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The endothelial nitric oxide synthase (<jats:italic>eNOS<\/jats:italic>) gene and nitric oxide (NO) levels has been reported to be associated with PE predisposition in various populations. Therefore, present study was designed to investigate the role of NO levels and<jats:italic>eNOS<\/jats:italic>gene variants in preeclamptic women in Pakistan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 600 women were evaluated, 188 of PE with mild features, 112 of PE with severe features and 300 normotensive pregnant women. NO levels were detected by Greiss reaction method and genotyping following sequencing was conducted for<jats:italic>eNOS<\/jats:italic>gene variants. Further<jats:italic>insilico<\/jats:italic>studies were performed to get insights into the structural and functional impact of identifies mutation on eNOS protein as well as on protein regulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Reduced concentrations of NO were reported in all PE groups (p\u2009&lt;\u20090.05) as compared to controls. The frequency of c.894\u00a0T (p.298Asp) and g.-786C alleles were significantly associated with PE. In addition, novel homozygous variant g.2051G\u2009&gt;\u2009A was also significantly associated with PE when compared to normotensive women. Dynamic simulation studies revealed that Glu298Asp mutation destabilize the protein molecule and decrease the overall stability of eNOS protein. Molecular docking analysis of mutant promoter with transcription factors STAT3 and STAT6 proposed changes in protein regulation upon these reported mutations in upstream region of the gene.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Considering the results of current study, the functional alterations induced by these variants may influence the bioavailability of NO and represents a genetic risk factor for increased susceptibility to PE. However, large studies or meta-analysis are necessary to validate these findings.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12978-021-01213-9","type":"journal-article","created":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T19:02:46Z","timestamp":1627498966000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Association of endothelial nitric oxide synthase gene variants with preeclampsia"],"prefix":"10.1186","volume":"18","author":[{"given":"Ghazala","family":"Shaheen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarwat","family":"Jahan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nousheen","family":"Bibi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asmat","family":"Ullah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rani","family":"Faryal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Almajwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayyaba","family":"Afsar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dara","family":"Al-disi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Abulmeaty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz Abdullah","family":"Al Khuraif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Arshad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhail","family":"Razak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,28]]},"reference":[{"issue":"3","key":"1213_CR1","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1159\/000358831","volume":"77","author":"Y Chen","year":"2014","unstructured":"Chen Y, Wang D, Zhou M, Chen X, Chen J. 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