Patch made from umbilical cord layers can reverse spina bifida in utero

Researchers at McGovern Medical School at The University of Texas Health Science Center at Houston have developed a new method to treating spina bifida in utero: a patch made of a layer of the umbilical cord.

The patch, created from donated umbilical cord layers from healthy newborns, is placed on the uncovered part of the fetus's spinal cord. The fetus is then able to heal itself without a scar.

"The promise of this patch is that the umbilical cord contains specific natural material called heavy chain hyaluronic acid/pentraxin3 that has regenerative properties," said Ramesha Papanna, MD, MPH, lead author, assistant professor at McGovern Medical School and maternal-fetal medicine specialist at the Fetal Center at Children's Memorial Hermann Hospital. "It allows the local tissue to grow in at the repair site instead of a healing by scar formation that occurs with traditional repair methods. This decrease in scar formation may help improve the spinal cord function further and reduce the need for future surgeries to remove the effects of the scar tissue on the spinal cord."

The patch is able to close larger defects and acts as a bioscaffold to allow the fetus to heal itself faster with this minimally invasive approach. "This patch acts as a scaffold, which is watertight and allows native tissue to regenerate in an organized manner, and has anti-scarring, anti-inflammatory properties. Preventing the scarring could prevent tethering, which can prevent further damage to the cord," said co-author Lovepreet K. Mann, M.B.B.S., instructor in McGovern Medical School's Department of Obstetrics, Gynecology and Reproductive Sciences.

Researchers conducted two case studies and the results mirrored each other:

1. The first study was done on a fetus where the defect measured 5 x 6 cm and there was evidence of Chiari II malformation, where the brain stem and the cerebellum protrude into the spinal canal or neck area. At 24 weeks, fetal surgery was performed and the defect was closed with the skin patch from the umbilical cord. At 37.5 weeks, the fetus was born with the patch intact. There was no leakage of the patch and after two weeks the skin had healed over the patch. The child showed normal movement in the legs, normal bladder function and the Chiari II malformation was gone.
2. The second case involved a fetus having a defect measuring 4 x 5 cm with Chiari II malformation. Surgery was performed in week 25with a patch and the baby was born after 37.5 weeks. Again, the patch covered the lesions and within 30 days skin grew over the patch. The baby showed normal motor functions and the Chiari II malformation was reversed.

The research team has recently conducted a third surgery and are continuing to develop a method to making the skin heal inside the uterus as well as different ways to use the patch in an even more less-invasive way.