Engineered mesenchymal stem cell-derived extracellular vesicles attenuate acute glaucoma-induced neuroinflammation by reprogramming microglial polarization

Retinal microglia-mediated neuroinflammation is a critical driver of pathological damage in glaucoma, leading to irreversible loss of retinal ganglion cells (RGCs). Current treatments remain limited in effectively targeting and modulating this neuroinflammatory component within the retinal microenvironment. To address this, we engineered cRGD peptide-functionalized mesenchymal stem cell (MSC)-derived extracellular vesicles (cRGD-EVs) capable of actively targeting activated microglia for the localized delivery of anti-inflammatory miRNAs. After intravitreal administration, cRGD-EVs demonstrated enhanced accumulation in the retina and specific uptake by activated microglia in a rat model of retinal ischemia/reperfusion (RIR) injury. Both in vitro co-culture models and in vivo analyses confirmed the targeting efficacy and phenotypic reprogramming of microglia from a pro-inflammatory (M1) to an anti-inflammatory (M2) state. Intravitreal injection of cRGD-EVs loaded with key miRNAs (let-7c-5p, miR-21a-5p, and miR-146a-5p) significantly suppressed NF-κB pathway activation and reduced the expression of downstream pro-inflammatory cytokines. Treated animals exhibited notable preservation of retinal structure, increased RGC survival, and significant recovery of visual function, as measured by electroretinography. Furthermore, in acute ocular hypertension model, cRGD-EV treatment attenuated glaucomatous neurodegeneration and improved overall retinal homeostasis. These findings highlight cRGD-EVs as a promising targeted biologic delivery system for treating neuroinflammatory components of glaucoma and potentially other retinal diseases characterized by microglial activation.