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Equine veterinary journal2026; doi: 10.1002/evj.70297

Antimicrobial effects of equine regenerative medicine products: A systematic review and meta-analysis of in vitro and in vivo studies.

Abstract: Equine regenerative medicine products involving platelet-rich plasma (PRP), mesenchymal stromal cells (MSCs), and their derivatives are increasingly explored for antimicrobial and therapeutic roles, but their efficacy and between-study variability remain unclear. Objective: To systematically review and meta-analyse in vitro and in vivo evidence on antimicrobial effects of equine regenerative medicine products and to evaluate their efficacy against key pathogens. Methods: Systematic review and meta-analysis: METHODS: We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses and searched studies (2010-2025) reporting PRP/MSC antimicrobial interventions in equine models. In vitro studies reporting colony-forming unit (CFU) outcomes were meta-analysed. Continuous outcomes were pooled as standardised mean differences (SMD; the mean difference divided by the pooled standard deviation with 95% confidence intervals [CI]), using a random-effects model. Heterogeneity was assessed by I and significance as p < 0.05. Predefined subgroup analyses by product class and pathogen were performed. Risk of bias was assessed with a predefined checklist. In vivo outcomes were synthesised narratively. Results: Twenty-four studies met inclusion criteria; 13/17 in vitro studies contributed CFU data for meta-analysis. Platelet-derived products showed a pooled SMD of 0.94 (95% CI 0.33-1.54; p = 0.003; I = 27%) against Staphylococcus aureus. Against Escherichia coli, regenerative products showed a non-significant effect (SMD 1.07; 95% CI 0.01-2.13; p = 0.05; I = 65%). MSC-based products produced a non-significant SMD of 0.55 (95% CI -0.46-1.55; p = 0.29; I = 38%) versus S. aureus. Seven in vivo studies reported clinical improvements, and combination therapies with antibiotics often enhanced bacterial clearance. Conclusions: Interpretation is limited by substantial methodological heterogeneity across studies and by potential risk of bias. Conclusions: Platelet-derived regenerative products demonstrate in vitro antimicrobial activity against a representative Gram-positive bacterium, S. aureus; however, current heterogeneous and limited in vivo evidence provides only tentative support for their use as adjuncts, rather than standalone antimicrobial therapies. Well-designed, standardised in vitro and in vivo studies are needed.
© 2026 EVJ Ltd.
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Publication Date: 2026-08-02 PubMed ID: 42543167DOI: 10.1002/evj.70297Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This research article systematically reviews and meta-analyzes the antimicrobial effectiveness of equine regenerative medicine products, specifically platelet-rich plasma (PRP) and mesenchymal stromal cells (MSCs), based on both in vitro and in vivo studies.
  • The study evaluates these products’ ability to inhibit pathogens commonly involved in equine infections, with a focus on Staphylococcus aureus and Escherichia coli.

Introduction and Research Objective

  • Equine regenerative medicine uses biologically derived products like PRP and MSCs to promote healing.
  • There is growing interest in the potential antimicrobial properties of these products, which could complement or replace antibiotics in treating infections in horses.
  • The main question addressed is how effective these products are against key pathogens, and how consistent these effects are across different studies.

Methodology

  • The authors conducted a systematic review following PRISMA guidelines to ensure rigorous and transparent study selection from 2010 to 2025.
  • They included studies investigating antimicrobial effects of PRP and MSCs in equine models, both in vitro (lab-based) and in vivo (within live animals).
  • For in vitro studies reporting bacterial growth outcomes quantified by colony-forming units (CFU), a meta-analysis was performed.
  • Data synthesis used standardized mean differences (SMD) to measure effect size, combining results from multiple studies using a random-effects model to account for variability among studies.
  • Heterogeneity among studies was assessed by the I² statistic; p-values <0.05 were considered statistically significant.
  • Subgroup analyses examined outcomes by product type (platelet-derived vs. MSC-based) and by specific pathogens (S. aureus and E. coli).
  • A risk of bias assessment was performed using a predefined checklist to evaluate study quality and potential sources of error.
  • In vivo studies’ results were summarized narratively, given variability and difficulty in quantitative synthesis.

Results – In Vitro Studies

  • Out of 24 studies fitting criteria, 13 of 17 in vitro investigations provided sufficient CFU data for meta-analysis.
  • Platelet-derived products demonstrated a statistically significant antimicrobial effect against Staphylococcus aureus, a representative Gram-positive bacterium.
  • The pooled SMD for platelet-derived products against S. aureus was 0.94 (95% CI: 0.33 to 1.54) with a p-value of 0.003, indicating a moderate positive effect and low-to-moderate heterogeneity (I² = 27%).
  • Against Escherichia coli, a Gram-negative bacterium, regenerative products showed a non-significant trend toward antimicrobial activity (SMD 1.07, 95% CI: 0.01 to 2.13, p = 0.05), but with considerable heterogeneity (I² = 65%).
  • MSC-based products exhibited a non-significant antimicrobial effect versus S. aureus (SMD 0.55, 95% CI: -0.46 to 1.55, p = 0.29, I² = 38%).

Results – In Vivo Studies

  • Seven in vivo studies reported improvements in clinical signs following treatment with regenerative products.
  • Evidence suggested that combining these regenerative therapies with traditional antibiotics often enhanced bacterial clearance compared to either treatment alone.
  • However, the in vivo data were limited and heterogeneous, preventing robust quantitative meta-analysis.

Conclusions and Implications

  • Platelet-derived equine regenerative medicine products have demonstrated measurable and statistically significant antimicrobial effects in vitro against Gram-positive bacteria, particularly Staphylococcus aureus.
  • The evidence for efficacy against Gram-negative bacteria like E. coli and for MSC-based products is less clear and generally non-significant so far.
  • In vivo evidence is limited, mixed, and does not yet strongly support the use of these products as standalone antimicrobial therapies.
  • They may be useful as adjunctive treatments when combined with antibiotics, improving bacterial clearance and possibly enhancing healing outcomes.
  • The studies reviewed suffer from methodological heterogeneity and varying quality, making interpretation difficult.
  • The authors emphasize the need for well-designed, standardized, and adequately powered in vitro and in vivo studies to clarify the antimicrobial potential and clinical utility of these equine regenerative medicine products.

Significance and Future Directions

  • This review highlights potential avenues for antimicrobial therapy in veterinary medicine that could reduce reliance on antibiotics and help address antibiotic resistance challenges.
  • Further research should focus on:
    • Standardizing preparation and evaluation protocols for PRP and MSC products.
    • Conducting controlled clinical trials with relevant equine infectious disease models.
    • Elucidating mechanisms by which regenerative products exert antimicrobial effects.
    • Determining optimal combinations with antibiotics to maximize clinical benefit.

Cite This Article

APA
Chen S, Jia Y, Yang L, Xie Y, Zhu Y, Li J. (2026). Antimicrobial effects of equine regenerative medicine products: A systematic review and meta-analysis of in vitro and in vivo studies. Equine Vet J. https://doi.org/10.1002/evj.70297

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Chen, Shuyao
  • Dongfangmadu Equine Teaching Hospital, College of Veterinary Medicine, China Agricultural University, Beijing, China.
Jia, Yuchen
  • Dongfangmadu Equine Teaching Hospital, College of Veterinary Medicine, China Agricultural University, Beijing, China.
Yang, Luo
  • Dongfangmadu Equine Teaching Hospital, College of Veterinary Medicine, China Agricultural University, Beijing, China.
Xie, Yuxin
  • Dongfangmadu Equine Teaching Hospital, College of Veterinary Medicine, China Agricultural University, Beijing, China.
Zhu, Yiping
  • Dongfangmadu Equine Teaching Hospital, College of Veterinary Medicine, China Agricultural University, Beijing, China.
  • State Key Laboratory of Veterinary Public Health and Safety, China Agricultural University, Beijing, China.
Li, Jing
  • Dongfangmadu Equine Teaching Hospital, College of Veterinary Medicine, China Agricultural University, Beijing, China.
  • State Key Laboratory of Veterinary Public Health and Safety, China Agricultural University, Beijing, China.

Grant Funding

  • ZZYD2025010 / Xinjiang Talent Development Fund

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