Despite nearly 5000 years of study and treatment, breast cancer remains the most common form of cancer in women. Breast cancer is the leading cause of malignant mortality in women, and its treatments are a significant cause of morbidity. Women with mutations in the gene Breast Cancer 1 (BRCA1) have a 70% chance of developing breast cancer in their lifetimes. While the molecular subtyping of breast cancer has formed the basis of targeted therapies, the majority of breast cancers that develop in women with a BRCA1 mutation will be ‘triple-negative’, with no targeted therapies, poor prognosis, and decreased overall survival. Changes in the BRCA1 breast epithelium have been observed before tumors are detected, however, BRCA1 mutations are carried in all cells of mutation carriers, not just the epithelium. The mesenchymal stromal cells pericytes, fibroblasts, and adipocytes have been observed to be an important, albeit enigmatic contributor to breast tumorigenesis and metastasis. These less well studied connective tissue stromal cells and the preneoplastic changes that occur in them before tumorigenesis are the focus of this dissertation. The overarching hypothesis of this dissertation is that the breast microenvironment is distorted in women with BRCA1 mutations, and that stromal cells contribute to cancer initiation. A persistent challenge in elucidating the roles of pericytes, fibroblasts, and adipocytes in the breast cancer microenvironment has been the lack of distinguishing molecular phenotypic markers of these cell types. To overcome this challenge, our lab has performed single cell RNA sequencing (scRNAseq) of more than 200,000 stromal and epithelial cells from a 22-patient cohort of high-risk BRCA1 mutation carrier and non-mutation carrier patient surgical breast samples. I show that scRNAseq has the resolution to distinguish fibroblasts and pericytes from one another, and develop a novel flow cytometry strategy to isolate these cells for the first time from the human breast and find that they have distinctive differentiation capacities. Using our scRNAseq data of preneoplastic breasts I identify pro-proliferative changes in stromal cell communications with epithelial cells in BRCA+/mut tissues. We test these signals from pericytes and fibroblasts and find that they have the potential to alter the cell proliferation and cell fate of breast epithelium.
Finally, to determine the transcriptomic profile of adipocytes, which are not amenable to standard methods of droplet based single-cell sequencing, I develop a method to isolate the nuclei from adipocytes and submit them to scRNAseq. Using this method, I distinguish vast differences between the adipocytes of human breast tissues and those of murine mammary glands.
As a body of work, this dissertation emphasizes the importance of mesenchymal stromal cells in the breast microenvironment and highlights the individually important roles they play in breast cancer tumorigenesis.