Fibroadipogenic Progenitor Cells Contribute to Tongue Skeletal Muscle Hypertrophy in Beckwith-Wiedemann Syndrome

Abstract

Beckwith-Wiedemann syndrome (BWS) is a pediatric imprinting disorder characterized by tissue overgrowth, most commonly macroglossia, which can result in airway and feeding complications. Although dysregulated growth is a defining feature of BWS, the cellular interactions that drive organ-specific overgrowth remain poorly understood. We previously demonstrated that BWS macroglossia arises through distinct cell-intrinsic and cell-extrinsic mechanisms depending on molecular subtype. Here, we identify fibroadipogenic progenitor cells (FAPs) as modulators of myogenic differentiation and fusion in the human BWS tongue. BWS-derived FAPs were not increased in abundance in situ and did not exhibit hyperproliferation in vitro. Instead, FAPs from one BWS subtype promoted enhanced differentiation and fusion of normal human myoblasts. Secretome profiling revealed enrichment of CATHEPSIN L and TRANSFERRIN in conditioned media from these FAP populations, and functional perturbation of these factors supported their role in regulating myogenesis. These findings define a non-cell-autonomous mechanism of muscle overgrowth and implicate mesenchymal-myogenic signaling as a context-dependent driver of tissue expansion in an imprinting disorder.