Zinc finger proteins and ATP‐binding cassette transporter‐dependent multidrug resistance

Abstract Background Multidrug resistance (MDR) remains a significant challenge in cancer treatment, leading to poor clinical outcomes. Dysregulation of ATP‐binding cassette (ABC) transporters has been identified as a key contributor to MDR. Zinc finger proteins (ZNPs) are key regulators of transcription and have emerged as potential contributors to cancer drug resistance. Bridging the knowledge gap between ZNPs and MDR is essential to understand a source of heterogeneity in cancer treatment. This review sought to elucidate how different ZNPs modulate the transcriptional regulation of ABC genes, contributing to resistance to cancer therapies. Methods The search was conducted using PubMed, Google Scholar, EMBASE and Web of Science. Results In addition to ABC‐blockers, the transcriptional features regulated by ZNP are expected to play a role in reversing ABC‐mediated MDR and predicting the efficacy of anticancer treatments. Among the ZNP‐induced epithelial to mesenchymal transition, SNAIL, SLUG and Zebs have been identified as important factors in promoting MDR through activation of ATM, NFκB and PI3K/Akt pathways, exposing the metabolism to potential ZNP‐MDR interactions. Additionally, nuclear receptors, such as VDR, ER and PXR have been found to modulate certain ABC regulations. Other C2H2‐type zinc fingers, including Kruppel‐like factors, Gli and Sp also have the potential to contribute to MDR. Conclusion Besides reviewing evidence on the effects of ZNP dysregulation on ABC‐related chemoresistance in malignancies, significant markers of ZNP functions are discussed to highlight the clinical implications of gene‐to‐gene and microenvironment‐to‐gene interactions on MDR prospects. Future research on ZNP‐derived biomarkers is crucial for addressing heterogeneity in cancer therapy.