Fetal metabolic adaptations to cardiovascular stress in twin-twin transfusion syndrome

Parchem, Jacqueline G.; Fan, Huihui; Mann, Lovepreet K.; Won, Jong Jin; Gross, Steven S.; Zhao, Zhongming; Taegtmeyer, Heinrich; Papanna, Ramesha

doi:10.1016/j.isci.2023.107424

iScience

2023

DOI: 10.1016/j.isci.2023.107424

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Fetal metabolic adaptations to cardiovascular stress in twin-twin transfusion syndrome

Jacqueline G. Parchem¹,

Huihui Fan²,

Lovepreet K. Mann³

et al.

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2024

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Cited by 2 publications

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“…Metabolomics is the study of small intermediates and/or products of cellular metabolism that can acutely reflect the fetal status in various disease states (Chen et al, 2023). Previous work in the field of metabolomics has shown that TTTS and the resultant cardiac strain in recipient twins leads to alterations in fatty acid, glucose, and steroid hormone metabolism (Parchem et al, 2023). What is not known, however, is what the impact of surgery itself is upon the fetus, especially in fetuses with cardiac strain.…”

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confidence: 99%

Acute Fetal Metabolomic Changes in Twins Undergoing Fetoscopic Surgery for Twin-Twin Transfusion Syndrome

Forde,

Martin,

Watanabe-Chailland

et al. 2024

Twin Res Hum Genet

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Fetuses undergo major surgical stress as well as fluid shifts secondary to both twin-twin transfusion (TTTS) as well as the fetoscopic surgery for treatment of TTTS. While the pathophysiology of TTTS is understood, the acute metabolic changes that fetuses experience from fetoscopic surgery are not. We sought to evaluate the changes in recipient metabolomic profile secondary to TTTS surgery. Amniotic fluid was collected at the beginning and end of four TTTS surgical cases performed from 12/2022−2/2023. Samples were immediately processed and evaluated via NMR-based Metabolomics Facility protocol. In univariate analysis, 12 metabolites (glucose, lactate, and 10 key amino acids) showed statistically significant changes between the beginning and end of the surgery. Among these, 11 metabolites decreased at the end, while only lactate increased. Supervised oPLS-DA modeling revealed pyruvate and lactate as the two metabolites most impact on the variance between cases, and that 40% of metabolomic changes could be attributed directly to the timing that the sample was taken (i.e., if pre- or postoperatively). These results indicate significant metabolic changes in the recipient twin during fetoscopic surgery for TTTS. These findings of decreased glucose, increased lactate, and decreased amnio acids would indicate increased catabolism during surgery. This study raises questions regarding optimal maternal and fetal nutrition during surgery and if nutritional status could be optimized to further improve twin survival during fetoscopic surgery.

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mentioning

confidence: 99%

Acute Fetal Metabolomic Changes in Twins Undergoing Fetoscopic Surgery for Twin-Twin Transfusion Syndrome

Forde,

Martin,

Watanabe-Chailland

et al. 2024

Twin Res Hum Genet

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Suture Characteristics after Exposure to Amniotic Fluid from an in vitro Model of Fetal Surgery

Buskmiller,

Vincent,

Munoz

et al. 2024

Fetal Diagn Ther

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Introduction Suture tensile properties have only been tested in extrauterine environments. Amniotic fluid (AF) is a complex milieu of enzymes and inflammatory factors. This study tested the mechanical properties of sutures with a variety of inherent properties, after exposure to AF from patients with conditions prompting fetal intervention. Methods AF was obtained from three patients with twin-twin transfusion syndrome (TTTS), and three patients with neural tube defects (NTD). Six types of 2-0 sutures were placed on 1.2 N of tension to mimic placement in vivo, and incubated in AF at 37° C (98.6° F). These included ethylene terephthalate (Ethibond), glycomer 631 (V-Loc), poliglecaprone 25 (Monocryl), poly-4-hydroxybutyrate (Monomax), polydioxanone (PDS), and polyglactin 910 (Vicryl). Failure load, stress, strain, and initial modulus were tested after 24 hours of incubation and after 4 weeks, and compared with control (unincubated) sutures using t tests, Kruskal-Wallis tests, and stress-strain curves. Results Poliglecaprone 25 and polyglactin 910 dissolve more quickly in AF compared to outside the uterus, disintegrating at 4 weeks. Ethylene terephthalate and polydioxanone experienced little change across 4 weeks of incubation. Glycomer 631 and poly-4-hydroxybutyrate exhibited interesting behavior in AF: glycomer 631 became more deformable at 24 hours but later regained toughness by 4 weeks, while poly-4-hydroxybutyrate became tougher and in some cases stronger with time in AF. As a class, braided sutures act more like rigid materials, and monofilaments act like deformable plastics. Conclusion These findings along with other suture characteristics such as ease of handling and availability may inform fetal intervention teams as they optimize procedures in a relatively new surgical field.

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Fetal metabolic adaptations to cardiovascular stress in twin-twin transfusion syndrome

Cited by 2 publications

References 77 publications

Acute Fetal Metabolomic Changes in Twins Undergoing Fetoscopic Surgery for Twin-Twin Transfusion Syndrome

Acute Fetal Metabolomic Changes in Twins Undergoing Fetoscopic Surgery for Twin-Twin Transfusion Syndrome

Suture Characteristics after Exposure to Amniotic Fluid from an in vitro Model of Fetal Surgery

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