Transamniotic Stem Cell Therapy

Lazow, Stefanie P.; Fauza, Dario O.

doi:10.1007/5584_2019_416

Cited by 15 publications

(7 citation statements)

References 92 publications

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“…These include cell based therapies, alternatives to fetal surgery and alternatives to the standard surgical repair of the fetal spinal cord lesion. Dr. Dario Fauza and colleagues at Boston Children's Hospital are investigating transamniotic stem cell therapy (TRASCET) as an alternative to the open fetal MMC repair (40). They have investigated the use of mesenchymal stromal cells obtained from the amniotic fluid and the placenta (41).…”

Section: Future Direction Of the Fetal MMC Repairmentioning

confidence: 99%

Fetal myelomeningocele repair: a narrative review of the history, current controversies and future directions

Yamashiro¹,

Farmer²

2021

Transl Pediatr

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Fetal surgery is a relatively new field of medicine. The purpose of this narrative review is to present the history of how fetal surgery became the standard of care for myelomeningocele (MMC), the current controversies of this treatment, and active areas of research that may change how MMC is treated. Fetal surgery for MMC emerged out of the University of California, San Francisco in the 1980s in the laboratory of Dr. Michael Harrison. Initial research focused on testing the hypothesis that the in utero repair of MMC could improve outcomes in the ovine model. Evidence from this model suggested that in utero repair decreases the secondary damage to the exposed neural tissue and improves post-natal neurologic outcomes, opening the door for human intervention. This was followed by the Management of Myelomeningocele Study (MOMS), which was a multicenter randomized controlled trial comparing the prenatal versus postnatal MMC repair. The MOMS trial was stopped early due to the improved outcomes of the prenatal repair, establishing the open fetal MMC repair as the standard of care. Since the MOMS trial, two primary areas of controversy have arisen: the operative approach and criteria for the repair. The three operative approaches include open, endoscopic and a hybrid approach combining open and endoscopic.Several of the inclusion and exclusion criteria from the MOMS trial have been challenged, to include body mass index, gestational diabetes, other fetal abnormalities, maternal infections and Rh alloimmunization.New areas of research have also emerged, exploring cell based therapies to improve fetal outcomes, alternatives to fetal surgery and alternatives to primary skin closure of the fetus.

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Section: Future Direction Of the Fetal MMC Repairmentioning

confidence: 99%

Fetal myelomeningocele repair: a narrative review of the history, current controversies and future directions

Yamashiro¹,

Farmer²

2021

Transl Pediatr

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“…Although the defect in neural tube closure is currently irreversible, eliminating or minimizing prenatal injury to the persistently exposed spinal cord is a promising therapeutic approach to improve neurological outcomes. Therefore, MMC studies have focused on optimizing closure of the MMC defect to protect the spinal cord from ongoing intrauterine trauma using surgical and/or tissue engineering approaches (Watanabe et al, 2015 ; Botelho et al, 2017 ; Danzer et al, 2020 ; Lazow and Fauza, 2020 ). To further improve neurological outcomes, development of targeted prenatal therapies must be an essential direction of MMC research.…”

Section: Perspectivementioning

confidence: 99%

Spinal Cord Injury in Myelomeningocele: Prospects for Therapy

Janik

Manire

Smith

et al. 2020

Front. Cell. Neurosci.

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Myelomeningocele (MMC) is the most common congenital defect of the central nervous system and results in devastating and lifelong disability. In MMC, the initial failure of neural tube closure early in gestation is followed by a progressive prenatal injury to the exposed spinal cord, which contributes to the deterioration of neurological function in fetuses. Prenatal strategies to control the spinal cord injury offer an appealing therapeutic approach to improve neurological function, although the definitive pathophysiological mechanisms of injury remain to be fully elucidated. A better understanding of these mechanisms at the cellular and molecular level is of paramount importance for the development of targeted prenatal MMC therapies to minimize or eliminate the effects of the injury and improve neurological function. In this review article, we discuss the pathological development of MMC with a focus on in utero injury to the exposed spinal cord. We emphasize the need for a better understanding of the causative factors in MMC spinal cord injury, pathophysiological alterations associated with the injury, and cellular and molecular mechanisms by which these alterations are induced.

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“…Mesenchymal cells are typically obtained from the AF or placenta and then injected into the amniotic cavity. 79 AF-and placenta-derived mesenchymal stem cells have been shown to significantly improve the bowel condition at birth compared to no treatment or saline injection. 75,76,78,93 Furthermore, AF mesenchymal stem cells have been shown to concentrate at the placenta and intestines, suggesting both direct and hematogenous seeding of these stem cells.…”

Section: Stem Cell Therapymentioning

confidence: 99%

“…This technique has been evaluated in rat 75,76,93 and rabbit 78 models of gastroschisis. Mesenchymal cells are typically obtained from the AF or placenta and then injected into the amniotic cavity 79 . AF‐ and placenta‐derived mesenchymal stem cells have been shown to significantly improve the bowel condition at birth compared to no treatment or saline injection 75,76,78,93 .…”

Section: Fetal Interventionsmentioning

confidence: 99%

Is there a role for fetal interventions in gastroschisis management? – An updated comprehensive review

et al. 2020

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We conducted a comprehensive evidence‐based review on the epidemiology and current standard of care of gastroschisis management as well as the pathophysiology, rationale and feasibility of fetal therapy as a viable alternative. Gastroschisis is a periumbilical abdominal wall defect characterized by abdominal viscera herniation in utero. It affects 4 in 10 000 live births, but the prevalence has steadily increased in recent years. Gastroschisis is typically diagnosed on routine second‐trimester ultrasound. The overall prognosis is favorable, but complex gastroschisis, which accounts for about 10% to 15% of cases, is associated with a higher mortality, significant disease burden and higher healthcare costs due to long‐ and short‐term complications. The current standard of care has yet to be established but generally involves continued fetal surveillance and multidisciplinary perinatal care. Postnatal surgical repair is achieved with primary closure, staged silo closure or sutureless repair. Experimental animal studies have demonstrated the feasibility of in utero closure, antiinflammatory therapy and prenatal regenerative therapy. However, reports of early preterm delivery and amnioinfusion trials have failed to show any benefit in humans. Further experimental studies and human trials are necessary to demonstrate the potential benefit of fetal therapy in gastroschisis.

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Transamniotic Stem Cell Therapy

Cited by 15 publications

References 92 publications

Fetal myelomeningocele repair: a narrative review of the history, current controversies and future directions

Fetal myelomeningocele repair: a narrative review of the history, current controversies and future directions

Spinal Cord Injury in Myelomeningocele: Prospects for Therapy

Is there a role for fetal interventions in gastroschisis management? – An updated comprehensive review

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