Tissue engineering for prenatal applications

Fetal therapies have become available for a restricted number of life-threatening clinical conditions. Harnessing tissue engineering for prenatal applications has not been widely pursued even though isolating cells from fetal and extraembryonic tissues has been routinely done for years. The objectives of this thesis were twofold: i) the development of materials based and tissue engineering based strategies to prevent iatrogenic preterm prelabour rupture of fetal membranes (iPPROM) after diagnostic or therapeutic interventions into the amniotic cavity and ii) the generation of tissue substitutes from patient derived fetal cells, which can be employed for prenatal or perinanal transplantation to restore or replace defective tissues. For the prevention of iPPROM, mussel-mimetic tissue adhesive (mussel glue) a biomaterial which was recently described to not compromise cell viability and to have good tissue sealing capability was compared to fibrin glue. In this in vivo study we assessed whether in a mid-gestational rabbit model punctured fetal membranes could be efficiently sealed with mussel glue. Mussel glue showed comparable in vivo performance to fibrin glue in sealing fetal membranes though no apparent healing of the membranes could be observed in any of the samples. The limited ability of naturally derived scaffolds to promote fetal membrane healing inspired the engineering of synthetic plugging material with specifically tailored biological and mechanical properties which could activate the cells in the amnion and induce a healing response. In this thesis the modularly designed biomimetic poly(ethylene glycol) (PEG)-based hydrogel platform (called TG-PEG from here on) was used together with fetal cells to demonstrate that upon presentation of appropriate biological cues in 3D tissue mimicking environment, mesenchymal progenitor cells from amnion can be mobilized, induced to proliferate and supported in maintaining their native extracellular matrix production, thus creating a suitable environment for healing to take place. These data provide the basis for future engineering of materials with defined mechanical and biochemical properties and the ability to present migration and proliferation inducing factors, namely PDGF, bFGF, or EGF which could be key in resolving the clinical problem of iPPROM and allowing the field of fetal surgery to move forward. Cleft palate, where the bones of the palatal halves fail to fuse properly, is one of the most common birth defects. Tissue engineering has been envisioned as a treatment option but current approaches have been limited by the lack of i) appropriate autologous cell sources and ii) structural organization and vascularization. Tissue engineering of cleft palates using of autologous amniocentesis-derived and thus ethically unproblematic fetal amniotic fluid cells (AFCs) could be done parallel to the ongoing pregnancy with living reconstruction material being ready when the child is born. We describe using TG-PEG hydrogels to first evaluate 3D osteogenic differentiation of AFCs and creation of vascular structures from AFC derived endothelial cells (enAFC) and undifferentiated AFC either in random or organized channel cocultures in vitro and in vivo. Next, these approaches were combined in an osteogenic matrix with a channel perfused with enAFC and finally the integration and functional properties of these fetal bone constructs was tested in ectopic mouse model

Engineered cell instructive matrices for fetal membrane healing

Iatrogenic preterm prelabour rupture of fetal membranes (iPPROM) occurs in 6-45% of the cases after fetoscopic procedures posing a significant threat to fetal survival and well-being. Number of available diagnostic and therapeutic fetal interventions is increasing and thus developing treatment options for iPPROM is growing more important than ever before. Fetal membranes exhibit very restricted regeneration and little is known about factors which might modulate their healing potential, rendering various materials and strategies to seal or heal fetal membranes pursued over the past decades relatively fruitless. Additionally, biocompatible materials with tunable in vivo stability and mechanical and biological properties have not been available. Using poly(ethylene glycol) (PEG)-based biomimetic matrices we provide evidence that upon presentation of appropriate biological cues in 3D, mesenchymal progenitor cells from amnion can be mobilized, induced to proliferate and supported in maintaining their native extracellular matrix production, thus creating a suitable environment for healing to take place. These data suggest that engineering materials with defined mechanical and biochemical properties and the ability to present migration and proliferation inducing factors, such as PDGF, bFGF, or EGF could be key in resolving the clinical problem of iPPROM and allowing the field of fetal surgery to move forward

Mussel-mimetic tissue adhesive for fetal membrane repair: an ex vivo evaluation

Iatrogenic preterm prelabor rupture of membranes (iPPROM) remains the main complication after invasive interventions into the intrauterine cavity. Here, the proteolytic stability of mussel-mimetic tissue adhesive (mussel glue) and its sealing behavior on punctured fetal membranes are evaluated. The proteolytic degradation of mussel glue and fibrin glue were compared in vitro. Critical pressures of punctured and sealed fetal membranes were determined under close to physiological conditions using a custom-made inflation device. An inverse finite element procedure was applied to estimate mechanical parameters of mussel glue. Mussel glue was insensitive whereas fibrin glue was sensitive towards proteolytic degradation. Mussel glue sealed 3.7mm fetal membrane defect up to 60mbar (45mmHg) when applied under wet conditions, whereas fibrin glue needed dry membrane surfaces for reliable sealing. The mussel glue can be represented by a neo-Hookean material model with elastic coefficient C(1)=9.63kPa. Ex-vivo-tested mussel glue sealed fetal membranes and resisted pressures achieved during uterine contractions. Together with good stability in proteolytic environments, this makes mussel glue a promising sealing material for future applications

Mussel mimetic tissue adhesive for fetal membrane repair: initial in vivo investigation in rabbits

OBJECTIVE: Iatrogenic preterm prelabour rupture of fetal membranes (iPPROM) remains the main complication after invasive interventions into the intrauterine cavity. The aim of this study was to evaluate the sealing capability and tissue interaction of mussel-mimetic tissue adhesive (mussel glue) in comparison to fibrin glue on punctured fetal membranes in vivo. STUDY DESIGN: A mid-gestational rabbit model was used for testing the materials. The fetal sacs of pregnant rabbits at day 23 were randomly assigned into experimental groups: unoperated (negative control), unclosed puncture (positive control), commercially available fibrin glue (FG) with decellularized amnion scaffold (DAM), mussel glue (MG) with DAM, or mussel glue alone. Evaluation was done at term (30 days' gestation) assessing fetal survival, fetal membrane integrity and histology of the membranes. RESULTS: Fetal survival was not significantly lower in any of the treatment groups compared to the negative control. All plugging materials could be found at the end of the pregnancy and no adverse effects on the fetus or the pregnant does could be observed. Sac integrity was higher in all treatment groups compared to the positive control group but significant only in the FG+DAM group. Cellular infiltration could be seen in fibrin glue and DAM in contrast to mussel glue which was only tightly adhering to the surrounding tissue. These cells were mostly of mesenchymal phenotype staining positive for vimentin. CD68 positive macrophages were found clustered around all the plugging materials, but their numbers were only significantly increased for the mussel glue alone group compared to negative controls. CONCLUSIONS: Mussel glues performance in sealing fetal membranes in the rabbit model was comparable to that of fibrin glue. Taking into account its other favorable properties, it is a noteworthy candidate for a clinically applicable fetal membrane sealant