Mem Inst Oswaldo Cruz, Rio de Janeiro, VOLUME 121 | 2026
Research Articles
Extracellular vesicles isolated from the plasma of COVID-19 and sepsis patients: characterisation and association with clinical outcomes
1Universidade Federal de São Paulo, Infectologia da Escola Paulista de Medicina, São Paulo, SP, Brasil
2Universidade Federal de São Paulo, Instituto de Ciências Ambientais, Químicas e Farmacêuticas, Departamento de Ciências Farmacêuticas, Laboratório de Imunologia Celular e Bioquímica de Fungos e Protozoários, Diadema, SP, Brasil
3Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Belo Horizonte, MG, Brasil
4Hospital Sepaco, São Paulo, SP, Brasil
DOI: 10.1590/0074-02760250109
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ABSTRACT
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.
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Financial support: FAPESP [Grants 2017/21052-0 and 2020/05110-2 (to RS), Grant 2020/07870-4 (to ACT)].
+ Corresponding authors: ana.torrecilhas@unifesp.br | 
https://orcid.org/0000-0001-5724-2199 / rsalomao@unifesp.br | https://orcid.org/0000-0003-1149-4598
Received 29 April 2025
Accepted 26 September 2025
HOW TO CITE
de Carvalho JFN, Meneghetti P, Barbosa GR, Silvestrini MMA, Santos SS, Freitas FG, et al. Extracellular vesicles isolated from the plasma of COVID-19 and sepsis patients: characterisation and association with clinical outcomes. Mem Inst Oswaldo Cruz. 2025; 120: e250109.
HANDLING EDITOR
Adeilton Alves Brandão | https://orcid.org/0000-0001-5877-607X
