Treatment with low-dose tacrolimus inhibits bleeding complications in a patient with hereditary hemorrhagic telangiectasia and pulmonary arterial hypertension.
Pulm Circ 2018;
9:2045894018805406. [PMID:
30260738 PMCID:
PMC6432681 DOI:
10.1177/2045894018805406]
[Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) can be found in patients suffering from a
loss-of-function mutation of the gene encoding for the activin receptor-like
kinase 1 (ALK-1), a bone morphogenetic protein (BMP) type 1 receptor.
Interestingly, ALK-1 mutations also lead to hereditary hemorrhagic
telangiectasia (HHT), an autosomal dominant disease characterized by
arteriovenous malformations (AVMs) leading to potentially life-threatening
bleeding complications such as epistaxis. Current therapeutic options for both
diseases are limited and often only temporary or accompanied by severe side
effects. Here, we report of a patient with a mutation of the ALK-1 gene
suffering from both HHT and PAH. Recently, it was shown that tacrolimus
increased ALK-1 signaling and had beneficial effects in selected end-stage PAH
patients. We thus hypothesized that treatment with tacrolimus may prevent
disease progression in this patient. Surprisingly, treatment with low-dose
tacrolimus dramatically improved his HHT-associated epistaxis but did not
attenuate progression of PAH.
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