S. Zhang, W.C. Chu, R.C. Lai, S.K. Lim, J.H.P. Hui, W.S. Toh

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Exosomes derived from human embryonic mesenchymal stem cells promote osteochondral regeneration S. Zhang, W.C. Chu, R.C. Lai, S.K. Lim, J.H.P. Hui, W.S. Toh Osteoarthritis and Cartilage Volume 24, Issue 12, Pages 2135-2140 (December 2016) DOI: 10.1016/j.joca.2016.06.022 Copyright © 2016 The Author(s) Terms and Conditions

Fig. 1 In vivo cartilage repair at 6 weeks post-surgery. Osteochondral defects (1.5 mm diameter and 1 mm depth) were created on the trochlear grooves at both knees of SD rats. Exosome-treated defects were compared against the contralateral control defects treated with PBS. (A) Representative gross morphologies. (B) ICRS macroscopic scores. Values represent the means ± 95% CI. P-values were determined by unpaired two-tailed Student t test (n = 6 per group). (C) Staining results of HE and Saf-O, and immunohistochemical staining for type II, I and VI collagens. (D) Modified O'Driscoll histologic scores for cartilage repair at 6 weeks. Values represent means ± 95% CI. P-values were determined by unpaired two-tailed Student t test (n = 6 per group). The results of histologic scores showed that the defects treated with MSC exosomes produced better repair than the control defects at 6 weeks. Exosome treatment (100 μg per 100 μl injection on a weekly basis) induced significant cartilaginous neotissue with comparable matrix staining and structural integration to the adjacent host cartilage. Comparatively, PBS-treated defects showed mostly fibrous and non-cartilaginous tissue. Histological scoring showed significant difference in the repair of osteochondral defects between the groups (P = 0.004). Osteoarthritis and Cartilage 2016 24, 2135-2140DOI: (10.1016/j.joca.2016.06.022) Copyright © 2016 The Author(s) Terms and Conditions

Fig. 2 In vivo cartilage repair at 12 weeks post-surgery. Exosome-treated defects were compared against the contralateral control defects treated with PBS and unoperated native control. (A) Representative gross morphologies. (B) ICRS macroscopic scores. Values represent the mean ± 95% CI. P-values were determined by unpaired two-tailed Student t test (n = 6 per group). (C) Staining results of HE and Saf-O, and immunohistochemical staining for type II, I, VI and X collagens. (D) Modified O'Driscoll histologic scores for cartilage repair at 12 weeks. Values represent means ± 95% CI. P-values were determined by unpaired two-tailed Student t test (n = 6 per group). By the end of 12 weeks, exosome-treated group showed a new cartilage layer with good surface regularity and structural integration. The regenerated neocartilage layer appeared hyaline with comparable matrix staining to the age-matched native cartilage. There was also complete subchondral bone regeneration. Histologic scoring showed significant difference in the repair of osteochondral defects between the groups (P < 0.001). Osteoarthritis and Cartilage 2016 24, 2135-2140DOI: (10.1016/j.joca.2016.06.022) Copyright © 2016 The Author(s) Terms and Conditions

Supplementary Fig. 1 Characterization of human embryonic MSC-derived exosomes. MSC exosomes exhibited typical exosome characteristics. (A) Western blot analysis of MSC exosome. 20 μg of MSC exosomes were resolved on polyacrylamide gels before electroblotted onto a nitrocellulose membrane. The membrane was probed with primary antibodies (CD81, TSG101 or ALIX) followed by HRP-coupled secondary antibodies against the primary antibodies, and visualized by chemiluminescence. (B) Size distribution of MSC exosome by NanoSight. Exosomes were diluted 5000× with 0.22-μm filtered PBS. The size distribution of exosomes was then measured using NanoSight LM10 and analysed by Nanoparticles Tracking Analysis software. (C) RNA profile of MSC exosomes. RNA was extracted from the exosome preparation using Trizol LS reagent. 200 ng exosomal RNAs were resolved on a 15% Novex Tris–borate–EDTA (TBE)–urea gels and then stained with ethidium bromide. Osteoarthritis and Cartilage 2016 24, 2135-2140DOI: (10.1016/j.joca.2016.06.022) Copyright © 2016 The Author(s) Terms and Conditions

Supplementary Fig. 2 Lubricin staining. Exosome-treated tissues were compared against the contralateral control tissues treated with PBS and the unoperated native control. Immunohistochemical staining for lubricin at 12 weeks. Isotype negative control was included. Representative images (n = 6). Scale bar = 100 μm. Osteoarthritis and Cartilage 2016 24, 2135-2140DOI: (10.1016/j.joca.2016.06.022) Copyright © 2016 The Author(s) Terms and Conditions