Exosomal microRNA: A Diagnostic Marker for Lung Cancer

BackgroundTo date, there is no screening test for lung cancer shown to affect overall mortality. MicroRNAs (miRNAs) are a class of small noncoding RNA genes found to be abnormally expressed in several types of cancer, suggesting a role in the pathogenesis of human cancer. Their accumulation within the peripheral circulation appears to be unique to cancer. The genome-wide expression profiling of miRNAs has been shown to be significantly different among primary lung cancers and corresponding noncancerous lung tissues. In studies demonstrating diagnostic miRNA signatures of NSCLC, specific miRNAs were overexpressed compared with normal lung tissue (miR-17-3p, miR-21, miR-106a, miR-146, miR-155, miR-191, miR-192, miR-203, miR-205, miR-210, miR-212, and miR-214). In this study, we evaluate the levels of circulating tumor exosomes, the circulating levels of exosomal small RNA, and specific exosomal miRNAs in patients with and without lung adenocarcinoma, correlating the levels with the American Joint Committee on Cancer (AJCC) stage of disease to validate it as an acceptable marker for diagnosis and prognosis in patients with adenocarcinoma of the lung.Patients and MethodsPlasma from patients with lung adenocarcinoma and a control group without known lung cancer or other active cancer were collected. Exosomes were isolated from plasma samples by a 2-step procedure using size-exclusion chromatography and magnetic activated cell sorting (MACS). Plasma samples (1 mL) were separated on Sepharose 2B, monitoring elution at 280 nm, and using a modified MACS procedure, exosomes of tumor origin were isolated using anti—epithelial cell adhesion molecule. Small RNA was isolated from circulating tumor exosomes using mirVana isolation kit (Ambion, Austin, TX) and this low molecular RNA enriched fraction was used for miRNA profiling as defined by microarray analysis. Low molecular weight RNA (5 μg) was used for hybridization on miRNA microarray chips. These miRNA were identified as hsa-miR-17-3p, hsa-miR-21, hsa-miR-106a, hsa-miR-146, hsa-miR-155, miR-191, miR-192, miR-203, miR-205, miR-210, miR212, and hsa-miR-214.ResultsTo date, 28 patients and 9 controls, AJCC stages I-IV, ages 21–80 years, were enrolled in the study. Exosome concentration ranged from 1.02–9.24 mg/mL for the lung adenocarcinoma group versus 0.62–1.7 mg/mL in the control group. The total miRNA concentration ranged from 131.1–275 ug/mL for the lung adenocarcinoma group versus 44.9–131.1 ug/mL in the control group. The mean exosome value in the lung cancer group was 2.85 mg/mL (CI, 1.94–3.76) and 0.77 mg/mL (CI, 0.68–0.86; P < .001). The mean RNA value in the lung cancer group was 158.6 ug/mL (CI, 145.7–171.5) and 68.1 ug/mL (CI, 57.2–78.9; P < .001). The only patient in the control group who had an exosome concentration > 1.0 mg/mL and RNA concentration > 100 ug/mL had a history of vulvar cancer without evidence of active disease. No correlation between the levels and the stage of disease was found. To compare the presence of specific miRNAs between tumors and their corresponding circulating exosomes, miRNA fractions were isolated and profiled from circulating tumor exosomes and the original tumor. MicroRNA profiling was performed in duplicate, using microarrays containing probes for 467 human mature miRNA. Comparisons between peripheral circulation-derived exosomes and tumors indicated that the miRNA signatures were not significantly different. This approach confirmed that the 12 specific miRNA were elevated in NSCLC and that the associations of these 12 were mirrored in the circulating exosomes. The levels of tumor-derived miRNA profiles exhibited a strong correlation with the levels of peripheral blood-derived exosomal miRNAs (for miR-17-3p, r = 0.76; miR-21, r = 0.77; miR-146, r = 0.88; miR-155, r = 0.85; miR-191, r = 0.83; miR-203, r = 0.85; miR-205, r = 0.91; and miR-214, r = 0.71).ConclusionThe significant difference in total exosome and miRNA levels between patients with lung cancer and controls suggests that exosomal miRNA is a screening test for lung adenocarcinoma. There is no obvious correlation between the total exosomal miRNA levels and stage of disease; however, it has been suggested in miRNA profiling studies of tumor tissue, that miRNA expression might be critical for the development of cancer but not for its progression. If specific miRNA levels predict response to treatment and can add prognostic information in addition to conventional staging needs further study. While validation studies will be necessary before bypassing the use with tumor mass biopsies, the use of exosomal miRNA profiling could extend this approach to screening of asymptomatic individuals as well as for monitoring disease recurrence.