Twin-to-twin transfusion syndrome: an antiangiogenic state?

Presented at the 28th Annual Meeting of the Society for Maternal–Fetal Medicine, Dallas, TX, Jan. 28-Feb. 2, 2008.

Received 2 December 2007; received in revised form 14 January 2008; accepted 6 February 2008.

Objective

An imbalanced chronic blood flow between the donor and recipient twin through placental vascular anastomoses is the accepted pathophysiology of twin-to-twin transfusion syndrome (TTTS). Vascular endothelial growth factor receptor-1 (VEGFR-1) mRNA is overexpressed only in the syncytiotrophoblast of the donor twin in some cases of TTTS. This study was conducted to determine maternal plasma concentrations of placental growth factor (PlGF), soluble VEGFR-1, and soluble endoglin (s-Eng) in monochorionic-diamniotic pregnancies with and without TTTS.

Study Design

This case-control study included monochorionic-diamniotic pregnancies between 16-26 weeks with and without TTTS. Maternal plasma concentrations of PlGF, sVEGFR-1, and s-Eng were determined with ELISA. A P value < .05 was considered statistically significant.

Results

Patients with TTTS had higher median plasma concentrations of s-Eng (14.8 ng/mL vs 7.8 ng/mL; P < .001) and sVEGFR-1 (6383.1 pg/mL vs 3220.1 pg/mL; P < .001]; and lower median plasma concentrations of PlGF (115.5 pg/mL vs 359.3 pg/mL; P = .002) than those without TTTS.

Conclusion

We propose that an antiangiogenic state may be present in some cases of TTTS.

Key words: angiogenesis, angiogenic factors, birthweight discordancy, endoglin, monochorionic, placental growth factor, PlGF, sFlt1, sVEGFR-1, TTTS, twin pregnancy

a Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, MI

b Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI

c Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI

d Department of Pathology, Wayne State University, Detroit, MI

e Center for Perinatal Diagnosis and Research (CEDIP), Sotero del Rio Hospital, P. Universidad Catolica de Chile, Puente Alto, Chile

f Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL.

Reprints: Roberto Romero, MD, Perinatology Research Branch, NICHD, NIH, DHHS, Wayne State University/Hutzel Women’s Hospital, 3990 John R, Box 4, Detroit, MI 48201.

This research was supported in part by the Intramural Research Program of the National Institute of Child Health and Human Development, NIH, DHHS.

Cite this article as: Kusanovic JP, Romero R, Espinoza J, et al. Twin-to-twin transfusion syndrome: an antiangiogenic state? Am J Obstet Gynecol 2008;198:382.e1-382.e8.

PII: S0002-9378(08)00152-X

doi:10.1016/j.ajog.2008.02.016

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