Plasma based assessment of extracellular vesicles biomarkers in Alzheimer’s Disease

Abstract

AbstractBackgroundCurrently there are no widely accepted diagnostic tests for Alzheimer’s disease (AD). Although there is much excitement in the field of biomarker development, most proposed tests for AD are expensive, require highly specialized sample handling, invasive approaches or radiation exposure. The goal of this project was to develop non‐invasive AD biomarker assessment using nanoflow cytometry to examine proteins on circulating brain‐derived extracellular vesicles in plasma.MethodPlasma samples were collected from a population of individuals clinically diagnosed with MCI and mild, moderate or severe Alzheimer’s disease and cognitively intact control subjects. Plasma was incubated with fluorescently‐conjugated antibodies against candidate biomarkers including oligomeric amyloid, fibrillar amyloid, amyloidβ‐42, pTau‐T181, pTau‐T217, pTau‐S235, Ubiquitin, Neurofilament, α‐synuclein and synaptophysin. After incubation, labelled events were quantified using the Apogee Microplus nanoflow cytometer. Using Receiver‐Operator Curve (ROC) analysis, the ability of individual markers and various combinations to distinguish diagnostic groups was determined.ResultNanoflow cytometry quantification of pTau‐T181, pTau‐T217, pTau‐S235, pTau‐T231, Aβ‐42 (among others) successfully distinguished MCI and AD plasma from healthy controls. Using ROC analysis, our most sensitive antibodies (pTau‐ T231) separate controls from AD patients with an AUC of 0.96 (Sens: 0.95/Spec: 1.0). Other prominent antibodies include pTau 181 with an AUC of 0.93 (Sens: 0.92/Spec: 0.92). The most promising combination of antibodies combines beta‐amyloid42 and pTau‐181 to separate AD patients from controls with an AUC of 0.960 (Sens: 0.93, Spec: 0.92). Isolation of EVs from plasma and validation of marker labeling was performed with Western Blot, ELISA and transmission electron microscopy.ConclusionHere we demonstrate the use of nanoflow cytometry to directly quantitate proteins on circulating extracellular vesicles in plasma from MCI and AD patients. The assays are rapid, inexpensive, directly quantitative, and require mini sample volume and manipulation. Future studies are required involving a larger population of patients who have had ‘gold standard’ biomarkers (Amyloid and tau CSF measurements), longitudinal follow‐up and/or autopsy confirmed diagnosis of AD.