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Hali F, Moubine I, Berrami H, Serhier Z, Othmani MB, Chiheb S. Predictors of poor response to oral propranolol in infantile hemangiomas. Arch Pediatr 2023; 30:455-457. [PMID: 37394367 DOI: 10.1016/j.arcped.2023.06.004] [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: 01/08/2023] [Revised: 03/12/2023] [Accepted: 06/04/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Propranolol is the first-line treatment for infantile hemangiomas (IH). Cases of propranolol-resistant infantile hemangiomas are rarely reported. The purpose of our study was to investigate the predictive factors for poor response to propranolol. METHODS A prospective analytical study was conducted between January 2014 and January 2022 including all patients with IH who received oral propranolol therapy at a dose of 2-3 mg/kg/day maintained for at least 6 months. RESULTS A total of 135 patients with IH were treated with oral propranolol. Poor response was reported in 18 (13.4%) of the patients: 72% were girls and 28% were boys. Overall, 84% of the IH were mixed, and hemangiomas were multiple in three cases (16%), nasal tip hemangiomas accounted for four cases (22%), and 15 patients (83%) had segmental hemangiomas. There was no significant association between the age or sex of the children and type of response to treatment (p > 0.05). No significant association was found between the type of hemangioma and the therapeutic outcome as well as the recurrence after treatment discontinuation (p > 0.05). Multivariate logistic regression analysis revealed that nasal tip hemangiomas, multiple hemangiomas, and segmental hemangiomas were at greater risk of poor response to beta-blockers (p < 0.05). CONCLUSION Poor response to propranolol therapy has rarely been reported in the literature. In our series, it was approximately 13.4%. To our knowledge, no previous publications have focused on the predictive factors of poor response to beta-blockers. However, the reported risk factors for recurrence are discontinuation of treatment before 12 months of age, mixed or deep type IH, and female gender. In our study, the predictive factors for poor response were multiple type IH, segmental type IH, and location on the nasal tip.
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Affiliation(s)
- Fouzia Hali
- Department of Dermatology and Venerology, Ibn Rochd University Hospital of Casablanca, Morocco
| | - Insaf Moubine
- Department of Dermatology and Venerology, Ibn Rochd University Hospital of Casablanca, Morocco.
| | - Hind Berrami
- Department of Medical Informatics, Ibn Rochd University Hospital of Casablanca, Morocco
| | - Zineb Serhier
- Department of Medical Informatics, Ibn Rochd University Hospital of Casablanca, Morocco
| | | | - Soumiya Chiheb
- Department of Dermatology and Venerology, Ibn Rochd University Hospital of Casablanca, Morocco
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Huang Y, Ran X, Xu X, Pradhan S, Sun J, Tang H, Ran Y. Itraconazole Oral Solution for a Case of Infantile Hemangioma: Monitoring the Efficacy by Dermoscopy and MRI. Dermatol Ther (Heidelb) 2021; 11:1861-1866. [PMID: 34302597 PMCID: PMC8484420 DOI: 10.1007/s13555-021-00579-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/03/2021] [Indexed: 02/05/2023] Open
Abstract
Infantile hemangioma is a common and challenging benign vascular tumor. Although involution is spontaneous, approximately 10% of infantile hemangioma of large size or in specific locations may cause ulceration, severe cosmetic and functional problems that may require intervention. Treatment options include oral propranolol, topical timolol, and oral corticosteroids. However, the clinical response is not always satisfactory. We report the case of a 4-month-old boy who presented with an irregular erythematous plaque on his left shoulder 3 days after birth. Infantile hemangioma was diagnosed. Topical application of 0.5 ml of 0.5% timolol maleate eye drops for half an hour each time three times a day was initiated. After nearly 3 months of follow-up, the size of the lesion gradually increased. Finally, after 115 days of treatment with itraconazole oral solution (the total dose was about 4025 mg), the refractory infantile hemangioma was successfully treated. Hepatic and renal function remained normal with only mild diarrhea during the course of oral medication. Treatment compliance of oral itraconazole in infants has been reported to be good. Dermoscopy and magnetic resonance imaging (MRI) played a crucial role in in vivo observation of the hemangioma changes with vascular regression during the treatment process.
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Affiliation(s)
- Ying Huang
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Ran
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxi Xu
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Sushmita Pradhan
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hehan Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuping Ran
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, China
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Huang AH, Mannschreck D, Aggarwal P, Mahon M, Cohen BA. Retrospective case series of increased oral propranolol dosage for infantile hemangiomas. Pediatr Dermatol 2020; 37:1057-1062. [PMID: 32869385 DOI: 10.1111/pde.14281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 06/01/2020] [Accepted: 06/14/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Infantile hemangiomas (IH) are the most common benign tumor of infancy. Although oral propranolol is currently first-line therapy, optimal dosing for treatment of IH remains debated. We sought to identify hemangioma characteristics associated with poor response to standard dosing (2 mg/kg/d) and to assess the therapeutic benefit of higher dosing. METHODS Retrospective chart review was conducted of 559 patients with IH seen at Johns Hopkins between 2008 and 2018, of whom 245 (44%) were treated with propranolol. Baseline characteristics were compared between patients who received increased propranolol dosing (≥2.5 mg/kg/d) and those who remained on standard dose (2 mg/kg/d). Changes in the Hemangioma Activity Score (HAS) during the increased dosage period were scored by two trained, blinded pediatric dermatologists. RESULTS Of 245 patients, 204 (83%) received standard 2 mg/kg/d propranolol dosing while 41 (17%) received a higher dose of ≥2.5 mg/kg/d. The most common location of IH in both groups was the face. In the increased dosage group, 85.4% of IH were of mixed or deep morphology with a mean greatest diameter of 4.6 cm. IH requiring increased dosing received longer courses of propranolol (mean of 389 vs. 282 days, P < .001) and underwent higher rates of excision by plastic surgery (26.8% vs. 5.9%, P < .001). Mean change in HAS over the period with dosage ≥2.5 mg/kg/d was minimal (-0.70; P < .001). CONCLUSIONS Most recalcitrant IH were located on the face, larger in diameter, and of mixed or deep morphology. Patients had little improvement in HAS score with increased propranolol dosing implemented late in the treatment course with over one-fourth ultimately receiving surgical excision.
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Affiliation(s)
- Amy H Huang
- Division of Pediatric Dermatology, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Diana Mannschreck
- Division of Pediatric Dermatology, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Prachi Aggarwal
- Division of Pediatric Dermatology, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mark Mahon
- Division of Pediatric Dermatology, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bernard A Cohen
- Division of Pediatric Dermatology, John Hopkins University School of Medicine, Baltimore, Maryland, USA
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Dávila-Osorio VL, Iznardo H, Roé E, Puig L, Baselga E. Propranolol-resistant infantile hemangioma successfully treated with sirolimus. Pediatr Dermatol 2020; 37:684-686. [PMID: 32323340 DOI: 10.1111/pde.14163] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 02/25/2020] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
Infantile hemangiomas are the most common benign vascular tumors in childhood. Propranolol is the first-line treatment for infantile hemangiomas, but failures may occur. Sirolimus, an mTOR inhibitor, is a promising drug for the treatment of vascular malformations and vascular tumors. We present the case of a child with multiple infantile hemangiomasthat was successfully treated with sirolimus and propranolol after failure of combined propranolol and prednisolone treatment.
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Affiliation(s)
| | - Helena Iznardo
- Department of Dermatology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Esther Roé
- Department of Dermatology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Lluis Puig
- Department of Dermatology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Eulalia Baselga
- Department of Dermatology, Hospital Sant Joan de Deu, Barcelona, Spain
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Zhang JW, Yin SY, Zhou DK, Wen JX, Gao H, Chen L, Wang ZX. Quantitative Evaluation of Percutaneous Local Drug Perfusion Against Refractory Infantile Hemangioma via 3-D Power Doppler Angiography. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:610-619. [PMID: 31810804 DOI: 10.1016/j.ultrasmedbio.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 10/26/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
To assess the practicality of 3-D power Doppler angiography (3-D-CPA) for local drug perfusion dosage guidance of refractory infantile hemangioma (IH) treatment, 47 cases (48 lesions) of refractory IH were selected for local bleomycin infusion (once a month). Ultrasound was performed before treatment and 1 and 2 months after the first treatment. The 3-D volume (V) change of infantile hemangiomas and the ratio of bleomycin injection to 3-D V before treatment were calculated, and statistical analysis was performed. One month after percutaneous local drug perfusion, 37 participants (77.08%) exhibited significant improvement; controlled growth was observed on six lesions (12.5%); and treatment of the remaining 5 lesions (10.42%) failed to suppress growth. The calculated tolerable and effective dose of bleomycin for refractory IH was 0.34 ± 0.03 mL/cm3; the corresponding 3-D V decreased approximately 70.27 ± 6.27%. Three-dimensional CPA can provide abundant information on internal lesions. In particular, 3-D-CPA can quantitatively assess changes in lesion volume and guide the effective and rational use of interventional drugs.
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Affiliation(s)
- Jin-Wei Zhang
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shu-Yue Yin
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - De-Kai Zhou
- Department of Hemangioma, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jie-Xin Wen
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hui Gao
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Lu Chen
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhao-Xia Wang
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.
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Gomez-Acevedo H, Dai Y, Strub G, Shawber C, Wu JK, Richter GT. Identification of putative biomarkers for Infantile Hemangiomas and Propranolol treatment via data integration. Sci Rep 2020; 10:3261. [PMID: 32094357 PMCID: PMC7039967 DOI: 10.1038/s41598-020-60025-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/20/2019] [Indexed: 12/29/2022] Open
Abstract
Infantile hemangiomas (IHs) are the most common benign tumors in early childhood. They show a distinctive mechanism of tumor growth in which a rapid proliferative phase is followed by a regression phase (involution). Propranolol is an approved treatment for IHs, but its mechanism of action remains unclear. We integrated and harmonized microRNA and mRNA transcriptome data from newly generated microarray data on IHs with publicly available data on toxicological transcriptomics from propranolol exposure, and with microRNA data from IHs and propranolol exposure. We identified subsets of putative biomarkers for proliferation and involution as well as a small set of putative biomarkers for propranolol's mechanism of action for IHs, namely EPAS1, LASP1, SLC25A23, MYO1B, and ALDH1A1. Based on our integrative data approach and confirmatory experiments, we concluded that hypoxia in IHs is regulated by EPAS1 (HIF-2α) instead of HIF-1α, and also that propranolol-induced apoptosis in endothelial cells may occur via mitochondrial stress.
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Affiliation(s)
- Horacio Gomez-Acevedo
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | - Yuemeng Dai
- Mesquite Rehabilitation Institute, Mesquite, Texas, USA
| | - Graham Strub
- Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Carrie Shawber
- Department of Surgery, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University, New York, New York, USA
| | - June K Wu
- Department of Reproductive Sciences in Obstetrics & Gynecology and Surgery, Columbia University, New York, New York, USA
| | - Gresham T Richter
- Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Children's Hospital, Little Rock, Arkansas, USA
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Cardiac arrest in a toddler treated with propranolol for infantile Hemangioma: a case report. Ital J Pediatr 2017; 43:103. [PMID: 29149854 PMCID: PMC5693590 DOI: 10.1186/s13052-017-0421-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Propranolol has become the first-line treatment for complicated Infantile Hemangioma (IH), showing so far a good risk-benefit profile. Case presentation We report the case of a toddler, on propranolol, who suffered cardiac arrest during an acute viral infection. She had a neurally-mediated syncope that progressed to asystole, probably because of concurrent factors as dehydration, beta-blocking and probably individual susceptibility to vaso-vagal phenomena. In fact a significant history of breath-holding spells was consistent with vagal hyperactivity. Conclusions The number of patients treated with propranolol for IHs will increase and sharing experience will help to better define the safety profile of this drug.
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Zhou S, Liu P, Jiang W, Zhang H. Identification of potential target genes associated with the effect of propranolol on angiosarcoma via microarray analysis. Oncol Lett 2017; 13:4267-4275. [PMID: 28588707 PMCID: PMC5452868 DOI: 10.3892/ol.2017.5968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 02/13/2017] [Indexed: 01/16/2023] Open
Abstract
The purpose of the present study was to explore the effect of propranolol on angiosarcoma, and the potential target genes involved in the processes of proliferation and differentiation of angiosarcoma tumor cells. The mRNA expression profile (GSE42534) was downloaded from the Gene Expressed Omnibus database, including three samples without propranolol treatment (control), three samples with propranolol treatment for 4 h and three samples with propranolol treatment for 24 h. The differentially expressed genes (DEGs) in angiosarcoma tumor cells with or without propranolol treatment were obtained via the limma package of R and designated DEGs-4 h and DEGs-24 h. The DEGs-24 h group was divided into two sets. Set 1 contained the DEGs also contained in the DEGs-4 h group. Set 2 contained the remainder of the DEGs. Functional and pathway enrichment analysis of sets 1 and 2 was performed. The protein-protein interaction (PPI) networks of sets 1 and 2 were constructed, termed PPI 1 and PPI 2, and visualized using Cytoscape software. Modules of the two PPI networks were analyzed, and their topological structures were simulated using the tYNA platform. A total of 543 and 2,025 DEGs were identified in angiosarcoma tumor cells treated with propranolol for 4 and 24 h, respectively, compared with the control group. A total of 401 DEGs were involved in DEGs-4 h and DEGs-24 h, including metallothionein 1, heme oxygenase 1, WW domain-binding protein 2 and sequestosome 1. Certain significantly enriched gene ontology (GO) terms and pathways of sets 1 and 2 were identified, containing 28 overlapping GO terms. Furthermore, 121 nodes and 700 associated pairs were involved in PPI 1, whereas 1,324 nodes and 11,839 associated pairs were involved in PPI 2. A total of 45 and 593 potential target genes were obtained according to the node degrees of PPI 1 and PPI 2. The results of the present study indicated that a number of potential target genes, including AXL receptor tyrosine kinase, coatomer subunit α, DR1-associated protein 1 and ERBB receptor feedback inhibitor 1 may be involved in the effect of propranolol on angiosarcoma.
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Affiliation(s)
- Shiyong Zhou
- Department of Lymphoma, Sino-US Center of Lymphoma and Leukemia, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Pengfei Liu
- Department of Lymphoma, Sino-US Center of Lymphoma and Leukemia, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Wenhua Jiang
- Department of Radiotherapy, Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Huilai Zhang
- Department of Lymphoma, Sino-US Center of Lymphoma and Leukemia, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P.R. China
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