Intravenous allogeneic mesenchymal stromal cell therapy in 13 Pugs with presumptive early necrotizing meningoencephalitis

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Objective: To describe the tolerability and activity of IV allogeneic mesenchymal stromal cell (MSC) therapy in 13 Pugs with presumptive early necrotizing meningoencephalitis (NME). Methods: 255 Pugs were screened from 2021 to 2024 for neurological examination (NE) abnormalities suggestive of early NME. All dogs received a minimum of 2 NEs spaced 2 to 4 weeks apart. An NE score (NES) was assigned at each visit. Magnetic resonance imaging, CSF analysis, and infectious disease testing was obtained in all affected Pugs. Pugs with consistent or progressive NES and MRI or CSF findings supportive of early NME were eligible for MSC therapy. Results: NE abnormalities prior to MSC therapy included spinal hyperesthesia (11 of 13 [85%]), paw placement deficit (11 of 13 [85%]), menace deficit (9 of 13 [69%]), obtundation (9 of 13 [69%]), seizures (7 of 13 [54%]), and ataxia (4 of 13 [31%]). The NES improved in all dogs within 24 hours of the first dose of MSC (mean improvement, 86%). Mild adverse events were noted after 3 of 30 MSC doses (10%). All 13 dogs are currently in remission (follow-up time, 5 to 43 months); 7 of 13 Pugs (54%) remained in remission after MSC therapy alone, and 6 of 13 (46%) required the addition of immunosuppressive therapy. Conclusions: IV allogeneic MSC administration was well tolerated and resulted in immediate clinical benefit in this small cohort of Pugs with presumptive early NME. Strategies to maintain the long-term benefits of MSC therapy require further study. Clinical Relevance: Immunomodulatory MSC therapy may be a potential treatment for neuroinflammatory disease in dogs. Further studies are needed to optimize long-term benefits.

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