Download AlloWrap Surgeon Presentation

What is so Interesting About Fetal Healing?
Spina
Bifida
100% chance
of being
Paralyzed
Fetal Surgery?
NIH
Study
Hundreds of
Surgeries
Performed
50% chance of
success now
Unexpected
Find?
Despite Large
Incisions
during Surgery
No Scars…
(https://www.youtube.com/watch?v=iP9LlyHDXpc)
Amniotic Membrane Regulates Healing
Response to Trauma
Repair
Regeneration
Protect: Scar
Restore to Original
(1992 - Scarless Fetal Healing, Therapeutic Implications (Adzick))
Amniotic Membrane Regulates Healing
Growth
Factors
Cytokines
Promotes
Cell
Proliferation
Regulate
Cell
Proliferation
(2012 - AM, From Structure and Functions to Clinical Applications (Mamede))
History of Amniotic Membrane (AM)
What is Amniotic Membrane?
•
Placental based Tissue harvested from
Living Donors
•
First used in 1910 as wound dressing
•
1990’s ocular
•
Today: Surgical Barrier, Wound Care,
Dressing, Ocular, Spine, F&A….
Amniotic Membrane
How can amniotic
membrane help prevent
adhesions?
1. Physical Separation
2. Chemical Signaling
Ideal Wound Barrier or Soft Tissue Wrap
1. Physical
Separation
Ideal
Wound
Barrier
2. Chemical
Signaling
1. Physical Separation: Stays in the Body Past Critical Healing Stage
Stages of Healing
1.
Injury/Bleeding
–
–
2.
Inflammation
–
–
–
3.
“Cleans up the debris”
Protects against infection
Becomes the bad guy eventually
(Remember this!)
Proliferation
–
–
–
–
4.
“Caps the Pipes”
Body sends coagulants
“Build a new Framework”
Cell rebuilding and growth
Fibrosis can get out of control
Scarring
Remodeling
(1989 - Phys Therapy - The Biology of Scar Formation (Hardy 1989))
1. Physical Separation: Stays in the Body Past Critical Healing Stage
Inflam
Proliferation
Tissue Presence
High
Remodeling
AlloWrap
Other Barriers
Low
0
10
20
30
Days in Healing Process
40
1. Physical Separation: Stays in the Body Past Critical Healing Stage
HUMAN AMNIOTIC TISSUE AS AN
ANTI-ADHESION, ANTI-FIBROTIC
BARRIER IN AN OVINE SPINAL
LAMINECTOMY MODEL
• Collaboration with Colorado State
University
• Ovine Laminectomy Model
• Study Design
–
– 8 weeks in-vivo
– Two implants per sheep
– Locations: (L5/L4; L2/L3)
Conclusion: At 8 weeks, AlloWrap was
still present as a surgical barrier.
1. Physical Separation: Stays in the Body Past Critical Healing Stage
ALLOWRAP® SURGICAL BARRIER
REMAINS IN THE BODY THROUGH
THE CELL PROLIFERATION PHASE
OF THE HEALING PROCESS WHILE
OTHER SURGICAL BARRIERS ARE
RESORBED
• Evaluation of the critical stages of
healing
• Comparison of other surgical
barriers
• Conclusion: AlloWrap remains in the
body passed the cell proliferation
stage of healing and into the
remodeling stage
Ideal Wound Barrier or Soft Tissue Wrap
1. Physical
Separation
Ideal
Wound
Barrier
2. Chemical
Signaling
2. Chemical Signaling – Growth Factor Regulation
Growth
Factors
Cytokines
Promotes
Cell
Proliferation
Regulate
Cell
Proliferation
2. Chemical Signaling – Anti-Inflammatory
Inflammation
Proliferation
Growth
Factors
Cytokines
Promotes
Cell
Proliferation
Regulate Cell
Proliferation
IL-10
HLA
IL-8
•
•
•
IL-8-pro-inflammatory chemokine
HLA-ligand to CD44 which is expressed
on inflammatory cell
Stromal matrix signals
(2004 - Laboratory Science - How Does Amniotic Membrane Work (Tseng))
Stromal
2. Chemical Signaling – Anti-Scarring
Inflammation
IL-8
FGF
IL-6
Proliferation
Growth
Factors
Cytokines
Promotes
Cell
Proliferation
Regulate Cell
Proliferation
IL-10
TGF-β
TNF- α
•
•
•
•
FGF
Amniotic Membrane down regulates TGF-B
Fibroblast response to scar-promoting cytokines is different
in adults vs. infants
IL-10 suppresses IL-6, IL-8, and TNF-α
Production of Neurotrophic factors-promote scarless healing
(2004 - Laboratory Science - How Does Amniotic Membrane Work (Tseng))
2. Chemical Signaling – Anti-Microbial
Defensin
•
Defensins
–
–
•
Epithelial cell surfaces are antimicrobial
Bind to bugs and destroy them
Elastase Inhibitors
–
–
Secrete proteinase inhibitor Elafin
Inactivates invading microbes
2001 - Journal of Bio Chem - Isolation & Char of Human b-Defensin-3, a Novel Human Inducible Peptide Antibiotic (Harder)
2003 - Reprod Biology & Endo - Innate Immune Defences in the Human Endometrium (King)
Science of Amniotic Membrane: Immune Privilege
Body Response to Foreign Object
• Surgical
Intervention
2
• Foreign
Object
Detected
1
(1995 - Unraveling Immune Privilege (Streilein))
• Immune
response by
Body
3
4
• Antibodies
Invade &
Fight
• Delayed
Healing
5
Science of Amniotic Membrane: Immune Privilege
Why Doesn’t the Body See
AM as a Foreign Body?
• If the body sees foreign DNA, the
body will attack cells
• Every fetus contains foreign DNA
• AM protects the fetus from being
identified as a foreign entity.
• Therefore, AM is naturally
Immune Privilege.
(1995 - Unraveling Immune Privilege (Streilein))
Amniotic Membrane
How can amniotic membrane
help prevent adhesions?
1. Physical Separation
•
Remains in the body past
fibrosis stage
•
Other therapies dissolve too
quickly
2. Chemical Signaling
•
Down Regulates Inflammation
•
Down Regulates Fibrosis
which causes scarring
How has Amniotic Membrane Been Used?
Burn (Ocular or Facial)
Craniotomy
(Tomita)
(Branski, Safawi)
Laminectomy
(Sameniego, Tao, Choi)
Ulnar or Flexor Nerves
(Kim, Demirkan, Ozgenel)
Tethered Cord
(Nakaji)
Abdominal Repair
or OBGYN
Sciatic Nerve
(diZerega)
Achilles
(Jay)
Diabetic
Wounds
Achilles, Tarsal
Tunnel, or Neuroma
(Jay, Ng)