Department of Surgery, University of California, San Francisco, CA 94143-0570, USA.
J Pediatr Surg. 2011 Dec;46(12):2279-83. doi: 10.1016/j.jpedsurg.2011.09.014.
BACKGROUND/PURPOSE: Spinal cord damage in myelomeningocele (MMC) results from abnormal cord development and subsequent local trauma. Prenatal surgery prevents additional neural injury. However, existing damage is not reversed. Biodegradable nanofibrous scaffolds (NSs) promote regeneration of neural tissues. They mimic the microtopography of the extracellular matrix and guide tissue formation and organization. The purpose of this pilot study was to evaluate the practicality and safety of using biodegradable NS as a regenerative device in prenatal MMC repair.
Two fetal lambs underwent a surgically induced MMC defect followed by open fetal repair using aligned biodegradable NS. Lambs were killed at day 138. Spinal cords were examined for inflammation or fibrosis and stained for spinal cord architecture, myelin, and neuron cell bodies.
Prenatal repair with NS demonstrated technical feasibility. There was no evidence of a surrounding inflammatory response or foreign-body reaction to the scaffold.
Biodegradable NS can be used surgically for the prenatal repair of MMC in a large animal model and does not appear to elicit an inflammatory or fibrotic reaction in fetal tissue. Further studies will determine their potential for neural cell infiltration, delivery of growth factors, drugs or stem cells, and functional recovery greater than standard repair.
背景/目的：脊髓脊膜膨出（MMC）导致的脊髓损伤源于脊髓发育异常和随后的局部创伤。产前手术可防止进一步的神经损伤。然而，现有的损伤无法逆转。可生物降解的纳米纤维支架（NS）可促进神经组织再生。它们模仿细胞外基质的微观形貌，引导组织形成和组织。本研究旨在评估可生物降解 NS 作为产前 MMC 修复再生装置的实用性和安全性。
两只羔羊接受了手术诱导的 MMC 缺陷，然后采用排列的可生物降解 NS 进行开放性胎儿修复。羔羊在 138 天时被处死。检查脊髓是否有炎症或纤维化，并对脊髓结构、髓鞘和神经元细胞体进行染色。
NS 的产前修复表现出技术可行性。支架周围没有炎症反应或异物反应的证据。
可生物降解 NS 可在大型动物模型中进行产前 MMC 修复手术，并且似乎不会在胎儿组织中引起炎症或纤维化反应。进一步的研究将确定它们在神经细胞浸润、生长因子、药物或干细胞输送以及功能恢复方面的潜力，超过标准修复。
