Elabela in pregnancy: Physiology, associated disorders and translational perspectives (Review)

Elabela (ELA) has emerged as a critical regulator of reproductive success, signaling through the cognate apelin receptor (APJ) (encoded by the APLNR gene) to orchestrate embryonic development and placental function. The present narrative review summarizes evidence spanning from molecular mechanisms to clinical phenotypes, evaluating the role of ELA in both physiological pregnancy and major complications, including preeclampsia, fetal growth restriction and gestational diabetes, as well as emerging associations with placental disorders and early pregnancy loss. The present review addresses three key challenges: i) The receptor paradox in APJ‑low or APJ‑negative contexts; ii) inconsistencies among clinical ELA measurements; and iii) the need to distinguish direct ELA evidence from inference drawn from apelin studies. Current findings position ELA as a candidate biomarker and experimental therapeutic target; however, its clinical utility remains unproven due to pre‑analytical variability across sample types (plasma vs. serum), inconsistencies between detection platforms (ELISA vs. immunohistochemistry), and biological heterogeneity across specific disease subtypes (such as preeclampsia and heart failure). Future work should focus on defining receptor‑ and isoform‑specific signaling, standardizing ELA measurement and establishing pharmacokinetics, dose‑response relationships, delivery strategies and maternal‑fetal safety.