Human Placental Allograft Membranes: Promising Role in Cardiac Surgery and Repair

Abstract

Despite the immense investment in research devoted to cardiovascular diseases, mechanisms of progression and potential treatments, it remains one of the leading causes of death in the world. Cellular based strategies have been explored for decades, having mixed results, while more recently inflammation and its role in healing, regeneration and disease progression has taken center stage. Placental membranes are immune privileged tissues whose native function is acting as a protective barrier during fetal development, a state which fosters regeneration and healing. Their unique properties stem from a complex composition of extracellular matrix, growth factors and cytokines involved in cellular growth, survival, and inflammation modulation. Placental allograft membranes have been used successfully in complex wound applications but their potential in cardiac wounds has only begun to be explored. Although limited, pre-clinical studies demonstrated benefits when using placental membranes compared to other standard of care options for pericardial repair or infarct wound covering, facilitating cardiomyogenesis of stem cell populations in vitro and supporting functional performance in vivo. Early clinical evidence also suggested use of placental allograft membranes as a cardiac wound covering with the potential to mitigate the predominantly inflammatory environment such as pericarditis and prevention of new onset post-operative atrial fibrillation. Together, these studies demonstrate the promising translational potential of placental allograft membranes as post-surgical cardiac wound coverings. However, the small number of publications on this topic highlights the need for further studies to better understand how to support the safe and efficient use of placenta allograft membranes in cardiac surgery.

Epicardial placement of human placental membrane allografts in coronary artery bypass graft surgery is associated with reduced postoperative atrial fibrillation: a pilot study for a future multi-center randomized controlled trial

“…However, the time course of POAF, occurring within the first 5 days of surgery corresponds to a higher level of inflammatory biomarkers [11], such as the advanced glycation end products (AGE) pathway and reactive oxygen species (ROS), linked with high levels of epicardial and pericardial inflammation on post-operative days 3-6 [12]. Additionally, some anti-inflammatory agents have shown some early promise in reducing POAF incidence [13] with early studies of placental tissue in cardiovascular applications also showing success [14].…”

Human placental membrane placement in coronary artery bypass grafting surgery is associated with reduced postoperative atrial fibrillation

“…Additionally, some anti-inflammatory agents have shown some early promise in reducing POAF incidence 15 . Similarly, early exploration of the use of placental tissue in cardiovascular applications has also shown some success 16 . Briefly, placental tissue is known to be immune privileged and contains numerous growth factors and cytokines involved in cell behavior, inflammation, and angiogenesis [17][18][19][20][21] .…”

Use of the Human Placenta in the Healing of Foot Ulcers in People With Diabetes: Integrative Review

“…The human placenta and its derivatives (umbilical cord, placental disc, sac and amniotic fluid) are privileged immune tissues, with a complex composition of extracellular matrix rich in nutrients, growth factors and cytokines involved in cell growth, survival and modulation of inflammation 1 .…”

“…In view of these particular characteristics, placenta has been successfully used for the treatment of difficult-toheal wounds, such as diabetes mellitus (DM) ulcers [1][2][3] . This is a relevant finding, given that neuropathic ulcers caused by DM are a serious and costly complication for the Brazilian National Health System.…”