Twin-to-twin transfusion syndrome: an antiangiogenic state?
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.
Kusanovic
Juan Pedro
JP
Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA.
Romero
Roberto
R
Espinoza
Jimmy
J
Nien
Jyh Kae
JK
Kim
Chong Jai
CJ
Mittal
Pooja
P
Edwin
Sam
S
Erez
Offer
O
Gotsch
Francesca
F
Mazaki-Tovi
Shali
S
Than
Nandor G
NG
Soto
Eleazar
E
Camacho
Natalia
N
Gomez
Ricardo
R
Quintero
Ruben
R
Hassan
Sonia S
SS
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*
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