Circulating Cell-Free Placental mRNA in the Maternal Plasma as a Predictive Marker for Twin-Twin Transfusion Syndrome

Abstract

Twin-twin transfusion syndrome (TTTS), which is a serious complication in monochorionic diamniotic twins (MCDA-T), involves unequal blood flow via the placental vascular anastomoses from the donor to the recipient twin. Although the placental anastomoses are present in all MCDA-T and both fetuses are genetically identical, TTTS occurs in only 15% of MCDA-T, and much of the pathophysiological basis of TTTS remains poorly understood. Clinically, a staging system based on the ultrasound features of TTTS is widely used for the management (1) but not for the prediction of TTTS. In addition, the known predictive findings observable by ultrasonographic examination are detectable only in a small portion of TTTS cases (2). New predictive markers are therefore desirable for the early detection and prevention of TTTS. Recently, placental mRNAs, such as human placental lactogen (PL) and some other hormones were detected in maternal plasma, and concentrations of each marker were measured with quantitative real-time reverse transcription (RT)-PCR (3)(4). Thus, circulating cell-free mRNA (cf-mRNA) in maternal plasma has become an attractive target for the noninvasive …