1
|
Ning J, Wang F, Liu SQ, Zhang RZ, Liu DM, Li Y. Clinical Observation on the Therapeutic Effect of Port-Wine Stains with Intravenous Injection of Hematoporphyrin Monomethyl Ether (HMME). Clin Cosmet Investig Dermatol 2024; 17:1183-1191. [PMID: 38800356 PMCID: PMC11127686 DOI: 10.2147/ccid.s459613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
Background Hematoporphyrin monomethyl ether (HMME) is a promising photosensitizer for photodynamic therapy (PDT) and has found wide application in the treatment of port-wine stains (PWS). Objective This study aims to observe and analyze the clinical efficacy and safety of HMME-PDT in the treatment of PWS patients. It also aims to evaluate the usefulness of color Doppler flow imaging (CDFI), an ultrasound technique for detecting blood flow in skin lesions, in assessing clinical efficacy. Methods Thirty-three patients with PWS underwent HMME-PDT at our dermatology outpatient clinic between January 2019 and March 2020. Data on patient demographics, lesion location, lesion type (pink, purple, nodular thickening), treatment frequency, and pre- and post-treatment images were collected and retrospectively analyzed. CDFI was performed on three patients. Results All patients received intravenous HMME and underwent irradiation with 532 nm green LED light. Of these, 5 patients received 1 session of HMME-PDT, 14 received 2 sessions, 9 received 3 sessions and the remaining 5 patients received more than 3 sessions. Of the 33 patients, 9 were cured (27.27%), 10 showed improvement (30.30%), 11 experienced a reduction in symptoms (33.33%), and 3 showed no significant improvement (9.09%). Most patients reported local pain and oedema, and no systemic adverse effects were observed. Clinical efficacy correlated with lesion type and total number of treatment sessions. CDFI appears to be an excellent technique for assessing clinical efficacy. Conclusion HMME-PDT is a safe and effective method for the treatment of PWS. CDFI examination appears to be a promising assessment tool. However, further validation with larger sample sizes is warranted.
Collapse
Affiliation(s)
- Jing Ning
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People’s Republic of China
| | - Fang Wang
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People’s Republic of China
| | - Shui-Qing Liu
- Department of Ultrasound in Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People’s Republic of China
| | - Ru-Zhi Zhang
- Department of Dermatology, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 240000, People’s Republic of China
| | - Dan-Min Liu
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People’s Republic of China
| | - Yan Li
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People’s Republic of China
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Nguyen V, Gao C, Hochman ML, Kravitz J, Chen EH, Friedman HI, Wenceslau CF, Chen D, Wang Y, Nelson JS, Jegga AG, Tan W. Endothelial cells differentiated from patient dermal fibroblast-derived induced pluripotent stem cells resemble vascular malformations of port-wine birthmark. Br J Dermatol 2023; 189:780-783. [PMID: 37672656 PMCID: PMC10653332 DOI: 10.1093/bjd/ljad330] [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] [Received: 07/04/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023]
Abstract
Lesional induced pluripotent stem cell-derived endothelial cells can resemble pathological vascular phenotypes of port-wine birthmark (PWB). Our data demonstrate that multiple pathways, including Hippo and Wnt, NFκB, TNF, MAPK and cholesterol metabolism, are dysregulated. These data suggest new therapeutics can be developed to target such dysregulated pathways in the treatment of PWB.
Collapse
Affiliation(s)
- Vi Nguyen
- Department of Cell Biology and Anatomy, School of Medicine
| | - Chao Gao
- Department of Cell Biology and Anatomy, School of Medicine
| | | | - Jacob Kravitz
- Department of Cell Biology and Anatomy, School of Medicine
| | | | | | - Camilla F Wenceslau
- Department of Cell Biology and Anatomy, School of Medicine
- Department of Biomedical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, USA
| | | | - Yunguan Wang
- Department of Pediatrics, University of Cincinnati College of Medicine, 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
| | - Wenbin Tan
- Department of Cell Biology and Anatomy, School of Medicine
- Department of Biomedical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, USA
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Liu L, Zhou L, Zhao Q, Li X, Yang L, Li E, Wei D, Jiang X. Histological analysis of different types of port-wine stains to guide clinical decision making: A retrospective study. Indian J Dermatol Venereol Leprol 2022; 89:204-212. [PMID: 35593279 DOI: 10.25259/ijdvl_730_2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/01/2022] [Indexed: 02/05/2023]
Abstract
Background and objectives Port-wine stains are defined as congenital benign vascular lesions. The treatment of port-wine stains remains a challenge, worldwide. This study aimed to analyze the histological characteristics in different types of port-wine stains and provide guidance for clinical decision-making. Methods and materials Biopsies were from the hospital from 2015 to 2021. H&E staining, Immunofluorescence staining, Masson's trichrome staining and Weigert staining were performed on the tissues. Results A total of 35 port-wine stains patients were included in the study of four distinct types, namely red port-wine stains (11 cases), purple port-wine stains (seven cases), hypertrophic port-wine stains (nine cases) and nodular port-wine stains (eight cases). The mean vessel diameter of the different types was 38.7 ± 5.9 μm, 93.5 ± 9.7 μm, 155.6 ± 21.8 μm and 155.6 ± 29.54 μm, respectively. Mean vessel depth was 396.4 ± 31 μm, 944.2 ± 105.4 μm, 2,971 ± 161.3 μm and 3,594 ± 364.6 μm, respectively. The vessels in red port-wine stains, purple port-wine stains and hypertrophic port-wine stains were mainly composed of capillary and venous malformations, whereas those in nodular port-wine stains were venous or arteriovenous malformations. Limitation The main limitation of the current study was the small number of patients. Conclusion As the disease progresses, vessel diameters become larger, the vessel wall becomes thicker and vessels were found in a greater depth. A treatment plan should be scientifically formulated keeping in mind the histological characteristics of port-wine stains.
Collapse
Affiliation(s)
- Lian Liu
- Department of Dermatology, Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Diseaserelated Molecular Network, Wuhou District, Chengdu, Sichuan, China
| | - Li Zhou
- Department of Core Facility, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, China
| | - Qian Zhao
- Department of medical cosmetology, Chengdu Second People's Hospital, Qingyun South Street, Chengdu, Sichuan, China
| | - Xiaoxue Li
- Department of Dermatology, Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Diseaserelated Molecular Network, Wuhou District, Chengdu, Sichuan, China
| | - Lihua Yang
- Department of Dermatology, Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Diseaserelated Molecular Network, Wuhou District, Chengdu, Sichuan, China
| | - Erlong Li
- Department of Dermatology, Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Diseaserelated Molecular Network, Wuhou District, Chengdu, Sichuan, China
| | - Danfeng Wei
- Department of Dermatology, Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Diseaserelated Molecular Network, Wuhou District, Chengdu, Sichuan, China
| | - Xian Jiang
- Department of Dermatology, Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Diseaserelated Molecular Network, Wuhou District, Chengdu, Sichuan, China
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Valdivielso-Ramos M, Torrelo A, Martin-Santiago A, Hernández-Nuñez A, Azaña JM, Campos M, Berenguer B, Garnacho G, Moreno R, Colmenero I. Histopathological hallmarks of cutaneous lesions of capillary malformation-arteriovenous malformation syndrome. J Eur Acad Dermatol Venereol 2020; 34:2428-2435. [PMID: 32124491 DOI: 10.1111/jdv.16326] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/06/2020] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Capillary malformation-arteriovenous malformation (CM-AVM) syndrome is a recently described syndrome with distinctive cutaneous lesions. Very little is known about the histopathology of these lesions. OBJECTIVE The purpose of the study was to evaluate the histopathological characteristics of the pink macules of the CM-AVM syndrome and to investigate if these pink macules could be classified as capillary malformations or arteriovenous malformations based on their histopathological features. DESIGN-SETTINGS-PARTICIPANTS We conducted a retrospective multicenter study involving eight hospitals in Spain. Fifteen biopsies from pink macules of the CM-AVM syndrome were analysed and compared with five biopsies of diverse capillary malformations and three stage I arteriovenous malformations. RESULTS Pink macules' biopsies of the CM-AVM syndrome showed similar features including a high vascular density encompassing capillaries and numerous thick-walled arterioles mainly located in the superficial dermis, a predominance of elongated over round vessels, scarce or absent erythrocytes within the lumina and discrete perivascular inflammation. CMs were characterized by an increased number of capillary-type vessels mostly rounded and located in the upper dermis. AVMs were composed by highly increased numbers of vessels with a branching pattern involving the full thickness of the dermis, without erythrocytes within the lumina. Wilms tumour 1 protein was positive in the endothelial cells both in pink macules of the CM-AVM and in arteriovenous malformations. CONCLUSIONS AND RELEVANCE Pink macules of the CM-AVM syndrome seem to be different from capillary malformations. Our results suggest that histologically and immunohistochemically they are closer to incipient arteriovenous malformations than to capillary malformations. A deepened knowledge about the nature of these skin lesions will contribute to the better understanding of capillary malformation-arteriovenous malformation syndrome, and will open the possibility of new and more specific treatments in the future.
Collapse
Affiliation(s)
| | - A Torrelo
- Dermatology Department, Hospital Niño Jesus, Madrid, Spain
| | | | | | - J M Azaña
- Dermatology Department, Hospital Albacete, Albacete, Spain
| | - M Campos
- Dermatology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - B Berenguer
- Plastic Surgery Department, Hospital Gregorio Marañón, Madrid, Spain
| | - G Garnacho
- Dermatology Department, Hospital Reina Sofia, Córdoba, Spain
| | - R Moreno
- Dermatology Department, Hospital del Henares, Madrid, Spain
| | - I Colmenero
- Pathology Department, Hospital Niño Jesus, Madrid, Spain
| |
Collapse
|
11
|
Jeon H, Bernstein LJ, Belkin DA, Ghalili S, Geronemus RG. Pulsed Dye Laser Treatment of Port-Wine Stains in Infancy Without the Need for General Anesthesia. JAMA Dermatol 2020; 155:435-441. [PMID: 30865245 DOI: 10.1001/jamadermatol.2018.5249] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Recent concerns regarding repetitive use of general anesthesia in children younger than 3 years have placed greater importance on the controversy surrounding the timing of the initiation of port-wine stain (PWS) laser treatment. Objective To evaluate the use of PWS treatments at the age of 1 year or younger in the office setting without general anesthesia. Design, Setting, and Participants Retrospective cohort study based on medical record reviews at a single, high-volume laser center for children who started pulsed dye laser treatment at the age of 1 year or younger for their PWS between 2000 and 2017. The data cutoff was at 1 year after the initial treatment to have comparable data points. Main Outcomes and Measures The primary outcome was improvement of PWSs using before and after photographs, which were reviewed by 4 physicians independently and graded using the following 5-point visual analog scale (VAS): poor (grade 1: 0%-25% improvement), fair (grade 2: 26%-50% improvement), good (grade 3: 51%-75% improvement), excellent (grade 4: 76%-99% improvement), and complete (grade 5: 100% improvement) clearance. Results Of the 197 patients (73 [37.1%] boys; 124 [62.9%] girls), most (149 [75.6%]) had facial lesions. The mean age at the time of first treatment was 3.38 months (range, 5-355 days) and the mean number of treatments was 9.8 (range, 2-23; median, 10). Per the mean physician VAS grading of 197 patients, 51 patients (25.9%) showed 100% clearance (mean [range] VAS score of 4.78 [4.5 - 5]); 81 patients (41.1%) showed 76 to 99% improvement (mean [range] VAS score of 3.91 [3.5 to <4.5]); 44 patients (22.3%) showed 51% to 75% improvement (mean [range] VAS score of 2.86 [2.5 to <3.5]); 13 patients (6.6%) showed 26% to 50% improvement (mean [range] VAS score of 2.12 [1.5 to <2.5]); and 8 patients (4.1%) showed 0 to 25% improvement (mean [range] VAS score of 0.78 [0 to <1.5]). The presence of a V1 (first branch of the trigeminal nerve [ophthalmic nerve]) lesion was associated with a statistically significantly higher clearance rate by a VAS grade of 0.55 (95% CI, 0.25-0.84; P < .001). The mean (SD) VAS grade for all patients was 3.65 (1.26), corresponding to excellent clearance. None of the patients experienced scarring or permanent pigmentary change. Conclusions and Relevance In this study, treatment of PWSs in infancy was both safe and effective. Early intervention allows for treatment without general anesthesia, maximizing the chance to achieve clearance before school age and thereby minimizing the negative outcome of PWSs for both the patient and the family.
Collapse
Affiliation(s)
- Hana Jeon
- Laser & Skin Surgery Center of New York, New York
| | - Leonard J Bernstein
- Laser & Skin Surgery Center of New York, New York.,Department of Dermatology, Weill Cornell Medical Center, New York, New York
| | - Daniel A Belkin
- Laser & Skin Surgery Center of New York, New York.,Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | | | - Roy G Geronemus
- Laser & Skin Surgery Center of New York, New York.,Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| |
Collapse
|
12
|
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
| |
Collapse
|
13
|
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.
Collapse
|
14
|
Klyuchareva SV, Ponomarev IV, Pushkareva AE. Numerical Modeling and Clinical Evaluation of Pulsed Dye Laser and Copper Vapor Laser in Skin Vascular Lesions Treatment. J Lasers Med Sci 2018; 10:44-49. [PMID: 31360368 DOI: 10.15171/jlms.2019.07] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Different yellow lasers have been successfully used for the treatment of vascular lesions. This study is aimed to ascertain the role and efficiency of copper vapor lasers (CVLs) and pulsed dye lasers (PDLs) for the treatment of vascular lesions using numerical modeling and to compare results with our clinical experience. In this study we aimed to develop criteria for the choice of more efficient laser exposure mode, investigate more relevant modes of laser irradiation to ensure selective photothermolysis of target vessels, and compare the CVL and PDL efficiency in the course of patients with skin vascular lesions (SVL) treatment. Methods: We performed numerical simulation of the processes of heating a vessel with CVL and PDL to temperatures at which its coagulation could occur. Calculated fluencies were compared with clinical results of laser therapy performed on 1242 patients with skin hemangiomas and vascular malformations (SHVM), including 635 patients treated with CVL and 607 patients treated with PDL. PDL and CVL provided excellent results in 40 and ten days after treatment. The treatment was not painful. Patients did not need anesthesia. Postoperative crusts were greater with PDL than with CVL. Results: Results of computer simulation of a selective vessel heating using PDL and CVL radiation are presented. By results obtained, depth of the location and sizes of vessels that could be selectively heated to more than 75°C are determined. Conclusion: Based on calculated and clinical data, the heating mode for dysplastic vessels using a series of CVL micropulses could be regarded to be safer and more efficient than the mode of a PDL short, powerful pulse.
Collapse
Affiliation(s)
- S V Klyuchareva
- I.I. Mechnikov North-West State Medical University, 47 Piskarevkiy Prospect, Saint-Petersburg, 195067, Russian Federation
| | - Igor V Ponomarev
- P.N. Lebedev Physics Institute, RAS, 53 Leninskiy Prospect, Moscow, 119991, Russian Federation
| | - A E Pushkareva
- Saint Petersburg National Research University of Information Technologies, Mechanics and Optics; 49 Kronverkskiy Prospect, St. Petersburg, 197101, Russian Federation
| |
Collapse
|
15
|
Yin R, Rice SJ, Wang J, Gao L, Tsai J, Anvari RT, Zhou F, Liu X, Wang G, Tang Y, Mihm MC, Belani CP, Chen DB, Nelson JS, Tan W. Membrane trafficking and exocytosis are upregulated in port wine stain blood vessels. Histol Histopathol 2018; 34:479-490. [PMID: 30302745 DOI: 10.14670/hh-18-051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Port wine stain (PWS) is characterized as a progressive dilatation of immature venule-like vasculatures which result from differentiation-impaired endothelial cells. In this study, we aimed to identify the major biological pathways accounting for the pathogenesis of PWS. METHODS Sequential windowed acquisition of all theoretical fragment ion mass spectra (SWATH-MS) was used to identify differentially expressed proteins in PWS lesions, followed by confirmative studies with immunohistochemistry, immunoblot and transmission electron microscopy (TEM). RESULTS 107 out of 299 identified proteins showed differential expressions in PWS lesions as compared to normal skin, mainly involving the functions of biosynthesis, membrane trafficking, cytoskeleton and cell adhesion/migration. The confirmative studies showed that expressions of membrane trafficking/exocytosis related proteins such as VAT1, IQGAP1, HSC70, clathrin, perlecan, spectrin α1 and GDIR1 were significantly increased in PWS blood vessels as compared to normal ones; while collagen subtypes 6A1 and 6A3 were decreased in PWS skin. Furthermore, TEM studies showed there is a significant upregulation of extracellular vesicle exocytosis from PWS blood vessels as compared to control. CONCLUSIONS The biological process of membrane trafficking and exocytosis is enhanced in PWS blood vessels. Our results imply that the extracellular vesicles released by lesional endothelial cells may act as potential intercellular signaling mediators to contribute to the pathogenesis of PWS.
Collapse
Affiliation(s)
- Rong Yin
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA.,Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, South Carolina, USA.,Department of Dermatology, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | | | - Jinwei Wang
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA.,Department of Urology, the Xiangya 3rd Hospital, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Lin Gao
- Department of Dermatology, Xijing Hospital, Xi'an, China
| | - Joseph Tsai
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA
| | - Radean T Anvari
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA
| | - Fang Zhou
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA.,Department of Urology, the Xiangya 3rd Hospital, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Xin Liu
- Penn State Cancer Institute, Hershey, PA, USA
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Xi'an, China
| | - Yuxin Tang
- Department of Urology, the Xiangya 3rd Hospital, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Martin C Mihm
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chandra P Belani
- Penn State Cancer Institute, Hershey, PA, USA.,Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Dong-Bao Chen
- Department of Obstetrics and Gynecology, University of California, Irvine, California, USA
| | - J Stuart Nelson
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA.,Department of Biomedical Engineering, University of California, Irvine, California, USA
| | - Wenbin Tan
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA.,Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, South Carolina, USA.
| |
Collapse
|
16
|
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.
Collapse
|
17
|
Tan W, Wang J, Zhou F, Gao L, Yin R, Liu H, Sukanthanag A, Wang G, Mihm MC, Chen DB, Nelson JS. Coexistence of Eph receptor B1 and ephrin B2 in port-wine stain endothelial progenitor cells contributes to clinicopathological vasculature dilatation. Br J Dermatol 2017; 177:1601-1611. [PMID: 28599054 DOI: 10.1111/bjd.15716] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Port-wine stain (PWS) is a vascular malformation characterized by progressive dilatation of postcapillary venules, but the molecular pathogenesis remains obscure. OBJECTIVES To illustrate that PWS endothelial cells (ECs) present a unique molecular phenotype that leads to pathoanatomical PWS vasculatures. METHODS Immunohistochemistry and transmission electron microscopy were used to characterize the ultrastructure and molecular phenotypes of PWS blood vessels. Primary culture of human dermal microvascular endothelial cells and in vitro tube formation assay were used for confirmative functional studies. RESULTS Multiple clinicopathological features of PWS blood vessels during the development and progression of the disease were shown. There were no normal arterioles and venules observed phenotypically and morphologically in PWS skin; arterioles and venules both showed differentiation impairments, resulting in a reduction of arteriole-like vasculatures and defects in capillary loop formation in PWS lesions. PWS ECs showed stemness properties with expression of endothelial progenitor cell markers CD133 and CD166 in non-nodular lesions. They also expressed dual venous/arterial identities, Eph receptor B1 (EphB1) and ephrin B2 (EfnB2). Co-expression of EphB1 and EfnB2 in normal human dermal microvascular ECs led to the formation of PWS-like vasculatures in vitro, for example larger-diameter and thick-walled capillaries. CONCLUSIONS PWS ECs are differentiation-impaired, late-stage endothelial progenitor cells with a specific phenotype of CD133+ /CD166+ /EphB1+ /EfnB2+ , which form immature venule-like pathoanatomical vasculatures. The disruption of normal EC-EC interactions by coexistence of EphB1 and EfnB2 contributes to progressive dilatation of PWS vasculatures.
Collapse
Affiliation(s)
- W Tan
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, U.S.A
| | - J Wang
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, U.S.A.,The Third Xiangya Hospital, Xiangya School of Medicine, Central South University, Changsha, Hunan, 412000, China
| | - F Zhou
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, U.S.A.,The Third Xiangya Hospital, Xiangya School of Medicine, Central South University, Changsha, Hunan, 412000, China
| | - L Gao
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, U.S.A.,Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - R Yin
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, U.S.A.,Department of Dermatology, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - H Liu
- Shandong Provincial Institute of Dermatology and Venereology, Jinan, Shandong, 250022, China
| | - A Sukanthanag
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, U.S.A
| | - G Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - M C Mihm
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, U.S.A
| | - D-B Chen
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, CA, U.S.A
| | - J S Nelson
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, U.S.A.,Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, U.S.A
| |
Collapse
|
18
|
Gao L, Yin R, Wang H, Guo W, Song W, Nelson JS, Tan W, Wang G. Ultrastructural characterization of hyperactive endothelial cells, pericytes and fibroblasts in hypertrophic and nodular port-wine stain lesions. Br J Dermatol 2017; 177:e105-e108. [PMID: 28182251 DOI: 10.1111/bjd.15373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L Gao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - R Yin
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.,Department of Dermatology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - H Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - W Guo
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - W Song
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - J S Nelson
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA, 92617, U.S.A.,Department of Biomedical Engineering, University of California, Irvine, CA, 92617, U.S.A
| | - W Tan
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA, 92617, U.S.A
| | - G Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| |
Collapse
|