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World J Cardiol. Jan 26, 2016; 8(1): 74-80
Published online Jan 26, 2016. doi: 10.4330/wjc.v8.i1.74
Cardiovascular drugs in the treatment of infantile hemangioma
Israel Fernandez-Pineda, Regan Williams, Lucia Ortega-Laureano, Ryan Jones
Israel Fernandez-Pineda, Lucia Ortega-Laureano, Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN 38105, United States
Regan Williams, Department of Pediatric Surgery, Le Bonheur Children’s Hospital, Memphis, TN 38105, United States
Ryan Jones, Department of Pediatric Cardiology, Le Bonheur Children’s Hospital, Memphis, TN 38105, United States
Author contributions: Fernandez-Pineda I, Williams R, Ortega-Laureano L and Jones R designed the review article and wrote the manuscript.
Conflict-of-interest statement: The authors declare that there is no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Israel Fernandez-Pineda, MD, Department of Surgery, St. Jude Children’s Research Hospital, 332 N Lauderdale, Memphis, TN 38105, United States. israel.fernandez-pineda@stjude.org
Telephone: +1-901-5952315
Received: May 28, 2015
Peer-review started: June 1, 2015
First decision: August 16, 2015
Revised: September 4, 2015
Accepted: October 23, 2015
Article in press: October 28, 2015
Published online: January 26, 2016
Processing time: 238 Days and 5.9 Hours
Abstract

Since the introduction of propranolol in the treatment of complicated infantile hemangiomas (IH) in 2008, other different beta-blockers, including timolol, acetabutolol, nadolol and atenolol, have been successfully used for the same purpose. Various hypotheses including vasoconstriction, inhibition of angiogenesis and the induction of apoptosis in proliferating endothelial cells have been advanced as the potential beta-blocker-induced effect on the accelerated IH involution, although the exact mechanism of action of beta-blockers remains unknown. This has generated an extraordinary interest in IH research and has led to the discovery of the role of the renin-angiotensin system (RAS) in the biology of IH, providing a plausible explanation for the beta-blocker induced effect on IH involution and the development of new potential indications for RAS drugs such as angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers in the treatment of IH. This review is focused on the current use of cardiovascular drugs in the treatment of IH.

Keywords: Infantile hemangioma; Beta-blockers; Renin-angiotensin system; Angiogenesis

Core tip: This article aimed to review the different beta-blockers used in the treatment of children with infantile hemangioma, the pre-treatment cardiologic work-up required and the potential side-effects associated with beta-blockers therapy in such a young population. Other cardiovascular drugs with potential effects on infantile hemangioma including angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers are also reviewed.