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Adenosine triphosphate-binding cassette transporters: key players in maintaining fetal health during pregnancy

Xian-Hong Wang1, Ghazala Saeed2, Ali Afzal3,4

  • 1Department of Internal Medicine and Pediatrics, Medical School, Henan Provincial Research Center of Engineering Technology for Nuclear Protein Medical Detection, Zhengzhou Health College, Zhengzhou, Henan, China.

Frontiers in Endocrinology
|July 31, 2026
PubMed

Insights

ATP binding cassette (ABC) transporters regulate fetal health by controlling substance transport across the placenta. Their dysfunction is linked to pregnancy complications, with potential for pharmacogenomic interventions.

Area of Science:

  • Biochemistry
  • Genetics
  • Obstetrics

Background:

  • ATP binding cassette (ABC) transporters are crucial for maternal-fetal exchange, influencing metabolic homeostasis and chemical exposure.
  • These transporters at the maternal-fetal interface manage xenobiotics, cholesterol, bile acids, steroid hormones, and immune tolerance.

Purpose of the Study:

  • To investigate the mechanisms of ABC transporter dysfunction in various pregnancy disorders.
  • To explore the role of signaling pathways and genetic variations in transporter dysfunction.

Main Methods:

  • Integration of cryo-electron microscopy structures, single-cell transcriptomics, and ex vivo placental pharmacology.
  • Analysis of NRF2-dependent antioxidant signaling and HIF-1α-dependent BCRP suppression.
  • Examination of cytokine-mediated downregulation (TNF-α, IL-1β) and autophagy.

Main Results:

  • Identified mechanisms underlying transporter dysfunction in preeclampsia, cholestasis, preterm birth, gestational diabetes, intrauterine growth restriction, and miscarriage.
  • Highlighted the impact of hypoxia and inflammatory cytokines on transporter activity.
  • Revealed potential pharmacogenomic applications for specific ABC transporter variants.

Conclusions:

  • ABC transporter dysfunction significantly contributes to adverse pregnancy outcomes.
  • Pharmacogenomic strategies, such as ABCG2 genotyping for glyburide and ABCB4 variant profiling, offer promising clinical applications.

Keywords:
ATP-binding cassette transportersfetal healthplacentapreeclampsiapregnancypreterm birth

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