ERG-driven prostate cancer emerges from basal-luminal hybrid cells.

To gain insight into how ERG translocations cause prostate cancer, we performed single cell transcriptional profiling of an autochthonous mouse model at an early stage of disease initiation. Despite broad expression of ERG in prostate epithelial cells, we observed enhanced proliferation primarily in an intermediate subpopulation with a basal identity based on transcriptomics but with luminal morphology and cytokeratin expression. Through a series of lineage tracing and primary prostate epithelial transplantation experiments, we find that tumor initiating activity resides in a subpopulation of basal cells that also express luminal genes such as Tmprss2 and Nkx3 . 1 , but not in the larger population of classical luminal cells. Upon ERG activation, these basal-luminal hybrid cells expand into a highly proliferative population of intermediate basal-luminal identity then transition to fully differentiated luminal cells that reflect the lineage of ERG-positive cancers. These findings help resolve a preexisting debate about the cell of origin of ERG-driven prostate cancer and narrow the focus for future mechanistic studies to a basal-luminal subpopulation of tumor initiating cells.