Abstract:Objective To investigate the mechanism by which exosomes derived from M2 macrophages under hypoxic conditions regulate the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs).Methods Murine macrophage line RAW264.7 and murine BMSC line CP-M131 were cultured to the third passage. Macrophages were polarized to M2 phenotype using interleukin-4. Exosomes from M2 macrophages cultured under normoxic (N-M2 exo) and hypoxic (H-M2 exo) conditions were extracted and characterized. CP-M131 cells were divided into PBS group, N-M2 exo group (treated with 90 ng/mL N-M2 exo), and H-M2 exo group (treated with 90 ng/mL H-M2 exo) for 72 hours. Exosome uptake by BMSCs was observed via immunofluorescence. Quantitative real-time PCR (qRT-PCR) and Western blotting were used to detect mRNA and protein expression of bone morphogenetic protein-2 (BMP-2), Alkaline phosphatase (ALP), Runt-related transcription factor (Runx), extracellular signal-regulated kinase (ERK), and phosphorylated ERK (p-ERK). ALP staining was performed to assess osteogenic differentiation.Results M2 macrophage polarization and exosome isolation were successfully achieved. Compared to the N-M2 exo group, the H-M2 exo group exhibited significantly upregulated mRNA and protein expression of BMP-2, ALP, and Runx in CP-M131 cells (P < 0.05). ERK and p-ERK protein expression were also elevated in the H-M2 exo group (P < 0.05). ALP staining confirmed enhanced osteogenic differentiation in the H-M2 exo group.Conclusion Hypoxic M2 macrophage-derived exosomes promote osteogenic differentiation of BMSCs through ERK pathway activation.