title: Elevated Serum Levels of Alpha-Fetoprotein in Patients with Infantile Hemangioma Are Not Derived from within the Tumor.
abstract: OBJECTIVE
  The embryonic-like stem cell origin of infantile hemangioma (IH) and the observed elevated serum levels of alpha-fetoprotein (AFP) in patients with hepatic IH led us to investigate if this tumor was the source of AFP.
  
  
  METHODS
  We measured serial serum levels of AFP in patients with problematic proliferating IH treated with surgical excision or propranolol treatment. We also investigated the expression of AFP in extrahepatic IH samples using immunohistochemical staining, mass spectrometry, NanoString gene expression analysis, and in situ hybridization.
  
  
  RESULTS
  Serum levels of AFP normalized following surgical excision or propranolol treatment. Multiple regression analysis for curve fittings revealed a different curve compared to reported normal values in the general populations. AFP was not detected in any of the IH samples examined at either the transcriptional or translational levels.
  
  
  CONCLUSIONS
  This study demonstrates the association of proliferating IH with elevated serum levels of AFP, which normalized following surgical excision or propranolol treatment. We have shown that IH is not the direct source of AFP. An interaction between the primitive mesoderm-derived IH and the endogenous endodermal tissues, such as the liver, via an intermediary, may explain the elevated serum levels of AFP in infants with extrahepatic IH.
authors.affiliation: Gillies McIndoe Research Institute , Wellington , New Zealand.
authors.forename: Tinte
authors.initials: T
authors.lastname: Itinteang
authors.affiliation: Gillies McIndoe Research Institute , Wellington , New Zealand.
authors.forename: Alice M
authors.initials: AM
authors.lastname: Chibnall
authors.affiliation: Gillies McIndoe Research Institute, Wellington, New Zealand; University of Auckland, Auckland, New Zealand.
authors.forename: Reginald
authors.initials: R
authors.lastname: Marsh
authors.affiliation: Gillies McIndoe Research Institute, Wellington, New Zealand; Centre for Biodiscovery, School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Dunne
authors.affiliation: Gillies McIndoe Research Institute , Wellington , New Zealand.
authors.forename: Sophie
authors.initials: S
authors.lastname: de Jong
authors.affiliation: Gillies McIndoe Research Institute , Wellington , New Zealand.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Davis
authors.affiliation: Gillies McIndoe Research Institute, Wellington, New Zealand; Centre for the Study and Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Wellington, New Zealand; Department of Paediatrics, Hutt Hospital, Wellington, New Zealand.
authors.forename: Philip
authors.initials: P
authors.lastname: Leadbitter
authors.affiliation: Gillies McIndoe Research Institute, Wellington, New Zealand; Centre for the Study and Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Wellington, New Zealand.
authors.forename: Swee T
authors.initials: ST
authors.lastname: Tan
keywords: alpha-fetoprotein; endoderm; extrahepatic; infantile hemangioma; primitive mesoderm