Clinical Outcomes and Safety of Tendon-Derived Mesenchymal Stem Cell Therapy

Clinical Outcomes and Safety of Tendon-Derived Mesenchymal Stem Cell Therapy in Equine Tendon and Ligament Injuries

J Equine Vet Sci. 2026 Nov 5:106203. doi: 10.1016/j.jevs.2026.106203. Online ahead of print.
Authors
M Levoz 1 , J Piret 2 , V Toppets 2 , M K Shikh Alsook 2 , J-F Kaux 3 , N Antoine 2 , M Vandersmissen 4 , L Evrard 4 , G De La Rebière de Pouyade 4
Affiliations

1 Department of Morphology and Pathology, Histology, FARAH, Quartier Vallée 2, B43a, Uliège, 4000, Liège, Belgium. Electronic address: marine.levoz@uliege.be.
2 Department of Morphology and Pathology, Histology, FARAH, Quartier Vallée 2, B43a, Uliège, 4000, Liège, Belgium.
3 Physical Medicine Service and Department of Motility Sciences, GIGA, Avenue de l’Hôpital 11, B34, Uliège, 4000, Liège, Belgium.
4 Equine Teaching and Clinical Department, Surgery, FARAH, Quartier Vallée 2, B43a, Uliège, 4000, Liège, Belgium.

PMID: 42988184
DOI: 10.1016/j.jevs.2026.106203

Abstract

Background: Equine tendinopathies and desmopathies are common musculoskeletal disorders characterized by a limited regenerative capacity and a high risk of recurrence. Tendon-derived mesenchymal stem cells (TDSCs) represent a promising regenerative therapy due to their immunomodulatory and pro-regenerative properties.

Objectives: This preliminary prospective clinical study aimed to evaluate the safety and potential efficacy of allogeneic post-mortem TDSCs, for the treatment of superficial digital flexor tendon (SDFT) and suspensory ligament (SL) injuries in horses.

Methods: Nine horses were monitored longitudinally for up to 18 months following intralesional TDSC injection. Clinical outcome was assessed using subjective lameness evaluation, objective locomotion analysis with inertial sensors and standardized ultrasonographic examinations.

Results: The treatment was well tolerated, with no major adverse effects, supporting the low immunogenicity of allogeneic TDSCs. Overall clinical improvement was observed during the follow-up period and was consistent with improved locomotor symmetry measured objectively. Ultrasonographic findings suggested favorable tissue remodeling, including a reduction in hypoechoic lesions and progressive reorganization of the fibrillar architecture. However, treatment responses were heterogeneous, with SDFT lesions showing earlier clinical and ultrasonographic improvement than SL lesions. Nevertheless, this trend was not reflected in long-term outcomes, as only two horses, both presenting SL lesions, returned to their previous level of competition without reported recurrence.

Conclusion: Allogeneic TDSCs appear to be a safe and promising therapeutic approach for equine tendon and ligament injuries. Nevertheless, their ability to reduce long-term recurrence remains uncertain and should be investigated in larger controlled clinical trials.

Keywords: Desmopathy; horse; mesenchymal stem cells; tendinopathy; treatment.

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