Spina bifida is a severe neurological malformation. If untreated, it leads to considerable physical and mental disabilities. Today, fetal surgery is the state-of-the-art treatment option to yield the best possible outcomes minimizing mechanical and/or neurotoxic and degenerative damage throughout gestation. In case of large defects, when the primary skin closure is not feasible, the availability of autologous skin and cartilage substitutes would be a great help. One limitation regarding the clinical application of fetal skin grafts in clinics for prenatal closure of spina bifida lesions is the necessity to conduct two separate fetal operations. First to obtain the fetal skin sample from the fetus, and second to close the spina bifida defect using laboratory-grown skin. Therefore, our principal goal is to develop fetal dermo-epidermal skin substitutes using pluripotent stem cells derived from amniotic fluid samples. Amniotic fluid can be easily obtained in relatively large quantities during frequently performed diagnostic amniocenteses. We want to isolate, identify and sort amniotic fluid stem cells by FACS. We want to culture and differentiate them into chondrocytes, fibroblasts and keratinocytes. We may become able to produce cartilage and dermo-epidermal skin substitutes with the aim of transplantation in an in vivo model and in the future to apply combined cartilage/skin in fetal surgery.
