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PAPP-A is a large zinc binding protein, which acts as a metalloprotease and specifically cleaves IGFBP-4 and IGFBP-5, resulting in release of bound IGF. PAPP-A can also act as a regulator of IGF bioactivity in a number of biological systems, including the human ovary and cardiovascular systems. It was shown that PAPP-A levels are elevated in patients with unstable angina or acute myocardial infarction. Furthermore, PAPP-A is believed to be involved in local proliferative processes such as wound healing and bone remodeling. Moreover, PAPP-A is produced in high concentrations during pregnancy and is released into the maternal circulation. In placenta, PAPP-A is expressed in X cells in septa and anchoring villi, and in syncytiotrophoblasts in the chorionic villi.
PAPP-A is present in serum and placenta during pregnancy; with levels increasing throughout pregnancy. Low levels of PAPP-A are associated with a number of fetal chromosomal abnormalities, as well as pre-eclampsia and stillbirth.PAPP-A levels may be a potentially highly specific marker for heart disease.