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Primitive mesodermal cells with a neural crest stem cell phenotype predominate proliferating infantile haemangioma
  1. Tinte Itinteang1,2,
  2. Swee T Tan1,2,3,
  3. Helen Brasch2,4,
  4. Darren J Day1,2
  1. 1School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
  2. 2Centre for the Study & Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand
  3. 3University of Otago, Wellington, New Zealand
  4. 4Department of Pathology, Hutt Hospital, Wellington, New Zealand
  1. Correspondence to Professor Swee T Tan, Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Private Bag 31-907, High Street, Lower Hutt, Wellington, New Zealand; swee.tan{at}


Aims Infantile haemangioma is a tumour of the microvasculature characterised by aggressive angiogenesis during infancy and spontaneously gradual involution, often leaving a fibro-fatty residuum. The segmental distribution of a subgroup of infantile haemangioma, especially those associated with midline structural anomalies that constitute posterior fossa malformations–hemangiomas–arterial anomalies–cardiac defects–eye abnormalities–sternal cleft and supraumbilical raphe syndrome (PHACES), led us to investigate whether neural crest cells might be involved in the aetiology of this tumour.

Methods Immunohistochemical staining on paraffin embedded infantile haemangioma sections and immunocytochemical staining on cells derived from proliferating haemangioma cultures were performed.

Results The endothelium of proliferating infantile haemangioma contains abundant cells that express the neurotrophin receptor (p75), a cell surface marker that identifies neural crest cells, and also for brachyury, a transcription factor expressed in cells of the primitive mesoderm. The endothelium is also immunoreactive for the haematopoietic stem cell marker, CD133; the endothelial-haematopoietic stem/progenitor marker, CD34; the endothelial cell markers, CD31 and VEGFR-2; and the mesenchymal stem cell markers, CD29 and vimentin. Additionally, immunoreactivity for the transcription factors, Sox 9 and Sox 10, that are expressed by prospective neural crest cells was also observed. Cells from microvessel-like structures were isolated from in vitro cultured haemangioma tissue explants embedded in a fibrin matrix. Immunostaining of these cells showed that they retained expression of the same lineage-specific markers that are detected on the paraffin embedded tissue sections.

Conclusions These data infer that infantile haemangioma is derived from primitive mesoderm and that the cells within the lesion have a neural crest stem cell phenotype, and they express proteins associated with haematopoietic, endothelial, neural crest and mesenchymal lineages. The authors propose a model to account for the natural progression of infantile haemangioma based upon the multipotent expression profile of the primitive mesoderm and their neural crest stem cell phenotype to form all the cell lineages detected during infantile haemangioma proliferation and involution.

  • Infantile haemangioma
  • neural crest
  • stem cells
  • primitive mesoderm
  • brachyury
  • neurotrophin
  • haemangioblast
  • mesenchymal
  • angiogenesis
  • biological sciences
  • cell biology
  • haematopoesis
  • vascular disease

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  • Equal senior authors: STT, DJD.

  • This paper was presented, in part, at the Australian and New Zealand Vascular Anomalies Interest Group Meeting, 22 October 2009, Melbourne, Australia; the New Zealand Association of Plastic Surgeons' Annual Scientific Meeting, 21 November, 2009, Auckland, New Zealand; the Royal Australasian College of Surgeons' 46th Surgical Research Society Meeting, Adelaide, Australia, 20 November 2009; and the International Society for the Study of Vascular Anomalies Workshop, Brussels, Belgium, 21–24 April 2010.

  • Funding We wish to thank the Wellington Regional Plastic Surgery Unit Research & Education Trust; the Wellington Medical Research Foundation, the Surgical Research Trust; and Pub Charity for their financial support of this project. TI is supported by a Royal Australasian College of Surgeons' Foundation for Surgery Scholarship.

  • Competing interests None.

  • Patient consent Obtained from the parents.

  • Ethics approval Ethics approval was provided by the Wellington Regional Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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