AbstractBackgroundNRG1gene fusions may be clinically actionable, since cancers carrying the fusion transcripts can be sensitive to tyrosine kinase inhibitors. TheNRG1gene encodes ligands for the HER2(ERBB2)-ERBB3 heterodimeric receptor tyrosine kinase, and the gene fusions are thought to lead to autocrine stimulation of the receptor. TheNRG1fusion expressed in the breast cancer cell line MDA-MB-175 serves as a model example of such fusions, showing the proposed autocrine loop and exceptional drug sensitivity. However, its structure has not been properly characterised, its oncogenic activity has not been fully explained, and there is limited data on such fusions in breast cancer.MethodsWe analysed genomic rearrangements and transcripts ofNRG1in MDA-MB-175 and a panel of 571 breast cancers.ResultsWe found that the MDA-MB-175 fusion—originally reported as aDOC4(TENM4)-NRG1fusion, lacking the cytoplasmic tail ofNRG1—is in reality a double fusion,PPP6R3-TENM4-NRG1, producing multiple transcripts, some of which include the cytoplasmic tail. We hypothesise that manyNRG1fusions may be oncogenic not for lacking the cytoplasmic domain but because they do not encode NRG1’s nuclear-localised form. The fusion in MDA-MB-175 is the result of a very complex genomic rearrangement, which we partially characterised, that creates additional expressed gene fusions,RSF1-TENM4,TPCN2-RSF1, andMRPL48-GAB2.We searched forNRG1rearrangements in 571 breast cancers subjected to genome sequencing and transcriptome sequencing and found four cases (0.7%) with fusions,WRN-NRG1,FAM91A1-NRG1,ARHGEF39-NRG1, andZNF704-NRG1, all splicing intoNRG1at the same exon as in MDA-MB-175. However, theWRN-NRG1andARHGEF39-NRG1fusions were out of frame. We identified rearrangements ofNRG1in many more (8% of) cases that seemed more likely to inactivate than to create activating fusions, or whose outcome could not be predicted because they were complex, or both. This is not surprising becauseNRG1can be pro-apoptotic and isinactivated in some breast cancers.ConclusionsOur results highlight the complexity of rearrangements ofNRG1in breast cancers and confirm that some do not activate but inactivate. Careful interpretation ofNRG1rearrangements will therefore be necessary for appropriate patient management.