Abstract 1718: Topical botanical extract for management of chemotherapy-induced alopecia.
Authors: Liu JiaWei , Zhang Lei , Harti Saad 
Published: August 2014

Abstract
Introduction
Chemotherapy-induced alopecia (CIA) is considered the most visible and emotionally distressing side effect of cancer therapy. But there are no approved pharmacologic treatments available for CIA and the main physical treatment with scalp cooling is considered of relative to poor quality. In the course of CIA, the rapidly growing and dividing cell populations in anagen phase of hair follicles are damaged by the systemic chemotoxic agents and undergo premature apoptosis, inducing early onset of catagen. The intrinsic pathway of apoptosis is essentially mitochondrial dependent and executed by members of anti-apoptotic Bcl-2. It has been suggested that early onset of catagen also serves as the major universal down-stream factor of androgenetic alopecia (AGA). Pharmacological inhibition of apoptosis pathways has been proposed to prevent CIA. Considering the complexity of hair growth and cycling in human and the sensitivity of cancer patients, AGA subjects could potentially be recruited as CIA mimic for proof of concept study.
We present our study of a GMP-grade botanical extract (hereafter “the Product”) on AGA subjects using Bcl-2 as a biomarker. Bcl-2 expression levels in non-alopecia and AGA subjects were checked and compared. The number of anagen (A) and telogen (T) hairs before and after the Product application was recorded by phototrychogram to evaluate the respective A/T ratio. By increasing intracellular level of Bcl-2, topical application of the Product may provide with a promising avenue for the future study to manage CIA.
Study Design
Hairs in the anagen and telogen phase were identified and counted using Phototrichogram on 19 AGA male subjects before and after 1.5 and 3 months topical application of the Product. The respective A/T ratio of AGA male subjects at day 1, day 44, and day 86 was calculated.
Histomorphometrical Analysis: using scalp biopsy, Bcl-2+ cells analysis has been performed by determining their fractional area (%) in the epidermis of 25 male non-alopecia subjects and 15 AGA subjects before and after 3 months topical application of the Product.
Results
After the Product application, the A/T ratio was raised from 2.96 (day 1) to 4.30 (day 44), and remained at 4.35 all along the study period (day 86).
Average epidermal fraction of Bcl-2+ cells in AGA subjects before vs after the Product application significantly increased by 89% (from 1.72 to 3.24; p = 0.001, paired t-test), but remained below the normal level of Bcl-2 in non-alopecia subjects (4.73). No Adverse Events were reported.
Conclusion
The anti-hair loss Product is a safe Bcl-2 up-regulating agent that can prevent premature apoptosis (early onset of catagen) in AGA subjects. It may be used as topical management for CIA in cancer patients receiving chemo- or radiotherapies, in a dosage and a formulation to be investigated.
Citation Format: JiaWei Liu, Lei Zhang, Saad Harti. Topical botanical extract for management of chemotherapy-induced alopecia. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1718. doi:10.1158/1538-7445.AM2013-1718