Fifteen percent of lung cancer cases occur in never-smokers and show characteristics that are molecularly and clinically distinct from those in smokers. Epidermal growth factor receptor (EGFR) gene mutations, which are correlated with sensitivity to EGFR-tyrosine kinase inhibitors (EGFR-TKIs), are more frequent in never-smoker lung cancers. In this study, microRNA (miRNA) expression profiling of 28 cases of never-smoker lung cancer identified aberrantly expressed miRNAs, which were much fewer than in lung cancers of smokers and included miRNAs previously identified (e.g., up-regulated miR-21) and unidentified (e.g., down-regulated miR-138) in those smoker cases. The changes in expression of some of these miRNAs, including miR-21, were more remarkable in cases with EGFR mutations than in those without these mutations. A significant correlation between phosphorylated-EGFR (p-EGFR) and miR-21 levels in lung carcinoma cell lines and the suppression of miR-21 by an EGFR-TKI, AG1478, suggest that the EGFR signaling is a pathway positively regulating miR-21 expression. In the never-smoker-derived lung adenocarcinoma cell line, H3255, with mutant EGFR and high levels of p-EGFR and miR-21, antisense inhibition of miR-21 enhanced AF1478-induced apoptosis. In a never-smoker-derived adenocarcinoma cell line, H441, with wild-type EGFR, the antisense miR-21 not only showed the additive effect with AG1478 but also induced apoptosis by itself. These results suggest that aberrantly increased expression of miR-21, which is enhanced further by the activiated EGFR signaling pathway, plays a significant role in lung carcinogenesis in never-smokers as well as in smokers, and is a potential therapeutic target in both EGFR-mutant and wild-type cases. We have shown that mir-21 is a prognostic classifier of early stage lung cancer in three independent cohorts, i.e. U.S., Norwegian, and Japanese.
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