Abstract
Problem
Infantile hemangiomas have a well-known distinct proliferative phase characterized by rapid proliferation of capillaries, followed by an involuting phase characterized by spontaneous and steady regression of the tumor. Histologically, proliferating hemangiomas are composed of masses of compact capillaries lined by plump endothelial cells with high mitotic rates. As the lesions involute, mitosis gradually decreases with increased apoptosis of endothelial cells, and vascular tissue is gradually replaced with fibrofatty tissue. Vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) are among several markers that have been qualitatively found in proliferating and involuting phases of infantile hemangiomas, respectively. The purpose of this study is to quantitatively measure growth factors in proliferating and involuting hemangiomas.
Methods
A high-throughput xMAP multiplex immunobead assay technology (Luminex Corp., Austin, TX) was used to test VEGF, FGF, endothelial growth factor (EGF), and granulocyte-colony stimulating factor (G-CSF) in 22 infantile hemangioma specimens, 8 plasma specimens from hemangioma patients, and normal skin. Results were then correlated to histologic findings at the time of surgical removal.
Results
When compared to plasma and normal skin as controls, infantile hemangiomas demonstrated increased amounts of VEGF and EGF in actively proliferating hemangiomas and increased amounts of FGF, in both proliferating and involuting hemangiomas. G-CSF was insignificant in hemangioma specimens.
Conclusion
VEGF, EGF and FGF are upregulated in infantile hemangiomas and may represent important therapeutic targets.
Significance
This is the first study to quantitatively measure growth factors in infantile hemangiomas at different growth stages. Definitive evidence of increased growth factors in proliferating hemangiomas may lead to further consideration of angiogenic inhibitors as an alternative treatment modality to surgery, laser or steroids.
Support
This research study was supported by the Vascular Birthmarks Foundation.
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