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Wu Y, Zhao P, Song W, Lu W, Dai T, Wang L. Our experience with propranolol for infantile hemangioma. Skin Res Technol 2023; 29:e13310. [PMID: 37113082 PMCID: PMC10234167 DOI: 10.1111/srt.13310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND/OBJECTIVES The most frequent benign vascular tumor in children is infantile hemangioma (IH). For severe IHs, propranolol has become the first-line Treatment. Despite the fact that several studies have comprehensive therapy regimens, including the best time to start Treatment, dosage, visit frequency, and treatment duration, there is still controversy about the best time to start and stop propranolol medication. METHODS Between January 2016 and February 2019, dermatologists experienced hemangioma treatment and recommended propranolol treatment for 232 IHs. A total of 90 patients completed the treatment process after undergoing a color Doppler ultrasound test. RESULTS Propranolol uniquely affects each IH. Ninety patients were divided into two groups in this study: entire regression (n = 40) and partial regression (n = 50). The entire regression group's initial treatment period (4.3 ± 2.97 months) was substantially shorter than the partial regression group's (5.2 ± 4.57 months) (p < 0.05). Between the entire regression group (23.4 ± 12.8 months) and the partial regression group (24.5 ± 16.6 months), there was no significant difference in time to reduce propranolol. The partial regression group (32.9 ± 25.3month) had a lengthier treatment course than the entire regression group (23.4 ± 13.7 months) (p < 0.05). The partial regression group (22%), like the entire regression group, had a higher recurrence rate (5%). The overall proportion of hemangiomas on the face (particularly periocular hemangioma) in the regression group was greater than in the control group. CONCLUSION The entire regression group's initial treatment time was significantly shorter than the partial regression group's. As a result, as soon as a hemangioma is discovered, it should be treated. To determine the appropriate time to reduce propranolol, we must evaluate the patient's age and the percentage of tumor regression. Periocular hemangioma may have a better prognosis than other types. Given the small number of patients in our study, we will need to do more research in the future to confirm our findings.
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Affiliation(s)
- Yao Wu
- Department of DermatologyChildren's Hospital of Fudan University and National Children Medical CenterShanghaiChina
| | - Piaoping Zhao
- Department of DermatologyChildren's Hospital of Fudan University and National Children Medical CenterShanghaiChina
| | - Wei Song
- Department of DermatologyChildren's Hospital of Fudan University and National Children Medical CenterShanghaiChina
| | - Wenmin Lu
- Department of DermatologyChildren's Hospital of Fudan University and National Children Medical CenterShanghaiChina
| | - Ting Dai
- Department of DermatologyChildren's Hospital of Fudan University and National Children Medical CenterShanghaiChina
| | - Liuhui Wang
- Department of DermatologyChildren's Hospital of Fudan University and National Children Medical CenterShanghaiChina
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Macca L, Altavilla D, Di Bartolomeo L, Irrera N, Borgia F, Li Pomi F, Vaccaro F, Squadrito V, Squadrito F, Vaccaro M. Update on Treatment of Infantile Hemangiomas: What’s New in the Last Five Years? Front Pharmacol 2022; 13:879602. [PMID: 35721150 PMCID: PMC9204338 DOI: 10.3389/fphar.2022.879602] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/05/2022] [Indexed: 01/04/2023] Open
Abstract
Among benign vascular tumors of infancy, hemangiomas are the commonest, affecting approximately 5–10% of one-year-old children. They are derived from a benign proliferation of vascular endothelial cells (VECs) in the mesoderm and may arise anywhere on the body around 1–2 weeks after birth. Infantile hemangiomas (IHs) are characterized by an early proliferative phase in the first year followed by a spontaneous progressive regression within the following 5 years or longer. IH prevalence is estimated to be 5%–10% in one-year-old children and commonly affects female, Caucasian and low-birth weight infants. Although most of them spontaneously regress, approximately 10% requires treatment to prevent complications due to the site of occurrence such as bleeding, ulceration, cosmetically disfigurement, functional impairment, or life-threatening complications. For over 30 years, steroids have represented the first-line treatment for IHs, but recently topical or systemic β-blockers are increasingly being used and recognized as effective and safe. A search for “Cutaneous infantile hemangioma” [All Fields] AND “Treatment” [All Fields] was performed by using PubMed and EMBASE databases. Treatment of IHs with labeled drugs, such as oral propranolol, but also with off-label drugs, such as topical β-blockers, including topical timolol and carteolol, steroids, itraconazole or sirolimus, with a focus on formulations types and adverse events were described in our review. We also discussed the benefits of pulsed dye laser and the treatment of IHs with involvement of central nervous system, namely the PHACE and LUMBAR syndrome.
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Affiliation(s)
- Laura Macca
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Domenica Altavilla
- Department of Clinical and Experimental Medicine, Pharmacology, University of Messina, Messina, Italy
| | - Luca Di Bartolomeo
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
- *Correspondence: Luca Di Bartolomeo,
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, Pharmacology, University of Messina, Messina, Italy
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Federica Li Pomi
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Federico Vaccaro
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Violetta Squadrito
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi, Pediatry”, University of Messina, Messina, Italy
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine, Pharmacology, University of Messina, Messina, Italy
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
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Tan X, Guo S, Wang C. Propranolol in the Treatment of Infantile Hemangiomas. Clin Cosmet Investig Dermatol 2021; 14:1155-1163. [PMID: 34511960 PMCID: PMC8423716 DOI: 10.2147/ccid.s332625] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 12/31/2022]
Abstract
Propranolol, as the first generation of β-blocker family, was initially introduced in the clinical application for tachycardia and hypertension in the 1960s. However, the occasional discovery of propranolol in the involution of infantile hemangiomas (IHs) brought us a new perspective. IHs are the most common infantile tumor, affecting 4–10% newborns. So far, oral propranolol is the first-line medication for IHs treatment. At the same time, local injection and topical propranolol are developing. Despite the worldwide application, the precise mechanism of propranolol of IHs has not been completely studied. In this article, we reviewed and summarized the current information on pharmacology, mechanism, efficacy, and adverse effects of propranolol. Novel design of biomaterials and bioactive molecules are needed for new treatment and ideal pathway to attain the minimal effective treatment concentration and eliminate the adverse effects.
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Affiliation(s)
- Xin Tan
- Department of Plastic Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Shu Guo
- Department of Plastic Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Chenchao Wang
- Department of Plastic Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
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Hansen L, Brasch HD, Paterson E, Patel J, Bockett N, Davis PF, Tan ST. Expression of Cathepsins B, D, and G in Extracranial Arterio-Venous Malformation. Front Surg 2021; 8:676871. [PMID: 34409065 PMCID: PMC8367294 DOI: 10.3389/fsurg.2021.676871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/30/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives: We have previously identified a population of cells that expressed stemness-associated markers in extracranial arterio-venous malformation (AVM) and demonstrated expression of cathepsins B, D, and G on embryonic stem cell (ESC)-like populations in other vascular anomalies. This study investigated the expression of cathepsins B, D, and G, and their localization in relation to this primitive population in extracranial AVM. Methods: Immunohistochemical staining was performed on AVM tissue samples from 13 patients to demonstrate expression of cathepsins B, D, and G. Western blotting was performed on four AVM tissue samples and three AVM-derived primary cell lines to confirm protein expression of cathepsins B and D proteins. RT-qPCR was performed on three AVM-derived primary cell lines to demonstrate transcript expression of cathepsins B, D, and G. Enzymatic activity assays were performed on three AVM-derived primary cell lines to investigate if cathepsins B and D were active. Localization of the cathepsins was investigated using immunofluorescence dual-staining of the cathepsins with the ESC markers OCT4 and SOX2, and mast cells marker chymase on two of the 13 AVM tissue samples. Results: Immunohistochemical staining demonstrated expression of cathepsins B, D, and G in all 13 AVM tissue samples. Western blotting showed expression of cathepsins B and D proteins in all four AVM tissue samples and all three AVM-derived primary cell lines. RT-qPCR demonstrated transcripts of cathepsins B, D, and G in all three AVM-derived primary cell lines. Enzymatic activity assays showed that cathepsins B and D were active. Immunofluorescence staining showed expression of cathepsins B and D on the OCT4+/SOX2+ endothelium and media of the lesional vessels and cells within the stroma in AVM nidus. Cathepsin G was expressed on the chymase+ phenotypic mast cells. Conclusions: This study demonstrated the novel finding of the expression of cathepsins B, D, and G in AVM. Cathepsins B and D were expressed by the primitive population, and cathepsin G was localized to mast cells, within the AVM nidus.
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Affiliation(s)
- Lauren Hansen
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | - Helen D Brasch
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | - Erin Paterson
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | - Josie Patel
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | | | - Paul F Davis
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | - Swee T Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand.,Centre for the Study and Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Lower Hutt, New Zealand.,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
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5
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Kilmister EJ, Hansen L, Davis PF, Hall SRR, Tan ST. Cell Populations Expressing Stemness-Associated Markers in Vascular Anomalies. Front Surg 2021; 7:610758. [PMID: 33634164 PMCID: PMC7900499 DOI: 10.3389/fsurg.2020.610758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/31/2020] [Indexed: 12/31/2022] Open
Abstract
Treatment of vascular anomalies (VAs) is mostly empirical and, in many instances unsatisfactory, as the pathogeneses of these heterogeneous conditions remain largely unknown. There is emerging evidence of the presence of cell populations expressing stemness-associated markers within many types of vascular tumors and vascular malformations. The presence of these populations in VAs is supported, in part, by the observed clinical effect of the mTOR inhibitor, sirolimus, that regulates differentiation of embryonic stem cells (ESCs). The discovery of the central role of the renin-angiotensin system (RAS) in regulating stem cells in infantile hemangioma (IH) provides a plausible explanation for its spontaneous and accelerated involution induced by β-blockers and ACE inhibitors. Recent work on targeting IH stem cells by inhibiting the transcription factor SOX18 using the stereoisomer R(+) propranolol, independent of β-adrenergic blockade, opens up exciting opportunities for novel treatment of IH without the β-adrenergic blockade-related side effects. Gene mutations have been identified in several VAs, involving mainly the PI3K/AKT/mTOR and/or the Ras/RAF/MEK/ERK pathways. Existing cancer therapies that target these pathways engenders the exciting possibility of repurposing these agents for challenging VAs, with early results demonstrating clinical efficacy. However, there are several shortcomings with this approach, including the treatment cost, side effects, emergence of treatment resistance and unknown long-term effects in young patients. The presence of populations expressing stemness-associated markers, including transcription factors involved in the generation of induced pluripotent stem cells (iPSCs), in different types of VAs, suggests the possible role of stem cell pathways in their pathogenesis. Components of the RAS are expressed by cell populations expressing stemness-associated markers in different types of VAs. The gene mutations affecting the PI3K/AKT/mTOR and/or the Ras/RAF/MEK/ERK pathways interact with different components of the RAS, which may influence cell populations expressing stemness-associated markers within VAs. The potential of targeting these populations by manipulating the RAS using repurposed, low-cost and commonly available oral medications, warrants further investigation. This review presents the accumulating evidence demonstrating the presence of stemness-associated markers in VAs, their expression of the RAS, and their interaction with gene mutations affecting the PI3K/AKT/mTOR and/or the Ras/RAF/MEK/ERK pathways, in the pathogenesis of VAs.
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Affiliation(s)
| | - Lauren Hansen
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | - Paul F. Davis
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | | | - Swee T. Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand
- Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
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Koh SP, Leadbitter P, Smithers F, Tan ST. β-blocker therapy for infantile hemangioma. Expert Rev Clin Pharmacol 2021; 13:899-915. [PMID: 32662682 DOI: 10.1080/17512433.2020.1788938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Fifteen percent of proliferating infantile hemangioma (IH) require intervention because of the threat to function or life, ulceration, or tissue distortion. Propranolol is the mainstay treatment for problematic proliferating IH. Other β-blockers and angiotensin-converting enzyme (ACE) inhibitors have been explored as alternative treatments. AREAS COVERED The demonstration of a hemogenic endothelium origin of IH, with a neural crest phenotype and multi-lineage differentiation capacity, regulated by the renin-angiotensin system, underscores its programmed biologic behavior and accelerated involution induced by propranolol, other β-blockers and ACE inhibitors. We review the indications, dosing regimens, duration of treatment, efficacy and adverse effects of propranolol, and therapeutic alternatives including oral atenolol, acebutolol, nadolol, intralesional propranolol injections, topical propranolol and timolol, and oral captopril. EXPERT OPINION Improved understanding of the biology of IH provides insights into the mechanism of action underscoring its accelerated involution induced by propranolol, other β-blockers and ACE inhibitors. More research is required to understand the optimal dosing and duration, efficacy and safety of these alternative therapies. Recent demonstration of propranolol's actions mediated by non-β-adrenergic isomer R-propranolol on stem cells, offers an immense opportunity to harness the efficacy of β-blockers to induce accelerated involution of IH, while mitigating their β-adrenergic receptor-mediated adverse effects.
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Affiliation(s)
- Sabrina P Koh
- Gillies McIndoe Research Institute , Wellington, New Zealand
| | - Philip Leadbitter
- Gillies McIndoe Research Institute , Wellington, New Zealand.,Centre for the Study & Treatment for Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital , Wellington, New Zealand.,Department of Paediatrics, Hutt Hospital , Wellington, New Zealand
| | - Fiona Smithers
- Centre for the Study & Treatment for Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital , Wellington, New Zealand
| | - Swee T Tan
- Gillies McIndoe Research Institute , Wellington, New Zealand.,Centre for the Study & Treatment for Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital , Wellington, New Zealand.,Department of Surgery, The University of Melbourne , Parkville, Victoria, Australia
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7
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Influence of Cytochrome P450 2D6 Polymorphisms on the Efficacy of Oral Propranolol in Treating Infantile Hemangioma. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8732871. [PMID: 32219146 PMCID: PMC7081015 DOI: 10.1155/2020/8732871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 01/05/2023]
Abstract
Objective The aim of this study is to evaluate the association of genetic polymorphisms in Cytochrome P450 2D6(CYP2D6) and the change in VEGF levels with the response to propranolol in patients with Infantile hemangiomas (IH). Methods IH patients who underwent over six months of propranolol therapy and received oral propranolol only were enrolled. The target dose of propranolol was 1 mg kg-1day-1. Deoxyribonucleic acid was obtained from venous blood leukocytes. Genotypes of CYP2D6 (rs1065852 and rs1135840) were tested by polymerase chain reaction (PCR) and by sequencing the products. Baseline serum VEGF and serum VEGF one month after treatment were measured. The clinical responses after six months of treatment were evaluated. Genotypes of CYP2D6 (rs1065852 and rs1135840) and VEGF levels were compared between good responders and poor-to-moderate responders. Results 72 patients were enrolled in the study. Patients with CYP2D6 (rs1135840) G/G homozygote had the highest response rate to propranolol. No significant association was found between the response rates and CYP2D6 (rs1065852) polymorphism. No significant differences were found in baseline serum VEGF, serum VEGF one month after treatment, and VEGF ratio between good responders and poor-to-moderate responders. Conclusion The response to propranolol treatment in IH patients was associated with the gene polymorphism of CYP2D6 (rs1135840). A low-dose propranolol regimen was effective and safe in young infants with IH. The change of serum VEGF levels after one month's treatment could not be used to predict the response rate to propranolol.
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8
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Tasić-Kostov M, Ilić D. Off-label prescriptions in dermatology: Challenges of new routes of administration for certain old drugs. ACTA FACULTATIS MEDICAE NAISSENSIS 2020. [DOI: 10.5937/afmnai37-25282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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9
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Solman L, Glover M, Beattie PE, Buckley H, Clark S, Gach JE, Giardini A, Helbling I, Hewitt RJ, Laguda B, Langan SM, Martinez AE, Murphy R, Proudfoot L, Ravenscroft J, Shahidullah H, Shaw L, Syed SB, Wells L, Flohr C. Oral propranolol in the treatment of proliferating infantile haemangiomas: British Society for Paediatric Dermatology consensus guidelines. Br J Dermatol 2019; 179:582-589. [PMID: 29774538 DOI: 10.1111/bjd.16779] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Infantile haemangiomas (IH) are the most common vascular tumours of infancy. Despite their frequency and potential complications, there are currently no unified U.K. guidelines for the treatment of IH with propranolol. There are still uncertainties and diverse opinions regarding indications, pretreatment investigations, its use in PHACES (posterior fossa malformations-haemangiomas-arterial anomalies-cardiac defects-eye abnormalities-sternal cleft and supraumbilical raphe) syndrome and cessation of treatment. OBJECTIVES To provide unified guidelines for the treatment of IH with propranolol. METHODS This study used a modified Delphi technique, which involved an international treatment survey, a systematic evidence review of the literature, a face-to-face multidisciplinary panel meeting and anonymous voting. RESULTS The expert panel achieved consensus on 47 statements in eight categories, including indications and contraindications for starting propranolol, pretreatment investigations, starting and target dose, monitoring of adverse effects, the use of propranolol in PHACES syndrome and how to stop treatment. CONCLUSIONS These consensus guidelines will help to standardize and simplify the treatment of IH with oral propranolol across the U.K. and assist in clinical decision-making.
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Affiliation(s)
- L Solman
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, U.K
| | - M Glover
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, U.K
| | | | - H Buckley
- Queen Alexandra Hospital, Portsmouth, U.K
| | - S Clark
- Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, U.K
| | - J E Gach
- Birmingham Children's Hospital, Birmingham, U.K
| | - A Giardini
- Paediatric Cardiology Division, Great Ormond Street Hospital for Children, London, U.K
| | - I Helbling
- Leicester Royal Infirmary, Leicester, U.K
| | - R J Hewitt
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London, U.K
| | - B Laguda
- Chelsea and Westminster Hospital, London, U.K
| | - S M Langan
- London School of Hygiene and Tropical Medicine, London, U.K
| | - A E Martinez
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, U.K
| | - R Murphy
- Sheffield Teaching Hospitals, Sheffield, U.K
| | | | | | | | - L Shaw
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, U.K
| | - S B Syed
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, U.K
| | - L Wells
- Nottingham Children's Hospital, London, U.K
| | - C Flohr
- Unit of Population-Based Dermatology Research and Department of Paediatric Dermatology, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, U.K
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Expression of Components of the Renin-Angiotensin System by the Embryonic Stem Cell–Like Population within Keloid Lesions. Plast Reconstr Surg 2019; 144:372-384. [DOI: 10.1097/prs.0000000000005867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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van Schaijik B, Tan ST, Marsh RW, Itinteang T. Expression of (pro)renin receptor and its effect on endothelial cell proliferation in infantile hemangioma. Pediatr Res 2019; 86:202-207. [PMID: 31091531 DOI: 10.1038/s41390-019-0430-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/06/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Propranolol is the preferred treatment for problematic proliferating infantile hemangioma (IH) by targeting the renin-angiotensin system (RAS) expressed by IH endothelium. (Pro)renin receptor (PRR) is a major component of the RAS associated with the canonical wnt signaling pathway. We proposed that activation of PRR by renin causes proliferation of IH. METHODS The expression of PRR in IH tissue samples was investigated using immunohistochemical (IHC) staining and NanoString analysis. NanoString analysis was also used to confirm transcriptional expression of PRR in CD34-sorted proliferating IH-derived primary cell lines. MTT assay was utilized to determine the effect of exogenous renin on the number of viable IH cells. RT-qPCR was used to determine the effect of renin on the stem cell gene expression. RESULTS NanoString analysis and IHC staining confirmed transcriptional and translational expression of PRR, which was localized to the non-endothelial and the endothelial IH cell populations. MTT assay demonstrated an increased number of viable IH cells by administration of renin and the effect was negated by the wnt receptor blocker dickkopf-1. CONCLUSION Our results present a model for renin-induced increased proliferation of IH cells through PRR acting via the wnt signaling pathway, which may account for accumulation of cells in IH during the proliferative phase of the tumor.
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Affiliation(s)
| | - Swee T Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand. .,Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand.
| | - Reginald W Marsh
- Gillies McIndoe Research Institute, Wellington, New Zealand.,University of Auckland, Auckland, New Zealand
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Anger J, Oliveira EMD, Gabel J. EFFECTIVENESS OF FIXED DOSES OF PROPRANOLOL IN THE TREATMENT OF HEMANGIOMAS REGARDLESS OF CHILD'S WEIGHT GAIN: A CASE REPORT. ACTA ACUST UNITED AC 2019; 37:392-395. [PMID: 31090848 PMCID: PMC6868553 DOI: 10.1590/1984-0462/;2019;37;3;00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/28/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To present the outcomes of fixed doses of propranolol tablets for the treatment of hemangiomas. CASE DESCRIPTION Two illustrative cases of hemangioma in infant patients younger than six months old are described. Treatments were started in 2010 and 2011 and were monitored until August 2017. Patients were treated with fixed doses, initially calculated based on the upper limit of 3 mg/kg/day and administrated in two daily doses rounded down to the nearest multiple of five milligrams. Dosage was not adjusted to patients' weight gain. The tablets were crushed and then diluted in a maximum amount of 3 mL of water. This procedure was necessary because propranolol was not available in oral solution in 2009, when dosages available in the Brazilian market were 10, 40 and 80 mg. Both patients presented significative improvement in the first 60 days and were in complete remission by the end of the treatment. COMMENTS It is possible to treat patients with Propranolol 10 mg tablets, even though the dosage is not as precise as when calculated according to patients' weight. The maintenance of a fixed dose, ignoring the patient's progressive weight gains, helps avoiding the rebound effect and decreases complications.
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Affiliation(s)
- Jaime Anger
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - José Gabel
- Project "Einstein na Comunidade Paraisópolis", São Paulo, SP, Brazil
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Papali'i-Curtin JC, Brasch HD, van Schaijik B, de Jongh J, Marsh RW, Tan ST, Itinteang T. Expression of Components of the Renin-Angiotensin System in Pyogenic Granuloma. Front Surg 2019; 6:13. [PMID: 31024924 PMCID: PMC6465765 DOI: 10.3389/fsurg.2019.00013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 02/25/2019] [Indexed: 12/29/2022] Open
Abstract
Background: There is a growing body of research demonstrating expression of the renin-angiotensin system (RAS) by a putative embryonic stem cell (ESC)-like population within vascular anomalies. This study investigated the expression of components of the RAS in relation to the putative ESC-like population within pyogenic granuloma (PG) that we have recently reported. Methods: PG samples from 14 patients were analyzed for the expression of components of the RAS: pro-renin receptor (PRR), angiotensin converting enzyme (ACE), angiotensin II receptor 1 (ATIIR1) and angiotensin II receptor 2 (ATIIR2), using 3,3-diaminobenzidine (DAB) immunohistochemical (IHC) staining. Immunofluorescence (IF) IHC staining was performed to localize these proteins on four of the PG samples. RT-qPCR was performed on two snap-frozen PG samples. Western blotting (WB) was performed on one snap-frozen PG sample and two PG-derived primary cell lines. Results: DAB IHC staining demonstrated the expression of ACE, PRR, ATIIR1, and ATIIR2 in all 14 PG tissue samples. RT-qPCR analysis confirmed abundant mRNA transcripts for PRR, ACE, AIITR1 and ATIIR2, relative to the housekeeping gene. WB confirmed the presence of PRR, ATIIR1, and ACE in the PG tissue sample, and PRR and ATIIR1, in the PG-derived primary cell lines. IF IHC staining demonstrated the expression of PRR, ACE, ATIIR1 on the primitive population that expressed NANOG and SOX2 on the ERG+ endothelium of the microvessels within PG. Conclusion: We have demonstrated the expression of PRR, ACE, and ATIIR1 by the putative the ESC-like population within PG.
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Affiliation(s)
- Jessica C Papali'i-Curtin
- Gillies McIndoe Research Institute, Wellington, New Zealand.,Centre for the Study and Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
| | - Helen D Brasch
- Gillies McIndoe Research Institute, Wellington, New Zealand.,Centre for the Study and Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
| | | | | | | | - Swee T Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand.,Centre for the Study and Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
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Price A, Rai S, Mcleod RWJ, Birchall JC, Elhassan HA. Topical propranolol for infantile haemangiomas: a systematic review. J Eur Acad Dermatol Venereol 2018; 32:2083-2089. [PMID: 29569772 DOI: 10.1111/jdv.14963] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 03/05/2018] [Indexed: 12/28/2022]
Abstract
Infantile haemangiomas are the most common tumour of infancy. Whilst the majority are left untreated to involute spontaneously, residual skin changes commonly occur, particularly in superficial haemangiomas. The current first-line treatment for problematic lesions is oral propranolol; however due to the risk of systemic adverse effects, the use of off-label topical preparations has recently been investigated. Our systematic review was conducted in accordance with PRISMA guidelines. Four databases were searched to identify original articles evaluating the use of topical propranolol as the primary therapy for infantile haemangiomas. Twelve articles with a total of 597 patients and 632 haemangiomas were included. Three topical propranolol preparations were used, creams, ointments and gels and were all prepared by local pharmaceutical laboratories. The concentration of propranolol ranged from 0.5% to 5%. Treatment duration ranged from two weeks to 16.5 months. Overall, 90% of lesions improved following the initiation of topical propranolol. A good or excellent response, defined as a reduction in the size of at least 50%, was seen in 59% of lesions. Earlier initiation of treatment (less than 3 months of age) was associated with improved outcomes. No systemic adverse effects were reported. Minor local reactions were seen in 1.3% of patients. Topical propranolol is safer than oral propranolol, though may be less effective. Topical propranolol may be more suitable for patients with small, superficial haemangiomas at risk of cosmetic sequelae, where the cosmetic or symptomatic impact does not warrant oral propranolol treatment.
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Affiliation(s)
- A Price
- Wound Healing Research Unit, Cardiff University, Cardiff, UK
| | - S Rai
- School of Medicine, Cardiff University, Cardiff, UK
| | - R W J Mcleod
- ENT Department, University Hospital of Wales, Cardiff, UK
| | - J C Birchall
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - H A Elhassan
- ENT Department, University Hospital of Wales, Cardiff, UK
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15
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Sulzberger L, Tan EMS, Davis PF, Brasch HD, Tan ST, Itinteang T. Phosphorylated Forms of STAT1, STAT3 and STAT5 Are Expressed in Proliferating but Not Involuted Infantile Hemangioma. Front Surg 2018; 5:31. [PMID: 29725593 PMCID: PMC5917091 DOI: 10.3389/fsurg.2018.00031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/29/2018] [Indexed: 11/13/2022] Open
Abstract
We have recently demonstrated the expression of embryonic stem cell markers on the endothelium of infantile hemangioma, a functional hemogenic endothelium with the capacity for primitive erythropoiesis in vitro. Despite recent work characterizing stem cells within proliferating infantile hemangioma, the expression of STAT proteins, well documented for their roles in stem cell signaling, has not been investigated. 3,3-Diaminobenzidine and immunofluorescence immunohistochemical staining revealed expression of pSTAT1, pSTAT3 and pSTAT5 in proliferating infantile hemangioma samples with the strongest expression of pSTAT3. There was reduced expression of these pSTAT proteins in the involuted infantile hemangioma samples. Western blotting confirmed the identification of all these three proteins in proliferating infantile hemangioma. It is therefore not surprising that the phosphorylated/activated forms of these proteins are relatively abundantly expressed in proliferating, in comparison to involuted infantile hemangioma samples. We speculate that the reduced STAT activation, as infantile hemangioma involutes, is a reflection of the depletion of the abundant stem cells within proliferating infantile hemangioma, as the lesion involutes.
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Affiliation(s)
| | - Elysia M S Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | - Paul F Davis
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | - Helen D Brasch
- Gillies McIndoe Research Institute, Wellington, New Zealand.,Centre for the Study and Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
| | - Swee T Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand.,Centre for the Study and Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
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16
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Wang Y, Zhang X, Yang Y, Zhang J, Yang Y, Lu Y. Efficacy and Safety of 2% Topical Propranolol Cream for the Treatment of Proliferating Infantile Strawberry Hemangiomas. Indian J Pediatr 2017; 84:425-429. [PMID: 28194699 DOI: 10.1007/s12098-017-2303-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 01/30/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of 2% topical propranolol cream in the treatment of proliferating infantile strawberry hemangiomas. METHODS A total of 40 infants were enrolled; 2% propranolol cream was applied three times daily. In the subsequent monthly visit, dynamic changes in tumor size, texture, and color were recorded. The adverse events (AEs) were observed. Treatment outcomes were scored on a four-point scale. All patients were followed up for 12 mo after treatment. RESULTS The overall response was graded Scale 1 (poor response) in 2 patients, Scale 2 (moderate response) in 15 patients, Scale 3 (good response) in 17 patients, and Scale 4 (excellent response) in 6 patients. No significant differences were seen in treatment outcomes between female and male patients, among lesion locations/size, or in the age at the start of the treatment. No obvious AEs were reported. CONCLUSIONS 2% topical propranolol cream is safe and effective for the treatment of proliferating infantile strawberry hemangiomas.
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Affiliation(s)
- Yuanyuan Wang
- Department of Plastic and Cosmetic Surgery, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, 400042, People's Republic of China
| | - Xingcun Zhang
- Department of Plastic and Cosmetic Surgery, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, 400042, People's Republic of China
| | - Yadong Yang
- Department of Plastic and Cosmetic Surgery, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, 400042, People's Republic of China
| | - Junbo Zhang
- Department of Plastic and Cosmetic Surgery, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, 400042, People's Republic of China
| | - Yunchuan Yang
- Department of Plastic and Cosmetic Surgery, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, 400042, People's Republic of China
| | - Yuangang Lu
- Department of Plastic and Cosmetic Surgery, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, 400042, People's Republic of China.
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17
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18
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Tan EMS, Blackwell MG, Dunne JC, Marsh R, Tan ST, Itinteang T. Neuropeptide Y receptor 1 is expressed by B and T lymphocytes and mast cells in infantile haemangiomas. Acta Paediatr 2017; 106:292-297. [PMID: 27889920 DOI: 10.1111/apa.13684] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/19/2016] [Accepted: 11/23/2016] [Indexed: 01/11/2023]
Abstract
AIM We investigated the expression of neuropeptide Y (NPY), NPY receptor 1 (NPYR1) and NPY receptor 2 (NPYR2) in infantile haemangiomas (IHs). METHODS Immunohistochemical (IHC) staining was performed on proliferating IHs from six patients aged 4-13 (mean 8.7) months and involuted IHs from six patients aged 5-59 (mean 18.7) years, for the expression of NPY, NPYR1 and NPYR2. Protein and messenger ribonucleic acid expression corresponding to these proteins was investigated by Western blotting and NanoString analysis, respectively. RESULTS IHC staining, Western blotting and NanoString analysis demonstrated the presence of NPYR1, but not NPYR2, within proliferating and involuted IHs. IHC staining showed NPYR1 was expressed by B and T lymphocytes expressing CD45 and mast cells expressing tryptase. IHC staining demonstrated the presence of NPY on the NPYR1+ cells, but it was not detected by Western blotting or NanoString analysis. CONCLUSION NPYR1, but not NPYR2, was present in IHs. The localisation of NPYR1 to B and T lymphocytes and mast cells suggests its role in the biology of IHs. The demonstration of NPY on the NPYR1+ cells, without active transcription, suggests that NPY was not being produced within IHs.
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Affiliation(s)
| | | | | | - Reginald Marsh
- Gillies McIndoe Research Institute Wellington New Zealand
- University of Auckland Auckland New Zealand
| | - Swee T. Tan
- Gillies McIndoe Research Institute Wellington New Zealand
- Centre for the Study and Treatment of Vascular Birthmarks Wellington Regional Plastic Maxillofacial and Burns Unit Hutt Hospital Wellington New Zealand
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19
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Petrovic J, Trifunovic B, Vukomanovic G, Topalovic M, Trajkovic G, Parezanović V. Oral propranolol for infantile hemangiomas: a prospective study on the role of 48-hour Holter monitoring in additional safety assessment. J DERMATOL TREAT 2017; 28:554-558. [DOI: 10.1080/09546634.2016.1277177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Jelena Petrovic
- Department for Cardiology, University Children’s Hospital Tirsova, Belgrade, Serbia
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Branislav Trifunovic
- Department for Plastic and Reconstructive Surgery, University Children’s Hospital Tirsova, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Goran Vukomanovic
- Department for Cardiology, University Children’s Hospital Tirsova, Belgrade, Serbia
| | - Mirko Topalovic
- Department for Cardiology, University Children’s Hospital Tirsova, Belgrade, Serbia
| | - Goran Trajkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute for Medical Statistics and Informatics, Belgrade, Serbia
| | - Vojislav Parezanović
- Department for Cardiology, University Children’s Hospital Tirsova, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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20
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Al-Jazaeri A. The response pattern and adherence to oral propranolol among Saudi children treated for infantile hemangioma. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2017. [DOI: 10.1016/j.jdds.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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21
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Sirachainan N, Lekanan W, Thammagasorn Y, Wanitkun S, Kadegasem P, Chunharas A. Response to propranolol in infantile hemangioma. Pediatr Int 2016; 58:662-5. [PMID: 27460401 DOI: 10.1111/ped.12992] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 03/07/2016] [Accepted: 03/17/2016] [Indexed: 11/27/2022]
Abstract
Propranolol, 2 mg/kg/day, is effective in the treatment of infantile hemangioma. We report the response to propranolol in infants with hemangioma at a dose of 1 mg/kg/day. Sixteen infants with newly diagnosed infantile hemangioma were given propranolol at a dose titrated from 0.5 mg/kg/day then increased to 1 or 2 mg/kg/day based on response to treatment until the lesions showed clinical stability for 3 consecutive months. Five out of 16 patients (31.2%) responded to propranolol at 1 mg/kg/day, while the remainder required 2 mg/kg/day for response. Vascular endothelial growth factor significantly decreased after treatment (median, 117.8 pg/mL; range, 35.3-468.7 pg/mL vs 59.2 pg/mL; range, 26.3-133.0 pg/mL; P = 0.016). Therefore, we recommend initiating treatment at 0.5 mg/kg/day for 2 days, then 1 mg/kg/day for 1 month. If the hemangioma has not decreased in size by 1 month follow up, the dose is subsequently increased to 2 mg/kg/day.
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Affiliation(s)
- Nongnuch Sirachainan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wasuthida Lekanan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yuwaluk Thammagasorn
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suthep Wanitkun
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Praguywan Kadegasem
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Amornsri Chunharas
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Siljee S, Keane E, Marsh R, Brasch HD, Tan ST, Itinteang T. Expression of the Components of the Renin-Angiotensin System in Venous Malformation. Front Surg 2016; 3:24. [PMID: 27200356 PMCID: PMC4853390 DOI: 10.3389/fsurg.2016.00024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/11/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Venous malformation (VM) is the most common form of vascular malformation, consisting of a network of thin-walled ectatic venous channels with deficient or absent media. This study investigated the expression of the components of the renin-angiotensin system (RAS), namely, (pro)renin receptor (PRR), angiotensin-converting enzyme (ACE), angiotensin II receptor 1 (ATIIR1), and angiotensin II receptor 2 (AIITR2) in subcutaneous (SC) and intramuscular (IM) VM. MATERIALS AND METHODS SC (n = 7) and IM (n = 7) VM were analyzed for the expression of PRR, ACE, ATIIR1, and ATIIR2 using 3,3-diaminobenzidine and immunofluorescent (IF) immunohistochemical (IHC) staining and NanoString gene expression analysis. RESULTS IHC staining showed expression of PRR, ACE, and ATIIR1, and faint expression of ATIIR2 in the endothelium of SC and IM VM. Furthermore, ATIIR2 was expressed by cells away from the endothelium in both SC and IM VM lesions examined. NanoString analysis demonstrated the presence of PRR, ACE, and ATIIR1 but not ATIIR2. CONCLUSION The presence of PRR, ACE, ATIIR1, and potentially ATIIR2, in both SC and IM VM, suggests a role for the RAS in the biology of VM. This novel finding may lead to a mechanism-based therapy for VM.
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Affiliation(s)
- Sam Siljee
- Gillies McIndoe Research Institute , Wellington , New Zealand
| | - Emily Keane
- Gillies McIndoe Research Institute , Wellington , New Zealand
| | - Reginald Marsh
- Gillies McIndoe Research Institute, Wellington, New Zealand; University of Auckland, Auckland, New Zealand
| | - Helen D Brasch
- Gillies McIndoe Research Institute, Wellington, New Zealand; Department of Pathology, Hutt Hospital, Wellington, New Zealand
| | - Swee T Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand; Centre for the Study and Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
| | - Tinte Itinteang
- Gillies McIndoe Research Institute , Wellington , New Zealand
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23
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Danchin M, Boyce SL, Phuong L, Cooper E, Vidmar S. Low Dose Propanolol for Infantile Haemangioma. J Paediatr Child Health 2016; 52:581. [PMID: 27329922 DOI: 10.1111/jpc.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Margie Danchin
- Consultant Paediatrician, Department of General Medicine, Royal Children's Hospital, Senior Research Fellow, Murdoch Children's Research Institute and Senior Fellow, Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Suzanne Lesley Boyce
- Paediatric General Medical Fellow, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Linny Phuong
- Paediatric Registrar, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Eden Cooper
- Paediatric Resident, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Suzanna Vidmar
- Senior Research Officer, Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute and Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Does hypoxia play a role in infantile hemangioma? Arch Dermatol Res 2016; 308:219-27. [PMID: 26940670 DOI: 10.1007/s00403-016-1635-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/13/2015] [Accepted: 02/15/2016] [Indexed: 12/17/2022]
Abstract
Infantile hemangioma (IH), the most common tumor of infancy, is characterized by rapid growth during infancy, followed by spontaneous involution over 5-10 years. Certain clinical observations have led to the suggestion that IH is triggered and maintained by hypoxia. We review the literature on the possible role of hypoxia in the etiology of IH, in particular, (1) the role of hypoxia inducible factor-1α (HIF-1α) and its downstream targets including GLUT-1 and VEGF; (2) the pathophysiological link between IH and retinopathy of prematurity; (3) hypoxic events in the early life including placental insufficiency, pre-eclampsia and low birthweight that have the potential to promote hypoxic stress; and (4) the evidence supporting the development of IH independent of HIF-1α. We also discuss these observations in the context of recent evidence of the crucial role of stem cells and the cytokines niche that governs their proliferation and inevitable differentiation, offering novel insights into the biology of IH. We propose that various triggers may simultaneously up-regulate HIF-1α, which is downstream of the renin-angiotensin system, specifically angiotensin II, which promotes production of HIF-1α. These developments shed light to the understanding of this enigmatic condition.
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Sulzberger L, Baillie R, Itinteang T, de Jong S, Marsh R, Leadbitter P, Tan S. Serum levels of renin, angiotensin-converting enzyme and angiotensin II in patients treated by surgical excision, propranolol and captopril for problematic proliferating infantile haemangioma. J Plast Reconstr Aesthet Surg 2016; 69:381-6. [DOI: 10.1016/j.bjps.2015.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/08/2015] [Accepted: 10/15/2015] [Indexed: 11/25/2022]
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Winter PR, Itinteang T, Leadbitter P, Tan ST. PHACE syndrome--clinical features, aetiology and management. Acta Paediatr 2016; 105:145-53. [PMID: 26469095 DOI: 10.1111/apa.13242] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/25/2015] [Accepted: 10/12/2015] [Indexed: 02/06/2023]
Abstract
UNLABELLED PHACE syndrome comprises a spectrum of anomalies including posterior fossa malformations, haemangioma, arterial anomalies, cardiac defects and eye anomalies. PHACE should be considered in any patient with a large facial segmental infantile haemangioma (IH), and multidisciplinary management is crucial. Low-dose propranolol is effectively for the treatment of IH associated with PHACE syndrome. Recent evidence suggests IH is comprised of mesoderm-derived haemogenic endothelium. CONCLUSION The embryonic developmental anomaly nature of IH provides an insight into the origin of PHACE syndrome.
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Affiliation(s)
| | | | - Phillip Leadbitter
- Gillies McIndoe Research Institute; Wellington New Zealand
- Centre for the Study & Treatment of Vascular Birthmarks; Wellington Regional Plastic; Maxillofacial & Burns Unit; Wellington New Zealand
- Department of Paediatrics; Hutt Hospital; Wellington New Zealand
| | - Swee T. Tan
- Gillies McIndoe Research Institute; Wellington New Zealand
- Centre for the Study & Treatment of Vascular Birthmarks; Wellington Regional Plastic; Maxillofacial & Burns Unit; Wellington New Zealand
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Effect of 22 Novel Cytochrome P450 2D6 (CYP2D6) Variants Found in the Chinese Population on Hemangeol Metabolism In Vitro. Eur J Drug Metab Pharmacokinet 2015; 41:759-765. [DOI: 10.1007/s13318-015-0307-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Dickerson EB, Bryan BA. Beta Adrenergic Signaling: A Targetable Regulator of Angiosarcoma and Hemangiosarcoma. Vet Sci 2015; 2:270-292. [PMID: 29061946 PMCID: PMC5644640 DOI: 10.3390/vetsci2030270] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 09/05/2015] [Accepted: 09/08/2015] [Indexed: 01/07/2023] Open
Abstract
Human angiosarcomas and canine hemangiosarcomas are highly aggressive cancers thought to arise from cells of vascular origin. The pathological features, morphological organization, and clinical behavior of canine hemangiosarcomas are virtually indistinct from those of human angiosarcomas. Overall survival with current standard-of-care approaches remains dismal for both humans and dogs, and each is likely to succumb to their disease within a short duration. While angiosarcomas in humans are extremely rare, limiting their study and treatment options, canine hemangiosarcomas occur frequently. Therefore, studies of these sarcomas in dogs can be used to advance treatment approaches for both patient groups. Emerging data suggest that angiosarcomas and hemangiosarcomas utilize beta adrenergic signaling to drive their progression by regulating the tumor cell niche and fine-tuning cellular responses within the tumor microenvironment. These discoveries indicate that inhibition of beta adrenergic signaling could serve as an Achilles heel for these tumors and emphasize the need to design therapeutic strategies that target tumor cell and stromal cell constituents. In this review, we summarize recent discoveries and present new hypotheses regarding the roles of beta adrenergic signaling in angiosarcomas and hemangiosarcomas. Because the use of beta adrenergic receptor antagonists is well established in human and veterinary medicine, beta blockade could provide an immediate adjunct therapy for treatment along with a tangible opportunity to improve upon the outcomes of both humans and dogs with these diseases.
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Affiliation(s)
- Erin B Dickerson
- Department of Veterinary Clinical Sciences, University of Minnesota College of Veterinary Medicine, St. Paul, MN 55108, USA.
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA.
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Brad A Bryan
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX 79912, USA.
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Itinteang T, Chudakova DA, Dunne JC, Davis PF, Tan ST. Expression of Cathepsins B, D, and G in Infantile Hemangioma. Front Surg 2015; 2:26. [PMID: 26137466 PMCID: PMC4470331 DOI: 10.3389/fsurg.2015.00026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/02/2015] [Indexed: 12/27/2022] Open
Abstract
AIMS The role of the renin-angiotensin system (RAS) in the biology of infantile hemangioma (IH) represents an emerging paradigm, particularly the involvement of renin, angiotensin converting enzyme, and angiotensin II. This study investigated the expression of cathepsins B, D, and G, enzymes that may modulate the RAS, in IH. MATERIALS AND METHODS The expression of cathepsins B, D, and G was examined using immunohistochemistry, enzyme activity assays, mass spectrometry, and NanoString gene expression assay in IH samples at different phases of development. RESULTS Immunohistochemical staining showed the expression of cathepsins B, D, and G in proliferating and involuted IH samples. This was confirmed at the transcriptional level using NanoString gene expression assays. Mass spectrometry confirmed the identification of cathepsins D and G in all three phases of IH development, whereas cathepsin B was detected in 2/2 proliferating and 1/2 involuting lesions. Enzyme activity assays demonstrated the activity of cathepsins B and D, but not G, in all phases of IH development. CONCLUSION Our data demonstrated the presence of cathepsins B, D, and G in IH. Their role in modulating the RAS and the biology of IH offers potential novel targets for the management of this tumor.
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Affiliation(s)
| | | | - Jonathan C. Dunne
- Gillies McIndoe Research Institute, Wellington, New Zealand
- Centre for Biodiscovery, School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Paul F. Davis
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | - Swee T. Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand
- Centre for the Study & Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
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Characterisation of lymphocyte subpopulations in infantile haemangioma. J Clin Pathol 2015; 68:812-8. [DOI: 10.1136/jclinpath-2015-203073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/25/2015] [Indexed: 12/19/2022]
Abstract
AimsInterstitial CD45+ cells and T lymphocytes have previously been demonstrated within infantile haemangioma (IH). This study investigated the expression of B and T lymphocyte markers by the CD45+ population, and the expression of Thy-1, a marker of thymocyte progenitors, which have the ability to give rise to both B and T cells.MethodsImmunohistochemical (IHC) staining was performed on proliferating and involuted IHs for the expression of CD45, CD3, CD20, CD79a, Thy-1 and CD34. The presence of mRNA corresponding to CD45, CD3G, CD20 and Thy-1 was confirmed by reverse transcriptase-polymerase chain reaction in snap-frozen IH tissues. Cell counting of 3,3-diaminobenzidine IHC-stained slides was performed on CD45+ only cells and dually stained CD45+/CD3+ cells or CD45+/CD20+ cells and analysed statistically. In situ hybridisation and mass spectrometry were also performed to confirm the presence and abundance of Thy-1, respectively.ResultsIHC staining showed a subpopulation of CD45+ interstitial cells that expressed the T lymphocyte marker, CD3, and another subpopulation that expressed the B lymphocyte marker, CD20, in proliferating and diminished in involuted IHs. The abundant expression of Thy-1 on the endothelium of proliferating, but not involuted IH, was demonstrated by IHC staining and confirmed by in situ hybridisation and mass spectrometry.ConclusionsBoth B and T lymphocytes are present within the interstitium of proliferating and involuted IH. The expression of Thy-1 by the endothelium suggests that B and T cells in IH may have originated from within the lesion, rather than migrating from the peripheral circulation.
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PHACE(S) Syndrome With Absent Intracranial Internal Carotid Artery and Anomalous Circle of Willis. J Craniofac Surg 2015; 26:e315-7. [DOI: 10.1097/scs.0000000000001701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Itinteang T, Withers AHJ, Davis PF, Tan ST. Biology of infantile hemangioma. Front Surg 2014; 1:38. [PMID: 25593962 PMCID: PMC4286974 DOI: 10.3389/fsurg.2014.00038] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 08/30/2014] [Indexed: 01/07/2023] Open
Abstract
Infantile hemangioma (IH), the most common tumor of infancy, is characterized by an initial proliferation during infancy followed by spontaneous involution over the next 5-10 years, often leaving a fibro-fatty residuum. IH is traditionally considered a tumor of the microvasculature. However, recent data show the critical role of stem cells in the biology of IH with emerging evidence suggesting an embryonic developmental anomaly due to aberrant proliferation and differentiation of a hemogenic endothelium with a neural crest phenotype that possesses the capacity for endothelial, hematopoietic, mesenchymal, and neuronal differentiation. Current evidence suggests a putative placental chorionic mesenchymal core cell embolic origin of IH during the first trimester. This review outlines the emerging role of stem cells and their interplay with the cytokine niche that promotes a post-natal environment conducive for vasculogenesis involving VEGFR-2 and its ligand VEGF-A and the IGF-2 ligand in promoting cellular proliferation, and the TRAIL-OPG anti-apoptotic pathway in preventing cellular apoptosis in IH. The discovery of the role of the renin-angiotensin system in the biology of IH provides a plausible explanation for the programed biologic behavior and the β-blocker-induced accelerated involution of this enigmatic condition. This crucially involves the vasoactive peptide, angiotensin II, that promotes cellular proliferation in IH predominantly via its action on the ATIIR2 isoform. The role of the RAS in the biology of IH is further supported by the effect of captopril, an ACE inhibitor, in inducing accelerated involution of IH. The discovery of the critical role of RAS in IH represents a novel and fascinating paradigm shift in the understanding of human development, IH, and other tumors in general.
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Affiliation(s)
| | - Aaron H. J. Withers
- Centre for the Study and Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
| | - Paul F. Davis
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | - Swee T. Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand
- Centre for the Study and Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
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