Exosomes and their possible applications in the management of gestational diabetes

Gestational diabetes mellitus (GDM) is thought to be the most common metabolic gestational complication. Its prevalence has been continuously increasing in recent decades along with the rising epidemic of obesity in modern societies. GDM is associated with an increased risk of fetal growth abnormalities, birth traumas, and several neonatal complications. Widely available screening tools, fasting glucose measurements, combined with oral glucose tolerance test results, contribute to the reduction of the risk of those complications. Nevertheless, we are still looking for novel reliable early markers of GDM. It has been established that high 1^st-trimester exosome concentrations could predispose the development of GDM in later pregnancy. Exosomes can be easily isolated from various tissues and body fluids in pregnant patients. Due to this, extracellular vesicle concentration assessment appears as a new promising tool in the prediction of GDM at the preclinical stage of the disease. Furthermore, it has been found that women already diagnosed with GDM have significantly higher exosome concentrations compared with healthy individuals. These findings could help to elucidate the molecular pathogenesis of GDM. Exosomes are loaded with various molecules especially proteins, lipids, mRNAs, and microRNAs. Altered expression of numerous microRNAs and enzymes such as dipeptidyl peptidase-IV in exosomes isolated from patients with GDM may suggest their direct contribution to the mechanisms of glucose intolerance. This knowledge could be used in the development of new therapeutic strategies in patients with GDM. Nevertheless, it should be emphasized that these are only preliminary results that require further investigations.

Running title: Exosomes in gestational diabetes