Thermosensitive injectable hydrogel loaded with hypoxia-induced exosomes maintains chondrocyte phenotype through NDRG3-mediated hypoxic response

Current clinical treatments cannot effectively delay the progression of osteoarthritis (OA). Consequently, joint replacement surgery is required for late-stage OA when patients cannot tolerate pain and joint dysfunction. Therefore, the prevention of OA progression in the early and middle stages is an urgent clinical problem. In a previous study, we demonstrated that NDRG3-mediated hypoxic response might be closely related to the development and progression of OA. In this study, an injectable thermosensitive hydrogel was established by cross-linking Pluronic F-127 and hyaluronic acid (HA) for the sustained release of hypoxia-induced exosomes (HExos) derived from adipose-derived mesenchymal stem cells. We demonstrated that for OA at the early and middle stages, the HExos-loaded HP hydrogel could maintain the chondrocyte phenotype by enhancing chondrocyte autophagy, reducing chondrocyte apoptosis, and promoting chondrocyte activity and proliferation through the NDRG3-mediated hypoxic response. This novel composite hydrogel, which could activate the NDRG3-mediated hypoxic response, may provide new ideas and a theoretical basis for the treatment of early- and mid-stage OA.