In utero repair of myelomeningocele with autologous amniotic membrane in the fetal lamb model

Erin Brown, Payam Saadai, Christopher D. Pivetti, Michael S. Beattie, Jacqueline C. Bresnahan, Aijun Wang, Diana L Farmer

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background Despite advances in prenatal repair, myelomeningocele (MMC) still produces devastating neurologic deficits. The amniotic membranes (AM) are a biologically active tissue that has been used anecdotally for human fetal MMC repair. This study evaluated the use of autologous AM compared to skin closure in an established fetal MMC model. Methods Seven fetal lambs underwent surgical creation of MMC at gestational age of 75 days followed by in utero repair at gestational age of 100 days. Lambs were repaired with an autologous AM patch followed by skin closure (n = 4) or skin closure alone (n = 3). Gross necropsy and histopathology of the spinal cords were performed at term to assess neuronal preservation at the lesion. Results An increase in preserved motor neurons and a larger area of spinal cord tissue were seen in AM-repaired lambs, as was decreased wound healing of the overlying skin. Loss of nearly all spinal cord tissue with limited motor neuron preservation was seen in skin only-repaired lambs. Conclusions AM-repaired lambs showed increased protection of spinal cord tissue compared to skin only-repaired lambs, but the overlying skin failed to close in AM-repaired lambs. These results suggest a potential role for AM in fetal MMC repair that warrants further study.

Original languageEnglish (US)
Pages (from-to)133-138
Number of pages6
JournalJournal of Pediatric Surgery
Volume49
Issue number1
DOIs
StatePublished - Jan 2014

Fingerprint

Meningomyelocele
Amnion
Skin
Spinal Cord
Motor Neurons
Gestational Age
Neurologic Manifestations
Wound Healing

Keywords

  • Amniotic membranes
  • Fetal surgery
  • Myelomeningocele
  • Spina bifida
  • Spinal cord injury

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

In utero repair of myelomeningocele with autologous amniotic membrane in the fetal lamb model. / Brown, Erin; Saadai, Payam; Pivetti, Christopher D.; Beattie, Michael S.; Bresnahan, Jacqueline C.; Wang, Aijun; Farmer, Diana L.

In: Journal of Pediatric Surgery, Vol. 49, No. 1, 01.2014, p. 133-138.

Research output: Contribution to journalArticle

Brown, Erin ; Saadai, Payam ; Pivetti, Christopher D. ; Beattie, Michael S. ; Bresnahan, Jacqueline C. ; Wang, Aijun ; Farmer, Diana L. / In utero repair of myelomeningocele with autologous amniotic membrane in the fetal lamb model. In: Journal of Pediatric Surgery. 2014 ; Vol. 49, No. 1. pp. 133-138.
@article{886cd6485eff418e851d894d0dd0b074,
title = "In utero repair of myelomeningocele with autologous amniotic membrane in the fetal lamb model",
abstract = "Background Despite advances in prenatal repair, myelomeningocele (MMC) still produces devastating neurologic deficits. The amniotic membranes (AM) are a biologically active tissue that has been used anecdotally for human fetal MMC repair. This study evaluated the use of autologous AM compared to skin closure in an established fetal MMC model. Methods Seven fetal lambs underwent surgical creation of MMC at gestational age of 75 days followed by in utero repair at gestational age of 100 days. Lambs were repaired with an autologous AM patch followed by skin closure (n = 4) or skin closure alone (n = 3). Gross necropsy and histopathology of the spinal cords were performed at term to assess neuronal preservation at the lesion. Results An increase in preserved motor neurons and a larger area of spinal cord tissue were seen in AM-repaired lambs, as was decreased wound healing of the overlying skin. Loss of nearly all spinal cord tissue with limited motor neuron preservation was seen in skin only-repaired lambs. Conclusions AM-repaired lambs showed increased protection of spinal cord tissue compared to skin only-repaired lambs, but the overlying skin failed to close in AM-repaired lambs. These results suggest a potential role for AM in fetal MMC repair that warrants further study.",
keywords = "Amniotic membranes, Fetal surgery, Myelomeningocele, Spina bifida, Spinal cord injury",
author = "Erin Brown and Payam Saadai and Pivetti, {Christopher D.} and Beattie, {Michael S.} and Bresnahan, {Jacqueline C.} and Aijun Wang and Farmer, {Diana L}",
year = "2014",
month = "1",
doi = "10.1016/j.jpedsurg.2013.09.043",
language = "English (US)",
volume = "49",
pages = "133--138",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "1",

}

TY - JOUR

T1 - In utero repair of myelomeningocele with autologous amniotic membrane in the fetal lamb model

AU - Brown, Erin

AU - Saadai, Payam

AU - Pivetti, Christopher D.

AU - Beattie, Michael S.

AU - Bresnahan, Jacqueline C.

AU - Wang, Aijun

AU - Farmer, Diana L

PY - 2014/1

Y1 - 2014/1

N2 - Background Despite advances in prenatal repair, myelomeningocele (MMC) still produces devastating neurologic deficits. The amniotic membranes (AM) are a biologically active tissue that has been used anecdotally for human fetal MMC repair. This study evaluated the use of autologous AM compared to skin closure in an established fetal MMC model. Methods Seven fetal lambs underwent surgical creation of MMC at gestational age of 75 days followed by in utero repair at gestational age of 100 days. Lambs were repaired with an autologous AM patch followed by skin closure (n = 4) or skin closure alone (n = 3). Gross necropsy and histopathology of the spinal cords were performed at term to assess neuronal preservation at the lesion. Results An increase in preserved motor neurons and a larger area of spinal cord tissue were seen in AM-repaired lambs, as was decreased wound healing of the overlying skin. Loss of nearly all spinal cord tissue with limited motor neuron preservation was seen in skin only-repaired lambs. Conclusions AM-repaired lambs showed increased protection of spinal cord tissue compared to skin only-repaired lambs, but the overlying skin failed to close in AM-repaired lambs. These results suggest a potential role for AM in fetal MMC repair that warrants further study.

AB - Background Despite advances in prenatal repair, myelomeningocele (MMC) still produces devastating neurologic deficits. The amniotic membranes (AM) are a biologically active tissue that has been used anecdotally for human fetal MMC repair. This study evaluated the use of autologous AM compared to skin closure in an established fetal MMC model. Methods Seven fetal lambs underwent surgical creation of MMC at gestational age of 75 days followed by in utero repair at gestational age of 100 days. Lambs were repaired with an autologous AM patch followed by skin closure (n = 4) or skin closure alone (n = 3). Gross necropsy and histopathology of the spinal cords were performed at term to assess neuronal preservation at the lesion. Results An increase in preserved motor neurons and a larger area of spinal cord tissue were seen in AM-repaired lambs, as was decreased wound healing of the overlying skin. Loss of nearly all spinal cord tissue with limited motor neuron preservation was seen in skin only-repaired lambs. Conclusions AM-repaired lambs showed increased protection of spinal cord tissue compared to skin only-repaired lambs, but the overlying skin failed to close in AM-repaired lambs. These results suggest a potential role for AM in fetal MMC repair that warrants further study.

KW - Amniotic membranes

KW - Fetal surgery

KW - Myelomeningocele

KW - Spina bifida

KW - Spinal cord injury

UR - http://www.scopus.com/inward/record.url?scp=84892579114&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892579114&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2013.09.043

DO - 10.1016/j.jpedsurg.2013.09.043

M3 - Article

VL - 49

SP - 133

EP - 138

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 1

ER -