Harnessing BMSCs for Ischemic Stroke: Decoding Multimodal Repair and Navigating the Path to Clinical Translation

Ischemic stroke (IS) is characterized by a high incidence rate, high disability rate and high recurrence rate. The existing treatment methods have limitations such as a narrow time window and limited recovery of neurological function. Bone marrow mesenchymal stem cells (BMSCs) have become a research hotspot in the regenerative treatment of IS due to their multi-directional differentiation potential, paracrine regulation and immune regulation characteristics. This review explores the mechanism of action, strategies for enhancing therapeutic efficacy and the progress of clinical transformation of BMSCs in the treatment of IS. Basic research indicates that BMSCs improve neurological function through multiple mechanisms such as migrating to ischemic foci, secreting neurotrophic factors, promoting angiogenesis, and inhibiting apoptosis of nerve cells. Gene modification technology and the application of exosomes can further potentiate therapeutic efficacy. The optimization of injection routes, cell types, transplantation time Windows and cell doses is crucial to the therapeutic effect. Clinical studies have initially confirmed the safety of BMSCs treatment and some functional improvement effects, but there are still problems such as small sample size and unclear long-term efficacy. In the future, it is necessary to further clarify the treatment mechanism, optimize the treatment plan, and promote the transformation of basic research into clinical practice (Graphical Abstract).