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Pandey A, Srivastava A, Pant N, Singh S, Rawat J. Intralesional steroid in the era of propranolol for infantile hemangioma-Do we need it? J Plast Reconstr Aesthet Surg 2023; 77:117-122. [PMID: 36566639 DOI: 10.1016/j.bjps.2022.11.038] [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: 12/30/2021] [Revised: 10/06/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Despite its effectivity, there are reports of poor response to propranolol in the treatment of infantile hemangioma (IH). The literature is limited to the type of IH that fails to respond to propranolol. This study was conducted to analyze which types of hemangiomas respond poorly to propranolol and the effects of intralesional triamcinolone (IL TMC) in them. MATERIAL AND METHODS In this prospective cohort study, IH was classified as superficial, deep, and mixed. The clinical details were recorded. Propranolol was started in the patients at a dose of 1 mg/kg/day and increased to 2-3 mg/kg/day. The response to the treatment was evaluated as excellent, good, poor, and no response. IL TMC was given in the non-responding group at a dose of 1-2 mg/kg at one-month interval for a total of six doses after stopping propranolol. RESULTS Ninety-six patients (median age, 7 months; M/F = 2:1) were treated. Superficial hemangioma was present in 40 (41.7%), deep in 10 (10.4%), and mixed in 46 (47.9%) patients. The response was statistically better if initiated within four months of age. It was not influenced by the sex, number, site, or size. The response was statistically better in superficial hemangioma. IL TMC was administered in the 16 patients. The response was good or excellent in 10 patients. CONCLUSION Propranolol will be used as a first-line drug for IH. All superficial IHs are likely to respond. There will be a possibility of non-responding mixed or deep IH. Use of IL TMC seems reasonable for IH not responding to propranolol.
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Affiliation(s)
- Anand Pandey
- Department of Pediatric Surgery, King George's Medical University, Lucknow, 226003, UP, India.
| | - Anurag Srivastava
- Department of Pediatric Surgery, King George's Medical University, Lucknow, 226003, UP, India
| | - Nitin Pant
- Department of Pediatric Surgery, King George's Medical University, Lucknow, 226003, UP, India
| | - Sudhir Singh
- Department of Pediatric Surgery, King George's Medical University, Lucknow, 226003, UP, India
| | - Jiledar Rawat
- Department of Pediatric Surgery, King George's Medical University, Lucknow, 226003, UP, India
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Ji F, Liu Y, Shi J, Liu C, Fu S, Wang H, Ren B, Mi D, Gao S, Sun D. Single-Cell Transcriptome Analysis Reveals Mesenchymal Stem Cells in Cavernous Hemangioma. Front Cell Dev Biol 2022; 10:916045. [PMID: 35865633 PMCID: PMC9294370 DOI: 10.3389/fcell.2022.916045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
A cavernous hemangioma, well-known as vascular malformation, is present at birth, grows proportionately with the child, and does not undergo regression. Although a cavernous hemangioma has well-defined histopathological characteristics, its origin remains controversial. In the present study, we characterized the cellular heterogeneity of a cavernous hemangioma using single-cell RNA sequencing (scRNA-seq). The main contribution of the present study is that we discovered a large number of embryonic mesenchymal stem cells (MSCs) in a cavernous hemangioma and proposed that cavernous hemangiomas may originate from embryonic MSCs. Further analysis of the embryonic MSCs revealed that: 1) proinflammatory cytokines and related genes TNF, TNFSF13B, TNFRSF12A, TNFAIP6, and C1QTNF6 are significantly involved in the MSC-induced immune responses in cavernous hemangiomas; 2) UCHL1 is up-regulated in the embryonic MSC apoptosis induced by proinflammatory cytokines; 3) the UCHL1-induced apoptosis of MSCs may play an important role in the MSC-induced immune responses in cavernous hemangiomas; and 4) UCHL1 can be used as a marker gene to detect embryonic MSCs at different apoptosis stages. In addition to MSCs, ECs, macrophages, T lymphocytes and NKCs were intensively investigated, revealing the genes and pathways featured in cavernous hemangiomas. The present study revealed the origin of cavernous hemangiomas and reported the marker genes, cell types and molecular mechanisms, which are associated with the origin, formation, progression, diagnosis and therapy of cavernous hemangiomas. The better understanding of the MSC-induced immune responses in benign tumours helps to guide future investigation and treatment of embryonic MSC-caused tumours. Our findings initiated future research for the rediscovery of MSCs, cancers/tumours and the UCHL1-induced apoptosis.
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Affiliation(s)
- Fulong Ji
- Department of Paediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yong Liu
- Department of Paediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinsong Shi
- College of Life Sciences, Nankai University, Tianjin, China
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Chunxiang Liu
- Department of Paediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Siqi Fu
- Department of Paediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Heng Wang
- Department of Paediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Bingbing Ren
- Department of Paediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Dong Mi
- Department of Clinical Laboratory, Affiliated Maternity Hospital, Nankai University, Tianjin, China
| | - Shan Gao
- College of Life Sciences, Nankai University, Tianjin, China
- *Correspondence: Shan Gao, ; Daqing Sun,
| | - Daqing Sun
- Department of Paediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Shan Gao, ; Daqing Sun,
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