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Increased folic acid consumption by women has helped reduce the incidence of spina bifida, a serious birth defect in which a portion of the spinal cord and its surrounding structures develop outside the body. But it remains a relatively common condition. While attempts are being made to repair spina bifida in utero with fetal surgery, spinal cord function shows only limited improvement, and researchers at Children's Hospital Boston remain unsatisfied.
"To date, all that has been attempted is the prevention of further insult to the cord, rather than repairing the damage that has already occurred in utero," notes Dario Fauza, MD, of Children's Department of Surgery and Advanced Fetal Care Center.
Now, a pilot animal study led by Fauza provides preliminary evidence in support of a better treatment using neural stem cells (NSCs), which have been shown to be involved in the repair of a number of central nervous system abnormalities. In the study, Fauza's team did typical in utero surgical repair on fetal lambs, but augmented it in some of the animals by infusing NSCs directly into the spinal cord. To maximize the cells' regenerative impact, the researchers introduced them relatively early in spinal cord development. The cells engrafted in the most damaged areas and produced chemical factors that protect nerve cells and encourage nerve growth—the first steps in initiating a repair process. The findings appeared in the September 2008 issue of the journal Surgery. One of the next steps, currently underway in animals, is to have the fetus provide its own NSCs.
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