Why 20 Million vs 40 Million Stem Cells Can Both Be Powerful — and When Each Makes Sense in ALS

Why 20 Million vs 40 Million Stem Cells Can Both Be Powerful — and When Each Makes Sense in ALS

Introdução

When a person or a family faces a diagnosis such as ALS (Esclerose Lateral Amiotrófica), one of the first questions they ask is:

“What can be done to slow this down?”

Over the last two decades, células-tronco mesenquimais (MSC) have emerged as one of the most promising biological tools to modulate inflammation, protect neurons, and slow degeneration.

One of the most common questions patients ask is:

“Is 40 million stem cells better than 20 million? Is twice the dose twice as effective?”

The answer is surprisingly nuanced — and understanding it can save patients both money and false expectations.

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What are mesenchymal stem cells (MSC)?

Mesenchymal stem cells are special repair cells that live mainly in:

• medula óssea
• tecido adiposo
• connective tissue

They have four remarkable abilities:

1. They calm inflammation
2. They protect neurons
3. They release growth and healing signals
4. They regulate the immune system

They do not replace neurons — instead, they change the biological environment in which neurons live.

This is extremely important in ALS, because ALS is not just neuron death — it is a disease of:

• inflamação crônica
• immune mis-regulation
• toxic microenvironment
• estresse oxidativo
• blood-brain barrier dysfunction

MSCs target all of these.

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How many MSCs are normally in your blood?

In a healthy adult:

• There are thousands to tens of thousands of MSCs in the entire bloodstream at any moment
• In many people, there are almost none

These cells live mostly in tissues — not in blood.

So biologically speaking:

The natural concentration of MSCs in the blood is extremely low.

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What happens when we inject 20–40 million MSCs?

When MSCs are given intravenously, we create a temporary flood of healing cells.

Normal level	1,000 – 50,000 MSC
Therapeutic infusion	20,000,000 – 40,000,000 MSC

Isso significa:

• 20 million = thousands to tens of thousands times more
• 40 million = even higher

But here is the key truth:

Biology does not respond linearly.

More does not always mean proportionally better.

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The Plateau Effect — Why More Cells Do Not Equal More Healing

Na medicina, this is called a dose-response curve.

Let us visualize it:

Biological
Effect
  |
100|                _________
 90|              _/
 80|            _/
 70|          _/
 60|        _/
 50|      _/
 40|    _/
 30|  _/
 20|_/
   +-----------------------------
        5   10   20   40   80
           MSC Dose (Millions)

This curve shows something critical:

• From 5 → 10 million = huge jump in effect
• From 10 → 20 million = big jump
• From 20 → 40 million = smaller jump
• From 40 → 80 million = tiny jump

This is called the therapeutic plateau.

Once you pass a certain threshold, the body’s biological systems are already fully activated.

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What MSCs actually do in ALS

MSCs do not “fix” neurons — they protect the ones that remain.

They do this by:

• Reducing toxic inflammation around motor neurons
• Suppressing autoimmune attack
• Increasing blood supply and oxygenation
• Releasing neurotrophic factors (BDNF, NGF, VEGF)
• Stabilizing the blood-brain barrier
• Protecting mitochondria inside neurons

Once these systems are turned on, doubling the cell dose does not double the effect.

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So what is the real difference between 20M and 40M?

Clinically and biologically:

Dose	What it does
20 million	Reaches the therapeutic threshold for immune modulation, neuroproteção, and inflammation control
40 million	Extends and strengthens the same effects, giving more durability and more coverage

In simple terms:

20 million turns the system ON
40 million keeps it ON longer and stronger

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Why 20 million is often ideal in early or slow ALS

In early-stage or slow-progressing ALS:

• Neurons are still present
• Inflammation is moderate
• Immune dysregulation is not extreme

Então 20 million MSCs:

• already create a massive biological shift
• already activate all healing pathways
• already slow the disease environment

Using 40 million here gives only modest extra benefit for much higher cost.

This is why many experienced clinicians prefer:

20 million for early or slow disease

It is efficient, powerful, and cost-effective.

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Why 40 million makes sense in late or aggressive ALS

In advanced or fast-progressing ALS:

• Inflammation is severe
• Immune activation is high
• Neurons are under heavy stress
• Tissue damage is widespread

Here, the system is harder to control.

Então 40 million MSCs:

• create a larger biological buffer
• provide longer-lasting immunomodulation
• deliver more neuroprotective signals

This is not because 20 million “doesn’t work” — it’s because the battlefield is bigger.

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Think of it like fire suppression

If a small fire starts in a room:

• One fire extinguisher is enough

If a large fire is burning:

• You need many more

The mechanism is the same — only the scale changes.

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Safety and compatibility

Because these are autologous MSCs (from the patient):

• No rejection
• No immune attack
• No genetic mismatch
• No tumor risk when properly prepared

This allows higher doses to be used safely when needed.

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Conclusão

20 million MSCs:

• Already exceed natural levels by thousands of times
• Already activate all key healing pathways
• Already provide most of the biological benefit

40 million MSCs:

• Extend and strengthen the same mechanisms
• Are most useful in aggressive, advanced disease

This is not about “more is better” — it is about using the right biological dose for the right stage of disease.

That is what truly personalized regenerative medicine means.