Alterations in maternal-fetal cellular trafficking after fetal surgery.
OBJECTIVE
Bidirectional trafficking of cells between the mother and the fetus is routine in pregnancy and a component of maternal-fetal tolerance. Changes in fetal-to-maternal cellular trafficking have been reported in prenatal complications, but maternal-to-fetal trafficking has never been studied in the context of fetal intervention. We hypothesized that patients undergoing open fetal surgery would have altered maternal-fetal cellular trafficking.


METHODS
Cellular trafficking was analyzed in patients with myelomeningocele (MMC) who underwent open fetal surgical repair (n = 5), patients with MMC who had routine postnatal repair (n = 6), and healthy control healthy patients (n = 9). As an additional control for the fetal operation, trafficking was also analyzed in patients who were delivered by an ex utero intrapartum treatment procedure (n = 6). Microchimerism in maternal and cord blood was determined using quantitative real-time polymerase chain reaction for nonshared alleles.


RESULTS
Maternal-to-fetal trafficking was significantly increased in patients who underwent open fetal surgery for MMC compared with healthy controls, patients who underwent postnatal MMC repair, and patients who underwent ex utero intrapartum treatment. There were no differences in fetal-to-maternal cell trafficking among groups.


CONCLUSIONS
Patients undergoing open fetal surgery for MMC have elevated levels of maternal microchimerism. These results suggest altered trafficking and/or increased proliferation of maternal cells in fetal blood and may have important implications for preterm labor.
Division of Pediatric Surgery and Fetal Treatment Center, Department of Surgery, University of California, San Francisco, CA 94143-0570, USA. payam.saadai@ucsfmedctr.org
Payam
P
Saadai
Tzong-Hae
TH
Lee
Geoanna
G
Bautista
Kelly D
KD
Gonzales
Amar
A
Nijagal
Michael P
MP
Busch
Chong Jai
CJ
Kim
Roberto
R
Romero
Hanmin
H
Lee
Shinjiro
S
Hirose
Larry
L
Rand
Douglas
D
Miniati
Diana L
DL
Farmer
Tippi C
TC
MacKenzie
D000402:Airway Obstruction / Q000151:congenital / Q000601:surgery; D002465:Cell Movement; D046528:Chimerism; D005260:Female; D005312:Fetal Blood / Q000166:cytology; D046128:Fetal Therapies; D005331:Fetomaternal Transfusion; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D020883:Hysterotomy; D007231:Infant, Newborn; D008591:Meningomyelocele / Q000196:embryology* / Q000601:surgery*; D007752:Obstetric Labor, Premature; D036801:Parturition; D011247:Pregnancy; D060888:Real-Time Polymerase Chain Reaction; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012445:Sacrococcygeal Region; D016037:Single-Blind Method; D013724:Teratoma / Q000196:embryology / Q000601:surgery