Carbohydrate and fatty acid perturbations in the amniotic fluid of the recipient twin of pregnancies complicated by twin-twin transfusion syndrome in relation to treatment and fetal cardiovascular risk

Abstract

Changes in carbohydrate and fatty acid metabolic profiles are noted in recipients with cardiac dysfunction, and further changes are noted after treatment. Validation and investigation may identify targets for potential pharmacological treatment.

Twin‐twin transfusion syndrome is associated with alterations in the metabolic profile of maternal plasma in early gestation: a pilot study

“…Dunn and colleagues have previously reported on higher levels of fatty acids and lower levels of carbohydrates in the amniotic fluid of post‐FLC; moreover, they suggested that metabolic disorders existed in TTTS, and that the changes were associated with fetal or placental energy metabolism and the echocardiographic measures of recipient cardiac function 14 …”

“…Methionine, a sulfur‐containing amino acid, is a major component in protein synthesis, 36 and the blockade of methionine metabolism in endothelial cells leads to endothelial damage or inflammation 41 . In the metabolome of amniotic fluid, higher levels of carbohydrates in TTTS pregnancies before fetoscopic laser coagulation treatment, as well as higher levels of fatty acids at posttreatment, 14 indicate that this treatment can partially correct metabolic changes. These studies suggest that amino acids are associated with placentation and angiogenesis.…”

“…Metabolomics is a powerful tool for investigating the final downstream products of genotype and environmental interactions, and this technique may be employed to investigate the complex interactions between specific metabolites and other factors, as well as the relationship between metabolites and disease 13 . In a comparison of pre‐ and post‐laser coagulation, Dunn and colleagues observed perturbations in carbohydrate and fatty acid levels in the fetal “recipient” amniotic fluid of monochorionic pregnancies that were complicated by TTTS, 14 thus indicating that this pathological process may be associated with aberrant metabolism. Moreover, a profound change in the first‐trimester metabolite profile of the maternal plasma has been noted in women who subsequently developed early‐onset preeclampsia, 15 thus indicating that metabolic changes in the first trimester may be an indicator of the occurrence or development of diseases.…”

Comprehensive Metabolomic Profiling of Cord Blood and Placental Tissue in Surviving Monochorionic Twins Complicated by Twin-Twin Transfusion Syndrome With or Without Fetoscopic Laser Coagulation Surgery: A Retrospective Cohort Study

“…In our analysis of maternal plasma, our laboratory previously found that TTTS-complicated pregnant women had an altered metabolome before 16 weeks of gestation, and these alterations included changes in fatty acids, Krebs cycle intermediates, and amino acids ( Yang et al, 2021 ). Correspondingly, it was previously implied that the altered carbohydrate and fatty acid profile in the amniotic fluid of the TTTS-complicated recipient co-twin has a close association with FLC treatment, fetal cardiovascular dysfunction, and anomalies ( Dunn et al, 2016 ). However, to date, the metabolomics of samples which are more relevant to the fetal circulation in TTTS with or without FLC surgery has rarely been reported.…”

Twin-Twin Transfusion Syndrome

“…(Blickstein 1990) 1. Changes in carbohydrate and fatty acid metabolic profiles in the amniotic fluid are noted in recipient sacs of TTTS pregnancies with cardiac dysfunction, and further changes are noted after treatment (Dunn et al 2016). 2.…”