Devaud Yannick R, Avilla-Royo Eva, Lionetti Leonardo, Tronnier Helena, Seehusen Frauke, Monné Rodriguez Josep M, Moehrlen Ueli, Weisskopf Miriam, Vonzun Ladina, Strübing Nele, Ochsenbein-Kölble Nicole, Ehrbar Martin
Department of Obstetrics, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
KOVE medical AG, Zurich, Switzerland.
Fetal Diagn Ther. 2023;50(5):332-343. doi: 10.1159/000530958. Epub 2023 May 12.
One of the main concerns for all fetal surgeries is the risk of preterm delivery due to the preterm prelabor rupture of the fetal membranes (iPPROM). Clinical approaches to seal fetal membrane (FM) defects are missing due to the lack of appropriate strategies to apply sealing biomaterials at the defect site.
Here, we test the performance of a previously developed strategy to seal FM defects with cyanoacrylate-based sealing patches in an ovine model up to 24 days after application.
Patches sealed tightly the fetoscopy-induced FM defects and remained firmly attached to the defect over 10 days. At 10 days after treatment, 100% (13/13) of the patches were attached to the FMs, and 24 days after treatment 25% (1/4) of the patches placed in CO2 insufflation, and 33% (1/3) in NaCl infusion remained. However, all successfully applied patches (20/24) led to a watertight sealing at 10 or 24 days after treatment. Histological analysis indicated that cyanoacrylates induced a moderate immune response and disrupted the FM epithelium.
Together, these data show the feasibility of minimally invasive sealing of FM defects by locally gathering tissue adhesive. Further development to combine this technology with refined tissue glues or healing-inducing materials holds great promise for future clinical translation.
所有胎儿手术的主要担忧之一是由于胎膜早破（iPPROM）导致早产的风险。由于缺乏在缺损部位应用密封生物材料的适当策略，目前尚无封闭胎儿胎膜（FM）缺损的临床方法。
在此，我们在绵羊模型中测试了一种先前开发的用基于氰基丙烯酸酯的密封贴片封闭FM缺损的策略在应用后长达24天的性能。
贴片紧密封闭了胎儿镜检查引起的FM缺损，并在10天内牢固地附着在缺损处。治疗后10天，100%（13/13）的贴片附着在胎膜上，治疗后24天，置于二氧化碳注入组的贴片留存率为25%（1/4），置于氯化钠注入组的贴片留存率为33%（1/3）。然而，所有成功应用的贴片（20/24）在治疗后10天或24天均实现了水密密封。组织学分析表明，氰基丙烯酸酯引发了中度免疫反应并破坏了胎膜上皮。
总之，这些数据表明通过局部聚集组织粘合剂微创封闭FM缺损是可行的。将该技术与精制组织胶水或促愈合材料相结合的进一步发展对未来的临床转化具有巨大潜力。
