International Journal of Molecular and Cellular Medicine (IJMCM)

Chronic neurological deficits frequently persist after ischemic stroke despite advances in acute treatment, secondary prevention, and rehabilitation. Mesenchymal stromal cell (MSC)-based regenerative approaches and their secreted factors, including extracellular vesicles such as exosomes, have emerged as potential adjuncts to promote neuroplasticity and functional recovery, although clinical evidence remains limited. A 73-year-old man with chronic post-ischemic stroke underwent an individualized multimodal regenerative protocol integrated with standard medical care and rehabilitation. The treatment primarily involved intravenous allogeneic umbilical cord-derived mesenchymal stromal cell (MSC) therapy followed by maintenance MSC-derived secretome therapy, with other supportive interventions, and follow-up over six months. Clinical outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Modified Ashworth Scale (MAS), Barthel Index, Six-Minute Walk Test (6MWT), Energy Visual Analog Scale (VAS), neurological examination, and patient-reported outcomes. Muscle spasticity improved (MAS 3 to 1), walking endurance increased (6MWT 220–360 m), and Energy VAS improved (3/10 to 8/10). Grip strength, right upper-limb sensation, balance, and gait stability improved, while independence in daily activities was maintained. NIHSS and mRS scores remained unchanged. During follow-up, the patient experienced transient hypotension and a recurrent ischemic stroke; based on the available clinical information, a definitive causal relationship with the regenerative interventions could not be established. No serious adverse event was definitively attributed to the regenerative interventions based on the available clinical assessment. This case demonstrates the feasibility of integrating UC-MSC and MSC-derived secretome-based regenerative therapy into chronic stroke rehabilitation. Although functional improvements were documented, causal conclusions cannot be drawn from a single case. Prospective controlled studies are needed to establish safety and clinical effectiveness.