Immunohistochemical and Histopathological Characterization of Spina Bifida Defect Tissues Removed After Prenatal and Postnatal Surgical Repair

Abstract

Background: Myelomeningocele or spina bifida is an open neural tube defect that is characterized by protrusion of the meninges and the spinal cord through a deformity in the vertebral arch and spinous process. Myelomeningocele of post-natal tissue is well described; however, pre-natal tissue of this defect has no known previous histologic characterization. We compared the histology of different forms of pre-natal myelomeningocele and post-natal myelomeningocele tissue obtained via prenatal intrauterine and postnatal surgical repairs. Methods: Pre-and post-natal tissues from spina bifida repair surgeries were obtained from lipomyelomeningocele, myeloschisis, and myelomeningocele spina bifida defects. Tissue samples were processed for H&E and immunohistochemical staining (KRT14 and p63) to assess epidermal and dermal development. Results: Prenatal skin near the defect site develops with normal epidermal, dermal, and adnexal structures. Within the grossly cystic specimens, histology shows highly dense fibrous connective tissue with complete absence of a normal epidermal development with a lack of p63 and KRT14 expression. Conclusion: Tissues harvested from prenatal and postnatal spina bifida repair surgeries appear as normal skin near the defect site. However, cystic tissues consist of highly dense fibrous connective tissue with complete absence of normal epidermal development.

Keywords:

• Histology
• immuno­chemistry
• prenatal
• postnatal
• spina bifida

Acknowledgments

The authors would like to thank the University of Colorado School of Medicine Morphology and Phenotyping Core for their assistance with tissue processing and H&E staining. We would also like to thank the University of Colorado-Department of Surgery Academic Enrichment Fund for their financial support for this work. This work was presented as a poster at the American Academy of Dermatology conference in 2023.

Author contributions

The manuscript was written through contributions of all authors. All authors have given approval to the final version of the manuscript. James Bardill and Melissa Laughter conducted histology, imaging, data analysis, and manuscript writing. Jaclyn Anderson reviewed histology and immunohistochemistry stains and conducted manuscript writing. Ahmed Gilani performed histology and manuscript review. Hilary Hoffman collected and processed tissues, and manuscript review. Maranke Koster assisted with imaging, histological analysis and manuscript review. Ahmed Marwan wrote the IRB protocol, performed prenatal surgeries for tissue collection, provided direction and guidance for all aspects of this study, and participated in critical review of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Research Scholar Award, Research Institute – Children’s Hospital Colorado. Academic Enrichment Fund Grant, Department of Surgery, University of Colorado Anschutz Medical Campus.