Supplementary Material for: Therapeutic Potential of Human Adipose-Derived Stem Cell Exosomes in Stress Urinary Incontinence – An in Vitro and in Vivo Study

<b><i>Background/Aims:</i></b> To evaluate whether local injection of exosomes derived from human adipose-derived stem cells (hADSCs) facilitates recovery of stress urinary incontinence (SUI) in a rat model. <b><i>Methods:</i></b> For the <i>in vitro</i> study, a Cell Counting Kit-8 (CCK-8) array and proteomic analysis were performed. For the <i>in vivo</i> study, female rats were divided into four groups: sham, SUI, adipose-derived stem cell (ADSC), and exosomes (<i>n</i> = 12 each). The SUI model was generated by pudendal nerve transection and vaginal dilation. Vehicle, hADSCs, or exosomes were injected into the peripheral urethra. After 2, 4, and 8 weeks, the rats underwent cystometrography and leak point pressure (LPP) testing, and tissues were harvested for histochemical analyses. <b><i>Results:</i></b> The CCK-8 experiment demonstrated that ADSC-derived exosomes could enhance the growth of skeletal muscle and Schwann cell lines in a dose-dependent manner. Proteomic analysis revealed that ADSC-derived exosomes contained various proteins of different signaling pathways. Some of these proteins are associated with the PI3K-Akt, Jak-STAT, and Wnt pathways, which are related to skeletal muscle and nerve regeneration and proliferation. <i>In vivo</i> experiments illustrated that rats of the exosome group had higher bladder capacity and LPP, and had more striated muscle fibers and peripheral nerve fibers in the urethra than rats of the SUI group. Both urethral function and histology of rats in the exosome group were slightly better than those in the ADSC group. <b><i>Conclusions:</i></b> Local injection of hADSC-derived exosomes improved functional and histological recovery after SUI.