AAP Paper
Chest wall repair with engineered fetal bone grafts: an efficacy analysis in an autologous leporine model

https://doi.org/10.1016/j.jpedsurg.2010.02.116Get rights and content

Abstract

Purpose

We sought to compare the efficacy of engineered fetal bone grafts with acellular constructs in an autologous model of chest wall repair.

Methods

Rabbits (n = 10) with a full-thickness sternal defect were equally divided in 2 groups based on how the defect was repaired, namely, either with an autologous bone construct engineered with amniotic mesenchymal stem cells on a nanofibrous scaffold or a size-matched identical scaffold with no cells. Animals were killed at comparable time-points 18 to 20 weeks postimplantation for multiple analyses.

Results

Gross evidence of nonunion confirmed by micro–computed tomography scanning was present in 3 (60%) of 5 of the acellular implants but in no engineered grafts. Histology confirmed the presence of bone in both types of repair, albeit seemingly less robust in the acellular grafts. Mineral density in vivo was significantly higher in engineered grafts than in acellular ones, with more variability among the latter. There was no difference in alkaline phosphatase activity between the groups.

Conclusions

Chest wall repair with an autologous osseous graft engineered with amniotic mesenchymal stem cells leads to improved and more consistent outcomes in the midterm when compared with an equivalent acellular prosthetic repair in a leporine model. Amniotic fluid-derived engineered bone may become a practical alternative for perinatal chest wall reconstruction.

Section snippets

Materials and methods

This study was approved by the Institutional Animal Care and Use Committee of Children's Hospital Boston under protocol number A05-12-104.

Results

There was no mortality or postoperative complication after any of the chest wall reconstructions. At necropsy, complete closure of the defect was evident on gross inspection in all animals with engineered grafts. On the other hand, 3 (60%) of 5 rabbits that received acellular implants displayed evidence of nonunion on gross examination, suggested by a mobile sternum in the area of repair. This difference was not statistically significant on Fisher's Exact test, however, in this small early

Discussion

The current study builds on our prior work demonstrating the feasibility of this therapeutic concept, by providing a first look at the comparative efficacy of aMSC-based bone grafts in experimental chest wall reconstruction [10]. We continued to use the full-thickness sternal repair model here for a couple of reasons. On the one hand, this model does not allow for vascular in-growth into the graft from its dorsal aspect, which faces the (beating) heart, thus mimicking one of the more plausible

Acknowledgments

The authors are indebted to Dr Arthur Nedder, DVM, and Mr Mark Kelly for their exemplary veterinary care.

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Presented at the 61st Annual Meeting of the Section on Surgery, American Academy of Pediatrics, Washington, DC, 2009.

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