Melatonin-Primed Mesenchymal Stem Cells-Derived Small Extracellular Vesicles Alleviated Neurogenic Erectile Dysfunction by Reversing Phenotypic Modulation.

Erectile dysfunction (ED) is an adverse side effect of pelvic surgery with no effective treatment. In this study, we explored whether melatonin could improve the therapeutic effects of small extracellular vesicles (sEVs), derived from mesenchymal stem cells (MSCs), on cavernous nerve injury (CNI) ED and investigated the underlying mechanisms. The sEVs from melatonin-pretreated MSCs (MT-EVs) and MSCs (NC-EVs) were isolated and applied to CNI ED. Transplantation of MT-EVs remarkably increased erectile function and reduced phenotypic modulation in CNI ED rats. MT-EVs increased Calponin 1 and SMA and decreased OPN, Vimentin, and cell migration capabilities. The therapeutic effects of MT-EVs were superior to those of NC-EVs. Sequencing implied that miR-10a-3p was enriched in MT-EVs, and directly targeted the protein kinase inhibitor α (PKIA). After the suppression of miR-10a-3p, the therapeutic actions of MT-EVs were abolished but were rescued by PKIA. Similarly, RhoA/ROCK was inhibited by MT-EVs, but this action was reversed by suppressing miR-10a-3p, accompanied by corresponding changes in PKIA. In conclusion, transplantation of MT-EVs could significantly alleviate CNI ED. MT-EVs may relieve the phenotypic modulation of the corpora cavernosum smooth muscle cells via the miR-10a-3p/PKIA/RhoA/ROCK signaling axis. These nanovesicles should be potential therapeutic vectors or bioactive materials for CNI ED. This article is protected by copyright. All rights reserved.