Early Investigations into Improving Bowel and Bladder Function in Fetal Ovine Myelomeningocele Repair
jpedsurg.org shows its articles on its own site.
Read the article on jpedsurg.org ↗Article · Jan 2022 · 1 min read
In brief
In brief
Ovine study demonstrates that fetal myelomeningocele repair augmented with placental mesenchymal stromal cells on extracellular matrix achieves near-normal bowel and bladder function postnatally. Results show 80% normal voiding posture, preserved rectoanal inhibitory reflex, and similar organ muscle thickness compared to controls.
Written by the GCMD Library team from the article.
Introduction
Fetal myelomeningocele (MMC) repair improves lower extremity motor function. We have previously demonstrated that augmentation of fetal MMC repair with placental mesenchymal stromal cells (PMSCs) seeded on extracellular matrix (PMSC-ECM) further improves motor function in the ovine model. However, little progress has been made in improving bowel and bladder function, with many patients suffering from neurogenic bowel and bladder. We hypothesized that fetal MMC repair with PMSC-ECM would also improve bowel and bladder function.
Methods
MMC defects were surgically created in twelve ovine fetuses at median gestational age (GA) 73 days, followed by defect repair at GA101 with PMSC-ECM. Fetuses were delivered at GA141. Primary bladder function outcomes were voiding posture and void volumes. Primary bowel function outcome was anorectal manometry findings including resting anal pressure and presence of rectoanal inhibitory reflex (RAIR). Secondary outcomes were anorectal and bladder detrusor muscle thickness. PMSC-ECM lambs were compared to normal lambs (n=3).
Results
Eighty percent of PMSC-ECM lambs displayed normal voiding posture compared to 100% of normal lambs (p=1). Void volumes were similar (PMSC-ECM 6.1ml/kg vs. normal 8.8ml/kg, p=0.4). Resting mean anal pressures were similar between cohorts (27.0mmHg PMSC-ECM vs. normal 23.5mmHg, p=0.57). RAIR was present in 3/5 PMSC-ECM lambs that underwent anorectal manometry and all normal lambs (p=0.46). Thicknesses of anal sphincter complex, rectal wall muscles, and bladder detrusor muscles were similar between cohorts.
Conclusion
Ovine fetal MMC repair augmented with PMSC-ECM results in near-normal bowel and bladder function. Further work is needed to evaluate these outcomes in human patients.