Abstract：
Defining the optimal therapy for endometritis remains a significant challenge for clinicians. Given the public health threat posed by antibiotic resistance and the inconclusiveness of traditional therapies, regenerative medicine has been proposed as an alternative. The objective of this study was to conduct a comprehensive systematic review and meta-analysis, to investigate the efficacy of regenerative medicine products in the treatment of both post-breeding persistent and chronic degenerative endometritis (PBIE/CDE) in mares, following the PRISMA guidelines. This research could be a comprehensive scientific reference for determining appropriate treatments and clinical strategies. All studies exploring the use of regenerative medicine therapies (i.e., plasma products, autologous conditioned serum, mesenchymal stem cells MSCs, and MSC derivatives) in the treatment of PBIE/CDE were included, regardless of the specific protocol used, the evaluated outcomes, or the diagnostic method employed. Two authors independently gathered data and evaluated the risk of bias for each study. Treatment effects were assessed using risk ratios for dichotomous data, accompanied by 95 % confidence intervals. Data were aggregated utilizing the fixed-effects model. The quality of evidence for each outcome was evaluated using GRADE criteria. Eighteen studies were included in the systematic review, while fifteen trials were included in the meta-analysis. A sub-meta-analysis was conducted separately on platelet-derived products, as well as on MSCs and their derivatives. The results demonstrated an overall positive effect of regenerative therapies in treating PBIE/CDE, particularly those involving MSCs and their derivatives. The positive outcomes include an anti-inflammatory effect, characterized by reduced intrauterine fluid accumulation, neutrophils, and cytokine concentrations. Additionally, improvements in pregnancy, foaling, and embryo recovery rates have been observed in some cases. Despite the limited number of randomized controlled studies and the high variability among protocols, including the timing of treatment, type, and volume of products used, the use of regenerative products, especially MSCs and their derivatives, has promising results in terms of both efficacy and safety for treating PBIE/CDE in mares.
摘要：
确定子宫内膜炎的最佳治疗方法仍然是临床医生面临的重大挑战。鉴于抗生素耐药性带来的公共卫生威胁和传统疗法的不确定性，再生医学已被提议作为替代方案。本研究的目的是进行全面的系统评价和荟萃分析，研究再生医学产品治疗母马繁殖后持续性和慢性退行性子宫内膜炎（PBIE/CDE）的疗效，遵循PRISMA准则。这项研究可以为确定适当的治疗方法和临床策略提供全面的科学参考。所有探索使用再生医学疗法的研究(即，等离子产品,自体条件血清，间充质干细胞,MSCs,和MSC衍生物）在PBIE/CDE的治疗中被包括，不管使用的具体协议，评估的结果，或采用的诊断方法。两位作者独立收集了数据，并评估了每项研究的偏倚风险。使用二元数据的风险比评估治疗效果，伴随着95%的置信区间。使用固定效应模型汇总数据。使用GRADE标准评估每个结果的证据质量。18项研究纳入了系统评价，而15项试验被纳入荟萃分析.分别对血小板衍生产品进行了亚荟萃分析，以及MSC及其衍生物。结果表明，再生疗法在治疗PBIE/CDE方面具有整体积极作用，特别是涉及MSC及其衍生物的那些。积极的结果包括抗炎作用，以减少宫内积液为特征，中性粒细胞，和细胞因子浓度。此外,改善怀孕，foaling,在某些情况下观察到胚胎恢复率。尽管随机对照研究的数量有限，方案之间的差异很大，包括治疗的时机,type,和使用的产品数量，再生产品的使用，特别是MSC及其衍生物，在治疗母马PBIE/CDE的疗效和安全性方面均有希望的结果。
