CASE REPORT article
Front. Immunol.
Sec. T Cell Biology
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1656724
Mesenchymal stromal cells as rescue therapy in biologic-refractory psoriasis: insights from a case series
Provisionally accepted
Su Mar Lwin1,2
Shane Solanky1,2
Cristiano Scottà3
Chiara Giacomini1Shir Azrielant1,4
Isabella Tosi1,2Atheer Al-Haddabi5Emelia Duarte-Williamson5Hannah Dawe1,2Sarah Walsh5
John Mcgrath1,2
Giovanna Lombardi1
Francesco Dazzi1Christopher E M Griffiths1,5*- 1King's College London, London, United Kingdom
- 2St John's Institute of Dermatology, London, United Kingdom
- 3Brunel University London, London, United Kingdom
- 4Tel Aviv University, Tel Aviv-Yafo, Israel
- 5King's College Hospital, London, United Kingdom
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Cytokine-targeted biologics have revolutionized the management of moderate-to-severe psoriasis; however, a growing number of patients are failing all available therapies. Mesenchymal stromal cells (MSCs), with immunomodulatory properties, offer a novel therapeutic option. We report three adult female patients with long-standing, severe plaque psoriasis refractory to multiple biologic therapies, treated with two intravenous infusions of allogeneic umbilical cord-derived MSCs (UC-MSCs; 1.96–3.00x106 cells/kg) one week (W) apart. Two patients received UC-MSCs as monotherapy; one received them alongside etanercept. Upon relapse, two patients resumed their last failed biologic at W9 while one switched to a new biologic at W24. UC-MSCs were well-tolerated and yielded variable clinical benefits. The best responder to MSCs experienced an 87% reduction in Psoriasis Area and Severity Index (PASI87) by W4. Two patients showed improved responses to previously failed biologics (absolute PASI 0-2), sustained for over 2 years following re-initiation. Multi-parameter flow cytometry revealed increased frequencies of CD4+ and CD8+ skin-homing (CLA+CD103-) and skin-recirculating (CLA+CD103+) memory T cells, CD25HiCD127LoFoxP3+ regulatory T cells, and non-classical (CD14LoCD16+) monocytes, associated with clinical improvements. These findings suggest that UC-MSCs may potentially provide direct benefit in biologic-refractory psoriasis and restore responsiveness to previously ineffective biologics, possibly by resetting the immune response. Further investigation in larger cohorts is warranted.
Keywords: Psoriasis, multiple biologic-refractory, Mesenchymal Stromal Cells, immunomodulatory, regulatory T cells, monocytes. MSCs for Severe Biologic-Refractory Psoriasis
Received: 30 Jun 2025; Accepted: 11 Aug 2025.
Copyright: © 2025 Lwin, Solanky, Scottà, Giacomini, Azrielant, Tosi, Al-Haddabi, Duarte-Williamson, Dawe, Walsh, Mcgrath, Lombardi, Dazzi and Griffiths. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Christopher E M Griffiths, King's College London, London, United Kingdom
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