Abstract
Adipose tissue secretes dozens of biologically active molecules known as adipokines or adipocytokines. Apelin receptor early endogenous ligand (ELABELA, also known as ELA or APELA) is a circulating signaling protein expressed in placental tissue that binds to apelin receptors. The first animal experimental findings suggested that the ELABELA deficiency might be responsible for the pathogenesis of preeclampsia--like symptoms, i.e., hypertension and proteinuria in mice. Exogenous ELABELA supplementation reverted preeclampsia symptoms and normalized fetal birth weight in mice. Several in vitro studies confirmed that ELABELA supplementation could improve trophoblast cell functions such as invasiveness and proliferation capacity. Thus, the ELABELA axis could serve as the target of innovative therapies for gestational complications. Nonetheless, most human studies do not support the thesis that disturbances in ELABELA secretion in early pregnancy are associated with an increased risk of preeclampsia. Therefore, it is unlikely that ELABELA could serve as a novel early marker of preeclampsia in humans. Alterations in the ELABELA secretion have also been discovered among patients with other gestational complications such as GDM and fetal growth restriction.