Exogenous Stem Cell Therapy for COPD & Emphysema

The Global Burden of Disease Study, led by the Institute for Health Metrics and Evaluation, estimates that hundreds of millions of people worldwide are living with COPD, and the World Health Organization reports that COPD causes about 5% of all deaths around the world each year. Chronic obstructive pulmonary disease (COPD) & Emphysema result in the rapid loss of lung tissue and airway obstruction due to chronic airway inflammation, resulting in progressive destruction of lung parenchyma, alveolar ducts, alveoli, and respiratory bronchioles. Cell-based approaches are being investigated for COPD. Their effects on symptoms, lung function, exacerbations and adverse events require evidence for the specific intervention. The two most common types of COPD are pulmonary emphysema and recurring bronchitis.

COPD Stem Cell Therapy at a Glance

• What it is: an investigational approach using expanded umbilical cord mesenchymal stem cells (UC-MSC+). Proposed inflammatory and repair mechanisms are separate from demonstrated clinical benefit in COPD or emphysema.
• Who it is for: adults with a confirmed diagnosis of mild-to-moderate COPD, emphysema, chronic bronchitis or bronchiectasis who have stopped smoking and can travel. End-stage disease, oxygen dependence that prevents travel and active smoking usually exclude a candidate.
• How it is delivered: a two-week outpatient program with 2 to 8 cell infusions per treatment stage, combining intravenous infusion with targeted airway delivery through a nebulizer, followed by optional pulmonary rehabilitation.
• What the evidence shows: cell-based approaches remain investigational. Small studies and differing preparations do not establish general safety, durable lung-function improvement or effectiveness of the center’s specific protocol. Individual study findings need assessment of the comparison group, outcomes and adverse events.
• What it costs: there is no single list price. A fixed medical quote follows a review of your spirometry, imaging and treatment history (see the cost section below).
• Next step: send recent spirometry or lung-function tests, chest CT or X-ray reports and your medication history for a physician-led review.

What is COPD?

COPD is short for Chronic Obstructive Pulmonary Disease. COPD is a progressive illness that makes it very difficult to breathe correctly. “Progressive” means that the disease gets worse with time. One of the most common symptoms of this condition is heavy coughing. Coughing produces a lot of mucus (a slimy substance produced by the body), which can cause chest tightness, wheezing, and labored breathing. Cigarette smoking is the leading cause of chronic obstructive pulmonary disease, while pleural mesothelioma is caused mainly by asbestos exposure. Still, it can also be developed as a complication from other disorders/diseases, such as lupus and systemic autoimmune diseases. Most people suffering from COPD are also smokers. Long-term exposure to high levels of lung irritants, such as air pollution, smoke, dust, and chemical fumes, is also a significant contributor to acute lung injury. To better understand COPD, it is beneficial to understand the function of the pulmonary system and how breathing processes occur. The air through the mouth goes straight to your windpipe, then to the bronchial tubes. Many smaller, thinner tubes branch out from the bronchial tubes, called bronchioles, inside your lungs.^[1]

The bronchioles are directly connected to small, round air sacs called alveoli. The tiny blood vessels known as capillaries run inside the walls of the alveoli. As soon as air reaches the alveoli, the oxygen in the air passes through the walls of the air-filled spaces and then into the blood through the capillaries. At the same time, carbon dioxide waste gas goes into the alveolar sacs from the capillaries. This procedure is known as gas exchange.^[2]

The alveoli and airways are inherently flexible and elastic. Every time you breathe, the alveoli sacs fill up like little balloons. Whenever you breathe out, the opposite happens: the air-filled spaces deflate, and air escapes.

The Function of the Respiratory Tract

All cells in the human body require a steady supply of fresh oxygen to survive. The respiratory system is responsible for delivering oxygen to all the cells in the human body while removing the waste product carbon dioxide, which can be lethal in excess. Several parts of the respiratory system include the airway, voice box, windpipe, and respiratory tract. The airway consists of the nose, larynx, pharynx, bronchi, mouth, bronchioles, and trachea. The airways are usually divided into upper and lower respiratory tracts. After the trachea, the airways divide into an ever-smaller bronchial tree (bronchi), and at the end of this tree are the individual alveoli sacs.

Symptoms of COPD

The causes of COPD are numerous, but for many cases of COPD, the patient may not display any indications. As the disease progresses, signs and complications become much more articulated. The most common signs & indications for COPD diagnosis are:

1. “Smoker cough,” which is another name for a persistent cough or coughing that produces a lot of excess mucus
2. Labored Breathing: This mainly occurs during physical stress, such as playing sports or climbing stairs
3. Strange sounds while breathing: A dry, squeaky, whistling, or wheezing sound when exhaling can indicate early-stage COPD
4. Frequent tightness in the chest area is an early warning sign of chronic inflammatory COPD
5. A persistent cough occurs primarily in the morning due to airway inflammation or being blocked with thick, viscous mucus

Although many COPD patients notice such complaints, they do not take them seriously. Coughing is usually the first symptom, but it is initially not noticed or very alarming for most. People who are not very physically active may only recognize COPD when it has reached an advanced stage, when breathing is difficult, even at rest. Researchers have also found that many heavy smokers may already have COPD but might not feel any manifestations until it’s confirmed with a lung function test. Having COPD can also compromise your body’s defense mechanisms, leading to frequent colds and other respiratory infections, including influenza.

Advanced Signs of Pulmonary Diseases

The severity of a patient’s indications depends entirely on the extent of lung damage. Patients who keep smoking will develop lung fibrosis and damage to the lung tissue much faster than those who stop smoking. Intractable signs of end-stage COPD may cause swelling in the feet, ankles, and legs, leading to rapid weight loss and reduced overall muscle endurance, which can result in injuries to the hips & knees.

COPD Management Guidelines

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The disease develops slowly. However, there are always phases in which the signs suddenly worsen, especially for patients with COPD with acute exacerbations. The trigger is then usually a respiratory tract infection, and these exacerbations significantly accelerate the progression of chronic inflammatory COPD. Over time, COPD exacerbations increase, and a reduction in lung capacity/lung function can also increase the risk of other diseases such as Spondyloarthropathy, rheumatoid arthritis, Parkinson’s, ataxia, and brain strokes.

What is Emphysema?

Pulmonary Emphysema is part of a family of lung diseases called COPD. Emphysema is a chronic pulmonary disease that is diagnosed after critical damage (permanently dilated or destroyed) to the alveoli. These over-inflated lung sections retain “old” air in the air sacs, so less “fresh” atmosphere can be absorbed. Overinflation of the alveoli increases during physical exertion and is the leading cause of winded breathing. The damage to the alveoli can be done in several ways, including:

• Destroyed
• Overinflated
• Stretched
• Narrowed

Overinflation of the alveoli results from breakdown of the air sac walls, leading to decreased respiratory function and frequent breathlessness. Any damage to the air sacs reduces the inner surface of the alveoli, which are critical for the gas exchange between air and blood. The reduction in cell mass results in a progressive decline in blood oxygen and in oxygen delivery to vital organs, which can lead to peripheral neuropathy, CHF, pulmonary hypertension, DCM with reduced ejection fraction, and myocardial infarction. Damage to the alveolar sacs can be challenging to manage with traditional medications, as chronic inflammation creates permanent holes in the lower lung tissue. Persistent coughing and sputum are other common manifestations of concomitant inflammation (bronchitis).

Some Common Risk Factors and Causes of Pulmonary Emphysema include:

• Smoking
• COPD
• Recurrent respiratory infections such as bronchitis, asthma, and pneumonia
• Environmental Pollutants such as coal, cadmium, grains, and isocyanates
• automobile exhaust gases or specks of dust and gases found in the workplace
• Mineral dust & cotton dust are also COPD risk factors
• Hereditary predispositions such as Alpha-1-antitrypsin deficiency ( α1-antitrypsin ), a deficiency of a protective protein (protease inhibitor, PI). The condition is genetic and results in reduced alpha-1-antitrypsin (AAT) production, leading to AAT deficiency.

▶Stem Cell Therapy for COPD and Emphysema

The Four Stages of COPD

Stage of Pulmonary Disease	FEV1 (percent of predicted), with an FEV1/FVC ratio below 0.70 confirming obstruction
Stage I = Mild	More than or equal to 80%
Stage II = Moderate	Less than 80%, More than 50%
Stage III – Severe	Less Than 50%, More than 30%
Stage IV – Very Severe	Less than 30%

Diagnosing COPD & Emphysema

Emphysema is a form of chronic obstructive pulmonary disease marked by abnormal and permanent enlargement of the air spaces beyond the terminal bronchioles, with destruction of their walls. Diffuse parenchymal lung disease (DPLD), also called interstitial lung disease, is a separate group of conditions and is not a type of COPD. Emphysema and dyspnea usually occur in patients with bronchitis and obstructive pulmonary and respiratory problems. It is rare for patients to be diagnosed with pure Emphysema ( without displaying other indications ) unless it’s related to COPD due to hereditary/genetic abnormalities. Most patients we treat at the Lung Regen Center have a combination of bronchitis, emphysematous lungs, or cardiometabolic diseases caused by airway impairment. This combination of dyspnea is casually referred to as COPD or COLD (chronic obstructive lung disease).

There are three primary types of Emphysema, including:

1. Centriacinar emphysema begins in the patient’s respiratory bronchioles and then spreads to the upper lobes of the lungs. This type of Emphysema is usually caused by long-term tobacco/cigarette smoking.
2. Panacinar emphysema is primarily found in the lower lung regions and tends to destroy alveolar tissue, leading to wheezing. This type of lung disease is commonly found in patients displaying an antitrypsin deficiency with alpha-1 antitrypsin and is a genetic/hereditary disease often seen in patients with end-stage Emphysema.
3. Paraseptal Emphysema occurs in and around the pleura or septae. This type of disease is mainly associated with chronic autoinflammatory conditions that arise after a lung infection or dyspnea

Genetic Testing for Lung Disease & Pulmonary Cancers

The Lung Regeneration Center offers DNA screenings for mutated genes that lead to lung diseases, including:

• FLCN gene, which is associated with Birt-Hogg-Dubé syndrome (pulmonary cysts)
• TSC1 and TSC2 genes, which are associated with TSC (tuberous sclerosis complex) and lung tumors
• COPA genes, which are associated with autosomal dominant interstitial disease (autoimmune)
• PGM3, SPINK5, DOCK8, and STAT3 genes are associated with Hyper IgE syndrome, an immunodeficiency that causes frequent lung infections
• The EGFR gene, which is usually tested in lung tumor tissue, where acquired mutations are most typical of lung adenocarcinoma; rare inherited EGFR variants can raise lung cancer risk
• MARS gene, which is associated with autosomal dominant Charcot-Marie-Tooth disease and autosomal recessive interstitial disease

Genetic screening of pulmonary illnesses is recommended for family members of patients with a family history of lung diseases or cancers or as a tool to confirm an existing diagnosis. Early intervention is key for managing Pulmonary diseases. We do not offer lung transplantation or gene therapies to treat pulmonary disease, but there are several Phase 1 clinical trials underway with the hopes of one day curing COPD completely.^[3] To help reduce any risk of developing COPD, emphysematous lungs, and pulmonary hypertension, consider making lifestyle changes and getting regular exercise.

Latest Treatment Options for COPD

Therapeutic options for chronic pulmonary infections and COPD vary with patient severity. Still, they can help ease some signs, prevent further complications, and gradually slow the progression of the disease using a variety of methods, starting with smoking cessation.

Medications for COPD: Some medications can help reduce symptoms of chronic COPD and reduce frequent exacerbations & flare-ups. Unfortunately, the effectiveness of medicines varies among patients, so your pulmonary specialists might recommend several options to reduce inflammation, relax the airway muscles, or widen the airways to help you breathe more easily. Some common COPD medications include:

1. Theophylline is an older oral medication that is no longer a first-line COPD treatment. It may be added for some patients whose symptoms are not controlled with inhaled bronchodilators, and it needs careful dosing and blood-level monitoring because of side effects and drug interactions.
2. Bronchodilator medications are delivered via nebulizer or inhaler to relax the muscles in your airways. There are two types of bronchodilators: anticholinergics and selective beta-2-agonists, which are often used to treat COPD exacerbations.
3. Glucocorticoids to reduce airway inflammation can be administered orally or via inhalation with a nebulizer.
4. Phosphodiesterase-4 inhibitors can be taken orally to relax the airway and reduce inflammation. They are generally reserved for patients with late-stage COPD or chronic bronchitis.
5. Antibiotics and antivirals to fight some respiratory infections. Vaccines are also recommended for people with COPD to reduce the risk of respiratory infections. Pneumococcal vaccination helps protect against pneumococcal pneumonia, a Tdap booster protects against whooping cough (pertussis), and yearly influenza and COVID-19 vaccines are also advised; your doctor can confirm which vaccines you need.

Oxygen therapy for Chronic Obstructive Pulmonary Disease – Supplemental oxygen is prescribed for patients with low blood oxygen levels. It can be delivered via a nasal cannula or a mask to help patients breathe more easily. A portable oxygen unit may be needed to allow patients to move more easily.

Surgeries for COPD – Surgeries are usually reserved for severe cases of COPD, often as a last resort when other clinical options have failed. Surgery is more commonly used for cases of severe Emphysema. One type of lung surgery is a bullectomy. Large, abnormal bullae (air spaces) are removed during a bullectomy surgery. Another surgical procedure is lung volume reduction, which involves surgically removing injured areas of the upper lung. The riskiest and most challenging treatment option is lung transplants, where new lungs totally or partially replace a patient’s damaged organ from a living or deceased donor.

Stem Cell Therapy for COPD

Patients undergoing clinical intervention at the Lung Regeneration Center have usually already tried a wide range of COPD therapies, with varying levels of success or failure. Patients seeking a more modern approach, such as stem cell therapeutics for COPD, have tried other medical options first but often find it challenging to deal with the severe side effects or positive long-term results. Cell-based approaches for COPD are being investigated. Whether a particular intervention improves lung function, and how its risks compare with other options, must be assessed from human studies of that intervention. Laboratory evidence of repair does not establish that a treatment rebuilds damaged lung tissue in patients. In COPD, airflow into and out of the airways is markedly reduced, leading to frequent exacerbations. Chronic airway obstruction symptoms are due to one or more of the following reasons:

Anatomy guide

Airways and air sacs

A guide to the lungs, the airways that carry air, and the air sacs where gas exchange takes place.

Trachea

The windpipe carrying air toward the lungs.

Bronchi

The main airways branching into the lungs.

Lung

The organ containing the branching airways and air sacs.

Open airway

A cross-section with a clear central opening.

Narrowed airway

A cross-section with less open space for airflow.

Air sacs (alveoli)

Small sacs where gas exchange takes place.

• Due to an underlying medical condition, the airways and sacs lose their elastic properties.
• The walls between the alveoli are diseased or destroyed
• The walls inside the airways become inflamed and too thick for gas exchange
• Too much mucus is produced by the airways, which causes it to clog the airways

Cell-based research and lung function

Stem cells are recognized for their ability to renew and produce specialized cells, but cell populations have different properties. The definition of totipotent cells should not be applied to an adult mesenchymal preparation. Proposed effects on inflammation or repair pathways do not establish restoration of lung tissue in patients. The related topic of inflammatory bowel diseases, such as ulcerative colitis and Crohn’s disease also requires condition-specific evidence.

Treatment for Emphysema

Expanded umbilical cord mesenchymal stem cells (UC-MSC+) are being studied for their ability to reduce inflammation in the lungs. Any benefit is thought to come from immunomodulation, a calming effect on the immune response; the therapy has not been shown to stop the disease or cure chronic bronchitis, and like any treatment it carries risks. The proposed mechanisms discussed for COPD and other pulmonary diseases, such as Idiopathic Pulmonary Fibrosis (IPF), Bronchiectasis, Atelectasis, and Emphysema, involve angiogenesis and inflammatory signaling. These mechanisms do not establish new capillary growth, tissue repair or improved lung function after a particular intervention.^[4]

Investigational cell approaches to chronic airway obstruction

COPD, asthma, fibrosis, lung cancer and Cystic fibrosis are different diseases. Evidence about one condition or cell preparation cannot establish effectiveness for the others. Intravenous administration, direct injection and airway delivery also differ in exposure and risks. A proposed combination protocol requires its own evidence; describing a route as targeted or proprietary does not establish painless delivery, tissue rebuilding or improved clinical outcomes.^[5]

How should cell-based approaches for COPD be assessed?

Lung Cell Transplant – Requirements

The total number of clinical sessions for COPD & Emphysema will depend on patient needs. A proposed cell-based intervention requires individual assessment; mild-to-moderate disease does not by itself establish suitability, safety or benefit. The therapeutic approach uses expanded umbilical cord mesenchymal stem cells (UC-MSC+) delivered in multiple stages over a 2-week course. Long-term effects depend on the severity of the existing condition, and candidates with progressive respiratory diseases, end-stage COPD, bullous lung disease, Popcorn Lung (Bronchiolitis Obliterans) disease, other COPD complications, chronic respiratory system inflammation, and structural alveolar degeneration may not be good candidates, depending on the severity of airflow obstruction. ^[6]

Pulmonary Rehabilitation After Therapy (Optional): Pulmonary Rehabilitation and breathing exercises for COPD are strongly recommended and are available at affiliated local hospitals in Bangkok, depending on the patient’s travel limitations and timing constraints. A dedicated lung rehabilitation specialist will be available upon request for 2-5 hours per day and up to 6 days per week. Medical visas and accommodations for an extended stay with an oxygen nebulizer may also be provided upon special request.

Total Treatment Length: The Lung Regeneration Center protocol is an outpatient procedure, but will require multiple stages of over two weeks of therapy in Bangkok (depending on the severity/spread of the underlying disease).

Clinical guide

Cell sources and terminology

A guide to the source labels used in the laboratory illustration.

1. Adipose tissue

   ADSC

2. Bone marrow

   BM-MSC

3. Peripheral blood

   PB-MSC

4. Placental tissue

   P-MSC

5. Umbilical cord

   UC-MSC

6. UC-MSC+

   The Regeneration Center’s terminology used in this article.

COPD Treatment Benefits & Guidelines

Due to varying degrees of lung damage, our medical team must review patients’ preclinical and clinical records to better understand their needs. Learn more about COPD clinical trials around the world. To get more information about lung cell therapy or to begin the COPD lung stem cells review process, please prepare your recent pulmonary tests and medical records (MRI or Chest CT Scans) and contact us today.

What Clinical Studies Show About Stem Cells for COPD

Three published studies frame what is known today. A placebo-controlled, randomized trial of 62 people with moderate-to-severe COPD gave four monthly intravenous infusions of allogeneic mesenchymal stem cells (100 million cells per infusion) and followed participants for two years. No infusion toxicities or treatment-related serious adverse events occurred, and participants with raised C-reactive protein at entry showed an early fall in that inflammatory marker, but lung-function tests and quality-of-life scores did not differ from placebo.^[8] A 2020 pilot study of 20 patients with GOLD stage C and D COPD treated with expanded allogeneic umbilical cord mesenchymal stem cells (1 million cells per kilogram) reported significant improvements in the mMRC dyspnea score, the COPD Assessment Test and the number of exacerbations over six months, with no serious adverse events; FEV1, C-reactive protein and six-minute walk distance did not change significantly.^[9] A 2024 review of stem cell therapies for COPD concludes that mesenchymal stem cells remain the most practical candidate because of their low tumorigenicity, immunomodulatory activity and paracrine support of alveolar repair, while noting that cell heterogeneity, dosing and delivery route still need standardization before routine clinical use.^[7]

Clinical studies should be read outcome by outcome, including symptoms, exacerbations, lung function and adverse events. A change in an inflammatory marker is different from a demonstrated improvement in breathing or long-term health. The Regeneration Center protocol differs from the trial interventions in cell source, cell enrichment and its combined intravenous and airway delivery route, so results from those studies cannot be transferred directly to this program. Response is measured against your own baseline spirometry, imaging and symptom scores 3 to 5 months after treatment.

2026 Guidelines for Treating COPD & Emphysema

The total number of pulmonary stem cell infusions will depend on the severity of the lung disease, and multiple stages may be necessary for patients with more extensive lung damage. Different delivery routes have different risks and cannot be ranked by an unsupported percentage. A comparative claim requires an identifiable study using the same product, patient group, endpoints and follow-up. No general 40% improvement is established here. Because lung diseases are progressive, some patients may require allogeneic UC-MSC+ cells. Patients with honeycombing, severe respiratory damage, or multiple comorbidities may require multiple infusions.

Lung Rehabilitation after Pulmonary Stem Cell Therapy

Post-Treatment Lung Rehabilitation: Pulmonary rehabilitation services are optional but strongly recommended following any treatment. For patients who can stay in Thailand, we offer a comprehensive integrative rehabilitation program in partnership with local hospitals in Bangkok. Pulmonary rehabilitation is also beneficial for patients experiencing severe difficulty breathing or severe lung hardening. Smoking is also much discouraged for patients with this condition, and active smokers will not qualify for our treatment. The rehabilitation packages in Bangkok are available to all candidates as needed (2-5 hours per day, six days per week). Medical treatment visas and hotel accommodations for long-term stays can also be provided upon request.

Due to varying degrees of respiratory diseases, our medical team must review patients’ medical files for approval. The medical review can be done online or in person. Suitable candidates will be required to stay in Bangkok for a minimum of 2 weeks. To begin the qualification process, please prepare your recent pulmonary tests, such as spirometry, lung function tests, and radiologic scans (MRI or HRCT), and contact us today.

Published Clinical Citations

[1] ^ Al-Jamal, R, W A H Wallace, and D J Harrison. 2005. Gene therapy for chronic obstructive pulmonary disease: twilight or triumph? Expert opinion on biological therapy, no. 3. https://www.ncbi.nlm.nih.gov/pubmed/15833071

[2] ^ Antonucci, Ivana, Andrea Pantalone, Stefano Tete, Vincenzo Salini, Cesar V Borlongan, David Hess, and Liborio Stuppia. 2012. Amniotic fluid stem cells: a promising therapeutic resource for cell-based regenerative therapy. Current pharmaceutical design, no. 13. https://www.ncbi.nlm.nih.gov/pubmed/22352751

[3] ^ Jin, Zhixian, Xinghua Pan, Kaihua Zhou, Hong Bi, Liyan Wang, Lu Yu, and Qing Wang. 2015. Biological effects and mechanisms of action of mesenchymal stem cell therapy in chronic obstructive pulmonary disease. The Journal of international medical research, no. 3 (April 1). doi:10.1177/0300060514568733. https://www.ncbi.nlm.nih.gov/pubmed/25834280

[4] ^ Lim S, Lam DC, Muttalif AR, Yunus F, Wongtim S, Lan le TT, et al. Impact of chronic obstructive pulmonary disease (COPD) in the Asia-Pacific region: the EPIC Asia population-based survey. Asia Pacific family medicine. 2015;14(1):4. doi: 10.1186/s12930-015-0020-9. PubMed: 25937817.

[5] ^ Mora, Ana L, and Mauricio Rojas. 2013. Adult stem cells for chronic lung diseases. Respirology (Carlton, Vic.), no. 7. doi:10.1111/resp.12112. https://www.ncbi.nlm.nih.gov/pubmed/23648014

[6] ^ Akram, Khondoker M, Neil Patel, Monica A Spiteri, and Nicholas R Forsyth. 2016. Lung Regeneration: Endogenous and Exogenous Stem Cell-Mediated Therapeutic Approaches. International Journal of molecular sciences, no. 1 (January 19). doi:10.3390/ijms17010128. https://www.ncbi.nlm.nih.gov/pubmed/26797607

[7] ^ Lai, Sumei, and Zhifeng Guo. 2024. Stem cell therapies for chronic obstructive pulmonary disease: mesenchymal stem cells as a promising treatment option. Stem Cell Research & Therapy 15, no. 1 (September 19): 312. doi:10.1186/s13287-024-03940-9. https://pubmed.ncbi.nlm.nih.gov/39300523/

[8] ^ Weiss, Daniel J, Richard Casaburi, Robin Flannery, Michelle LeRoux-Williams, and Donald P Tashkin. 2013. A placebo-controlled, randomized trial of mesenchymal stem cells in COPD. Chest 143, no. 6 (June): 1590-1598. doi:10.1378/chest.12-2094. https://pubmed.ncbi.nlm.nih.gov/23172272/

[9] ^ Le Thi Bich, Phuong, Ha Nguyen Thi, Hoang Dang Ngo Chau, Tien Phan Van, Quyet Do, Hung Dong Khac, Dong Le Van, et al. 2020. Allogeneic umbilical cord-derived mesenchymal stem cell transplantation for treating chronic obstructive pulmonary disease: a pilot clinical study. Stem Cell Research & Therapy 11, no. 1 (February 13): 60. doi:10.1186/s13287-020-1583-4. https://pubmed.ncbi.nlm.nih.gov/32054512/