Urinary extracellular vesicles (uEVs) have received considerable attention as a potential biomarker source for the diagnosis of urinary diseases. Present studies mainly focus on the discovery of biomarkers based on high-throughput proteomics, while limited efforts have been paid to applying the uEVs' biomarkers for the diagnosis of early urinary disease. Herein, we demonstrate a diagnosis protocol to realize ultrasensitive detection of uEVs and accurate classification of early urinary diseases, by combing a ratiometric three-dimensional (3D) DNA machine with machine learning (ML). The ratiometric 3D DNA machine platform is constructed by conjugating a padlock probe (PLP) containing cytosine-rich (C-rich) sequences, anchor strands, and nucleic-acid-stabilized silver nanoclusters (DNA_AgNCs) onto the magnetic nanoparticles (MNPs). The competitive binding of uEVs with the aptamer releases the walker strand, thus the ratiometric 3D DNA machine was activated to undergo an accurate amplification reaction and produce a ratiometric fluorescence signal. The present biosensor offers a detection limit of 9.9 × 10³ particles mL^-1 with a linear range of 10⁴-10⁸ particles mL^-1 for uEVs. Two ML algorithms, K-nearest neighbor (KNN) and support vector machine (SVM), were subsequently applied for analyzing the correlation between the sensing signals of uEV multibiomarkers and the clinical state. The disease diagnostic accuracy of optimal biomarker combination reaches 95% and 100% by analyzing with KNN and SVM, and the disease type classification exhibits an accuracy of 94.7% and 89.5%, respectively. Moreover, the protocol results in 100% accurate visual identification of clinical uEV samples from individuals with disease or as healthy control by a t-distributed stochastic neighbor embedding (tSNE) algorithm.

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