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A case report of sirolimus use in early fetal management of lymphatic malformation


Sirolimus, by targeting the mammalian target of rapamycin (mTOR) pathway, has demonstrated efficacy on lymphatic malformations (LMs) in adults and neonates. The current hypothesis is that the earlier the lesion is treated, the better it responds. This has prompted the idea that sirolimus administration might be efficacious to treat fetal LMs as well. Here we report a successful management of a cervicofacial fetal LM with sirolimus taken orally by the mother from the 22nd week of pregnancy until 2 weeks before planned delivery. Repeated cordocentesis recorded a 30% transplacental crossing of sirolimus. Continuation of sirolimus after birth allowed resection of the residual mass. We have followed the physical and neurological evolution of the child for 6 years since the fetal administration of sirolimus. We conclude that early administration of sirolimus during pregnancy with maternal serum monitoring may be proposed to high-risk fetal LMs in selected cases.

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Fig. 1: Intrauterine evolution.
Fig. 2: LM evolution under sirolimus medication.
Fig. 3: Post natal evolution.

Data availability

All data generated and analyzed during this study are included in the published article.


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All authors of this publication are members of the Vascular Anomaly Working Group (VASCA WG) of the European Reference Network for Rare Multisystemic Vascular Diseases (VASCERN) (project ID: 769036). We thank the parents of the patient for consenting to having their child’s history and photographs published. The studies in the groups of M.V. and L.M.B. were financially supported by the Fonds de la Recherche Scientifique (FNRS grants T.0247.19 (to M.V.) and T.0146.16 and P.C013.20 (to L.M.B.)); the Fund Generet managed by the King Baudouin Foundation (grant 2018-J1810250-211305) (to M.V.); the Walloon Region through the FRFS-WELBIO strategic research program (WELBIO-CR-2019C-06) (to M.V.); the Leducq Foundation Networks of Excellence Program grant ‘ReVAMP’ (LFCR grant 21CVD03); and the European Union’s Horizon 2020 Research and Innovation Program Theralymph under grant agreement 874708. They were also supported by a Pierre M. fellowship (M.V.). The authors are grateful to D. Adams (Children’s Hospital of Philadelphia) for expert review and suggestions for the manuscript; the nurse coordinator, O. Debue (Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain), for excellent assistance in patient follow-up; and P. Dresse (Human Molecular Genetics, de Duve Institute, UCLouvain) and L. Huybrechts (Center for Vascular Anomalies, Saint-Luc University Hospital, UCLouvain) for their skilled secretarial help.

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Authors and Affiliations



E.S., A.V.D, M.V and L.M.B. conceived and designed the study. M.V. and L.M.B. obtained funds for the research. E.S., A.V.D., C.d.T., J.M.B., P.B. and L.M.B. followed the pregnancy. P.C. and D.D. analyzed the radiological data. B.L., S.S., F.V., C.P. and L.M.B. were involved in the clinical and surgical care of the child after birth. N.R. was in charge of the genetic analyses. All authors analyzed the data and contributed to writing and reviewing the manuscript. Each author approved the submitted manuscript and agreed both to be personally accountable for their own contributions and to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved and the resolution documented in the literature.

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Correspondence to Laurence M. Boon.

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Nature Cardiovascular Research thanks Bas Verhoeven, Benjamin T. Barnes and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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(1) Detailed informed consent. (2) Patient perspective.

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Numerical source data for Fig. 2.

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Seront, E., Biard, J.M., Van Damme, A. et al. A case report of sirolimus use in early fetal management of lymphatic malformation. Nat Cardiovasc Res 2, 595–599 (2023).

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