Combined mesenchymal and neural stem cell therapy enhances neurological recovery in cerebral infarction

BACKGROUND Acute cerebral infarction (ACI), a leading cause of death and disability, causes brain ischemia due to vessel blockage. Current time-limited interventions, such as clot removal, often fail to restore full function. Neurorestoration is vital, but complicated. Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) promote angiogenesis and neuroprotection. Stem cell therapy has potential to promote neurorestoration. Specifically, neural stem cells (NSC) reconstruct neural tissue, while mesenchymal stem cells (MSCs) provide support and secrete beneficial factors. Combining NSCs and MSCs in stem cell therapy may synergistically enhance ACI recovery, potentially via the regulation of VEGF and bFGF. However, the mechanisms underlying this combined approach remain unclear. AIM To investigate the therapeutic effect of combined NSC and MSC transplantation on neurological recovery and bFGF/VEGF expression in ACI patients. METHODS This study enrolled 156 patients with ACI treated from June 2022 to June 2023. Patients were randomly assigned to two groups: The control group (n = 78) received conventional drug therapy, while the observation group (n = 78) received conventional therapy and combined NSC and MSC transplantation. The following outcomes were compared between groups: National Institutes of Health Stroke Scale (NIHSS) score, Barthel index, cerebral perfusion and diffusion on magnetic resonance imaging, serum bFGF and VEGF levels, clinical efficacy, and adverse events. RESULTS Serum VEGF and bFGF levels negatively correlated with NIHSS scores in patients with ACI (r = -0.388, r = -0.239; P < 0.05). The observation group (NSC and MSC) showed a significantly higher clinical efficacy of treatment than the controls (85.9% vs 69.2%; P < 0.05). Both groups showed improved cerebral perfusion, increased Barthel index, and decreased NIHSS scores post-treatment (P < 0.05), with significantly greater improvements in the observation group. Serum VEGF and bFGF levels increased significantly in both groups (P < 0.05), but were higher in the observation group. Adverse events in the observation group (transient fever: 4 cases; agitation: 1 case; headache: 2 cases) were mild and resolved with symptomatic treatment. Six-month follow-up revealed no abnormalities in magnetic resonance imaging, electrocardiogram, or blood tests. CONCLUSION NSC-MSC combination therapy enhances neurological function and cerebral perfusion in patients with ACI by upregulating VEGF and bFGF expression, demonstrating favorable clinical efficacy and safety.