t r a n s l a t i o n a l p r o t e o m i c s 1 ( 2 0 1 3 ) 38–52
Available online at www.sciencedirect.com
jou rnal homepage: http://www.elsevier.com/locate/trprot
Review
Blood microvesicles: From proteomics to physiology
a,∗ a a b
Jean-Daniel Tissot , Giorgia Canellini , Olivier Rubin , Anne Angelillo-Scherrer ,
a a a
Julien Delobel , Michel Prudent , Niels Lion
a
Service Régional Vaudois de Transfusion Sanguine, Switzerland
b
Service and Central Laboratory of Hematology, Lausanne University Hospital, Switzerland
a r t i c l e i n f o a b s t r a c t
Article history: Phospholipid vesicles of less than 1 m are present in blood in physiological state and their
Received 22 March 2013 concentration may vary under pathological conditions. Various names such as exosomes
Received in revised form (EXS) and microparticles (MPS) have been used to designate these extracellular vesicles
17 April 2013 (EVS). Although EXs and MPS possibly arise from separate mechanisms, they share numer-
Accepted 30 April 2013 ous similarities representing a challenge for their purification and characterization. These
vesicles generally originate from various types of cells such as red blood cells, platelets,
Keywords: leukocytes or endothelial cells but also from tumor cells. They participate in numerous
Aging biological processes including hemostasis. It is therefore of major scientific interest to char-
Blood cells acterize the protein content of these different types of EVS and that of their membranes in
Exosomes order to elucidate the essential functions of these dynamic vesicular compartments. Pro-
Microparticles teomics has been shown to be a particularly adequate tool in this study field. This review
Microvesicles attempts to link proteomic data with physiological roles and functions of blood EVS.
Proteomics © 2013 The Authors. Published by Elsevier B.V. Open access under CC BY license.
Contents
1. Introduction ...... 39
2. Quantification and isolation of blood vesicles ...... 39
3. Proteomics of blood vesicles ...... 41
3.1. Proteomics of red blood cell-derived vesicles ...... 41
3.2. Proteomics of platelet-derived vesicles ...... 43
3.3. Proteomics of leukocyte-derived vesicles ...... 43
3.4. Proteomics of endothelial cell-derived vesicles...... 44
Abbreviations: EEVS, endothelial-derived microvesicles; ELISA, enzyme linked immune-sorbent assays; EVS, extracellular vesicles; EXS,
exosomes; DSL, dynamic light scattering; LEVS, leukocyte-derived microvesicles; MPS, microparticles; NTA, nanoparticle tracking analysis;
PEVS, platelet-derived microvesicles; RBC, red blood cell; REVS, red blood cell-derived microvesicles; ROS, reactive oxygen species.
∗
Corresponding author at: Route de la Corniche 2, CH-1066 Epalinges, Switzerland. Tel.: +41 21 314 65 89; fax: +41 21 314 65 78.
E-mail address: [email protected] (J.-D. Tissot).
2212-9634 © 2013 The Authors. Published by Elsevier B.V. Open access under CC BY license. http://dx.doi.org/10.1016/j.trprot.2013.04.004
t r a n s l a t i o n a l p r o t e o m i c s 1 ( 2 0 1 3 ) 38–52 39
4. Biology of blood vesicles ...... 44
4.1. Red blood cell-derived vesicles ...... 44
4.2. Platelet-derived vesicles ...... 46
4.3. Leukocyte-derived vesicles ...... 46
4.4. Endothelial cell-derived vesicles ...... 47
5. Conclusions and perspectives ...... 47
Conflict of interest ...... 47
References ...... 47
A model of MPS formation including translocases, lipid rafts,
1. Introduction
various protein modifications and irreversible membrane rear-
rangements has been proposed (Fig. 2) [24,25]. MPS are not
Proteomics is of major interest for the study of blood and blood
cell fragments or “dust” without any biological function [26].
diseases [1–11]. Plasma proteins and their modification in var-
They play a role in various broad biological functions such as
ious conditions have been extensively evaluated over the last
thrombosis and hemostasis [20,27,28], inflammation [27,29] or
decades in search of specific biomarkers of human diseases
immunosuppression [30,31]. However, numerous similarities
[12], particularly in cancer patients [13,14]. Proteomics rep-
exist between EXS and MPS with respect to their physical char-
resents nowadays the technique of choice – if not the gold
acteristics and compositions. These similarities frequently
standard – to characterize amyloidosis in tissue and plasma
hampered the separation and purification of these EVS in body
samples obtained from patients with protein deposition syn-
fluids and brought confusion in the scientific literature. In this
dromes [15,16].
review, we will mainly focus on blood EVS, with a particular
The proteome of many blood cells has been well charac-
emphasis on platelet and RBC EVS, as well as on MPS released
terized, especially that of red blood cells (RBCs) and platelets.
during storage of blood units. For clarity purposes, the term
The interest of applying proteomic technology to such cells is
EVS will be used in the following sections, grouping both MPS
mainly related to the fact that they share a limited capacity to
and EXS.
synthesize new proteins. In this context, there is a rising value
Quantification, proteomic analysis as well as the biol-
of proteomics compared to genomics and it is not surprising
ogy of RBC-derived EVS (REVS), platelet-derived EVS (PEVS),
that it has also proved effective in determining the protein
leukocyte-derived EVS (LEVS), and of endothelial cell-derived-
content of extracellular vesicles (EVS). Release of membrane
EVS (EEVS) are different, even if they share many common
vesicles, a process conserved in both prokaryotes and eukary-
determinants. This review will present proteomic data that are
otes, represents an evolutionary link, and suggests essential
“specific” for each type of EVS and then, will give insights onto
functions of this dynamic vesicular compartment [17]. Recent
the physiology of the various forms of EVS that are normally
studies provided support for the concept of EVS as vectors for
present in the blood or in blood products.
the intercellular exchange of biological signals and informa-
tion [18]. EVS are able to transfer part of their components and
content to selected target cells, allowing cell activation, phe-
notypic modification, and reprogramming of cell function [19]. 2. Quantification and isolation of blood
Because EVS circulate in the blood flow, they serve as shut- vesicles
tle modules and signaling transducers not only in their local
environment but also at distance from their site of origin. A variety of techniques is commonly used to study EVS (Fig. 3).
Classification of membrane vesicles, protocols of their iso- Traditionally, a limited set of technologies has been used
lation and detection, molecular details of vesicular release, to characterize micro- and nano-vesicles with more tech-
clearance and biological functions are still under intense niques being available to the micro sized particles [32]. These
investigation. EVS have been identified in the blood circula- include: flow cytometry, dynamic light scattering (DLS), elec-
tion for a long time, and have been first considered as cell tron microscopy [33,34] or enzyme linked immune-sorbent
fragments. In fact, EVS are quite heterogeneous and at least assays (ELISA) [35–37]. Most widespread is flow cytometry;
two main distinct types have been identified: exosomes (EXS) commercial flow cytometry typically has a lower practi-
and microparticles (MPS). Both EXS and MPS are detected in cal size limit (for polystyrene beads) of around 300 nm at
blood flow, and arose out of cells such as platelets, leukocytes which point the signal is indistinguishable from the base-
and endothelial cells [20]. EXS are small (40–100 nm in diam- line noise level. Whilst this detection limit can be extended
eter), spherical vesicles of endocytic origin that are secreted with the use of fluorescent labels, at lower sizes the ability
upon fusion of the limiting membrane of multivesicular bod- to accurately size such particles is quite limited. Dynamic
ies with the plasma membrane. Red blood cell (RBC)-derived light scattering has also been used in this application,
vesicles (REVS) have been also described in blood samples but being an ensemble measurement, the results comprise
obtained from patients with many different diseases as well as either a simple z-average (intensity weighted) particle size
a storage lesion from red blood cell preparations dedicated for and polydispersity, or a very limited-resolution particle size
transfusion [21,22]. EXS contain subproteome cytosolic pro- distribution profile [38,39]. Electron microscopy is a useful
teins, mRNAs and miRNAs, and are involved in intercellular research tool for studying micro- and nanovesicles but at the
signaling. In contrast, MPS bud directly from the plasma mem- expense of capital running costs, extensive sample prepara-
brane and their size ranges from 100 nm to 1 m (Fig. 1) [23]. tion [40].
40 t r a n s l a t i o n a l p r o t e o m i c s 1 ( 2 0 1 3 ) 38–52
Fig. 1 – (A) Formation of extracellular vesicles from spicules of echinocytes (confocal differential interference contrast
microscopy, magnification 4000×). (B) A single red blood cell derived (micro-)vesicle surrounded by nanovesicles
(transmission electron microscopy, magnification 67 000×).
Most frequently, EVS are counted in biological samples by Chandler et al. evaluated methods to number PEVS in fresh
flow cytometry [21,41,42]. Several authors have pointed out and frozen aliquots of plasma as well as in fresh and frozen
that despite flow cytometry is the technique of choice for aliquots of platelet-rich plasma [50]. They measured platelet
evaluation of EVS, it is limited by lack of adequate standardiza- (CD41+) and annexin V+, and were able to determine PEVS in
tion [43]. Preanalytical as well as analytical issues have been blood samples from normal individuals. Platelet-rich plasma
evaluated in detail by Yuana et al. [44]. Preanalytical parame- from healthy individuals contained 730 000/l total EVS based
ters were also studied in our laboratory, when measuring EVS on light-scattering measurements, and a median of 27 000/l
in stored blood products: in addition to the flow cytometry of those EVS were of platelet origin. They also provided
parameters chosen for the numbering of EVS, we observed that emphasis on the importance of preanalytical issues show-
many preanalytical variables have to be taken into account ing that freeze–thawing has variable effects on EVS counts,
(diluents used, temperature, vortexing duration, etc.) [45,46]. depending on the sample preparation used. For instance, it
In addition, Mullier et al. recently evaluated many aspects of has been reported that the centrifugation protocols influence
the prenalytical conditions as well as pending issue that has the EV counts [45,48].
to be considered when measuring EVS in blood samples [47]. Strasser et al. reported a comparison analysis of three
Because REVS express transmembrane proteins such as different methods for the quantification and characteriza-
band 3, glycophorins, or blood group antigens, it is quite con- tion of PEVS [51]. The authors, in their study, analyzed
venient to use specific antibodies raised against glycophorin A, PEVS from 31 healthy blood donors and compared pre-
CD47 or other blood group specific antigens for flow cytometric and postdonation results of donors with data of platelet-
purposes. The expression of negatively charged phospholipids pheresis products by three different methods; PEVS counts
(surface phosphatidylserine) at the external part of the vesi- were analyzed by flow cytometry using calibrated beads of
cles membrane can be explored by using annexin V as a defined diameter and annexin V-fluorescein isothiocyanate
ligand. However, standardization is mandatory in order to and CD41-phycoerythrin staining, whereas PEVS activity was
be able to compare data from different sets of experiments, tested by prothrombinase assay and, finally, a procoagulant
to compare normal individuals with patients and to com- phospholipid-dependent clotting time assay was used. The
pare data from different laboratories. Recently, Xiong et al. results showed a concentration of PEVS that was more than
presented a standardized approach based on quantitative threefold higher in single-platelet units compared to double-
flow cytometric technique [48]. The enumeration of REVS is platelet units. The prothombinase assay and the procoagulant
made possible by using a fixed number of different-sized cal- clotting assay also revealed a significant higher PEVS activ-
ibration beads spiked into each sample. The master bead ity in single platelet units compared to double platelet units.
mixture allowed defining the relative side and forward light These results are important for the transfusion medicine com-
scatter properties of the EVS events and enhanced the accu- munity; they confirm that various procedures may results in
racy of the enumeration process. Such an approach certainly the production of different products.
may also prove useful to measure EVS that derives from An alternative approach for measuring EVS is nanoparti-
endothelial cells, leukocytes or platelets. Numbering of PEVS cle tracking analysis (NTA) [44,52,53]. In nanoparticle tracking
is a challenge. Validation of the usefulness of cytometry to analysis, the size is derived from the measure of Brownian
analyze PEVS was provided by Leong et al. who combined motion of EVS in a liquid suspension [44,52]. This technol-
flow cytometry and atomic force microscopy [49]. In addi- ogy has been successfully applied for the analysis of EVS
tion, the authors demonstrated that atomic force microscopy derived from placenta, and allows specific EXS and EVS in
allows performing nanoscale measurements of individual the range of 50–1000 nm in liquid suspension. On the con-
PEVS events isolated by flow cytometry. This method provided trary of DLS that measures all the particles at the same
the first quantitative nanoscale images of PEVS ultrastructure. time, NTA visualizes individual particle and counts them in
t r a n s l a t i o n a l p r o t e o m i c s 1 ( 2 0 1 3 ) 38–52 41
real-time. NTA also provides high-resolution particle size dis-
tribution profiles and concentration measurements. However,
NTA is time consuming and the detection of small particles
is underestimated when larger particles are present [44]. The
technique is commercially available (NanoSight Ltd., Ames-
bury, UK; www.nanosight.com).
Various approaches have been developed for isolating
blood EVS. The particles can be immuno-adsorbed on sur-
faces using specific antibodies, using different centrifugation
approaches with or without density gradients, or as recently
reported using cell sorting [54]. In their study, Bosman et al.
isolated EVS from whole blood by differential centrifuga-
tion followed by fluorescence-activated flow cytometry. They
removed intact cells by low speed centrifugation from cit-
rated blood, and vesicles were isolated from the supernatant,
concentrated and washed with phosphate-buffered saline by
centrifugation. The EVS were then stained with specific anti-
bodies in order to label REVS and PEVS, respectively. Finally,
EVS were sorted on a flow cytometer, and analyzed using pro-
teomic tools.
3. Proteomics of blood vesicles
Proteomics is an ideal tool to study EVS [55,56]. The number
of papers published on this topic is rapidly increasing. Pro-
teomics has been used to evaluate EVS from mesenchymal
stem cells [57], from tumor cells [58,59], in ascite of patients
presenting with colon cancer [60], from HIV-infected lympho-
cytes [61], in saliva, in urine [62,63], in amniotic fluid [64]
or human cerebrospinal fluid [65], just to cite the expend-
ing field of research covered by different groups interested in
the study of EVS. The technique has been also successfully
applied to the evaluation of blood EVS [66,67] as performed
by Bastos-Amador et al. who analyzed EVS from plasma of
healthy donors and showed a remarkably high variability in
the protein content of EVS from different donors [68].
Fig. 2 – Model of formation of microparticles. The
phospholipid organization of the membrane is under the
control of three enzymes: flippase, floppase and 3.1. Proteomics of red blood cell-derived vesicles
scramblase. (A) In resting cells, flippase internalizes
negatively charged phospholipids and maintains the Differentiation of erythroblasts into mature RBC is a com-
asymmetry of the phospholipid bilayer. Floppase and plex mechanism, and many steps have been described. The
scramblase are inactive, and the cytoplasmic calcium final pathway leads to the transformation of reticulocytes into
concentration is low. (B) Upon activation, intracellular circulating RBCS. Carayon et al. analyzed the composition of
calcium concentration increases, flippase is inhibited while EXS released by reticulocytes during their differentiation [69].
floppase and scramblase are activated. Floppase Several mechanisms are involved in the process leading to
externalizes phosphatidyserine, a negative phospholipid, maturation of reticulocytes into mature RBCS and resulting
and scramblase translocates phospholipids non-specifically in the synthesis of large amounts of hemoglobin as well as in
through the membrane resulting in the loss of the elimination of numerous cellular components. By combin-
phospholipid asymmetry. (C) Increased intracellular ing proteomic and lipidomic approaches, the authors observed
calcium also activates proteases that cleave the alterations in the composition of the EXS retrieved over the
cytoskeleton; the membrane become less rigid and can bleb course of a 7-day in vitro differentiation protocol, and pro-
resulting in the formation and release of vesicles posed a model in which EXS are involved in specific pathways
Reprinted from [22], with permission from S. Karger. of cellular differentiation and maturation.
Bosman et al. presented pioneering proteomic investiga-
tions of EVS isolated from RBCS [70–72], and of EVS isolated
from plasma [54]. In these series of studies, RBC membrane
and EVS membrane were compared, allowing the identifica-
tion of several proteins differentially expressed between the
two types of samples. Furthermore, the authors were able
42 t r a n s l a t i o n a l p r o t e o m i c s 1 ( 2 0 1 3 ) 38–52
Fig. 3 – Technical approaches for microparticle investigation. Combination of these methods are most frequently used for
vesicle characterization.
to characterize the effects of cellular aging on RBCS in vivo. et al., accumulation of band 3 aggregates is observed, espe-
They compared the proteome of REVS with that of the RBCS cially at the end of the storage period 54. Moreover, they probed
membrane separated according to cell age. They observed the the level of protein oxidation (carbonylation) that was signifi-
presence of band 3 and actin in the REVS but the absence of cantly higher in vesicles, compared to originated membranes,
almost all other integral membrane and cytoskeletal proteins. up to 21 days of storage. Then, the level of oxidation drasti-
They also identified specific alterations in band 3 aggregation cally decreased, which has been attributed to the depletion of
and degradation related to aging and compatible with a unique highly carbonylated proteins. They concluded on the ability of
RBC aging process, the mechanism of which being specifi- RBCs to get rid of harmful materials by vesiculation.
cally band 3-centered. Finally, their results pointed out that In our laboratory, we evaluated REVS from RBC stored
the age-related recruitment of plasma proteins, proteins of in blood banking conditions [74] and analyzed their oxi-
the ubiquitin–proteasome system, and small G proteins to the dation patterns by evaluating carbonylation as a hallmark
RBC membrane supports the hypothesis that changes and/or of protein oxidative lesions [75]. In order to improve global
degradation of band 3 is involved in vesiculation [54]. RBC protein carbonylation assessment, subcellular fraction-
Under the same period, Kriebardis et al. have followed the ation has been performed, allowing to study four protein
proteome of REVS during storage of EC [73]. They found that populations that were (i) soluble hemoglobin, (ii) hemoglobin-
microparticles contained Hb and modified Hb, and mainly depleted soluble fraction, (iii) integral membrane and (iv)
proteins with MW lower than 70 kDa. REVS are depleted of cytoskeleton membrane protein fractions. In addition, car-
spectrins and cytoskelateal proteins such as proteins 4.1 and bonylation in REVS has been investigated. We observed
4.2, and contain lipid raft proteins. Because of the absence of that carbonylation in the cytoskeletal membrane fraction
protein 4.2, they suggested that the subpopulation observed increased remarkably between day 29 and day 43, and that
concerns proteins that are not band3-cytoskeletal linked (or protein carbonylation within MPS released during storage
we may also speculate that this subpopulation contains mem- showed a two-fold increase along the storage period. Taken
brane proteins originally linked to the cytoskeleton and that together, a scheme of protein oxidation has been proposed
were released after various lesions). As shown by Bosman (Fig. 4), suggesting a cumulative aspect of the storage lesion: a
t r a n s l a t i o n a l p r o t e o m i c s 1 ( 2 0 1 3 ) 38–52 43
cellular compartment-based evolution of global carbonylation with modified levels in these patients (increased levels of
in stored RBCS, an increasing elimination of harmful car- peroxiredoxin 6, apolipoprotein E, cyclophilin A and heat
bonylated proteins through microvesiculation and a potential shock protein 90), suggesting that the oxidative damage in
role of hemichrome-induced cytoskeleton oxidation in this RBC and platelets potentially induces production of EVS
elimination process. The oxidative pattern in REVS observed with altered proteome that may facilitate thromboembolic
in this study (level of carbonylation higher at the end of the complications.
storage) differs from the one published by Kriebardis et al.
[73]. In their study, they normalized the oxidation level to 3.2. Proteomics of platelet-derived vesicles
the corresponding RBC membranes, which may explain the
differences in case of accumulation of oxidized proteins at State of the art of platelet proteomics has been recently
the membranes. Delobel et al. also identified mechanisms reviewed [79–82]. A number of investigations focused on stud-
of oxidation of proteins and postulated that REVS may have ies using subproteomic strategies to analyze specific platelet
a role, as cargos leading to their elimination [75]. Finally, conditions (resting or activated), compartments (membrane,
the group of Bosman provided very recently interesting data granules and MPS) or fractions (phosphoproteome or glyco-
dealing with the physiology of RBC removal and alloimmu- proteome) [83–85]. More specifically, the proteome of PEVS has
nization [76]. The authors investigated if RBC storage leads to been the object of proteomic studies. Gracia et al. found that
the increased expression of non-physiological antigens, and PEVS contain membrane surface proteins such as GPIIIa, GPIIb,
for that purpose, used immunoprecipitation, testing RBCS and P-selectin, as well as other platelet proteins such as the
and REVS from blood units of increasing storage periods chemokines CXCL4 and CXCL7 [86]. In another study, Jin et al.
with patient plasma containing RBC autoantibodies. The compared the proteome of PEVS with that of plasma using
immunoprecipitate was analyzed using proteomic tools. With two-dimensional gel electrophoresis and mass spectrometry
such an approach, the authors observed that patient plasma [87]. They were able to identify 83 different proteins that were
autoantibody binding increased with RBC storage time, not reported in the plasma proteome. Dean et al. presented
which was not the case with healthy volunteer plasma, and results of proteomic studies evaluating PEVS released by acti-
showed that pathology-associated antigenicity changes with vated platelets [88]. In this study, PEVS were separated by gel
storage. They also identified several membrane proteins as filtration chromatography into 4 size classes to facilitate iden-
candidate antigens (namely band 3, adducing, ankyrin, band tification of active protein and lipid components, and proteins
4.1, band 4.2 and other protein of the band 3 complex) for were separated using two-dimensional gel electrophoresis,
immunization. The protein complexes that were precipitated liquid chromatography, and identified by tandem mass spec-
by the patient autoantibodies were different whether RBCS or trometry. The authors observed that PEVS of different sizes
vesicles formed during RBC storage were used, indicating that significantly differ in the content of plasma membrane recep-
the storage-associated REVS have a different immunization tors and adhesion molecules, chemokines, growth factors and
potential. Soluble immune mediators including complement protease inhibitors. The thousands of platelet proteins and
factors were present in the patient plasma immunoprecipi- interactions discovered so far by these different powerful pro-
tates, but not in the controls. The fascinating observations teomic approaches represent a precious source of information
made by the group of Bosman support the theory that dis- for both basic science and clinical applications in the field of
turbed RBC aging during storage of blood units contributes platelet biology.
to transfusion-induced alloantibody and autoantibody
formation. 3.3. Proteomics of leukocyte-derived vesicles
Using flow cytometry analysis, Almizraq et al. observed a
significant increase in the mean number of EVS per mL during The protein characterization of LEVS is still largely unex-
storage, with significant decreases in the amount of phospho- plored. Furthermore, many preanalytical difficulties should be
lipids and total lipids within the RBC membrane. These results taken into account, because of the great diversity of leukocytes
clearly indicate that lipidomics of the storage lesion of RBCS in blood circulation. It is therefore mandatory to purify each
is certainly a new avenue of research [77]. different type of LEVS using specific expressed CD antigens. A
The proteome of REVS from patients with beta- first attempt of deciphering the proteome of B-cell LEVS has
thalassemia/hemoglobin E has been explored by been published by Wubbolts et al., ten years ago [89]. In this
Chaichompoo et al. [78]. In these patients, aggregability study, highly purified human B cell-derived EVS were analyzed
and oxidative damage of RBCS, combined with platelet activa- by mass spectrometry which revealed the presence of major
tion and increased amount of REVS may provoke thrombotic histocompatibility complex class I and class II, heat shock cog-
events. The authors evaluated the number of EVS, the oxida- nate 70, heat shock protein 90, integrin alpha 4, CD45, moesin,
tive stress status, the procoagulant activity, as well as the tubulin (alpha and beta), actin, G(i)alpha(2), and a multitude
proteome of EVS obtained from patients. By flow cytometric of other proteins. EVS appeared to be enriched in cholesterol,
analysis, the number of phosphatidylserine-bearing EVS was sphingomyelin, and ganglioside GM3, lipids that are typically
significantly higher as compared to controls. The high levels concentrated in detergent-resistant membranes.
of EVS did not only correlate with the increase of procoagulant LEVS of HIV-1-infected and -uninfected lymphocytic H9
activity but also with the increase of platelet counts. These cells were evaluated by Li et al. [61]. Using the technique of
EVS corresponded to two major populations: REVS and PEVS. stable isotope labeling by amino acids in cell culture (SILAC),
Proteome analysis (two-dimensional gel electrophoresis the authors compared protein expression patterns in the EVS
followed by mass spectrometry) identified about 30 proteins compartment of HIV-1-infected and -uninfected lymphocytes.
44 t r a n s l a t i o n a l p r o t e o m i c s 1 ( 2 0 1 3 ) 38–52
Fourteen proteins were found to be differentially expressed in (discocyte), to stomatocyte and to echinocyte (the form of RBC
the LEVS fraction of HIV-1-infected cells versus -uninfected leading to the formation of EVS) [98].
controls. Three immunomodulatory molecules were repro- Under normal conditions, REVS account for approximately
ducibly identified and included ADP-ribosyl cyclase 1 (CD38), 7.3% of EVS found in whole blood. The other populations
l
-lactate dehydrogenase B chain, and annexin V. This study consist of particles derived from platelets (38.5%) and EVS
revealed that LEVS released from HIV-1-infected cells are resulting from endothelial cells (43.5%) [48]. Many compre-
composed of a unique and quantitatively different protein hensive studies have been published this last decade on the
signature and harbor regulatory molecules that impact the various aspects of the biology of blood EVS [99], and their
processes of cellular apoptosis. roles in physiology as well as in physiopathology have been
In patients with B-cell malignancy, accumulation of LEVS explored in details.
have been observed and analyzed using proteomic tools by Here, a brief summary of the accumulating knowledge on
Miguet et al., in order to identify specific biomarker capa- blood EVS will be presented.
ble of diagnosing difficult cases such as leukemic phase of
non-Hodgkin lymphoma [90,91]. These studies allowed the 4.1. Red blood cell-derived vesicles
identification CD148, a membrane receptor with phosphatase
activity, as a discriminating biomarker candidate. For confir- REVS formation has been described as part of RBC senes-
mation purposes, flow cytometry analyses were performed on cence [71] and also proposed as a part of an apoptosis-like
158 patients and 30 controls revealing that CD148 was overex- form in these cells [100]. This “ageing” process of RBC was
pressed in mantle cell lymphoma as compared to other B-cell observed during storage in blood bank condition [22,74,101].
neoplasms. During their 120 days of lifespan, RBCS lose approximately
20% of their volume through vesicles emission whereas their
hemoglobin concentration increases by 14% [102]. Vesicula-
3.4. Proteomics of endothelial cell-derived vesicles
tion would be a mean for RBCS to get rid of specific harmful
agents such as denatured hemoglobin, C5b-9 complement
Until now, a few proteomic studies have been published
attack complex, band 3 neoantigen and IgG that tend to accu-
on the proteome of EEVS. Nevertheless, EEVS have been
mulate in RBCS or on their membrane during their lifespan
characterized at the proteome level by Banfi et al. [92].
[71,101,103]. The release of REVS plays a protective role that
Mass spectrometry analyses revealed the presence of newly
allows RBCS to clear away dangerous molecules, such as oxi-
described proteins such as metabolic enzymes, proteins
dized proteins [75], and thus, preventing their early removal
involved in adhesion and fusion processes, members of
from blood flow. In the other hand, REVS could promote
protein folding event, cytoskeleton associated proteins and
removal of RBCS by accumulating CD47 which is an inte-
nucleosome. In an interesting study, Liu et al. provided infor-
gral membrane protein present on RBC’s surface, acting as
mation not only on proteomics of EEVS but also on the changes
a marker of self. Thanks to CD47, normal RBCS are recog-
of the protein content in the endothelial cells after stimulation
nized as self by macrophages (through their signal regulatory
and EEVS release [93]. A direct correlation between the pro-
protein ␣) and phagocytosis is inhibited. Senescent or dam-
teins that form EEVS and tumor necrosis factor-␣-activated
aged RBCS whose CD47 expression is reduced by shedding
endothelial cells was observed.
of REVS enriched in CD47 would no longer be recognized as
self and thus be eliminated by macrophages [104–106]. Still in
the context of RBC aging process, two main models result-
4. Biology of blood vesicles ing in microvesiculation have been proposed, the eryptosis
model and the band 3 clustering. The term “eryptosis” has
The biology of REVS, PEVS, LEVS, and of EEVS is depend- been introduced a few years ago by Lang’s group [100]. It
ent of the cells from which they originate. Nevertheless, describes mechanism similar to apoptosis of nucleated cells
many physiological properties, such as their role in fibrino- in response to various stresses but applied to RBCS. Influx of
lysis, may be shared by EVS deriving from different cellular ionic calcium through nonspecific cation channels leads to
origin, as demonstrated for LEVS and EEVS. However, when activation of several enzymes such as calpain or scramblase.
generation of plasmin is analyzed in more details, it was Reasons triggering this calcium intake are largely unknown
possible to demonstrate that LEVS expressed urokinase-type but alteration of nonspecific cation channels is often men-
plasminogen activator activity whereas EEVS are presenting tioned as a possible cause [107,108]. The band 3 clustering
tissue plasminogen activator and tissue plasminogen activa- model is characterized by protein oxidation. The oxidation of
tor/inhibitor complexes [94]. hemoglobin contributes to hemichrome formation, which is
The forces that maintain cellular and adhesive forces of constituted of Hb derived products (likely met-hemoglobin)
the cellular membrane has been studied in details, both the- linked to the inner leaflet, followed by the clustering and
oretically [95] and in physiological condition [96]. Thus, the aggregation of band 3 multimers in the membrane [109]. Band
remodeling of the RBC membrane that maintains its bicon- 3 clustering forms or uncovers senescent neoantigens, prob-
cave shape has been deciphered [97]. Finally, the physical ably because of relatively small structural modifications that
forces involved in the membrane structure has been stud- are recognized by naturally occurring autologous IgG with sub-
ied, and a model resulting from different dynamic forces has sequent complement activation [110]. Both models share the
been evaluated allowing to better understand the fluctuations same final outcome, which is phosphatidylserine external-
of the membrane leading to the formation of a normal RBC ization on RBCS membrane and degradation of cytoskeleton
t r a n s l a t i o n a l p r o t e o m i c s 1 ( 2 0 1 3 ) 38–52 45
Fig. 4 – Hypothesis of oxidation-driven vesiculation in stored RBCS. (1) RBC antioxidant defenses prevent protein
carbonylation by reducing reactive oxygen species (ROS) into less reactive intermediates. After a certain storage period,
these defenses are exceeded by the oxidative stress and protein carbonylation occurs on both soluble and membrane
proteins. (2) Carbonylated proteins are recognized and degraded by the 20S proteasome. (3) Over-oxidized proteins crosslink
and cannot be degraded by proteasome anymore, inhibiting degradation of fairly oxidized proteins as well as other
damaged proteins due to steric obstruction. (4) Oxidized hemoglobin aggregates as hemichromes and binds to and alters
band 3 conformation. (5) Hemichromes heme autoxidation produces ROS which induces cytoskeleton and membrane
protein oxidation. (6) Membrane vesiculation allows elimination of altered band 3 and oxidized membrane proteins.
Reprinted from [75], with permission from Elsevier.
proteins followed by modification in the phosphorylation sta- and in the subsequent loss of modulation of calcium homeo-
tus of band 3 (Fig. 4) [75]. Based on recent data, a clearer stasis [119]. Increased intracellular levels of calcium appeared
picture of the molecular mechanisms underlying this pro- to promote vesiculation, even if the eryptosis-like phenomena
cess is emerging: oxidative damage induces the binding of is also induced by a calcium-independent fashion by starva-
hemoglobin to band 3, activation of calcium-dependent per- tion [120].
meable channels, phosphorylation of key player proteins and EVS have been observed in blood storage as well as in differ-
aggregation of band 3 leading to vesiculation. This process ent hematological diseases that have been recently reviewed
gives sufficient membrane flexibility resulting in REVS for- [21,22]. Briefly, REVS are involved in clinical situations char-
mation and release. The hypothesis of an oxidative stress acterized by hemolysis or endothelial activation. In sickle
being involved in RBCS storage lesions has been reinforced cell disease, the abnormal hemoglobin S adds to the mem-
by the studies of Stowell et al. [111]. By adding ascorbic acid brane instability and favors the development of EVS [121]. In
solution to RBCs during storage, the authors observed a ben- this disease, EVS number correlates to the rate of intravas-
eficial effect on recovery and immunogenicity of RBCs after cular hemolysis and the degree of coagulation activation
transfusion, but not cytokine induction. They also demon- [122,123] and defines subclinical phenotypes with enhanced
strated a significant decrease in EVS formation. Thus, the complications [124]. Phosphatidylserine-positive REVS poten-
addition of ascorbic acid (or other antioxidants) to human tiate thrombin generation [122,123,125] through factor XI
RBCs may have beneficial effects. Almizraq et al., by assessing activation [28,122,126]. However, other investigators identified
RBCs throughout storage also observed significant increases activated factor XII as being the key player in the coagula-
in percent hemolysis, while significant decreases in ATP con- tion cascade [127]. In paroxysmal nocturnal hemoglobinuria,
centrations as well as the mean corpuscular hemoglobin complement activation may be involved in EVS generation
concentration [77,112]. The metabolic deregulation has been which contributes to the thrombotic profile of these patients
identified during RBC aging in vivo [113–116], and in vitro [21,128–130]. In stem cell transplants, REVS may be useful in
[117,118], resulting in the impairment of the potassium pumps distinguishing acute graft-versus-host disease from infection
46 t r a n s l a t i o n a l p r o t e o m i c s 1 ( 2 0 1 3 ) 38–52
or sepsis [131]. However, other types of EVS are elevated in 4.3. Leukocyte-derived vesicles
such patients [132,133]. In malaria, rates of REVS are also cor-
related with the degree of parasitemia and the severity of the LEVS represent only a small proportion of blood EVS, but
infection [133,134]. bear important physiological properties. As mentioned, LEVS
During RBC storage, many biochemical changes happen, express markers from their parental cells (neutrophils, mono-
referred as “storage lesions” including RBCS membrane mod- cytes/macrophages, and lymphocytes) and are therefore quite
ifications (it becomes more rigid), lipid rafts rearrangement, heterogeneous. They harbor membrane and cytoplasmic pro-
disruption of phospholipids asymmetry and EVS release teins as well as bioactive lipids notably related to coagulation
[4,71,135]. The accumulation of EVS during blood storage is and inflammation. They may carry tissue factor or coagulation
well described [74]. Recently, we identified that these EVS have inhibitors and, as a result, may participate in hemosta-
factor XI dependent procoagulant properties and that they are sis and pathological thrombosis [148]. LEVS also have both
able to initiate and propagate thrombin generation [28]. EVS pro-inflammatory and anti-inflammatory properties and are
from stored RBCS also carry blood group antigens that may clearly involved in a number of biological processes. EVS
play a role in alloimmunization [41]. derived are released from polymorphonuclear neutrophils EVS
upon activation. These EVS interfere with the maturation of
monocyte-derived dendritic cells [149] and down-modulate
the inflammatory response of human macrophages and den-
4.2. Platelet-derived vesicles dritic cells exposed to TLR-2 and -4 ligands [150]. This
down-modulation appeared to be mediated via the engage-
Platelet production is a complex process [136], beginning ment and activation of the Mer receptor tyrosine kinase
2+
within the bone marrow. Different molecular mechanisms are (MerTK), as well as by an immediate Ca flux and a rapid
involved in the formation of platelets from megakaryocytes release of TGF-beta1.
[137], leading to the splitting of large platelets which can LEVS show a complex relation with endothelial cells, at
also be considered as megaparticles. Platelets in circulation the same time improving the endothelial function or on the
release both large vesicles that are plasma membrane-derived contrary inducing an endothelial dysfunction. Consequently
microparticles and small ones that represent multivesicular LEVS are largely implicated in all stages of atherosclerosis
body-derived EXS [138]. The distinction between these two and circulate at a high level in the bloodstream of patients
populations of PEVS is difficult because of an overlap in their with high atherothrombotic risk. LEVS modify the endothelial
molecular properties and in their sizes. Furthermore, as PEVS function and promote the recruitment of inflammatory cells
are released through several induction pathways, different in the vascular wall both representing necessary processes for
types of PEVS may be produced, each one bearing its mech- the progression of the atherosclerotic lesion. In addition, LEVS
anism of action. In a paper dealing with the biology of PEVS, favor the neovascularization within the vulnerable plaque
Varon et al. reviewed the extra-hemostatic effects of PEVS and, when the plaque is ruptured, take part in coagulation
and presented the possible roles of PEVS other than participa- and platelet activation. LEVS also participate in angiogene-
tion in blood coagulation [139]. In summary, they showed that sis [65]. LEVS, as well as other types of EVS – notably those
PEVS express and transfer functional receptors from platelet deriving from tumor cells – bind plasminogen and vectorize
membranes, increase expression of adhesion molecules on plasminogen activators, leading to an efficient plasmin gen-
cells, stimulate the release of cytokines, activate intracellular eration and matrix metalloproteinases activation [151]. Thus,
signaling pathways, alter vascular reactivity, induce angio- LEVS behave as an efficient catalytic surface involved in vascu-
genesis, and are involved in cancer metastasis. They also lar and matrix proteolysis-related biological processes, acting
mentioned that a high PEVS level is highly correlated with in many biological processes such as fibrinolysis, cell survival,
aggressive tumors and a poor clinical outcome. PEVS also matrix remodeling, angiogenesis, and tumor metastasis.
have important physiopathological role in patients presenting Circulating levels of LEVS appear to be increased in adults
with type-II heparin induced thrombocytopenia [140]. PEVS with chronic B-cell lymphoproliferations (chronic lymphocytic
participate in several homeostatic multi-cellular processes leukemia, small cell lymphoma and mantle cell lymphoma)
[141], such as hemostasis, maintenance of vascular integrity, [91,152] and in children with B-cell neoplasm [153]. Finally,
and immunity, but they also have tasks in thrombotic [142], LEVS derived from leukemic cells probably play a pathological
inflammatory diseases [143] and cancer progression [144]. As role by participating to the coagulopathy that is some-
perfectly coined by Mause in an invited editorial, PEVS have times observed in patients with acute myeloblastic leukemia
a hegemonic role in atherogenesis [145]. PEVS are also gen- [154,155]. In a study evaluating patients with acute promyelo-
erated when platelets are prepared for transfusion [51], and cytic leukemia (a situation characterized by serious bleeding
investigators recently demonstrated that these PEVS are not and thrombotic complications), Ma et al. analyzed LEVS
removed by the various filters that are used for leukoreduction from 30 patients and healthy controls [156]. The morphol-
[146]. A stimulating new hypothesis is potential role of PEVS as ogy of the LEVS was examined by using transmission electron
a mediator of neurogenesis. Specifically, factors from platelets microscopy and laser scanning confocal microscopy. LEVS
and their PEVS may promote neo-neurogenesis by stimulat- were quantified and analyzed for their thrombin-generating
ing endogenous neural stem cells proliferation, migration and potential. Counts of LEVS in patients with acute promyelocitic
differentiation, and by stimulating niche angiogenesis and the leukemia were elevated and were typically from promyelo-
release of neurogenic signals from endothelial cells and astro- cytic cells (CD33+, tissue factor+). The CD33+ LEVS levels
cytes [147]. correlated with patient leukocyte counts and coagulation
t r a n s l a t i o n a l p r o t e o m i c s 1 ( 2 0 1 3 ) 38–52 47
activation (evaluated by measuring d-dimer). Moreover, LEVS launched (Journal of Extracellular Vesicles; eISSN 2001-3078),
from patients decreased the coagulation times and induced which will be the official journal of the Society. The first issue
thrombin generation; interestingly, LEVS-associated thrombin is out of press. Proteomics, as highlighted in the last part of
generation was reduced by adding an anti-human tissue factor this review, is certainly a tool of major importance to char-
antibody, but neither with anti-factor XI nor anti-tissue factor acterize the proteins that are present in EVS. Proteomics has
pathway inhibitor. shown its power in a lot of topics and applications, and EVS
is and will be one of them. However, making a list of pro-
4.4. Endothelial cell-derived vesicles teins is insufficient to understand the multiple functions and
roles of EVS, and proteomics is not a unique solution in fine.
Vascular homeostasis is the reflection of quiescent, but The challenges remain the EVS isolation to obtain homoge-
competent endothelium. EEVS are released by endothelium nous subpopulations, the fractionation for accurate proteomic
[157,158]. They are now recognized as key players in a mul- analyses and the coupling to a functional approach, includ-
titude of biological functions necessary for the maintenance ing complementary data. Definitively EVS are not the rubbish
of endothelial integrity and vascular biology. EEVS have been of the cell, and should be integrated in the cellular biology.
demonstrated to act as primary and secondary messengers The future of biomarker discovery related to specific disease
of vascular inflammation, thrombosis, vasomotor response, will focus on EVS release in body fluids from various cells. A
angiogenesis, and endothelial survival. EEVS also induce cell fascinating field of research is open and largely dedicated to
cycle arrest through redox-sensitive processes in endothe- specialists in proteomic sciences.
lial cells, thus having implications in vascular senescence
[159]. These often-neglected EEVS are emerging as poten-
tially useful indicators of dysfunctioning endothelium. They Conflict of interest
have been implicated in many different diseases such as pre-
None.
eclampsia in pregnancy [160], pulmonary hypertension [161],
chronic graft versus host disease [162], antiphospholipid syn-
drome [163], or vasculitis such as in Kawasaki’s syndrome
r e f e r e n c e s
[164]. They also have been detected in cancer patients in
whose circulating levels of MPS correlate with prognosis, and
could be used as prognostic markers for example in advanced
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