The impact of laser surgery on angiogenic and anti-angiogenic factors in twin-twin transfusion syndrome: a prospective study.
OBJECTIVE
To examine the effect of laser surgery on angiogenic and anti-angiogenic factors in patients with twin-twin transfusion syndrome (TTTS).


METHODS
Cases of TTTS and uncomplicated monochorionic diamniotic twin pregnancies between 16 and 26 weeks' gestation were prospectively enrolled into the study. Maternal blood samples were obtained to measure angiogenic factors (vascular endothelial growth factor-A [VEGF], placental-derived growth factor [PlGF], and endothelin) and anti-angiogenic factors (soluble fms-like tyrosine kinase (sFlt-1), soluble endoglin (sEng), and sFlt-1/PlGF ratio). For cases, these factors were measured at visit 1 (pre-operatively), visit 2 (postoperative day one), and visit 3 (at least 3 weeks after surgery). In controls, the factors were measured at visit 1 (enrollment) and visit 2 (at least 3 weeks later). Levels of angiogenic and anti-angiogenic factors between cases and controls were compared.


RESULTS
At enrollment, the TTTS cases demonstrated an anti-angiogenic state with significantly higher sFlt-1, sEng, sFlt-1/PlGF ratio, and lower PlGF. Laser surgery, comparing visit 1-3, had a partial corrective effect on TTTS cases. sFlt-1 significantly decreased several weeks after surgery. The other factors (PlGF, endothelin, sFlt-1, sEng, and sFlt-1/PlGF ratio) were not statistically significantly different by visit 3.


CONCLUSIONS
Laser surgery partially corrected the angiogenic profile in patients with TTTS.
a Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA.
Andrew H
AH
Chon
b Department of Maternal-Fetal Medicine, San Gabriel Valley Perinatal Medical Group , Monterey Park , CA , USA.
Emiliano R
ER
Chavira
c Department of Preventive Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA.
Melissa L
ML
Wilson
c Department of Preventive Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA.|d Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology , Keck School of Medicine, University of Southern California , Los Angeles , CA , USA.
Sue A
SA
Ingles
a Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA.
Arlyn
A
Llanes
a Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA.
Ramen H
RH
Chmait
D000328:Adult; D016022:Case-Control Studies; D000071063:Endoglin / Q000097:blood*; D005260:Female; D046128:Fetal Therapies; D005330:Fetofetal Transfusion / Q000097:blood* / Q000601:surgery; D006801:Humans; D053685:Laser Therapy; D018919:Neovascularization, Physiologic; D000072483:Placenta Growth Factor / Q000097:blood*; D011247:Pregnancy; D011446:Prospective Studies; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*; D055815:Young Adult
D000071063:Endoglin; D000072483:Placenta Growth Factor; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1
Angiogenesis; VEGF; twin–twin transfusion syndrome