Toll-like receptor 3-activated allogeneic umbilical cord blood-derived mesenchymal stromal cells as an adjunct for the treatment of synovial sepsis in 3 horses.

TLR-3-activated CB-MSCs may resolve resistant equine septic synovitis when combined with conventional therapy.

This case series describes the treatment of three horses with chronic or antimicrobial-resistant septic synovitis using TLR-3-activated allogeneic umbilical cord blood-derived mesenchymal stromal cells (CB-MSCs) as an adjunctive therapy. All horses presented with severe lameness, joint effusion, and synovial fluid parameters consistent with sepsis. Cases 2 and 3 involved antimicrobial-resistant bacterial infections, while cases 2 and 3 also presented with concurrent osteitis and septic tendinitis. Despite standard treatment with systemic and regional antimicrobials and synovial lavage, cases 1 and 2 showed inadequate response. All three horses received 20 million TLR-3-activated CB-MSCs administered via regional limb perfusion or direct intra-articular injection. Following the combination treatment approach, septic synovitis was resolved in all cases. The authors suggest that TLR-3-activated CB-MSCs represent a promising adjunctive therapeutic option for managing challenging septic synovitis cases, particularly those involving chronic or antimicrobial-resistant infections, and highlight the importance of developing alternative treatment strategies in response to rising antimicrobial resistance.

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