Blood Plasma Analysis in Ovarian Cancer Patients Using an AFM/MS Approach: Effect of Sample Dilution on Proteome Depth.

Early detection of ovarian cancer remains challenging because of the lack of sensitive and reproducible blood-based biomarkers. A major challenge in plasma proteomics is the extremely wide dynamic range of protein concentrations, which prevents simultaneous detection of both high- and low abundance proteins and limits the identification of disease-associated signals. In this study, we applied a combined atomic force microscopy and mass spectrometry (AFM/MS) approach to investigate how sample dilution affects plasma proteome coverage and the detection of differences between healthy donors and patients with stage I and stage III ovarian cancer. Plasma samples were analyzed at two dilution levels (1:100 and 1:10,000). At 1:100 dilution, a total of 235 proteins were identified across all samples, representing the union of all replicates and groups. The reproducible CORE proteome comprised 169 proteins in the Healthy group, 183 in the Stage I group, and 193 in the Stage III group. Differential analysis revealed distinct, non-overlapping protein sets at each dilution level. At 1:100 dilution, most altered proteins were decreased in patients and corresponded to major plasma components, including complement proteins and protease inhibitors. At 1:10,000 dilution, most altered proteins were increased and were predominantly immunoglobulin-related proteins, along with complement regulatory components. These findings show that sample dilution determines which fraction of the plasma proteome is observable. Here, proteome depth refers to the total number of non-redundant proteins accessible within the analytical workflow. When CORE sets from all groups were combined, 216 proteins were identified at 1:100 and 149 at 1:10,000, with 133 shared between the two dilution conditions. The higher dilution contributed 16 additional CORE proteins not detected in the 1:100 CORE union, increasing the combined CORE set to 232 proteins. Thus, higher dilution alone did not increase proteome depth, but provided complementary protein identifications that increased cumulative proteome depth when both dilution conditions were considered together. This effect reflects dilution-dependent selectivity in the composition of the detectable protein subset.