Neurological Outcomes after Human Umbilical Cord Patch for In Utero Spina Bifida Repair in a Sheep Model.
OBJECTIVE
The objective of our study was to test the hypothesis that in utero repair of surgically created spina bifida in a sheep model using cryopreserved human umbilical cord (HUC) patch improves neurological outcome.


METHODS
Spina bifida with myelotomy was surgically created in timed pregnant ewes at gestational day (GD) 75. The fetuses were randomly assigned to unrepaired versus HUC and treated at GD 95 and then delivered at GD 140. Neurological evaluation was performed using the Texas Spinal Cord Injury Scale (TSCIS), bladder control using ultrasound, and the hindbrain herniation.


RESULTS
Three lambs without the spina bifida creation served as controls. There were four lambs with spina bifida: two were unrepaired and two underwent HUC repair. The control lambs had normal function. Both unrepaired lambs had nonhealed skin lesions with leakage of cerebrospinal fluid, a 0/20 TSCIS score, no bladder control, and the hindbrain herniation. In contrast, both HUC lambs had a completely healed skin defect and survived to day 2 of life, a 3/20 and 4/20 TSCIS score (nociception), partial bladder control, and normal hindbrain anatomy.


CONCLUSIONS
Cryopreserved HUC patch appears to improve survival and neurological outcome in this severe form of the ovine model of spina bifida.
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth, The University of Texas Health Science at Houston, McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas.
Ramesha
R
Papanna
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth, The University of Texas Health Science at Houston, McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas.
Lovepreet K
LK
Mann
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth, The University of Texas Health Science at Houston, McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas.
Saul
S
Snowise
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth, The University of Texas Health Science at Houston, McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas.
Yisel
Y
Morales
Department of Radiology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts.
Sanjay P
SP
Prabhu
The Ocular Surface Center, Miami, Florida; TissueTech, Inc., Miami, Florida.
Scheffer C G
SC
Tseng
Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, Mississippi.
Raymond
R
Grill
Division of Pediatric Neurosurgery, The Department of Pediatrics, UTHealth, The University of Texas Health Science at Houston, McGovern Medical School, Houston, Texas; Department of Pediatric Surgery, UTHealth, The University of Texas Health Science at Houston, McGovern Medical School, Houston, Texas.
Stephen
S
Fletcher
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth, The University of Texas Health Science at Houston, McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas.
Kenneth J
KJ
Moise
neural tube defect; regenerative healing; sheep spina bifida model; spina bifida repair; umbilical cord