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Low-dose propranolol for multiple hepatic and cutaneous hemangiomas with deranged liver function
Swee Thong Tan1, Tinte Itinteang, Philip Leadbitter
1Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, High Street, Private Bag 31-907, Lower Hutt, New Zealand. swee.tan@huttvalleydhb.org.nz
Pediatrics
|March 2, 2011
Summary
Low-dose propranolol effectively treated infantile hemangiomas (IHs) in an infant with liver dysfunction. This suggests IH is a developmental anomaly influenced by the renin-angiotensin system, offering potential new therapeutic targets.
Area of Science:
- Vascular Biology
- Developmental Biology
- Pediatric Gastroenterology
Background:
- Infantile hemangiomas (IHs) are common benign vascular tumors in infants.
- Hepatic and cutaneous IHs can lead to significant morbidity, including liver dysfunction.
- Current treatment options for IHs have limitations.
Observation:
- A case of an infant presenting with multiple hepatic and cutaneous IHs and abnormal liver function is described.
- The infant was successfully treated with a low dose of propranolol.
- IH is proposed to be a developmental anomaly originating from hemogenic endothelium.
Findings:
- Hemogenic endothelium in IHs is suggested to be derived from primitive mesoderm with neural crest-cell phenotype.
- The renin-angiotensin system is implicated in governing hemogenic endothelium.
- This system may explain propranolol's efficacy and IH involution.
Implications:
- Low-dose propranolol represents a viable therapeutic strategy for complex IH cases.
- Targeting the renin-angiotensin system offers novel therapeutic avenues for IH.
- Further research into angiotensin-converting enzyme and angiotensin II receptor 2 inhibitors is warranted.
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