysis demonstrated moderate diagnostic performance of PTX-3 for predicting suboptimal FORT (AUC = 0.77; cut-off: 20.4 ng/mL). In multivariate analysis, FF PTX-3 (beta = - 0.65, p = 0.001), TSG-6 (beta = - 0.42), and ITI (beta = - 0.37) were independent negative predictors of FORT, while AFC was positively associated.ConclusionElevated follicular PTX-3 levels are linked to hyperandrogenism and ovarian reserve in PCOS, but may impair embryo quality and functional follicular response. PTX-3 may serve as a potential biomarker of ovarian inflammation and compromised oocyte competence, independent of BMI or systemic insulin resistance.