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Epidemiology of the disorders of the Pik3ca-related overgrowth spectrum (Pros)

Abstract

PIK3CA pathogenic variants are responsible for a group of overgrowth syndromes, collectively known as PIK3CA-Related Overgrowth Spectrum (PROS). These gain-of-function variants arise postzygotically, and, according to time of onset, kind of embryonal tissue affected and regional body extension, give rise to heterogeneous phenotypes. PROS rarity and heterogeneity hamper the correct estimation of its epidemiology. Our work represents the first attempt to define the prevalence of PROS according to the established diagnostic criteria and molecular analysis and based on solid demographic data. We assessed the prevalence in Piedmont Region (Italy), including in the study all participants diagnosed with PROS born there from 1998 to 2021. The search identified 37 cases of PROS born across the 25-year period, providing a prevalence of 1:22,313 live births. Molecular analysis was positive in 81.0% of participants. Taking into account the cases with a detected variant in PIK3CA (n = 30), prevalence of molecularly positive PROS was 1:27,519.

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Fig. 1: Incidence per live birth per year.

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Data availability

Depersonalized data that support the findings of this study are available within the paper and/or are available on request from the corresponding author AM.

References

  1. Keppler-Noreuil KM, Rios JJ, Parker VER, Semple RK, Lindhurst MJ, Sapp JC, et al. PIK3CA-related overgrowth spectrum (PROS): Diagnostic and testing eligibility criteria, differential diagnosis, and evaluation. Am J Med Genet Part A. 2015;167:287–95. https://doi.org/10.1002/ajmg.a.36836.

    Article  CAS  Google Scholar 

  2. Lindhurst MJ, Parker VER, Payne F, Sapp JC, Rudge S, Harris J, et al. “Mosaic overgrowth with fibroadipose hyperplasia is caused by somatic activating mutations in PIK3CA. Nat Genet. 2012;44:928–33. https://doi.org/10.1038/ng.2332.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Harnarayan P, Harnanan D. The Klippel-Trénaunay Syndrome in 2022: Unravelling Its Genetic and Molecular Profile and Its Link to the Limb Overgrowth Syndromes. Vasc Health Risk Manag. 2022;18:201–9. https://doi.org/10.2147/VHRM.S358849.

  4. Rios JJ, Paria N, Burns DK, Israel BA, Cornelia R, Wise CA, et al. Somatic gain-of-function mutations in PIK3CA in patients with macrodactyly. Hum Mol Genet. 2013;22:444–51. https://doi.org/10.1093/hmg/dds440.

    Article  CAS  PubMed  Google Scholar 

  5. Goss JA, Konczyk DJ, Smits P, Sudduth CL, Bischoff J, Liang MG, et al. Diffuse capillary malformation with overgrowth contains somatic PIK3CA variants. Clin Genet. 2020;97:736–40. https://doi.org/10.1111/cge.13702.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Sarma K, Nayak MK, Mishra B, Gaikwad SB. Megalencephaly-Capillary Malformation-Polymicrogyria Syndrome (MCAP): A Rare Dynamic Genetic Disorder. Cureus. 2022;14:e25123. https://doi.org/10.7759/cureus.25123.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Carli D, Kalantari S, Manicone R, Coppo P, Francia di Celle P, La Selva R, et al. Kaposiform hemangioendothelioma further broadens the phenotype of PIK3CA-related overgrowth spectrum. Clin Genet. 2021;100:624–7. https://doi.org/10.1111/cge.14047.

    Article  CAS  PubMed  Google Scholar 

  8. Weng J, Yang Y, Song D, Huo R, Li H, Chen Y, et al. Somatic MAP3K3 mutation defines a subclass of cerebral cavernous malformation. Am J Hum Genet. 2021;108:942–50. https://doi.org/10.1016/j.ajhg.2021.04.005.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Mussa A, Leoni C, Iacoviello M, Carli D, Ranieri C, Pantaleo A et al. Genotypes and phenotypes heterogeneity in PIK3CA-related overgrowth spectrum and overlapping conditions: 150 novel patients and systematic review of 1007 patients with PIK3CA pathogenetic variants.” J Med Genet. 1–11:2022, https://doi.org/10.1136/jmedgenet-2021-108093.

  10. Madsen RR, Vanhaesebroeck B, Semple RK. Cancer-Associated PIK3CA Mutations in Overgrowth Disorders. Trends Mol Med. 2018;24:856–70. https://doi.org/10.1016/j.molmed.2018.08.003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Keppler-Noreuil KM, Sapp JC, Lindhurst MJ, Parker VER, Blumhorst C, Darling T, et al. Clinical delineation and natural history of the PIK3CA-related overgrowth spectrum. Am J Med Genet Part A. 2014;164:1713–33. https://doi.org/10.1002/ajmg.a.36552.

    Article  CAS  Google Scholar 

  12. Chang F, Liu L, Fang E, Zhang G, Chen T, Cao K, et al. Molecular Diagnosis of Mosaic Overgrowth Syndromes Using a Custom-Designed Next-Generation Sequencing Panel. J Mol Diagn. 2017;19:613–24. https://doi.org/10.1016/j.jmoldx.2017.04.006.

    Article  CAS  PubMed  Google Scholar 

  13. Mirzaa G, Timms AE, Conti V, Boyle EA, Girisha KM, Martin B et al. PIK3CA-associated developmental disorders exhibit distinct classes of mutations with variable expression and tissue distribution. JCI Insight. 2016. https://doi.org/10.1172/jci.insight.87623.

  14. Kuentz P, St-Onge J, Duffourd Y, Courcet JB, Carmignac V, Jouan T, et al. Molecular diagnosis of PIK3CA-related overgrowth spectrum (PROS) in 162 patients and recommendations for genetic testing. Genet Med J Am Coll Med Genet. 2017;19:989–97. https://doi.org/10.1038/gim.2016.220.

    Article  CAS  Google Scholar 

  15. Carli D, Ferrero GB, Fusillo A, Coppo P, La Selva R, Zinali F, et al. A new case of Smith-Kingsmore syndrome with somatic MTOR pathogenic variant expands the phenotypic spectrum to lateralized overgrowth. Clin Genet. 2021;99:719–23. https://doi.org/10.1111/cge.13931.

    Article  CAS  PubMed  Google Scholar 

  16. Chang CA, Perrier R, Kurek KC, Estrada-Veras J, Lehman A, Yip S, et al. Novel findings and expansion of phenotype in a mosaic RASopathy caused by somatic KRAS variants. Am J Med Genet A. 2021;185:2829–45. https://doi.org/10.1002/ajmg.a.62356.

    Article  CAS  PubMed  Google Scholar 

  17. Mussa A, Carli D, Cardaropoli S, Ferrero GB, Resta N. Lateralized overgrowth with vascular malformation caused by a somatic PTPN11 pathogenic variant: Another piece added to the puzzle of mosaic RASopathies. Genes Chromosom Cancer. 2022;61:689–95. https://doi.org/10.1002/gcc.23086.

    Article  CAS  PubMed  Google Scholar 

  18. Siegel DH, Cottrell CE, Streicher JL, Schilter KF, Basel DG, Baselga E, et al. Analyzing the Genetic Spectrum of Vascular Anomalies with Overgrowth via Cancer Genomics. J Investig Dermatol. 2018;138:957–67. https://doi.org/10.1016/j.jid.2017.10.033.

    Article  CAS  PubMed  Google Scholar 

  19. Mussa A, Carli D, Cardaropoli S, Ferrero GB, Resta N. Lateralized and Segmental Overgrowth in Children. Cancers (Basel). 2021;13. https://doi.org/10.3390/cancers13246166.

  20. Data on file. Novartis Pharmaceuticals Corp; 2020. https://www.prosspectrum.com/about-pros/pros-overview/. (accessed Dec. 02, 2022).

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Acknowledgements

We are grateful to the patients and their families who made this research possible by consenting to the use of data collected as part of their care. We thank the Italian Association of individuals with PROS (Associazione Italiana Macrodattilia e PROS—APS) who contributed to this study.

Funding

No specific grant for this research was received from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

Authors

Contributions

Conceptualization: AM, GR. Formal analysis and methodology: AM, GR. Investigation: AM, GR, SC, DC, ML, AG, PC, RLS, MP, RB, AT, CR. Resources: AM, SC, DC, ML, AG, PC, RLS, MP, RB, AT, CR, NR. Supervision: NR. Writing-original draft: AM, GR. Writing-review and editing: AM. All other authors approved this paper.

Corresponding author

Correspondence to Alessandro Mussa.

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Competing interests

The authors declare no competing interests.

Ethics approval

Given the retrospective nature of the study, approval by Ethic Committee was not required. Informed consent to genetic analysis on peripheral blood, tissue biopsy, or other samples was obtained by parents of participants and archived by authors according to the local ethic committee’s policy. Individual data included in this paper have been de-identified and presented in aggregate. The study was conducted in accordance with the ethical principles enshrined in the Helsinki Declaration.

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Reynolds, G., Cardaropoli, S., Carli, D. et al. Epidemiology of the disorders of the Pik3ca-related overgrowth spectrum (Pros). Eur J Hum Genet 31, 1333–1336 (2023). https://doi.org/10.1038/s41431-023-01414-9

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