Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK. Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0HS, UK.
Joint Department of Physics, Institute of Cancer Research, Sutton, London SM2 5NG, UK.
Sci Transl Med. 2016 Jul 13;8(347):347ra95. doi: 10.1126/scitranslmed.aaf2135.
We investigated the efficacy, maternofetal responses, and safety of using high-intensity focused ultrasound (HIFU) for noninvasive occlusion of placental vasculature compared to sham treatment in anesthetized pregnant sheep. This technique for noninvasive occlusion of placental vasculature may be translatable to the treatment of conditions arising from abnormal placental vasculature, such as twin-twin transfusion syndrome (TTTS). Eleven pregnant sheep were instrumented with maternal and fetal arterial catheters and time-transit flow probes to monitor cardiovascular, acid-base, and metabolic status, and then exposed to HIFU (n = 5) or sham (n = 6) ablation of placental vasculature through the exposed uterine surface. Placental vascular flow was occluded in 28 of 30 targets, and histological examination confirmed occlusion in 24 of 30 targets. In both HIFU and sham exposures, uterine contact reduced maternal uterine artery flow, but delivery of oxygen and glucose to the fetal brain remained normal. HIFU can consistently occlude in vivo placental vessels and ablate blood flow in a pregnant sheep model. Cardiovascular and metabolic fetal responses suggest that the technique is safe in the short term and potentially translatable to human pregnancy.
我们研究了高强度聚焦超声（HIFU）用于非侵入性阻断胎盘血管与假治疗相比在麻醉孕妇羊中的功效、母婴反应和安全性。这种非侵入性胎盘血管阻断技术可能适用于治疗由异常胎盘血管引起的疾病，例如双胎输血综合征（TTTS）。11 只怀孕的绵羊被安置了母胎动脉导管和时间过渡流量探头，以监测心血管、酸碱和代谢状况，然后通过暴露的子宫表面暴露于 HIFU（n = 5）或假治疗（n = 6）来消融胎盘血管。在 30 个目标中有 28 个目标中胎盘血管血流被阻断，组织学检查证实 30 个目标中有 24 个目标被阻断。在 HIFU 和假治疗暴露中，子宫接触减少了母体子宫动脉血流，但胎儿大脑的氧气和葡萄糖输送仍保持正常。HIFU 可以在体内胎盘血管中一致地阻断并在绵羊模型中消融血流。心血管和代谢胎儿反应表明，该技术在短期内是安全的，并且可能适用于人类妊娠。
