# Mesenchymal stromal cell therapy restores intestinal integrity and attentuates inflammation in a preterm piglet model of necrotizing enterocolitis

## TL;DR

This study shows that mesenchymal stromal cells can reduce intestinal damage and inflammation in a preterm piglet model of a severe gut disease.

## Contribution

First demonstration of MSC therapeutic benefit in a preterm piglet model of NEC, supporting translational potential.

## Key findings

- Medium-dose MSCs improved clinical scores and reduced intestinal injury in preterm piglets.
- MSC treatment decreased pro-inflammatory cytokine levels in serum and ileum.
- RNA sequencing was used to analyze intestinal tissue response to MSC therapy.

## Abstract

Necrotizing enterocolitis (NEC) is a life-threatening gastrointestinal disease of prematurity characterized by inflammation, necrosis, and high morbidity. Current therapies are limited, necessitating the development of novel treatments. Mesenchymal stromal cells (MSCs) have shown promise in murine NEC models. Given the anatomical and physiological similarities between premature piglets and human infants, we employed a preterm piglet model to evaluate MSC efficacy. We hypothesized that intraperitoneal MSC administration would reduce intestinal injury in NEC.

Preterm piglets were delivered via cesarean section. NEC was induced on day 3 through hypertonic enteral feeding. MSCs were administered intraperitoneally at low, medium, or high doses. Piglets were monitored and euthanized based on clinical criteria. Clinical scores, weight change, gross and histologic intestinal injuries were assessed. Cytokine levels in serum and ileum were quantified via ELISA, and intestinal tissue was analyzed by RNA sequencing. Statistical significance was set at p < 0.05.

Medium-dose MSCs significantly improved clinical scores and reduced both gross and histologic intestinal injury (p < 0.05). A corresponding decrease in pro-inflammatory cytokines was observed.

This is the first study to demonstrate therapeutic benefit of MSCs in a preterm piglet NEC model, supporting their potential use in translational NEC therapies.

The online version contains supplementary material available at 10.1007/s00383-026-06324-7.