cell attachment and growth. As with any component of the cell culture system, it is advisable to test new and old plastic ware in parallel for toxicity and ability to support growth in vitro. Hoehn's laboratory switched several times between Corning and Falcon and tested additional brands because of considerable fluctuations in quality.604
Incubator failure
Incubator failure is not a trivial cause of culture loss. The main threats are breakdown of the gas supply or equipment. AF cells cannot tolerate a pH close to or higher than 8 for more than 6–8 hours. On the other hand, a pH of less than 7.0 (for example, due to excess CO2 in the incubator) causes cells to stop dividing. A second danger is overheating of incubators due to mechanical failure or human error. Connection of incubators to emergency power sources is important. Temperature‐ and gas‐sensitive alarm systems are advisable.
Record keeping and quality control
With the advent of highly standardized cell culture methods, culture hazards have become a much rarer cause for concern in the prenatal diagnosis laboratory. Due to the greater number of specimens processed by the average laboratory, a variety of quality‐control measures need to be followed to avoid mistakes ranging from culture mixups to diagnostic errors. The most common and potentially serious laboratory errors are human errors in labeling and cross‐contamination of samples. Labeling errors can occur at any stage where cells are transferred between vessels: in the amniocentesis procedure room, at culture initiation, feeding and subculture, harvest, slide making, and even microscope analysis. Cross‐contamination of cells between patient samples is most common at the time of cell culture harvest, especially for suspension harvests. For these reasons, quality control and quality assurance programs must include a nonpunitive recording system for all laboratory events. A regular review of those events should seek patterns of error that can be eliminated by continuing education of laboratory staff or (often more effective) process improvement directed at reducing the opportunity for human error.
Laboratory directors and supervisors should be familiar with the College of American Pathologists Laboratory General and Cytogenetics checklists and the American College of Medical Genetics Standards and Guidelines.665 Laboratories should also participate in a peer review system such as the CAP proficiency surveys.
Safety in the laboratory
It is the responsibility of the laboratory director and all the laboratory staff to protect the rights, privacy and health of employees, ancillary staff and patients alike. AF specimens and all cultures up to the stage of fixation should be treated as potentially hazardous. Universal precautions are essential. Available resources include the CAP Safety Checklist and excellent reviews of laboratory safety and management.672–674
Mesenchymal stem cells in amniotic fluid
Multipotent mesenchymal stem cells (MSCs) can be obtained from several tissue sources and are of great interest for their potential uses in gene therapy and tissue repair. Those derived from adult bone marrow or other sources apart from AFCs have some drawbacks including their relative rarity and slow rate of proliferation in vitro. In contrast, MSCs derived from AFCs have distinct advantages.675–679 MSCs comprise about 1 percent of the cells in midtrimester AF and likely derive from fibroblastic F‐type cells.675 Recent advances in the isolation and culture of MSCs from AF are welcomed because these cells apparently do not form teratomas and are not tumorigenic even after many passages. Amniotic MSCs proliferate well and have stable normal telomeres, cytogenetics, and cell surface markers of pleuripotency, similar to embryonic stem cells. Amniotic MSCs also circumvent ethical objections associated with the use of embryonic stem cells.
Although more research is needed, amniotic MSCs appear to have immunogenic characteristics that are favorable for allogenic transplantation.680 They can be coaxed into differentiation along many lineages such as adipogenic, osteogenic, myogenic, endothelial, neurogenic, pancreatic, and hepatic, and including mesodermal, ectodermal, and endodermal lineages.480, 676, 678, 681–683 These cells are likely to find utility in a wide variety of cellular therapies,481, 675 including anticancer combination therapy.684 In a demonstration of whole‐tissue engineering for early repair of congenital malformations, heart valves have been fabricated using amniotic MSCs. The engineered heart valves exhibited normal endothelial surfaces and adequate opening and closing behavior.479 Under appropriate conditions, amniotic MSCs can form bone.676 The potential exists for amniotic MSCs to be employed for engineering tissues in time to be implanted shortly after birth to repair malformations of the heart, skin, bladder, or diaphragm.479, 685–687 This approach is unlikely, at least in the short term, to be helpful in the fetal therapy of spina bifida (see Chapters 29 and 30).
References
1 1. Parkin FM, Lind T, Cheyne GA. Biochemical and cytological changes in liquor amnii with advancing gestation. J Obstet Gynaecol Br Commonw 1969; 76:673.
2 2. Lind T, Hytten FE. Relation of amniotic fluid volume to fetal weight in the first half of pregnancy. Lancet 1970; i:1147.
3 3. Bourne GL. The anatomy of the human amnion and chorion. Proc R Soc Med 1966; 59:1127.
4 4. Bourne GL. The human amnion and chorion. London: Lloyd‐Luke, 1962.
5 5. Behrman RE, Parer JT, De Lannoy CW, Jr. Placental growth and the formation of amniotic fluid. Nature 1967; 214:678.
6 6. Seeds AEJ. Dynamics of amniotic fluid. In: Natelson S, Scommegna A, Epstein MB, eds. Amniotic fluid. New York: Wiley, 1974:23.
7 7. Nicolini U, Fisk NM, Talbert DG, et al. Intrauterine manometry: technique and application to fetal pathology. Prenat Diagn 1989; 9:243.
8 8. Fisk NM, Ronderos‐Dumit D, Tannirandorn Y, et al. Normal amniotic pressure throughout gestation. Br J Obstet Gynaecol 1992; 99:18.
9 9. Barbera A, Buscaglia M, Ferrazzi E, et al. Intra‐amniotic pressure is not affected by amniocentesis between 13 and 18 weeks of gestation. Eur J Obstet Gynecol Reprod Biol 1993; 50:185.
10 10. Hutchinson DL, Hunter CB, Neslen ED, et al. The exchange of water and electrolytes in the mechanism of amniotic fluid formation and the relationship to hydramnios. Surg Gynecol Obstet 1955; 100:391.
11 11. Pritchard JA. Deglutition by normal and anencephalic fetuses. Obstet Gynecol 1965; 25:289.
12 12. Hutchinson DL, Gray MJ, Plentl AA, et al. The role of the fetus in the water exchange of the amniotic fluid of normal and hydramniotic patients. J Clin Invest 1959; 38:971.
13 13. Gulbis B, Jauniaux E, Jurkovic D, et al. Biochemical investigation of fetal renal maturation in early pregnancy. Pediatr Res 1996; 39:731.
14 14. Thomas CR, Lang EK, Lloyd FP. Fetal pyelography – a method for detecting fetal life. A preliminary report. Obstet Gynecol 1963; 22:335.
15 15. Hibbard BM. Polyhydramnios and oligohydramnios. Clin Obstet Gynecol 1962; 5:1044.
16 16. Brace RA. Amniotic fluid volume and its relationship to fetal fluid balance: review of experimental data. Semin Perinatol 1986; 10:103.
17 17. Lotgering FK,Wallenburg HC. Mechanisms of production and clearance of amniotic fluid. Semin Perinatol 1986; 10:94.
18 18. Tervilae L. Transfer of water from maternal blood to amniotic fluid of live and dead fetuses in health and in some pathological conditions of the mother. A study with tritium‐labelled water. Ann Chir Gynaecol Fenn 1964; 53:1.
19 19. Bourne GL, Lacy D. Ultra‐structure of human amnion and its possible relation to the circulation of amniotic fluid. Nature