Small primary breast cancers can show surprisingly high potential for metastasis. Clinical decision making for tumor aggressiveness, including molecular profiling, relies primarily on analysis of the cancer cells. Here we show that this is insufficient; that the stromal microenvironment of the primary tumor plays a key role in tumor-cell dissemination and implantation at distant sites. We previously described two cancer-associated fibroblasts (CAFs) that either express (CD146pos) or lack (CD146neg) CD146 (official symbol MCAM; alias MUC18). We now find that when mixed with human breast cancer cells, each fibroblast subtype determines the fate of cancer-cells: CD146neg fibroblasts promote increased metastasis compared to CD146pos fibroblasts. Novel quantitative and qualitative proteomic analyses show that CD146pos CAFs produce an environment rich in basement membrane proteins, while CD146neg CAFs exhibit increases in FN1, LOX, and TNC; all over-expressed in aggressive disease. We also show clinically, that CD146neg CAFs predict for likelihood of lymph node involvement even in small primary tumors (<5 cm). Clearly small tumors enriched for CD146neg CAFs require aggressive treatments.


Heather M. Brechbuhl, Alexander S. Barrett, Etana Kopin, Jaime C. Hagen, Amy L. Han, Austin E. Gillen, Jessica Finlay-Schultz, Diana M. Cittelly, Philip Owens, Kathryn B. Horwitz, Carol A. Sartorius, Kirk C. Hansen, Peter Kabos


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