Extracellular vesicles from human urine‐derived stem cells merged in hyaluronic acid ameliorate erectile dysfunction in type 2 diabetic rats by glans administration.

Background: The high prevalence of erectile dysfunction (ED) in patients with type 2 diabetes mellitus (DM2) is a challenging clinical problem. Researches on extracellular vesicles from urine‐derived stem cells (USC‐EVs) have shown that they have significant therapeutic effects in a variety of diseases by injection including ED. Hyaluronic acid (HA) is especially useful for delivering bioactive molecules. This study investigated the effects and related mechanisms of local administration of human USC‐EVs combined with HA (USC‐EVs‐HA) on a rat model of DM2ED. Methods: UCSs were extracted from human urine samples and identified for preparation of the corresponding USC‐EVs. The effects of high glucose and USC‐EVs on human umbilical vein endothelial cells (HUVECs) were assessed in vitro using a CCK‐8 assay to determine cell proliferation and pick the most appropriate concentration for subsequent experiments. Scratch and tube formation assays were performed to assess the function of HUVECs. Quantitative real‐time polymerase chain reaction (PCR) was used to detect the expression of genes such as B‐cell lymphoma‐2 (Bcl‐2), Bcl‐2‐associated X protein (BAX), and superoxide dismutase‐2 (SOD2). HA, USC‐EVs, and USC‐EVs‐HA were prepared at concentrations and then administered topically to DM2ED rats multiple times. Intracavernous pressure and mean arterial pressure were measured to assess erectile function in rats. Masson, Tunel, Immunohistochemistry, and Western blot analysis were performed to assess the fibrosis and endothelial function in corpus cavernosum, respectively. Results: Compared with the control group, the proliferation, migration ability, and tube‐forming ability of HUVECs decreased in high glucose environment, while USC‐EVs could optimize the function of HUVECs, reverse the expression of apoptotic genes, and enhance the antioxidant capacity. USC‐EVs‐HA showed improvement in ED compared to the HA and USC‐EVs groups, and the 10‐dose group was better than the 5‐dose group. Histologically, the USC‐EVs‐HA group significantly improved apoptosis, angiogenesis, and smooth muscle regeneration in the corpus cavernosum compared to the HA group. Conclusions: The topical application of USC‐EVs‐HA in the treatment of DM2ED rats has been proved effective. The potential mechanism might to promote the proliferation of endothelial cells and smooth muscle in the corpus cavernosum, which leads to the remodeling of erectile function. And multiple dosing at intervals may make the effect more pronounced. [ABSTRACT FROM AUTHOR]