title: Fetal tissue engineering: diaphragmatic replacement.
abstract: OBJECTIVE
  Prosthetic repair of congenital diaphragmatic hernia has been associated with high complication rates. This study was aimed at applying fetal tissue engineering to diaphragmatic replacement.
  
  
  METHODS
  Fetal lambs underwent harvest of skeletal muscle specimens. Once expanded in vitro, fetal myoblasts were suspended in a collagen hydrogel submitted to controlled radial tension. The construct was then placed in a bioreactor. After birth, all animals underwent creation of 2 diaphragmatic defects. One defect was repaired with the autologous-engineered construct placed in between 2 acellular supporting membranes and the other with an identical construct but without any cells. Each animal was its own control (graft, n = 10). Animals were killed at different time-points postimplantation for histologic examination. Statistical analysis was by analysis of variance (ANOVA).
  
  
  RESULTS
  Fetal myoblasts expanded up to twice as fast as neonatal cells. Hydrogel-based radial tension enhanced construct architecture by eliciting cell organization within the scaffold. No eventration was present in 4 of 5 engineered constructs but in 0 of 5 acellular grafts (P<.05). At harvest, engineered constructs were thick and histologically resembled normal skeletal muscle, whereas acellular grafts were thin, floppy, and showed low cell density with increased fibrosis.
  
  
  CONCLUSIONS
  Unlike acellular grafts, engineered cellular diaphragmatic constructs are anatomically and histologically similar to normal muscle. Fetal tissue engineering may be a viable alternative for diaphragmatic replacement.
authors.affiliation: Harvard Center for Minimally Invasive Surgery and the Departments of Surgery, Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: D O
authors.initials: DO
authors.lastname: Fauza
authors.forename: J J
authors.initials: JJ
authors.lastname: Marler
authors.forename: R
authors.initials: R
authors.lastname: Koka
authors.forename: R A
authors.initials: RA
authors.lastname: Forse
authors.forename: J E
authors.initials: JE
authors.lastname: Mayer
authors.forename: J P
authors.initials: JP
authors.lastname: Vacanti
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D000831:Animals, Newborn; D019149:Bioreactors; D018929:Cell Culture Techniques; D004195:Disease Models, Animal; D005260:Female; D016332:Fetal Tissue Transplantation / Q000379:methods*; D005818:Genetic Engineering; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D007150:Immunohistochemistry; D011247:Pregnancy; D012756:Sheep; D014182:Transplantation, Autologous