Defects in the development of the vasculature are the underlying cause of many diseases including venous malformation (VM). VM is a congenital disease characterized by abnormal morphogenesis and expansion of veins1. Important studies on VM tissue and endothelial cells (EC) have identified gain-of-function mutations in two genes: TEK, which encodes the tyrosine kinase receptor TIE2, and PIK3CA, which encodes the p110α (catalytic subunit) isoform of PI3-kinase (PI3K)2,3,4,5. These somatic mutations result in ligand-independent hyper-activation of key angiogenic/growth signaling pathways, including PI3K/AKT, thereby resulting in dilated ectatic veins3. Despite these important genetic discoveries, the subsequent cellular and molecular mechanisms triggering abnormal angiogenesis and the formation of enlarged vascular channels are still not fully understood.
During normal and pathological angiogenesis, new vessels sprout from a pre-existing vascular network and EC undergo a sequence of important cellular processes including proliferation, migration, extracellular matrix (ECM) remodeling and lumen formation6. Two- and three- dimensional (2D/3D) in vitro cultures of EC are important tools to investigate each of these cellular properties individually. Nevertheless, there is a clear demand for a mouse model recapitulating pathological vessel enlargement within the host microenvironment while providing an efficient platform for preclinical evaluation of targeted drugs for translational research.
Up to date, a transgenic murine model of VM associated with TIE2 gain-of-function mutations has not been reported. Current transgenic VM mouse models rely on the ubiquitous or tissue-restricted expression of the activating mutation PIK3CA p.H1047R3,5. These transgenic animals provide significant insight into whole-body or tissue-specific effects of this hotspot PIK3CA mutation. The limitation of these models is the formation of a highly pathological vascular network resulting in early lethality. Thus, these mouse models do not fully reflect the sporadic occurrence of mutational events and localized nature of VM pathology.
On the contrary, patient-derived xenograft models are based on the transplantation or injection of pathological tissue or cells derived from patients into immunodeficient mice7. Xenograft models are a powerful tool to broaden knowledge about disease development and discovery of novel therapeutic agents8. In addition, using patient-derived cells allows scientists to recapitulate mutation heterogeneity to study the spectrum of patient phenotypes.
Here, we describe a protocol where patient-derived VM EC which express a mutant constitutively-active form of TIE2 and/or PIK3CA are injected subcutaneously in the back of athymic nude mice. Injected vascular cells are suspended in an ECM framework in order to promote angiogenesis as described in previous vascular xenograft models9,10,11. These VM EC undergo significant morphogenesis and generate enlarged, perfused pathological vessels in the absence of supporting cells. The described xenograft model of VM provides an efficient platform for preclinical evaluation of targeted drugs for their ability to inhibit uncontrolled lumen expansion.