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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
PubMed

Insights

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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