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Analysis of mechanism of fetal cardiovascular failure in monochorionic twin pregnancies

Research Project

Project/Area Number 19K09788
Research Category

Grant-in-Aid for Scientific Research (C)

Allocation TypeMulti-year Fund
Section一般
Review Section Basic Section 56040:Obstetrics and gynecology-related
Research InstitutionToho University

Principal Investigator

Nakata Masahiko  東邦大学, 医学部, 教授 (10294646)

Co-Investigator(Kenkyū-buntansha) 日根 幸太郎  東邦大学, 医学部, 講師 (50729308)
早田 英二郎  東邦大学, 医学部, 講師 (50804176)
與田 仁志  東邦大学, 医学部, 特任教授 (90589053)
Project Period (FY) 2019-04-01 – 2023-03-31
Project Status Completed (Fiscal Year 2022)
Budget Amount *help
¥4,160,000 (Direct Cost: ¥3,200,000、Indirect Cost: ¥960,000)
Fiscal Year 2021: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000)
Fiscal Year 2020: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000)
Fiscal Year 2019: ¥2,210,000 (Direct Cost: ¥1,700,000、Indirect Cost: ¥510,000)
Keywords双胎間輸血症候群 / 一絨毛膜双胎 / 双胎妊娠 / 脳性麻痺 / 胎児治療 / 静脈管 / E/e' / アルドステロン / 胎児循環 / 羊水 / 超音波パルスドプラ法 / Dual-gate Doppler method / Dual-gate Doppler法 / 胎児循環不全 / VEGF
Outline of Research at the Start

一絨毛膜(MC)双胎では、双胎間輸血症候群(TTTS)やselective IUGR(sIUGR)において循環不全を合併し予後が著しく不良となるが、そうでない場合でも中枢神経障害等の合併症が存在し、MC双胎特有の循環状態が関与すると考えられているが、その詳細な発症機序は不明である。
本研究では、循環不全に着目し、羊水・臍帯血の心不全マー カーを測定し、新たに確立した胎児心機能評価法を用いて関連性を検討する。加えて、胎盤における循環作動物質の組織学的発現の検討を行い、胎盤機能と児の循環状態について評価し、MC双胎における循環不全の病態解明を行うと共に、循環不全の臨床的評価法を確立する。

Outline of Final Research Achievements

We conducted a study to elucidate the pathogenesis of fetal circulatory failure in complications such as twin-to-twin transfusion syndrome and selective fetal growth restrction in monochorionic twins. We performed laser coagulation of placental anastomosis by fetoscope to twin-to-twin transfusion syndrome and selective fetal growth restrction, and examined the changes before and after the procedure. We also compared the results with those of twins who had not yet developed these conditions.
The measurement of fetal cardiac function using ultrasound equipment and fetal venous blood flow waveforms revealed that cardiac diastolic function was decreased from early onset in twin-to-twin transfusion syndromes. Aldosterone levels in amniotic fluid also differed between the two fetuses, even in non-TTTS, indicating a unique state of circulatory failure in these twins.

Academic Significance and Societal Importance of the Research Achievements

これまで未解明だった一絨毛膜双胎における双胎間輸血症候群の循環動態が明らかとなった。特に胎児循環不全に進展する以前からすでに胎児心拡張能が障害されていることが明らかとなったことは新たな知見であるとともに、双胎間輸血症候群の早期発見や発症予知につながる有用な情報である。また、双胎間輸血症候群未発症の一絨毛膜双胎でもすでに羊水中アルドステロンレベルに格差を認めることから、二絨毛膜双胎とは異なる循環評価の必要性が示唆された。
脳性麻痺や周産期死亡につながるこれらの疾患に対する病態解明や早期発見の可能性が拡大することは、少子化社会において広く国民に資する結果といえる。

Report

(5 results)
  • 2022 Annual Research Report   Final Research Report ( PDF )
  • 2021 Research-status Report
  • 2020 Research-status Report
  • 2019 Research-status Report
  • Research Products

    (7 results)

All 2022 2021 2020

All Journal Article (6 results) (of which Peer Reviewed: 6 results,  Open Access: 1 results) Book (1 results)

  • [Journal Article] Different expressions of cardiac biomarkers between different types of acquired right ventricular outflow tract abnormality in monochorionic twins2022

    • Author(s)
      Mayumi Takano, Kotaro Hine, Sumito Nagasaki, Junya Sakuma, Makiko Shimabukuro, Hikari Kotaki, Keiko Saito, Kohei Ogata, Hitoshi Yoda, Masahiko Nakata
    • Journal Title

      Prenatal Diagnosis

      Volume: 42 Issue: 11 Pages: 1448-1457

    • DOI

      10.1002/pd.6236

    • Related Report
      2022 Annual Research Report
    • Peer Reviewed
  • [Journal Article] Association of amniotic fluid natriuretic peptide levels with ductus venosus Doppler flow in recipient twins with twin-to-twin transfusion syndrome2022

    • Author(s)
      Mayumi Takano, Sumito Nagasaki, Junya Sakuma, Makiko Shimabukuro, Hikari Kotaki, Masahiko Nakata
    • Journal Title

      Journal of Medical Ultrasonics

      Volume: 49 Issue: 4 Pages: 703-708

    • DOI

      10.1007/s10396-022-01241-3

    • Related Report
      2022 Annual Research Report
    • Peer Reviewed
  • [Journal Article] Measurement of fetal automated fractional shortening using two-dimensional tracking in multiple centers2021

    • Author(s)
      Nagasaki Sumito、Nakata Masahiko、Takano Mayumi、Sakuma Junya、Nagai Ryuhei、Miyashita Susumu、Takahashi Yuichiro、Iwagaki Shigenori、Yamamoto Yuka、Morita Mineto
    • Journal Title

      Journal of Medical Ultrasonics

      Volume: 48 Issue: 1 Pages: 83-90

    • DOI

      10.1007/s10396-020-01069-9

    • Related Report
      2021 Research-status Report 2020 Research-status Report
    • Peer Reviewed
  • [Journal Article] Prediction of Twin-to-Twin Transfusion Syndrome Using Characteristic Waveforms of Ductus Venosus in Recipient Twins2020

    • Author(s)
      Mayumi Takano, Masahiko Nakata, Sumito Nagasaki, Junya Sakuma, Mineto Morita
    • Journal Title

      Twin Research and Human Genetics

      Volume: 23 Issue: 5 Pages: 292-297

    • DOI

      10.1017/thg.2020.73

    • Related Report
      2020 Research-status Report
    • Peer Reviewed / Open Access
  • [Journal Article] Assessment of Fetal Cardiac Function With Echocardiography2020

    • Author(s)
      Nakata M, Sakuma J, Takano M, Nagasaki S
    • Journal Title

      J Obstet Gynaecol Res

      Volume: 46 Issue: 1 Pages: 31-38

    • DOI

      10.1111/jog.14143

    • Related Report
      2019 Research-status Report
    • Peer Reviewed
  • [Journal Article] Asymmetrical Hemodynamic Influence of Twin-Twin Transfusion Syndrome on Fetal E/e' by the Dual Gate Doppler Method in Recipient Twins2020

    • Author(s)
      Takano M, Nakata M, Nagasaki S, Morita M.
    • Journal Title

      Fetal Diagn Ther

      Volume: 47 Issue: 4 Pages: 261-267

    • DOI

      10.1159/000501773

    • Related Report
      2019 Research-status Report
    • Peer Reviewed
  • [Book] 胎児疾患と胎児治療-病態生理,診断・治療のすべて2020

    • Author(s)
      中田雅彦(編著)
    • Total Pages
      295
    • Publisher
      株式会社メディカ出版
    • ISBN
      9784840472623
    • Related Report
      2020 Research-status Report

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Published: 2019-04-18   Modified: 2024-01-30  

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