PIK3CA Mutations and Metabolic Conditions Drive Clonal Expansion in Normal Esophagus

Major Finding: Gain-of-function PIK3CA mutations confer a fitness advantage and clonal expansion in normal esophagus.

Concept: The metabolic environment modulates the competitive advantage of PIK3CA-mutant clones in the esophagus.

Impact: Metformin reduces mutant cell advantage and may be a therapeutic strategy to limit oncogenic clones.