The short answer. “Stem cell therapy for MS” means two very different treatments. HSCT (also called AHSCT) is a hospital procedure using chemotherapy, with substantially stronger evidence in selected patients with highly active relapsing MS. MSC therapy uses mesenchymal stem cells, given by drip without chemotherapy, and remains investigational in MS: it has a good safety record in trials, but results are mixed. Neither replaces your neurologist or your disease-modifying treatment.
Why patients with MS ask about stem cells
Multiple sclerosis is an autoimmune disease in which the immune system attacks the protective coating of nerves in the brain and spinal cord. Most people start with relapses, attacks followed by partial or full recovery. Over years, disability can build up. Men with relapsing MS tend to accumulate disability faster than women.1
Modern disease-modifying drugs have changed the outlook for many patients. But some people continue to relapse despite them, and that is usually when the question of stem cells comes up.
Two very different treatments share the same name
When you read about “stem cell therapy for MS,” the article may be describing either of these. They differ in almost every way:
| HSCT (blood stem cell transplant) | MSC drip (mesenchymal stem cells) |
What it is | Your own blood-forming (haematopoietic) stem cells are collected, your immune system is suppressed or ablated with chemotherapy, and the stem cells are returned to rebuild it. | Mesenchymal stem cells, your own or from a donor, are given by IV drip, or into the spinal fluid in research settings. Nothing is destroyed first. |
Aim | To “reset” the immune system. | Being investigated for calming the immune response through the signals the cells release (a paracrine effect). |
Where | Specialist hospital transplant unit; several weeks of admission and recovery. | Outpatient clinic; a drip of a few hours. |
Evidence in MS | Strongest: in a randomised trial of 110 patients with highly active relapsing MS, HSCT clearly outperformed continued drug treatment.2 | Mixed: the largest trial did not meet its main goal; a smaller trial in progressive MS was positive.3,4 |
Main risks | The serious risks of chemotherapy, including infection. | Mainly short-lived fever; no increase in serious adverse events detected during trial follow-up.3,5 |
In the HSCT trial, only 3 of 52 transplanted patients worsened over the first year, compared with 34 of 51 who continued drug treatment, and disability scores improved on average.2 If your MS is highly active despite modern drugs, ask your neurologist about HSCT. I would rather you had that conversation before choosing anything else, including treatment with me.
What does the evidence show for MSCs in MS?
The largest trial (MESEMS) gave bone marrow MSCs or placebo by drip to 144 patients across 10 countries. The cells were safe and well tolerated, but they did not significantly reduce new active lesions on MRI at 24 weeks. Relapse rates showed a downward trend that was not statistically significant.3
A trial in progressive MS gave patients their own MSCs, either by drip or into the spinal fluid (intrathecally), against a sham treatment. After a year, 41% of the drip group and 59% of the intrathecal group had no evidence of disease activity, compared with 10% on sham. The intrathecal route did better on several measures, including walking and cognitive tests.4
So the honest summary is that MSCs are safe and may help some patients, but the large trials have not yet proven benefit. MS is not a condition where anyone should promise you a result.
How would stem cells and exosomes act in MS?
MSCs given by drip do not travel to the brain and replace damaged nerve tissue. Most are held at first in the lungs.6 Their effect comes mainly from the signals they release, which calm immune cells and support repair; this is called a paracrine effect.7
Exosomes are the packets that carry those signals, without the cells. In mice with an MS-like disease, exosomes from MSCs reduced symptoms, inflammation and loss of the nerve coating, increased regulatory T cells, and crossed into the spinal cord.8 That work has not yet been repeated in patients.
In my clinical experience, some patients notice changes sooner after exosome treatment, while responses after MSC treatment tend to develop more gradually, as the cells settle and produce their paracrine response, and may last longer. No comparative trial in MS has shown this; it is clinical observation, not established evidence. It is one reason I sometimes combine the two.
Considering stem cells for MS? Send me your diagnosis, your current treatment and your most recent MRI report before you book. I will tell you honestly whether MSC therapy is reasonable for you, or whether you should be asking your neurologist about HSCT instead. WhatsApp +971 52 328 6185.
A case from my practice
A man in his early thirties came to see me from elsewhere in the Gulf. He had lived with MS since he was young, and it had been aggressive. He was being admitted to hospital with a relapse roughly every six months, and when we first met he was using a wheelchair.
We made him no promises. He had one IV infusion of donor (allogeneic) mesenchymal stem cells, followed by three exosome infusions, travelling to Dubai every three to four weeks for each session. In the almost two years since he completed treatment, he has not had a relapse.
What this case can and cannot tell us
Can I say with certainty that the stem cells caused this? No. Can I say other patients will get the same result? Also no. One patient cannot answer either question.
There is a second reason for caution. Relapses in MS become less frequent over time on their own. In a study following nearly 2,500 patients for an average of 20 years, relapse rates fell by about 17% every five years, and more than three-quarters had a relapse-free stretch of five years at some point.9 A long gap after a run of relapses can happen without any new treatment.
I share this case because it is real and because it is why I take MS patients seriously, not because it proves anything. Whether MSCs reduce relapses has to be answered by trials, not by my best result.
Should I stop my MS medication?
No. Continue your disease-modifying treatment exactly as prescribed. MSC and exosome therapy are given alongside it, never instead of it. Stopping some MS drugs suddenly can trigger a severe rebound. I will write to your neurologist so your treatment is coordinated.
How would we know whether it helped?
- Relapses and hospital admissions, compared with the same period before treatment.
- Disability score (EDSS), recorded by your neurologist.
- MRI, at the intervals your neurologist already uses.
- Function you notice day to day, such as walking distance, fatigue and hand use, recorded the same way each time.
Is it safe?
In MESEMS, serious adverse events were not more frequent with MSCs than with placebo during the trial.3 Across 55 randomised trials and 2,696 patients in other conditions, the only side effect clearly linked to MSC drips was a short-lived fever; no increased rate of infection, thrombotic events or malignancy was detected during the available follow-up.5 That does not exclude rare or long-term risks.
At our clinic, cells and exosomes are prepared by two established, regulated laboratories: one Italian, operating since 2009 and in Dubai since 2013, and one British, in Dubai since 2017. Every patient is screened and assessed before treatment.
What about stem cells injected into the spinal fluid?
Some trials give MSCs intrathecally, through a lumbar puncture, so the cells go straight into the fluid around the brain and spinal cord instead of passing through the lungs first.
In the one trial that compared the two routes directly, in progressive MS, intrathecal delivery did better than the drip on relapses, new lesions, walking, hand function and cognitive tests.4
The wider picture is mixed. In a 2024 randomised trial, 54 patients with progressive MS had six intrathecal injections of cells grown from their own MSCs, or saline. The trial did not meet its main goal: 33% improved on treatment and 37% on saline. There were hints of benefit for walking in more disabled patients and for bladder function, but those findings were exploratory.10 In another study, a minority of patients given modified MSCs intrathecally improved in walking and hand function, but there was no placebo group to compare with.11
On safety, a review of 9 randomised trials and 540 patients with neurological conditions did not detect an increase in serious adverse events with intrathecal MSCs during trial follow-up. Back, neck and limb pain were more common.12 Headache in the days after injection is also common: 34% of treated patients in the 2024 trial, against 15% on saline.10
Intrathecal MSC treatment therefore remains investigational in MS, with mixed evidence. It is not an established MS treatment.
Why I take disease control seriously
When I speak to patients with MS, I always keep one thing in mind: neurological damage that accumulates over time may not be fully reversible. That changes how I think about risk and opportunity. If this were me or someone in my own family, I would want established treatment optimised first, but I would also want to understand every reasonable additional option that might help control disease activity.
I would not expect certainty from an investigational treatment, and I would never replace proven neurological care with it. But if an option had a plausible biological rationale, an acceptable safety profile, appropriate medical oversight and did not interfere with standard treatment, I would want to consider it. It might help and it might not, but I would want to make that decision with full information rather than look back after further irreversible damage and wonder whether there was something reasonable I had chosen not to explore.
In a disease where lost neurological function may not always come back, I think the question is not simply “Is this guaranteed to work?” Sometimes the more useful question is: “Is there enough rationale, enough safety data and little enough downside to justify considering it alongside proven treatment?”
How I approach MS in my practice
When I assess an MS patient interested in regenerative therapy, I use an individualised staged approach rather than a fixed protocol. Neurology care, disease-modifying therapy, MS subtype, current disease activity and recent MRI findings remain central to the decision. Where treatment is appropriate, the stages are usually:
- First, treatment through the bloodstream. One IV infusion of mesenchymal stem cells and one exosome IV.
- Then a review, before the second exosome session, of how the patient has responded and how they tolerated treatment.
- Then, where appropriate, referral to a neurologist to consider intrathecal treatment, in which stem cells are injected into the spinal fluid by lumbar puncture.
- Further exosome sessions follow, three to four weeks apart.
Why this order? The aim is to calm immune activity throughout the body first, and to see how the patient responds to cell treatment, before moving to the more invasive procedure.
Is this sequence supported by evidence? Honestly, it has not been tested. Trials have given MSCs by drip, intrathecally, or both at the same time,4,13 and the one direct comparison favoured the intrathecal route.4 No trial has studied a drip first and intrathecal treatment afterwards. This is an individualised clinical pathway based on my reasoning, not a validated MS treatment protocol, and I explain it to patients that way before they decide.
Travelling from Saudi Arabia or elsewhere in the Gulf? We plan treatment around your trips to Dubai, and review your records before your first visit. WhatsApp +971 52 328 6185.
Frequently asked questions
Can stem cells cure MS?
No. No stem cell treatment, including HSCT, is a cure. The aim is to reduce disease activity.
Can stem cells get me out of a wheelchair?
Disability that has built up over years usually reflects nerve damage that MSCs have not been shown to reverse. Some patients in one trial walked better,4 but nobody can promise improvement in walking, wheelchair use, disability score or relapse rate.
Should I have HSCT or an MSC drip?
If relapsing MS remains highly active despite appropriate disease-modifying therapy, HSCT currently has much stronger evidence and should be discussed with an MS neurologist.2 MSC therapy is different and remains investigational in MS. For patients who are not candidates for HSCT or who do not wish to undergo it, established disease-modifying options should still be reviewed with their neurologist before MSC treatment is considered as an adjunctive regenerative approach.
Does it help progressive MS?
The evidence is mixed. One trial in active progressive MS was positive, especially when the cells were given into the spinal fluid;4 a larger intrathecal trial did not meet its main goal.10 In my practice, intrathecal treatment is done by a neurologist on referral, after a first phase of IV treatment.
Why stem cells and exosomes together?
In my clinical observation, some patients respond sooner to exosomes, while responses to MSCs develop more gradually. This has not been tested in comparative MS trials, so combining them is an individual clinical decision, not a proven protocol.
How many visits will I need?
A typical plan is one stem cell IV and one exosome IV, then a review, then intrathecal treatment by a neurologist where appropriate, with further exosome sessions three to four weeks apart. You will know the full schedule before you start.
Book a regenerative consultation. An honest assessment, with your neurologist’s records reviewed first. WhatsApp +971 52 328 6185.
About the author Dr Shiva Faramarzi, MD, is an aesthetic, regenerative and longevity physician at Apogee Clinic, JBR, Dubai (DHA licence 43705219). She offers autologous and donor stem cell therapy and exosome IV treatment. This article is patient education and does not replace the advice of your neurologist.
References
- Ribbons KA, et al. Male sex is independently associated with faster disability accumulation in relapse-onset MS but not in primary progressive MS. PLoS One. 2015;10(6):e0122686. doi:10.1371/journal.pone.0122686
- Burt RK, et al. Effect of nonmyeloablative hematopoietic stem cell transplantation vs continued disease-modifying therapy on disease progression in patients with relapsing-remitting multiple sclerosis: a randomized clinical trial. JAMA. 2019;321(2):165–174. doi:10.1001/jama.2018.18743
- Uccelli A, et al. Safety, tolerability, and activity of mesenchymal stem cells versus placebo in multiple sclerosis (MESEMS): a phase 2, randomised, double-blind crossover trial. Lancet Neurol. 2021;20(11):917–929. doi:10.1016/S1474-4422(21)00301-X
- Petrou P, Kassis I, Levin N, et al. Beneficial effects of autologous mesenchymal stem cell transplantation in active progressive multiple sclerosis. Brain. 2020;143(12):3574–3588. doi:10.1093/brain/awaa333
- Thompson M, et al. Cell therapy with intravascular administration of mesenchymal stromal cells continues to appear safe: an updated systematic review and meta-analysis. EClinicalMedicine. 2020;19:100249. doi:10.1016/j.eclinm.2019.100249
- Fischer UM, et al. Pulmonary passage is a major obstacle for intravenous stem cell delivery: the pulmonary first-pass effect. Stem Cells Dev. 2009;18(5):683–692. doi:10.1089/scd.2008.0253
- Caplan AI, Correa D. The MSC: an injury drugstore. Cell Stem Cell. 2011;9(1):11–15. doi:10.1016/j.stem.2011.06.008
- Riazifar M, Mohammadi MR, Pone EJ, et al. Stem cell-derived exosomes as nanotherapeutics for autoimmune and neurodegenerative disorders. ACS Nano. 2019;13(6):6670–6688. doi:10.1021/acsnano.9b01004
- Tremlett H, Zhao Y, Joseph J, Devonshire V. Relapses in multiple sclerosis are age- and time-dependent. J Neurol Neurosurg Psychiatry. 2008;79(12):1368–1374. doi:10.1136/jnnp.2008.145805
- Harris VK, et al. Efficacy of intrathecal mesenchymal stem cell-neural progenitor therapy in progressive MS: results from a phase II, randomized, placebo-controlled clinical trial. Stem Cell Res Ther. 2024;15:151. doi:10.1186/s13287-024-03765-6
- Cohen JA, et al. Evaluation of neurotrophic factor secreting mesenchymal stem cells in progressive multiple sclerosis. Mult Scler J. 2022. doi:10.1177/13524585221122156
- Mesa Bedoya LE, et al. The safety profile of mesenchymal stem cell therapy administered through intrathecal injections for treating neurological disorders: a systematic review and meta-analysis of randomised controlled trials. Stem Cell Res Ther. 2024;15:146. doi:10.1186/s13287-024-03748-7
13. Karussis D, et al. Safety and immunological effects of mesenchymal stem cell transplantation in patients with multiple sclerosis and amyotrophic lateral sclerosis. Arch Neurol. 2010;67(10):1187–1194. doi:10.1001/archneurol.2010.248
Book a regenerative consultation. An honest assessment, with your neurologist’s records reviewed first. WhatsApp +971 52 328 6185.
About the author Dr Shiva Faramarzi, MD, is an aesthetic, regenerative and longevity physician at Apogee Clinic, JBR, Dubai (DHA licence 43705219). She offers autologous and donor stem cell therapy and exosome IV treatment. This article is patient education and does not replace the advice of your neurologist.
