# Levels of Proangiogenic Molecules and Terminal Complement Complex C5b-9 in the Crown of Circulating sEVs in Patients with Recurrent Glioblastomas: Relationship with Tumor Molecular Characteristics

## TL;DR

This study explores how specific molecules on circulating extracellular vesicles in blood relate to glioblastoma recurrence and tumor features.

## Contribution

The study identifies sEV profiles as potential biomarkers for glioblastoma recurrence and treatment response.

## Key findings

- C5b-9 was more common on sEVs with high VEGF-A in both groups of glioblastoma patients.
- GFAP+VEGF+dimMMP2-C5b-9+ vesicles were rare in patients without tumor recurrence.
- sEV profiles correlated with MGMT methylation and p53 mutation status in tumors.

## Abstract

Circulating small extracellular vesicles (sEVs) are emerging as potential biomarkers for glioblastoma progression. This study aimed to compare the levels of matrix metalloproteinases (MMP2 and MMP9), terminal complement complex (C5b-9), and VEGF-A in circulating sEVs in glioblastoma patients (GBMPs) with and without tumor recurrence. Using differential ultracentrifugation, sEVs were isolated from blood samples of GBMPs with no tumor recurrence for over one year (n = 6) and after first relapse (n = 14). The vesicles were characterized and quantified using flow cytometry. In both groups, C5b-9 was predominantly detected on tumor-specific circulating sEVs (glial fibrillary acidic protein (GFAP)-positive sEVs) with high VEGF-A expression, while C5b-9 was significantly less frequent on sEVs with low VEGF-A expression (p < 0.05). GFAP+VEGF+dimMMP2-C5b-9+ vesicles were rarely detected in GBMPs without relapse, suggesting their potential utility as biomarkers for a favorable relapse-free prognosis. In recurrent GBMPs, a positive correlation was observed between GFAP+VEGF+bright MMP2+C5b-9+ sEVs and MGMT gene promoter methylation levels (r = 0.543, p < 0.05). Additionally, a trend toward a negative correlation was found between GFAP+VEGF+bright MMP2+C5b-9- sEVs and mutant p53 expression in primary tumor tissue (r = −0.44, p = 0.114). These findings suggest that sEV profiles may serve as valuable prognostic markers for glioblastoma recurrence and treatment responses.