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Kralj-Iglič V, Pocsfalvi G, Mesarec L, Šuštar V, Hägerstrand H, Iglič A. Minimizing isotropic and deviatoric membrane energy - An unifying formation mechanism of different cellular membrane nanovesicle types. PLoS One 2020; 15:e0244796. [PMID: 33382808 PMCID: PMC7775103 DOI: 10.1371/journal.pone.0244796] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/16/2020] [Indexed: 12/25/2022] Open
Abstract
Tiny membrane-enclosed cellular fragments that can mediate interactions between cells and organisms have recently become a subject of increasing attention. In this work the mechanism of formation of cell membrane nanovesicles (CNVs) was studied experimentally and theoretically. CNVs were isolated by centrifugation and washing of blood cells and observed by optical microscopy and scanning electron microscopy. The shape of the biological membrane in the budding process, as observed in phospholipid vesicles, in erythrocytes and in CNVs, was described by an unifying model. Taking the mean curvature h and the curvature deviator d of the membrane surface as the relevant parameters, the shape and the distribution of membrane constituents were determined theoretically by minimization of membrane free energy. Considering these results and previous results on vesiculation of red blood cells it was interpreted that the budding processes may lead to formation of different types of CNVs as regards the compartment (exo/endovesicles), shape (spherical/tubular/torocytic) and composition (enriched/depleted in particular kinds of molecules). It was concluded that the specificity of pinched off nanovesicles derives from the shape of the membrane constituents and not primarily from their chemical identity, which explains evidences on great heterogeneity of isolated extracellular vesicles with respect to composition. One of the amazing properties of a biological membrane is the ability to undergo dramatic changes of its shape. It may exhibit very high curvature and thereby enclose nano-sized compartments that pinch off from the mother membrane and become freely moving cellular nanovesicles (CNVs). CNVs externalize the pieces of the cell and make them available to other cells within the same organism or other organisms. Therefore they have been acknowledged as mediators of communication between microorganisms, plants, animals and human. Furthernore, they dwell on the border between living and non-living things. Recent findings report on heterogeneity of the size and composition of CNVs found in isolates from different biological samples. As communication between cells is involved in many physiological and patophysiological processes, it is of importance to understand the mechanisms of CNVs formation and recognize the natural laws that mainly govern them. We point to an unifying mechanism that explains stability of differently shaped and composed CNVs by taking into account that the biological membrane tends to attain the minimum of its relevant energy. Conveniently, the procedure can be described by a mathematical model which allows for transparent comparison between experimentally induced shapes of membrane-enclosed vesicular structures and numerical calculations.
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Affiliation(s)
- Veronika Kralj-Iglič
- Faculty of Health Sciences, Laboratory of Clinical Biophysics, University of Ljubljana, Ljubljana, Slovenia
- Extracellular Vesicles and Mass Spetrometry Group, Institute of Biosciences and Bioresources, National Research Council of Italy, Napoli, Italy
- * E-mail:
| | - Gabriella Pocsfalvi
- Extracellular Vesicles and Mass Spetrometry Group, Institute of Biosciences and Bioresources, National Research Council of Italy, Napoli, Italy
| | - Luka Mesarec
- Faculty of Electrical Engineering, Laboratory of Physics, University of Ljubljana, Ljubljana, Slovenia
| | - Vid Šuštar
- Faculty of Medicine, Lymphocyte Cytoskeleton Group, University of Turku, Turku, Finland
| | - Henry Hägerstrand
- Faculty of Science and Engineering, Cell Biology, Åbo Akademi University, Åbo/Turku, Finland
- Novia University of Applied Sciences, Ekenäs, Finland
| | - Aleš Iglič
- Extracellular Vesicles and Mass Spetrometry Group, Institute of Biosciences and Bioresources, National Research Council of Italy, Napoli, Italy
- Faculty of Electrical Engineering, Laboratory of Physics, University of Ljubljana, Ljubljana, Slovenia
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Pang B, Zhu Y, Ni J, Ruan J, Thompson J, Malouf D, Bucci J, Graham P, Li Y. Quality Assessment and Comparison of Plasma-Derived Extracellular Vesicles Separated by Three Commercial Kits for Prostate Cancer Diagnosis. Int J Nanomedicine 2020; 15:10241-10256. [PMID: 33364756 PMCID: PMC7751609 DOI: 10.2147/ijn.s283106] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/07/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction Current standard biomarkers in clinic are not specific enough for prostate cancer (PCa) diagnosis. Extracellular vesicles (EVs) are nano-scale vesicles released by most mammalian cells. EVs are promising biomarker source for PCa liquid biopsy due to its minimal invasive approach, rich information and improved accuracy compared to the clinical standard prostate-specific antigen (PSA). However, current EV separation methods cannot separate pure EVs and the quality characteristics from these methods remain largely unknown. In this study, we evaluated the quality characteristics of human plasma-derived EVs by comparing three clinical suitable separation kits. Methods We combined EV separation by commercial kits with magnetic beads capture and flow cytometry analysis, and compared three kits including ExoQuick Ultra based on precipitation and qEV35 and qEV70 based on size exclusion chromatography (SEC). Results Our results indicated that two SEC kits provided higher EV purity and lower protein contamination compared to ExoQuick Ultra precipitation and that qEV35 demonstrated a higher EV yield but lower EV purity compared to qEV70. Particle number correlated very well particularly with CD9/81/63 positive EVs for all three kits, which confirms that particle number can be used as the estimate for EV amount. At last, we found that several EV metrics including total EVs and PSA-specific EVs could not differentiate PCa patients from health controls. Conclusion We provided a systematic workflow for the comparison of three separation kits as well as a general analysis process in clinical laboratories for EV-based cancer diagnosis. Better EV-associated cancer biomarkers need to be explored in the future study with a larger cohort.
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Affiliation(s)
- Bairen Pang
- St George and Sutherland Clinical School, UNSW Sydney, NSW 2052, Australia.,Cancer Care Centre, St. George Hospital, Sydney, NSW 2217, Australia
| | - Ying Zhu
- St George and Sutherland Clinical School, UNSW Sydney, NSW 2052, Australia.,Cancer Care Centre, St. George Hospital, Sydney, NSW 2217, Australia.,School of Biomedical Engineering, University of Technology Sydney, NSW 2007, Australia
| | - Jie Ni
- St George and Sutherland Clinical School, UNSW Sydney, NSW 2052, Australia.,Cancer Care Centre, St. George Hospital, Sydney, NSW 2217, Australia
| | - Juanfang Ruan
- Electron Microscope Unit, UNSW Sydney, NSW 2052, Australia.,School of Biotechnology and Biomolecular Sciences, UNSW Sydney, NSW 2052, Australia
| | - James Thompson
- St George and Sutherland Clinical School, UNSW Sydney, NSW 2052, Australia.,Department of Urology, St George Hospital, Sydney, NSW 2217, Australia.,Garvan Institute of Medical Research/APCRC, Sydney, UNSW 2010, Australia
| | - David Malouf
- Cancer Care Centre, St. George Hospital, Sydney, NSW 2217, Australia.,Department of Urology, St George Hospital, Sydney, NSW 2217, Australia
| | - Joseph Bucci
- St George and Sutherland Clinical School, UNSW Sydney, NSW 2052, Australia.,Cancer Care Centre, St. George Hospital, Sydney, NSW 2217, Australia
| | - Peter Graham
- St George and Sutherland Clinical School, UNSW Sydney, NSW 2052, Australia.,Cancer Care Centre, St. George Hospital, Sydney, NSW 2217, Australia
| | - Yong Li
- St George and Sutherland Clinical School, UNSW Sydney, NSW 2052, Australia.,Cancer Care Centre, St. George Hospital, Sydney, NSW 2217, Australia.,School of Basic Medical Sciences, Zhengzhou University, Henan 450001, People's Republic of China
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53
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Xing Y, Cheng Z, Wang R, Lv C, James TD, Yu F. Analysis of extracellular vesicles as emerging theranostic nanoplatforms. Coord Chem Rev 2020. [DOI: 10.1016/j.ccr.2020.213506] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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54
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Anastasi F, Greco F, Dilillo M, Vannini E, Cappello V, Baroncelli L, Costa M, Gemmi M, Caleo M, McDonnell LA. Proteomics analysis of serum small extracellular vesicles for the longitudinal study of a glioblastoma multiforme mouse model. Sci Rep 2020; 10:20498. [PMID: 33235327 PMCID: PMC7686310 DOI: 10.1038/s41598-020-77535-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/09/2020] [Indexed: 12/25/2022] Open
Abstract
Longitudinal analysis of disease models enables the molecular changes due to disease progression or therapeutic intervention to be better resolved. Approximately 75 µl of serum can be drawn from a mouse every 14 days. To date no methods have been reported that are able to analyze the proteome of small extracellular vesicles (sEV’s) from such low serum volumes. Here we report a method for the proteomics analysis of sEV's from 50 µl of serum. Two sEV isolation procedures were first compared; precipitation based purification (PPT) and size exclusion chromatography (SEC). The methodological comparison confirmed that SEC led to purer sEV’s both in terms of size and identified proteins. The procedure was then scaled down and the proteolytic digestion further optimized. The method was then applied to a longitudinal study of serum-sEV proteome changes in a glioblastoma multiforme (GBM) mouse model. Serum was collected at multiple time points, sEV’s isolated and their proteins analyzed. The protocol enabled 274 protein groups to be identified and quantified. The longitudinal analysis revealed 25 deregulated proteins in GBM serum sEV's including proteins previously shown to be associated with GBM progression and metastasis (Myh9, Tln-1, Angpt1, Thbs1).
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Affiliation(s)
- Federica Anastasi
- NEST Laboratories, Scuola Normale Superiore, 56127, Pisa, Italy.,Fondazione Pisana per la Scienza ONLUS, 56107, San Giuliano Terme, PI, Italy
| | - Francesco Greco
- Fondazione Pisana per la Scienza ONLUS, 56107, San Giuliano Terme, PI, Italy.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, 56127, Pisa, Italy
| | - Marialaura Dilillo
- Fondazione Pisana per la Scienza ONLUS, 56107, San Giuliano Terme, PI, Italy
| | - Eleonora Vannini
- CNR, Neuroscience Institute, 56124, Pisa, Italy.,Fondazione Umberto Veronesi, 20122, Milano, Italy
| | - Valentina Cappello
- Istituto Italiano di Tecnologia, Center for Nanotechnology Innovation @NEST, 56127, Pisa, Italy
| | - Laura Baroncelli
- CNR, Neuroscience Institute, 56124, Pisa, Italy.,IRCCS Fondazione Stella Maris, 56018, Calambrone, PI, Italy
| | - Mario Costa
- CNR, Neuroscience Institute, 56124, Pisa, Italy
| | - Mauro Gemmi
- Istituto Italiano di Tecnologia, Center for Nanotechnology Innovation @NEST, 56127, Pisa, Italy
| | - Matteo Caleo
- CNR, Neuroscience Institute, 56124, Pisa, Italy.,Department of Biomedical Sciences, University of Padua, 335122, Padua, Italy
| | - Liam A McDonnell
- Fondazione Pisana per la Scienza ONLUS, 56107, San Giuliano Terme, PI, Italy.
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55
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Zhang J, Shi J, Zhang H, Zhu Y, Liu W, Zhang K, Zhang Z. Localized fluorescent imaging of multiple proteins on individual extracellular vesicles using rolling circle amplification for cancer diagnosis. J Extracell Vesicles 2020; 10:e12025. [PMID: 33304477 PMCID: PMC7710127 DOI: 10.1002/jev2.12025] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 10/12/2020] [Accepted: 10/21/2020] [Indexed: 12/14/2022] Open
Abstract
Extracellular vesicles (EV) have attracted increasing attention as tumour biomarkers due to their unique biological property. However, conventional methods for EV analysis are mainly based on bulk measurements, which masks the EV‐to‐EV heterogeneity in tumour diagnosis and classification. Herein, a localized fluorescent imaging method (termed Digital Profiling of Proteins on Individual EV, DPPIE) was developed for analysis of multiple proteins on individual EV. In this assay, an anti‐CD9 antibody engineered biochip was used to capture EV from clinical plasma sample. Then the captured EV was specifically recognized by multiple DNA aptamers (CD63/EpCAM/MUC1), followed by rolling circle amplification to generate localized fluorescent signals. By‐analyzing the heterogeneity of individual EV, we found that the high‐dimensional data collected from each individual EV would provide more precise information than bulk measurement (ELISA) and the percent of CD63/EpCAM/MUC1‐triple‐positive EV in breast cancer patients was significantly higher than that of healthy donors, and this method can achieve an overall accuracy of 91%. Moreover, using DPPIE, we are able to distinguish the EV between lung adenocarcinoma and lung squamous carcinoma patients. This individual EV heterogeneity analysis strategy provides a new way for digging more information on EV to achieve multi‐cancer diagnosis and classification.
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Affiliation(s)
- Junli Zhang
- Henan Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases School of Pharmaceutical Sciences Zhengzhou University Zhengzhou 450001 China
| | - Jinjin Shi
- Henan Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases School of Pharmaceutical Sciences Zhengzhou University Zhengzhou 450001 China
| | - Hongling Zhang
- Henan Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases School of Pharmaceutical Sciences Zhengzhou University Zhengzhou 450001 China
| | - Yifan Zhu
- Henan Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases School of Pharmaceutical Sciences Zhengzhou University Zhengzhou 450001 China
| | - Wei Liu
- Henan Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases School of Pharmaceutical Sciences Zhengzhou University Zhengzhou 450001 China
| | - Kaixiang Zhang
- Henan Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases School of Pharmaceutical Sciences Zhengzhou University Zhengzhou 450001 China
| | - Zhenzhong Zhang
- Henan Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases School of Pharmaceutical Sciences Zhengzhou University Zhengzhou 450001 China
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56
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Kuang Y, Zheng X, Zhang L, Ai X, Venkataramani V, Kilic E, Hermann DM, Majid A, Bähr M, Doeppner TR. Adipose-derived mesenchymal stem cells reduce autophagy in stroke mice by extracellular vesicle transfer of miR-25. J Extracell Vesicles 2020; 10:e12024. [PMID: 33304476 PMCID: PMC7710129 DOI: 10.1002/jev2.12024] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 12/16/2022] Open
Abstract
Grafted mesenchymal stem cells (MSCs) yield neuroprotection in preclinical stroke models by secreting extracellular vesicles (EVs). The neuroprotective cargo of EVs, however, has not yet been identified. To investigate such cargo and its underlying mechanism, primary neurons were exposed to oxygen‐glucose‐deprivation (OGD) and cocultured with adipose‐derived MSCs (ADMSCs) or ADMSC‐secreted EVs. Under such conditions, both ADMSCs and ADMSC‐secreted EVs significantly reduced neuronal death. Screening for signalling cascades being involved in the interaction between ADMSCs and neurons revealed a decreased autophagic flux as well as a declined p53‐BNIP3 activity in neurons receiving either treatment paradigm. However, the aforementioned effects were reversed when ADMSCs were pretreated with the inhibitor of exosomal secretion GW4869 or when Hrs was knocked down. In light of miR‐25‐3p being the most highly expressed miRNA in ADMSC‐EVs interacting with the p53 pathway, further in vitro work focused on this pathway. Indeed, a miR‐25‐3p oligonucleotide mimic reduced cell death, whereas the anti‐oligonucleotide increased autophagic flux and cell death by modulating p53‐BNIP3 signalling in primary neurons exposed to OGD. Likewise, native ADMSC‐EVs but not EVs obtained from ADMSCs pretreated with the anti‐miR‐25‐3p oligonucleotide (ADMSC‐EVsanti‐miR‐25‐3p) confirmed the aforementioned in vitro observations in C57BL/6 mice exposed to cerebral ischemia. The infarct size was reduced, and neurological recovery was increased in mice treated with native ADMSC‐EVs when compared to ADMSC‐EVsanti‐miR‐25‐3p. ADMSCs induce neuroprotection by improved autophagic flux through secreted EVs containing miR‐25‐3p. Hence, our work uncovers a novel key factor in naturally secreted ADMSC‐EVs for the regulation of autophagy and induction of neuroprotection in a preclinical stroke model.
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Affiliation(s)
- Yaoyun Kuang
- University Medical Center Goettingen Department of Neurology Goettingen Germany
| | - Xuan Zheng
- University Medical Center Goettingen Department of Neurology Goettingen Germany
| | - Lin Zhang
- University Medical Center Goettingen Department of Neurology Goettingen Germany
| | - Xiaoyu Ai
- University Medical Center Goettingen Department of Neurology Goettingen Germany
| | - Vivek Venkataramani
- University Medical Center Goettingen Institute for Pathology Goettingen Germany
| | - Ertugrul Kilic
- Istanbul Medipol University Regenerative and Restorative Medical Research Center Istanbul Turkey
| | - Dirk M Hermann
- Department of Neurology University Hospital Essen University of Duisburg-Essen Essen Germany
| | - Arshad Majid
- Sheffield Institute for Translational Neuroscience University of Sheffield Sheffield UK
| | - Mathias Bähr
- University Medical Center Goettingen Department of Neurology Goettingen Germany
| | - Thorsten R Doeppner
- University Medical Center Goettingen Department of Neurology Goettingen Germany.,Istanbul Medipol University Regenerative and Restorative Medical Research Center Istanbul Turkey
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57
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Size-Exclusion Chromatography as a Technique for the Investigation of Novel Extracellular Vesicles in Cancer. Cancers (Basel) 2020; 12:cancers12113156. [PMID: 33121160 PMCID: PMC7693800 DOI: 10.3390/cancers12113156] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Extracellular vesicles (EVs) are small particles that are released by cancer cells, and they may hold vital information for researchers looking for early markers for diagnosis. Size-exclusion chromatography (SEC) is a classical technique that has become increasingly popular and can be used for rapid isolation and investigation of both their cargo and functionality. This systematic review highlights its main technical aspects, the type of materials involved and by covering the findings of the identified papers hopes to demonstrate the utility of this method in cancer research to date. Abstract Cancer cells release extracellular vesicles, which are a rich target for biomarker discovery and provide a promising mechanism for liquid biopsy. Size-exclusion chromatography (SEC) is an increasingly popular technique, which has been rediscovered for the purposes of extracellular vesicle (EV) isolation and purification from diverse biofluids. A systematic review was undertaken to identify all papers that described size exclusion as their primary EV isolation method in cancer research. In all, 37 papers were identified and discussed, which showcases the breadth of applications in which EVs can be utilised, from proteomics, to RNA, and through to functionality. A range of different methods are highlighted, with Sepharose-based techniques predominating. EVs isolated using SEC are able to identify cancer cells, highlight active pathways in tumourigenesis, clinically distinguish cohorts, and remain functionally active for further experiments.
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58
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Lin S, Zhou S, Yuan T. The "sugar-coated bullets" of cancer: Tumor-derived exosome surface glycosylation from basic knowledge to applications. Clin Transl Med 2020; 10:e204. [PMID: 33135347 PMCID: PMC7551131 DOI: 10.1002/ctm2.204] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/29/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Scientific interest in exosomes has exploded in recent decades. In 1990 only three articles were published on exosomes, while over 1,700 have already been published half-way into 2020.1 While researchers have shown much interest in exosomes since being discovered in 1981, an appreciation of the potential role of glycans in exosome structure and function has emerged only recently. Glycosylation is one of the most common post-translational modification, which functions in many physiological and pathological aspects of cellular function. Many components of exosomes are heavily glycosylated including proteins, lipids, among others. Thus, glycosylation undoubtedly has a great impact on exosome biosynthesis and function. Despite the importance of glycosylation in exosomes and the recent recognition of them as biomarkers for not only malignancies but also other system dysfunction and disease, the characterization of exosome glycans remains understudied. In this review, we discuss glycosylation patterns of exosomes derived from various tissues, their biological features, and potential for various clinical applications. We highlight state-of-the-art knowledge about the fine structure of exosomes, which will allow researchers to reconstruct them by surface modification. These efforts will likely lead to novel disease-related biomarker discovery, purification tagging, and targeted drug transfer for clinical applications in the future.
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Affiliation(s)
- Shanyi Lin
- Department of Orthopaedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiP. R. China
| | - Shumin Zhou
- Institute of Microsurgery on ExtremitiesShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiP. R. China
| | - Ting Yuan
- Department of Orthopaedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiP. R. China
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59
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Extracellular Vesicles as an Efficient and Versatile System for Drug Delivery. Cells 2020; 9:cells9102191. [PMID: 33003285 PMCID: PMC7600121 DOI: 10.3390/cells9102191] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/24/2020] [Accepted: 05/30/2020] [Indexed: 12/12/2022] Open
Abstract
Despite the recent advances in drug development, the majority of novel therapeutics have not been successfully translated into clinical applications. One of the major factors hindering their clinical translation is the lack of a safe, non-immunogenic delivery system with high target specificity upon systemic administration. In this respect, extracellular vesicles (EVs), as natural carriers of bioactive cargo, have emerged as a promising solution and can be further modified to improve their therapeutic efficacy. In this review, we provide an overview of the biogenesis pathways, biochemical features, and isolation methods of EVs with an emphasis on their many intrinsic properties that make them desirable as drug carriers. We then describe in detail the current advances in EV therapeutics, focusing on how EVs can be engineered to achieve improved target specificity, better circulation kinetics, and efficient encapsulation of therapeutic payloads. We also identify the challenges and obstacles ahead for clinical translation and provide an outlook on the future perspective of EV-based therapeutics.
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60
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Arola-Arnal A, López de Las Hazas MC, Iglesias-Carres L, Mantilla-Escalante DC, Suárez M, Busto R, Visioli F, Bladé C, Dávalos A. Exosomes transport trace amounts of (poly)phenols. Food Funct 2020; 11:7784-7792. [PMID: 32808000 DOI: 10.1039/d0fo01824d] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
(Poly)phenols have varied biological activities that may account for the beneficial effects of fruits and vegetables as part of a healthy diet. Although their cellular absorption and their many mechanisms of action have been partly elucidated, their transport through the systemic circulation, other than their binding to albumin, is poorly described. We aimed at determining whether (poly)phenols can be transported by extracellular vesicles. We supplemented rats with a dietary grape seed polyphenol extract (GSPE) and we quantified (poly)phenols and their metabolites at 3 and 7 h post-gavage. After quantitative LC-MS/MS analysis of circulating aglycones, and microbial-derived, or phase II-derived metabolites we recorded a quantitatively very modest transport of (poly)phenols in plasma exosomes when isolated by commercial ultracentrifugation or precipitation kits. Our data suggest that GSPE-derived (poly)phenols are minimally, if at all, transported by exosomes.
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Affiliation(s)
- Anna Arola-Arnal
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Nutrigenomics Research Group, 43007, Tarragona, Spain
| | - María-Carmen López de Las Hazas
- Laboratory of Epigenetics of Lipid Metabolism, Madrid Institute for Advanced Studies (IMDEA)-Food, CEI UAM + CSIC, 28049 Madrid, Spain.
| | - Lisard Iglesias-Carres
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Nutrigenomics Research Group, 43007, Tarragona, Spain
| | - Diana C Mantilla-Escalante
- Laboratory of Epigenetics of Lipid Metabolism, Madrid Institute for Advanced Studies (IMDEA)-Food, CEI UAM + CSIC, 28049 Madrid, Spain.
| | - Manuel Suárez
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Nutrigenomics Research Group, 43007, Tarragona, Spain
| | - Rebeca Busto
- Servicio de Bioquímica-Investigación, Hospital Universitario Ramón y Cajal, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain and CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Francesco Visioli
- Laboratory of Functional Foods, Madrid Institute for Advanced Studies (IMDEA)-Food, CEI UAM + CSIC, 28049 Madrid, Spain and Department of Molecular Medicine, University of Padova, 35121 Padova, Italy
| | - Cinta Bladé
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Nutrigenomics Research Group, 43007, Tarragona, Spain
| | - Alberto Dávalos
- Laboratory of Epigenetics of Lipid Metabolism, Madrid Institute for Advanced Studies (IMDEA)-Food, CEI UAM + CSIC, 28049 Madrid, Spain.
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Characterization of Extracellular Vesicles from Entamoeba histolytica Identifies Roles in Intercellular Communication That Regulates Parasite Growth and Development. Infect Immun 2020; 88:IAI.00349-20. [PMID: 32719158 DOI: 10.1128/iai.00349-20] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022] Open
Abstract
Extracellular vesicles (EVs) secreted by eukaryotic and prokaryotic cells to transport lipids, proteins, and nucleic acids to the external environment have important roles in cell-cell communication through cargo transfer. We identified and characterized EVs from Entamoeba histolytica, a protozoan parasite and a human pathogen. Conditioned medium from amebic parasites contained particles consistent with the expected size and morphology of EVs. Mass spectrometry was used to characterize the EV proteome and showed that it was enriched in common exosome marker proteins, including proteins associated with vesicle formation, cell signaling, and metabolism, as well as cytoskeletal proteins. Additionally, the EVs were found to selectively package small RNAs (sRNA), which were protected within the vesicles against RNase treatment. Sequencing analysis of the sRNA contained in EVs revealed that the majority were 27 nucleotides (nt) in size and represented a subset of the cellular antisense small RNA population that has previously been characterized in Entamoeba RNA interference (RNAi) pathway proteins, including Argonaute, were also present in amebic EVs. Interestingly, we found that the amebic EVs impacted intercellular communication between parasites and altered encystation efficiency. EVs isolated from encysting parasites promoted encystation in other parasites, whereas EVs from metabolically active trophozoites impeded encystation. Overall, the data reveal that Entamoeba secrete EVs that are similar in size and shape to previously characterized exosomes from other organisms and that these EVs contain a defined protein and small RNA cargo and have roles in intercellular communication among parasites and influence growth kinetics.
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Extracellular vesicles as natural therapeutic agents and innate drug delivery systems for cancer treatment: Recent advances, current obstacles, and challenges for clinical translation. Semin Cancer Biol 2020; 80:340-355. [DOI: 10.1016/j.semcancer.2020.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022]
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63
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Biomaterials and extracellular vesicles in cell-free therapy for bone repair and regeneration: Future line of treatment in regenerative medicine. MATERIALIA 2020. [DOI: 10.1016/j.mtla.2020.100736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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64
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Le Gall L, Ouandaogo ZG, Anakor E, Connolly O, Butler Browne G, Laine J, Duddy W, Duguez S. Optimized method for extraction of exosomes from human primary muscle cells. Skelet Muscle 2020; 10:20. [PMID: 32641118 PMCID: PMC7341622 DOI: 10.1186/s13395-020-00238-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/22/2020] [Indexed: 01/19/2023] Open
Abstract
Skeletal muscle is increasingly considered an endocrine organ secreting myokines and extracellular vesicles (exosomes and microvesicles), which can affect physiological changes with an impact on different pathological conditions, including regenerative processes, aging, and myopathies. Primary human myoblasts are an essential tool to study the muscle vesicle secretome. Since their differentiation in conditioned media does not induce any signs of cell death or cell stress, artefactual effects from those processes are unlikely. However, adult human primary myoblasts senesce in long-term tissue culture, so a major technical challenge is posed by the need to avoid artefactual effects resulting from pre-senescent changes. Since these cells should be studied within a strictly controlled pre-senescent division count (<21 divisions), and yields of myoblasts per muscle biopsy are low, it is difficult or impossible to amplify sufficiently large cell numbers (some 250 × 106 myoblasts) to obtain sufficient conditioned medium for the standard ultracentrifugation approach to exosome isolation. Thus, an optimized strategy to extract and study secretory muscle vesicles is needed. In this study, conditions are optimized for the in vitro cultivation of human myoblasts, and the quality and yield of exosomes extracted using an ultracentrifugation protocol are compared with a modified polymer-based precipitation strategy combined with extra washing steps. Both vesicle extraction methods successfully enriched exosomes, as vesicles were positive for CD63, CD82, CD81, floated at identical density (1.15-1.27 g.ml−1), and exhibited similar size and cup-shape using electron microscopy and NanoSight tracking. However, the modified polymer-based precipitation was a more efficient strategy to extract exosomes, allowing their extraction in sufficient quantities to explore their content or to isolate a specific subpopulation, while requiring >30 times fewer differentiated myoblasts than what is required for the ultracentrifugation method. In addition, exosomes could still be integrated into recipient cells such as human myotubes or iPSC-derived motor neurons. Modified polymer-based precipitation combined with extra washing steps optimizes exosome yield from a lower number of differentiated myoblasts and less conditioned medium, avoiding senescence and allowing the execution of multiple experiments without exhausting the proliferative capacity of the myoblasts.
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Affiliation(s)
- Laura Le Gall
- Northern Ireland Center for Stratified/Personalised Medicine, Biomedical Sciences Research Institute, Ulster University, Derry~Londonderry, UK
| | | | - Ekene Anakor
- Northern Ireland Center for Stratified/Personalised Medicine, Biomedical Sciences Research Institute, Ulster University, Derry~Londonderry, UK
| | - Owen Connolly
- Northern Ireland Center for Stratified/Personalised Medicine, Biomedical Sciences Research Institute, Ulster University, Derry~Londonderry, UK
| | | | - Jeanne Laine
- Centre for Research in Myology, INSERM UMRS_974, Sorbonne Université, Paris, France
| | - William Duddy
- Northern Ireland Center for Stratified/Personalised Medicine, Biomedical Sciences Research Institute, Ulster University, Derry~Londonderry, UK
| | - Stephanie Duguez
- Northern Ireland Center for Stratified/Personalised Medicine, Biomedical Sciences Research Institute, Ulster University, Derry~Londonderry, UK.
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Kuipers ME, Nolte-'t Hoen ENM, van der Ham AJ, Ozir-Fazalalikhan A, Nguyen DL, de Korne CM, Koning RI, Tomes JJ, Hoffmann KF, Smits HH, Hokke CH. DC-SIGN mediated internalisation of glycosylated extracellular vesicles from Schistosoma mansoni increases activation of monocyte-derived dendritic cells. J Extracell Vesicles 2020; 9:1753420. [PMID: 32489529 PMCID: PMC7241508 DOI: 10.1080/20013078.2020.1753420] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/13/2022] Open
Abstract
Helminths like Schistosoma mansoni release excretory/secretory (E/S) products that modulate host immunity to enable infection. Extracellular vesicles (EVs) are among these E/S products, yet molecular mechanisms and functionality of S. mansoni EV interaction with host immune cells is unknown. Here we demonstrate that EVs released by S. mansoni schistosomula are internalised by human monocyte-derived dendritic cells (moDCs). Importantly, we show that this uptake was mainly mediated via DC-SIGN (CD209). Blocking DC-SIGN almost completely abrogated EV uptake, while blocking mannose receptor (MR, CD206) or dendritic cell immunoreceptor (DCIR, CLEC4A) had no effect on EV uptake. Mass spectrometric analysis of EV glycans revealed the presence of surface N-glycans with terminal Galβ1-4(Fucα1-3)GlcNAc (LewisX) motifs, and a wide array of fucosylated lipid-linked glycans, including LewisX, a known ligand for DC-SIGN. Stimulation of moDCs with schistosomula EVs led to increased expression of costimulatory molecules CD86 and CD80 and regulatory surface marker PD-L1. Furthermore, schistosomula EVs increased expression of IL-12 and IL-10 by moDCs, which was partly dependent on the interaction with DC-SIGN. These results provide the first evidence that glycosylation of S. mansoni EVs facilitates the interaction with host immune cells and reveals a role for DC-SIGN and EV-associated glycoconjugates in parasite-induced immune modulation.
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Affiliation(s)
- Marije E Kuipers
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands.,Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Esther N M Nolte-'t Hoen
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Alwin J van der Ham
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | | | - D Linh Nguyen
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Clarize M de Korne
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Roman I Koning
- Department of Cell & Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - John J Tomes
- Institute of Biological, Environmental and Rural Sciences (IBERS), Aberystwyth University, Aberystwyth, UK
| | - Karl F Hoffmann
- Institute of Biological, Environmental and Rural Sciences (IBERS), Aberystwyth University, Aberystwyth, UK
| | - Hermelijn H Smits
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Cornelis H Hokke
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
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66
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Purity Determines the Effect of Extracellular Vesicles Derived from Mesenchymal Stromal Cells. Cells 2020; 9:cells9020422. [PMID: 32059497 PMCID: PMC7072280 DOI: 10.3390/cells9020422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 12/15/2022] Open
Abstract
Extracellular vesicles (EVs) have been recently identified as vital components of cell-based therapies based on the observation that conditioned media from cultured stromal cells reproduce some of the beneficial effects of intact cells. In order to obtain clinically active EVs derived from Mesenchymal Stromal Cells (MSCs) different procedures have been reported in the literature. Usually, non-confluent cells are incubated with culture medium for 48 h either with EV-depleted Fetal Bovine Serum (FBS) or without FBS. Our aim was to compare the effects of EVs isolated by ultracentrifugation from human umbilical cord MSC conditioned media obtained using these two conditions: with EV-depleted FBS (UC) or without FBS (UCw/o) on the mRNA expression levels of extracellular matrix related genes using the mouse chondrogenic cell line ATDC-5. We observed a deleterious effect on chondrogenic cells treated with UCw/o, showing higher mRNA expression levels of different metalloproteinases and decorin (Dcn) and lower collagen (Col1a1 and Col2a1) and aggrecan (Acan) mRNA levels. To elucidate whether this deleterious effect was induced by the EVs or by any proteins co-purified in the EV pellet, we used size exclusion chromatography (SEC) to further purify the EV pellet, obtaining an EV enriched fraction (EV or EVw/o) and a protein enriched fraction (Prot or Protw/o). Our results pointed that the negative effect on the chondrogenic cell line was due to the contaminant proteins coisolated with the EVs by ultracentrifugation and not from the EVs themselves. Thus, these results highlight the importance of working with well purified EV preparations to specifically achieve their therapeutic effect.
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67
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Exosomes Derived from Adipose Mesenchymal Stem Cells Restore Functional Endometrium in a Rat Model of Intrauterine Adhesions. Reprod Sci 2020; 27:1266-1275. [PMID: 31933162 DOI: 10.1007/s43032-019-00112-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/09/2019] [Indexed: 12/18/2022]
Abstract
Intrauterine adhesion (IUA) caused by endometrial injury is one of the important causes of infertility in women of reproductive age and requires advanced treatment strategies. Increasing evidence suggests that the therapeutic effects of mesenchymal stem cells (MSC) mainly depend on their capacity to secrete paracrine factors and are mediated by MSC-derived exosomes. This study aimed to identify exosomes derived from adipose-derived mesenchymal stem cells (ADSC-exo) and explore the therapeutic potential in IUA rat models. ADSC-exo exhibited classic cup-shaped morphology with a positive expression of Alix and CD63 and were mainly concentrated at 109.5 nm. In IUA model, treatment with ADSC-exo maintained normal uterine structure, promoted endometrial regeneration and collagen remodeling, and enhanced the expression of integrin-β3, LIF, and VEGF. An improved receptivity of the regenerated endometrium was confirmed. Our findings demonstrated that ADSC-exo promoted endometrial regeneration and fertility restoration. It suggested that topical administration of ADSC-exo in uterus could be a promising strategy for patients suffering severe intrauterine adhesions and infertility.
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68
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Affiliation(s)
| | | | - Ronghu Wu
- School of Chemistry and Biochemistry and the Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
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69
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Du J, Yuan C, Wang W, Yu Z, Hao R, Zhang Y, Guan M, Li N, Yang H. Aptasensor-enabled quantitative analysis of nano-sized extracellular vesicles by flow cytometry. Analyst 2020; 145:7551-7558. [DOI: 10.1039/d0an01652g] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Flow cytometry analysis of extracellular vesicles enabled by an aptamer-based biosensor to interact with tetraspanin CD63 proteins.
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Affiliation(s)
- Jing Du
- Laboratory of Biomedical Microsystems and Nano Devices
- Center for Bionic Sensing and Intelligence
- Institute of Bio-medical and Health Engineering
- Shenzhen Institutes of Advanced Technology
- Chinese Academy of Sciences
| | - Chao Yuan
- Laboratory of Biomedical Microsystems and Nano Devices
- Center for Bionic Sensing and Intelligence
- Institute of Bio-medical and Health Engineering
- Shenzhen Institutes of Advanced Technology
- Chinese Academy of Sciences
| | - Weijie Wang
- Center for Synthetic Biology Engineering Research
- Shenzhen Institutes of Advanced Technology
- Chinese Academy of Sciences
- Shenzhen 518055
- China
| | - Zitong Yu
- Laboratory of Biomedical Microsystems and Nano Devices
- Center for Bionic Sensing and Intelligence
- Institute of Bio-medical and Health Engineering
- Shenzhen Institutes of Advanced Technology
- Chinese Academy of Sciences
| | - Rui Hao
- Laboratory of Biomedical Microsystems and Nano Devices
- Center for Bionic Sensing and Intelligence
- Institute of Bio-medical and Health Engineering
- Shenzhen Institutes of Advanced Technology
- Chinese Academy of Sciences
| | - Yi Zhang
- Laboratory of Biomedical Microsystems and Nano Devices
- Center for Bionic Sensing and Intelligence
- Institute of Bio-medical and Health Engineering
- Shenzhen Institutes of Advanced Technology
- Chinese Academy of Sciences
| | - Min Guan
- Center for Human Tissues and Organs Degeneration
- Institute of Biomedicine and Biotechnology
- Shenzhen Institutes of Advanced Technology
- Chinese Academy of Sciences
- Shenzhen 518055
| | - Nan Li
- Center for Synthetic Biology Engineering Research
- Shenzhen Institutes of Advanced Technology
- Chinese Academy of Sciences
- Shenzhen 518055
- China
| | - Hui Yang
- Laboratory of Biomedical Microsystems and Nano Devices
- Center for Bionic Sensing and Intelligence
- Institute of Bio-medical and Health Engineering
- Shenzhen Institutes of Advanced Technology
- Chinese Academy of Sciences
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70
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Božič D, Hočevar M, Kononenko V, Jeran M, Štibler U, Fiume I, Pajnič M, Pađen L, Kogej K, Drobne D, Iglič A, Pocsfalvi G, Kralj-Iglič V. Pursuing mechanisms of extracellular vesicle formation. Effects of sample processing. ADVANCES IN BIOMEMBRANES AND LIPID SELF-ASSEMBLY 2020. [DOI: 10.1016/bs.abl.2020.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Metabolomics Applied to the Study of Extracellular Vesicles. Metabolites 2019; 9:metabo9110276. [PMID: 31718094 PMCID: PMC6918219 DOI: 10.3390/metabo9110276] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 10/31/2019] [Accepted: 11/07/2019] [Indexed: 12/20/2022] Open
Abstract
Cell-secreted extracellular vesicles (EVs) have rapidly gained prominence as sources of biomarkers for non-invasive biopsies, owing to their ubiquity across human biofluids and physiological stability. There are many characterisation studies directed towards their protein, nucleic acid, lipid and glycan content, but more recently the metabolomic analysis of EV content has also gained traction. Several EV metabolite biomarker candidates have been identified across a range of diseases, including liver disease and cancers of the prostate and pancreas. Beyond clinical applications, metabolomics has also elucidated possible mechanisms of action underlying EV function, such as the arginase-mediated relaxation of pulmonary arteries or the delivery of nutrients to tumours by vesicles. However, whilst the value of EV metabolomics is clear, there are challenges inherent to working with these entities—particularly in relation to sample production and preparation. The biomolecular composition of EVs is known to change drastically depending on the isolation method used, and recent evidence has demonstrated that changes in cell culture systems impact upon the metabolome of the resulting EVs. This review aims to collect recent advances in the EV metabolomics field whilst also introducing researchers interested in this area to practical pitfalls in applying metabolomics to EV studies.
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72
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Gao XF, Wang ZM, Wang F, Gu Y, Zhang JJ, Chen SL. Exosomes in Coronary Artery Disease. Int J Biol Sci 2019; 15:2461-2470. [PMID: 31595163 PMCID: PMC6775305 DOI: 10.7150/ijbs.36427] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/01/2019] [Indexed: 02/07/2023] Open
Abstract
Exosomes, the nanosized vesicles released from various cell types, contain many bioactive molecules, such as proteins, lipids, and nucleic acids, which can participate in intercellular communication in a paracrine manner or an endocrine manner, in order to maintain the homeostasis and respond to stress adaptively. Currently, exosomes have already been utilized as diagnostic biomarkers and therapeutic tools in cancer clinical trials. There has also been great progress in cell and animal exosomes studies of coronary artery disease (CAD). Emerging evidence suggests that exosomes released from endothelial cells, smooth muscle cells, adipose cells, platelets, cardiomyocytes, and stem cells have been reported to play crucial roles in the development and progression of CAD. Moreover, it has been showed that exosomes released from different cell types exhibit diverse biological functions, either detrimental or protective, depending on the cell state and the microenvironment. However, the systematic knowledge of exosomes in CAD at the patient level has not been well established, which are far away from clinical application. This review summarizes the basic information about exosomes and provides an update of the recent findings on exosome-mediated intercellular communication in the development and progression of CAD, which could be helpful for understanding the pathophysiology of CAD and promoting the further potential clinical translation.
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Affiliation(s)
- Xiao-Fei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Cardiology, Nanjing Heart Centre, Nanjing, China
| | - Zhi-Mei Wang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Wang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yue Gu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun-Jie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Cardiology, Nanjing Heart Centre, Nanjing, China
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Cardiology, Nanjing Heart Centre, Nanjing, China
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