Immune cells regulate circulating adipocyte extracellular vesicle levels in response to metabolic shifts

Extracellular vesicles (EVs) are now recognized as potent mediators of intercellular and inter-organ signaling and implicated in the pathogenesis of obesity and its associated comorbidities such as diabetes, cancer, cardiovascular disease, and neurodegeneration. Despite a surge of new functional information about EVs, we still lack a basic understanding of how endogenous EV levels are controlled to regulate inter-organ signaling. New flow cytometry technology has allowed us to study the regulation of circulating, endogenous EVs from metabolically relevant cell types like adipocytes. From this, we provide evidence for a paradigm of EV regulation where tissue resident immune cells, predominantly macrophages, clear EVs released by local tissue cells or EVs entering the tissue from circulation, an activity that determines circulating EV levels. In obesity, EV uptake by adipose tissue immune cells is reduced, concomitant with increased circulating adipocyte-specific EVs (adipoEVs) and reduced EV clearance rates. AdipoEVs are significantly elevated in mouse circulation from one day to 20 weeks of high-fat feeding. In humans we found that adipocyte EV levels negatively correlate with whole-body and liver insulin sensitivity and are not associated with adipose mass. This work suggests that tissue resident immune cells act as a gatekeeper for tissue EV entry into circulation and are thereby a major regulator of inter-organ EV signaling.