American Journal of Obstetrics & Gynecology
Volume 198, Issue 4 , Pages 382.e1-382.e8, April 2008

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.

  • Juan Pedro Kusanovic, MD

      Affiliations

    • Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, MI
    • Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
    • ,
  • Roberto Romero, MD

      Affiliations

    • Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, MI
    • Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI
    • Corresponding Author InformationReprints: Roberto Romero, MD, Perinatology Research Branch, NICHD, NIH, DHHS, Wayne State University/Hutzel Women’s Hospital, 3990 John R, Box 4, Detroit, MI 48201.
    • ,
  • Jimmy Espinoza, MD

      Affiliations

    • Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, MI
    • Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
    • ,
  • Jyh Kae Nien, MD

      Affiliations

    • Center for Perinatal Diagnosis and Research (CEDIP), Sotero del Rio Hospital, P. Universidad Catolica de Chile, Puente Alto, Chile
    • ,
  • Chong Jai Kim, MD

      Affiliations

    • Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, MI
    • Department of Pathology, Wayne State University, Detroit, MI
    • ,
  • Pooja Mittal, MD

      Affiliations

    • Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, MI
    • Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
    • ,
  • Sam Edwin, PhD

      Affiliations

    • Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, MI
    • ,
  • Offer Erez, MD

      Affiliations

    • Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, MI
    • ,
  • Francesca Gotsch, MD

      Affiliations

    • Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, MI
    • ,
  • Shali Mazaki-Tovi, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
    • ,
  • Nandor G. Than, MD, PhD

      Affiliations

    • Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, MI
    • ,
  • Eleazar Soto, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
    • ,
  • Natalia Camacho, MD

      Affiliations

    • Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, MI
    • Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
    • ,
  • Ricardo Gomez, MD

      Affiliations

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

      Affiliations

    • Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL.
    • ,
  • Sonia S. Hassan, MD

      Affiliations

    • Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, MI
    • Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI

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

 

 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

American Journal of Obstetrics & Gynecology
Volume 198, Issue 4 , Pages 382.e1-382.e8, April 2008