Hypoxic‐preconditioned mesenchymal stem cell‐derived small extracellular vesicles promote the recovery of spinal cord injury by affecting the phenotype of astrocytes through the miR‐21/JAK2/STAT3 pathway

Background Secondary injury after spinal cord injury (SCI) is a major obstacle to their neurological recovery. Among them, changes in astrocyte phenotype regulate secondary injury dominated by neuroinflammation. Hypoxia‐preconditioned mesenchymal stem cells (MSCs)‐derived extracellular vesicle (H‐EV) plays a multifaceted role in secondary injury by interacting with cellular components and signaling pathways. They possess anti‐inflammatory properties, regulate oxidative stress, and modulate apoptotic pathways, promoting cell survival and reducing neuronal loss. Given the unique aspects of secondary injury, H‐EV shows promise as a therapeutic approach to mitigate its devastating consequences. Our study aimed to determine whether H‐EV could promote SCI repair by altering the phenotype of astrocytes. Methods Rat bone marrow MSCs (BMSCs) and EVs secreted by them were extracted and characterized. After the SCI model was successfully constructed, EV and H‐EV were administered into the tail vein of the rats, respectively, and then their motor function was evaluated by the Basso–Beattie–Bresnahan (BBB) score, Catwalk footprint analysis, and electrophysiological monitoring. The lesion size of the spinal cord was evaluated by hematoxylin–eosin (HE) staining. The key point was to use glial fibrillary acidic protein (GFAP) as a marker of reactive astrocytes to co‐localize with A1‐type marker complement C3 and A2‐type marker S100A10, respectively, to observe phenotypic changes in astrocytes within tissues. The western blot (WB) of the spinal cord was also used to verify the results. We also compared the efficacy differences in apoptosis and inflammatory responses using terminal deoxynucleotidyl transferase dUTP terminal labeling (TUNEL) assay, WB, and enzyme‐linked immunosorbent assay (ELISA). Experiments in vitro were also performed to verify the results. Subsequently, we performed microRNA (miRNA) sequencing analysis of EV and H‐EV and carried out a series of knockdown and overexpression experiments to further validate the mechanism by which miRNA in H‐EV plays a role in promoting astrocyte phenotypic changes, as well as the regulated signaling pathways, using WB both in vivo and in vitro. Results Our findings suggest that H‐EV is more effective than EV in the recovery of motor function, anti‐apoptosis, and anti‐inflammatory effects after SCI, both in vivo and in vitro. More importantly, H‐EV promoted the conversion of A1 astrocytes into A2 astrocytes more than EV. Mo