Carboxypeptidase M modulates BMSCs osteogenesis–adipogenesis via the MAPK / ERK pathway: An integrated single‐cell and bulk transcriptomic study

Abstract The pathogenesis of osteoporosis (OP) is closely associated with the disrupted balance between osteogenesis and adipogenesis in bone marrow‐derived mesenchymal stem cells (BMSCs). We analyzed published single‐cell RNA sequencing (scRNA‐seq) data to dissect the transcriptomic profiles of bone marrow‐derived cells in OP, reviewing 56 377 cells across eight scRNA‐seq datasets from femoral heads (osteoporosis or osteopenia n = 5, osteoarthritis n = 3). Seventeen genes, including carboxypeptidase M (CPM), were identified as key osteogenesis‐adipogenesis regulators through comprehensive gene set enrichment, differential expression, regulon activity, and pseudotime analyses. In vitro, CPM knockdown reduced osteogenesis and promoted adipogenesis in BMSCs, while adenovirus‐mediated CPM overexpression had the reverse effects. In vivo, intraosseous injection of CPM ‐overexpressing BMSCs mitigated bone loss in ovariectomized mice. Integrated scRNA‐seq and bulk RNA sequencing analyses provided insight into the MAPK/ERK pathway's role in the CPM ‐mediated regulation of BMSC osteogenesis and adipogenesis; specifically, CPM overexpression enhanced MAPK/ERK signaling and osteogenesis. In contrast, the ERK1/2 inhibitor binimetinib negated the effects of CPM overexpression. Overall, our findings identify CPM as a pivotal regulator of BMSC differentiation, which provides new clues for the mechanistic study of OP.