Comprehensive phenotypic and genomic characterization of venous malformations.

Venous malformations (VMs) are the most common vascular malformations. TEK and PIK3CA are the causal genes of VMs, and may be involved in the PI3K/AKT pathway. However, the downstream mechanisms underlying the TEK or PIK3CA mutations in VMs are not completely understood. This study aimed to identify a possible association between genetic mutations and clinicopathological features. A retrospective clinical, pathological, and genetic study of 114 patients with VMs was performed. TEK, PIK3CA, and combined TEK/PIK3CA mutations were identified in 49 (43%), 13 (11.4%), and 2 (1.75%) patients, respectively. TEK-mutant VMs more commonly occurred in younger patients than TEK and PIK3CA mutation-negative VMs (other-mutant VMs), and showed more frequent skin involvement and no lymphocytic aggregates. No significant differences were observed in sex, location of occurrence, malformed vessel size, vessel density, or thickness of the vascular smooth muscle among the VM genotypes. Immunohistochemical analysis revealed that the expression levels of phosphorylated AKT (p-AKT) were higher in the TEK-mutant VMs than those in PIK3CA-mutant and other-mutant VMs. The expression levels of p-mTOR and its downstream effectors were higher in all the VM genotypes than those in normal vessels. Spatial transcriptomics revealed that the genes involved in "blood vessel development", "positive regulation of cell migration", and "extracellular matrix organization" were up-regulated in a TEK-mutant VM. Significant genotype-phenotype correlations in clinical and pathological features were observed among the VM genotypes, indicating gene-specific effects. Detailed analysis of gene-specific effects in VMs may offer insights into the underlying molecular pathways and implications for targeted therapies.

Interface Engineering for High-Performance Thermoelectric Carbon Nanotube Films.

Carbon nanotubes (CNTs) stand out for their exceptional electrical, thermal, and mechanical attributes, making them highly promising materials for cutting-edge, lightweight, and flexible thermoelectric applications. However, realizing the full potential of advanced thermoelectric CNTs requires precise management of their electrical and thermal characteristics. This study, through interface optimization, demonstrates the feasibility of reducing the thermal conductivity while preserving robust electrical conductivity in single-walled CNT films. Our findings reveal that blending two functionalized CNTs offers a versatile method of tailoring the structural and electronic properties of CNT films. Moreover, the modified interface exerts a substantial influence over thermal and electrical transfer, effectively suppressing heat dissipation and facilitating thermoelectric power generation within CNT films. As a result, we have successfully produced both p- and n-type thermoelectric CNTs, attaining impressive power factors of 507 and 171 µW/mK2 at room temperature, respectively. These results provide valuable insights into the fabrication of high-performance thermoelectric CNT films.

HOXA10 promotes Gdf5 expression in articular chondrocytes.

Growth differentiation factor 5 (GDF5), a BMP family member, is highly expressed in the surface layer of articular cartilage. The GDF5 gene is a key risk locus for osteoarthritis and Gdf5-deficient mice show abnormal joint development, indicating that GDF5 is essential in joint development and homeostasis. In this study, we aimed to identify transcription factors involved in Gdf5 expression by performing two-step screening. We first performed microarray analyses to find transcription factors specifically and highly expressed in the superficial zone (SFZ) cells of articular cartilage, and isolated 11 transcription factors highly expressed in SFZ cells but not in costal chondrocytes. To further proceed with the identification, we generated Gdf5-HiBiT knock-in (Gdf5-HiBiT KI) mice, by which we can easily and reproducibly monitor Gdf5 expression, using CRISPR/Cas9 genome editing. Among the 11 transcription factors, Hoxa10 clearly upregulated HiBiT activity in the SFZ cells isolated from Gdf5-HiBiT KI mice. Hoxa10 overexpression increased Gdf5 expression while Hoxa10 knockdown decreased it in the SFZ cells. Moreover, ChIP and promoter assays proved the direct regulation of Gdf5 expression by HOXA10. Thus, our results indicate the important role played by HOXA10 in Gdf5 regulation and the usefulness of Gdf5-HiBiT KI mice for monitoring Gdf5 expression.

Addressing the Trade-Off between Crystallinity and Yield in Single-Walled Carbon Nanotube Forest Synthesis Using Machine Learning.

Synthetic trade-offs exist in the synthesis of single-walled carbon nanotube (SWCNT) forests, as growing certain desired properties can often come at the expense of other desirable characteristics such as the case of crystallinity and growth efficiency. Simultaneously achieving mutually exclusive properties in the growth of SWCNT forests is a significant accomplishment, as it requires overcoming these trade-offs and balancing competing mechanisms. To address this, we trained a machine-learning regression model with a set of 585 "real" experimental synthesis data, which were taken using an automatic synthesis reactor. Subsequently, 16000 exploratory "virtual" experiments were performed by our trained model to examine potential routes toward addressing the current crystallinity-height trade-off limitation, and suggestions on growth conditions were predicted. Importantly, additional validation using "real" experimental syntheses showed good agreement with the predictions as well as a 48% increase in growth efficiency while maintaining the high crystallinity (G/D-ratio). This highlighted the effectiveness and accuracy of the predictive capability of our machine-learning model, which achieved improved results in less than 50 validation tests. Furthermore, the trained model revealed the surprising importance of the nature of the carbon feedstock, particularly the reactivity and concentration, as a route for overcoming the trade-off between the SWCNT crystallinity and growth efficiency. These results of the high-efficiency synthesis of highly crystalline SWCNT forests represent a significant advance in overcoming synthetic trade-off barriers for complex multivariable systems.

Sequential N2 Adsorption by the Nanopore Entrance Filling Scheme in Nanopores of Carbon Nanotubes.

The adsorption dynamics and mechanism of nitrogen molecules in 1-7 nm carbon nanotubes (CNTs) at 77 K were investigated by experiments and molecular dynamics simulations. The adsorbed nitrogen amount rapidly increased in 7 nm CNTs, while it gradually increased in 1 and 3 nm CNTs. The gradual increase in 3 nm CNTs was unexpected because of the presence of sufficient adsorption sites and the weak adsorption potential of nitrogen. The molecular dynamics simulations indicated that molecules were condensed in the entrance of nanopores after monolayer adsorption in 3 nm CNTs and monolayer and bilayer adsorption in 5 nm CNTs, called nanopore entrance filling. The proposed adsorption mechanism of nitrogen molecules in CNT nanopores is as follows: first, layer-by-layer adsorption occurs on monolayer sites, followed by preferential adsorption at the nanopore entrance. Consequently, preadsorbed molecules form a fluidic pore neck similar to an ink-bottle pore. Then, newly adsorbed molecules are condensed on the fluidic pore neck, and condensed molecules in the nanopore entrance finally move into the inner part of the nanopore. The proposed sequential adsorption mechanism via nanopore entrance filling without pore blocking starkly differs from micropore filling in micropores and layer-by-layer adsorption associated with capillary condensation in mesopores.

Predicting ecosystem changes by a new model of ecosystem evolution.

In recent years, computer simulation has been increasingly used to predict changes in actual ecosystems. In these studies, snapshots of ecosystems at certain points in time were instantly constructed without considering their evolutionary histories. However, it may not be possible to correctly predict future events unless their evolutionary processes are considered. In this study, we developed a new ecosystem model for reproducing the evolutionary process on an oceanic island, targeting Nakoudojima Island of the Ogasawara Islands. This model successfully reproduced the primitive ecosystem (the entire island covered with forest) prior to the invasion of alien species. Also, by adding multiple alien species to this ecosystem, we were able to reproduce temporal changes in the ecosystem of Nakoudojima Island after invasion of alien species. Then, we performed simulations in which feral goats were eradicated, as had actually been done on the island; these suggested that after the eradication of feral goats, forests were unlikely to be restored. In the ecosystems in which forests were not restored, arboreous plants with a high growth rate colonized during the early stage of evolution. As arboreous plants with a high growth rate consume a large amount of nutrient in soil, creating an oligotrophic state. As a result, plants cannot grow, and animal species that rely on plants cannot maintain their biomass. Consequently, many animals and plants become extinct as they cannot endure disturbances by alien species, and the ecosystem loses its resilience. Therefore, even if feral goats are eradicated, forests are not restored. Thus, the founder effect from the distant past influences future ecosystem changes. Our findings show that it is useful to consider the evolutionary process of an ecosystem in predicting its future events.

Soil phosphorous is the primary factor determining species-specific plant growth depending on soil acidity in island ecosystems with severe erosion.

Disturbances caused by invasive ungulates alter soil environments markedly and can prevent ecosystem recovery even after eradication of the ungulates. On oceanic islands, overgrazing and trampling by feral goats has caused vegetation degradation and soil erosion, which can alter soil chemistry. To understand the effects of the changes on plant performance, we conducted a laboratory experiment to assess herbaceous species growth under various soil conditions with phosphorous, nutrients, and acidity. Subsoil was collected from Nakodo-jima in the northwest Pacific. Six herbaceous species dominating the island were grown in soils with three levels of added CaCO3 and P2O5 and two levels of added KNO3. After 4 weeks of growth, the total dry plant weight was significantly lower with no added P2O5, regardless of the addition of KNO3. Three species weighed more under P2O5 and KNO3 addition in high-pH soil, whereas the remaining three weighed less. Our results indicated that herbaceous species growth is limited primarily by phosphorous availability; the limitation is dependent on soil pH, and the trend of dependency differs among species. This implies that ecosystems with extreme disturbances cannot recover without improving the soil chemistry.

The acid-sensing nociceptor TRPV1 controls breast cancer progression in bone via regulating HGF secretion from sensory neurons.

Cancers showing excessive innervation of sensory neurons (SN) in their microenvironments are associated with poor outcomes due to promoted growth, increased tumor recurrence, metastasis, and cancer pain, suggesting SNs play a regulatory role in cancer aggressiveness. Using a preclinical model in which mouse 4T1 breast cancer (BC) cells were injected into the bone marrow of tibiae, we found 4T1 BC cells aggressively colonized bone with bone destruction and subsequently spread to the lung. Of note, 4T1 BC colonization induced the acidic tumor microenvironment in bone in which SNs showed increased innervation and excitation with elevated expression of the acid-sensing nociceptor transient receptor potential vanilloid-1 (TRPV1), eliciting bone pain (BP) assessed by mechanical hypersensitivity. Further, these excited SNs produced increased hepatocyte growth factor (HGF). Importantly, the administration of synthetic and natural TRPV1 antagonists and genetic deletion of TRPV1 decreased HGF production in SNs and inhibited 4T1 BC colonization in bone, pulmonary metastasis from bone, and BP induction. Our results suggest the TRPV1 of SNs promotes BC colonization in bone and lung metastasis via up-regulating HGF production in SNs. The SN TRPV1 may be a novel therapeutic target for BC growing in the acidic bone microenvironment and for BP.

Fam20C overexpression in odontoblasts regulates dentin formation and odontoblast differentiation.

FAM20C phosphorylates secretory proteins at S-x-E/pS motifs, and previous studies of Fam20C-dificient mice revealed that FAM20C played essential roles in bone and tooth formation. Inactivation of FAM20C in mice led to hypophosphatemia that masks direct effect of FAM20C in these tissues, and consequently the direct role of FAM20C remains unknown. Our previous study reported that osteoblast/odontoblast-specific Fam20C transgenic (Fam20C-Tg) mice had normal serum phosphate levels and that osteoblastic FAM20C-mediated phosphorylation regulated bone formation and resorption. Here, we investigated the direct role of FAM20C in dentin using Fam20C-Tg mice. The tooth of Fam20C-Tg mice contained numerous highly phosphorylated proteins, including SIBLINGs, compared to that of wild-type mice. In Fam20C-Tg mice, coronal dentin volume decreased and mineral density unchanged at early age, while the volume unchanged and the mineral density elevated at maturity. In these mice, radicular dentin volume and mineral density decreased at all ages, and histologically, the radicular dentin had wider predentin and abnormal apical-side dentin with embedded cells and argyrophilic canaliculi. Immunohistochemical analyses revealed that abnormal apical-side dentin had bone and dentin matrix properties accompanied with osteoblast-lineage cells. Further, in Fam20C-Tg mice, DSPP content which is important for dentin formation, was reduced in dentin, especially radicular dentin, which might lead to defects mainly in radicular dentin. Renal subcapsular transplantations of tooth germ revealed that newly formed radicular dentin replicated apical abnormal dentin of Fam20C-Tg mice, corroborating that FAM20C overexpression indeed caused the abnormal dentin. Our findings indicate that odontoblastic FAM20C-mediated phosphorylation in the tooth regulates dentin formation and odontoblast differentiation.

A Comprehensive and Versatile Multimodal Deep-Learning Approach for Predicting Diverse Properties of Advanced Materials.

A multimodal deep-learning (MDL) framework is presented for predicting physical properties of a ten-dimensional acrylic polymer composite material by merging physical attributes and chemical data. The MDL model comprises four modules, including three generative deep-learning models for material structure characterization and a fourth model for property prediction. The approach handles an 18-dimensional complexity, with ten compositional inputs and eight property outputs, successfully predicting 913 680 property data points across 114 210 composition conditions. This level of complexity is unprecedented in computational materials science, particularly for materials with undefined structures. A framework is proposed to analyze the high-dimensional information space for inverse material design, demonstrating flexibility and adaptability to various materials and scales, provided sufficient data are available. This study advances future research on different materials and the development of more sophisticated models, drawing the authors closer to the ultimate goal of predicting all properties of all materials.

A Microwave-Assisted, Solvent-Free Approach for the Versatile Functionalization of Carbon Nanotubes.

While the functionalization of carbon nanotubes (CNTs) has attracted extensive interest for a wide range of applications, a facial and versatile strategy remains in demand. Here, we report a microwave-assisted, solvent-free approach to directly functionalize CNTs both in raw form and in arbitrary macroscopic assemblies. Rapid microwave irradiation was applied to generate active sites on the CNTs while not inducing excessive damage to the graphitic network, and a gas-phase deposition afforded controllable grafting for thorough or regioselective functionalization. Using methyl methacrylate (MMA) as a model functional group and a CNT sponge as a model assembly, homogeneous grafting was exhibited by the increased robust hydrophobicity (contact angle increase from 30 to 140°) and improved structural stability (compressive modulus increased by 135%). Therefore, when our MMA-functionalized CNTs served as a solar absorber for saline distillation, high operating stability with a superior water evaporation rate of ∼2.6 kg m-2 h-1 was observed. Finally, to highlight the efficacy and versatility of this functionalization approach, we fabricated asymmetrically hydrophobic CNT sponges by regioselective functionalization to serve as a moisture-driven generator, which demonstrated a stable open-circuit voltage of 0.6 mV. This versatile, solvent-free approach can complement conventional solution-based techniques in the design and fabrication of multifunctional nanocarbon-based materials.

Cancer-nerve interplay in cancer progression and cancer-induced bone pain.

INTRODUCTION: Cancer-induced bone pain (CIBP) is one of the most common and debilitating complications associated with bone metastasis. Although our understanding of the precise mechanism is limited, it has been known that bone is densely innervated, and that CIBP is elicited as a consequence of increased neurogenesis, reprogramming, and axonogenesis in conjunction with sensitization and excitation of sensory nerves (SNs) in response to the noxious stimuli that are derived from the tumor microenvironment developed in bone. Recent studies have shown that the sensitized and excited nerves innervating the tumor establish intimate communications with cancer cells by releasing various tumor-stimulating factors for tumor progression. APPROACHES: In this review, the role of the interactions of cancer cells and SNs in bone in the pathophysiology of CIBP will be discussed with a special focus on the role of the noxious acidic tumor microenvironment, considering that bone is in nature hypoxic, which facilitates the generation of acidic conditions by cancer. Subsequently, the role of SNs in the regulation of cancer progression in the bone will be discussed together with our recent experimental findings. CONCLUSION: It is suggested that SNs may be a newly-recognized important component of the bone microenvironment that contribute to not only in the pathophysiology of CIBP but also cancer progression in bone and dissemination from bone. Suppression of the activity of bone-innervating SNs, thus, may provide unique opportunities in the treatment of cancer progression and dissemination, as well as CIBP.

Semaphorin 4D induces articular cartilage destruction and inflammation in joints by transcriptionally reprogramming chondrocytes.

Proinflammatory cytokines play critical roles in the pathogenesis of joint diseases. Using a mass spectrometry-based cloning approach, we identified Semaphorin 4D (Sema4D) as an inflammatory cytokine that directly promoted cartilage destruction. Sema4d-deficient mice showed less cartilage destruction than wild-type mice in a model of rheumatoid arthritis. Sema4D induced a proinflammatory response in mouse articular chondrocytes characterized by the induction of proteolytic enzymes that degrade cartilage, such as matrix metalloproteinases (MMPs) and aggrecanases. The activation of Mmp13 and Mmp3 expression in articular chondrocytes by Sema4D did not depend on RhoA, a GTPase that mediates Sema4D-induced cytoskeletal rearrangements. Instead, it required NF-κB signaling and Ras-MEK-Erk1/2 signaling downstream of the receptors Plexin-B2 and c-Met and depended on the transcription factors IκBζ and C/EBPδ. Genetic and pharmacological blockade of these Sema4D signaling pathways inhibited MMP induction in chondrocytes and cartilage destruction in femoral head organ culture. Our results reveal a mechanism by which Sema4D signaling promotes cartilage destruction.

Transcriptional regulation of FRZB in chondrocytes by Osterix and Msx2.

INTRODUCTION: Osteoarthritis is a common joint disease that causes destruction of articular cartilage and severe inflammation surrounding knee and hip joints. However, to date, effective therapeutic reagents for osteoarthritis have not been developed because the underlying molecular mechanisms are complex. Recent genetic findings suggest that a Wnt antagonist, frizzled-related protein B (FRZB), is a potential therapeutic target for osteoarthritis. Therefore, this study aimed to examine the transcriptional regulation of FRZB in chondrocytes. MATERIALS AND METHODS: Frzb/FRZB expression was assessed by RT-qPCR analyses in murine articular chondrocytes and SW1353 chondrocyte cell line. Overexpression and knockdown experiments were performed using adenovirus and lentivirus, respectively. Luciferase-reporter and chromatin immunoprecipitation assays were performed for determining transcriptional regulation. Protein-protein interaction was determined by co-immunoprecipitation analysis. RESULTS: Frzb was highly expressed in cartilages, especially within articular chondrocytes. Interleukin-1α markedly reduced Frzb expression in articular chondrocytes in association with cartilage destruction and increases in ADAM metallopeptidase with thrombospondin type 1 motif (Adamts) 4 and Adamts5 expression. Bone morphogenetic protein 2 (BMP2) increased FRZB expression in SW1353 cells through Smad signaling. Osterix and msh homeobox 2 (Msx2), both of which function as downstream transcription factors of BMP2, induced FRZB expression and upregulated its promoter activity. Co-immunoprecipitation results showed a physical interaction between Osterix and Msx2. Knockdown of either Osterix or Msx2 inhibited BMP2-dependent FRZB expression. Chromatin immunoprecipitation indicated a direct association of Osterix and Msx2 with the FRZB gene promoter. CONCLUSION: These results suggest that BMP2 regulates FRZB expression through Osterix and Msx2.

Regulatory Mechanisms of Prg4 and Gdf5 Expression in Articular Cartilage and Functions in Osteoarthritis.

Owing to the rapid aging of society, the numbers of patients with joint disease continue to increase. Accordingly, a large number of patients require appropriate treatment for osteoarthritis (OA), the most frequent bone and joint disease. Thought to be caused by the degeneration and destruction of articular cartilage following persistent and excessive mechanical stimulation of the joints, OA can significantly impair patient quality of life with symptoms such as knee pain, lower limb muscle weakness, or difficulty walking. Because articular cartilage has a low self-repair ability and an extremely low proliferative capacity, healing of damaged articular cartilage has not been achieved to date. The current pharmaceutical treatment of OA is limited to the slight alleviation of symptoms (e.g., local injection of hyaluronic acid or non-steroidal anti-inflammatory drugs); hence, the development of effective drugs and regenerative therapies for OA is highly desirable. This review article summarizes findings indicating that proteoglycan 4 (Prg4)/lubricin, which is specifically expressed in the superficial zone of articular cartilage and synovium, functions in a protective manner against OA, and covers the transcriptional regulation of Prg4 in articular chondrocytes. We also focused on growth differentiation factor 5 (Gdf5), which is specifically expressed on the surface layer of articular cartilage, particularly in the developmental stage, describing its regulatory mechanisms and functions in joint formation and OA pathogenesis. Because several genetic studies in humans and mice indicate the involvement of these genes in the maintenance of articular cartilage homeostasis and the presentation of OA, molecular targeting of Prg4 and Gdf5 is expected to provide new insights into the aetiology, pathogenesis, and potential treatment of OA.

Activation and Function of NLRP3 Inflammasome in Bone and Joint-Related Diseases.

Inflammation is a pivotal response to a variety of stimuli, and inflammatory molecules such as cytokines have central roles in the pathogenesis of various diseases, including bone and joint diseases. Proinflammatory cytokines are mainly produced by immune cells and mediate inflammatory and innate immune responses. Additionally, proinflammatory cytokines accelerate bone resorption and cartilage destruction, resulting in the destruction of bone and joint tissues. Thus, proinflammatory cytokines are involved in regulating the pathogenesis of bone and joint diseases. Interleukin (IL)-1 is a representative inflammatory cytokine that strongly promotes bone and cartilage destruction, and elucidating the regulation of IL-1 will advance our understanding of the onset and progression of bone and joint diseases. IL-1 has two isoforms, IL-1α and IL-1ß. Both isoforms signal through the same IL-1 receptor type 1, but the activation mechanisms are completely different. In particular, IL-1ß is tightly regulated by protein complexes termed inflammasomes. Recent research using innovative technologies has led to a series of discoveries about inflammasomes. This review highlights the current understanding of the activation and function of the NLRP3 (NOD-like receptor family, pyrin domain-containing 3) inflammasome in bone and joint diseases.

The lactate sensor GPR81 regulates glycolysis and tumor growth of breast cancer.

Metabolic reprogramming is a malignant phenotype of cancer. Cancer cells utilize glycolysis to fuel rapid proliferation even in the presence of oxygen, and elevated glycolysis is coupled to lactate fermentation in the cancer microenvironment. Although lactate has been recognized as a metabolic waste product, it has become evident that lactate functions as not only an energy source but a signaling molecule through the lactate receptor G-protein-coupled receptor 81 (GPR81) under physiological conditions. However, the pathological role of GPR81 in cancer remains unclear. Here, we show that GPR81 regulates the malignant phenotype of breast cancer cell by reprogramming energy metabolism. We found that GPR81 is highly expressed in breast cancer cell lines but not in normal breast epithelial cells. Knockdown of GPR81 decreased breast cancer cell proliferation, and tumor growth. Mechanistically, glycolysis and lactate-dependent ATP production were impaired in GPR81-silenced breast cancer cells. RNA sequencing accompanied by Gene Ontology enrichment analysis further demonstrated a significant decrease in genes associated with cell motility and silencing of GPR81 suppressed cell migration and invasion. Notably, histological examination showed strong expression of GPR81 in clinical samples of human breast cancer. Collectively, our findings suggest that GPR81 is critical for malignancy of breast cancer and may be a potential novel therapeutic target for breast carcinoma.

A Hydrogen-Free Approach for Activating an Fe Catalyst Using Trace Amounts of Noble Metals and Confinement into Nanoparticles.

Metallic iron (Fe) represents an exceptionally active catalyst, as shown in its use in the Haber-Bosch process to dissociate nitrogen molecules; however, the ease of corrosion by oxidation limits its usage. Hence, in most applications using metallic Fe catalysts, hydrogen is a necessary reactant. We report a novel hydrogen-free approach to fabricating reduced, highly active, and corrosion-resistive Fe-based catalysts using trace levels of noble metals (NMs) such as Ir, Rh, and Pt confined in the nanoparticle (NP). X-ray photoelectron spectroscopy (XPS) revealed that as little as ∼0.3 atom % was sufficient to induce the reduction of Fe. Extensive XPS analysis showed that the reduced NM atoms segregated to the NP surface and reduced the surrounding Fe atoms. We demonstrated the catalytic activity of the nanoparticles by the efficient synthesis of submillimeter tall, vertically aligned, and mainly double-walled carbon nanotube arrays using a completely hydrogen-free chemical vapor deposition process.

PIK3CA mutation correlates with mTOR pathway expression but not clinical and pathological features in Fibfibroipose vascular anomaly (FAVA).

BACKGROUND: Fibro-adipose vascular anomaly (FAVA) is a rare and new entity of vascular anomaly. Activating mutations in the phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) gene were identified at a frequency of 62.5% in FAVA cases. The PIK3CA mutations excessively activate mammalian target of rapamycin (mTOR) pathway, which promotes angiogenesis and lymphangiogenesis, implying that PIK3CA mutations may act as drivers of FAVAs. This study investigated the correlations between PIK3CA mutational status, clinicopathological features and immunohistochemical expression of the mTOR pathway in a series of FAVA. METHODS: We retrospectively evaluated the clinical and pathological findings of four FAVA cases. We performed next-generation sequencing (NGS) with a custom panel of genes associated with the mTOR pathway and genes responsible for other vascular anomalies; followed by direct sequencing and immunohistochemical analysis of the mTOR pathway. RESULTS: Two PIK3CA-mutation cases and two PIK3CA-wild-type (wt) cases exhibited similar typical clinical features of FAVA. Histological analysis revealed venous malformation, lymphatic malformation, nerves containing enlarged abnormal vessels and fibrofatty tissue were observed regardless of PIK3CA mutational status. In contrast to clinical and histological findings, the immunohistochemical expression of activated AKT and mTOR that are upstream of the mTOR pathway was detected in abnormal vessels of PIK3CA-mutation cases but not in those of PIK3CA-wt cases. However, activated eukaryotic translation initiation factor 4E-binding protein 1 (4EBP1) and ribosomal protein S6 kinase 1 (S6K1), both of which are downstream effectors of the mTOR pathway, were expressed in abnormal vessels of both PIK3CA-mutation and PIK3CA-wt cases. Furthermore, targeting NGS did not find any common genetic mutations involved in the mTOR pathway among PIK3CA-wt cases. CONCLUSIONS: There was no significant association between the presence of PIK3CA mutations and the clinicopathological features of FAVA, suggesting that the PIK3CA gene is not necessarily involved in the onset of FAVA. FAVAs lacking PIK3CA mutations may be caused by other gene mutations that activate 4EBP1 and S6K1.