Subconjunctival autologous muscle-derived mesenchymal stem cell therapy: A novel, minimally invasive approach for treating equine immune-mediated keratitis.

OBJECTIVE: To establish the safety of subconjunctival injections of autologous muscle-derived mesenchymal stem cells (mdMSCs) in healthy horses and to evaluate their effect in four horses (six eyes) with severe chronic equine immune-mediated keratitis (IMMK) that was unresponsive to medical treatments. METHODS: MdMSCs were cultured from minimally invasive muscle biopsies. In the safety group, four healthy horses received two subconjunctival injections of 2.5 and 5 million cells, respectively, at 1-month interval, to the same eye. Ocular side effects were monitored for 1 month following each injection. In the treatment group, six eyes received four to seven subconjunctival mdMSCs injections (2.5 or 5 million cells per injection) every 4 weeks, approximatively. Medical treatment was discontinued 1 week before and throughout the entire treatment period. A scoring system was used to assess the evolution of the ocular lesions. RESULTS: In the safety group, all horses exhibited mild to moderate chemosis and conjunctival hyperemia at the injection site, lasting 24-48 h. In the treatment group, all eyes initially responded positively to therapy, with a reduction in lesion scores observed after the first injection. Four eyes achieved control of the lesions with repeated injections during the 9.2 months of follow-up. CONCLUSION: The first subconjunctival injection of mdMSCs resulted in improvement of the ocular lesions. Repeated injections were found to be safe, minimally invasive and showed promise in managing refractory cases of equine IMMK. Further studies are warranted to demonstrate the long-term benefits of these injections and to optimize the therapeutic protocol.