Abstract
To test the hypothesis that discordant growth in monochorionic (MC) twins occurs at least in part due to disparity in placental amino acid transporter function, we measured plasma amino acid levels by HPLC in maternal and fetal blood samples collected at birth from gestational age matched twins with (n = 12) and without (n = 12) twin-twin transfusion syndrome (TTTS).
In the donor twin, fetal plasma concentrations and feto-maternal ratios of five essential amino acids—valine (p < 0.001), leucine (p < 0.001), iso-leucine (p < 0.05), histidine (p < 0.001) and L-arginine (p < 0.001)—were lower than the recipient and non-TTTS twin pairs. Fetal concentrations of the nonessential amino acids taurine (p < 0.001), serine (p < 0.01), glycine (p < 0.001) and tyrosine (p < 0.05) were also markedly lower in the donor than the recipient and non-TTTS twin pairs. In contrast, the fetal alanine level in the donor twin was higher than the recipient (664 ± 64 versus 396 ± 23 μM;p < 0.001) and the non-TTTS twin pairs (p < 0.01). No such differences between amino acid profiles in non-TTTS MC twin pairs were found. Maternal plasma amino acid levels between TTTS and non-TTTS groups were comparable. This study provides the first evidence that certain amino acids in the donor twin of chronic TTTS differ significantly from those of the co-twin while others were comparable between twin pairs. These data, therefore, argue against inter-twin transfusion as the sole cause of growth restriction of the donor twin and suggests instead that impaired placental transport of amino acids may be a likely mechanism.
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Abbreviations
- MC:
-
monochorionic
- F/M:
-
feto-maternal ratio
- IUGR:
-
intrauterine growth restriction
- TTTS:
-
twin, twin transfusion syndrome
- AGA:
-
appropriate for gestational age
- DC:
-
dichorionic
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Acknowledgements
The authors thank the staff of the delivery units at the Hammersmith Trust Hospitals, London, and St Mary's Hospital, Manchester, for assistance with collection of blood samples.
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This work was supported by the Research and Graduate Support Unit, University of Manchester.
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Bajoria, R., Hancock, M., Ward, S. et al. Discordant Amino Acid Profiles in Monochorionic Twins with Twin-Twin Transfusion Syndrome. Pediatr Res 48, 821–828 (2000). https://doi.org/10.1203/00006450-200012000-00020
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DOI: https://doi.org/10.1203/00006450-200012000-00020
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