From basal cell morphogenesis to the alopecia induced by hedgehog inhibitors: connecting the dots

Summary

The deciphering of the hedgehog (Hh) signaling pathway implicated in the tumorigenesis of basal cell carcinoma (BCC), led to the development of targeted drug therapies, e.g. the hedgehog pathway inhibitors (HPI), vismodegib and sonidegib. In the skin, physiologic Hh signaling is activated in growing hair follicles, where it is required for proliferation of the epithelium of hair follicles during morphogenesis and for their postnatal growth. The effects of HPI treatment leading to the regression of BCC and the development of alopecia, underpin the central role of the Hh pathway in BCC formation as well as hair cycling. Given the fact that BCC is a follicular- driven tumor, it is a fine tuning of events that regulate hair cycling, that may drive towards the formation of benign follicular hamartomas or malignant BCC neoplasms. The Wnt/β-catenin signaling interacts with the Hh signaling during HF morphogenesis, normal hair cycling and BCC development. The aim of this review is to present how key molecular events implicated in Hh pathway crosstalk in the hair follicle are also involved in BCC pathogenesis and result in the alopecia developed by HPI treatment.

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