Hemangioma is a type of tumor commonly found in infants that is characterized by heavy vascularization and a disfiguring appearance. Hemangioma, though benign, can sometimes proliferate and be threatening to infants. Current treatments for infantile hemangioma include surgical removal as well as the use of topical and oral medication. However, current therapies are often ineffective at treating lesions and are commonly accompanied by dangerous side effects, creating the need for a new, safer treatment. This study targets the Yes-Associated Protein-1 (YAP-1), which has been described as an oncogene, by use of an interfering RNA technique in attempts to mediate tumor growth and progression. Western blotting of treatment and control BEND3 murine cells reveals that YAP-1 is knocked-down in treatment groups which have been infected with shYAP-1 siRNA genes. By successfully knocking down the YAP-1 protein, the potential for developing a novel targeted therapy for infantile hemangioma has been established.

Infantile hemangiomas (IHs), benign vascular lesions present on the surface of the skin of children, are treated with systemic or topical beta-adrenergic antagonists (known as “beta-blockers”). However, systemic beta-blocker therapy is associated with serious adverse events in pediatric patients, and there are currently no topical formulations optimized for the skin. The objectives of this work were to 1) evaluate the local skin concentrations and drug permeation through the skin using novel beta-blocker formulations, and 2) characterize the epidermal properties and skin surface inflammatory mediators of IH skin. Skin concentrations and drug permeation through the skin from current topical treatment options were quantified in vitro; these data served as benchmarks to which other treatment paradigms in later studies were compared. Microneedle (MN)-mediated delivery of two beta-blockers, propranolol and timolol, was evaluated in vitro using solid MNs and two dissolving MN array formulations. Solid MNs increased skin concentrations of timolol compared to intact skin, while producing similar skin concentrations of propranolol. Drug permeation through the skin was increased for both drugs after MN pretreatment. Both formulations of dissolving MN arrays were ineffective at increasing local skin concentrations compared to intact skin. This was likely due to the small loading capacity of drug into the array. Drug-loaded microemulsions (ME) of varying composition were formulated and characterized. All ME formulations had solubilization properties, and water rich MEs had the greatest cumulative release through a homogenous membrane compared to surfactant rich MEs. Drug-loaded MEs did not increase local skin concentrations in vitro compared to a drug solution; however, water rich ME formulations produced greater skin-to-receiver ratio of drug concentration, indicating their potential for skin accumulation. MN pretreatment increased the skin-to-receiver ratios for surfactant rich formulations but not for water rich formulations, indicating this enhancement in skin retention after MN pretreatment is formulation dependent. These results demonstrate the potential for topical treatment of IHs upon further optimization of delivery and formulation parameters. The epidermal properties and skin surface mediators of IH skin were compared to normal, unaffected skin. Significant differences in barrier function and color, as well as chemokine and growth factor concentrations, were observed between the two sites. These results provide a greater understanding of the IH properties that have previously not been quantified. Similar changes in lesion color, which correlate to efficacy, were observed after beginning treatment with oral propranolol or topical timolol, while changes in barrier function were similar between the two treatment groups. These results indicate topical timolol may be a safe alternative for systemic treatment for superficial IHs without a loss of efficacy.

Touchant près de 3 à 10 % des nouveau-nés, les hémangiomes infantiles (HI) sont des tumeurs vasculaires bénignes, les plus fréquentes chez les nourrissons. Les HI sévères sont actuellement traités par un bêtabloqueur, le propranolol, dont l’efficacité a été découverte de manière fortuite. Ainsi, son mécanisme d’action est méconnu. Le propranolol se fixe sur les récepteurs beta-adrénergiques et empêche leur activation par les catécholamines comme la noradrénaline. Nous nous sommes donc interrogés sur la relation entre le propranolol et la noradrénaline dans cette tumeur. Nous avons montré une forte expression de la noradrénaline et des enzymes de synthèse des catécholamines dans les HI, comparés aux hémangiomes congénitaux, qui diminuent lorsque la tumeur involue ou est traitée par le propranolol. Nous avons ensuite réalisé un modèle in vitro ressemblant à l’HI à partir de cellules isolées d’HI capables de synthétiser les catécholamines : les cellules endothéliales et les péricytes. Ce modèle nous permettra d’étudier l’impact de la noradrénaline et du propranolol sur ces cellules. Parallèlement, notre équipe a réalisé un modèle in vivo qui a permis de mettre en évidence le rôle clé de la protéine quaporine-1 (AQP1) dans la réponse antitumorale du propranolol. Nous avons également étudié l’expression de l’AQP1 dans les HI et les hémangiomes congénitaux et découvert un type cellulaire adventitiel exprimant l’AQP1 dans les HI, le télocyte. Au total, notre travail sur l’HI a mis en évidence d’une part une possibilité de production endogène accrue de noradrénaline, probablement antagonisée avec succès par le propranolol, et la découverte de télocytes AQP1+ qui pourraient avoir un rôle dans la spécificité de la réponse des HI au propranolol. / Affecting nearly 3 to 10 % of newborns, infantile hemangiomas (HI) are the most common benign vascular tumors in infants. Severe HIs are currently treated with a beta-blocker, propranolol, whose efficacy was discovered by serendipidity. Propranolol binds to beta-adrenergic receptors and prevents their activation by catecholamines such as noradrenaline. We therefore wondered about the relationship between propranolol and noradrenaline in this tumor. We showed a strong expression of noradrenaline and catecholamine synthesis enzymes in HI, compared to congenital hemangiomas, which decrease when the tumor involutes or is treated with propranolol. We then realize an in vitro model resembling HI from cells isolated from HI capable of synthesizing catecholamines: endothelial cells and pericytes. This model will permit to study the impact of noradrenaline and propranolol on these cells. At the same time, our team created an in vivo model that highlighted the key role of aquaporin-1 protein (AQP1) in the antitumor response to propranolol. We have also studied the expression of AQP1 in HI and congenital hemangiomas, and discovered an adventitious cell type expressing AQP1 in HI, the telocyte. Altogether, our work on HI has revealed firstly the possibility of increased endogenous production of norepinephrine, probably successfully antagonized by propranolol, and secondly the presence of AQP1 + cells which could have a central role central in the specificity of HI response to propranolol.

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The circulatory system is one of the first systems that develops during embryogenesis. Angiogenesis describes the formation of blood vessels as a part of the circulatory system and is essential for organ growth in embryogenesis as well as repair in adulthood. A dysregulation of vessel growth contributes to the pathogenesis of many disorders. Thus, an imbalance between pro- and antiangiogenic factors could be observed in infantile hemangioma (IH). IH is the most common benign tumor during infancy, which appears during the first month of life. These vascular tumors are characterized by rapid proliferation and subsequently slower involution. Most IHs regress spontaneously, but in some cases they cause disfigurement and systemic complications, which requires immediate treatment. Recently, a therapeutic effect of propranolol on IH has been demonstrated. Hence, this non-selective β-blocker became the first-line therapy for IH. Over the last years, our understanding of the underlying mechanisms of IH has been improved and possible mechanisms of action of propranolol in IH have postulated. Previous studies revealed that gap junction proteins, the connexins (Cx), might also play a role in the pathogenesis of IH. Therefore, affecting gap junctional intercellular communication is suggested as a novel therapeutic target of propranolol in IH. In this review we summarize the current knowledge of the molecular processes, leading to IH and provide new insights of how Cxs might be involved in the development of these vascular tumors