BACKGROUND: 'Mirror syndrome' (Ballantyne's syndrome) refers to the association of fetal hydrops with placentomegaly and severe maternal edema. Preeclampsia occurs in approximately 50% of these cases. Soluble vascular endothelial growth factor receptor-1 (sVEGFR-1), an anti-angiogenic factor, has been implicated in the pathophysiology of preeclampsia (PE). OBJECTIVE: The objective of this study was to determine if the maternal plasma concentration of sVEGFR-1 is elevated in patients with mirror syndrome. STUDY DESIGN: This case-control study included patients with uncomplicated pregnancies (n = 40) and those with mirror syndrome (n = 4) matched for gestational age. Mirror syndrome was defined as fetal hydrops and severe maternal edema. Maternal plasma sVEGFR-1 concentrations were determined using specific enzyme-linked immunosorbent assays. Immunohistochemistry of sVEGFR-1 on villous trophoblasts was also performed in samples from one patient with mirror syndrome and compared with those from a patient with spontaneous preterm delivery matched for gestational age. Non-parametric statistics were used for analysis (p < 0.05). RESULTS: (1) The median maternal plasma concentration of sVEGFR-1 was significantly higher in patients with mirror syndrome than in the control group (median: 3974 pg/mL, range: 3083-10 780 vs. median: 824 pg/mL, range: 260-4712, respectively; p < 0.001). (2) All patients with mirror syndrome had sVEGFR-1 concentrations above the 95th percentile for gestational age. Syncytiotrophoblast, especially syncytial knots, showed strong staining with antibodies against sVEGFR-1 in placental samples from the patient with mirror syndrome, but not in those from the patient with spontaneous preterm delivery. CONCLUSION: High maternal plasma concentrations of sVEGFR-1 were observed in mirror syndrome. We propose that this anti-angiogenic factor may participate in the pathophysiology of this syndrome. Thus, maternal plasma determination of sVEGFR-1 may help to identify the hydropic fetus that places the mother at risk for preeclampsia.
BACKGROUND:'Mirror syndrome' (Ballantyne's syndrome) refers to the association of fetal hydrops with placentomegaly and severe maternal edema. Preeclampsia occurs in approximately 50% of these cases. Soluble vascular endothelial growth factor receptor-1 (sVEGFR-1), an anti-angiogenic factor, has been implicated in the pathophysiology of preeclampsia (PE). OBJECTIVE: The objective of this study was to determine if the maternal plasma concentration of sVEGFR-1 is elevated in patients with mirror syndrome. STUDY DESIGN: This case-control study included patients with uncomplicated pregnancies (n = 40) and those with mirror syndrome (n = 4) matched for gestational age. Mirror syndrome was defined as fetal hydrops and severe maternal edema. Maternal plasma sVEGFR-1 concentrations were determined using specific enzyme-linked immunosorbent assays. Immunohistochemistry of sVEGFR-1 on villous trophoblasts was also performed in samples from one patient with mirror syndrome and compared with those from a patient with spontaneous preterm delivery matched for gestational age. Non-parametric statistics were used for analysis (p < 0.05). RESULTS: (1) The median maternal plasma concentration of sVEGFR-1 was significantly higher in patients with mirror syndrome than in the control group (median: 3974 pg/mL, range: 3083-10 780 vs. median: 824 pg/mL, range: 260-4712, respectively; p < 0.001). (2) All patients with mirror syndrome had sVEGFR-1 concentrations above the 95th percentile for gestational age. Syncytiotrophoblast, especially syncytial knots, showed strong staining with antibodies against sVEGFR-1 in placental samples from the patient with mirror syndrome, but not in those from the patient with spontaneous preterm delivery. CONCLUSION: High maternal plasma concentrations of sVEGFR-1 were observed in mirror syndrome. We propose that this anti-angiogenic factor may participate in the pathophysiology of this syndrome. Thus, maternal plasma determination of sVEGFR-1 may help to identify the hydropic fetus that places the mother at risk for preeclampsia.
Authors: Tinnakorn Chaiworapongsa; Roberto Romero; Yeon Mee Kim; Gi Jin Kim; Mi Ran Kim; Jimmy Espinoza; Emmanuel Bujold; Luís Gonçalves; Ricardo Gomez; Samuel Edwin; Moshe Mazor Journal: J Matern Fetal Neonatal Med Date: 2005-01
Authors: Richard J Levine; Sharon E Maynard; Cong Qian; Kee-Hak Lim; Lucinda J England; Kai F Yu; Enrique F Schisterman; Ravi Thadhani; Benjamin P Sachs; Franklin H Epstein; Baha M Sibai; Vikas P Sukhatme; S Ananth Karumanchi Journal: N Engl J Med Date: 2004-02-05 Impact factor: 91.245
Authors: Tinnakorn Chaiworapongsa; Roberto Romero; Jimmy Espinoza; Emmanuel Bujold; Yeon Mee Kim; Luis F Gonçalves; Ricardo Gomez; Samuel Edwin Journal: Am J Obstet Gynecol Date: 2004-06 Impact factor: 8.661
Authors: Roberto Romero; Tinnakorn Chaiworapongsa; Offer Erez; Adi L Tarca; Maria Teresa Gervasi; Juan Pedro Kusanovic; Pooja Mittal; Giovanna Ogge; Edi Vaisbuch; Shali Mazaki-Tovi; Zhong Dong; Sun Kwon Kim; Lami Yeo; Sonia S Hassan Journal: J Matern Fetal Neonatal Med Date: 2010-05-12
Authors: Tinnakorn Chaiworapongsa; Roberto Romero; Steven J Korzeniewski; Piya Chaemsaithong; Edgar Hernandez-Andrade; James H Segars; Alan H DeCherney; M Cathleen McCoy; Chong Jai Kim; Lami Yeo; Sonia S Hassan Journal: J Matern Fetal Neonatal Med Date: 2016-05-10
Authors: Eleazar Soto; Roberto Romero; Karina Richani; Jimmy Espinoza; Tinnakorn Chaiworapongsa; Jyh Kae Nien; Sam S Edwin; Yeon Mee Kim; Joon Seok Hong; Luis F Goncalves; Lami Yeo; Moshe Mazor; Sonia S Hassan; Juan Pedro Kusanovic Journal: J Matern Fetal Neonatal Med Date: 2010-07