PIK3CA-related overgrowth spectrum (PROS) zebrafish models reveal pan-lineage developmental dysregulation

Post-zygotic gain-of-function PIK3CA mutations arising during embryonic development cause disorders collectively known as the PIK3CA-related overgrowth spectrum (PROS). This ranges from minor, localized overgrowth to devastating multi-tissue overgrowth. Disease severity is widely attributed to a combination of PIK3CA genotype, affected cell type, and developmental timing of mutation acquisition. However, in PROS this explains neither the biased pattern of overgrowth - disproportionately affecting mesoderm and neuroectoderm-derived tissues - nor the typical low mutation burden within areas of extensive tissue overgrowth. Indeed, growing evidence suggests PROS mutations cause overgrowth non-cell-autonomously, although mechanisms of this are poorly understood. Here, we develop mosaic zebrafish models of PROS with overexpression of orthologous hotspot pik3ca mutations (pik3caPROS) to visualize and examine the effects of mutated cells on early development, in whole live animals. Reminiscent of PROS, we observe a spectrum of embryonic vasculature malformations (VMs), accompanied by larval muscle and bone overgrowth. Surprisingly, VMs only rarely expressed pik3caPROS in constituent endothelial cells, with pik3caPROS-expressing cells often closely abutting malformations instead. Single-cell transcriptomics of pik3caPROSmosaic zebrafish prior to VM onset revealed that most pik3caPROS cells are relatively immature and developmentally inert or constitute a small minority of mesodermal-derived cell types. Despite this constriction, global changes to cell fate were evident, alongside pervasive, pan-lineage abnormalities of gene expression, and rewiring of predicted ligand-receptor communication between lineages. We propose that targeting signals that indirectly propagate overgrowth through non-cell autonomous mechanisms - as well as PI3K activation itself - is worthy of therapeutic investigation.