title: The use of propranolol in the treatment of infantile haemangiomas: an update on potential mechanisms of action.
abstract: Currently, propranolol is the preferred treatment for problematic proliferating infantile haemangiomas (IHs). The rapid action of propranolol has been shown to be especially dramatic in IHs involving dyspnoea, haemodynamic compromise, palpebral occlusion or ulceration. Another remarkable aspect of propranolol treatment revealed that the growth of the IHs was not only stabilized, but also that the improvement continued until complete involution was achieved, leading to a considerable shortening of the natural course of IH. However, the mechanisms underlying the effects of propranolol have not been fully elucidated. Recent studies have offered evidence of a variety of mechanisms. These include the promotion of pericyte-mediated vasoconstriction, the inhibition of vasculogenesis and catecholamine-induced angiogenesis, the disruption of haemodynamic force-induced cell survival, and the inactivation of the renin-angiotensin system. This review summarizes these mechanisms and the new concepts that are emerging in this area of research. Moreover, several molecular mechanisms by which propranolol may modify neovascularization in IH have also been proposed. The antihaemangioma effect of propranolol may not be attributable to a single mechanism, but rather to a combination of events that have not yet been elucidated or understood. Further studies are needed to evaluate and verify these mechanisms to gain a greater understanding of the effects of the intake of propranolol on haemangioma involution.
authors.affiliation: Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Ji
authors.forename: S
authors.initials: S
authors.lastname: Chen
authors.forename: C
authors.initials: C
authors.lastname: Xu
authors.forename: L
authors.initials: L
authors.lastname: Li
authors.forename: B
authors.initials: B
authors.lastname: Xiang
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D020533:Angiogenesis Inhibitors / Q000494:pharmacology; D017209:Apoptosis / Q000187:drug effects; D002395:Catecholamines / Q000037:antagonists & inhibitors; D006391:Hemangioma / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D020286:Pericytes / Q000187:drug effects; D011433:Propranolol / Q000494:pharmacology / Q000627:therapeutic use*; D011943:Receptors, Adrenergic, beta / Q000187:drug effects; D012084:Renin-Angiotensin System / Q000187:drug effects; D012878:Skin Neoplasms / Q000188:drug therapy*; D014661:Vasoconstriction / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000494:pharmacology
chemical_list: D000319:Adrenergic beta-Antagonists; D020533:Angiogenesis Inhibitors; D002395:Catecholamines; D011943:Receptors, Adrenergic, beta; D014662:Vasoconstrictor Agents; D011433:Propranolol