Hao Wang,1,2,* Zihao Bai,3,* Yan Qiu,1,4,* Jiaxi Kou,1,4,* Yanqing Zhu,1,4 Qian Tan,1,4 Chen Chen,5 Ran Mo1,4 

1Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, People’s Republic of China; 2Department of Cardiothoracic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China; 3Nanjing Children’s Hospital, Clinical Teaching Hospital of Medical School, Nanjing, Jiangsu, People’s Republic of China; 4Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China; 5Department of Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Ran Mo, Email mr88mr88@163.com Chen Chen, Email chenchen055@163.com

Background: Diabetic wounds are a common and challenging complication of diabetes, characterized by delayed healing and increased risk of infection. Current treatment methods are limited and often ineffective in promoting wound repair. Mesenchymal stem cell (MSC)-derived exosomes have shown promise in regenerative medicine, but enhancing their therapeutic potential remains a key area of research.
Methods: In this study, MSCs were pretreated with empagliflozin (EMPA), and exosomes were isolated using ultracentrifugation. The morphology, size, and protein markers of EMPA-Exos were characterized. Their effects on human umbilical vein endothelial cells (HUVECs) were assessed using EdU assays, CCK-8 assays, scratch assays, Transwell assays, and Matrigel tube formation assays. The PTEN/AKT/VEGF signaling pathway was analyzed through Western blotting. In vivo, diabetic mouse wound models were used to evaluate the healing efficacy of EMPA-Exos.
Results: EMPA pretreatment enhanced the functional properties of MSC-derived exosomes, significantly improving HUVECs’ proliferation, migration, invasion, and angiogenesis compared to non-pretreated exosomes (P < 0.05). Transcriptomic analysis and pathway activation studies revealed that EMPA-Exos promoted angiogenesis through the PTEN/AKT/VEGF signaling pathway. In vivo experiments demonstrated accelerated wound healing and increased vascularization in diabetic mice treated with EMPA-Exos (P < 0.05).
Conclusion: EMPA-pretreated MSC-derived exosomes effectively enhance angiogenesis and accelerate diabetic wound healing by activating the PTEN/AKT/VEGF signaling pathway. This strategy offers a promising approach for improving diabetic wound repair and provides a potential new therapeutic avenue in regenerative medicine.

Keywords: exosomes, adipose-derived mesenchymal stem cells, Ad-MSCs, empagliflozin, diabetic wound healing, angiogenesis