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Qiu T, Xiang S, Zhou J, Yang M, Lan Y, Zhang X, Gong X, Zhang Z, Ji Y. Sirolimus for kaposiform hemangioendothelioma: Potential mechanisms of action and resistance. Int J Cancer 2024. [PMID: 39369447 DOI: 10.1002/ijc.35207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 09/19/2024] [Accepted: 09/24/2024] [Indexed: 10/08/2024]
Abstract
Kaposiform hemangioendotheliomas (KHEs) are vascular tumors that are considered borderline or locally aggressive and may lead to lethal outcomes. Traditional therapies, such as surgery and embolization, may be insufficient or technically impossible for patients with KHE. Sirolimus (or rapamycin), a specific inhibitor of mechanistic target of rapamycin, has recently been demonstrated to be very useful in the treatment of KHEs. Here, we highlight recent substantial progress regarding the effects of sirolimus on KHEs and discuss the potential mechanisms of action of sirolimus in treating this disease. The prevention of platelet activation and inflammation, along with antiangiogenic effects, the inhibition of lymphangiogenesis, the attenuation of fibrosis, or a combination of all these effects, may be responsible for the therapeutic effects of sirolimus. In addition, the mechanism of sirolimus resistance in some KHE patients is discussed. Finally, we review the somatic mutations that have recently been identified in KEH lesions, and discuss the potential of novel therapeutic targets based on these further understandings of the cellular and molecular pathogenesis of KHE.
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Affiliation(s)
- Tong Qiu
- Division of Oncology, Department of Pediatric Surgery and Med-X Center for Informatics, West China Hospital of Sichuan University, Chengdu, China
| | - Shanshan Xiang
- Division of Oncology, Department of Pediatric Surgery and Med-X Center for Informatics, West China Hospital of Sichuan University, Chengdu, China
| | - Jiangyuan Zhou
- Division of Oncology, Department of Pediatric Surgery and Med-X Center for Informatics, West China Hospital of Sichuan University, Chengdu, China
| | - Min Yang
- Division of Oncology, Department of Pediatric Surgery and Med-X Center for Informatics, West China Hospital of Sichuan University, Chengdu, China
| | - Yuru Lan
- Division of Oncology, Department of Pediatric Surgery and Med-X Center for Informatics, West China Hospital of Sichuan University, Chengdu, China
| | - Xuepeng Zhang
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Xue Gong
- Division of Oncology, Department of Pediatric Surgery and Med-X Center for Informatics, West China Hospital of Sichuan University, Chengdu, China
| | - Zixin Zhang
- Division of Oncology, Department of Pediatric Surgery and Med-X Center for Informatics, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Ji
- Division of Oncology, Department of Pediatric Surgery and Med-X Center for Informatics, West China Hospital of Sichuan University, Chengdu, China
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Cheng J, Zou Y, Fu R, Jin P, Huang M, Wu Z, Bai H, Huang X, Yuan H. Sirolimus combined with glucocorticoids in the treatment of Kasabach-Merritt phenomenon in a neonate: A case report. Medicine (Baltimore) 2024; 103:e37706. [PMID: 38579031 PMCID: PMC10994472 DOI: 10.1097/md.0000000000037706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/04/2024] [Indexed: 04/07/2024] Open
Abstract
RATIONALE Kaposiform hemangioendothelioma is an aggressive vascular tumor that is often associated with life-threatening coagulopathies and Kasabach-Merritt phenomenon. Pathologic biopsies can provide a good basis for diagnosis and treatment. Therapy with srolimus combined with glucocorticoids may offer patients a favorable prognosis. PATIENT CONCERNS A large purplish-red mass on the knee of a child with extremely progressive thrombocytopenia and refractory coagulation abnormalities. Conventional doses of glucocorticoids alone failed to improve coagulation abnormalities and the child developed large cutaneous petechiae and scalp hematomas. DIAGNOSIS Kaposiform hemangioendothelioma combined with Kasabach-Merritt phenomenon. INTERVENTIONS The patient received prednisolone 2.0 mg/kg*d for 4 days. Blood products were transfused to ensure vital signs and to complete the pathologic biopsy. Sirolimus combined with prednisolone was given after clarifying the diagnosis of Kaposiform hemangioendothelioma. OUTCOMES The tumor basically disappeared on examination and the ultrasound showed a subcutaneous hyperechoic mass with normal blood flow. LESSONS Sirolimus combined with glucocorticoids is effective in controlling Kasabach-Merritt phenomenon and pathologic biopsy is important for definitive diagnosis.
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Affiliation(s)
- Jun Cheng
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Yun Zou
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Ronghua Fu
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Pingliang Jin
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Mengyu Huang
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Zhiping Wu
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Hanxiang Bai
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Xiangqun Huang
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Hua Yuan
- Department of Plastic Surgery, Jiangxi Provincial Children’s Hospital, Nanchang, China
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Kopeć J, Sałacińska-Łoś E, Orzechowska M, Sokolnicka M, Gawłowska-Marciniak A, Przemysław P. mTOR Pathway Substrates Present High Activation in Vascular Malformations and Significantly Decrease with Age. Diagnostics (Basel) 2023; 14:38. [PMID: 38201347 PMCID: PMC10795840 DOI: 10.3390/diagnostics14010038] [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: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Vascular anomalies often result in aesthetic flaws, pain, and impair the quality of life. They require challenging treatments that frequently do not provide the desired results. The mammalian target of rapamycin (mTOR) is directly involved in the development of these malformations. However, the exact mechanism behind mTOR dysregulation has not been unambiguously defined. The purpose of this study is to investigate the activation of selected substrates of mTOR to partially assess its involvement in the disease process. METHODS We analyzed tissue samples collected from patients with vascular anomalies treated in our department. We included patients with histopathological diagnoses of lymphatic, venous, capillary malformations, mixed lesions, and a control group of healthy skin samples. We stained the samples using H and E and immunohistochemistry. We used primary antibodies against p70 S6 Kinase, 4EBP1, and p-4EBP1. We graded their color reactions. The statistical analyses were performed using the FactoMineR and factoextra R v.4.1 packages. p-values < 0.05 were considered statistically significant. RESULTS The analysis of 82 patients showed that healthy tissue vessels expressed lower levels of tested mTOR pathway substrates compared to high activation in vascular malformations. Elevated substrate expression in a comparison between sexes revealed higher P-4EBP1 expression in the female malformation group. We observed a decrease in mTOR substrate expression with age. CONCLUSION The higher expression of mTOR substrates in vascular malformations compared to healthy tissue confirms their involvement in abnormal vascular development. Age-related changes in mTOR substrate expression highlight the need for timely intervention. Our study contributes to the understanding of the mTOR signaling pathway in vascular malformations and highlights its potential as a therapeutic target, contributing to personalized medicine.
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Affiliation(s)
- Jakub Kopeć
- Pediatric Surgery and Oncology Department, Medical University of Łódź, 90-419 Lodz, Poland; (E.S.-Ł.); (A.G.-M.); (P.P.)
| | - Elżbieta Sałacińska-Łoś
- Pediatric Surgery and Oncology Department, Medical University of Łódź, 90-419 Lodz, Poland; (E.S.-Ł.); (A.G.-M.); (P.P.)
| | - Magdalena Orzechowska
- Molecular Carcinogenesis Department, Medical University of Łódź, 90-752 Lodz, Poland;
| | - Monika Sokolnicka
- Pathomorphology Department, Medical University of Łódź, 90-752 Lodz, Poland;
| | - Aleksandra Gawłowska-Marciniak
- Pediatric Surgery and Oncology Department, Medical University of Łódź, 90-419 Lodz, Poland; (E.S.-Ł.); (A.G.-M.); (P.P.)
| | - Przewratil Przemysław
- Pediatric Surgery and Oncology Department, Medical University of Łódź, 90-419 Lodz, Poland; (E.S.-Ł.); (A.G.-M.); (P.P.)
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Liu L, Gu W, Teng L, Xu Y, Zheng F, Hu M, Lu M, Xu X. Kaposiform hemangioendothelioma presented with raynaud phenomenon: a case report. BMC Pediatr 2023; 23:574. [PMID: 37978357 PMCID: PMC10655467 DOI: 10.1186/s12887-023-04407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare vascular neoplasm affecting infants or young children. KHE includes a spectrum of lesions, ranging from small and superficial tumors to large and invasive lesions with Kasabach-Merritt phenomenon (KMP). Currently, no published studies have reported a KHE presenting as thrombocytopenia and Raynaud phenomenon. CASE PRESENTATION A 2-year-old boy with right hand swelling and thrombocytopenia was admitted to our hospital. His right hand turned swelling and red, even occasionally cyanotic. This condition became worse in response to cool environments and improved with warming, and platelet counts were between 50 ~ 80 × 10^9/L. Physical examination on admission revealed the swelling and frostbite-like rash of the right-hand fingers, and the skin temperature of the right hand was lower than the left. On day 3 of admission, chest CT results showed an irregular mass on the right side of the spine. The puncture biopsy demonstrated positive CD31, D2-40, and FLI1 immunohistochemical staining, but negative GLUT1 staining, confirming the diagnosis of KHE. Furthermore, endothelin-1 (ET1) expression levels significantly increased, and eNOS and A20 expression levels significantly decreased comparing with control patients. The patient received methylprednisolone and sirolimus treatments, and his condition gradually improved during the follow-up. CONCLUSIONS We reported the first case of KHE presenting with thrombocytopenia and Raynaud phenomenon. The development of Raynaud phenomenon could be associated with increased ET-1 and reduced eNOS and A20 expressions. Careful differential diagnosis of hidden KHE should be considered in children with thrombocytopenia and Raynaud phenomenon.
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Affiliation(s)
- Lingke Liu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
- Pediatrics, The Affiliated Hospital of Shaoxing University, Shaoxing, 312000, PR China
| | - Weizhong Gu
- Pathology, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Liping Teng
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Yiping Xu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Fei Zheng
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Minfei Hu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Meiping Lu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Xuefeng Xu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China.
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Wang Z, Yan H, Ma Y, Yao W, Zheng S, Li K. Case Report: Kaposiform hemangioendothelioma with PIK3CA mutation successfully treated with sirolimus. Front Oncol 2023; 13:1132702. [PMID: 37274236 PMCID: PMC10235594 DOI: 10.3389/fonc.2023.1132702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/27/2023] [Indexed: 06/06/2023] Open
Abstract
Kaposiform hemangioendothelioma (KHE) is an extremely rare, locally aggressive vascular neoplasm. The etiopathogenesis of KHE is still poorly understood. In the present study, we found a new mutation in KHE (c.685delA, p.Thr229fs). The KHE patient with the PIK3CA mutation showed complete regression after sirolimus treatment. We propose that the presence of the PIK3CA mutation in KHE may correlate with good response to sirolimus.
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Affiliation(s)
- Zuopeng Wang
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Hanlei Yan
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Yangyang Ma
- Department of Pathology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Wei Yao
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Shan Zheng
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Kai Li
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
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Secco LP, Coubes C, Meyer P, Chenine L, Roubertie A, Malinge MC, Bessis D. Dermatological and genetic data in tuberous sclerosis: A prospective single-center study of 38 patients. Ann Dermatol Venereol 2022; 149:241-244. [PMID: 35527063 DOI: 10.1016/j.annder.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/20/2021] [Accepted: 02/09/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is a genetic disorder involving the TSC1 or TSC2 gene. Skin signs are prominent, but dermatological data are scarce. This study aims to describe the cutaneous signs of TSC with the genotype. METHODS We studied the dermatological characteristics of 38 patients with TSC at the University Hospital of Montpellier. We collected details of genotypic features. RESULTS All the patients presented at least one cutaneous sign. The dermatological examination alone was sufficient to establish a definite diagnosis of TSC based on the diagnostic criteria for 34/38 patients. No association was found between cutaneous signs and the presence of a TSC1 or TSC2 mutation. We noted skin signs that were poorly described in the disease, namely epidermal nevus in 3 patients, vascular malformation in 2 patients, and keratosis pilaris in 9 patients. DISCUSSION While several studies demonstrate a more severe neurological phenotype in TSC2 mutated patients, skin expression does not appear to differ according to the mutated gene. Further case reports and molecular genetic studies are needed to determine the link between epidermal nevus, vascular malformations, keratosis pilaris and TSC.
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Affiliation(s)
- L-P Secco
- Department of Dermatology, Montpellier University Hospital Center, 34295 Montpellier, France.
| | - C Coubes
- Department of Genetics, Montpellier University Hospital Center, 34295 Montpellier, France
| | - P Meyer
- Department of Pediatric Neurology, Montpellier University Hospital Center, 34295 Montpellier, France
| | - L Chenine
- Department of Nephrology, Montpellier University Hospital Center, 34295 Montpellier, France
| | - A Roubertie
- Department of Pediatric Neurology, Montpellier University Hospital Center, 34295 Montpellier, France
| | - M-C Malinge
- Department of Genetics, Angers University Hospital Center, 49100 Angers, France
| | - D Bessis
- Department of Dermatology, Montpellier University Hospital Center, 34295 Montpellier, France
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The mmu_circRNA_37492/hsa_circ_0012138 function as potential ceRNA to attenuate obstructive renal fibrosis. Cell Death Dis 2022; 13:207. [PMID: 35246505 PMCID: PMC8897503 DOI: 10.1038/s41419-022-04612-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/21/2022] [Accepted: 02/04/2022] [Indexed: 12/11/2022]
Abstract
Circular RNAs (circRNAs) are involved in the pathogenesis of certain renal diseases, however, the function and mechanism of them in renal fibrosis remains largely unknown. In the present study, RNA expression data in unilateral ureteral obstruction (UUO) kidneys was obtained from our previous circRNA Microarray and public Gene Expression Omnibus datasets to construct a ceRNA network. The effects of target circRNA as long as the homologous human circRNA on renal fibrosis was examined in vitro and in vivo. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis was further performed among genes regulated by the human circRNA. We found that circRNA_37492, showing well connection degree in the ceRNA network, was abundant expression and high sequence conservation. We observed that the expression of circRNA_37492 was induced by the TGF-β1 or UUO in BUMPT cells and C57BL/6 mice, respectively. In vitro, cytoplasmic circRNA_37492 inhibited type I, III collagen and fibronectin deposition by sponging miR-7682-3p and then upregulated its downstream target Fgb. In vivo, overexpression of circRNA_37492 attenuated fibrotic lesions in the kidneys of UUO mice via targeting miR-7682-3p/Fgb axis. Furthermore, hsa_circ_0012138, homologous with circRNA_37492, may potentially target miR-651-5p/FGB axis in human renal fibrosis. Not only that, GO and KEGG enrichment revealed that hsa_circ_0012138-regulated genes were previously demonstrated to related to the fibrosis. In conclusion, we for the first time demonstrated that circRNA_37492 attenuated renal fibrosis via targeting miR-7682-3p/Fgb axis, and the homologous hsa_circRNA_0012138 was speculated as a possible ceRNA to regulate multiple gene expressions and involve in human renal fibrosis, suggesting that circRNA_37492/hsa_circ_0012138 may serve as potent therapy target for obstructive renal fibrosis disease.
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Carli D, Kalantari S, Manicone R, Coppo P, Francia di Celle P, La Selva R, Santoro F, Ranieri C, Cardaropoli S, Fagioli F, Ferrero GB, Resta N, Mussa A. Kaposiform hemangioendothelioma further broadens the phenotype of PIK3CA-related overgrowth spectrum. Clin Genet 2021; 100:624-627. [PMID: 34402524 DOI: 10.1111/cge.14047] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/25/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare locally aggressive mixed vascular tumor, with typical onset in early childhood and characterized by progressive angio- and lymphangiogenesis. Its etiopathogenesis and molecular bases are still unclear. Here, we report the first case of congenital KHE harboring a PIK3CA mosaic pathogenic variant (c.323G > A, p.Arg108His) in a boy with very subtle PIK3CA-related overgrowth spectrum (PROS) features. This finding provides insights into the pathophysiology of KHE, offering targeted therapeutic options by inhibition of the PI3K/Akt/mTOR pathway. We propose the inclusion of this mixed lymphatic and vascular anomaly within the PROS.
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Affiliation(s)
- Diana Carli
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Silvia Kalantari
- Immunogenetics and Transplant Biology Service, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Rosaria Manicone
- Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Paola Coppo
- Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paola Francia di Celle
- Molecular Pathology Laboratory, Pathology Division, Città della Salute e della Scienza University Hospital, Torino, Italy
| | - Roberta La Selva
- Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Federica Santoro
- Department of Medical Sciences, Pathology Unit, Città della Salute e della Scienza Hospital, University of Torino, Torino, Italy
| | - Carlotta Ranieri
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Simona Cardaropoli
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Franca Fagioli
- Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Giovanni Battista Ferrero
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Nicoletta Resta
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Alessandro Mussa
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
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