Ischaemic vascular diseases are critically linked to mitochondrial dysfunction in endothelial cells, which impairs angiogenesis and tissue repair. Although mitochondrial transplantation has emerged as a promising regenerative strategy, its clinical translation remains limited by inefficient delivery and poor retention in target tissues. Here, we demonstrate that mitochondrial-enriched extracellular vesicles derived from adipose-derived stem cells (ADSC-mitoEVs) function as an efficient cell-free nanotherapeutic that restores angiogenic function both in vitro and in a murine model of diabetic hindlimb ischaemia. Mechanistically, ADSC-mitoEV uptake triggers PINK1/Parkin-mediated mitophagy in recipient endothelial cells, a process essential for initiating angiogenesis. Moreover, ADSC-mitoEVs also directly deliver functional mitochondrial proteins, including superoxide dismutase 2 (SOD2), into the endogenous mitochondrial network, which enhances antioxidant activity and improves bioenergetic capacity independently of mitophagy, as demonstrated by reduced reactive oxygen species and elevated ATP production even in PINK1-silenced cells. Our findings establish ADSC-mitoEVs as a versatile cell-free nanotherapeutic that promotes mitochondrial quality control and metabolic reprogramming, offering a potent therapeutic avenue for ischaemic vascular diseases.
Zhu et al. (Wed,) studied this question.