Brain‐derived neurotropic factor mediates neuroprotection of mesenchymal stem cell‐derived extracellular vesicles against severe intraventricular hemorrhage in newborn rats

Brain‐derived neurotropic factor (BDNF), which is secreted by mesenchymal stem cells (MSCs), protects against severe intraventricular hemorrhage (IVH)‐induced brain injuries. Although the paracrine protective effects of MSCs are mediated primarily by extracellular vesicles (EVs), the therapeutic efficacy of MSC‐derived EVs and the role of the BDNF in the EVs have not been studied. This study aimed to determine whether MSC‐derived EVs attenuate severe IVH‐induced brain injuries, and if so, whether this protection is mediated by BDNF transfer. We compared the therapeutic efficacy of MSCs, MSC‐derived EVs with or without BDNF knockdown, and fibroblast‐derived EVs in vitro in rat cortical neuronal cells challenged with thrombin and in vivo in newborn rats by injecting 200 μL of blood at postnatal day (P) 4 and transplanting 1 × 10(5) MSCs or 20 μg of EVs at P6. The MSCs and MSC‐derived EVs, but not the EVs derived from BDNF‐knockdown MSCs or fibroblasts, significantly attenuated in vitro thrombin‐induced neuronal cell death and in vivo severe IVH‐induced brain injuries such as increased neuronal cell death, astrogliosis, and inflammatory responses; reduced myelin basic protein and neurogenesis; led to progression of posthemorrhagic hydrocephalus; and impaired behavioral test performance. Our data indicate that MSC‐derived EVs are as effective as parental MSCs in attenuating severe IVH‐induced brain injuries, and this neuroprotection is primarily mediated by BDNF transfer via EVs.