title: In utero repair of an experimental neural tube defect in a chronic sheep model using biomatrices.
abstract: OBJECTIVE
  Persistent exposure of the unprotected spinal cord to amniotic fluid and the uterine wall can lead to progressive damage of neural tissue in case of a myelomeningocele (two-hit hypothesis). The aim of this study was to evaluate whether in utero repair of an experimental neural tube defect in a fetal lamb could protect neural tissue from secondary injury and save neurologic functions after birth.
  
  
  METHODS
  In 19 fetal lambs, a neural tube defect was created at 79 days' gestation. In 12 lambs the defect was covered either with a novel, molecular defined collagen-based biocompatible and biodegradable matrix (UMC) or with a small intestinal submucosa (SIS) biomatrix (Cook) or by closing the skin over the defect.
  
  
  RESULTS
  All lambs with the defect covered showed no or minor neurologic morbidity in contrast to the lambs with the defect uncovered in which major neurologic morbidity was seen.
  
  
  CONCLUSIONS
  These results demonstrate that long-term exposure of the open spinal cord to the intrauterine environment can lead to damage of neural tissue and, consequently loss of neurologic functions and that coverage of the defect can lead to a better neurologic outcome. Furthermore, we could show that a UMC biomatrix and an SIS biomatrix are useful for in utero coverage of a surgically created neural tube defect in our model.
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands. A.Eggink@obgyn.umcn.nl
authors.forename: A J
authors.initials: AJ
authors.lastname: Eggink
authors.forename: L A J
authors.initials: LA
authors.lastname: Roelofs
authors.forename: W F J
authors.initials: WF
authors.lastname: Feitz
authors.forename: R M H
authors.initials: RM
authors.lastname: Wijnen
authors.forename: R A
authors.initials: RA
authors.lastname: Mullaart
authors.forename: J A
authors.initials: JA
authors.lastname: Grotenhuis
authors.forename: T H
authors.initials: TH
authors.lastname: van Kuppevelt
authors.forename: M M Y
authors.initials: MM
authors.lastname: Lammens
authors.forename: A J
authors.initials: AJ
authors.lastname: Crevels
authors.forename: A
authors.initials: A
authors.lastname: Hanssen
authors.forename: P P
authors.initials: PP
authors.lastname: van den Berg
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001672:Biocompatible Materials / Q000494:pharmacology*; D002908:Chronic Disease; D003094:Collagen / Q000494:pharmacology; D004195:Disease Models, Animal; D005260:Female; D005315:Fetal Diseases / Q000503:physiopathology / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods*; D008591:Meningomyelocele / Q000503:physiopathology / Q000601:surgery*; D009436:Neural Tube Defects / Q000503:physiopathology / Q000601:surgery*; D011247:Pregnancy; D020127:Recovery of Function; D012756:Sheep; D023822:Tissue Engineering
chemical_list: D001672:Biocompatible Materials; D003094:Collagen