Multi-omics insights into stem cell-mediated regeneration after traumatic spinal cord injury: cell fate, niche remodeling, and functional integration

Stem-cell grafts may replace neural cells, protect host tissue, or change local signaling after spinal cord injury. Their effects depend on the starting cell product, how donor cells respond to the lesion, and whether they contribute to useful function. This narrative review examines neural stem/progenitor cells and neural products derived from pluripotent stem cells. Mesenchymal stromal cells (MSCs) provide a comparison for repair driven mainly by secreted factors. Transplantation studies show that regional identity and developmental stage affect graft behavior, that the lesion can redirect donor-cell fate, and that neural and stromal products can alter host responses. In selected models, neural grafts also form active connections with host circuits. Molecular profiling identifies product heterogeneity, early donor-cell states, and secreted factors associated with host responses. Injury atlases describe changes in cell populations, tissue locations, and metabolites, helping researchers choose questions for graft studies. These findings come from separate studies; no study has yet tested the full multi-omics sequence from product features to recovery. Future work should connect product measurements before transplantation to donor, host, and functional changes over time. It should test whether proposed mechanisms affect function and whether findings hold across products and recipients. Clinical translation will also require potency tests tied to intended function, long-term safety monitoring, and measures of motor, sensory, autonomic, and daily function.