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Extracellular Vesicle-Derived microRNA-410 From Mesenchymal Stem Cells Protects Against Neonatal Hypoxia-Ischemia Brain Damage Through an HDAC1-Dependent EGR2/Bcl2 Axis

Hypoxia-ischemia brain damage (HIBD) is a neurological disorder occring in neonates, which is exacerbated by neuronal apoptosis. Mesenchymal stem cells (MSCs)-derived extracellular vesicles (EVs) have been proposed as a promising strategy for treating or preventing ischemia-related diseases. However, their mechanisms in HIBD remain unclear. Thus, we aimed to address the role of EV-derived microRNA (miR)-410 in HIBD. Neonatal HIBD mouse model was constructed using HI insult, from which neurons were isolated, followed by exposure to oxygen glucose deprivation (OGD). EVs were isolated from human umbilical cord (hUC)-derived MSCs. In silico analyses, dual-luciferase reporter gene and chromatin immunoprecipitation assays were adopted to determine relationships among miR-410, histone deacetylase 1 (HDAC1), early growth response protein 2 (EGR2), and B cell lymphoma/leukemia 2 (Bcl2). The functional roles of EV-derived miR-410 were determined using loss- and gain-of functions experiments, and by evaluating neuronal viability, cell-cycle distribution and neuronal apoptosis in vitro as well as modified neurological severity score (mNSS), edema formation, and cerebral infarction volume in vivo. hUC-MSCs-derived EVs protected against HIBD in vivo and inhibited the OGD-induced neuronal apoptosis in vitro. miR-410 was successfully delivered to neurons by hUC-MSCs-EVs and negatively targeted HDAC1, which inversely mediated the expression of EGR2/Bcl2. Upregulation of EV-derived miR-410 promoted the viability but inhibited apoptosis of neurons, which was reversed by HDAC1 overexpression. EV-derived miR-410 elevation reduced mNSS, edema formation, and cerebral infarction volume by increasing EGR2/Bcl2 expression through downregulating HDAC1 expression in vivo. In summary, EV-derived miR-410 impeded neuronal apoptosis by elevating the expression of EGR2/Bcl2 via HDAC1 downregulation, thereby providing a potential strategy for treating or preventing HIBD.


INTRODUCTION
Perinatal hypoxia-ischemia (HI) is the main cause of acute neonatal brain injury, leading to long-term neurological impairments including behavioral, social, cognitive, and even functional motor deficits . HI brings a high mortality rate, especially in infants and children (Thatipamula et al., 2015). Aberrant activation of the immune system has been linked to deleterious inflammatory responses, thus serving as a driver for neonatal HI (Ziemka-Nalecz et al., 2017). A previous study has noted that enhanced neuronal cell death correlates to exacerbated HI in the immature brain (Rodriguez et al., 2018). Mesenchymal stem cells (MSCs) also confer protection against hypoxia-ischemia brain damage (HIBD) (Zheng et al., 2018). Extracellular vesicles (EVs) released from human umbilical cordderived MSCs (hUC-MSCs) exert neuroprotective functions against perinatal brain injury and reduce neuronal cell death (Thomi et al., 2019a). Elucidating the inhibitory mechanisms of MSCs-derived EVs on neuronal apoptosis is therefore critical to attenuating HIBD.
Extracellular vesicles are nanometer-sized spherical bilayered proteolipids, which are responsible for cell-cell communication (Kim et al., 2017). The administration of EVs improves recovery of function and structural injury of fetal brain following HI insult (Ophelders et al., 2016). In particular, MSCs-derived EVs have been suggested to be promising targets for treating ischemiarelated disease (Gonzalez-King et al., 2017). EVs derived from human Wharton's jelly MSCs exhibit the potential to inhibit apoptosis of neuronal cells induced by HI (Joerger-Messerli et al., 2018). Of note, microRNA-410 (miR-410) expression is confined to the developing central nervous system (Wheeler et al., 2006;Han et al., 2012), which is highly suggestive of a significant role in neurogenesis. Indeed, a functional study has suggested the activation of miR-410-3p to be a potential therapeutic target for the clinical treatment of HIBD (Xiao et al., 2020). Additionally, administration of miR-410 encapsulated in MSCs (Ti et al., 2016) confers neuroprotective effects against oxidative stress following ischemic stroke . In the first phase of this study, we identified Histone deacetylase 1 (HDAC1) as an miR-410 target via our in silico analyses. HDAC1 regulates gene transcription by removing acetyl groups from histone or non-histone proteins (Ma and Schultz, 2016). A previous study has noted that downregulated HDAC1 activity was found at the promoter of early growth response 2 (EGR2), thereby elevating EGR2 expression in neurodegenerative disorders (Adler and Schmauss, 2016). As a transcription factor, EGR2 exerts pivotal functions on myelination in the peripheral nervous system (Tozza et al., 2019) and also upregulates the expression of apoptosis regulator B cell lymphoma/leukemia 2 (Bcl2) during positive selection (Lauritsen et al., 2008). Bcl2 exerts a pivotal function in apoptosis and is engaged in carcinogenesis and immune responses . Furthermore, elevated expression of Bcl2 leads to improved neurological outcomes following HI (Yin et al., 2018). In previous research, the oxygen glucose deprivation (OGD) model has been widely used to simulate brain ischemia in vitro (Shao et al., 2016;Zheng et al., 2018;Jiao et al., 2020). Thus, we utilized in this study a mouse model of HIBD and OGD-exposed neurons to explore the regulatory network involving EV-derived miR-410 and HDAC1-dependent EGR2-Bcl2 axis in HI. Our motivation is that understanding better the molecular regulation of EV-derived miR-410 on HI might provide an avenue for protecting against neonatal HI.

Ethical Approval
Mice were treated humanely using approved procedures granted by the Ethics Committee of The First Hospital of Jilin University.

Establishment of HIBD in Neonatal Mice
C57BL/6J mice (Guangdong Medical Laboratory Animal Center, Guangzhou, Guangdong, China) were allowed to give birth naturally. Neonatal mice aged between postnatal days 9 and 10 (day of birth regarded as postnatal day 0) were adopted to establish the HIBD model. In brief, following induction of isoflurane anesthesia, the left carotid artery in mice was ligated permanently and the skin wound was closed using surgical glue (Vetbond, SweVet, Sweden). Neonatal mice were allowed to recover for 1 h with their Dam before being placed in a chamber (36 • C) containing air. After 10 min, the chamber was filled with a mixture of normal air and nitrogen to a final oxygen concentration of 10% for 20 min. Normal air was then infused back into the chamber. 10 min later, the neonatal mice were returned to their Dam until euthanasia. The HIBD caused unilateral brain injury in the right hemisphere (ipsilateral to the artery ligation), while no sign of injury was observed in the contralateral (left) hemisphere. Sham-operated mice were anesthetized with the exposure of the left carotid artery without ligation.

Isolation and Identification of EVs
Prior to isolation of hUC-MSCs, the EVs in FBS were removed using ultracentrifugation (120,000 × g; 3 h; 4 • C) and hUC-MSCs were maintained in DMEM supplemented with EVs-depleted FBS, followed by the collection of cell suspension medium every other day, three times in succession. The suspension was then transferred to conical tubes and cells were pelleted using centrifugation (300 × g; 10 min; 4 • C). Cell debris in the supernatant was removed using centrifugation (16,500 × g; 20 min; 4 • C). The supernatant was filtered using a 0.22 µm filter and transferred to a new tube, followed by ultracentrifugation (120,000 × g; 70 min; 4 • C) to pellet the EVs. The supernatant was immediately aspirated and the sample was ultracentrifuged as described above. All ultracentrifugation steps were performed at 4 • C in a Beckman ultracentrifuge (TL-100) with a TLS-55 swinging bucket rotor. A Beckman Allegra X-15R tabletop centrifuge was used for low-speed centrifugation. The EVsenriched pellet was resuspended in 100 µL sterile phosphate buffer saline (PBS) to retrieve maximal EVs.
The protein contents of EVs were assessed using the bicinchoninic acid kit protein assay kit (Pierce Protein Biology; Thermo Fisher Scientific, Austin, TX, United States). Transmission electron microscopy (Leica, Wetzlar, Germany) and NanoSight NS300 (Malvern Instruments, Ltd., Malvern, Worcestershire, United Kingdom) were used to determine the morphology or size of EVs, respectively, followed by the assessment of EV surface markers [CD63 molecule (CD63), ALG-2 interacting protein X (Alix), tumor susceptibility 101 (TSG101)] using immunoblotting.
Purified hUC-MSCs-EVs were treated with 20 µg/µL proteinase K containing 0.05% Triton X-100 or RNase A, followed by silver staining and gel electrophoresis to test the efficacy of the enzyme treatment.

Immunofluorescence
The EVs were labeled with PKH26 (red fluorescent cell label; Sigma-Aldrich). In brief, EVs were diluted in 500 µL of diluent C and then incubated with 2 µL of PKH26 for 5 min. FBS was then added to stop the reaction. Finally, the cells were washed twice with DMEM, added to the neurons, followed by incubation (3 • C; 12 h). Hoechst 33342 (10 µg/ml) was added to stain the nuclei in the cells. The cells were observed via a fluorescence microscope 20 min later (Olympus, Tokyo, Japan).

Culture of Neurons
Neurons were prepared from the cortex of C57BL/6J mice on postnatal day 1. In brief, the cerebral cortex was isolated from the neonatal mice, and cells were dissociated in a trypsin solution (1.25 mg/mL in Hank's buffered salt solution; 10 min; 37 • C). Following centrifugation and resuspension, the cell suspension was seeded into six-well plates pre-coated with Polylysine (P1149; Sigma, St. Louis, MO, United States), and cultured in neurobasal medium (Life, Carlsbad, CA, United States, 21103-049) supplemented with 2% B27 supplement (Life, 17504-044) and 500 µM glutamine (Life, 25030081) in a humidified incubator with 5% CO 2 at 37 • C.
Following a 7-day culture in vitro, cells were exposed to OGD for 3 h followed by reoxygenation. In brief, cells were plated in DMEM in the absence of glucose (Life, 11966-025), and exposed to hypoxia (95% N 2 /5% CO 2 ) at 37 • C for 3 h. Following 3-h OGD treatment, the normal neurobasal medium was adopted to replace cell culture medium and the cells were developed in the 5% CO2, 37 • C incubator.
The neonatal mice were treated with repeated intraperitoneal injections of MSCs-EVs. In brief, mice were first injected at 14 h before HI, for the second time immediately before exposure to hypoxia, the third time after the mice were removed from the hypoxic chamber, and finally at 3 h after hypoxia.

Lentiviral Vector Construction and Cell Infection
The lentiviral vectors containing agomir and antagomir (both obtained from Genepharma, Shanghai, China) were introduced into neurons or MSCs according to the manufacturer's instructions provided by FuGENE R HD Transfection Reagent (Promega, Madison, WI, United States) or the Lipofectamine 2000 kit (Invitrogen, Carlsbad, CA, United States), respectively. In brief, purified MSCs were incubated with Lipofectamine 2000 from which antagomir was prepared, and their mixture was incubated at 37 • C for 2 h, followed by ultracentrifugation again to pellet EVs and discard the supernatant.
Lentiviral vectors (pGLV2-U6-Puro) containing HDAC1 short hairpin RNA (sh-RNA) and its negative control (NC) were obtained from Genepharma. pGLV2-U6-Puro of HDAC1 sh-RNA and negative controls were transfected into 293T cells according to the manufacturer's instructions provided by EndoFectin Lenti transfection reagent. Following 48-h culture, lentiviral particles in the supernatant were collected and filtered for neuron infection.

Modified Neurological Severity Score (mNSS)
Modified neurological severity score (mNSS) serves as a criterion for neurological assessment to movement, reflex, sensation, and balance in rodents (Yao et al., 2009;Piao et al., 2018), and was here used to assess the extention of neurological injury of neonatal mice at 6 h after HI. The score ranged from 0 to 18, where 1-6 indicated mild injury, 7-12 represented moderate injury, and 13-18 indicated severe injury. Assessor were blinded to the experimental treatments.

2,3,5-Triphenyltetrazolium Chloride (TTC) Staining
The mice were anesthetized by intraperitoneal injection of 1% pentobarbital sodium (30 mg/kg) at 6 h after HI, and the blood was washed by rapid perfusion of the heart using 100 mL pre-cooled (4 • C) normal saline. The mice were euthanized, followed by brain removal and dissection on ice and measurement of its length. The forebrain was cooled at −20 • C for 10 min and sectioned into 2 mmthick serial sections. Then, the sections were placed into 2% 2,3,5-triphenyltetrazolium chloride (TTC) solution (2530-85-0, Guidechem, Shanghai, China), incubated in the dark at 37 • C for 30 min (with uniform staining ensured by section flipping), and fixed in paraformaldehyde phosphate (4%) overnight. The edema formation and volume of cerebral infarction were determined as previously described (Si et al., 2006).

EV Tracking
PKH-26 red fluorescent (Sigma-Aldrich, St. Louis, MO, United States)-labeled EVs were injected into the ipsilateral hemisphere during HI and at 6 h after HI, and the deeply anesthetized mice were euthanized by intracardiac perfusion of 0.1 M PBS supplemented with 4% paraformaldehyde. Coronal brain sections (60 µm) were sectioned and stained with DAPI (1: 500, Sigma, D9542) to stain nuclei, and a fluorescence microscope (Olympus) was used to record images.

Flow Cytometry
Cells were washed with cold PBS (three times) and centrifuged with the supernatant discarded. Cells were resuspended with PBS with the concentration adjusted to 1 × 10 5 cells/mL, followed by fixation in pre-cooled ethanol (−20 • C; 1 mL; 75%) at 4 • C for 1 h. Next, cells were added with RNaseA (100 µL) in the dark, incubated at 37 • C for 30 min, and dyed using 400 µL of propidium iodide (PI) (Sigma). A flow cytometer with red fluorescence was finally adopted to determine the cell-cycle distribution at 488 nm wavelength.
Cells at the concentration of 1.25 × 10 6 cells/mL were stained using PI for 10 min and subjected to cell apoptosis analysis using Annexin-V-fluorescein isothiocyanate flow cytometer (40302ES20, Qcbio Science & Technologies Co., Ltd., Shanghai, China) and FACSCalibur flow cytometer (342975, BD, Franklin Lakes, NJ, United States). The number of cells was counted at 488 nm wavelength and analyzed using Cell Quest software.
Microarray database GSE23160 was subjected to online coexpression analysis tool MEM 9 to predict the co-expression genes. The human transcription factor obtained from hTFtarget 10 were intersected genes obtained from the co-expression analysis and the differential analysis to obtain the downstream target genes of miR-410.

Reverse Transcription Quantitative Polymerase Chain Reaction (RT-qPCR)
Total RNA was extracted from neurons and hippocampus using TRIzol (Invitrogen, Shanghai, China) and cDNA was synthesized by Primescript RT kit (TaKaRa, Dalian, China). Real-time qPCR was performed using Platinum SYBR Green qPCR SuperMix-UDG kit (Life Technologies, Gaithersburg, MD, United States) or a TaqMan Probe Master Mix kit (Vazyme Biotech Co., Nanjing, China). The RT system included 2 µL 5 × PrimeScript Buffer (for Real Time), 0.5 µL PrimeScript RT Enzyme Mix I, 0.5 µL oligo(dT) primer (50 µm), 0.5 µL random 6-mers (100 µm), 2 µg total RNA and 20 µL RNase Free dH 2 O. The samples were allowed to react at 37 • C for 15 min, 85 • C for 5 s and 4 • C for the remaining time. The cDNA generated following RT was maintained in a −80 • C refrigerator. RT-qPCR was performed be means of the TaqMan probe. The reaction conditions were set as follows: pre-denaturation at 95 • C for 30 s, with 40 cycles of denaturation at 95 • C for 10 s, annealing at 60 • C for 20 s, and extension at 70 • C for 10 s. The reaction system consisted of 12.5 µL Premix Ex Taq or SYBR Green Mix, 1 µL forward primer, 1 µL reverse primer, 1-4 µL of cDNA, and 25 µL ddH 2 O. β-actin serves as an endogenous control for HDAC1, EGR2, and Bcl2, while U6 for miR-410. The primers are listed in Table 1.

Statistical Analysis
All data are shown as mean ± standard deviation derived from at least 3 independent studies, and analyzed by SPSS 21.0 software (IBM, Armonk, NY, United States), with p < 0.05 as the level of statistical significance. After confirming that the data conformed to normal distribution and homogeneity of variance, the unpaired Student's (t)-test was applied for the comparisons between two groups and one-way analysis of variance (ANOVA) followed by Tukey's correction for multiple comparisons among more than two groups. Repeated measures ANOVA was conducted to compare data at different time points, followed by Bonferroni's post hoc test.

hUC-MSCs-Derived EVs Protect Against HIBD in Neonatal Mice
A previous report has shown that MSCs confer protection against HIBD (Zheng et al., 2018). In addition, EVs have also been reported to protect the fetal brain following HI (Ophelders et al., 2016). We isolated EVs from hUC-MSCs and adopted transmission electron microscopy and NanoSight (Figures 1A,B) to evaluate the isolated EVs, which revealed that the EVs were typically cup-shaped particles of 30 -100 nm in diameter. Immunoblotting results ( Figure 1C) identified that EVs were positive for CD63, ALIX, and TSG101, and negative for GM130, suggesting the successful isolation of EVs from hUC-MSCs.
To understand the role of hUC-MSCs-derived EVs in HI, we established a HIBD model in neonatal mice and treated the HIBD mice with PBS, EFS, or MSCs-EVs. Immunofluorescence results ( Figure 1D) revealed red-labeled (PKH26) EVs in hippocampus, indicating the uptake of EVs by hippocampus in mice. mNSS ( Figure 1E) was then analyzed and results displayed that mNSS substantially increased in HIBD mice compared with shamoperated mice, while MSCs-EVs treatment markedly reduced the mNSS in comparison to PBS treatment in HIBD mice (p < 0.05). PBS or EFS treatment exhibited no marked change in mNSS in HIBD mice (p > 0.05). Edema formation and TTC staining, in which normal brain tissues were stained red while necrotic brain tissues were white (Figures 1F,G), displayed that edema formation and cerebral infarction volume remarkably increased in HIBD mice compared to sham-operated mice, while MSCs-EVs treatment markedly reduced edema formation and cerebral infarction volume in comparison to PBS treatment in HIBD mice (p < 0.05). EFS treatment provoked no marked change in edema formation and cerebral infarction volume in HIBD mice (p > 0.05). Hematoxylin and Eosin (H&E) staining was performed to analyze the neuron morphology (Figure 1H), which demonstrated that neuronal cells were uniformly arranged and sized, and intact in sham-operated mice, but in the HIBD mice with or without treatment of PBS or EFS, cells had disorderly arrangement, and were shrunken with karyopyknosis, incomplete staining, and unclear cell membranes. In HIBD mice treated with MSCs-EVs, cells were neatly arranged, with uniform size, intact structure, only slight shrinkage, and light staining. Taken together, hUC-MSCs-derived EVs prevent HIBD in neonatal mice.

hUC-MSCs-Derived EVs Inhibit the OGD-Induced Neuronal Apoptosis in vitro
To understand the role of hUC-MSCs-derived EVs in vitro, we isolated neurons and evaluated them by immunofluorescent staining (Figure 2A), which revealed successful isolation of neurons, with over 95% NeuN-positive cells. Next, LDH content was measured as a marker of dead/damaged cells (Shao et al., 2016;Zheng et al., 2018), which showed significantly increased LDF content in primary neurons exposed to OGD, while further addition of MSCs-EVs reduced the LDH content. Combined treatment of OGD + EFS did not induce significant effects on LDH content. Moreover, LDH secreted from neurons treated with EVs at 0, 24, 48 h prior to OGD was determined and results displayed that EV treatment markedly dropped the content of LDH from neurons. Neurons treated with EVs at 24 h exhibited the highest reduction of LDH content (Figure 2B), and were selected for the subsequent experiments.
To elucidate the effect of EVs on OGD-induced neuronal viability, we adopted the MTT assay ( Figure 2C), which showed that compared with normal primary neurons, OGD remarkably reduced the viability of neurons. Increased viability of neurons was observed in OGD-exposed neurons after MSCs-EVs treatment compared to PBS treatment (p < 0.05), but no significant difference was found between OGD-exposed neurons with PBS treatment and OGD-exposed neurons with EFS (p > 0.05). As shown in Figures 2D,E, flow cytometry results revealed that compared with normal primary neuron, OGD treatment induced more G1-phase cells and fewer S-phase cells, while increasing neuronal apoptosis. OGD-exposed neurons treated with MSCs-EVs showed reduced neuronal apoptosis, decreased G1-phase cells, and increased S-phase cells compared to those treated with PBS (p < 0.05). EFS treatment in OGDexposed neurons exhibited no difference from neurons treated with PBS (p > 0.05). Immunofluorescence results ( Figure 2F) revealed red-labeled (PKH26) EVs in neurons, indicating their uptake of EVs. Consistenty, these results showed that hUC-MSCs-derived EVs inhibited the OGD-induced neuronal apoptosis in vitro. The neuron morphology determined using H&E staining (200×). *p < 0.05 vs. sham-operated mice; #p < 0.05 vs. HIBD mice treated with PBS. Unpaired t-test was applied for the comparisons between two groups and one-way ANOVA followed by Tukey's multiple comparisons was used for comparisons among three or more groups.

EVs-Carried RNAs Are Responsible for HIBD
Extracellular vesicles have been known to carry diverse cargos, such as RNAs and proteins (Hou et al., 2019). We treated MSCs-EVs with the same amount of purified MSCs-EVs, or MSCs-EVs treated by proteinase K and RNase A for silver staining and gel electrophoresis to test the efficacy of the enzyme treatment. Results showed that proteins and RNAs were degraded in MSCs-EVs treated with enzymes (Figures 3A,B). In addition, gel electrophoresis results showed that the RNA components carried by MSCs-EVs were mainly small RNAs (<100 base pairs) ( Figure 3A). To determine the complete structure of the enzyme-treated MSCs-EVs, we also conducted NanoSight analysis and identified intact EVs following enzyme treatment ( Figure 3C).
To understand the effect of MSCs-EVs on neuronal cells, we added MSCs-EVs and/or MSCs-EVs treated with protease or RNase A to the OGD-exposed neuronal cells. MTT assay and flow cytometry results (Figures 3D-F) displayed that proteinase treatment did not alter viability and apoptosis in OGD-exposed neurons treated with MSCs-EVs (p > 0.05). OGD-exposed neurons treated with RNase A and MSCs-EVs showed markedly lower neuron viability but higher apoptosis, with more G1-phase cells and fewer S-phase cells (p < 0.05).
MicroRNA-410 has been revealed to be encapsulated in MSCs (Ti et al., 2016) and miR-410 confers neuroprotective effects on oxidative stress-induced apoptosis following ischemic stroke . We adopted RT-qPCR ( Figure 3G) to determine the expression of miR-410 in neurons and identified markedly upregulated miR-410 expression when neurons were treated with MSCs-EVs. Taken together, EV-encapsulated miR-410 from hUC-MSCs inhibited the OGD-induced neuronal apoptosis.
In silico Analyses of miR-410 in Regulating the HDAC1/EGR2/Bcl2 Axis To explore the downstream target of miR-410, we adopted the DIANA TOOL, miRDB, miRWalk, StarBase, TargetScan, and microRNA database to predict the downstream target genes of mouse miR-410, which identified HDAC1 (Figure 4A). The binding sites between miR-410 and HDAC1 in mice and humans were predicted by StarBase (Figure 4B). The gene expression dataset GSE23160 from GEO database predicted 124 differentially expressed genes (DEGs) related to ischemic/reperfusion injury ( Figure 4C). Through the (E) Neuronal cell apoptosis determined using flow cytometry. (F) The red-labeled (PKH26) EVs in neurons determined using immunofluorescence (500×). *p < 0.05 vs. untreated neurons; #p < 0.05 vs. neurons treated with PBS. Unpaired t-test was applied for the comparisons between two groups and one-way ANOVA followed by Tukey's multiple comparisons was used for comparisons among more than two groups. Repeated measures ANOVA was conducted to compare data at different time points, followed by Bonferroni's post hoc test.
co-expression analysis from MEM database, we obtained 6,606 co-expression genes of HDAC1 in mice. We intersected the co-expressed genes, with the DEGs and 678 human transcription factors from the database hTFtarget. EGR2 was identified as the key transcription factor in this intersection ( Figure 4D). The relationship between EGR2 and Bcl2 ( Figure 4E) was also obtained from hTFtarget. A previous study has noted downregulated expression of HDAC1 at the promoter of EGR2, thereby elevating EGR2 expression in neurodegenerative disorders (Adler and Schmauss, 2016). EGR2 upregulated the expression of Bcl2 during positive selection (Lauritsen et al., 2008). Given these results, we speculated that miR-410 may inhibit HIBD by mediating the HDAC1/EGR2/Bcl2 axis.

miR-410 Inhibits Apoptosis but Promotes the Viability of Neurons by Mediating the HDAC1/EGR2/Bcl2 Axis
Dual-luciferase reporter gene assay results ( Figure 5A) verified that HDAC1 was targeted by miR-410. We synthesized agomir and pcDNA3 to infect neurons to achieve stable overexpression of miR-410 and HDAC1. At 24-h after infection, RT-qPCR and immunoblotting (Figures 5B,F,G) displayed downregulation of miR-410 and upregulation of HDAC1 in OGD-exposed neurons compared to untreated neurons. After OGD exposure, increased miR-410 and decreased HDAC1 levels were found in the transduction of particles containing miR-410 agomir compared to those containing agomir NC. Compared with OGD-exposed neurons infected with miR-410 agomir + NC, the expression of miR-410 remained unaltered, but HDAC1 expression was upregulated in OGD-exposed neurons infected with miR-410 agomir + HDAC1. MTT assays and flow cytometry (Figures 5C-E) displayed that agomir-NC treatment exhibited no marked disparity in viability and apoptosis in OGD-exposed neurons (p > 0.05). Elevated neuronal viability but inhibited apoptosis with fewer G1-phase cells and more S-phase cells was observed in response to miR-410 agomir treatment compared with agomir-NC in OGDexposed neurons, but this effect was reversed by HDAC1 overexpression (p < 0.05).
To elucidate the role of miR-410-HDAC1/EGR2/Bcl2 axis in HIBD, we adopted RT-qPCR ( Figure 5F) to determine the mRNA expression of EGR2, Bcl2, and HDAC1 and results showed downregulated mRNA expression of EGR2 and Bcl2 but upregulated HDAC1 expression in OGD-exposed neurons compared with untreated neurons, but opposite results were observed when OGD-exposed neurons were treated with miR-410 agomir compared to those treated with agomir NC. In OGD-exposed neurons, both miR-410 agomir treatment and HDAC1 overexpression repressed mRNA expression of EGR2 and Bcl2, but elevated HDAC1 compared with miR-410 agomir or NC treatment (p < 0.05). Immunoblotting results (Figure 5G) showed downregulation of acetyl-histone 3, EGR2 and Bcl2, but upregulation of HDAC1 and cleaved-Caspase-3/pro-Caspase-3 in OGD-exposed neurons compared with untreated neurons, but an opposite effect was observed in response to miR-410 agomir treatment FIGURE 3 | Extracellular vesicle-derived miR-410 from hUC-MSCs inhibits the OGD-exposed neuronal apoptosis. OGD-exposed neurons treated with equal amounts of purified EVs, together with either 20 µg/µL proteinase K or RNase A supplemented with 0.05% Triton X-100 in panels (A-F). OGD-exposed neurons were introduced with PBS, MSCs-EVs or EFS in panel The expression of miR-410 in neurons determined by RT-qPCR following treatment of MSCs-EVs. *p < 0.05 vs. MSCs-EVs or OGD-exposed neurons introduced with MSCs-EVs or neurons. One-way ANOVA followed by Tukey's multiple comparisons was used for comparisons among more than two groups. Repeated measures ANOVA was conducted to compare data at different time points, followed by Bonferroni's post hoc test. compared with agomir NC in OGD-exposed neurons. In OGDexposed neurons, treatment with miR-410 agomir and HDAC1 overexpression repressed protein expression of acetyl-histone 3, EGR2 and Bcl2, but elevated levels of HDAC1, cleaved-Caspase-3/pro-Caspase-3 compared with miR-410 agomir and NC treatment. ChIP assay ( Figure 5H) results revealed that, compared to the untreated neurons, the OGD-exposed neurons showed increased enrichment of HDAC1 and decreased enrichment of acetyl-histone 3 were found in the EGR2 promoter region, but opposite effects were observed in response FIGURE 5 | Upregulation of miR-410 inhibits apoptosis but enhances the viability of OGD-exposed neurons by elevation of EGR2/Bcl2 axis via HDAC1 repression. OGD-exposed neurons were treated with lentiviral vectors containing miR-410 agomir, and/or HDAC1 overexpression.  H) The enrichment of HDAC1 and acetyl-histone 3 at the promoter region of EGR2 determined by ChIP. *p < 0.05 vs. untreated neurons; #p < 0.05 vs. OGD-exposed neurons infected with agomir-NC; &p < 0.05 vs. OGD-exposed neurons infected with miR-410 agomir and NC. Unpaired t-test was applied for comparisons between two groups. One-way ANOVA followed by Tukey's multiple comparisons was used for comparisons among more than two groups. Repeated measures ANOVA was conducted to compare data at different time points, followed by Bonferroni's post hoc test.
to miR-410 agomir compared with agomir NC in OGDexposed neurons. In OGD-exposed neurons, treatment with miR-410 agomir and HDAC1 overexpression increased HDAC1 enrichment, but reduced acetyl-histone 3 enrichment in the EGR2 promoter region compared with miR-410 agomir and NC treatment. Taken together, miR-410 inhibited apoptosis but promoted the viability of neurons by mediating the HDAC1/EGR2/Bcl2 axis.

EV-Derived miR-410 From hUC-MSCs Inhibits OGD-Induced Apoptosis via EGR2/Bcl2 Axis by Downregulating HDAC1
To verify the function of EV-derived miR-410 in HIBD, we transduced miR-410 antagomir into EVs. Following 2-h infection, we adopted RT-qPCR ( Figure 6A) to determine the expression of miR-410. Results exhibited that the expression of miR-410 in EV markedly reduced after infection of miR-410 antagomir. Dual-luciferase reporter gene assay results ( Figure 6B) verified that HDAC1 was targeted by EV-derived miR-410. Next, we infected OGD-exposed neurons with a lentiviral vector containing sh-HDAC1 and RT-qPCR ( Figure 6C) results confirmed decreased miR-410 expression after treatment of OGD-exposed neurons with miR-410 antagomir-EV. No differences in miR-410 expression were observed upon infection of sh-HDAC1 in OGD-exposed neurons infected with miR-410 antagomir-EV.
To verify the downstream regulatory mechanism of EV-derived miR-410, we used RT-qPCR ( Figure 6D) to determine the mRNA expression of HDAC1, EGR2, and Bcl2 in OGD-exposed neurons after different treatment. Results revealed upregulated mRNA expression of HDAC1 and downregulated EGR2 and Bcl2 expression in response to miR-410 antagomir-EV treatment compared with antagomir-NC-EV treatment, but these effects were reversed by sh-HDAC1. Immunoblotting results ( Figure 6E) revealed that the protein expression of HDAC1, acetyl-histone 3, EGR2, Bcl2 and cleaved-Caspase-3/pro-Caspase-3 remained unchanged in OGD-exposed neurons infected with antagomir-NC-EV compared with mock-EV. Upregulated protein expression of HDAC1 and cleaved-Caspase-3/pro-Caspase-3, but downregulated protein levels of acetyl-histone 3, EGR2 and Bcl2 were observed in response to miR-410 antagomir-EV compared with antagomir-NC-EV in OGD-exposed neurons, but those changes were reversed by sh-HDAC1. ChIP assay ( Figure 6F) results revealed that HDAC1 and acetyl-histone enrichment remained unaltered in OGD-exposed neurons infected with antagomir-NC-EV compared with mock-EV. The increased HDAC1 enrichment, but decreased acetyl-histone 3 enrichment in the EGR2 promoter region were observed in response to miR-410 antagomir-EV compared with antagomir-NC-EV in OGD-exposed neurons, but those changes were reversed by sh-HDAC1.
adopted to analyze the role of EV-derived miR-410 in the viability and apoptosis of OGD-exposed neurons. Results displayed no marked disparity in viability and apoptosis in OGD-exposed neurons infected with antagomir-NC-EV compared with mock-EV. The repressed neuronal viability, but higher apoptosis with more G1-phase cells and fewer S-phase cells were observed in response to miR-410 antagomir-EV treatment compared with antagomir-NC-EV in OGDexposed neurons, but the effect on apoptosis was reversed by sh-HDAC1. Coherently, the delivery of miR-410 via EVs inhibited injury-induced neuronal apoptosis and promoted the proliferation of neurons, which was obtained through the HDAC1 pathway.

EV-Encapsulated miR-410 Protects Against HIBD via EGR2/Bcl2 Elevation by Repressing HDAC1 in Neonatal Mice
To verify the downstream regulatory mechanisms of EV-derived miR-410 in the neonatal mouse model of HIBD, we injected The expression of cleaved-Caspase-3/pro-Caspase-3, HDAC1, EGR2, BCL2, and acetyl-histone 3 determined by immunoblotting. *p < 0.05 vs. sham-operated mice; #p < 0.05 vs. HIBD mice treated with PBS; &p < 0.05 vs. HIBD mice infected with lentiviral vector containing antagomir-NC-EVs. Unpaired t-test was applied for the comparisons between two groups and one-way ANOVA followed by Tukey's multiple comparisons was used for comparisons among more than two groups. lentiviral vectors containing miR-410 antagomir-EV or antagomir-NC-EV into HIBD mice. Analysis of mNSS ( Figure 7A) displayed that mNSS potently rose in HIBD mice infected with miR-410 antagomir-EV compared with antagomir-NC-EV. Edema formation and cerebral infarction volume remarkably increased in HIBD mice infected with miR-410 antagomir-EV compared with antagomir-NC-EV (Figures 7B,C). Morphological analysis demonstrated that HIBD mice infected with antagomir-NC-EV had well-orientated neuronal cells with uniform size and complete structure, but cells in HIBD mice infected miR-410 antagomir-EV had disorder arrangment, were shrunken, and showed karyopyknosis, with incomplete staining, and unclear cell membranes ( Figure 7D).
To verify the downstream regulation mechanism of EV-derived miR-410 in vivo, we used RT-qPCR ( Figure 7E) to determine the expression of miR-410, HDAC1, EGR2, and Bcl2 in mice. Results revealed that the expression of miR-410, EGR2, and Bcl2 was markedly downregulated, but HDAC1 mRNA expression was upregulated in HIBD mice compared to sham-operated mice, but opposite effecs were observed in response to MSCs-EVs compared to PBS in HIBD mice. miR-410 antagomir-EV infection in HIBD mice resulted in downregulated miR-410, EGR2, and Bcl2, but elevated HDAC1 mRNA expression compared with antagomir-NC-EV. Compared to sham-operated mice, downregulation of acetyl-histone 3, EGR2, and Bcl2, and upregulation of cleaved-Caspase-3/pro-Caspase-3 and HDAC1 were observed in cerebral tissues of HIBD mice, but opposite effects were observed in response to MSCs-EVs compared to PBS in HIBD mice ( Figure 7F). The protein expression of acetyl-histone 3, EGR2 and Bcl2 was repressed, but HDAC1 and cleaved-Caspase-3/pro-Caspase-3 expression upregulated in HIBD mice infected with miR-410 antagomir-EV, compared to antagomir-NC-EV. Taken together, EV-derived miR-410 attenuated HIBD by downregulating HDAC1 and thereby, upregulating EGR2/Bcl2 in vivo.

DISCUSSION
Hypoxia-ischemia accounts for the majority of cases of fetal brain damage, and is accompanied by persistent neurological sequelae, including cerebral palsy, mental retardation, as well as epilepsy (Fathali et al., 2010). MSC transplantation has been suggested to treat neuronal loss and improve motoric behavior following HI insult (van Velthoven et al., 2010). We explored how EVderived miR-410 from hUC-MSCs affects apoptosis and viability of neurons in vitro and alleviates brain damage in a mice model of HIBD. We found evidence to support our hypothesis that EV-encapsulated miR-410 can inhibit apoptosis and enhance the viability of neurons by downregulating HDAC1 and upregulating FIGURE 8 | The graphical summary of the function and mechanism of EV-derived miR-410 in HIBD. miR-410 is transferred from hUC-MSCs to neurons via EVs. miR-410 negatively targets HDAC1, and HDAC1 downregulation at the promoter of EGR2 elevates the expression of EGR2/Bcl2 axis, thereby enhancing viability and inhibiting apoptosis of neurons.
Initially, we found that hUC-MSCs-derived EVs inhibited the OGD-induced neuronal apoptosis in vitro and prevented HIBD in vivo. Consistently, another study has noted that EVs derived from human Wharton's jelly MSCs inhibited HI-induced neuronal cell death (Joerger-Messerli et al., 2018). In our present study, we also displayed that the elevation of miR-410 derived from hUC-MSCs-released EVs enhanced viability, but inhibited apoptosis of neurons evidenced by the reduced level of cleaved-Caspase-3/pro-Caspase-3. Concordant with our study, EVs derived from hUC-MSCs inhibit neuroinflammation mediated by microglia in perinatal brain injury, thus serving as a promising target for perinatal brain injury (Thomi et al., 2019b). miR-410 has been confirmed to be transferred from hUC-MSCsderived EVs to lung adenocarcinoma cells .
Elevation of miR-410 contributed to reduced neuronal apoptosis and infarction volume in the hippocampus, but increased neuron survival rates and cell cycle entry, thereby conferring neuroprotective effects against oxidative stress-induced apoptosis following ischemic stroke . Conversely, knockdown of miR-410 impaired neuronal cell viability and increased the apoptotic rate, accompanied by increased caspase-3 activity (Ge et al., 2019). A reduced level of cleaved caspase-3 indicates decreased neuronal apoptosis in neonatal hypoxicischemic encephalopathy . In addition, EV-derived miR-410 protected against HIBD as evidenced by reduced mNSS, edema formation and cerebral infarction volume in vivo. Consistent with these results, elevated mNSS exacerbates nerve function and traumatic brain injury (Kang et al., 2016). In general, increased edema formation and cerebral infarction volume are indicative of worsened neurological deficits in ischemic brain damage .
In the subsequent experiment, we demonstrated that HDAC1 was negatively targeted by EV-derived miR-410, and that HDAC1 repression inhibited apoptosis and promoted the viability of neurons. Consistently, another study displayed that the elevation of HDAC1 exacerbated brain tissue loss and neurological impairment in ischemic stroke accompanied by downregulation of acetyl-histone H3 (Wang et al., 2017). A recent study showed that the silencing of HDAC1 confers protection against neuronal damage, accompanied by inhibited apoptosis of hippocampal neurons and attenuated neurological function in a traumatic brain injury mouse model . HDAC1 was identified as a target of miR-410 via our in silico analyses. Meanwhile, our results in vivo also suggested that HDAC1 repression is correlated to the reduction of mNSS, edema formation, and cerebral infarction volume. Nevertheless, downstream regulatory mechanisms of miRNAs are currently a widely studied mechanism Liu J. et al., 2020), and epigenetic mechanisms such as DNA methylation and histone modification are also known to mediate miRNAs, which in turn have a regulatory role on epigenetics (Chen et al., 2018;Liu X. et al., 2020;Zhao et al., 2020). It remains to be established whether miR-410 can regulate other epigenetic markers in an HIBD model. Furthermore, we find that HDAC1 regulates the expression of EGR2, which led to increased Bcl2 expression, thereby impairing neuronal apoptosis. A previous study has noted downregulated expression of HDAC1 at the promoter of EGR2, thereby elevating EGR2 expression in neurodegenerative disorders (Adler and Schmauss, 2016). The elevation of EGR2 has been proposed to confer protection against ischemic stroke in rat brains, accompanied by reduced infarction volume, enhanced neurological function and increased surviving neuron number (Niu et al., 2018). In addition, the induction of Bcl2 has been shown to be dependent on EGR2 in macrophages (Yuan et al., 2014). The upregulation of Bcl2 has been associated with ameliorated ischemic brain injury in experimental stroke (Yang et al., 2017). Also, increased antiapoptotic Bcl2 expression has been used as a marker of improved neurological function, bloodbrain barrier impairment, neurodegeneration, and brain edema Evran et al., 2020), thus supporting the neuroprotective benefits of this pathway.

CONCLUSION
In conclusion, the current study sheds light on the mechanisms underlying the effect of EV-derived miRNA from hUC-MSCs on HIBD. In particular, EV-derived miR-410 downregulated HDAC1 expression, thereby elevating the signaling of EGR2/Bcl2 axis. This mechanism might contribute to the enhanced viability and reduced apoptosis of neurons from neonatal HIBD mice, which also highlights EV-derived miR-410 as a future therapeutic approach for treating neonatal HIDB. However, we only adopted a single dose of EVs in our experiments. Further studies shall be aimed at identifying the optimum dose and the times of injections and validating further the regulatory roles of miR-410 and HDAC1 in HIBD.

DATA AVAILABILITY STATEMENT
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.

ETHICS STATEMENT
The animal study was reviewed and approved by The First Hospital of Jilin University.

AUTHOR CONTRIBUTIONS
JH and BZ designed the study. SY was involved in data collection. XH and YH performed the statistical analysis and preparation of figures. HZ and CX drafted the manuscript. All authors read and approved the final manuscript.