Neurological Outcomes after Human Umbilical Cord Patch for In Utero Spina Bifida Repair in a Sheep Model

Ramesha Papanna; Lovepreet K. Mann; Saul Snowise; Yisel Morales; Sanjay P. Prabhu; Scheffer C. G. Tseng; Raymond Grill; Stephen Fletcher; Kenneth J. Moise Jr.

doi:10.1055/s-0036-1592316

American Journal of Perinatology Reports, Table of Contents

AJP Rep 2016; 06(03): e309-e317
DOI: 10.1055/s-0036-1592316

Case Report

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neurological Outcomes after Human Umbilical Cord Patch for In Utero Spina Bifida Repair in a Sheep Model

Ramesha Papanna

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth, The University of Texas Health Science at Houston, McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas

,

Lovepreet K. Mann

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth, The University of Texas Health Science at Houston, McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas

,

Saul Snowise

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth, The University of Texas Health Science at Houston, McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas

,

Yisel Morales

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth, The University of Texas Health Science at Houston, McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas

,

Sanjay P. Prabhu

²Department of Radiology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts

,

Scheffer C. G. Tseng

³The Ocular Surface Center, Miami, Florida

⁴TissueTech, Inc., Miami, Florida

,

Raymond Grill

⁵Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, Mississippi

,

Stephen Fletcher

⁶Division of Pediatric Neurosurgery, The Department of Pediatrics, UTHealth, The University of Texas Health Science at Houston, McGovern Medical School, Houston, Texas

⁷Department of Pediatric Surgery, UTHealth, The University of Texas Health Science at Houston, McGovern Medical School, Houston, Texas

,

Kenneth J. Moise Jr.

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth, The University of Texas Health Science at Houston, McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas

› Author Affiliations

Abstract

Objectives The objective of our study was to test the hypothesis that in utero repair of surgically created spina bifida in a sheep model using cryopreserved human umbilical cord (HUC) patch improves neurological outcome.

Methods Spina bifida with myelotomy was surgically created in timed pregnant ewes at gestational day (GD) 75. The fetuses were randomly assigned to unrepaired versus HUC and treated at GD 95 and then delivered at GD 140. Neurological evaluation was performed using the Texas Spinal Cord Injury Scale (TSCIS), bladder control using ultrasound, and the hindbrain herniation.

Results Three lambs without the spina bifida creation served as controls. There were four lambs with spina bifida: two were unrepaired and two underwent HUC repair. The control lambs had normal function. Both unrepaired lambs had nonhealed skin lesions with leakage of cerebrospinal fluid, a 0/20 TSCIS score, no bladder control, and the hindbrain herniation. In contrast, both HUC lambs had a completely healed skin defect and survived to day 2 of life, a 3/20 and 4/20 TSCIS score (nociception), partial bladder control, and normal hindbrain anatomy.

Conclusions Cryopreserved HUC patch appears to improve survival and neurological outcome in this severe form of the ovine model of spina bifida.

Keywords

neural tube defect - umbilical cord - regenerative healing - sheep spina bifida model - spina bifida repair

Full Text

References

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