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Updated: Mar 21, 2026

Mapping Dysfunctional Protein-Protein Interactions in Disease
Published on: October 24, 2025
PAPP-A and the IGF system
Philippe Monget1, Claus Oxvig2
1Institut national de la recherche agronomique, physiologie de la reproduction et des comportements, 37380 Nouzilly, France.
Insights
Pregnancy-associated plasma protein-A (PAPP-A) is a metalloproteinase that regulates insulin-like growth factor (IGF) bioavailability by cleaving IGF binding proteins. Targeting PAPP-A offers a strategy to modulate IGF signaling in various tissues.
Area of Science:
- Biochemistry
- Molecular Biology
- Endocrinology
Background:
- Pregnancy-associated plasma protein-A (PAPP-A) is a metalloproteinase initially identified as a placental protein.
- PAPP-A is widely expressed and cleaves insulin-like growth factor binding proteins (IGFBPs), specifically IGFBP-2, -4, and -5.
- It functions locally as a growth-promoting enzyme by releasing bioactive IGF near its receptor.
Purpose of the Study:
- To elucidate the mechanisms regulating PAPP-A activity and its role in IGF bioavailability.
- To explore PAPP-A as a potential therapeutic target for modulating IGF signaling.
Main Methods:
- Investigated PAPP-A's enzymatic activity and substrate specificity (IGFBP-2, -4, -5).
- Examined PAPP-A's interaction with glycosaminoglycans and inhibitors like pro-MBP and stanniocalcin-2 (STC2).
- Utilized in vivo experiments to assess the role of IGFBP-4 as a key PAPP-A substrate.
Main Results:
- PAPP-A specifically cleaves IGFBP-2, -4, and -5, influencing IGF bioavailability.
- Pro-MBP and STC2 inhibit PAPP-A activity through complex formation.
- IGFBP-4 is identified as the primary substrate for PAPP-A in regulating IGF bioavailability.
- Regulation mechanisms include transcriptional control, competition with other IGFBPs, and proteolytic inhibition.
Conclusions:
- PAPP-A plays a crucial role in modulating IGF bioavailability through specific IGFBP cleavage.
- The interaction between PAPP-A and IGFBP-4 is key for regulating IGF signaling.
- PAPP-A represents a viable therapeutic target for inhibiting IGF signaling driven by elevated PAPP-A activity.
Abstract:
Firstly discovered as a placental protein present abundantly in the circulation of pregnant women, pregnancy-associated plasma protein-A (PAPP-A) is widely expressed in multiple tissues. PAPP-A is a metalloproteinase that is able to specifically cleave three insulin-like growth factor binding proteins (IGFBPs): IGFBP-2, -4 and -5. PAPP-A binds tightly to glycosaminoglycans present on the surface of cells, thus functioning within tissues as a growth-promoting enzyme, releasing bioactive IGF in close proximity to the IGF receptor. Pro-MBP and stanniocalcin-2 (STC2) appear to be the main inhibitors of PAPP-A activity, by forming a covalent complex with the protease. According to in vivo experiments, IGFBP-4 is believed to be the main PAPP-A substrate to regulate IGF bioavailability. The regulation of PAPP-A includes transcriptional control of its gene, competing reactions with other IGFBPs potentially sequestering IGF from IGFBP-4 and hence antagonizing PAPP-A-mediated IGF activation, and proteolytic inhibition of PAPP-A. Finally, PAPP-A may serve as a therapeutic target to indirectly inhibit IGF signalling in tissues where this is driven by increased PAPP-A activity. By taking advantage of the intricate interaction between PAPP-A and IGFBP-4, highly specific and selective inhibition of PAPP-A is possible.
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