This study characterizes the dynamics of spinal cord-derived EVs during EAE, giving novel insights into possible roles of EVs in the pathophysiology of MS. We found marked changes in inflammatory, glial and synaptic proteins and pathways as well as a shift in the predicted contribution of various immune and glial cells types, corroborating that EVs can provide a snapshot of crucial disease processes such as CNS compartmentalized inflammation, re/de-myelination and synaptic pathology and might mediate them. We further found published inflammatory EV biomarkers identified in people with MS [8, 9, 17–20] to be altered in our EAE spinal cord EV, suggesting an overlap of the pathological processes in EVs during EAE and MS and an overlap of EV proteomic changes in the CNS and periphery.
We chose spinal cord-derived EVs as the focus of this study because the spinal cord is an early and severely affected, well-studied region in the EAE model and is clinically relevant to MS pathology. The major limitation of this choice was the small amount of spinal cord tissue compared with the less severely affected brain tissue per mouse. Despite pooling five spinal cords for three EAE score-matched biological batches for each timepoint, the protein output was low, limiting the possible downstream experiments. The selection of two timepoints, reflecting acute inflammation at day 16 and the initiation of resolution of neuroinflammation at day 25, were selected to offer a comprehensive view of EV changes across distinct phases of the disease.
Despite advances over the last decade, the separation, accurate characterization, and uniform classification of EVs remains challenging but constantly evolving. We followed a well-established, frequently used EV separation method involving differential centrifugation followed by SEC [22] and characterized the EVs according to the MISEV criteria [41]. We found a strong enrichment of known EV markers and a reduction of plasma, nuclear, cytosolic, and most mitochondrial proteins. A recent study comparing three CNS tissue EV separation protocols – SEC, sucrose gradient ultracentrifugation, and phosphatidylserine affinity capture – highlighted the speed and robustness of SEC, but also reported contamination with soluble proteins using this method [42]. However, our protocol differs from this publication in several steps: we carried out filtration with a smaller cut-off (0.22uM vs 0.45uM) and used higher centrifugation speeds to eliminate larger EVs – which reduces contamination and refines the studied EV subset. Indeed, in a direct comparison of 0.22uM filtered to non-filtered EVs, it has been shown that 0.22uM filtration resulted in a more homogenous population of EVs including exosomes and small microvesicles [43]. This aligns with the small EV size we detected with our method, and which others have obtained using this method [44]. To investigate if our observations were specific or enhanced in EVs, we compared the changes in the EV fraction to changes in the 10K pellet. In several analyses, we detected more pronounced changes in EVs, supporting interest in these particles providing a detailed snapshot of ongoing pathological tissue processes during EAE.
Our proteomics data suggest that EVs play a role in the propagation and regulation of immune responses in the EAE model. At day 16 and, to a lesser extent, also at day 25, many of the top dysregulated proteins in EAE EVs compared to naïve EVs are related to MS-associated immune pathways, including antigen presentation, the complement system, and innate immune responses. The substantial increase in the abundance of antigen-presenting proteins in the spinal cord EVs from EAE mice implies EVs may mediate antigen presentation in the EAE model. Previously, it has been shown that EVs can present antigen and activate leukocytes independent of their cell of origin either directly [45], with the help of cross-dressing bystander antigen-presenting cells [46], or through the transfer of MHC-mounted antigens onto acceptor cells [47]. In the context of MS and its animal models, it is not yet fully understood how and why the peripheral immune system mounts an immune response against oligodendrocytes to trigger disease and, later, what activates CNS reactive peripheral lymphoid cells in the meninges prior to direct cellular contact with CNS cells. Based on our findings, it is tempting to speculate that the increase in antigen-presenting EVs might play a part in activating lymphocytes locally and in the periphery or bordering tissue since EVs are thought to cross the BBB [48]. Since we observe an increase in MHC class II, class I proteins and constituents of the immunoproteasome in EVs, this antigen presentation might occur through both direct- and cross-presentation. An active proteome in and cross-presentation by EVs has been reported for platelet EVs [49]. Microglia [50], B-cells [45], and dendritic cells [51] have been identified as possible sources of antigen-presenting EVs. In our relative immune cell and glia cell type abundance analysis (CIBERSORTx and BRETIGEA) of the pooled EVs, we found a sharp increase in microglial EVs but no major shift in dendritic cell EV populations. Predicted B-cell contribution to the EV pool was increased in some analyses but not in others.
Another group of immune-related proteins upregulated in the EAE tissue-derived EVs were complement proteins. There are several reports of complement proteins in or possibly bound to EVs from plasma [9] and cell culture supernatants [52]. Complement-containing EVs from adventitial fibroblasts have been reported to induce proinflammatory responses in myeloid cells [52]. Complement-containing EVs in circulating astrocyte-enriched EVs are neurotoxic and reduce neurite complexity [53]. In a previous study, our group found that plasma-derived astrocyte-enriched EVs from people with MS contained higher levels of complement components than healthy controls [9]. This suggests that some of the changes we see in CNS-derived complement-containing EVs in the EAE model also occur in people with MS.
Pattern recognition receptors (PRRs), including TLR2, TLR7 and Clec6a, are another group of inflammatory proteins among the top dysregulated proteins in EAE EVs. In neuroinflammation, these receptors induce innate immune responses when recognizing pathogen- or danger-associated molecular patterns. TLRs are expressed on EVs [54]. Interestingly, in an earlier study investigating potential biomarkers from plasma-derived EVs, our group found that TLR levels are altered in the EVs of people with MS [8].
ATP synthesis and aerobic respiration-related proteins and pathways were among the most strongly downregulated in EAE. EVs are known to shuttle glycolytic enzymes and produce ATP [55, 56]. In the CNS, neuronal progenitors and glial cells have been shown to release EVs with mitochondria or functional mitochondrial units. Reportedly, Neuronal stem cell (NSC) EVs contain several ATPases we found to be reduced in EAE in our study (Atp5f1d and a). The transfer of intact mitochondria to phagocytes through these NSC-EVs, prevented the pro-inflammatory metabolic activation of phagocytes in vitro and in EAE [57]. Further, astrocyte-derived EVs, containing mitochondria, are reportedly shuttled to neurons and promote their survival [58]. In EAE, axonal mitochondria (of the spinal cord) are reduced in number, less mobile and show reduced complex 1 activity [59]. These signs of mitochondrial dysfunction are detected as early as day 15 [60]. This aligns with our observation of reduced complex 1 associated proteins in the EAE EVs, supporting the hypothesis that disruption of homeostatic metabolic cues transferred by EVs may promote neurodegeneration and inflammation in EAE. In future, targeting these metabolic changes in EVs or restoring metabolic enzymes in EVs might be an interesting therapeutic approach in EAE and MS. Indeed, in murine models of stroke, administration of mitochondria-containing EVs (targeting the BBB) have been reported to have protective effects [61].
Besides inflammatory responses, we also detected marked changes in glia cell-derived EV proteins. Glia-specific cell deconvolution analysis showed that astrocyte, and mature oligodendrocyte proteins are decreased in EAE EVs, while microglial and oligodendrocyte precursor proteins are upregulated. Demyelinating lesions with extensive loss of myelin and mature oligodendrocytes are hallmarks of both MS and EAE. In vitro, both murine and human mature oligodendrocytes have been shown to release myelin-containing EVs [15, 62]. In EAE spinal cord EVs the abundance of many myelin proteins was reduced at both day 16 and 25 post-immunization, with lower levels at the chronic time point, reflecting the loss of OLs. Interestingly, two peripheral myelin proteins – MPZ and PMP2 – and regulators of nerve ensheathment – Prx, Mpp6 and Naalad2 – [63–65], were among the top upregulated proteins at day 25 compared to day 16. These proteins are predominantly found in Schwann cells from the peripheral nervous system (PNS). In mouse models of demyelination [66] and more recently also in spinal cord and cerebellar MS lesions [67] it has been shown that Schwann cells can migrate to demyelinated areas and in rare contexts contribute to remyelination. The PNS myelin protein and ensheathment regulator containing EVs in EAE indicate that EVs might play a role in Schwann cell remyelination of the CNS at day 25. Interestingly, at day 25 the abundance of CNS myelin proteins is still mainly decreased compared to both naïve and day 16. Possible explanations for this include: (1) the overall known limited successful remyelination in the EAE model even at chronic timepoints [68] (2) in our model the increase in the expression of PNS myelin proteins precedes CNS myelin proteins, hence there are fewer CNS myelin + EVs (3) CNS myelin proteins are not frequently packaged into EVs during remyelination (4) A slow increase in CNS myelin is masked by an ongoing clearance of dysfunctional/ partially degraded myelin in or bound to tissue-derived EVs. Alongside the changes in myelin protein, we found an increase in proteins associated with OPC differentiation, reflecting the induction of this reparative process. The functional relevance of the changes in OL-derived proteins in the EAE tissue EV pool remains unclear. As suggested above, they might play a role in regulating intrinsic function by clearing degraded myelin or pro-myelinating signaling. In the literature OL-EVs from culture supernatants have been shown to promote axonal health and function [69, 70]. Further OL-EVs injected into EAE mice suppress disease by inducing immunosuppressive monocytes and reducing autoreactive T cells [15]. However accumulating OL-EVs containing PLP, MAG and MOG might also exacerbate disease, as they have been shown to block OPC differentiation in vitro [71].
Microglial and astrocytic proteins were also altered throughout EAE. Homeostatic microglial markers were among the top down-regulated markers at both day 16 and 25, while the relative predicted microglial contribution using BRETEGA [34] showed a sharp increase in microglial contribution. This aligns with previous studies that have reported a higher number of microglia- (and macrophage-) derived EVs in the CSF during EAE and in pwMS [10]. The increase could be explained by a higher EV secretory capacity of microglia in response to inflammatory stimuli, such as ATP or pro-inflammatory cytokines in EAE. In vitro ATP treatment of microglia induces their release of EVs, that contain cell adhesion, phagocytosis, apoptosis, metabolism, and antigen-presentation-associated proteins and promote the induction of neurotoxic astrocytes [72]. Similarly, treatment of microglia with IL-1β, TNF-α and IFN-ɣ induces their release of pro-inflammatory EVs that block OPC differentiation in vitro and remyelination in vivo through indirect effects on astrocytes [73]. Complementing these findings, homeostatic and regenerative microglia, induced by IL-4 or co-culturing with immunosuppressive mesenchymal stem cells, produce EVs that dampen inflammation and promote remyelination and synaptic function [16, 73]. Our finding of reduced homeostatic microglial markers, such as TMEM119 and P2YR12, in tissue EVs could therefore also contribute to a disruption of these functions at day 16 and 25 of EAE. A reduction of these homeostatic markers in EVs has also been reported in humans, in CNS tissue-derived EVs from Alzheimer’s patients [74].
With respect to astrocytic EVs, we noted a reduction in their relative contribution to the tissue EV pool, using cell deconvolution analysis. Possible explanations for this could be reduced production of astrocyte-derived EVs or faster CNS clearance or uptake. The former seems less likely considering previous studies that have shown increased astrocytic EV production in vitro in response to inflammatory stimuli, such as TNFa [75] and IL-1b [76]. Interestingly, supporting the latter, Dickens et al. have shown that neuroinflammation-induced astrocytic EVs rapidly cross the BBB and regulate the peripheral immune response to CNS inflammation [76]. In line with this, in a previous study, we found increased levels of circulating GLAST + EVs in the blood of pwMS [9]. Besides clearance across the BBB, astrocyte-derived EVs might also be depleted from the tissue EV pool by cellular uptake during neuroinflammation. Supporting this, You et al. showed that EVs produced by human primary astrocytes treated with IL-1b in vitro show significantly higher uptake into neurons than non-treated astrocyte EVs [77]. Though under resting condition astrocyte-derived EVs have neurotrophic effects[78], the inflammation-associated astrocytic EVs impaired neuronal differentiation and function [77], which aligns with numerous previous studies showing the detrimental effects of EVs from inflammatory-activated astrocytes on neurons and glia [79, 80].
Synaptic pathology and neurodegeneration are hallmarks of MS and EAE, and were detectable in the proteome of the EVs in our study. Synaptic vesicle and neurotransmitter regulation-related pathways were among the top dysregulated GO terms down-regulated at both day 16 and 25 of EAE and the neuronal contribution to the EV pool was reduced in the BRETIGEA deconvolution analysis. Neuronal EVs released from healthy neurons have both autocrine functions – promoting synaptic plasticity, neurite outgrowth, and neuronal health [81–84] – and paracrine functions on astrocytes and microglia – inducing glutamate clearance, synaptic pruning and reducing proinflammatory cytokine production [85–87]. Interestingly EVs also exert some of these effects, namely promoting neurite outgrowth, on metabolically challenged neurons. However, how inflammation affects the neuronal EV release and contents is not yet well understood. Our results suggest that in EAE neuronal EV release is reduced (or neuronal EVs are more rapidly cleared) and they contain lower levels of synaptic proteins. Based on the physiological function of neuronal EVs, this could contribute to the synaptic pathology and neurodegeneration in the model. The more pronounced reduction of inhibitory synapse-associated proteins and post-synaptic proteins compared to excitatory and presynaptic proteins, is particularly noteworthy, since these imbalances have been described as a pattern of synaptic pathology in EAE and MS: Inhibitory networks are disrupted earlier, and more pronounced in EAE [88], MS and focal demyelination models [89, 90], compared to excitatory networks. Similarly, though still a matter of debate and mainly described in the visual pathway, the degeneration of the pre-synaptic components seems to precede the post-synaptic [91–93]. Interestingly, our findings also align with EV biomarker studies in pwMS. Previously, we detected lower levels of the synaptic proteins in circulating neuronal EVs of pwMS compared to healthy controls [9]. Further, a recent study by another group showed reduced circulating levels of neuronal EVs in pwMS compared to healthy controls [18], though in our earlier study with a comparable cohort size we did not see any differences [9]. Alongside the loss in mature neuronal markers, we observed a loss in immature neuronal markers in the EAE EVs, the latter however normalized at day 25, indicating an increased number of neuronal progenitors or an increase in their secretory activity. Functionally, neuronal progenitor derived EVs have been shown to dampen inflammation and aging-associated changes in the CNS [94].
Besides giving insight into the pathological changes in EVs during EAE, our study is also a useful resource for future studies investigating biomarkers or developing EV-based or -targeted therapies in EAE and ultimately MS. One possible approach for EV-targeted therapies is to inhibit EV release, with the aim to prevent the spread of pathological signals contained in them. This has shown some success in preclinical models of acute brain injury and Alzheimer’s disease [95, 96]. Further knockout of A-SMase, which is required for the shedding of microvesicles, has also been shown to be protective in EAE. Yet these are preventative studies and their protective effect might primarily be explained through the dampening of EVs’ contribution to neuroinflammation. Our data shows a shift of the EV proteome through the course of EAE from predominantly inflammatory to attempted remyelinating and regenerating proteins, including an increase of OPC differentiation-associated, neuronal progenitor marker proteins and M2-macrophage-associated proteins at day 25 compared to day 16. This suggests that continuous blocking of EV release, though beneficial in early inflammatory disease stages, might worsen the outcome later by inhibiting beneficial EV signaling during the resolution of the neuroinflammation and repair. Indeed, there is evolving literature on the protective effects of EVs subsets in neuroinflammation [15]. In future studies it will be interesting to investigate the functional relevance and factors regulating the release of the OPC, newly-formed OLs or neuronal progenitor protein containing EVs we characterized in our study.
Our study provides insight into how plasma and CSF EV biomarkers in pwMS reflect CNS tissue EV changes and if changes in EVs during EAE reflect changes in pwMS. Overall, we found changes in the EAE tissue EV proteomealign with changes in EV biomarkers in MS. In a previous study, we identified increased complement component levels in astrocyte-enriched plasma EVs as biomarkers for MS [9]. In the EAE tissue EVs, we also detected increased levels of complement components. Which cell types drive the changes in complement we detect in our spinal cord EVs however remains unclear but could be investigated in future in light of the new developments in cell-origin specific proteomics [97]. Other MS inflammatory plasma EV biomarkers include T- and B- cell associated CD4, alpha1-microglobulin (Ambp), fibrinogen (Fgb) and gelsolin (Gsn) [18]. In both pwMS (compared to healthy controls) and in our EAE spinal cord EVs (compared to naïve mice) Gsn was reduced and AMBP and FGB were increased. Interestingly, fibrinogen-containing EVs have been shown to induce CNS-reactive T cells in EAE [19]. The CD4 + plasma EV numbers are increased in active compared to stable MS [18] and in RRMS compared to healthy controls [17]. In our tissue EVs CD4 was elevated at peak of disease compared to naïve mice and showed some normalization compared to peak at the chronic timepoint. The changes in plasma EV TLR3 and CD14 levels in pwMS were also reflected in our study, though in contrast to what has been described in pwMS we noted no change in TLR4 [8, 17]. In future, we aim to gain further insight into how our observed changes compare to changes in human disease by characterizing MS tissue EVs.