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ResearchIn-Press PreviewCell biologyGastroenterology Open Access | 10.1172/JCI191855

Somatic mutations in TBX3 promote hepatic clonal expansion by accelerating VLDL secretion

Gregory Mannino,1 Gabriella Quinn,2 Min Zhu,1 Zixi Wang,1 Xun Wang,1 Boyuan Li,1 Meng-Hsiung Hsieh,1 Thomas Mathews,1 Lauren Zacharias,1 Wen Gu,1 Purva Gopal,3 Natalia Brzozowska,4 Peter Campbell,4 Matt Hoare,5 Glen Liszczak,6 and Hao Zhu1

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Mannino, G. in: PubMed | Google Scholar

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Quinn, G. in: PubMed | Google Scholar

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Zhu, M. in: PubMed | Google Scholar

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Wang, Z. in: PubMed | Google Scholar |

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Wang, X. in: PubMed | Google Scholar |

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Li, B. in: PubMed | Google Scholar

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Hsieh, M. in: PubMed | Google Scholar

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Mathews, T. in: PubMed | Google Scholar

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Zacharias, L. in: PubMed | Google Scholar

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Gu, W. in: PubMed | Google Scholar

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Gopal, P. in: PubMed | Google Scholar

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Brzozowska, N. in: PubMed | Google Scholar

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Campbell, P. in: PubMed | Google Scholar

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Hoare, M. in: PubMed | Google Scholar |

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Liszczak, G. in: PubMed | Google Scholar

1Children’s Research Institute, Department of Pediatrics and Internal Medici, Simmons Comprehensive Cancer Center, Children’s Research Institute Mouse Genome Engineering Core, University of Texas Southwestern Medical Center, Dallas, United States of America

2Department of Immunology, University of Texas Southwestern Medical Center, Dallas, United States of America

3Department of Pathology, University of Texas Southwestern Medical Center, Dallas, United States of America

4Cancer Genome Project, Wellcome Sanger Institute, Hinxton, United Kingdom

5Department of Medicine, University of Cambridge Early Cancer Institute, Hutchison Research Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom

6Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, United States of America

Find articles by Zhu, H. in: PubMed | Google Scholar |

Published July 10, 2025 - More info

J Clin Invest. https://doi.org/10.1172/JCI191855.
Copyright © 2025, Mannino et al. This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Published July 10, 2025 - Version history
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Abstract

Somatic mutations that increase clone fitness or resist disease are positively selected, but the impact of these mutations on organismal health remains unclear. We previously showed that Tbx3 deletion increases hepatocyte fitness within fatty livers. Here, we detected TBX3 somatic mutations in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). In mice, Tbx3 deletion protected against, whereas Tbx3 overexpression exacerbated MASLD. Tbx3 deletion reduced lipid overload by accelerating VLDL secretion. Choline deficient diets, which block VLDL secretion, abrogated this protective effect. TBX3 transcriptionally suppressed the conventional secretory pathway and cholesterol biosynthesis. Hdlbp is a direct target of TBX3 that is responsible for the altered VLDL secretion. In contrast to wild-type TBX3, the TBX3 I155S and A280S mutations found in patients failed to suppress VLDL secretion. In conclusion, TBX3 mutant clones expand during MASLD through increased lipid disposal, demonstrating that clonal fitness can benefit the liver at the cost of hyperlipidemia.

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Supplemental material

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View Supplemental table 1: Demographics and disease scores from patients sequenced from Figure 1

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