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In our study, we analyzed placental tissue from infants with FGR and from infants classified as small for gestational age (SGA) or appropriate for gestational age (AGA), performing comprehensive analyses that included transcriptomics and metabolomics. By examining villus tissue biopsies and 3D trophoblast organoids, we identified significant metabolic changes in placentas associated with FGR. These changes include adaptations to reduced oxygen levels and modifications in arginine metabolism, particularly within the polyamine and creatine phosphate synthesis pathways. Specifically, we found that placentas with FGR utilize arginine to produce phosphocreatine, a crucial energy reservoir for ATP production that is essential for maintaining trophoblast function. In addition, we found polyamine insufficiency in FGR placentas due to increased SAT1 expression. SAT1 facilitates the acetylation and subsequent elimination of spermine and spermidine from trophoblasts, resulting in a deficit of polyamines that cannot be compensated by arginine or polyamine supplementation alone, unless SAT1 expression is suppressed. Our study contributes significantly to the understanding of metabolic adaptations associated with placental dysfunction and provides valuable insights into potential therapeutic opportunities for the future.<\/jats:p>","DOI":"10.1096\/fj.202401946r","type":"journal-article","created":{"date-parts":[[2024,11,30]],"date-time":"2024-11-30T03:24:31Z","timestamp":1732937071000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The central role of creatine and polyamines in fetal growth restriction"],"prefix":"10.1096","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0202-2222","authenticated-orcid":false,"given":"Eros","family":"Di Giorgio","sequence":"first","affiliation":[{"name":"Department of Medicine University of Udine  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9756-0511","authenticated-orcid":false,"given":"Serena","family":"Xodo","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology Santa Maria della Misericordia Hospital, ASUFC  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9978-8130","authenticated-orcid":false,"given":"Maria","family":"Orsaria","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Department of Medicine University of Udine  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1243-8398","authenticated-orcid":false,"given":"Laura","family":"Mariuzzi","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Department of Medicine University of Udine  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6132-6333","authenticated-orcid":false,"given":"Raffaella","family":"Picco","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Udine  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3619-4981","authenticated-orcid":false,"given":"Vanessa","family":"Tolotto","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Udine  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2731-4435","authenticated-orcid":false,"given":"Ylenia","family":"Cortolezzis","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Udine  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7550-6135","authenticated-orcid":false,"given":"Francesca","family":"D'Este","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Udine  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0666-4361","authenticated-orcid":false,"given":"Nicole","family":"Grandi","sequence":"additional","affiliation":[{"name":"Laboratory of Molecular Virology, Department of Life and Environmental Sciences University of Cagliari  Cagliari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1896-9410","authenticated-orcid":false,"given":"Lorenza","family":"Driul","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Udine  Udine Italy"},{"name":"Clinic of Obstetrics and Gynecology Santa Maria della Misericordia Hospital, ASUFC  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6429-1220","authenticated-orcid":false,"given":"Ambrogio","family":"Londero","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit IRCCS Institute Giannina Gaslini  Genova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3344-7207","authenticated-orcid":false,"given":"Luigi E.","family":"Xodo","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Udine  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,11,30]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.05.010"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004251"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22134"},{"key":"e_1_2_13_5_1","unstructured":"Defining normal and abnormal fetal growth: promises and challenges \u2013 ScienceDirect [Internet]. 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