title: Twin-to-twin transfusion syndrome: an antiangiogenic state?
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  We propose that an antiangiogenic state may be present in some cases of TTTS.
authors.affiliation: Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA.
authors.forename: Juan Pedro
authors.initials: JP
authors.lastname: Kusanovic
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.forename: Jimmy
authors.initials: J
authors.lastname: Espinoza
authors.forename: Jyh Kae
authors.initials: JK
authors.lastname: Nien
authors.forename: Chong Jai
authors.initials: CJ
authors.lastname: Kim
authors.forename: Pooja
authors.initials: P
authors.lastname: Mittal
authors.forename: Sam
authors.initials: S
authors.lastname: Edwin
authors.forename: Offer
authors.initials: O
authors.lastname: Erez
authors.forename: Francesca
authors.initials: F
authors.lastname: Gotsch
authors.forename: Shali
authors.initials: S
authors.lastname: Mazaki-Tovi
authors.forename: Nandor G
authors.initials: NG
authors.lastname: Than
authors.forename: Eleazar
authors.initials: E
authors.lastname: Soto
authors.forename: Natalia
authors.initials: N
authors.lastname: Camacho
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gomez
authors.forename: Ruben
authors.initials: R
authors.lastname: Quintero
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Hassan
mesh_terms: D000328:Adult; D015703:Antigens, CD / Q000097:blood*; D016022:Case-Control Studies; D000071063:Endoglin; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005330:Fetofetal Transfusion / Q000097:blood*; D006801:Humans; D018919:Neovascularization, Physiologic; D000072483:Placenta Growth Factor; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood*; D011956:Receptors, Cell Surface / Q000097:blood*; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*
chemical_list: D015703:Antigens, CD; C064206:ENG protein, human; D000071063:Endoglin; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D011956:Receptors, Cell Surface; D000072483:Placenta Growth Factor; D040281:Vascular Endothelial Growth Factor Receptor-1