RNA profiling has emerged as a powerful tool to investigate the biomarker potential of 18 human biofluids. However, despite enormous interest in extracellular nucleic acids, RNA 19 sequencing methods to quantify the total RNA content outside cells are rare. Here, we evaluate the 20 performance of the SMARTer Stranded Total RNA-Seq method in human platelet-rich plasma, 21 platelet-free plasma, urine, conditioned medium, and extracellular vesicles (EVs) from these 22 biofluids. We found the method to be accurate, precise, compatible with low-input volumes and 23 able to quantify a few thousand genes. We picked up distinct classes of RNA molecules, including 24 mRNA, lncRNA, circRNA, miscRNA and pseudogenes. Notably, the read distribution and gene 25 content drastically differ among biofluids. In conclusion, we are the first to show that the SMARTer 26 method can be used for unbiased unraveling of the complete transcriptome of a wide range of 27 biofluids and their extracellular vesicles. 28 30 31 2 of 15 1. Introduction
33All human biofluids contain a multitude of extracellular nucleic acids, harboring a wealth of 34 information about health and disease status. In addition to established non-invasive prenatal testing 35 of fetal nucleic acids in maternal plasma 1 , liquid biopsies have emerged as a novel powerful tool in 36 the battle against cancer 2 . Although in the past most attention was given to circulating DNA, its more 37 dynamic derivate extracellular RNA may provide additional layers of information. However, RNA 38 sequencing in biofluids is technically challenging. Low input amounts, large dynamic range, and 39 (partial) degradation of RNA hamper straightforward quantification. While sequencing of small 40 RNAs 3 and targeted or capture sequencing of longer RNAs 4 proved to be successful, studies using 41 total RNA sequencing on biofluids are rare. To date, only a few whole transcriptome profiling 42 attempts were made on urine, plasma or extracellular vesicles 5-9 , quantifying both polyadenylated 43 and non-polyadenylated RNA transcripts. However, all these methods suffer from one or more 44 limitations such as short fragment length, low amount of quantified genes or ribosomal RNA 45 contamination.
47The advantages of total RNA sequencing are plentiful. Indeed, detection is not limited to a set of pre-48 defined targets, nor to (3' ends of) polyadenylated RNAs. Next to polyadenylated mRNAs, various 49 other RNA biotypes including circular RNAs, histone RNAs, and a sizable fraction of long non-50 coding RNAs can be distinguished. In addition, the study of posttranscriptional regulation is possible 51 by comparing exonic and intronic reads 10 . Altogether, this generates a much more comprehensive 52 view of the transcriptome.
54Here we aimed to assess the performance of a strand-specific total RNA library preparation 55 method for different types of biofluids and derived extracellular vesicles (EVs). We applied the 56 method on platelet-rich plasma, platelet-free plasma, urine and conditioned medium from...