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With successful resolution of this inflammation, the mare\u2018s uterus will provide a hospitable environment for the development of the semi-allogenic conceptus. If the mare fails to resolve this inflammatory response within 48 h of breeding, she will become susceptible to persistent breeding-induced endometritis (PBIE) which will have detrimental effects on her fertility. This condition can then predispose the mare to bacterial or fungal endometritis leading to further degeneration of the endometrium. Optimisation of the mare\u2019s fertility requires a fine balance between allowing the natural immune response of the endometrium to its exposure to allogenic semen to run its course, and yet preventing its progression to PBIE or the involvement of infectious agents. This review discusses the challenges presented by PBIE, latent infections, biofilms, fungal infections and the need to utilise diagnostic methods available and implement targeted treatments to optimise fertility in the mare.<\/jats:p>","DOI":"10.1530\/rep-19-0478","type":"journal-article","created":{"date-parts":[[2020,9,8]],"date-time":"2020-09-08T12:48:21Z","timestamp":1599569301000},"page":"R95-R110","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-11","source":"Crossref","is-referenced-by-count":106,"title":["Equine endometritis: a review of challenges and new approaches"],"prefix":"10.1093","volume":"160","author":[{"given":"Lee","family":"H A Morris","sequence":"first","affiliation":[{"name":"EquiBreed NZ Ltd , Te Awamutu, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"M McCue","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences , Colorado State University, Fort Collins, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Aurich","sequence":"additional","affiliation":[{"name":"Centre for Artificial Insemination and Embryo Transfer , Vetmeduni Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,11,1]]},"reference":[{"key":"2026010712242175600_bib1","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1186\/1751-0147-44-121","article-title":"Uterine microbiology and antimicrobial susceptibility in isolated bacteria from mares with fertility problems","volume":"44","author":"Albihn","year":"2003","journal-title":"Acta Vet erinaria Scand inavica"},{"key":"2026010712242175600_bib2","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1111\/j.1600-0897.2005.00270.x","article-title":"Nitric oxide levels and nitric oxide synthase expression in uterine samples from mares susceptible and resistant to persistent breeding-induced endometritis","volume":"53","author":"Alghamdi","year":"2005","journal-title":"American Journal of Reproductive Immunology"},{"key":"2026010712242175600_bib3","doi-asserted-by":"publisher","first-page":"438","DOI":"10.2746\/042516407x1737581","article-title":"Reproductive efficiency of flatrace and national hunt thoroughbred mares and stallions in England","volume":"39","author":"Allen","year":"2007","journal-title":"Equine Veterinary Journal"},{"key":"2026010712242175600_bib4","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1177\/1040638711425589","article-title":"Outbreak of equine endometritis caused by a genotypically identical strain of Pseudomonas aeruginosa","volume":"23","author":"Allen","year":"2011","journal-title":"Journal of Veterinary Diagnostic Investigation"},{"key":"2026010712242175600_bib5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.theriogenology.2018.07.013","article-title":"Influence of cycle stage, age and endometrial biopsy score on oxytocin receptor distribution and gene expression in the cervix and uterus of non-pregnant mares","volume":"120","author":"Annandale","year":"2018","journal-title":"Theriogenology"},{"key":"2026010712242175600_bib6","first-page":"311","article-title":"Effects of susceptibility of mares to endometritis and stage of cycle on phagocytic activity of uterine-derived neutrophils","volume":"35","author":"Asbury","year":"1987","journal-title":"Journal of Reproduction and Fertility: Supplement"},{"key":"2026010712242175600_bib7","doi-asserted-by":"publisher","first-page":"2064","DOI":"10.1128\/AEM.72.3.2064-2069.2006","article-title":"Chelator-induced dispersal and killing of Pseudomonas aeruginosa cells in a biofilm","volume":"72","author":"Banin","year":"2006","journal-title":"Applied and Environmental Microbiology"},{"key":"2026010712242175600_bib8","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1016\/j.jevs.2015.08.018","article-title":"The evaluation of biofilm-forming potential of Escherichia coli collected from the equine female reproductive tract","volume":"35","author":"Beehan","year":"2015","journal-title":"Journal of Equine Veterinary Science"},{"key":"2026010712242175600_bib9","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1111\/j.2042-3306.2012.00608.x","article-title":"Retrospective study on equine uterine fungal isolates and antifungal susceptibility patterns (1999\u20132011)","volume":"44","author":"Beltaire","year":"2012","journal-title":"Equine Veterinary Journal: Supplement"},{"key":"2026010712242175600_bib10","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/s0749-0739(17","article-title":"Venereal disease","volume":"8","author":"Blanchard","year":"1992","journal-title":"Veterinary Clinics of North America: Equine Practice"},{"key":"2026010712242175600_bib11","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1080\/00480169.\/1987.35439","article-title":"Mycotic endometritis in mares. 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