Extracellular Vesicles (EVs) are small, membrane-derived vesicles found in bodily fluids that are highly involved in cell-cell communication and help regulate a diverse range of biological processes. Analysis of EVs using flow cytometry (FCM) has been notoriously difficult due to their small size and lack of discrete populations positive for markers of interest. Methods for EV analysis, while considerably improved over the last decade, are still a work in progress. Unfortunately, there is no one-size-fits-all protocol, and several aspects must be considered when determining the most appropriate method to use. Presented here are several different techniques for processing EVs and two protocols for analyzing EVs using either individual detection or a bead-based approach. The methods described here will assist with eliminating the antibody aggregates commonly found in commercial preparations, increasing signal–to-noise ratio, and setting gates in a rational fashion that minimizes detection of background fluorescence. The first protocol uses an individual detection method that is especially well suited for analyzing a high volume of clinical samples, while the second protocol uses a bead-based approach to capture and detect smaller EVs and exosomes.
EVs, also known as microparticles, are small, membrane-derived vesicles found in bodily fluids that are involved in cell-cell communication and help regulate a diverse range of biological processes1. Through expression of various surface markers and/or direct transfer of biological material, EVs are able to alter the function of recipient cells to play either activating or suppressing roles in intercellular communication2–4. Clinically, platelet-derived EVs are known to have strong anticoagulant activity5, while others have been shown to contribute to a wide range of conditions, from promoting tumor metastasis6 to protecting against disease7. EVs can be classified into smaller categories of cell-derived vesicles such as exosomes and microvesicles (MVs), depending on their size and mechanism of generation8. The nomenclature of cell-derived vesicle subpopulations continues to be a topic of ongoing debate8,9, however, exosomes are generally described as small, 40 to 100 nm particles derived from endosomal fusion with the plasma membrane, while MVs are larger 100 to 1,000 nm particles formed by shedding of the plasma membrane10. Here, the general term “EVs” will be used to refer to all types of extracellular biological vesicles released by cells.
Isolation of EVs from whole blood is a multi-step procedure and many different processing variables have been shown to affect EV content, including storage temperature and duration11,12, anticoagulant/preservative used13 and centrifugation method used14. A need for standardization of these variables has led to recommendations by the International Society on Thrombosis and Haemostasis Scientific and Standardization Committee (ISTH SSC) for proper blood processing and EV isolation procedures15,16, yet there exists no consensus among researchers on the optimal protocol to use 12. Most agree, however, that tightly controlled pre-analytical variables are crucial for accurate and reproducible data.
In order to analyze EVs, researchers have utilized various methods, including transmission electron microscopy17, scanning electron microscopy18,19, atomic force microscopy, dynamic light scattering20,21 and western blotting22,23. While FCM is the method of choice for many researchers9,24–26 due to its high throughput capabilities, analysis of EVs using FCM has been notoriously difficult due to their size and lack of discrete positive populations27–32. Compared to analysis of cells, the small size of the EVs results in 1) less fluorescence emitted due to the fewer number of antigens per particle and 2) limited feasibility of post-stain washing, which is necessary to reduce background fluorescence. Common challenges among researchers include signals arising from immunoglobulin aggregates27,28and self-aggregation of antibodies29. Furthermore, the long processing times and lengthy washing/isolation procedures used by many of the current protocols33,34 require multi-day time commitments to analyze a small number of samples, making them less than ideal for high throughput applications. Some researchers forgo a wash step altogether, rendering traditionally used FCM negative controls such as fluorescence minus one (FMO) and antibody isotypes useless for accurately assessing background fluorescence30.
Our protocols address three common problems that can impede proper FCM analysis of EVs: signals arising from antibody aggregates and other non-vesicles, difficulty in removing unbound antibody, and lack of discernible positive populations. The techniques described here will assist with eliminating the antibody aggregates commonly found in commercial preparations, increasing signal–to-noise ratio, and setting gates in a rational fashion that minimizes detection of background fluorescence. Two different detection methods are presented here: the first protocol uses an individual detection method that is especially well suited for analyzing a high volume of clinical samples, while the second protocol uses a beads-based approach to capture and detect smaller EVs and exosomes.