Circulating extracellular vesicles display immunotherapeutic targets and complement circulating tumor DNA in high-risk neuroblastoma

Extracellular vesicles (EVs) offer a minimally invasive window into tumor biology through surface molecules reflecting their cellular origin. Here, we investigated whether neuroblastoma-derived EVs retain tumor-associated surface markers and provide complementary information to established biomarkers in children with neuroblastoma. EVs from neuroblastoma cell lines were characterized using orthogonal biochemical, morphological and biophysical approaches, followed by analysis of GD2, L1CAM and NCAM1 surface expression. EV-associated markers were subsequently evaluated in blood plasma-derived EVs from children with neuroblastoma and pediatric controls and compared with clinical and circulating cell-free DNA (cfDNA) parameters. Neuroblastoma EVs displayed GD2, L1CAM and NCAM1 in patterns reflecting donor-cell surface expression, supported by a positive correlation between cellular and EV marker abundance (Spearman {rho}=0.74, P<0.0001). Genetic disruption of GD2 biosynthesis resulted in corresponding loss of EV-associated GD2, further supporting its cellular origin. In plasma, GD2-, L1CAM- and NCAM1-positive EVs were enriched in patients with high-risk neuroblastoma and correlated with LDH level, soft tissue disease burden (GD2, L1CAM) and cfDNA concentration (GD2, NCAM1). Longitudinal analyses demonstrated dynamic and partially discordant changes in EV- and cfDNA-markers. These findings identify tumor-associated EV surface phenotypes as complementary circulating biomarkers and support their further evaluation for minimally invasive monitoring of neuroblastoma evolution.