Therapeutic Strategies of Stem Cell and TCM in Progressive MS

1.Therapeutic Strategies of Stem Cell and TCM in Progressive MS

1.1 Overview of Progressive MS and Challenges
Progressive MS—comprising Secondary Progressive MS (SPMS) and Primary Progressive MS (PPMS)—represents a neurodegenerative phase with gradual disability accumulation and limited inflammatory relapses. Existing disease-modifying therapies (DMTs) are less effective in this stage, necessitating novel options like stem cell–based interventions and integrative therapies.

1.2 Stem Cell Therapies: Mechanisms and Clinical Evidence

(1) Intrathecal MSC-Neural Progenitor (MSC-NP) Therapy

• A randomized, double-blind, placebo-controlled Phase II trial showed that among SPMS or PPMS patients, 50% of those receiving intrathecal MSC-NPs (over six doses) improved muscle strength vs. 33% in placebo Neurology live.

• Earlier Phase I data (3 IT injections) in 20 progressive MS patients revealed that 75% had improvements in at least one domain—muscle strength, EDSS, walking ability, or bladder function. Benefits were sustained for up to 2 years, with no serious adverse events Frontiersneurology.org.

Mechanistically, MSC-NPs (derived from patient-specific MSCs under neural-induction conditions) offer enhanced safety and targeted neural repair, reducing risks of ectopic differentiation FrontiersMDPI.

(2) Bone Marrow– or Cord-Derived MSCs and HSCT

• Hematopoietic Stem Cell Transplantation (HSCT) aims to reboot the immune system. In aggressive MS, HSCT can halt progression and reduce disability, particularly in relapsing forms; efficacy in progressive MS remains less certain Verywell Health维基百科.

• Umbilical cord–derived MSCs (UC-MSCs) and adipose-derived MSCs demonstrate immunomodulation, remyelination, and improved function in preclinical and some clinical reports. One case of refractory progressive MS treated with BM+UC-MSCs showed stabilization, improved strength, and resolution of lesions over 4 years 国家生物技术信息中心.

(3) Mechanistic Summary

Stem cells exert therapeutic effects via three core pathways FrontiersPMCMDPIBioMed Central维基百科:

• Immunomodulation: Secretion of anti-inflammatory cytokines (e.g. IL-10, TGF-β), polarization of macrophages toward M2 phenotype, suppression of autoreactive T/B cells, inhibition of dendritic and NK cell activation.

• Neuroprotection & Remyelination: Promotion of oligodendrogenesis, protection from apoptosis, support via trophic factors like hepatocyte growth factor (HGF), microRNA-mediated repair.

• Differentiation and Secretome Action: MSCs/MSC-NPs can differentiate into neural/glial lineages, and their extracellular vesicles mediate neuroregeneration.

1.3 Chinese Medicine (TCM) in Progressive MS
One case involving scalp and body acupuncture plus herbal decoction alleviated tremor and spasm, enabling calm sitting and reading after four months 中医网. Though preliminary, it highlights TCM’s potential role in symptom relief and quality-of-life improvements.

1.4 Combined Strategy and Case Illustration
A hypothetical integrative model:

• Stem cell core: Engage MSC-NP or UC-MSC to modulate immunity and promote neural repair.

• TCM support: Use herbs to tonify qi and blood (e.g., Rehmannia, Astragalus), clear neuroinflammation, and acupuncture for spasticity or tremor relief.

• Expected synergy: Reduced neuroinflammation, improved remyelination/neuroprotection, better motor control, and enhanced overall well-being.

Case Example (composite model):
A 45-year-old with SPMS (EDSS 6.0) receives intrathecal MSC-NP therapy (3 injections across 6 months) combined with a TCM regimen (tonifying decoction plus scalp/body acupuncture). After one year:

• Muscle strength improves (aligned with trial data)

• Walking speed gains and EDSS plateau

• Reduced spasm/tremor and increased calm (anecdotal TCM effect)

2. 中文版：进行性 MS 中干细胞与中医结合治疗思路、机制与案例

2.1 进行性 MS 的特点与治疗挑战

进行性 MS（包括继发进展型 SPMS 和原发进展型 PPMS）特征为持续性神经退行性损伤和症状加重，常规 DMT 对其疗效有限，亟待新型策略。

2.2 干细胞治疗机制与临床证据

（1）MSC-NP 髓腔内注射治疗

• 一项 II 期双盲 RCT 显示 SPMS/PPMS 患者中，50% 接受 MSC-NP 注射者肌力改善，而对照组为 33% Neurology live。

• 早期 I 期研究中，20 例患者接受 3 次 MSC-NP 髓腔注射，75% 在肌力、EDSS、行走能力或膀胱功能等至少一个领域改善，持续 2 年，未见严重不良事件 Frontiersneurology.org。

这些 MSC-NP 来源于患者自身骨髓 MSC，在神经诱导条件下培养，具针对性和安全性高的优势 FrontiersMDPI。

（2）骨髓或脐带 MSC 与 HSCT 治疗

• 骨髓造血干细胞移植（HSCT）通过重构免疫系统可暂停 MS 活动，在高度活动性病例效果显著；进行性 MS 的疗效尚不明确 Verywell Health维基百科。

• 脐带 MSC、脂肪来源 MSC 等在实验模型中展示免疫调节、髓鞘修复能力。一例难治性进行性 MS 病例接受 BM+UC-MSC 治疗 4 年后，病程稳定，肌力增强，影像学改善 国家生物技术信息中心。

（3）机制总结

干细胞治疗主要通过三大机制发挥效用 FrontiersPMCMDPIBioMed Central维基百科：

• 免疫调节：分泌 IL-10、TGF-β 等抗炎因子，诱导 M2 型巨噬细胞，抑制自体反应性免疫，调节树突细胞与 NK 细胞功能。

• 神经保护与再髓鞘化：促进少突增殖/分化，分泌 HGF 等神经营养因子，并通过 microRNA 促进神经修复。

• 分化与分泌体作用：MSC/MSC-NP 可分化为神经或胶质细胞，其外泌体含修复信号。

2.3 中医在进行性 MS 中的作用

一例应用头皮及体针结合中药方的报告显示，患者震颤痉挛改善，四个月后能静坐阅读 中医网。尽管未构成循证基础，但提示中医在症状控制与生活质量改善方面的潜力。

2.4 整合治疗思路与案例构建

整合模型：以 MSC-NP/STEM intervention 为核心，辅以中医整体调理，包括补气活血、清热祛火、中医针灸缓解痉挛症状。

预期协同：减少神经炎症、提升再髓鞘及神经保护、改善运动控制与主观舒适度。

案例构想：
45 岁 SPMS 患者，EDSS 6.0，同意接受 MSC-NP 髓腔注射（6 个月内 3 次），以及中药汤剂+头皮/体针辅助治疗。1 年后：

• 肌力显著提升（符合 MSC-NP 研究结果）

• 行走速度加快，EDSS 倾向稳定

• 痉挛与震颤缓解，情绪与生活质量提升（对应中医作用）