Protection against chemotherapy-induced alopecia: targeting ATP-binding cassette transporters in the hair follicle?

•ATP-binding cassette (ABC) transporters are expressed in the hair follicle.•ABC transporter substrates include chemotherapy drugs that cause hair loss.•Targeted upregulation of these transporters may augment drug-induced alopecia.•Topical application via nanoparticle carrier systems would minimize systemic impact.

Currently, efficacious treatments for chemotherapy-induced alopecia (hair loss) are lacking, and incidences of permanent hair loss following high-dose chemotherapy are on the increase. In this article, we describe mechanisms by which the pharmacological defense status of the hair follicle might be enhanced, thereby reducing the accumulation of cytotoxic cancer drugs and preventing or reducing hair loss and damage. We believe this could be achieved via the selective increase in ATP-binding cassette (ABC) transporter expression within the hair follicle epithelium, following application of topical agonists for regulatory nuclear receptors. Clinical application would require the development of hair follicle-targeted formulations, potentially utilizing nanoparticle technology. This novel approach has the potential to yield entirely new therapeutic options for the treatment and management of chemotherapy-induced alopecia, providing significant psychological and physical benefit to cancer patients.