Cell-of-origin shapes tumor subtype in BRCA1-associated triple-negative breast cancer

Pathogenic germline BRCA1 variants greatly increase lifetime breast cancer risk, with no targeted prevention. Accrual of mutations following DNA repair errors in luminal progenitors is considered the chief mechanism of triple-negative breast cancer (TNBC) initiation, which cannot explain the organ specificity nor the phenotypic spectrum of the disease. Here we show that TNBC also originates in basal-myoepithelial cells, and that the cell of origin shapes TNBC subtype through aberrant epithelial differentiation, likely due to pleiotropic role of BRCA1 in regulating hormone signaling. Single-cell RNA sequencing of 67,001 cells from Wap-Cre Brca1/p53 mice and reanalysis of published Blg-Cre data show that aberrant basal-myoepithelial differentiation (Wap-Cre) generates the mesenchymal subtype (TNBC-M) and aberrant luminal differentiation (Blg-Cre) the basal-like subtype (TNBC-BL1). We also show that both subtypes occur at comparable frequency in BRCA1 carriers. Aberrant basal-myoepithelial differentiation precedes tumor formation, and only tumors derived from transplanted basal cells reproduce the basal-containing phenotype of spontaneous tumors. Comparison with a developmental atlas identifies de-differentiation of myoepithelial cells into basal cells lacking myoepithelial markers, a fetal state, whereas experimental metastases shift toward luminal states while retaining a TNBC-M-like transcriptional program. These findings support the inclusion of basal-myoepithelial and luminal cells in targeted prevention strategies for BRCA1 carriers, and adoption of TNBC subtyping for patient stratification and improving outcomes.