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

Kunpalin, Yada; Vergote, Simen; Joyeux, Luc; Telli, Onur; David, Anna L; Belfort, Michael; De Coppi, Paolo; (2023) Local host response of commercially available dural patches for fetal repair of spina bifida aperta in rabbit model. Prenatal Diagnosis , 43 (3) pp. 370-381. 10.1002/pd.6315. Green open access

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Abstract

OBJECTIVE: Fetal 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. METHODS: SBA was surgically induced at 23-24 days of gestation (term=31d). 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 GFAP. 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. RESULTS: Motor 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±270.7cells/mm2 ;p<0.0001). CONCLUSIONS: Covering the rabbit spinal cord with either Duragen or Durepair followed by skin closure, preserves motor neuron density and reduces the inflammatory response. This article is protected by copyright. All rights reserved.

Type: Article
Title: Local host response of commercially available dural patches for fetal repair of spina bifida aperta in rabbit model
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/pd.6315
Publisher version: https://doi.org/10.1002/pd.6315
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Neural tube defects, spina bifida aperta, myeloschisis, Arnold-Chiari II, malformation, dural patch, fetal surgery
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Maternal and Fetal Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10163814
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