Extracellular vesicles isolated from the plasma of COVID-19 and sepsis patients: characterisation and association with clinical outcomes

BACKGROUND Extracellular vesicles (EVs) are involved in the pathogenesis of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection. OBJECTIVES We analysed the concentration, size, cellular origin, and capacity for carrying viral components in plasma samples from patients with Coronavirus disease 2019 (COVID-19) and sepsis. METHODS Plasma samples from COVID-19 patients admitted to the intensive care unit (ICU) with sepsis (N = 42) and healthy individuals (N = 19) were analysed. EVs were characterised by size and concentration using nanoparticle tracking analysis (NTA), polymerase chain reaction (RT-qPCR) for SARS-CoV-2 components, and flow cytometry for immunophenotyping. EVs were marked with phosphatidylserine and tetraspanins. Cellular origin markers were used for neutrophils, endothelial cells, T lymphocytes and platelets. Cryo-EM was used to assess EV size and integrity. FINDINGS NTA showed an increased concentration of microparticles in patients. RT-qPCR analysis of EVs detected the virus in 14 samples, two of which were consistent with the Gamma variant. EVs predominantly derived from T cells and platelets and demonstrated an increased expression of CD81 in individuals who died. Cryo-EM revealed EVs with an average size of 200 nm. MAIN CONCLUSIONS Our findings suggest that patients’ EVs likely harboured viral components, suggesting their potential role as carriers of SARS-CoV-2. In addition, EVs from deceased patients demonstrated elevated levels of CD81 expression.