title: Serum levels of renin, angiotensin-converting enzyme and angiotensin II in patients treated by surgical excision, propranolol and captopril for problematic proliferating infantile haemangioma.
abstract: The role of the renin-angiotensin system (RAS) in the biology of infantile haemangioma (IH) and its accelerated involution induced by β-blockers was first proposed in 2010. This led to the first clinical trial in 2012 using low-dose captopril, an angiotensin-converting enzyme (ACE) inhibitor, demonstrating a similar response in these tumours. This study aimed to compare serial serum levels of the components of the RAS in patients before and after surgical excision, propranolol or captopril treatment for problematic proliferating IH. Patients with problematic proliferating IH underwent measurements of serum levels of plasma renin activity (PRA), ACE and angiotensin II (ATII) before, and 1-2 and 6 months following surgical excision, propranolol or captopril treatment. This study included 27 patients undergoing surgical excision (n = 8), propranolol (n = 11) and captopril (n = 8) treatment. Treatment with either surgical excision or propranolol resulted in significant decrease in the mean levels of PRA. Surgical excision or captopril treatment led to significant decline in the mean levels of ATII. All three treatment modalities had no significant effect on the mean levels of ACE. This study demonstrates the effect of surgical excision, propranolol and captopril treatment in lowering the levels of PRA and ATII, but not ACE, supporting a mechanistic role for the RAS in the biology of IH.
authors.affiliation: Gillies McIndoe Research Institute, New Zealand.
authors.forename: L
authors.initials: L
authors.lastname: Sulzberger
authors.affiliation: Gillies McIndoe Research Institute, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Baillie
authors.affiliation: Gillies McIndoe Research Institute, New Zealand.
authors.forename: T
authors.initials: T
authors.lastname: Itinteang
authors.affiliation: Gillies McIndoe Research Institute, New Zealand.
authors.forename: S
authors.initials: S
authors.lastname: de Jong
authors.affiliation: Gillies McIndoe Research Institute, New Zealand; University of Auckland, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Marsh
authors.affiliation: Centre for the Study & Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial & Burns Unit, New Zealand; Department of Paediatrics, Hutt Hospital, Wellington, New Zealand.
authors.forename: P
authors.initials: P
authors.lastname: Leadbitter
authors.affiliation: Gillies McIndoe Research Institute, New Zealand; Centre for the Study & Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial & Burns Unit, New Zealand. Electronic address: swee.tan@gmri.org.nz.
authors.forename: S T
authors.initials: ST
authors.lastname: Tan
mesh_terms: D000804:Angiotensin II / Q000097:blood; D002216:Captopril / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D018324:Hemangioma, Capillary / Q000097:blood / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009520:New Zealand; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D011379:Prognosis; D011433:Propranolol / Q000627:therapeutic use*; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods
chemical_list: D000804:Angiotensin II; D002216:Captopril; D011433:Propranolol; D007703:Peptidyl-Dipeptidase A; D012083:Renin
keywords: Angiotensin II; Angiotensin-converting enzyme; Infantile haemangioma; Plasma renin activity; Renin–angiotensin system