Local host response of commercially available dural patches for fetal repair of spina bifida aperta in rabbit model

Author:

Kunpalin Yada12ORCID,Vergote Simen13,Joyeux Luc4ORCID,Telli Onur1,David Anna L.12ORCID,Belfort Michael4,De Coppi Paolo15,Deprest Jan1235ORCID

Affiliation:

1. Department of Development and Regeneration Cluster Woman and Child, Biomedical Sciences MyFetUZ Fetal Research Center KU Leuven Leuven Belgium

2. Elizabeth Garrett Anderson Institute for Women's Health University College London London UK

3. Department of Obstetrics and Gynaecology University Hospitals Leuven Leuven Belgium

4. Division of Pediatric Surgery Michael E. DeBakey Department of Surgery Texas Children's Hospital Baylor College of Medicine Houston Texas USA

5. Great Ormond Street Institute of Child Health University College London London UK

Abstract

AbstractObjectiveFetal surgery for spina bifida aperta (SBA) by open hysterotomy typically repairs anatomical native tissue in layers. Increasingly, fetoscopic repair is performed using a dural patch followed by skin closure. We studied the host response to selected commercially available patches currently being used in a fetal rabbit model for spina bifida repair.MethodsSBA was surgically induced at 23–24 days of gestation (term = 31 days). Fetal rabbits were assigned to unrepaired (SBA group), or immediate repair with Duragen™ or Durepair™. Non‐operated littermates served as normal controls. At term, spinal cords underwent immunohistochemical staining including Nissl and glial fibrillary acidic protein. We hypothesized that spinal cord coverage with a dural patch and skin closure would preserve motor neuron density within the non‐inferiority limit of 201.65 cells/mm2 and reduce inflammation compared to unrepaired SBA fetuses.ResultsMotor neuron density assessed by Nissl staining was conserved both by Duragen (n = 6, 89.5; 95% CI −158.3 to −20.6) and Durepair (n = 6, 37.0; 95% CI −132.6 to −58.5), whereas density of GFAP‐positive cells to quantify inflammation was lower than in unrepaired SBA‐fetuses (SBA 2366.0 ± 669.7 cells/mm2 vs. Duragen 1274.0 ± 157.2 cells/mm2; p = 0.0002, Durepair 1069.0 ± 270.7 cells/mm2; p < 0.0001).ConclusionsCovering the rabbit spinal cord with either Duragen or Durepair followed by skin closure preserves motor neuron density and reduces the inflammatory response.

Publisher

Wiley

Subject

Genetics (clinical),Obstetrics and Gynecology

Reference51 articles.

1. EUROCAT Guide 1.4. Instructions for the Registration and Surveillance of Congenital Anomalies. [Online]. [Internet]. [cited 22 July 2021].2013.http://www.eurocat‐network.eu/accessprevalencedata/prevalencetables

2. Fetal surgery for spina bifida: Past, present, future

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