Propranolol in the Treatment of Problematic Infantile Hemangioma: Review of 35 Consecutive Patients from a Vascular Anomalies Clinic

Bertrand, Janie; Sammour, Rita; McCuaig, Catherine; Dubois, Josée; Hatami, Afshin; Ondrejchak, Sandra; Boutin, Christine; Bortoluzzi, Patricia; Laberge, Louise Caouette; Powell, Julie

doi:10.1177/120347541201600508

Cited by 17 publications

(18 citation statements)

References 11 publications

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“…For outpatient management, propranolol was started at a low daily dose that was gradually increased over 5 to 6 days to the full maintenance dose of 2 mg/kg/day. With this regimen, the authors felt that monitoring of heart rate and blood pressure was not necessary after initial dosing, as has been done in some centers , thus avoiding a prolonged hospital or clinic stay.…”

Section: Methodsmentioning

confidence: 99%

Cardiac Screening in Infants with Infantile Hemangiomas before Propranolol Treatment

Blei

McElhinney

Guarini

et al. 2014

Pediatric Dermatology

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There is no uniform pretreatment cardiac evaluation for infants treated with oral propranolol, which is now the drug of choice for hemangiomas of infancy requiring systemic medical intervention. The aim of this study was to report and evaluate the findings of pretreatment cardiac evaluation. Data were reviewed for patients evaluated by a single hemangioma specialist and a single pediatric cardiologist prior to initiation of propranolol for infantile hemangioma. Cardiac evaluation included a complete echocardiogram. From July 2009 through January 2013, 239 consecutive patients 12 months of age or younger (median 2.7 months) were screened. No patients had cardiac contraindications to propranolol. However, 50 patients (21%) had an abnormal echocardiogram: 39 atrial septal defects (5 associated with right heart enlargement), 6 ventricular septal defects, 2 patent ductus arteriosus, 1 aortic coarctation, 1 pulmonary valve stenosis, and 1 aberrant subclavian artery. Overall, 69 patients had an audible heart murmur, 44 of which were not associated with pathologic findings on echocardiogram. All patients with a ventricular septal defect and 16 of 39 with an atrial septal defect had a murmur. Two of seven patients with PHACE syndrome had cardiac anomalies. None of the findings precluded the use of propranolol. Assisted reproductive technologies were used in 18% of pregnancies, including in vitro fertilization in 12%. Cardiac contraindications to propranolol treatment are uncommon in patients with infantile hemangioma. However, anatomic abnormalities were more common than reported in the general population. Further study is necessary to determine whether there is a pathogenic relationship between cardiac defects and nonsyndromic infantile hemangioma.

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Section: Methodsmentioning

confidence: 99%

Cardiac Screening in Infants with Infantile Hemangiomas before Propranolol Treatment

Blei

McElhinney

Guarini

et al. 2014

Pediatric Dermatology

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“…Leaute-Labreze et al [63] presented efficacy of sympatholytic non-selective beta blocker known as propranolol, in therapy of infantile hemangiomas. The mechanism of action is unknown, but there are reports that suggest that within 24-48 hours, hemangiomas respond to therapy by size reduction and changes in color [64]. Although authors report that the drug is most effective in cases of proliferative hemangiomas, results of some cases have shown that hemangiomas in the post-proliferative stage respond well [64,65].…”

Section: Propranololmentioning

confidence: 99%

“…The mechanism of action is unknown, but there are reports that suggest that within 24-48 hours, hemangiomas respond to therapy by size reduction and changes in color [64]. Although authors report that the drug is most effective in cases of proliferative hemangiomas, results of some cases have shown that hemangiomas in the post-proliferative stage respond well [64,65]. A daily dose of propranolol is 2mg/kg and it is given in three equally doses [65].…”

Section: Propranololmentioning

confidence: 99%

Vascular Anomalies of the Maxillofacial Region: Diagnosis and Management

Fočo¹,

Brkić²

2013

A Textbook of Advanced Oral and Maxillofacial Surgery

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“…Bertrand et al (13) reviewed a series of 35 consecutive patients with infantile hemangioma and reported that oral propranolol was effective in controlling the proliferative phase of problematic infantile hemangioma, without causing serious adverse effects. A meta-analysis study conducted by Izadpanah et al (16) revealed that propranolol achieves a greater response rate in the treatment of infantile hemangiomas in comparison with corticosteroids (99 vs. <90%).…”

Section: Discussionmentioning

confidence: 99%

“…The therapeutic benefit of propranolol in hemangiomas was accidentally identified in 2008 by Léauté-Labrèze et al (12) who noted the regression of an infantile hemangioma following the administration of propranolol for steroid-induced hypertrophic cardiomyopathy. Since then, several other studies have also reported the effectiveness of propranolol in the treatment of problematic infantile hemangiomas (13,14). In the current study, we aimed to investigate the molecular mechanism(s) underlying the therapeutic effects of propranolol against hemangiomas, using primary infantile hemangioma endothelial cells (IHECs).…”

Section: Introductionmentioning

confidence: 99%

Induction of apoptosis in infantile hemangioma endothelial cells by propranolol

Dong³

et al. 2013

Experimental and Therapeutic Medicine

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Propranolol, a non-selective β-blocker, is emerging as an effective treatment for complicated hemangiomas. The aim of this study was to investigate the molecular mechanism(s) underlying the therapeutic effects of propranolol against hemangiomas, using primary infantile hemangioma endothelial cells (IHECs). IHECs were treated with various concentrations of propranolol and morphological changes and apoptosis were assessed. Changes in the expression levels of apoptosis-related genes were examined. Annexin-V staining revealed that propranolol at 40, 50 and 60 μg/ml caused a concentration-dependent increase in the apoptosis of IHECs. Morphological analyses revealed that exposure to 50 μg/ml propranolol resulted in typical apoptotic changes, including shrinkage, the formation of apoptotic bodies and retention of plasma membrane integrity. Gene expression analyses revealed that propranolol treatment led to a marked increase in the expression of caspase-8, cytochrome c, apoptosis-inducing factor, caspase-3 and poly (ADP-ribose) polymerase 1, as well as a concomitant reduction in lamin B1 expression. Our data collectively demonstrate that propranolol induces apoptosis of IHECs through activation of the intrinsic and extrinsic apoptotic pathways, which represents an important mechanism for its therapeutic effects against infantile hemangiomas.

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Propranolol in the Treatment of Problematic Infantile Hemangioma: Review of 35 Consecutive Patients from a Vascular Anomalies Clinic

Abstract: Propranolol was effective in controlling the proliferative phase of problematic IH. It was well tolerated in our study. Outpatient treatment is possible if parents follow strict guidelines. Propranolol should be a first-line treatment for problematic IH in carefully selected patients.

Cited by 17 publications

References 11 publications

Cardiac Screening in Infants with Infantile Hemangiomas before Propranolol Treatment

Cardiac Screening in Infants with Infantile Hemangiomas before Propranolol Treatment

Vascular Anomalies of the Maxillofacial Region: Diagnosis and Management

Induction of apoptosis in infantile hemangioma endothelial cells by propranolol

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