A Novel Smart Patch for the Fetoscopic Procedure to Repair Spina Bifida

一种用于胎儿镜手术修复脊柱裂的新型智能贴片

• 批准号: 10380758
• 负责人: Chia-Ying James Lin
• 金额: $ 51.98万
• 依托单位: UNIVERSITY OF CINCINNATI
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10380758
• 关键词: Action Potentials; Address; Adverse effects; Affect; Affinity; Amniotic Fluid; Animals; Astrocytes; Attention; Biodegradation; Biological Process; Biomedical Engineering; Bipolar I; Body part; Brain Stem; Cannulas; Caring; Cell Differentiation process; Cerebellum; Cerebrospinal Fluid; Characteristics; Chitosan; Clinical; Clinical Research; Congenital Abnormality; Data; Defect; Development; Devices; Dorsal; Effectiveness; Electrophysiology (science); Enzymes; Equation; Excision; Exposure to; Failure; Fetal Development; Fetus; Fibroblasts; Film; Foxes; Glass; Goals; Human; Hydrocephalus; Implant; Incidence; Infant; Intervention; Investigation; Lead; Limb structure; Long-Term Survivors; Magnetic Resonance Imaging; Mechanics; Meningomyelocele; Modeling; Monitor; Morbidity - disease rate; Motor; Motor Evoked Potentials; Muscle; Natural regeneration; Nerve; Nervous System Trauma; Neural Tube Closure; Neural tube; Neurologic; Neurons; Neuroprotective Agents; Newborn Infant; Open Spina Bifida; Operative Surgical Procedures; Orphan; Paralysed; Parents; Patch Tests; Pathology; Peritoneal; Physiological; Polyesters; Polylysine; Polymers; Procedures; Process; Randomized Clinical Trials; Reflex action; Research Project Grants; Risk; Rolipram; Scheme; Secure; Severities; Shapes; Sheep; Site; Spinal; Spinal Cord; Spinal Dysraphism; System; Techniques; Temperature; Testing; Time; Tissues; Tonsil; Transition Temperature; Translations; Trocars; Ventricular; Vertebral column; Walking; Water; biomaterial compatibility; caprolactone; cost; design; fetal; fetus surgery; hindbrain; improved; improved outcome; innovation; malformation; matrigel; minimally invasive; nerve stem cell; novel; postnatal; prenatal; preservation; psychological trauma; randomized trial; relating to nervous system; repaired; scaffold; seal; sheep model; spinal cord repair; tissue repair; wound closure; wound healing

Project Summary (Abstract) Open spina bifida or myelomeningocele (MMC) is a devastating neurologic congenital defect characterized by primary failure of neural tube closure of the spinal column during the embryologic period. Cerebrospinal fluid (CSF) leak caused by MMC in the developing fetus can result in a constellation of anomalies that include hindbrain herniation and brain-stem abnormalities. The exposure of extruded spinal cord to amniotic fluid also poses a significant risk for inducing partial or complete paralysis of the body parts beneath the spinal aperture. A recent randomized trial demonstrated that open fetal surgery is effective in reducing the postnatal neurologic morbidity, as evidenced by decreased incidence and severity of postnatal hydrocephalus and reduced need for postnatal ventricular-peritoneal shunting. However, as open fetal surgery has been noticed to be associated with increased potential for maternal-fetal morbidities, innovative minimally invasive fetoscopic techniques to repair MMC are receiving growing attentions for their less invasiveness. Nonetheless, deploying patches through small trocar ports and unfolding patches for defect coverage can be extremely cumbersome and thus uncontrollably prolongs the surgical duration. Moreover, inert patches necessitate postnatal removal surgeries, which lead to higher surgical costs and psychological trauma to the infant and parents. The long-term effectiveness for some mesh-like patches to barrier the defect is also debating. There is an enormous need to obtain a “smart” patch that is self-expanding, impermeable to cease the CSF leaking and biodegradable to accommodate the scheme of wound healing. Recently we have attempted to develop such a “smart patch” for the fetoscopic procedure to repair MMC that hopefully addresses all the hurdles aforementioned concurrently. By blending two polymers that have been utilized in fabricating biodegradable spinal implants, we developed a new patch made with poly(ε-caprolactone) (PCL) and poly(L-lactide) that possesses desired characteristics of shape retention, water-tightness, biocompatibility, affinity for cellular attachment, and biodegradation. The goal of the current project is to assess how the features of the newly designed patch can contribute to the protection of affected spinal cord that in turn alleviates complications associated with MMC defect. Using a sheep MMC model we have developed, we would like to further assess the efficacies of the new PLA/PCL patch in: (1) reducing the procedure time of fetoscopic coverage on MMC, (2) providing adequate barrier to stop CSF leak and protect the exposed spinal cord to mitigate the damage, which will help preserve and even improve the affected motor function, and (3) guiding and enhancing wound closure of MMC without tethering the spinal cord as our defined aims. If successful, our designed new patch will help advance fetoscopic approaches to become the most reliant procedure for the prenatal management of the MMC defect. This will greatly improve the outcome of the fetoscopic MMC repair, and facilitate the paradigm shifting for the surgical care of MMC.

项目概要（摘要） 开放性脊柱裂或脊髓脊膜膨出 (MMC) 是一种破坏性的神经先天性缺陷，其特征是 胚胎期脊柱神经管闭合的原发性失败。脑脊液 发育中的胎儿中由 MMC 引起的（脑脊液）泄漏可能会导致一系列异常，包括 后脑疝和脑干异常。挤压的脊髓也暴露于羊水中 造成脊柱孔下方身体部分部分或完全瘫痪的重大风险。一个 最近的随机试验表明，开腹胎儿手术可有效减少产后神经系统疾病 发病率，表现为产后脑积水的发生率和严重程度降低以及对药物的需求减少 出生后脑室-腹膜分流。然而，由于开放胎儿手术已被发现与 母婴发病的可能性增加，创新的微创胎儿镜技术进行修复 MMC 因其侵入性较小而受到越来越多的关注。尽管如此，通过小规模部署补丁 用于覆盖缺陷的套管针端口和展开的补片可能非常麻烦，因此无法控制 延长手术时间。此外，惰性贴片需要产后去除手术，这会导致 更高的手术费用以及对婴儿和父母的心理创伤。对某些人来说长期有效 用于阻挡缺陷的网状贴片也存在争议。非常需要获得一个“智能”补丁 是自膨胀的，不可渗透以阻止脑脊液泄漏，并且可生物降解以适应以下方案 伤口愈合。最近，我们尝试开发这样一种用于胎儿镜手术的“智能补丁” 修复 MMC，有望同时解决上述所有障碍。通过混合两种聚合物 已用于制造可生物降解的脊柱植入物，我们开发了一种新的补片 聚（ε-己内酯）（PCL）和聚（L-丙交酯），具有所需的形状保持特性， 水密性、生物相容性、细胞附着亲和力和生物降解性。当前的目标 该项目的目的是评估新设计的补丁的功能如何有助于保护受影响的人 脊髓，进而减轻与 MMC 缺陷相关的并发症。使用绵羊 MMC 模型，我们有 开发完成后，我们希望进一步评估新的 PLA/PCL 贴剂在以下方面的功效：(1) 减少 MMC 上胎儿镜覆盖的手术时间，(2) 提供足够的屏障来阻止 CSF 泄漏并保护 暴露脊髓以减轻损伤，这将有助于保留甚至改善受影响的运动功能 功能，以及（3）引导和增强 MMC 的伤口闭合，而不像我们定义的那样束缚脊髓 目标。如果成功，我们设计的新贴片将有助于推进胎儿镜检查方法，使其成为最可靠的方法 MMC 缺陷的产前管理程序。这将大大改善结果 胎儿镜下 MMC 修复，促进 MMC 手术治疗范式的转变。