title: Cryopreserved human amniotic membrane and a bioinspired underwater adhesive to seal and promote healing of iatrogenic fetal membrane defect sites.
abstract: BACKGROUND
  We investigated the ability of cryopreserved human amniotic membrane (hAM) scaffold sealed with an underwater adhesive, bio-inspired by marine sandcastle worms to promote healing of iatrogenic fetal membrane defects in a pregnant swine model.
  
  
  METHODS
  Twelve Yucatan miniature pigs underwent laparotomy under general anesthesia at 70 days gestation (term = 114 days). The gestational sacs were assigned to uninstrumented (n = 24) and instrumented with 12 Fr trocar, which was further randomized into four different arms-no hAM patch, (n = 22), hAM patch secured with suture (n = 16), hAM patch with no suture (n = 14), and hAM patch secured with adhesive (n = 9). The animals were euthanized 20 days after the procedure. Gross and histological examination of the entry site was performed for fetal membrane healing.
  
  
  RESULTS
  There were no differences in fetal survival, amniotic fluid levels, or dye-leakage from the amniotic cavity between the groups. The fetal membranes spontaneously healed in instrumented sacs without hAM patches. In sacs with hAM patches secured with sutures, the patch was incorporated into the swine fetal membranes. In sacs with hAM patches without sutures, 100% of the patches were displaced from the defect site, whereas in sacs with hAM patches secured with adhesive 55% of the patches remained in place and showed complete healing (p = 0.04).
  
  
  CONCLUSIONS
  In contrast to humans, swine fetal membranes heal spontaneously after an iatrogenic injury and thus not an adequate model. hAM patches became incorporated into the defect site by cellular ingrowth from the fetal membranes. The bioinspired adhesive adhered the hAM patches within the defect site.
authors.affiliation: The Fetal Center, Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Texas Medical School, Houston, TX, USA. Electronic address: ramesha.papanna@uth.tmc.edu.
authors.forename: R
authors.initials: R
authors.lastname: Papanna
authors.affiliation: The Fetal Center, Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Texas Medical School, Houston, TX, USA.
authors.forename: L K
authors.initials: LK
authors.lastname: Mann
authors.affiliation: Research & Development of Tissue Tech, Ocular Surface Center, P.A., Miami, FL, USA.
authors.forename: S C G
authors.initials: SC
authors.lastname: Tseng
authors.affiliation: Department of Engineering, College of Engineering, The University of Utah, Salt Lake City, UT, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Stewart
authors.affiliation: Department of Engineering, College of Engineering, The University of Utah, Salt Lake City, UT, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Kaur
authors.affiliation: Comparative Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Swindle
authors.affiliation: Department of Pathology, Yale University, New Haven, CT, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Kyriakides
authors.affiliation: Department of Pathology, The University of Texas Medical School, Houston, TX, USA.
authors.forename: N
authors.initials: N
authors.lastname: Tatevian
authors.affiliation: The Fetal Center, Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Texas Medical School, Houston, TX, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Moise
mesh_terms: D000269:Adhesives; D000650:Amnion / Q000293:injuries*; D000818:Animals; D015925:Cryopreservation; D004195:Disease Models, Animal; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000628:therapy*; D005332:Fetoscopy; D007049:Iatrogenic Disease; D011247:Pregnancy; D013552:Swine; D014945:Wound Healing / Q000502:physiology*
chemical_list: D000269:Adhesives
keywords: Fetal membrane healing; Fetal surgery; Preterm premature rupture of membranes; Regeneration; Underwater adhesive