Bladder Reconstruction with Human Amniotic Membrane in a Xenograft Rat Model: A Preclinical Study

Dimitri Barski, Holger Gerullis, Thorsten Ecke, Jin Yang, Gabriella Varga, Mihaly Boros, Isabel Pintelon, Jean-Pierre Timmermans, Thomas Otto, Dimitri Barski, Holger Gerullis, Thorsten Ecke, Jin Yang, Gabriella Varga, Mihaly Boros, Isabel Pintelon, Jean-Pierre Timmermans, Thomas Otto

Abstract

Background: Human amniotic membranes (HAMs) are assumed to have a number of unique characteristics including durability, hypoallergenic and anti-inflammatory properties. Materials and Methods: Multilayer HAMs from caesarian sections were applied to repair defined bladder defects in male Sprague-Dawley rats. The animals were sacrificed at 7, 21 and 42 days after implantation. Bladder volume capacity after grafting was measured. Histological analyses were performed to asses a number of parameters including HAM degradation, inflammatory reaction, graft rejection and smooth muscle ingrowth. Results: One rat died from sepsis in the treated group. No severe complications or signs of leakage were observed. Bladder capacity did not change over time. The initially increased inflammation in the HAM group diminished significantly over time (p<0.05). No signs of HAM degradation were observed and smooth muscle staining increased over time. Conclusions: HAMs appear to be durable and hypoallergenic grafts. The assumed suitability for the reconstruction of urinary tract justifies further research on detailed immunological process in larger grafts.

Keywords: IDEAL.; amniotic membrane; bladder augmentation; graft; rat experiment.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
A. Preparation of amniotic membrane with dissection from the chorion under laminar flow. B. Dried and cryopreserved multilayered amniotic membrane graft.
Figure 2
Figure 2
Bladder capacity pre- and postoperatively in the amnion treated group A and control group C1. The bladder capacity reduced significantly in the control group due to the scaring of the sutured lesion (* p˂0.05).
Figure 3
Figure 3
Macroscopic and histological evaluation (H&E staining) of inflammation and AM degradation over time (21 and 42 days after grafting). Reduction of inflammation over time. Decreased inflammatory cells (*) and increased vascularization (V) in the periamniotic transition zone were detected. No signs of AM degradation. Scale bar 200µm.
Figure 4
Figure 4
Reduction of inflammation over time, semiquantative analyses of inflammatory cells: Treated (A): Amnion repair of bladder defect. Control/Lesion (C1): Closure of bladder defect with suture. Control/Amnion (C2): Amnion bladder onlay without defect. Semi-quantitative score: 0 = 50%; 200x magnification. Data is expressed as median with range. *, significant reduction (p˂0.05).
Figure 5
Figure 5
Measurement of amnion thickness over time (7, 21 and 42 days): Treated (A): Amnion repair of bladder defect. Control/Amnion (C2): Amnion bladder onlay without defect. Data is expressed as mean with SD, p˂0.05.
Figure 6
Figure 6
Immunohistological analysis of a reconstructed urinary bladder wall at timepoint 3 (42 days). A: Amnion group, reconstruction with AM graft; B: Control group, reconstruction with suture, AM; Amniotic membrane, Ur; Urothelium, BL; lumen of urinary bladder, X; region of lesion in the bladder wall. (A) H&E staining displaying mild inflammatory infiltration. α-Actin staining reveals frequently arranged smooth muscle bundles (arrows). Strong immunoreactivity underneath the urothelium layer is observed. The region of the lesion can be clearly recognized in the control group with muscle bundles, while there is a smooth muscle ingrowth in the treated group.

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