Abstract：
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.
摘要：
胎儿经历了主要的手术压力以及继发于双胎输血（TTTS）以及用于治疗TTTS的胎儿镜手术的液体移位。虽然人们了解TTTS的病理生理学，胎儿从胎儿镜手术中经历的急性代谢变化没有。我们试图评估继发于TTTS手术的受体代谢组学特征的变化。在12/2022-2/2023进行的4例TTTS手术病例的开始和结束时收集羊水。立即处理样品并通过基于NMR的代谢组学设施方案进行评估。在单变量分析中，12种代谢物(葡萄糖，乳酸，和10种关键氨基酸）在手术开始和结束之间显示出统计学上的显着变化。其中,11种代谢物在结束时减少，而只有乳酸增加。监督的OPLS-DA模型显示丙酮酸和乳酸作为两种代谢物对病例之间的差异影响最大。并且40%的代谢组学变化可以直接归因于样本采集的时间(即，如果术前或术后)。这些结果表明，在TTTS的胎儿镜手术期间，受体双胞胎的代谢发生了显着变化。这些葡萄糖下降的发现，乳酸增加，和减少的羊膜酸将表明增加的分解代谢在手术过程中。这项研究提出了有关手术期间最佳母体和胎儿营养的问题，以及是否可以优化营养状况以进一步提高胎儿镜手术期间的双胎生存率。
