This protocol demonstrates a comprehensive workflow from the isolation of EVs to downstream proteomics and phosphoproteomics analyses (Figure 1). The triplicate urine samples were subjected to EV isolation. The isolated EVs were characterized by western blotting and subsequently processed for mass spectrometry-based proteomics sample preparation including protein extraction, enzymatic digestion, and peptide cleanup. For phosphoproteomics analysis, the phosphopeptides were further enriched based on metal ion-functionalized soluble nanopolymers. Both peptide and phosphopeptide samples were analyzed by high-resolution ion mobility mass spectrometry under data-independent mode. The result raw files were searched against Homo sapiens database, and library-free data-independent acquisition workflow was performed for identification and MS2-level quantification.
To characterize the isolated EVs and estimate the recovery yield, we first loaded an equivalent of 0.5 mL of urine containing EVs onto the gel for western blotting to detect the EV marker CD9 (Figure 2A). In addition, we included the EVs isolated from the same volume of urine using the most used method for EV isolation, differential ultracentrifugation (DUC), for comparison. The results showed that EVtrap was able to produce much higher CD9 signals compared to DUC, indicating an effective capture of EVs by the beads. Further quantitative values for each CD9 band signal demonstrated that EVtrap achieved a recovery yield of ~99% compared to the 5-fold intensity of the direct urine control, while DUC only recovered ~1.5% of EVs (Figure 2B).
By loading 2% of each sample onto the LC-MS/MS for proteomic profiling, we identified > 11,000 unique peptides from ~2,200 unique proteins (Figure 3A), indicating that this workflow provides an in-depth coverage of EV proteome. A high degree of overlap in protein identifications across samples was observed, with 72% of unique proteins being consistently identified in all three replicates (Figure 3B). Moreover, we compared the identification results with the ExoCarta database (Figure 3C)26. Notably, out of the top 100 EV markers and proteins, we successfully identified ~90 of these EV proteins, suggesting an unbiased and complete profiling of EV proteins through this proteomics analysis. To assess the quantitative precision, we further evaluated the distribution of coefficients of variation (CV) for the protein quantification results (Figure 3D). A low medium CV (5.7%) indicates the high reproducibility and reliability of the procedure, including EV isolation, sample preparation, and MS detection.
For the phosphoproteomics analysis, we used 98% of each peptide sample for the phosphopeptide enrichment and identified ~800 unique phosphopeptides corresponding to ~350 unique phosphoproteins (Figure 4A). The enrichment yielded an average of 72% phosphoserine (pS) peptides, 22% phosphothreonine (pT), and 6% phosphotyrosine (pY) peptides, respectively (Figure 4B). In terms of the identification reproducibility of the three replicates, 42% of phosphopeptides were identified by all three analyses, and there was a ~50% overlap between every two analyses (Figure 4C). A medium CV of 21.8% was determined for the quantification of phosphopeptides, suggesting an acceptable quantitative reproducibility using this protocol (Figure 4D).

Figure 1: Schematic workflow used for isolation of urinary extracellular vesicle (EV) and downstream analyses. EVs are isolated from urine samples through the extracellular vesicles total recovery and purification (EVtrap) approach, and the isolated EVs are directly subjected to western blotting analysis. For LC-MS/MS analysis, proteins are extracted from EVs and digested into peptides. The peptide samples after the cleanup steps can be used for proteomics analysis or phosphoproteomics analysis after phosphopeptide enrichment. Both proteomics and phosphoproteomics samples are analyzed by LC-MS/MS. Identification and quantification are then performed using data independent acquisition (DIA) workflow method. Please click here to view a larger version of this figure.

Figure 2: Characterization of isolated EVs by western blotting. (A) Detection of EV marker CD9 from 0.1 mL of direct urine sample (n=1), EVs isolated using differential centrifugation (DUC) approach (n=3), and EVs isolated using EVtrap approach (n=3). (B) Quantification of western blotting signals in (A) is presented as the percentage recovery relative to the direct urine sample (5-fold intensity = 100%). For the DUC and EVtrap samples, the bar plot displays the average intensities and standard deviations (represented by error bars) from the triplicates. Please click here to view a larger version of this figure.

Figure 3: Proteomics analysis of isolated EVs. (A) The total number of identified unique proteins and peptides in triplicates. (B) Venn diagram showing the overlap in identified unique proteins between replicates. (C) The number of identified unique proteins corresponding to the top 100 EV markers in the ExoCarta database. (D) Density plot showing the distribution of coefficient of variation (CV) for protein quantification. The median CV value is highlighted with a red dashed line. Please click here to view a larger version of this figure.

Figure 4: Phosphoproteomics analysis of isolated EVs. (A) The total number of identified unique phosphoproteins and phosphopeptides in triplicates. (B) Percentage composition of pSTY peptides after phosphopeptide enrichment. (C) Venn diagram showing the overlap in identified unique phosphopeptides between replicates. (D) Density plot showing the distribution of CV for phosphopeptide quantification. The median CV value is highlighted with a red dashed line. Please click here to view a larger version of this figure.