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Recently, injectable platelet-rich fibrin (I-PRF) and exosomes derived from mesenchymal stem cells (MSCs) have shown promise as regenerative treatments, offering potential benefits in matrix restoration and modulation of inflammatory responses. This study investigated the effects of I-PRF alone and in combination with MSC-derived exosomes on collagenase-induced superficial digital flexor (SDF) tendonitis in donkeys. Twenty-seven donkeys were randomly assigned to three treatment groups: saline (placebo), I-PRF, and PRF\/exosome. Tendon healing was monitored over a 20-week period using clinical evaluation, ultrasonography, histology, immunohistochemistry, and biomechanical testing. At the study endpoint, the combined PRF\/exosome group exhibited the greatest improvement in tendon consistency and weight-bearing ability compared to placebo (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001). Ultrasonographic findings were markedly better in the PRF\/exosome group, even though tendon cross-sectional area (T-CSA) remained elevated across all treated groups, while it decreased significantly in the placebo group. Immunohistochemical analysis revealed the highest collagen type I and lowest type III levels in tendons treated with PRF\/exosome. Biomechanical testing further demonstrated superior failure stress and strain in this group relative to placebo. Overall, these results indicate a potential synergistic effect of combining I-PRF with MSC-derived exosomes in promoting tendon repair. Nevertheless, additional long-term studies in naturally occurring tendon injuries are required to confirm these findings and assess their clinical relevance.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-44967-7","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T07:57:01Z","timestamp":1775807821000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mesenchymal stem cell derived exosomes and injectable platelet-rich fibrin enhance SDFT healing in a donkey tendonitis model"],"prefix":"10.1038","volume":"16","author":[{"given":"Mahmoud","family":"Najeb","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa","family":"Samy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Awad","family":"Rizk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esam","family":"Mosbah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iman","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gamal","family":"Karrouf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"issue":"4","key":"44967_CR1","doi-asserted-by":"publisher","first-page":"125","DOI":"10.4102\/jsava.v68i4.893","volume":"68","author":"A Olivier","year":"1997","unstructured":"Olivier, A., Nurton, J. & Guthrie, A. An epizoological study of wastage in thoroughbred racehorses in Gauteng, South Africa. J. S. Afr. Vet. Assoc. 68 (4), 125\u2013129 (1997).","journal-title":"J. S. Afr. Vet. Assoc."},{"issue":"2","key":"44967_CR2","doi-asserted-by":"publisher","first-page":"143","DOI":"10.2746\/042516407X159132","volume":"39","author":"K Lam","year":"2007","unstructured":"Lam, K., Parkin, T., Riggs, C. & Morgan, K. Descriptive analysis of retirement of Thoroughbred racehorses due to tendon injuries at the Hong Kong Jockey Club (1992\u20132004). Equine Vet. J. 39 (2), 143\u2013148 (2007).","journal-title":"Equine Vet. J."},{"issue":"6","key":"44967_CR3","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1111\/evj.12836","volume":"50","author":"I Dabbene","year":"2018","unstructured":"Dabbene, I. et al. Clinical findings and prognosis of interference injuries to the palmar aspect of the forelimbs in Standardbred racehorses: A study on 74 cases. Equine Vet. 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