EPC-EXs Improve Neuronal Survival and Oxidative Stress Through Different Uptaking Pathways in Diabetic Hypoxia Condition

Background: Hyperglycemia contributes to cardiovascular complications in patients with type 2 diabetes. We confirmed that high glucose (HG) induces endothelial dysfunction and cerebral ischemic injury is enlarged in diabetic mice. Stem cell-released exosomes have been shown to protect the brain from ischemic stroke. We have previously shown that endothelial progenitor cells (EPCs)-released exosomes (EPC-EXs) can protect endothial cells from hypoxia/reoxygenation (H/R) and HG-induced injury. Here, we aim to investigate the effects of EPC-EXs on astrocytes under H/R and HG-induced injury and whether miR-126 enriched EPC-EXs (EPC-EXsmiR126) have enhanced efficacy. Methods: EPC-EX uptake and co-localization were measured by fluorescent microscopy using PKH26 and DAPI staining. miR-126 enrichment was achieved by transfecting with miR-126 mimics and quantified with real-time PCR. After co-incubation, cell death or apoptosis was measured by using flow cytometric analysis and LDH (Lactate Dehydrogenase) assay. Oxidative stress/ROS (reactive oxygen species) generation was measured by DHE (Dihydroethidium) staining and lipid peroxidation assay. Results: The EPC-EXs were effectively taken up by the astrocytes in a concentration as well as time- dependent manners and were co-localized within the nucleus as well as the cytoplasm. Pathway uptake inhibitors revealed that the EPC-EXs are effectively taken up by the clathrin-mediated, caveolin-dependent, and micropinocytosis via PI3K/Akt pathway. H/R and HG-induced a cell injury which could be protected by EPC-EXs evidenced by decreased cell apoptosis, cell cytotoxicity, oxidative stress, and lipid peroxidation. Moreover, miR-126 overexpression could enhance the protective effects of EPC-EXs. Conclusions: These results collectively indicate that the EPC-EXs could protect astrocytes against the HG plus H/R-induced damage.