Diaphragmatic repair through fetal tissue engineering: a comparison between mesenchymal amniocyte- and myoblast-based constructs.
OBJECTIVE
We have previously shown that fetal tissue engineering is a preferred alternative to diaphragmatic repair in a large animal model. This study was aimed at comparing diaphragmatic constructs seeded with mesenchymal amniocytes and fetal myoblasts in this model.


METHODS
Neonatal lambs (n = 14) underwent repair of an experimental diaphragmatic defect with identical scaffolds, either seeded with labeled autologous cells (mesenchymal amniocytes in group 1 and fetal myoblasts in group 2) or as an acellular graft (group 3). At 1 to 12 months postoperatively, implants were harvested for multiple analyses.


RESULTS
Repair failure (reherniation or eventration) was significantly higher in group 3 than in groups 1 and 2, with no difference between groups 1 and 2. Seeded fetal myoblasts quickly lost their myogenic phenotype in vivo. All grafts contained cells with a fibroblastic-myofibroblastic profile. Elastin concentrations and both modular and ultimate tensile strengths were significantly higher in group 1 than in groups 2 and 3. There were no differences in glycosaminoglycans and type I collagen levels among the groups.


CONCLUSIONS
Diaphragmatic repair with a mesenchymal amniocyte-based engineered tendon leads to improved structural outcomes when compared with equivalent fetal myoblast-based and acellular grafts. The amniotic fluid is a preferred cell source for tissue-engineered diaphragmatic reconstruction.
Kunisaki
Shaun M
SM
Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
Fuchs
Julie R
JR
Kaviani
Amir
A
Oh
Jung-Tak
JT
LaVan
David A
DA
Vacanti
Joseph P
JP
Wilson
Jay M
JM
Fauza
Dario O
DO
D000818:Animals; D000831:Animals, Newborn; D024042:Collagen Type I / Q000032:analysis; D004549:Elastin / Q000032:analysis; D005333:Fetus; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D008648:Mesoderm / Q000166:cytology; D032446:Myoblasts; D012756:Sheep; D023822:Tissue Engineering / Q000379:methods*; D016896:Treatment Outcome
D024042:Collagen Type I; D004549:Elastin