Somatic MAP3K3 and PIK3CA mutations in sporadic cerebral and spinal cord cavernous malformations

Brain. 2021 Oct 22;144(9):2648-2658. doi: 10.1093/brain/awab117.


Cavernous malformations affecting the CNS occur in ∼0.16-0.4% of the general population. The majority (85%) of cavernous malformations are in a sporadic form, but the genetic background of sporadic cavernous malformations remains enigmatic. Of the 81 patients, 73 (90.1%) patients were detected carrying somatic missense variants in two genes: MAP3K3 and PIK3CA by whole-exome sequencing. The mutation spectrum correlated with lesion size (P = 0.001), anatomical distribution (P < 0.001), MRI appearance (P = 0.004) and haemorrhage events (P = 0.006). PIK3CA mutation was a significant predictor of overt haemorrhage events (P = 0.003, odds ratio = 11.252, 95% confidence interval = 2.275-55.648). Enrichment of endothelial cell population was associated with a higher fractional abundance of the somatic mutations. Overexpression of the MAP3K3 mutation perturbed angiogenesis of endothelial cell models in vitro and zebrafish embryos in vivo. Distinct transcriptional signatures between different genetic subgroups of sporadic cavernous malformations were identified by single cell RNA sequencing and verified by pathological staining. Significant apoptosis in MAP3K3 mutation carriers and overexpression of GDF15 and SERPINA5 in PIK3CA mutation carriers contributed to their phenotype. We identified activating MAP3K3 and PIK3CA somatic mutations in the majority (90.1%) of sporadic cavernous malformations and PIK3CA mutations could confer a higher risk for overt haemorrhage. Our data provide insights into genomic landscapes, propose a mechanistic explanation and underscore the possibility of a molecular classification for sporadic cavernous malformations.

Keywords: MAP3K3; PIK3CA; cavernous malformations; haemorrhage; somatic mutation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Animals
  • Child
  • Child, Preschool
  • Class I Phosphatidylinositol 3-Kinases / genetics*
  • Female
  • Hemangioma, Cavernous, Central Nervous System / diagnostic imaging*
  • Hemangioma, Cavernous, Central Nervous System / genetics*
  • Humans
  • MAP Kinase Kinase Kinase 3 / genetics*
  • Male
  • Middle Aged
  • Mutation / genetics*
  • Spinal Cord / diagnostic imaging*
  • Young Adult
  • Zebrafish


  • Class I Phosphatidylinositol 3-Kinases
  • PIK3CA protein, human
  • MAP Kinase Kinase Kinase 3
  • MAP3K3 protein, human