Serum concentrations of VEGF and bFGF in the course of propranolol therapy of infantile hemangioma in children: Are we closer to understand the mechanism of action of propranolol on hemangiomas?

Babiak-Choroszczak, Lidia; Giżewska-Kacprzak, Kaja; Gawrych, Elżbieta; Fischer, Katarzyna; Walecka, Anna; Puchalska-Niedbał, Lidia; Rajewska-Majchrzak, Justyna; Bagłaj, Maciej

doi:10.17219/acem/84800

Cited by 19 publications

(19 citation statements)

References 30 publications

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“…The detailed results were the subject of a previous publication. 6 The best therapeutic effect was obtained in the group of the youngest children, who started the treatment up to the 6 th month of life. The final therapeutic effect in the form of complete atrophy of the IH was noted in 69% of the children in this group.…”

Section: Resultsmentioning

confidence: 97%

Safety assessment during initiation andmaintenance of propranolol therapy for infantile hemangiomas

Babiak-Choroszczak¹,

Giżewska-Kacprzak²,

Dawid³

et al. 2019

Adv Clin Exp Med

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Background. Propranolol is an effective method of treatment for infantile hemangiomas (IH). A recent concern is a shift of the therapy into outpatient settings.Objectives. The aim of the study was to evaluate the safety of initiating and maintaining propranolol therapy for IH.Material and methods. The study involved 55 consecutive children with IH being treated with propranolol. The patients were assessed in the hospital at the initiation of the therapy and later in outpatient settings during and after the therapy. Each time, the following monitoring methods were used: physical examination, cardiac ultrasound (ECHO), electrocardiography (ECG), blood pressure (BP), heart rate (HR), and biochemical parameters: blood count, blood glucose, aspartate transaminase (AST), alanine transaminase (ALT), and ionogram. The therapeutic dose of propranolol was 2.0 mg/kg/day divided into 2 doses.Results. Four children were excluded during the qualification or the initiation of propranolol; a total of 51 patients were subject to the final analysis. All the children presented clinical improvement. There was a significant reduction in the mean HR values only at the initiation of propranolol. There were no changes in HR during the course of the therapy. Blood pressure values were within normal limits. Both systolic and diastolic values decreased in the first 3 months. Bradycardia and hypotension were observed sporadically, and they were asymptomatic. Electrocardiography did not show significant deviations. The pathological findings of the ECHO scans were not a contraindication to continuing the therapy. There were no changes in biochemical parameters. Apart from 1 symptomatic case of hypoglycemia, other low glucose episodes were asymptomatic and sporadic. The observed adverse effects were mild and the propranolol dose had to be adjusted in only 6 cases. Conclusions.Propranolol is effective, safe and well-tolerated by children with IH. The positive results of the safety assessment support the strategy of initiating propranolol in outpatient settings. Future studies are needed to assess the benefits of the therapy in ambulatory conditions.

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Section: Resultsmentioning

confidence: 97%

Safety assessment during initiation andmaintenance of propranolol therapy for infantile hemangiomas

Babiak-Choroszczak¹,

Giżewska-Kacprzak²,

Dawid³

et al. 2019

Adv Clin Exp Med

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“…This finding is consistent with results from previous studies. Babiak-Choroszczak et al [22] showed significant decrease in vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), and decreased blood flow in Doppler US during and after propranolol treatment. According to Shi et al [23], Doppler parameters including vascular density, blood flow velocity, and arterial peak systolic blood flow velocity significantly decreased in infantile heamangiomas after propranolol treatment.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound and MRI findings as predictors of propranolol therapy response in patients with infantile hemangioma

et al. 2021

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Objectives To evaluate the prognostic value of ultrasound and MRI findings in patients with infantile hemangioma undergoing propranolol therapy. Methods This study was based on retrospective interpretation of prospectively acquired data. Thirty-eight consecutive patients (28 females and 10 males; mean age ± standard deviation, 3.2 ± 2.2 months) who underwent propranolol treatment for infantile hemangioma were included. Pre-treatment ultrasound images were assessed in terms of echogenicity, lesion height and vascularity. Presence of prominent intratumoral fat, non-fat septa, and enhancement pattern on MRI were retrospectively evaluated. Mann-Whitney test, chi-square, and Fisher’s exact tests were used to compare imaging parameters between patients with treatment success and failure. Results All patients underwent ultrasound and 15 patients underwent MRI. A total of 24 patients showed successful treatment. Between patients with treatment success and failure, there were significant differences in increased vascularity on pre-treatment ultrasound (19/24 vs. 6/14, p = 0.025), decreased vascularity on post-treatment ultrasound (21/24 vs. 5/14, p = 0.001), and prominent intratumoral fat on MRI (1/8 vs. 5/7 p = 0.033). There were no significant differences in echogenicity, lesion height on ultrasound, non-fat septa and MR enhancement pattern. Conclusions Increased vascularity on pre-treatment ultrasound was significantly associated with successful treatment for propranolol therapy in patients with infantile hemangioma, whereas prominent fat component on MRI was significantly associated with treatment failure.

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“…Several mechanisms have been proposed, including vasoconstriction, suppression of vascular endothelial growth factor and basic fibroblast growth factor with resulting inhibition of angiogenesis, inhibition of nitric oxide, and prevention of differentiation of stem cells within the IH into pericytes or endothelial cells. [71][72][73][74][75] Before initiating propranolol, a thorough medical history, family history, and physical examination should be completed. In the absence of concerns, baseline EKG and echocardiogram are not indicated.…”

Section: Treatmentmentioning

confidence: 99%

Infantile Hemangioma: A Current Review

Pahl

McLean

2021

Journal of Pediatric Hematology/Oncology

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Infantile hemangiomas (IHs) are common vascular lesions which are benign but can cause significant functional and cosmetic morbidity. Since the fortuitous discovery of propranolol being effective to treat IH over a decade ago, the therapy and prognosis for children with IH have improved dramatically. Oral propranolol (as well as other oral beta-blockers and topical timolol) are safe and effective treatments, and have now supplanted other therapies. Making the correct diagnosis is crucial, because other vascular lesions can mimic IH. In addition, IH can be the first manifestation of an underlying syndrome. For IH requiring treatment, initiating treatment early is key to optimizing success. Therefore, early recognition and referral, if necessary, are important. Continued research on IH, both basic science and clinical, should result in continued advances.

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Serum concentrations of VEGF and bFGF in the course of propranolol therapy of infantile hemangioma in children: Are we closer to understand the mechanism of action of propranolol on hemangiomas?

Cited by 19 publications

References 30 publications

Safety assessment during initiation andmaintenance of propranolol therapy for infantile hemangiomas

Safety assessment during initiation andmaintenance of propranolol therapy for infantile hemangiomas

Ultrasound and MRI findings as predictors of propranolol therapy response in patients with infantile hemangioma

Infantile Hemangioma: A Current Review

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