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McGinness A, Gillam A, Yeh I, Mathes EF. Topical timolol: An effective treatment option for agminated pyogenic granuloma. Pediatr Dermatol 2018; 35:e300-e303. [PMID: 29961974 DOI: 10.1111/pde.13575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We present three patients with agminated pyogenic granulomas who experienced significant decrease in size and bleeding with treatment with topical timolol solution with minimal side effects. One patient had complete clinical resolution. For patients with agminated pyogenic granuloma who may otherwise have limited treatment options, timolol is an effective potential solution.
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Affiliation(s)
- Anelah McGinness
- School of Medicine, University of California, San Francisco, CA, USA
| | - Amy Gillam
- Department of Dermatology, Palo Alto Medical Foundation, Palo Alto, San Francisco, CA, USA.,Department of Dermatology, University of California, San Francisco, CA, USA
| | - Iwei Yeh
- Department of Dermatology, University of California, San Francisco, CA, USA.,Department of Pathology, University of California, San Francisco, CA, USA
| | - Erin F Mathes
- Department of Dermatology, University of California, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco, CA, USA
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Padia R, Bly R, Bull C, Geddis AE, Perkins J. Medical Management of Vascular Anomalies. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2018; 4:221-236. [PMID: 30505648 PMCID: PMC6261360 DOI: 10.1007/s40746-018-0130-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW This chapter will summarize the most recent literature regarding the current state of medical treatment for vascular anomalies. RECENT FINDINGS Research into the biology of these anomalies has strengthened our understanding of each anomaly and has helped to pave the way for more tailored treatment options involving molecular and/or genetic targets. SUMMARY While there is still a role for surgical intervention, medical therapies that target the etiology of vascular anomalies may represent an alternative or adjunctive approach in the management of these lesions.
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Affiliation(s)
- Reema Padia
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
| | - Randall Bly
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
| | - Catherine Bull
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
| | - Amy E. Geddis
- Cancer and Blood Disorders Clinic, Seattle Children's Hospital, Seattle, Washington, United States
| | - Jonathan Perkins
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
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Phillips JD, Zhang H, Wei T, Richter GT. Expression of β-Adrenergic Receptor Subtypes in Proliferative, Involuted, and Propranolol-Responsive Infantile Hemangiomas. JAMA FACIAL PLAST SU 2017; 19:102-107. [PMID: 27737446 DOI: 10.1001/jamafacial.2016.1188] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Importance Propranolol hydrochloride has become the primary medical treatment for problematic infantile hemangioma; however, the expression of propranolol's target receptors during growth, involution, and treatment of hemangioma remains unclear. Objective To measure and compare the expression of β1-, β2-, and β3-adrenergic receptors (ADBR1, ADBR2, and ADBR3, respectively) in proliferative (n = 10), involuted (n = 11), and propranolol-responsive (n = 12) hemangioma tissue. Design, Setting, and Participants Infantile hemangioma specimens were harvested for molecular investigation. Messenger RNA (mRNA) expression of the ADBR1, ADBR2, and ADBR3 genes was detected by real-time polymerase chain reaction. Protein level expression was measured by Western blot and standardized with densitometry. A total of 33 specimens were collected from patients in a tertiary pediatric hospital who underwent excision of problematic hemangiomas. This study was conducted from January 18, 2011, to September 24, 2013, and data analysis was performed from February 25, 2015, to June 25, 2016. Results Of the 33 patients included, 21 were female (64%). The mean (SD) patient age at the time of excision was 7 (2.5) months for the proliferative group lesions, 23.5 (10) months for the involuted group, and 16 (10) months for the propranolol group. The mean level of ADBR1 mRNA expression was significantly higher in proliferative hemangioma than in propranolol-responsive hemangioma (1.05 [0.56] vs 0.52 [0.36]; P = .01; 95% CI, 0.12-0.94). There was no difference in ADBR2 expression among the groups. Protein expression of ADBR3 was significantly higher in involuted (0.64 [0.12] vs 0.26 [0.04]; P < .01; 95% CI, 0.26-0.49) and propranolol-responsive hemangioma (0.66 [0.31] vs 0.26 [0.04]; P = .01; 95% CI, 0.16-0.68) compared with proliferative hemangioma. Conclusions and Relevance These data demonstrate the variable expression of ADBR subtypes among infantile hemangiomas during growth, involution, and response to treatment. These findings may have clinical implications regarding the use of selective vs nonselective β-blockade. Level of Evidence 2.
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Affiliation(s)
- James D Phillips
- Division of Pediatric Otolaryngology and Center for the Investigation of Congenital Aberrancies of Vascular Development, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for the Medical Sciences, Little Rock2Department of Otolaryngology Head and Neck Surgery, Arkansas Children's Hospital, Little Rock
| | - Haihong Zhang
- Division of Pediatric Otolaryngology and Center for the Investigation of Congenital Aberrancies of Vascular Development, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for the Medical Sciences, Little Rock2Department of Otolaryngology Head and Neck Surgery, Arkansas Children's Hospital, Little Rock
| | - Ting Wei
- Division of Pediatric Otolaryngology and Center for the Investigation of Congenital Aberrancies of Vascular Development, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for the Medical Sciences, Little Rock2Department of Otolaryngology Head and Neck Surgery, Arkansas Children's Hospital, Little Rock
| | - Gresham T Richter
- Division of Pediatric Otolaryngology and Center for the Investigation of Congenital Aberrancies of Vascular Development, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for the Medical Sciences, Little Rock2Department of Otolaryngology Head and Neck Surgery, Arkansas Children's Hospital, Little Rock
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Cole SW, Nagaraja AS, Lutgendorf SK, Green PA, Sood AK. Sympathetic nervous system regulation of the tumour microenvironment. Nat Rev Cancer 2015; 15:563-72. [PMID: 26299593 PMCID: PMC4828959 DOI: 10.1038/nrc3978] [Citation(s) in RCA: 356] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The peripheral autonomic nervous system (ANS) is known to regulate gene expression in primary tumours and their surrounding microenvironment. Activation of the sympathetic division of the ANS in particular modulates gene expression programmes that promote metastasis of solid tumours by stimulating macrophage infiltration, inflammation, angiogenesis, epithelial-mesenchymal transition and tumour invasion, and by inhibiting cellular immune responses and programmed cell death. Haematological cancers are modulated by sympathetic nervous system (SNS) regulation of stem cell biology and haematopoietic differentiation programmes. In addition to identifying a molecular basis for physiologic stress effects on cancer, these findings have also identified new pharmacological strategies to inhibit cancer progression in vivo.
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Affiliation(s)
- Steven W. Cole
- Department of Medicine, Division of Hematology-Oncology, Geffen School of Medicine, UCLA Molecular Biology Institute, Norman Cousins Center, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles
- Correspondence: , Department of Medicine/Hematology-Oncology, 11-934 Factor Bldg., UCLA School of Medicine, Los Angeles CA 90095-1678
| | - Archana S. Nagaraja
- Departments of Gynecologic Oncology and Cancer Biology, University of Texas M. D. Anderson Comprehensive Cancer Center
| | - Susan K. Lutgendorf
- Departments of Psychology, Obstetrics and Gynecology, Urology, and Holden Comprehensive Cancer Center, University of Iowa
| | - Paige A. Green
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, United States National Cancer Institute
| | - Anil K. Sood
- Departments of Gynecologic Oncology and Cancer Biology, University of Texas M. D. Anderson Comprehensive Cancer Center
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Elluru RG, Friess MR, Richter GT, Grimmer JF, Darrow DH, Shin JJ, Perkins JA. Multicenter Evaluation of the Effectiveness of Systemic Propranolol in the Treatment of Airway Hemangiomas. Otolaryngol Head Neck Surg 2015; 153:452-60. [DOI: 10.1177/0194599815591809] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 05/27/2015] [Indexed: 12/28/2022]
Abstract
Objective To evaluate the effectiveness of systemic propranolol in airway infantile hemangioma (AIH) treatment. Design Case series with chart review. Participants Patients with AIH treated with propranolol between 2009 and 2012 with at least a 1-year follow-up. Outcomes Presenting age, treating institution, syndrome presence, presenting AIH stage, endoscopy status, propranolol initiation location/dose/duration, time to stridor resolution, adjunctive medical and surgical therapy, and treatment-associated complications. Results Twenty-seven patients met inclusion criteria. Average age of diagnosis was 2.3 months (range, 1-5 months). The AIHs were stage 1 in 7 of 27 (26%), stage 2 in 12 of 27 (44%), and stage 3 in 8 of 27 (30%). Propranolol initiation was inpatient in 25 of 27 (93%) and outpatient in 2 of 27 (7%). Propranolol dose was maintained at 2 mg/kg/d in all patients for a minimum of 7 months (range, 7-34 months; median, 15 months). Stridor was eliminated within 24 hours or less of propranolol initiation in 23 of 27 (85%). At diagnosis, staging and propranolol initiation in 11 of 27 (41%) were managed with propranolol alone; the remaining 16 of 27 (59%) also had a steroid injection. The use of adjuvant therapy at the time of propranolol initiation and the size of the AIH were not statistically correlated. Twelve patients had additional treatments after the initiation of propranolol due to recurrence of respiratory symptoms, 1 of 27 (4%) of whom was considered a nonresponder. No complications related to propranolol use were noted. Conclusions This multisite study of AIH treatment with propranolol demonstrates similar effectiveness to surgical treatment modalities. Propranolol therapy for AIH had no complications, had potentially lower resource utilization, and should be considered a first-line AIH treatment.
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Affiliation(s)
- Ravindhra G. Elluru
- Divsion of Pediatric Otolaryngology, Dayton Children’s Hospital, Dayton, Ohio, USA
| | - Melanie R. Friess
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gresham T. Richter
- Divsion of Pediatric Otolaryngology, Arkansas Children’s Hospital, Little Rock, Arkansas, USA
| | - J. Fred Grimmer
- Divison of Pediatric Otolaryngology, University of Utah Medical Center, Salt Lake City, Utah, USA
| | - David H. Darrow
- Divison of Pediatric Otolaryngology, Children’s Hospital of The King’s Daughter, Norfolk, Virginia, USA
| | - Jennifer J. Shin
- Divison of Pediatric Otolaryngology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Jonathan A. Perkins
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, Washington, USA
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Kum JJ, Khan ZA. Mechanisms of propranolol action in infantile hemangioma. DERMATO-ENDOCRINOLOGY 2015; 6:e979699. [PMID: 26413184 PMCID: PMC4580045 DOI: 10.4161/19381980.2014.979699] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/20/2014] [Indexed: 12/17/2022]
Abstract
Infantile hemangioma is a common tumor of infancy. Although most hemangiomas spontaneously regress, treatment is indicated based on complications, risk to organ development and function, and disfigurement. The serendipitous discovery of propranolol, a non-selective β-adrenergic receptor blocker, as an effective means to regress hemangiomas has made this a first-line therapy for hemangioma patients. Propranolol has shown remarkable response rates. There are, however, some adverse effects, which include changes in sleep, acrocyanosis, hypotension, and hypoglycemia. Over the last few years, researchers have focused on understanding the mechanisms by which propranolol causes hemangioma regression. This has entailed study of cultured vascular endothelial cells including endothelial cells isolated from hemangioma patients. In this article, we review recent studies offering potential mechanisms of how various cell types found in hemangioma may respond to propranolol.
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Affiliation(s)
- Jina Jy Kum
- Department of Pathology and Laboratory Medicine; Schulich School of Medicine & Dentistry; Western University ; London, Ontario Canada
| | - Zia A Khan
- Department of Pathology and Laboratory Medicine; Schulich School of Medicine & Dentistry; Western University ; London, Ontario Canada ; Metabolism and Diabetes Research Program; Lawson Health Research Institute ; London, Ontario Canada ; Division of Genetics and Development; Children's Hospital Research Institute ; London, Ontario Canada
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Pandey A, Singh SP, Verma R, Gupta V. Re: Propranolol for infantile haemangiomas: Early experience from a tertiary center. J Cutan Aesthet Surg 2014; 7:137-8. [PMID: 25136223 PMCID: PMC4134652 DOI: 10.4103/0974-2077.138372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Anand Pandey
- Department of Surgery, Uttar Pradesh Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India E-mail:
| | - Shailendra P Singh
- Department of Surgery, Uttar Pradesh Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India E-mail:
| | - Rajesh Verma
- Department of Surgery, Uttar Pradesh Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India E-mail:
| | - Vipin Gupta
- Department of Surgery, Uttar Pradesh Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India E-mail:
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Blei F. Update March 2014. Lymphat Res Biol 2014. [DOI: 10.1089/lrb.2014.1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Blei F. Update December 2013. Lymphat Res Biol 2013. [DOI: 10.1089/lrb.2013.1142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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