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- W3048368459 abstract "ObjectiveAlthough a chronic blood flow imbalance between the donor and the recipient through placental vascular anastomoses is the accepted pathophysiology of twin-to-twin transfusion syndrome (TTTS), there is compelling evidence that this explanation cannot account for the spectrum of disease. This study was undertaken to test the hypothesis of whether an anti-angiogenic state is present in TTTS.Study designA case-control study was conducted including patients with monochorionic-diamniotic (MoDi) twin pregnancies at 16-26 weeks of gestation with (n=16) and without (n=53) TTTS. Maternal plasma concentrations of angiogenic and anti-angiogenic factors [placental growth factor (PlGF), soluble Vascular Endothelial Growth Factor Receptor-1 (sVEGFR-1) and soluble Endoglin (s-Eng)] were determined with specific and sensitive immunoassays. Non-parametric tests were used for statistical analyses. A p-value <0.05 was considered statistically significant.ResultsPatients with TTTS had: 1) a significantly higher median plasma concentration of s-Eng [14.8 ng/ml (interquartile range (IQR): 9.6-33.5) vs. 7.8 ng/ml (IQR: 6.7-9.5); p<0.001] and sVEGFR-1 [6383.1 pg/ml (IQR: 4874.5-18047.8) vs. 3220.1 pg/ml (IQR: 2310.1-5172.1); p<0.001]; and 2) a significantly lower median maternal plasma concentration of PlGF [115.5 pg/ml (IQR: 51.9-357.4) vs. 359.3 pg/ml (IQR: 224.6-693.9); p=0.002] than those without TTTS. Among twins without TTTS who had a birthweight discordancy >20%, the smaller twin had a significantly lower median umbilical cord plasma concentration of PlGF and s-Eng than the larger twin.Conclusion1) Patients with TTTS had significantly higher median maternal plasma concentrations of s-Eng and sVGFR-1 (both anti-angiogenic factors), and a significantly lower median maternal plasma concentration of PlGF (an angiogenic factor) than those without TTTS; 2) We propose that an anti-angiogenic state is present in TTTS and may explain some of the pathophysiology of the syndrome (i.e., mirror syndrome, SGA, etc.). ObjectiveAlthough a chronic blood flow imbalance between the donor and the recipient through placental vascular anastomoses is the accepted pathophysiology of twin-to-twin transfusion syndrome (TTTS), there is compelling evidence that this explanation cannot account for the spectrum of disease. This study was undertaken to test the hypothesis of whether an anti-angiogenic state is present in TTTS. Although a chronic blood flow imbalance between the donor and the recipient through placental vascular anastomoses is the accepted pathophysiology of twin-to-twin transfusion syndrome (TTTS), there is compelling evidence that this explanation cannot account for the spectrum of disease. This study was undertaken to test the hypothesis of whether an anti-angiogenic state is present in TTTS. Study designA case-control study was conducted including patients with monochorionic-diamniotic (MoDi) twin pregnancies at 16-26 weeks of gestation with (n=16) and without (n=53) TTTS. Maternal plasma concentrations of angiogenic and anti-angiogenic factors [placental growth factor (PlGF), soluble Vascular Endothelial Growth Factor Receptor-1 (sVEGFR-1) and soluble Endoglin (s-Eng)] were determined with specific and sensitive immunoassays. Non-parametric tests were used for statistical analyses. A p-value <0.05 was considered statistically significant. A case-control study was conducted including patients with monochorionic-diamniotic (MoDi) twin pregnancies at 16-26 weeks of gestation with (n=16) and without (n=53) TTTS. Maternal plasma concentrations of angiogenic and anti-angiogenic factors [placental growth factor (PlGF), soluble Vascular Endothelial Growth Factor Receptor-1 (sVEGFR-1) and soluble Endoglin (s-Eng)] were determined with specific and sensitive immunoassays. Non-parametric tests were used for statistical analyses. A p-value <0.05 was considered statistically significant. ResultsPatients with TTTS had: 1) a significantly higher median plasma concentration of s-Eng [14.8 ng/ml (interquartile range (IQR): 9.6-33.5) vs. 7.8 ng/ml (IQR: 6.7-9.5); p<0.001] and sVEGFR-1 [6383.1 pg/ml (IQR: 4874.5-18047.8) vs. 3220.1 pg/ml (IQR: 2310.1-5172.1); p<0.001]; and 2) a significantly lower median maternal plasma concentration of PlGF [115.5 pg/ml (IQR: 51.9-357.4) vs. 359.3 pg/ml (IQR: 224.6-693.9); p=0.002] than those without TTTS. Among twins without TTTS who had a birthweight discordancy >20%, the smaller twin had a significantly lower median umbilical cord plasma concentration of PlGF and s-Eng than the larger twin. Patients with TTTS had: 1) a significantly higher median plasma concentration of s-Eng [14.8 ng/ml (interquartile range (IQR): 9.6-33.5) vs. 7.8 ng/ml (IQR: 6.7-9.5); p<0.001] and sVEGFR-1 [6383.1 pg/ml (IQR: 4874.5-18047.8) vs. 3220.1 pg/ml (IQR: 2310.1-5172.1); p<0.001]; and 2) a significantly lower median maternal plasma concentration of PlGF [115.5 pg/ml (IQR: 51.9-357.4) vs. 359.3 pg/ml (IQR: 224.6-693.9); p=0.002] than those without TTTS. Among twins without TTTS who had a birthweight discordancy >20%, the smaller twin had a significantly lower median umbilical cord plasma concentration of PlGF and s-Eng than the larger twin. Conclusion1) Patients with TTTS had significantly higher median maternal plasma concentrations of s-Eng and sVGFR-1 (both anti-angiogenic factors), and a significantly lower median maternal plasma concentration of PlGF (an angiogenic factor) than those without TTTS; 2) We propose that an anti-angiogenic state is present in TTTS and may explain some of the pathophysiology of the syndrome (i.e., mirror syndrome, SGA, etc.). 1) Patients with TTTS had significantly higher median maternal plasma concentrations of s-Eng and sVGFR-1 (both anti-angiogenic factors), and a significantly lower median maternal plasma concentration of PlGF (an angiogenic factor) than those without TTTS; 2) We propose that an anti-angiogenic state is present in TTTS and may explain some of the pathophysiology of the syndrome (i.e., mirror syndrome, SGA, etc.)." @default.
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- W3048368459 date "2007-12-01" @default.
- W3048368459 modified "2023-09-23" @default.
- W3048368459 title "60: Twin-to-twin transfusion syndrome: An anti-angiogenic state" @default.
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