Fetal surgery is about trying to save the lives
or improve the lives of children by doing
something before birth.
It sounds like a crazy idea, operating inside the womb,
but it's actually 30-years-old now
and we've been doing it a long time.
Spina bifida is a birth defect where the
spinal cord and the spine don't form normally before birth.
It fails to close.
And because of that, that spinal cord is exposed
to the elements in utero and then in theory,
after birth.
In the old days, we just took care of that
problem after birth and protected the spinal
cord, closed up the skin so that children
would not get infected.
They wouldn't get meningitis, an infection in the spinal cord,
but we never had the expectation
that it would improve their paralysis.
We just assumed that paralysis was part of
the problem of spina bifida.
But we started to learn through the advent of ultrasound
and by doing some studies in
mice and things like that,
that it appeared that the spinal cord, even though it was exposed
was normal when it was formed.
And it just seemed to lose function during gestation,
that it was the trauma in utero.
The exposure to amniotic fluid,
just bumping up against the uterine wall that actually
damaged the spinal cord.
So, gosh, almost 20 years ago now,
we asked the question, if we operated before birth,
could that make the outcomes better?
That's a study that was called the MOMS Trial.
And interestingly, that was just finishing at the time I came to UC Davis.
And what we discovered was that if you operated before birth,
if you did fetal surgery, that
in fact, those children did have a better outcome.
I mean, this was miraculous.
For the first time,
the babies had some improvement
in the ability to move their legs and it appeared
that the spinal cord was somewhat improved.
And I thought, "If we can get some improvement, maybe we can get more improvement."
We looked at different kinds of cells.
iPS cells were popular at the time,
but we finally settled on mesenchymal stem cells
from the placenta.
We collaborated with Jan Nolta's group in the Institute for Regenerative Cures here
at UC Davis, got advice and assistance from her.
And then we took these special cells from the placenta,
cultured them in a unique way
that allowed these cells to secrete what I like to call
"magic stem cell juice."
We don't know exactly how it works,
but we certainly know that it secretes lots of important
growth factors for the spinal cord.
We used a patch that is already approved
by the FDA to repair problems either in the spinal
cord or the brain when they need an extra layer
to sort of close up what we call the
dura, the lining of the central nervous system of the brain and the spinal cord.
And we thought, "Well, let's see if our cells
can grow on this already FDA approved "dural patch."
And not only did they grow, they seem to love it,
but it's the same repair that was done
for the big national trial.
But this time we'll use a repair
that includes this patch with cells on it.
The reason it's important to do it
almost exactly the same way it was done before is
so that we can compare the results
in a similarly rigorous fashion.
So that we know it's really the cells that are making a difference.