FGF9 attenuates osteoarthritis progression through the NRF2/GPX3 antioxidant axis

Aims Osteoarthritis (OA), a prevalent age-related joint disease affecting over 250 million people globally, currently lacks effective disease-modifying treatments. Fibroblast growth factor 9 (FGF9) has shown cartilage-protective effects in post-traumatic OA models, but its role in chondrocyte degeneration and OA pathogenesis remains unclear. This study investigates FGF9’s function in human and murine chondrocytes and its therapeutic potential for OA. Methods Gene expression profiling was performed on primary chondrocytes from OA patients and normal controls. Senescence and reactive oxygen species (ROS) levels were assessed by β-galactosidase staining and flow cytometry. FGF9 function was evaluated through short hairpin RNA (shRNA)-mediated knockdown and treatment with FGF9-conditioned media (CM). The impact of FGF9-enriched exosomes on chondrocyte senescence was also examined in vitro. In vivo effects were tested using adenovirus-delivered FGF9 in a destabilization of the medial meniscus (DMM)-induced OA mouse model. Results FGF9 expression was significantly downregulated in OA chondrocytes (n = 195) compared to normal (n = 71). FGF9 knockdown elevated ROS levels and senescence via suppression of the NRF2/GPX3 antioxidant axis, while FGF9 promoted chondrogenesis in mesenchymal stem cells. Intra-articular FGF9 gene therapy reduced OA progression in DMM mice. Additionally, FGF9-enriched exosomes reduced senescence in primary chondrocytes in vitro. Conclusion FGF9 alleviates OA progression by activating the NRF2/GPX3 pathway, reducing ROS and chondrocyte senescence. These findings support the therapeutic potential of FGF9 and FGF9-enriched exosomes in OA treatment. Cite this article: Bone Joint Res 2026;15(6):632–646.