Lineage-tailored vesicles from human retinal ganglion-like cells drive metabolic homeostasis and bioenergetic recovery in glaucoma.

Retinal ganglion cells (RGCs) exhibit high bioenergetic demands, rendering them vulnerable to mitochondrial dysfunction and metabolic collapse during glaucomatous neurodegeneration. Therapeutic strategies capable of restoring mitochondrial homeostasis in human RGCs remain limited. We established a human retinal ganglion-like cell (RGLC) model of mitochondrial injury and evaluated neuroprotective efficacy of small extracellular vesicles (sEVs) derived from either undifferentiated BRN3B-H9 cells or differentiated lineage-tailored RGLCs. RGLC-derived sEVs (RGLC-sEVs) conferred robust neuroprotection, significantly enhancing neuronal survival, preserving neurite architecture, and mitigating mitochondrial stress following injury. These effects were reproducible in mixed retinal cultures and in an ocular hypertension mouse model of glaucoma, with neuroprotective benefits observed throughout the retinal landscape. Mechanistically, untargeted metabolomic profiling revealed extensive metabolic reprogramming involving oxidative phosphorylation, amino acid utilization, lipid metabolism, and redox regulatory pathways. In vitro tracking studies confirmed efficient uptake of sEVs by injured RGLCs, confirming effective vesicular cargo delivery under conditions that promote neuroprotection and metabolic recovery. Functional bioenergetic analysis further validated restoration of mitochondrial-glycolytic coupling and improved cellular energetic resilience. Collectively, our findings establish lineage-tailored RGLC-sEVs as a potent, cell-specific therapeutic candidate capable of reprogramming metabolic networks and restoring bioenergetic homeostasis in glaucomatous neurodegeneration, highlighting their translational potential for neuroprotective intervention in optic neuropathies.