Update on endometritis therapy

Abstract

IntroductionThe corner stones of equine endometritis therapy are still antimicrobials and support of uterine evacuation. Chelating agents are recommended to increase the effect of antibiotics particularly in biofilm producing organisms. The use of mucolytics has increased and kerosene and DMSO have been replaced by N-acetylcysteine. Immunomodulators, corticosteroids and cell-wall extracts, are the recent additions to our toolkit. Platelet-rich-plasma is the newest therapeutic method but needs still more research. Platelet-rich plasmaPlatelet-rich plasma (PRP) is autologous blood plasma that has been enriched with platelets by centrifugation. It contains -and releases through degranulation -several different growth factors and cytokines that stimulate tissue repair. Although PRP is used in many indications in human medicine, large-scale controlled clinical trials are lacking.Three abstracts have been published about the treatment of equine endometritis using PRP. Metcalf and Troedsson (2012) used 9 barren mares with a history of persistent mating induced endometritis (PMIE). The mares were inseminated and an endometrial biopsy was obtained the following day. All mares underwent an untreated cycle followed by a PRP-treated cycle. The mRNA expression of interleukins (IL) 1b, 6 and 8 and inducible nitric oxide synthase (iNOS) was significantly downregulated in the treated cycle as compared to the non-treated cycle. In the next experiment, Metcalf (2014) had 16 mares that had been barren for >2 years. The mares underwent a non-treated cycle and a cycle where 10 ml of PRP was infused into the uterus before insemination (AI). Pregnancy rate in the treated cycle was significantly higher than in the non-treated cycle (67 vs 19 %) and accumulation of intraluminal fluid was significantly less (22 vs 100 %). Reghini et al. (2014) inseminated 15 resistant and 8 susceptible mares in two cycles: treated and non-treated. In the treatment cycle, the mares received 20 ml of PRP into the uterus 4 h after AI. The resistant mares showed no differences between the cycles in NO concentration or in intrauterine (IU) fluid accumulation, but neutrophils in cytology diminished during the treated cycle. In susceptible mares, a significant decrease was observed after PRP treatment in the three parameters examined. All three experiments were conducted with a small number of mares, so no definite conclusions can be drawn. However, PRP might be worth trying to control PMIE in problem mares that do not seem to benefit from standard treatments. Immune modulatorsThe breeding induced inflammation involves chemokine-initiated recruitment of neutrophils to the uterus leading to the removal of excess spermatozoa and pathogens. There is a delicate balance between pro-and anti-inflammatory cytokines. Susceptible mares appear to have altered expression of cytokines, particularly a deficit in the production of anti- Summary: The corner stones of equine endometritis therapy are still antimicrobials and support of uterine evacuation. Ecbolic hormones, oxyt...

A Novel Approach to Minimising Acute Equine Endometritis That May Help to Prevent the Development of the Chronic State

“…The conventional methods to treat equine endometritis involve uterine lavage, with or without ecbolics such as oxytocin or prostaglandins, to aid uterine clearance, antibiotics (systemic or local), with vulvoplasty to correct conformational issues ( 56 ). These treatments have been available for decades and are well-reported in the literature, but the persistence of the problem in equine breeding suggests that new approaches might be necessary, perhaps in combination with some of the conventional therapies.…”