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Hammill AM, Boscolo E. Capillary malformations. J Clin Invest 2024; 134:e172842. [PMID: 38618955 PMCID: PMC11014659 DOI: 10.1172/jci172842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Capillary malformation (CM), or port wine birthmark, is a cutaneous congenital vascular anomaly that occurs in 0.1%-2% of newborns. Patients with a CM localized on the forehead have an increased risk of developing a neurocutaneous disorder called encephalotrigeminal angiomatosis or Sturge-Weber syndrome (SWS), with complications including seizure, developmental delay, glaucoma, and vision loss. In 2013, a groundbreaking study revealed causative activating somatic mutations in the gene (GNAQ) encoding guanine nucleotide-binding protein Q subunit α (Gαq) in CM and SWS patient tissues. In this Review, we discuss the disease phenotype, the causative GNAQ mutations, and their cellular origin. We also present the endothelial Gαq-related signaling pathways, the current animal models to study CM and its complications, and future options for therapeutic treatment. Further work remains to fully elucidate the cellular and molecular mechanisms underlying the formation and maintenance of the abnormal vessels.
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Affiliation(s)
- Adrienne M. Hammill
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elisa Boscolo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Gao C, Nguyen V, Hochman ML, Gao L, Chen EH, Friedman HI, Nelson JS, Tan W. Current clinical evidence is insufficient to support HMME-PDT as the first choice of treatment for young children with port wine birthmarks. Lasers Surg Med 2024; 56:321-333. [PMID: 38506454 DOI: 10.1002/lsm.23779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Port wine birthmark (PWB) is a congenital vascular malformation of the skin. Pulsed dye laser (PDL) is the "gold standard" for the treatment of PWB globally. Hematoporphyrin monomethyl ether (HMME or hemoporfin)-mediated photodynamic therapy (HMME-PDT) has emerged as the first choice for PWB treatment, particularly for young children, in many major hospitals in China during the past several decades. AIM To evaluate whether HMME-PDT is superior to PDL by comparing the clinical efficacies of both modalities. METHOD PubMed records were searched for all relevant studies of PWB treatment using PDL (1988-2023) or HMME-PDT (2007-2023). Patient characteristics and clinical efficacies were extracted. Studies with a quartile percentage clearance or similar scale were included. A mean color clearance index (CI) per study was calculated and compared among groups. An overall CI (C0), with data weighted by cohort size, was used to evaluate the final efficacy for each modality. RESULT A total of 18 HMME-PDT studies with 3910 patients in China were eligible for inclusion in this analysis. Similarly, 40 PDL studies with 5094 patients from nine different countries were eligible for inclusion in this analysis. Over 58% of patients in the HMME-PDT studies were minors (<18 years old). A significant portion (21.3%) were young children (<3 years old). Similarly, 33.2% of patients in the PDL studies were minors. A small proportion (9.3%) was young children. The overall clearance rates for PDL were slightly, but not significantly, higher than those for HMME-PDT in cohorts with patients of all ages (C0, 0.54 vs. 0.48, p = 0.733), subpopulations with only minors (C0, 0.54 vs. 0.46, p = 0.714), and young children (C0, 0.67 vs. 0.50, p = 0.081). Regrettably, there was a lack of long-term data on follow-up evaluations for efficacy and impact of HMME-PDT on young children in general, and central nervous system development in particular, because their blood-brain barriers have a greater permeability as compared to adults. CONCLUSION PDL shows overall albeit insignificantly higher clearance rates than HMME-PDT in patients of all ages; particularly statistical significance is nearly achieved in young children. Collectively, current evidence is insufficient to support HMME-PDT as the first choice of treatment of PWBs in young children given: (1) overall inferior efficacy as compared to PDL; (2) risk of off-target exposure to meningeal vasculature during the procedure; (3) administration of steriods for mitigation of side effects; -and (4) lack of long-term data on the potential impact of HMME on central nervous system development in young children.
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Affiliation(s)
- Chao Gao
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Vi Nguyen
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Marcelo L Hochman
- The Facial Surgery Center and the Hemangioma & Malformation Treatment Center, Charleston, South Carolina, USA
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lin Gao
- Department of Dermatology, XiJing Hospital, Xi'an, Shaanxi, China
| | - Elliott H Chen
- Division of Plastic Surgery, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Division of Plastic Surgery, Prisma Health Medical Group, Columbia, South Carolina, USA
| | - Harold I Friedman
- Division of Plastic Surgery, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Division of Plastic Surgery, Prisma Health Medical Group, Columbia, South Carolina, USA
| | - John Stuart Nelson
- Departments of Surgery and Biomedical Engineering, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, California, USA
| | - Wenbin Tan
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Department of Biomedical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina, USA
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Tan IJ, Truong TM, Pathak GN, Mehdikhani S, Rao B, Cohen BA. Evaluating the clinical efficacy of pulsed dye laser with sirolimus for treatment of capillary malformations: A systematic review. SKIN HEALTH AND DISEASE 2024; 4:e333. [PMID: 38312256 PMCID: PMC10831561 DOI: 10.1002/ski2.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/30/2023] [Accepted: 12/24/2023] [Indexed: 02/06/2024]
Abstract
Port-wine stains (PWS) are capillary vascular anomalies that are often treated with pulsed-dye laser (PDL). Revascularization limits persistent clearance; however, the anti-angiogenic effects of sirolimus (SIRO) may inhibit revascularization. This review aims to determine differences in PWS outcomes when treated with PDL monotherapy or in combination with SIRO. A systematic review was conducted using PubMed, Cochrane, and Embase databases. The following search terms were used: 'port wine stain PDL SIRO', 'port wine stain PDL', and 'port wine stain PDL and topical treatment' with (MeSH) and (Title/Abstract) limits. The search was limited to the English language and human-subject studies conducted between 1 January 2000 and 1 June 2023. Inclusion criteria included studies evaluating SIRO as an adjunct to PDL in patients with PWS. Data extraction and quality assessment were performed by two independent reviewers. A total of nine studies met the inclusion criteria, which included randomized controlled trials (3), case series (2), case reports (3), and a prospective intrapatient study (1), which represented a total of 58 patients. Five studies showed improvement of a measured post-treatment PDL parameter including shortening treatment time and less frequent dosing. A subset of studies (4/9) which did not demonstrate significant clinical improvements exhibited significant photographic evidence of improvement. Heterogeneity among the studies highlights the need for further research and standardization. While adjunctive SIRO shows promise, larger studies and comprehensive evaluation methods are required to establish conclusive safety and efficacy guidelines to shape clinical decision-making.
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Affiliation(s)
- Isabella J. Tan
- Robert Wood Johnson Medical School, RutgersThe State University of New JerseyPiscatawayNew JerseyUSA
| | - Thu M. Truong
- Robert Wood Johnson Medical School, RutgersThe State University of New JerseyPiscatawayNew JerseyUSA
| | - Gaurav N. Pathak
- Robert Wood Johnson Medical School, RutgersThe State University of New JerseyPiscatawayNew JerseyUSA
| | - Shaunt Mehdikhani
- Robert Wood Johnson Medical School, RutgersThe State University of New JerseyPiscatawayNew JerseyUSA
| | - Babar Rao
- Robert Wood Johnson Medical School, RutgersThe State University of New JerseyPiscatawayNew JerseyUSA
| | - Bernard A. Cohen
- Department of DermatologyThe Johns Hopkins HospitalBaltimoreMarylandUSA
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Nguyen V, Kravitz J, Gao C, Hochman ML, Meng D, Chen D, Wang Y, Jegga AG, Nelson JS, Tan W. Perturbations of Glutathione and Sphingosine Metabolites in Port Wine Birthmark Patient-Derived Induced Pluripotent Stem Cells. Metabolites 2023; 13:983. [PMID: 37755263 PMCID: PMC10537749 DOI: 10.3390/metabo13090983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/18/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
Port Wine Birthmarks (PWBs) are a congenital vascular malformation on the skin, occurring in 1-3 per 1000 live births. We have recently generated PWB-derived induced pluripotent stem cells (iPSCs) as clinically relevant disease models. The metabolites associated with the pathological phenotypes of PWB-derived iPSCs are unknown, and so we aim to explore them in this study. Metabolites were separated by ultra-performance liquid chromatography and screened with electrospray ionization mass spectrometry. Orthogonal partial least-squares discriminant, multivariate, and univariate analyses were used to identify differential metabolites (DMs). KEGG analysis was used to determine the enrichment of metabolic pathways. A total of 339 metabolites was identified. There were 22 DMs, among which nine were downregulated-including sphingosine-and 13 were upregulated, including glutathione in PWB iPSCs, as compared to controls. Pathway enrichment analysis confirmed the upregulation of glutathione and the downregulation of sphingolipid metabolism in PWB-derived iPSCs as compared to normal ones. We next examined the expression patterns of the key molecules associated with glutathione metabolism in PWB lesions. We found that hypoxia-inducible factor 1α (HIF1α), glutathione S-transferase Pi 1 (GSTP1), γ-glutamyl transferase 7 (GGT7), and glutamate cysteine ligase modulatory subunit (GCLM) were upregulated in PWB vasculatures as compared to blood vessels in normal skin. Other significantly affected metabolic pathways in PWB iPSCs included pentose and glucuronate interconversions; amino sugar and nucleotide sugars; alanine, aspartate, and glutamate; arginine, purine, D-glutamine, and D-glutamate; arachidonic acid, glyoxylate, and dicarboxylate; nitrogen, aminoacyl-tRNA biosynthesis, pyrimidine, galactose, ascorbate, and aldarate; and starch and sucrose. Our data demonstrated that there were perturbations in sphingolipid and cellular redox homeostasis in PWB vasculatures, which could facilitate cell survival and pathological progression. Our data implied that the upregulation of glutathione could contribute to laser-resistant phenotypes in some PWB vasculatures.
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Affiliation(s)
- Vi Nguyen
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC 29209, USA; (V.N.); (J.K.); (C.G.)
| | - Jacob Kravitz
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC 29209, USA; (V.N.); (J.K.); (C.G.)
| | - Chao Gao
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC 29209, USA; (V.N.); (J.K.); (C.G.)
| | - Marcelo L. Hochman
- The Facial Surgery Center and the Hemangioma & Malformation Treatment Center, Charleston, SC 29425, USA;
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Dehao Meng
- Applied Physics Program, California State University San Marcos, San Marcos, CA 92096, USA;
| | - Dongbao Chen
- Department of Obstetrics and Gynecology, University of California, Irvine, CA 92617, USA;
| | - Yunguan Wang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (Y.W.); (A.G.J.)
- Division of Gastroenterology, Cincinnati Children Hospital Medical Center, Cincinnati, OH 45229, USA
- Division of Human Genetics, Cincinnati Children Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Anil G. Jegga
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (Y.W.); (A.G.J.)
- Division of Biomedical Informatics, Cincinnati Children Hospital Medical Center, Cincinnati, OH 45229, USA
| | - J Stuart Nelson
- Departments of Surgery and Biomedical Engineering, Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92617, USA;
| | - Wenbin Tan
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC 29209, USA; (V.N.); (J.K.); (C.G.)
- Department of Biomedical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, SC 29208, USA
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Nguyen V, Gao C, Hochman ML, Kravitz J, Chen EH, Friedman HI, Wenceslau CF, Chen D, Wang Y, Nelson JS, Jegga AG, Tan W. Supporting materials: Endothelial cells differentiated from patient dermal fibroblast-derived induced pluripotent stem cells resemble vascular malformations of Port Wine Birthmark. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.02.547408. [PMID: 37662218 PMCID: PMC10473620 DOI: 10.1101/2023.07.02.547408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background Port wine birthmark (PWB) is a congenital vascular malformation resulting from developmentally defective endothelial cells (ECs). Developing clinically relevant disease models for PWB studies is currently an unmet need. Objective Our study aims to generate PWB-derived induced pluripotent stem cells (iPSCs) and iPSC-derived ECs that preserve disease-related phenotypes. Methods PWB iPSCs were generated by reprogramming lesional dermal fibroblasts and differentiated into ECs. RNA-seq was performed to identify differentially expressed genes (DEGs) and enriched pathways. The functional phenotypes of iPSC-derived ECs were characterized by capillary-like structure (CLS) formation in vitro and Geltrex plug-in assay in vivo . Results Human PWB and control iPSC lines were generated through reprogramming of dermal fibroblasts by introducing the "Yamanaka factors" (Oct3/4, Sox2, Klf4, c-Myc) into them; the iPSCs were successfully differentiated into ECs. These iPSCs and their derived ECs were validated by expression of a series of stem cell and EC biomarkers, respectively. PWB iPSC-derived ECs showed impaired CLS in vitro with larger perimeters and thicker branches as compared to control iPSC-derived ECs. In the plug-in assay, perfused human vasculature formed by PWB iPSC- derived ECs showed bigger perimeters and greater densities than those formed by control iPSC- derived ECs in severe combined immune deficient (SCID) mice. The transcriptome analysis showed that dysregulated pathways of stem cell differentiation, Hippo, Wnt, and focal adhesion persisted through differentiation of PWB iPSCs to ECs. Functional enrichment analysis showed that Hippo and Wnt pathway-related PWB DEGs are enriched for vasculature development, tube morphology, endothelium development, and EC differentiation. Further, members of the zinc finger (ZNF) gene family were overrepresented among the DEGs in PWB iPSCs. ZNF DEGs confer significant functions in transcriptional regulation, chromatin remodeling, protein ubiquitination, and retinoic acid receptor signaling. Furthermore, NF-kappa B, TNF, MAPK, and cholesterol metabolism pathways were dysregulated in PWB ECs as readouts of impaired differentiation. Conclusions PWB iPSC-derived ECs render a novel and clinically-relevant disease model by retaining pathological phenotypes. Our data demonstrate multiple pathways, such as Hippo and Wnt, NF-kappa B, TNF, MAPK, and cholesterol metabolism, are dysregulated, which may contribute to the development of differentiation-defective ECs in PWB. Bulleted statements What is already known about this topic?: Port Wine Birthmark (PWB) is a congenital vascular malformation with an incidence rate of 0.1 - 0.3 % per live births.PWB results from developmental defects in the dermal vasculature; PWB endothelial cells (ECs) have differentiational impairments.Pulse dye laser (PDL) is currently the preferred treatment for PWB; unfortunately, the efficacy of PDL treatment of PWB has not improved over the past three decades.What does this study add?: Induced pluripotent stem cells (iPSCs) were generated from PWB skin fibroblasts and differentiated into ECs.PWB ECs recapitulated their pathological phenotypes such as forming enlarged blood vessels in vitro and in vivo.Hippo and Wnt pathways were dysregulated in PWB iPSCs and ECs.Zinc-finger family genes were overrepresented among the differentially expressed genes in PWB iPSCs.Dysregulated NF-kappa B, TNF, MAPK, and cholesterol metabolism pathways were enriched in PWB ECs.What is the translational message?: Targeting Hippo and Wnt pathways and Zinc-finger family genes could restore the physiological differentiation of ECs.Targeting NF-kappa B, TNF, MAPK, and cholesterol metabolism pathways could mitigate the pathological progression of PWB.These mechanisms may lead to the development of paradigm-shifting therapeutic interventions for PWB.
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Affiliation(s)
- Vi Nguyen
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina 29209, USA
| | - Chao Gao
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina 29209, USA
| | - Marcelo L Hochman
- The Facial Surgery Center and the Hemangioma & Malformation Treatment Center, Charleston, South Carolina 29425, USA
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29425 USA
| | - Jacob Kravitz
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina 29209, USA
| | - Elliott H Chen
- Division of Plastic Surgery, School of Medicine, University of South Carolina, Columbia, South Carolina 29203, USA
- Division of Plastic Surgery, Prisma Health Medical Group, Columbia, South Carolina 29203, USA
| | - Harold I Friedman
- Division of Plastic Surgery, School of Medicine, University of South Carolina, Columbia, South Carolina 29203, USA
- Division of Plastic Surgery, Prisma Health Medical Group, Columbia, South Carolina 29203, USA
| | - Camilla F Wenceslau
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina 29209, USA
- Department of Biomedical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, USA
| | - Dongbao Chen
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, California 92617, USA
| | - Yunguan Wang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
- Division of Gastroenterology, Cincinnati Children Hospital Medical Center, Cincinnati, Ohio 45229, USA
- Division of Human Genetics, Cincinnati Children Hospital Medical Center, Cincinnati, Ohio 45229, USA
| | - J Stuart Nelson
- Departments of Surgery and Biomedical Engineering, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, California 92617, USA
| | - Anil G. Jegga
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
- Division of Biomedical Informatics, Cincinnati Children Hospital Medical Center, Cincinnati, Ohio 45229, USA
| | - Wenbin Tan
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina 29209, USA
- Department of Biomedical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, USA
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Nguyen V, Kravitz J, Gao C, Hochman ML, Meng D, Chen D, Wang Y, Jegga AG, Nelson JS, Tan W. Perturbations of glutathione and sphingosine metabolites in Port Wine Birthmark patient-derived induced pluripotent stem cells. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.18.549581. [PMID: 37503303 PMCID: PMC10370126 DOI: 10.1101/2023.07.18.549581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Port Wine Birthmark (PWB) is a congenital vascular malformation in the skin, occurring in 1-3 per 1,000 live births. We recently generated PWB-derived induced pluripotent stem cells (iPSCs) as clinically relevant disease models. The metabolites associated with the pathological phenotypes of PWB-derived iPSCs are unknown, which we aimed to explore in this study. Metabolites were separated by ultra-performance liquid chromatography and were screened with electrospray ionization mass spectrometry. Orthogonal partial least-squares discriminant analysis, multivariate and univariate analysis were used to identify differential metabolites (DMs). KEGG analysis was used for the enrichment of metabolic pathways. A total of 339 metabolites were identified. There were 22 DMs confirmed with 9 downregulated DMs including sphingosine and 13 upregulated DMs including glutathione in PWB iPSCs as compared to controls. Pathway enrichment analysis confirmed the upregulation of glutathione and downregulation of sphingolipid metabolism in PWB-derived iPSCs as compared to normal ones. We next examined the expression patterns of the key factors associated with glutathione metabolism in PWB lesions. We found that hypoxia-inducible factor 1α (HIF1α), glutathione S-transferase Pi 1 (GSTP1), γ-glutamyl transferase 7 (GGT7), and glutamate cysteine ligase modulatory subunit (GCLM) were upregulated in PWB vasculatures as compared to blood vessels in normal skins. Our data demonstrate that there are perturbations in sphingolipid and cellular redox homeostasis in the PWB vasculature, which may facilitate cell survival and pathological progression. Our data imply that upregulation of glutathione may contribute to laser-resistant phenotypes in the PWB vasculature.
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Affiliation(s)
- Vi Nguyen
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina 29209, USA
| | - Jacob Kravitz
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina 29209, USA
| | - Chao Gao
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina 29209, USA
| | - Marcelo L. Hochman
- The Facial Surgery Center and the Hemangioma & Malformation Treatment Center, Charleston, South Carolina 29425, USA
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29425 USA
| | - Dehao Meng
- Applied Physics Program, California State University San Marcos, San Marcos, California 92096 USA
| | - Dongbao Chen
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, California, 92617, USA
| | - Yunguan Wang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
- Division of Gastroenterology, Cincinnati Children Hospital Medical Center, Cincinnati, Ohio 45229, USA
- Division of Human Genetics, Cincinnati Children Hospital Medical Center, Cincinnati, Ohio 45229, USA
| | - Anil G. Jegga
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
- Division of Biomedical Informatics, Cincinnati Children Hospital Medical Center, Cincinnati, Ohio 45229, USA
| | - J Stuart Nelson
- Departments of Surgery and Biomedical Engineering, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, California 92617, USA
| | - Wenbin Tan
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina 29209, USA
- Department of Biomedical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, USA
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Liu L, Li X, Zhao Q, Yang L, Jiang X. Pathogenesis of Port-Wine Stains: Directions for Future Therapies. Int J Mol Sci 2022; 23:ijms232012139. [PMID: 36292993 PMCID: PMC9603382 DOI: 10.3390/ijms232012139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/26/2022] Open
Abstract
Port-wine stains (PWSs) are congenital vascular malformations that involve the skin and mucosa. To date, the mechanisms underlying the pathogenesis and progression of PWSs are yet to be clearly elucidated. The potential reasons for dilated vessels are as follows: (1) somatic GNAQ (R183Q) mutations that form enlarged capillary malformation-like vessels through angiopoietin-2, (2) decreased perivascular nerve elements, (3) the coexistence of Eph receptor B1 and ephrin B2, and (4) the deficiency of αSMA expression in pericytes. In addition, ERK, c-JNK, P70S6K, AKT, PI3K, and PKC are assumed to be involved in PWS development. Although pulsed-dye laser (PDL) remains the gold standard for treating PWSs, the recurrence rate is high. Topical drugs, including imiquimod, axitinib, and rapamycin, combined with PDL treatments, are expected to alter the recurrence rate and reduce the number of PDL sessions for PWSs. For the deep vascular plexus, photosensitizers or photothermal transduction agents encapsulated by nanocarriers conjugated to surface markers (CD133/CD166/VEGFR-2) possess a promising therapeutic potential in photodynamic therapy or photothermal therapy for PWSs. The pathogenesis, progression, and treatment of PWSs should be extensively investigated.
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Affiliation(s)
- Lian Liu
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu 610017, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu 610017, China
| | - Xiaoxue Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu 610017, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu 610017, China
| | - Qian Zhao
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu 610017, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu 610017, China
- Department of Medical Cosmetology, Chengdu Second People’s Hospital, Chengdu 610056, China
| | - Lihua Yang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu 610017, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu 610017, China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu 610017, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu 610017, China
- Correspondence: ; Tel.: +86-028-8542-3315; Fax: +86-028-8542-2560
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Wang B, Mei X, Wang Y, Hu X, Li F. Adjuncts to pulsed dye laser for treatment of port wine stains: a literature review. J COSMET LASER THER 2022; 23:209-217. [PMID: 35422188 DOI: 10.1080/14764172.2022.2052901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bing Wang
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, P. R. China
| | - Xianglin Mei
- Department of Pathology, The Second Hospital of Jilin University, Changchun, P. R. China
| | - Yanlong Wang
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, P. R. China
| | - Xin Hu
- Department of Dermatology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, P. R. China
| | - Fuqiu Li
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, P. R. China
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ISSVA Classification of Vascular Anomalies and Molecular Biology. Int J Mol Sci 2022; 23:ijms23042358. [PMID: 35216474 PMCID: PMC8876303 DOI: 10.3390/ijms23042358] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 01/19/2023] Open
Abstract
Vascular anomalies include various diseases, which are classified into two types according to the International Society for the Study of Vascular Anomalies (ISSVA) classification: vascular tumors with proliferative changes of endothelial cells, and vascular malformations primarily consisting of structural vascular abnormalities. The most recent ISSVA classifications, published in 2018, detail the causative genes involved in many lesions. Here, we summarize the latest findings on genetic abnormalities, with the presentation of the molecular pathology of vascular anomalies.
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Wang M, Lin Y, Shi W, Chen X, Mi Z, Jia Z, Pan Q, Wang Z, Han J, Liu H. Topical metformin suppresses angiogenesis pathways induced by pulsed dye laser irradiation in animal models. Exp Dermatol 2021; 31:393-397. [PMID: 34564891 DOI: 10.1111/exd.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 08/11/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
Pulsed dye laser (PDL) is the first-line treatment for port-wine stain (PWS). However, only a small portion of the lesions could be completely cleared by PDL treatment, which might be related to the regeneration and revascularization of the vascular structures after laser irradiation. Recently, it is believed that the suppression of regeneration and revascularization of photocoagulated blood vessels can achieve a better therapeutic outcome. We use rabbit ear and SD rat as the animal models to investigate whether PDL-induced angiogenesis can be suppressed by topical metformin. Our results showed that topical application of metformin can effectively suppress the PDL-induced early stage of angiogenesis via inhibition of the AKT/mTOR/P70S6K pathway in animal models.
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Affiliation(s)
- Meiling Wang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Yan Lin
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Wenhao Shi
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Xuechao Chen
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Zihao Mi
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Zhiwei Jia
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Qing Pan
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Zhenzhen Wang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Jian Han
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Huaxu Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
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11
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Swarbrick AW, Frederiks AJ, Foster RS. Systematic review of sirolimus in dermatological conditions. Australas J Dermatol 2021; 62:461-469. [PMID: 34328215 DOI: 10.1111/ajd.13671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/28/2021] [Accepted: 07/04/2021] [Indexed: 12/13/2022]
Abstract
Sirolimus is a mammalian target of rapamycin inhibitor (mTORI) with anti-proliferative, antiangiogenic and immunosuppressive properties. While approved in Australia as an anti-rejection medication for renal transplant patients, there is mounting evidence regarding the utility of oral and topical sirolimus in treating a plethora of dermatological conditions or conditions with cutaneous manifestations. Our aim was to present an overview of the evidence for current usage and breadth of the application of sirolimus in dermatology. We carried out a systematic review of all the literature published up to 31 August 2019 on oral and topical sirolimus with respect to dermatological conditions or conditions otherwise relevant to dermatology. While 3368 papers were initially produced in our search, 238 papers met our inclusion criteria and were examined in our review. The conditions examined were categorised into genodermatoses (9 conditions), infection (1 condition), inflammatory/autoimmune (10 conditions), neoplasm (3 conditions) and vascular (17 conditions). We extracted data on first author, publication year, journal, characteristics of the study and study patients, condition, drug modalities, drug efficacy, side effects, blood level of mTORI, co-interventions and follow-up. While there is level 1 evidence for the efficacy of sirolimus in conditions such as tuberous sclerosis complex (TSC) and GVHD prophylaxis, for many other conditions, the evidence is limited to level 4 evidence. Regarding oral systemic therapy, dosing regimens varied with the most common for children 0.8mg/m2 twice daily and for adults 1 mg twice daily. Doses were often adjusted to reach a typical trough level of between 5 and 15 ng/mL, though targets often varied. In the overall majority of cases, side effects were minimal or tolerable, including mucositis, cytopenias, lipid abnormalities and nausea/vomiting, and only a few cases had to stop due to adverse effects. Regarding topical therapy, concentration of formulations varied from 0.1% to 1% and were compounded into creams, ointments or gels and administered typically once or twice per day. The most common side effect was skin irritation. There were a number of limitations to our study. In particular, many of the published studies were case reports or case series with no comparator arm, leading to susceptibility of bias in conclusions drawn, in particular a high likelihood of publication bias. Given the heterogeneity amongst studies, comparisons or aggregation of results was difficult. There continues to be growing use of oral and topical sirolimus in dermatological conditions. It provides new therapeutic options to patients where previous therapies have either failed or are limited due to toxicity. However, further studies are warranted.
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Affiliation(s)
- Andrew W Swarbrick
- Department of Dermatology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Aaron J Frederiks
- Royal Perth Hospital, Perth, Australia.,School of Medicine, University of Western Australia, Perth, Australia
| | - Rachael S Foster
- Department of Dermatology, Sir Charles Gairdner Hospital, Nedlands, Australia.,Department of Dermatology, Perth Children's Hospital, Nedlands, Australia
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12
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Herold M, Goldberg G. Combination Therapy for the Treatment of Complex Vascular Lesions. Lasers Surg Med 2021; 53:1316-1324. [PMID: 34151443 DOI: 10.1002/lsm.23443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/11/2021] [Accepted: 05/23/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Combination treatment with debulking surgical procedures, vascular and ablative lasers, and topical and intralesional vascular therapies may improve outcomes in nodular hypertrophic and mixed complex vascular malformations; however, there is a paucity of data reporting specific combinations of these treatments. We report 15 cases of complex vascular malformations, which were successfully treated with novel combinations of these modalities. STUDY DESIGN/MATERIALS AND METHODS We performed a review of 15 patients treated with combination vascular laser therapy, electrosurgery, ablative laser technologies, and topical and intralesional vascular therapies from May 2000 to October 2020. Photographs were taken at intervals with attempts made for consistent lighting and positioning. RESULTS All 15 patients achieved an excellent clinical response to combination therapy with visible improvement of the hypertrophic, textural, and vascular components of their lesions. No major complications or adverse events were encountered during any of the treatments. CONCLUSION Combination multimodality therapy with surgical debulking, laser technologies, and topical and injection therapies can be highly effective and efficient in treating complex vascular malformations. © 2021 Wiley Periodicals LLC.
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Affiliation(s)
- Mitchell Herold
- Division of Dermatology, Department of Medicine, University of Arizona, College of Medicine, 1501 N. Campbell Ave, Tucson, Arizona, 85724
| | - Gerald Goldberg
- Division of Dermatology, Department of Medicine, University of Arizona, College of Medicine, 1501 N. Campbell Ave, Tucson, Arizona, 85724.,Clinical Professor of Dermatology and Pediatrics, University of Arizona, 1501 N. Campbell Ave, Tucson, Arizona, 85724.,Pima Dermatology, 5150 E Glenn St, Tucson, Arizona
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13
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Bertino F, Trofimova AV, Gilyard SN, Hawkins CM. Vascular anomalies of the head and neck: diagnosis and treatment. Pediatr Radiol 2021; 51:1162-1184. [PMID: 33860862 DOI: 10.1007/s00247-021-04968-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/27/2020] [Accepted: 01/07/2021] [Indexed: 01/19/2023]
Abstract
Vascular malformations and vascular tumors comprise the two specific subsets of vascular anomalies that arise as a result of disorganized angiogenesis and neoplasm, respectively. Malformations are separate entities from vascular tumors (e.g., hemangiomas) and are recognized by the International Society for the Study of Vascular Anomalies (ISSVA) as such. Vascular malformations are classified into four main groups: simple, combined, anomalies of major vessels, and those associated with other vascular anomalies. Vascular tumors are neoplastic growths of blood vessels and are morphologically and molecularly distinct from malformations but can arise in the head and neck and have syndromic association. Head and neck vascular anomalies are not uncommon in the pediatric population and require special care in the workup, diagnostic imaging and clinical care. The purpose of this manuscript is to discuss the diagnosis and management of the most common intracranial and extracranial vascular malformations and tumors in the head and neck in children and adolescents.
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Affiliation(s)
- Frederic Bertino
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA.
| | - Anna V Trofimova
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA
| | - Shenise N Gilyard
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA.,Division of Pediatric Radiology, Division of Interventional Radiology and Image Guided Medicine, Children's Healthcare of Atlanta, Emory + Children's Pediatric Institute, Atlanta, GA, USA
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14
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Geeurickx M, Labarque V. A narrative review of the role of sirolimus in the treatment of congenital vascular malformations. J Vasc Surg Venous Lymphat Disord 2021; 9:1321-1333. [PMID: 33737259 DOI: 10.1016/j.jvsv.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Vascular malformations arise from defects in the morphologic development of the vascular system and can have an impact on quality of life and/or lead to severe complications. To date, vascular malformations are frequently managed by invasive techniques, after which recurrence is common. Sirolimus, a downstream inhibitor of the phosphatidylinositol 3 kinase/AKT pathway and best known for its immunosuppressive effect, has been used off-label for lesions for which approved therapies were associated with unsatisfactory results or recurrence. The aim of this study was to review the available data on the effect of sirolimus on the size and symptoms of different types of malformations and to summarize the main safety issues. METHODS A literature search in Pubmed, Embase, Web of Science, and SCOPUS was performed. Case reports, case series, and clinical trials evaluating the effect of sirolimus in vascular malformations were eligible for this review. Fully terminated studies published between January 2010 and May 2019 reporting an evaluable response on size and/or symptoms were included. Relevant data on lesion size, symptoms, side effects and duration of treatment were extracted as reported in the study. Additionally, we reported 10 unpublished cases who were treated in UZ Leuven. RESULTS The literature review included 68 articles, describing 324 patients. The median duration of therapy was 12 months (range, 1-60 months). After 6 months of treatment, the size of the malformation had at least decreased in 67% of patients with common venous malformations (VM), in 93% of patients with blue rubber bleb nevus syndrome and in all patients with verrucous VM. The size of lymphatic malformations improved in more than 80% of the patients, even in the case of extensive involvement such as in Gorham-Stout disease and generalized lymphatic anomaly. In addition, the majority of patients with syndromic vascular malformations experienced a decrease in size and reported symptoms improved in almost all patients, regardless of the type of malformation. Side effects were common (53%) but usually mild; mucositis and bone marrow suppression were the most common. Regrowth or recurrence of symptoms occurred in 49% of patients who discontinued treatment. Comparable effects were seen in our own patients. CONCLUSIONS This review shows that sirolimus is effective in decreasing the size and/or symptoms of particularly lymphatic malformations as well as VMs. Although common, side effects were usually mild. Nevertheless, clinical trials are needed to confirm the safety and effectivity of sirolimus and to identify the required serum levels and duration of treatment.
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Affiliation(s)
- Marlies Geeurickx
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Veerle Labarque
- Department of Pediatric Hemato-Oncology, University Hospitals Leuven, Leuven, Belgium; Catholic University Leuven, Center for Molecular and Vascular Biology, Leuven, Belgium.
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15
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Fallahi M, Hallaji Z, Tavakolpour S, Niknam S, Salehi Farid A, Nili A, Teimourpour A, Daneshpazhooh M, Rahmati J, Haddady Abianeh S, Mahmoudi H. Evaluating the efficacy and safety of topical sirolimus 0.2% cream as adjuvant therapy with pulsed dye laser for the treatment of port wine stain: A randomized, double-blind, placebo-controlled trial. J Cosmet Dermatol 2020; 20:2498-2506. [PMID: 33251650 DOI: 10.1111/jocd.13867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/21/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Port Wine Stain (PWS) is a congenital capillary malformation. Although multiple treatments are required, the gold standard treatment for PWS is Pulsed Dye Laser (PDL). Given its anti-angiogenic effects, sirolimus can be considered as an adjuvant to PDL in PWS. AIM To evaluate the efficacy and safety of topical sirolimus (Rapamycin) 0.2% cream as adjuvant therapy for PDL for PWS. METHODS In this randomized double-blind placebo-controlled trial, 15 patients with PWS were enrolled. Each lesion was divided into upper and lower parts, and each part was assigned randomly to receive PDL (4 sessions, 2 months apart) plus sirolimus vs PDL and placebo. The response was evaluated using colorimetry, investigator global assessment (IGA), and patient global assessment (PGA) every two months for eight continuous months. RESULTS According to the colorimetric analysis, medial and lateral sides of the treatment and placebo parts did not differ significantly (both P-value > .05). However, according to PGA and IGA, there was a significant difference in favor of sirolimus (P-values = .041 and .039, respectively). Itching and dryness (86.7%), contact dermatitis (20%) were the most common adverse effects in the sirolimus group, while none of them were observed in placebo. CONCLUSION Although the improvement was significant subjectively, topical sirolimus 0.2% as an adjuvant to PDL does not appear to improve PWS erythema using calorimetric assessment.
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Affiliation(s)
- Mahsa Fallahi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Arak University of Medical Sciences, Arak, Iran
| | - Zahra Hallaji
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Somayeh Niknam
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Science, Tehran, Iran
| | - Ali Salehi Farid
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Nili
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Teimourpour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences Tehran, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Rahmati
- Department of Plastic and Reconstructive Surgery, Imam Khomeini Hospital and Razi Hospital, Tehran University of Medical Sciences Tehran, Tehran, Iran
| | - Shahriar Haddady Abianeh
- Department of Plastic and Reconstructive Surgery, Imam Khomeini Hospital and Razi Hospital, Tehran University of Medical Sciences Tehran, Tehran, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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16
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Wang M, Qin Y, Wang T, Orringer JS, Paulus YM, Yang X, Wang X. Removing Subcutaneous Microvessels Using Photo-Mediated Ultrasound Therapy. Lasers Surg Med 2020; 52:984-992. [PMID: 32394475 PMCID: PMC7655656 DOI: 10.1002/lsm.23260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVES We have developed a novel anti-vascular technique, termed photo-mediated ultrasound therapy (PUT), which utilizes nanosecond duration laser pulses synchronized with ultrasound bursts to remove the microvasculature through cavitation. The objective of the current study is to explore the potential of PUT in removing subcutaneous microvessels. STUDY DESIGN/MATERIALS AND METHODS The auricular blood vessels of two New Zealand white rabbits were treated by PUT with a peak negative ultrasound pressure of 0.45 MPa at 0.5 MHz, and a laser fluence of 0.056 J/cm2 at 1064 nm for 10 minutes. Blood perfusion in the treated area was measured by a commercial laser speckle imaging (LSI) system before and immediately after treatment, as well as at 1 hour, 3 days, 2 weeks, and 4 weeks post-treatment. Perfusion rates of 38 individual vessels from four rabbit ears were tracked during this time period for longitudinal assessment. RESULTS The measured perfusion rates of the vessels in the treated areas, as quantified by the relative change in perfusion rate, showed a statistically significant decrease for all time points post-treatment (P < 0.001). The mean decrease in perfusion is 50.79% immediately after treatment and is 32.14% at 4 weeks post-treatment. Immediately after treatment, the perfusion rate decreased rapidly. Following this, there was a partial recovery in perfusion rate up to 3 days post-treatment, followed by a plateau in the perfusion from 3 days to 4 weeks. CONCLUSIONS This study demonstrated that a single PUT treatment could significantly reduce blood perfusion by 32.14% in the skin for up to 4 weeks. With unique advantages such as low laser fluence as compared with photothermolysis and agent-free treatment as compared with photodynamic therapy, PUT holds the potential to be developed into a new tool for the treatment of cutaneous vascular lesions. Lasers Surg. Med. © 2020 Wiley Periodicals, LLC.
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Affiliation(s)
- Mingyang Wang
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
| | - Yu Qin
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, No.1239, Siping Road, Shanghai, 200092, China
| | - Tao Wang
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
- Institution of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, 236 Baidi Road, Tianjin, 300192, China
| | - Jeffrey S Orringer
- Department of Dermatology, University of Michigan, 1910 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, Michigan, 48109
| | - Yannis M Paulus
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
- Department of Ophthalmology and Visual Sciences, University of Michigan, W.K. Kellogg Eye Center, 1000 Wall Street, Ann Arbor, Michigan, 48109
| | - Xinmai Yang
- Institute for Bioengineering Research and Department of Mechanical Engineering, University of Kansas, 1530 W.15th Street, 3138 Learned Hall, Lawrence, Kansas, 66045
| | - Xueding Wang
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
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17
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Aesthetic Treatment Outcomes of Capillary Hemangioma, Venous Lake, and Venous Malformation of the Lip Using Different Surgical Procedures and Laser Wavelengths (Nd:YAG, Er,Cr:YSGG, CO 2, and Diode 980 nm). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228665. [PMID: 33266374 PMCID: PMC7700507 DOI: 10.3390/ijerph17228665] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/30/2022]
Abstract
Different approaches with different clinical outcomes have been found in treating capillary hemangioma (CH), venous lake (VL), or venous malformations (VM) of the lips. This retrospective study aims to assess scar quality, recurrence rate, and patient satisfaction after different surgeries with different laser wavelengths. A total of 143 patients with CH or VM were included. Nd:YAG laser was used for 47 patients, diode 980 nm laser was used for 32 patients (treatments by transmucosal photo-thermo-coagulation), Er,Cr:YSSG laser was used for 12 patients (treatments by excision), and CO2 laser was used for 52 patients (treatments by photo-vaporization). The Manchester scar scale was used by practitioners to assess the scar quality. The recurrence rate and patients' satisfaction were noted at different follow-ups during 12 months. Our retrospective study showed that laser-assisted aesthetic treatment of vascular lesions (CH, VL, and VM) of the lips can be considered effective regardless of the wavelength used (Er,Cr:YSGG, CO2, Nd:YAG, and diode 980 nm) or the treatment procedure (transmucosal photo-thermo-coagulation, photo-vaporization, and surgical excision). There was no significant difference in patient and practitioner satisfaction with aesthetic outcome at 6 months follow-up. Furthermore, the treatments of lip vascular lesions performed using Er,Cr:YSGG and CO2 lasers did not show any recurrence during the 12 months of follow-up, while recurrence rates of 11% ± 1.4% and 8% ± 0.9% were seen in the diode and Nd:YAG groups, respectively.
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18
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Artzi O, Mehrabi JN, Heyman L, Friedman O, Mashiah J. Treatment of port wine stain with
Tixel
‐induced rapamycin delivery following pulsed dye laser application. Dermatol Ther 2019; 33:e13172. [DOI: 10.1111/dth.13172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 11/09/2019] [Accepted: 11/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ofir Artzi
- Artzi Treatment and Research Center Tel Aviv Israel
- Department of DermatologyTel Aviv Sourasky Medical Center Tel Aviv Israel
| | | | - Lee Heyman
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Or Friedman
- Plastic Reconstructive Surgery DepartmentTel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Jacob Mashiah
- Department of DermatologyTel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
- Pediatric Dermatology Clinic, Dana‐Dwek Children's HospitalTel Aviv Sourasky Medical Center Tel Aviv Israel
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19
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Fu Z, Huang J, Xiang Y, Huang J, Tang Z, Chen J, Nelson JS, Tan W, Lu J. Characterization of Laser‐Resistant Port Wine Stain Blood Vessels UsingIn VivoReflectance Confocal Microscopy. Lasers Surg Med 2019; 51:841-849. [DOI: 10.1002/lsm.23134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Zhibing Fu
- Department of Dermatology, Third Xiangya HospitalCentral South University Changsha Hunan 410013 China
| | - Jinhua Huang
- Department of Dermatology, Third Xiangya HospitalCentral South University Changsha Hunan 410013 China
| | - Yaping Xiang
- Department of Dermatology, Third Xiangya HospitalCentral South University Changsha Hunan 410013 China
| | - Jian Huang
- Department of Dermatology, Third Xiangya HospitalCentral South University Changsha Hunan 410013 China
| | - Zhen Tang
- Department of Dermatology, Third Xiangya HospitalCentral South University Changsha Hunan 410013 China
| | - Jing Chen
- Department of Dermatology, Third Xiangya HospitalCentral South University Changsha Hunan 410013 China
| | - J. Stuart Nelson
- Department of Surgery, Beckman Laser Institute and Medical ClinicUniversity of California Irvine California 92617
| | - Wenbin Tan
- Department of Surgery, Beckman Laser Institute and Medical ClinicUniversity of California Irvine California 92617
- Department of Cell Biology and AnatomyUniversity of South Carolina School of Medicine Columbia South Carolina 29208
| | - Jianyun Lu
- Department of Dermatology, Third Xiangya HospitalCentral South University Changsha Hunan 410013 China
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20
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The Pathogenesis of Port Wine Stain and Sturge Weber Syndrome: Complex Interactions between Genetic Alterations and Aberrant MAPK and PI3K Activation. Int J Mol Sci 2019; 20:ijms20092243. [PMID: 31067686 PMCID: PMC6539103 DOI: 10.3390/ijms20092243] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022] Open
Abstract
Port wine stain (PWS) is a congenital vascular malformation involving human skin. Approximately 15-20% of children a facial PWS involving the ophthalmic (V1) trigeminal dermatome are at risk for Sturge Weber syndrome (SWS), a neurocutaneous disorder with vascular malformations in the cerebral cortex on the same side of the facial PWS lesions. Recently, evidence has surfaced that advanced our understanding of the pathogenesis of PWS/SWS, including discoveries of somatic genetic mutations (GNAQ, PI3K), MAPK and PI3K aberrant activations, and molecular phenotypes of PWS endothelial cells. In this review, we summarize current knowledge on the etiology and pathology of PWS/SWS based on evidence that the activation of MAPK and/or PI3K contributes to the malformations, as well as potential futuristic treatment approaches targeting these aberrantly dysregulated signaling pathways. Current data support that: (1) PWS is a multifactorial malformation involving the entire physiological structure of human skin; (2) PWS should be pathoanatomically re-defined as "a malformation resulting from differentiation-impaired endothelial cells with a progressive dilatation of immature venule-like vasculatures"; (3) dysregulation of vascular MAPK and/or PI3K signaling during human embryonic development plays a part in the pathogenesis and progression of PWS/SWS; and (4) sporadic low frequency somatic mutations, such as GNAQ, PI3K, work as team players but not as a lone wolf, contributing to the development of vascular phenotypes. We also address many crucial questions yet to be answered in the future research investigations.
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van Raath MI, van Amesfoort JE, Hermann M, Ince Y, Zwart MJ, Echague AV, Chen Y, Ding B, Huang X, Storm G, Heger M. Site-specific pharmaco-laser therapy: A novel treatment modality for refractory port wine stains. J Clin Transl Res 2019; 5:1-24. [PMID: 31579838 PMCID: PMC6765152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/29/2019] [Accepted: 04/18/2019] [Indexed: 10/27/2022] Open
Abstract
Despite extensive efforts to optimize laser therapy, i.e., the current gold standard treatment, a majority of port wine stain (PWS) patients responds suboptimally to laser therapy. This paper describes the niceties of a novel PWS treatment modality termed site-specific pharmaco-laser therapy (SSPLT). In contrast to the classic approach of enhancing the extent of intravascular photocoagulation (the photothermal response), SSPLT focuses on optimization of post-irradiation thrombus formation (i.e., the hemodynamic response) by combining conventional laser therapy with the administration of thermosensitive drug delivery systems that encapsulate prothrombotic and antifibrinolytic drugs. The aim of SSPLT is to instill complete lumenal occlusion in target vessels, which has been linked to optimal PWS blanching. RELEVANCE FOR PATIENTS The current treatment options for PWS patients are limited in efficacy. Novel therapeutic modalities are needed to more effectively treat patients with recalcitrant PWSs. SSPLT is an experimental-stage treatment modality that could serve as an adjuvant to pulsed dye laser therapy for a selected group of patients whose PWS is ill-responsive to standard treatment. The expected clinical result of SSPLT is improved lesional blanching.
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Affiliation(s)
- M. Ingmar van Raath
- 1Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China,2Department of Experimental Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Martin Hermann
- 3Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Yasin Ince
- 2Department of Experimental Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maurice J. Zwart
- 2Department of Experimental Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Agustina V. Echague
- 4Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yan Chen
- 5Department of Clinical Medicine, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China
| | - Baoyue Ding
- 1Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China
| | - Xuan Huang
- 1Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China
| | - Gert Storm
- 6Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands,7Department of Controlled Drug Delivery, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Michal Heger
- 1Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China,6Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands,Corresponding author: Michal Heger Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China Tel: +86-138-19345926.
Department of Pharmaceutics, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands Tel: +31-30-2533966.
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Alegre-Sánchez A, Boixeda P. RF-Topical Rapamycin as an Adjuvant to Laser Treatment in Capillary Malformations. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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23
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Musalem HM, Alshaikh AA, Tuleimat LM, Alajlan S. Outcome with topical sirolimus for port wine stain malformations after unsatisfactory results with pulse dye laser treatment alone. Ann Saudi Med 2018; 38:376-380. [PMID: 30284993 PMCID: PMC6180221 DOI: 10.5144/0256-4947.2018.376] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
UNLABELLED We used a topical formulation of sirolimus for treating port wine stain (PWS). Although pulsed dye laser (PDL) is the current treatment of choice for PWS, fast neovascularization after treatment is a major drawback. With PDL therapy there has been insufficient improvement and frustrating side effects. The objective was to study the efficacy and safety of combining topical sirolimus with PDL as dual therapy in managing PWS. We report five PWS cases that were treated with PDL initially, followed by 0.5-1% topical sirolimus. With dual therapy there was significant improvement over a shorter duration. More published studies of topical sirolimus are needed to clarify the role of dual therapy in managing PWS associated with capillary malformations. We encourage further prospective and comparative studies with a larger sample size. SIMILAR CASES PUBLISHED 1.
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Affiliation(s)
- Hebah Mohammadsalam Musalem
- Dr. Hebah Mohammadsalam Musalem, Department of Medicine,, Alfaisal University, Riyadh 11551,, Saudi Arabia, T: 966533112656, , ORCID:http://orcid.org/0000-0002-2478-9638
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24
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Topical Adjuncts to Pulsed Dye Laser for Treatment of Port Wine Stains: Review of the Literature. Dermatol Surg 2018; 44:796-802. [PMID: 29799824 DOI: 10.1097/dss.0000000000001507] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Port wine stains (PWS) pose a therapeutic challenge. Pulsed dye laser (PDL) is the treatment of choice; however, treatment is often ineffective and recurrences are common. OBJECTIVE This article provides a review of topical therapies that have been investigated to improve efficacy of PDL for the treatment of PWS. MATERIALS AND METHODS A literature search was performed through PubMed, EMBASE, Web of Science, and CINAHL, using the search terms "port wine stain," "pulsed dye laser," and "topical." RESULTS Clinical trials have investigated the topical agents, timolol, imiquimod, and rapamycin (RPM) in combination with PDL for the treatment of PWS. Topical timolol with PDL failed to show improved efficacy compared with PDL alone. Two clinical trials using imiquimod and PDL showed enhanced blanching of PWS compared with controls. Rapamycin and PDL were more effective than controls for facial PWS, but not for nonfacial PWS. CONCLUSION Topical imiquimod and RPM have shown some efficacy in treating PWS with PDL, but to date there is no topical adjuvant to PDL that reliably improves results for PWS.
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Abstract
Port wine stain (PWS) is a congenital, progressive vascular malformation. Many patients with PWS develop hypertrophy and discrete nodularity during their adult life, but the mechanism(s) remain incompletely understood. In this study, we attempted to investigate activation status of PKCα, PI3K, PDPK1 and PLC-γ and protein levels of PP2A and DAG to explore their potential roles in the formation of hypertrophic and nodular PWS lesions. We found phosphorylated levels of PKCα, PI3K, PDPK1, and PLC-γ and protein levels of PP2A and DAG showed moderate increases in the endothelial cells of hypertrophic PWS as compared to the adjacent normal skin. These increases extended throughout the entire stroma of blood vessels in PWS nodules. Many proliferating cells, such as fibroblasts, also showed strong activation of PKCα, PI3K, PDPK1 and PLC-γ and upregulations of PP2A and DAG in nodular PWS lesions. Our data showed that there is aberrant activation of PKCα, PI3K, PDPK1 and PLC-γ and upregulation of PP2A and DAG mainly in endothelial cells in hypertrophic PWS areas, but presenting in the entire vasculatures and surrounding fibroblasts in PWS nodules. Our data suggest that both PKCα and PI3K signaling pathways contribute to the development of hypertrophy and nodularity in adult PWS.
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26
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Alegre-Sánchez A, Boixeda P. RF-Topical Rapamycin as an Adjuvant to Laser Treatment in Capillary Malformations. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:915-916. [PMID: 29636196 DOI: 10.1016/j.ad.2017.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/31/2017] [Accepted: 09/03/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- A Alegre-Sánchez
- Unidad de Láser, Departamento de Dermatología, Hospital Ramón y Cajal, Madrid, España.
| | - P Boixeda
- Unidad de Láser, Departamento de Dermatología, Hospital Ramón y Cajal, Madrid, España
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Abstract
Vascular anomalies comprise a spectrum of diseases that are broadly classified as tumors and malformations. Diagnosis is often challenging, given a wide range of clinical presentations with overlapping signs and symptoms. Accurate diagnosis is critical to determine prognosis and to generate a management plan, which frequently involves multiple subspecialists during different phases of treatment. An updated classification system provides structure and clear, consistent terminology, allowing for improved diagnosis, provider communication, and collaboration. Historically, treatment of vascular anomalies was primarily surgical and medical therapies were limited or ineffective. Recent discoveries of pharmacologic agents effective in treating vascular anomalies have broadened our medical therapeutic options, limiting the need for unnecessary or high-risk procedures and improving patients' quality of life.
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Affiliation(s)
- Kiersten W Ricci
- Division of Hematology, Hemangioma and Vascular Malformation Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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28
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Higueros E, Roe E, Granell E, Baselga E. Sturge-Weber Syndrome: A Review. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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29
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Síndrome de Sturge-Weber: revisión. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:407-417. [DOI: 10.1016/j.ad.2016.09.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/11/2016] [Accepted: 09/18/2016] [Indexed: 12/14/2022] Open
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30
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Doh EJ, Ohn J, Kim MJ, Kim YG, Cho S. Prospective pilot study on combined use of pulsed dye laser and 1% topical rapamycin for treatment of nonfacial cutaneous capillary malformation. J DERMATOL TREAT 2017; 28:672-677. [DOI: 10.1080/09546634.2017.1306018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Eun Jin Doh
- Department of Dermatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jungyoon Ohn
- Department of Dermatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Min Ji Kim
- Department of Dermatology, Mapo-Gongdeok S&U Dermatology Clinic, Seoul, Korea
| | - Young Gull Kim
- Department of Dermatology, Mapo-Gongdeok S&U Dermatology Clinic, Seoul, Korea
| | - Soyun Cho
- Department of Dermatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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31
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Greveling K, Prens EP, van Doorn MB. Treatment of port wine stains using Pulsed Dye Laser, Erbium YAG Laser, and topical rapamycin (sirolimus)-A randomized controlled trial. Lasers Surg Med 2016; 49:104-109. [DOI: 10.1002/lsm.22548] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Karin Greveling
- Department of Dermatology; Erasmus MC University Medical Center Rotterdam; 3015 CA Rotterdam The Netherlands
| | - Errol P. Prens
- Department of Dermatology; Erasmus MC University Medical Center Rotterdam; 3015 CA Rotterdam The Netherlands
| | - Martijn B. van Doorn
- Department of Dermatology; Erasmus MC University Medical Center Rotterdam; 3015 CA Rotterdam The Netherlands
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32
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Choi B, Tan W, Jia W, White SM, Moy WJ, Yang BY, Zhu J, Chen Z, Kelly KM, Nelson JS. The Role of Laser Speckle Imaging in Port-Wine Stain Research: Recent Advances and Opportunities. IEEE JOURNAL OF SELECTED TOPICS IN QUANTUM ELECTRONICS : A PUBLICATION OF THE IEEE LASERS AND ELECTRO-OPTICS SOCIETY 2016; 2016:6800812. [PMID: 27013846 PMCID: PMC4800318 DOI: 10.1109/jstqe.2015.2493961] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Here, we review our current knowledge on the etiology and treatment of port-wine stain (PWS) birthmarks. Current treatment options have significant limitations in terms of efficacy. With the combination of 1) a suitable preclinical microvascular model, 2) laser speckle imaging (LSI) to evaluate blood-flow dynamics, and 3) a longitudinal experimental design, rapid preclinical assessment of new phototherapies can be translated from the lab to the clinic. The combination of photodynamic therapy (PDT) and pulsed-dye laser (PDL) irradiation achieves a synergistic effect that reduces the required radiant exposures of the individual phototherapies to achieve persistent vascular shutdown. PDL combined with anti-angiogenic agents is a promising strategy to achieve persistent vascular shutdown by preventing reformation and reperfusion of photocoagulated blood vessels. Integration of LSI into the clinical workflow may lead to surgical image guidance that maximizes acute photocoagulation, is expected to improve PWS therapeutic outcome. Continued integration of noninvasive optical imaging technologies and biochemical analysis collectively are expected to lead to more robust treatment strategies.
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Affiliation(s)
- Bernard Choi
- Departments of Biomedical Engineering and Surgery, the Beckman Laser Institute and Medical Clinic, and the Edwards Lifesciences Center for Advanced Cardiovascular Technology, all at University of California, Irvine 92612 USA
| | - Wenbin Tan
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | - Wangcun Jia
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | - Sean M. White
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | - Wesley J. Moy
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | - Bruce Y. Yang
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | | | | | - Kristen M. Kelly
- Department of Dermatology and the Beckman Laser Institute and Medical Clinic, all at University of California, Irvine 92612 USA
| | - J. Stuart Nelson
- Departments of Biomedical Engineering and Surgery and the Beckman Laser Institute and Medical Clinic, all at University of California, Irvine 92612 USA
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33
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Passeron T, Maza A, Fontas E, Toubel G, Vabres P, Livideanu C, Mazer JM, Rossi B, Boukari F, Harmelin Y, Dreyfus I, Mazereeuw-Hautier J, Lacour JP. Treatment of port wine stains with pulsed dye laser and topical timolol: a multicenter randomized controlled trial. Br J Dermatol 2016; 170:1350-3. [PMID: 24641096 DOI: 10.1111/bjd.12772] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Neoangiogenesis occurs within days following laser treatment of port wine stains (PWS), and plays a central role in treatment failures. Topical use of timolol can significantly reduce the production of vascular endothelial growth factor in vitro, and in animal models. OBJECTIVES The aim of this study was to assess the efficacy of topical timolol in combination with pulsed dye laser (PDL) treatment, compared with PDL alone, for treating PWS. METHODS This was a prospective multicenter controlled trial performed in children with PWS of the face who had not previously received laser treatment. After randomization, one group was treated with PDL alone, and the other with PDL followed by twice daily applications of timolol gel. Three laser sessions were performed at 1-month intervals with fixed parameters. The evaluation was performed on standardized pictures by two independent physicians blinded to the treatment received. The primary endpoint was marked or complete improvement of the PWS [Investigator Global Assessment (IGA) 3 or 4] 1 month after the third session. RESULTS Twenty-two children were included. Two patients were lost to follow-up. There was no difference in the success rate between the two groups (IGA 3 or 4 observed in one of 10 patients and two of 12 patients, for PDL alone, and for PDL associated with topical timolol, respectively; P = 1·0). No side-effect related to the application of topical timolol was observed. CONCLUSIONS The addition of timolol gel for preventing neoangiogenesis failed to significantly improve the efficacy of PDL treatment of PWS.
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Affiliation(s)
- T Passeron
- Department of Dermatology, University Hospital of Nice, Nice, France; INSERM U1065, Team 12, C3M, Nice, France
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Griffin TD, Foshee JP, Finney R, Saedi N. Port wine stain treated with a combination of pulsed dye laser and topical rapamycin ointment. Lasers Surg Med 2015; 48:193-6. [DOI: 10.1002/lsm.22436] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Thomas D. Griffin
- Department of Dermatology and Cutaneous Biology; Thomas Jefferson University Hospital; Philadelphia Philadelphia 19107
| | - James P. Foshee
- Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia Philadelphia 19107
| | - Robert Finney
- Department of Dermatology and Cutaneous Biology; Thomas Jefferson University Hospital; Philadelphia Philadelphia 19107
| | - Nazanin Saedi
- Department of Dermatology and Cutaneous Biology; Thomas Jefferson University Hospital; Philadelphia Philadelphia 19107
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35
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Colletti G, Dalmonte P, Moneghini L, Ferrari D, Allevi F. Adjuvant role of anti-angiogenic drugs in the management of head and neck arteriovenous malformations. Med Hypotheses 2015; 85:298-302. [DOI: 10.1016/j.mehy.2015.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/28/2015] [Indexed: 01/06/2023]
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36
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Taquin H, Lacour JP, Le Duff F, Chiaverini C, Passeron T. Treatment of resistant port-wine stains with bosentan and pulsed dye laser: a pilot prospective study. J Eur Acad Dermatol Venereol 2015; 30:1432-4. [PMID: 26304141 DOI: 10.1111/jdv.13275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H Taquin
- Department of Dermatology, University Hospital of Nice, Archet 2 Hospital, Route de saint Antoine de Ginestière, Nice, 06200, France
| | - J-P Lacour
- Department of Dermatology, University Hospital of Nice, Archet 2 Hospital, Route de saint Antoine de Ginestière, Nice, 06200, France
| | - F Le Duff
- Department of Dermatology, University Hospital of Nice, Archet 2 Hospital, Route de saint Antoine de Ginestière, Nice, 06200, France.,Clinical Research Center, University Hospital of Nice, Nice, France
| | - C Chiaverini
- Department of Dermatology, University Hospital of Nice, Archet 2 Hospital, Route de saint Antoine de Ginestière, Nice, 06200, France
| | - T Passeron
- Department of Dermatology, University Hospital of Nice, Archet 2 Hospital, Route de saint Antoine de Ginestière, Nice, 06200, France.,INSERM U1065, team 12, C3M, Nice, France
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37
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Yang B, Yang O, Guzman J, Nguyen P, Crouzet C, Osann KE, Kelly KM, Nelson JS, Choi B. Intraoperative, real-time monitoring of blood flow dynamics associated with laser surgery of port wine stain birthmarks. Lasers Surg Med 2015; 47:469-475. [PMID: 26040983 DOI: 10.1002/lsm.v47.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 05/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Port-wine stain (PWS) birthmarks affect ∼22 million people worldwide. After several treatment sessions, complete disappearance of the PWS occurs in only ∼10% of treated patients. There is a need to develop a new strategy to improve the efficacy of each treatment session and the overall treatment outcome. The study objective was to determine how intraoperative measurements of blood flow correlate with treatment response assessed several weeks post treatment. STUDY DESIGN/MATERIALS AND METHODS We employed Laser Speckle Imaging (LSI) to measure intraoperative blood-flow dynamics. We collected data from 24 subjects undergoing laser therapy for facial PWS birthmarks. Photographs were taken before treatment and at a follow-up visit, and analyzed by two expert observers. RESULTS Intraoperative LSI enables real-time monitoring of blood-flow dynamics in response to laser treatment and can inform clinicians on the need for focused re-treatment. The degree of PWS blanching achieved is positively correlated with the log-transformed acute blood-flow reduction (P = 0.022). CONCLUSION LSI is a simple, intraoperative monitoring tool during laser therapy of PWS birthmarks. LSI provides a single value for blood flow that correlates well with the degree of blanching achieved with laser therapy.
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Affiliation(s)
- Bruce Yang
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612
- Department of Biomedical Engineering, University of California, Irvine, California 92697
| | - Owen Yang
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612
- Department of Biomedical Engineering, University of California, Irvine, California 92697
| | - John Guzman
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612
- Department of Biomedical Engineering, University of California, Irvine, California 92697
| | - Paul Nguyen
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612
- Department of Biomedical Engineering, University of California, Irvine, California 92697
| | | | - Kathryn E Osann
- Division of Hematology/Oncology, School of Medicine, University of California, Irvine, California 92697
| | - Kristen M Kelly
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612
- Department of Dermatology, University of California, Irvine, California 92697
| | - J Stuart Nelson
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612
- Department of Biomedical Engineering, University of California, Irvine, California 92697
- Division of Hematology/Oncology, School of Medicine, University of California, Irvine, California 92697
- Department of Dermatology, University of California, Irvine, California 92697
- Department of Surgery, University of California, Irvine, California 92697
| | - Bernard Choi
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612
- Department of Biomedical Engineering, University of California, Irvine, California 92697
- Department of Surgery, University of California, Irvine, California 92697
- Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, California 92697
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38
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Bloom BS, Nelson JS, Geronemus RG. Topical rapamycin combined with pulsed dye laser (PDL) in the treatment of capillary vascular malformations—Anatomical differences in response to PDL are relevant to interpretation of study results. J Am Acad Dermatol 2015; 73:e71. [DOI: 10.1016/j.jaad.2015.03.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
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39
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Yang B, Yang O, Guzman J, Nguyen P, Crouzet C, Osann KE, Kelly KM, Nelson JS, Choi B. Intraoperative, real-time monitoring of blood flow dynamics associated with laser surgery of port wine stain birthmarks. Lasers Surg Med 2015; 47:469-75. [PMID: 26040983 DOI: 10.1002/lsm.22369] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Port-wine stain (PWS) birthmarks affect ∼22 million people worldwide. After several treatment sessions, complete disappearance of the PWS occurs in only ∼10% of treated patients. There is a need to develop a new strategy to improve the efficacy of each treatment session and the overall treatment outcome. The study objective was to determine how intraoperative measurements of blood flow correlate with treatment response assessed several weeks post treatment. STUDY DESIGN/MATERIALS AND METHODS We employed Laser Speckle Imaging (LSI) to measure intraoperative blood-flow dynamics. We collected data from 24 subjects undergoing laser therapy for facial PWS birthmarks. Photographs were taken before treatment and at a follow-up visit, and analyzed by two expert observers. RESULTS Intraoperative LSI enables real-time monitoring of blood-flow dynamics in response to laser treatment and can inform clinicians on the need for focused re-treatment. The degree of PWS blanching achieved is positively correlated with the log-transformed acute blood-flow reduction (P = 0.022). CONCLUSION LSI is a simple, intraoperative monitoring tool during laser therapy of PWS birthmarks. LSI provides a single value for blood flow that correlates well with the degree of blanching achieved with laser therapy.
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Affiliation(s)
- Bruce Yang
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612.,Department of Biomedical Engineering, University of California, Irvine, California 92697
| | - Owen Yang
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612.,Department of Biomedical Engineering, University of California, Irvine, California 92697
| | - John Guzman
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612.,Department of Biomedical Engineering, University of California, Irvine, California 92697
| | - Paul Nguyen
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612.,Department of Biomedical Engineering, University of California, Irvine, California 92697
| | | | - Kathryn E Osann
- Division of Hematology/Oncology, School of Medicine, University of California, Irvine, California 92697
| | - Kristen M Kelly
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612.,Department of Dermatology, University of California, Irvine, California 92697
| | - J Stuart Nelson
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612.,Department of Biomedical Engineering, University of California, Irvine, California 92697.,Division of Hematology/Oncology, School of Medicine, University of California, Irvine, California 92697.,Department of Dermatology, University of California, Irvine, California 92697.,Department of Surgery, University of California, Irvine, California 92697
| | - Bernard Choi
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612.,Department of Biomedical Engineering, University of California, Irvine, California 92697.,Department of Surgery, University of California, Irvine, California 92697.,Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, California 92697
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40
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Ortiz A. A novel approach to port-wine stains. Br J Dermatol 2015; 172:556-7. [DOI: 10.1111/bjd.13533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Ortiz
- Laser and Cosmetic Dermatology; Division of Dermatology; University of California San Diego; 8899 University Center Ln. #350 San Diego CA 92122 U.S.A
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41
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Topical rapamycin combined with pulsed dye laser in the treatment of capillary vascular malformations in Sturge-Weber syndrome: Phase II, randomized, double-blind, intraindividual placebo-controlled clinical trial. J Am Acad Dermatol 2015; 72:151-8.e1. [DOI: 10.1016/j.jaad.2014.10.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/26/2014] [Accepted: 10/08/2014] [Indexed: 11/29/2022]
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Gao L, Nadora DM, Phan S, Chernova M, Sun V, Preciado SMO, Jia W, Wang G, Mihm MC, Nelson JS, Tan W. Topical axitinib suppresses angiogenesis pathways induced by pulsed dye laser. Br J Dermatol 2014; 172:669-76. [PMID: 25283693 DOI: 10.1111/bjd.13439] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND The recurrence of port-wine stain (PWS) blood vessels by pulsed dye laser (PDL)-induced angiogenesis is a critical barrier that must be overcome to achieve a better therapeutic outcome. OBJECTIVES To determine whether PDL-induced angiogenesis can be suppressed by topical axitinib. METHODS The mRNA expression profiles of 86 angiogenic genes and phosphorylation levels of extracellular signal regulated kinases (ERKs), phosphorylated protein kinase B (AKT) and ribosomal protein S6 kinase (p70S6K) in rodent skin were examined with or without topical axitinib administration after PDL exposure. RESULTS The PDL-induced increased transcriptional levels of angiogenic genes peaked at days 3-7 post-PDL exposure. Topical application of 0·5% axitinib effectively suppressed the PDL-induced increase in mRNA levels of the examined angiogenic genes and activation of AKT, P70S6K and ERK from days 1 to 7 post-PDL exposure. After topical administration, axitinib penetrated into rodent skin to an approximate depth of 929·5 μm. CONCLUSIONS Topical application of 0·5% axitinib can systematically suppress the PDL-induced early stages of angiogenesis via inhibition of the AKT/mammalian target of rapamycin/p70S6K and Src homology 2 domain containing transforming protein-1/mitogen-activated protein kinase kinase/ERK pathway cascades.
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Affiliation(s)
- L Gao
- Department of Surgery and Biomedical Engineering, Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA, 92617, U.S.A; Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
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Gao L, Phan S, Nadora DM, Chernova M, Sun V, Preciado SMO, Ballew B, Jia Z, Jia W, Wang G, Mihm MC, Nelson JS, Tan W. Topical rapamycin systematically suppresses the early stages of pulsed dye laser-induced angiogenesis pathways. Lasers Surg Med 2014; 46:679-88. [PMID: 25270513 DOI: 10.1002/lsm.22296] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Administration of topical rapamycin (RPM) suppresses the regeneration and revascularization of photocoagulated blood vessels induced by pulsed dye laser (PDL). OBJECTIVE To systematically elucidate the molecular pathophysiology of the inhibition of PDL-induced angiogenesis by topical RPM in a rodent model. METHODS The mRNA expression profiles of 86 angiogenic genes and phosphorylation levels of ribosomal protein S6 kinase (P70S6K) in rodent skin were examined with or without topical RPM administration post-PDL exposure. RESULTS The PDL-induced systematic increases in transcriptional levels of angiogenic genes showed a peak expression at days 3-7 post-PDL in rodent skin. Topical application of 1% RPM significantly and systematically suppressed the PDL-induced increase in mRNA levels of the examined angiogenic genes during the first five days post-PDL. The phosphorylation levels of P70S6K increased after PDL exposure but those increases were suppressed by the topical RPM. After topical application, RPM penetrated to an approximate depth of 768.4 μm into rodent skin. CONCLUSION Topical application of 1% RPM can significantly and systematically suppress the PDL-induced early stage of angiogenesis via inhibition of the AKT/mTOR/P70S6K pathway in a rodent model.
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Affiliation(s)
- Lin Gao
- Department of Surgery and Biomedical Engineering, Beckman Laser Institute and Medical Clinic, University of California, Irvine, 92612, California; Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
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44
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Abstract
PURPOSE OF REVIEW Children and their parents typically present to pediatricians to discuss treatment options for melanocytic nevi, nevus sebaceus, port-wine stains, and hemangiomas. Each of these conditions may be medically managed, but in some situations surgical intervention may be preferable. RECENT FINDINGS Although recent studies have improved our understanding of melanoma risk among patients with congenital nevi, prospective trials are needed to more accurately assess whether surgical excision mitigates this risk. The risk of basal cell carcinoma within nevus sebaceus appears to be low, but more conclusive data requires further studies with modern immunohistochemical analysis. Pulsed dye laser is effective for treating port-wine stains, although the optimal timing is controversial. While oral and topical beta blockers have revolutionized the treatment of proliferating infantile hemangiomas, laser and/or surgical excision are useful in selected situations. SUMMARY Excisional and/or laser surgery are indicated for certain common dermatologic conditions in children, although the optimal timing of these interventions is often subjective. Pediatricians should be familiar with why and when to refer patients for surgery of these common dermatological conditions.
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Affiliation(s)
- Julianne A Mann
- Department of Dermatology and Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
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45
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Barreau M, Dompmartin A. Les malformations cutanées vasculaires non syndromiques. Ann Dermatol Venereol 2014; 141:56-67. [DOI: 10.1016/j.annder.2013.10.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 10/18/2013] [Accepted: 10/23/2013] [Indexed: 01/19/2023]
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46
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Savas JA, Ledon JA, Franca K, Chacon A, Nouri K. Pulsed dye laser-resistant port-wine stains: mechanisms of resistance and implications for treatment. Br J Dermatol 2013; 168:941-53. [PMID: 23290045 DOI: 10.1111/bjd.12204] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Port-wine stains (PWS) are among the most common congenital vascular malformations. Unlike capillary haemangiomas, these lesions do not involute spontaneously but rather become progressively more disfiguring as the patient ages. While benign in nature, the cosmetic deformity and attendant psychological and emotional distress prompt the majority of those afflicted to seek treatment. The pulsed dye laser (PDL) has long been considered the treatment of choice for these vascular lesions; however, very few patients achieve total clearance with PDL therapy and a significant number of lesions fail to respond at all. In order to address these recalcitrant cases, the mechanisms that contribute to treatment resistance must be understood and novel laser and light therapies must be employed. This review will address what is currently known about lesion-specific characteristics of PDL-resistant PWS as well as discuss current and future treatment options.
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Affiliation(s)
- J A Savas
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL 33136, USA.
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Sebaratnam DF, Lim AC, Lowe PM, Goodman GJ, Bekhor P, Richards S. Lasers and laser-like devices: Part two. Australas J Dermatol 2013; 55:1-14. [DOI: 10.1111/ajd.12111] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/11/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Deshan F Sebaratnam
- Department of Dermatology; Royal Prince Alfred Hospital; Camperdown New South Wales
- University of Sydney; Camperdown New South Wales
| | - Adrian C Lim
- Department of Dermatology; Royal North Shore Hospital; St Leonards New South Wales
| | - Patricia M Lowe
- Department of Dermatology; Royal Prince Alfred Hospital; Camperdown New South Wales
- University of Sydney; Camperdown New South Wales
| | | | - Philip Bekhor
- Department of Dermatology; Royal Childrens Hospital; Melbourne Victoria
| | - Shawn Richards
- Skin and Cancer Foundation Australia; Westmead New South Wales Australia
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A review of contemporary options for medical management of hemangiomas, other vascular tumors, and vascular malformations. Pharmacol Ther 2013; 139:327-33. [DOI: 10.1016/j.pharmthera.2013.05.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 04/26/2013] [Indexed: 01/06/2023]
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50
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[Therapeutic tools for port-wine stains]. Ann Dermatol Venereol 2013; 140:226-33; quiz 225, 234. [PMID: 23466161 DOI: 10.1016/j.annder.2012.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/14/2012] [Accepted: 12/13/2012] [Indexed: 11/24/2022]
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