Harnessing decellularized amniotic membrane properties for ureteral repair: A fibromodulin-driven approach

Ureteral reconstruction remains a significant challenge due to the risk of fibrosis and insufficient epithelial regeneration, leading to suboptimal outcomes with current surgical techniques. To address these issues, a tubular porous scaffold was developed by integrating enzymatically digested decellularized amniotic membrane (dAM) with silk fibroin and gelatin solutions, utilizing freeze-drying, compression, and cross-linking techniques. Proteomic analysis revealed that the scaffold retained key bioactive properties of dAM, promoting epithelial regeneration while inhibiting fibrosis in vitro and in vivo. Transcriptomic analyses revealed that fibromodulin (Fmod) upregulation in the scaffold modulates TGF-β1-related biological pathways, contributing to its antifibrotic effects. This study bridges biomaterial innovation with clinical needs, offering a promising strategy for scarless ureteral repair and providing a strong theoretical foundation for the translational application of dAM in regenerative medicine.