Pulm Circ. 2013 Dec;3(4):792-801. doi: 10.1086/674766.
Interdisciplinary networks for the treatment of childhood pulmonary vascular disease: what pulmonary hypertension doctors can learn from pediatric oncologists.
Pulmonary circulation
Georg Hansmann
Affiliations
Affiliations
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany.
PMID: 25006395
PMCID: PMC4070820 DOI: 10.1086/674766
Abstract
The pathobiology of pulmonary arterial hypertension (PAH) is complex and multifactorial. None of the current therapies has been shown to be universally effective or able to reverse advanced pulmonary vascular disease, characterized by plexiform vascular lesions, or to prevent right ventricular failure in advanced PAH. It is thus unlikely that only one factor, pathway, or gene mutation will explain all forms and cases. Pediatric oncologists recognized a need for intensified, collaborative research within their field more than 40 years ago and implemented major clinical and translational networks worldwide to achieve evidence-based "tailored therapies." The similarities in the pathobiology (e.g., increased proliferation and resistance to apoptosis in vascular cells and perivascular inflammation) and the uncertainties in the proper treatment of both cancer and pulmonary hypertension (PH) have led to the idea of building interdisciplinary networks among PH centers to achieve rapid translation of basic research findings, optimal diagnostic algorithms, and significant, sustained treatment results. Such networks leading to patient registries, clinical trials, drug development, and innovative, effective therapies are urgently needed for the care of children with PH. This article reviews the current status, limitations, and recent developments in the field of pediatric PH. It is suggested that the oncologists' exemplary networks, concepts, and results in the treatment of acute lymphoblastic leukemia are applicable to future networks and innovative therapies for pediatric pulmonary hypertensive vascular disease and right ventricular dysfunction.
Keywords: children; clinical trial; neonates; network; pulmonary hypertension; vascular disease
References
- Heart. 2005 Aug;91(8):1064-9 - PubMed
- J Am Coll Cardiol. 2013 Dec 24;62(25 Suppl):D117-26 - PubMed
- Circulation. 2010 May 11;121(18):2045-66 - PubMed
- Chest. 2010 Jun;137(6 Suppl):69S-77S - PubMed
- Circulation. 2012 Jan 3;125(1):113-22 - PubMed
- Pulm Circ. 2011 Aug 2;1(2):280-285 - PubMed
- Eur Respir J. 2007 Jul;30(1):104-9 - PubMed
- Pulm Circ. 2011;1(2):286-298 - PubMed
- J Clin Invest. 2012 Dec;122(12):4306-13 - PubMed
- Pharmacol Ther. 2009 Jan;121(1):69-88 - PubMed
- Circulation. 2008 Sep 9;118(11):1195-201 - PubMed
- Circulation. 2012 Nov 27;126(22):2601-11 - PubMed
- Cancer Cell. 2007 Jan;11(1):37-51 - PubMed
- J Am Coll Cardiol. 2013 Dec 24;62(25 Suppl):D51-9 - PubMed
- J Am Coll Cardiol. 2013 Dec 24;62(25 Suppl):D34-41 - PubMed
- J Am Coll Cardiol. 2005 Jun 7;45(11):1849-55 - PubMed
- Circulation. 2006 Oct 3;114(14):1482-9 - PubMed
- J Am Coll Cardiol. 2013 Dec 24;62(25 Suppl):D60-72 - PubMed
- Circulation. 2008 Sep 30;118(14):1486-95 - PubMed
- Eur Respir J. 2009 Feb;33(2):318-24 - PubMed
- Sci Transl Med. 2013 Oct 23;5(208):208sr5 - PubMed
- Pulm Circ. 2013 Jan;3(1):217-25 - PubMed
- Am J Respir Crit Care Med. 2006 May 1;173(9):1023-30 - PubMed
- Circulation. 2007 Mar 13;115(10):1275-84 - PubMed
- Circulation. 2011 Oct 18;124(16):1755-64 - PubMed
- Eur Heart J. 2009 Oct;30(20):2493-537 - PubMed
- Pulm Circ. 2013 Jan;3(1):203-5 - PubMed
- Chest. 1998 Sep;114(3 Suppl):225S-230S - PubMed
- Ann Intern Med. 1991 Sep 1;115(5):343-9 - PubMed
- Am J Respir Crit Care Med. 2010 Sep 1;182(5):661-8 - PubMed
- Radiology. 2004 Dec;233(3):774-80 - PubMed
- J Am Coll Cardiol. 2013 Dec 24;62(25 Suppl):D22-33 - PubMed
- Am J Respir Crit Care Med. 2009 Dec 1;180(11):1131-42 - PubMed
- Lancet. 2012 Feb 11;379(9815):537-46 - PubMed
- Am J Respir Crit Care Med. 2010 Dec 15;182(12):1554-62 - PubMed
- Arch Cardiovasc Dis. 2010 Feb;103(2):66-74 - PubMed
- Leukemia. 2000 Dec;14(12):2307-20 - PubMed
- Am J Respir Crit Care Med. 2010 Nov 1;182(9):1171-7 - PubMed
- Pulm Circ. 2013 Jan;3(1):245-51 - PubMed
- J Am Coll Cardiol. 2009 Jun 30;54(1 Suppl):S10-S19 - PubMed
- J Clin Invest. 2008 May;118(5):1846-57 - PubMed
- Circulation. 2002 Jan 15;105(2):244-50 - PubMed
- Circ Res. 2004 Oct 15;95(8):830-40 - PubMed
- J Clin Invest. 2013 Aug;123(8):3600-13 - PubMed
- Circulation. 2008 Apr 1;117(13):1717-31 - PubMed
- Curr Vasc Pharmacol. 2012 May;10(3):289-99 - PubMed
- Heart. 2010 Sep;96(17):1401-6 - PubMed
- Circulation. 2009 Apr 28;119(16):2250-94 - PubMed
- Heart. 2010 Sep;96(17):1337-8 - PubMed
- Circulation. 2012 May 1;125(17):2165-70 - PubMed
- Chest. 2010 Jun;137(6 Suppl):95S-101S - PubMed
- Circ Res. 2005 Mar 4;96(4):442-50 - PubMed
- Circulation. 2013 Mar 12;127(10):1128-38 - PubMed
- Circulation. 2010 Jun 22;121(24):2661-71 - PubMed
- J Am Coll Cardiol. 2008 Nov 18;52(21):1683-92 - PubMed
- Am J Respir Crit Care Med. 2009 Dec 1;180(11):1122-30 - PubMed
- Circulation. 2011 Jun 28;123(25):2919-21 - PubMed
- Eur Respir J. 2013 Sep;42(3):689-700 - PubMed
- Am J Respir Crit Care Med. 2008 Jan 1;177(1):108-13 - PubMed
- Pulm Circ. 2012 Apr-Jun;2(2):170-81 - PubMed
- Pulm Circ. 2013 Jan;3(1):206-16 - PubMed
- Sci Transl Med. 2009 Dec 23;1(12):12ps14 - PubMed
Publication Types