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Kim YM, Son JY, Ahn DK. Botulinum toxin type A is a potential therapeutic drug for chronic orofacial pain. J Oral Biosci 2024; 66:496-503. [PMID: 38908515 DOI: 10.1016/j.job.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Botulinum toxin type A (BTX-A), produced by the gram-positive anaerobic bacterium Clostridium botulinum, acts by cleaving synaptosome-associated protein-25 (SNAP-25), an essential component of the presynaptic neuronal membrane that is necessary for fusion with the membrane proteins of neurotransmitter-containing vesicles. Recent studies have highlighted the efficacy of BTX-A in treating chronic pain conditions, including lower back pain, chronic neck pain, neuropathic pain, and trigeminal neuralgia, particularly when patients are unresponsive to traditional painkillers. This review focuses on the analgesic effects of BTX-A in various chronic pain conditions, with a particular emphasis on the orofacial region. HIGHLIGHT This review focuses on the mechanisms by which BTX-A induces analgesia in patients with inflammatory and temporomandibular joint pain. This review also highlights the fact that BTX-A can effectively manage neuropathic pain and trigeminal neuralgia, which are difficult-to-treat chronic pain conditions. Herein, we present a comprehensive assessment of the central analgesic effects of BTX-A and a discussion of its various applications in clinical dental practice. CONCLUSION BTX-A is an approved treatment option for various chronic pain conditions. Although there is evidence of axonal transport of BTX-A from peripheral to central endings in motor neurons, the precise mechanism underlying its pain-modulating effects remains unclear. This review discusses the evidence supporting the effectiveness of BTX-A in controlling chronic pain conditions in the orofacial region. BTX-A is a promising therapeutic agent for treating pain conditions that do not respond to conventional analgesics.
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Affiliation(s)
- Yu-Mi Kim
- Department of Oral Physiology, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - Jo-Young Son
- Department of Oral Physiology, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - Dong-Kuk Ahn
- Department of Oral Physiology, School of Dentistry, Kyungpook National University, Daegu, South Korea.
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Campanati A, Diotallevi F, Radi G, Martina E, Marconi B, Bobyr I, Offidani A. Efficacy and Safety of Botulinum Toxin B in Focal Hyperhidrosis: A Narrative Review. Toxins (Basel) 2023; 15:147. [PMID: 36828461 PMCID: PMC9966525 DOI: 10.3390/toxins15020147] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/22/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Botulinum toxin type B (BoNT-B), known as Myobloc® in the United States and as Neurobloc® in Europe, is a new therapeutically available serotype among the botulinum toxin family. During the last years several data have been reported in literature investigating its efficacy and safety, as well as defining the dosing and application regiments of BoNT-B in the treatment of hyperhidrosis. Moreover, recent studies have been examining its safety profile, which may be different from those known about BoNT-A. The aim of this review is to provide information about what is currently known about BoNT-B in regards to the treatment of focal hyperhidrosis.
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Affiliation(s)
- Anna Campanati
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60121 Ancona, Italy
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3
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Meurens F, Carlin F, Federighi M, Filippitzi ME, Fournier M, Fravalo P, Ganière JP, Grisot L, Guillier L, Hilaire D, Kooh P, Le Bouquin-Leneveu S, Le Maréchal C, Mazuet C, Morvan H, Petit K, Vaillancourt JP, Woudstra C. Clostridium botulinum type C, D, C/D, and D/C: An update. Front Microbiol 2023; 13:1099184. [PMID: 36687640 PMCID: PMC9849819 DOI: 10.3389/fmicb.2022.1099184] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023] Open
Abstract
Clostridium botulinum is the main causative agent of botulism, a neurological disease encountered in humans as well as animals. Nine types of botulinum neurotoxins (BoNTs) have been described so far. Amongst these "toxinotypes," the A, the B and E are the most frequently encountered in humans while the C, D, C/D and D/C are mostly affecting domestic and wild birds as well as cattle. In France for instance, many cases and outbreaks are reported in these animal species every year. However, underestimation is very likely at least for avifauna species where the detection of dead animals can be challenging. Knowledge about BoNTs C, D, C/D, and D/C and the diseases they cause in animals and humans is still scarce and unclear. Specifically, the potential role of animal botulism outbreaks in cattle and poultry as a source of human illness needs to be further assessed. In this narrative review, we present the current knowledge about toxinotypes C, D, C/D, and D/C in cattle and poultry with, amongst various other aspects, their epidemiological cycles. We also discuss the zoonotic potential of these toxinotypes and some possible ways of risk mitigation. An adapted and effective management of botulism outbreaks in livestock also requires a better understanding of these less common and known toxinotypes.
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Affiliation(s)
- François Meurens
- INRAE, Oniris, BIOEPAR, Nantes, France,Department of Veterinary Microbiology and Immunology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada,*Correspondence: François Meurens,
| | | | | | - Maria-Eleni Filippitzi
- Laboratory of Animal Health Economics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthieu Fournier
- Univ Rouen Normandie, Univ Caen Normandie, CNRS, M2C, UMR 6143, Rouen, France
| | - Philippe Fravalo
- Chaire Agroalimentaire du Cnam, Conservatoire des Arts et Métiers, EPN7, Ploufragan, France
| | | | | | | | | | - Pauline Kooh
- Risk Assessment Department, ANSES, Maisons-Alfort, France
| | - Sophie Le Bouquin-Leneveu
- Hygiene and Quality of Poultry and Pig Products Unit, ANSES, French Agency for Food, Environmental and Occupational Health Safety, Ploufragan, France
| | - Caroline Le Maréchal
- Hygiene and Quality of Poultry and Pig Products Unit, ANSES, French Agency for Food, Environmental and Occupational Health Safety, Ploufragan, France
| | - Christelle Mazuet
- Institut Pasteur, Université Paris Cité, CNR Bactéries anaérobies et Botulisme, Paris, France
| | | | - Karine Petit
- Risk Assessment Department, ANSES, Maisons-Alfort, France
| | - Jean-Pierre Vaillancourt
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Cédric Woudstra
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
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Shikhkerimov RK, Istomina EV. Recombinant botulinum toxin as a new stage in the development of botulinum toxin therapy. Possibilities and perspectives of use in neurological practice. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2022. [DOI: 10.14412/2074-2711-2022-6-103-109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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5
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Bérard M, Leducq S, Laribi K, Samaran R, Maillard H. Factors associated with efficacy of botulinum toxin A injections in primary axillary hyperhidrosis: a retrospective study of ninety patients. Dermatol Ther 2022; 35:e15620. [DOI: 10.1111/dth.15620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/12/2022] [Accepted: 06/02/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Sophie Leducq
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC) CHRU Tours Tours France
| | - Kamel Laribi
- Department of Hematology Le Mans Hospital Le Mans France
| | - Romain Samaran
- Department of Dermatology Le Mans Hospital Le Mans France
| | - Hervé Maillard
- Department of Dermatology Le Mans Hospital Le Mans France
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Carré D, Martin V, Kouidri Y, Morin R, Norlund M, Gomes A, Lagarde JM, Lezmi S. The distribution of neuromuscular junctions depends on muscle pennation, when botulinum neurotoxin receptors and SNAREs expression are uniform in the rat. Toxicon 2022; 212:34-41. [DOI: 10.1016/j.toxicon.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/12/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022]
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Pirazzini M, Montecucco C, Rossetto O. Toxicology and pharmacology of botulinum and tetanus neurotoxins: an update. Arch Toxicol 2022; 96:1521-1539. [PMID: 35333944 PMCID: PMC9095541 DOI: 10.1007/s00204-022-03271-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/28/2022] [Indexed: 12/27/2022]
Abstract
Tetanus and botulinum neurotoxins cause the neuroparalytic syndromes of tetanus and botulism, respectively, by delivering inside different types of neurons, metalloproteases specifically cleaving the SNARE proteins that are essential for the release of neurotransmitters. Research on their mechanism of action is intensively carried out in order to devise improved therapies based on antibodies and chemical drugs. Recently, major results have been obtained with human monoclonal antibodies and with single chain antibodies that have allowed one to neutralize the metalloprotease activity of botulinum neurotoxin type A1 inside neurons. In addition, a method has been devised to induce a rapid molecular evolution of the metalloprotease domain of botulinum neurotoxin followed by selection driven to re-target the metalloprotease activity versus novel targets with respect to the SNARE proteins. At the same time, an intense and wide spectrum clinical research on novel therapeutics based on botulinum neurotoxins is carried out, which are also reviewed here.
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Affiliation(s)
- Marco Pirazzini
- Department of Biomedical Sciences, University of Padova, Via Ugo Bassi 58/B, 35131, Padova, Italy.,Centro Interdipartimentale di Ricerca di Miologia, CIR-Myo, University of Padova, Via U. Bassi 58/B, 35131, Padova, Italy
| | - Cesare Montecucco
- Department of Biomedical Sciences, University of Padova, Via Ugo Bassi 58/B, 35131, Padova, Italy. .,Institute of Neuroscience, National Research Council, Via Ugo Bassi 58/B, 35131, Padova, Italy.
| | - Ornella Rossetto
- Department of Biomedical Sciences, University of Padova, Via Ugo Bassi 58/B, 35131, Padova, Italy.,Centro Interdipartimentale di Ricerca di Miologia, CIR-Myo, University of Padova, Via U. Bassi 58/B, 35131, Padova, Italy.,Institute of Neuroscience, National Research Council, Via Ugo Bassi 58/B, 35131, Padova, Italy
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Bohart Z, Cassidy C, Merrill D, Villani M, Villani R, Cappabianca L, Pitkin M. Temporary Botulinum Immobilization of Residuum Muscles for Facilitation of the Initial Ingrowth of Skin to the Porous Skin and Bone Integrated Pylon in the Technology of Direct Skeletal Attachment: Large Animal Model. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:758238. [PMID: 35891709 PMCID: PMC9312073 DOI: 10.3389/fresc.2022.758238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/07/2022] [Indexed: 12/03/2022]
Abstract
Enhancing the technology of bone-anchored limb prosthetics, we present a modified porcine model for developing an infection-free integration between the skin and a percutaneous bone implant. The deeply porous Skin and Bone Integrated Pylon (SBIP) presented an infection-free skin-implant interface both after implantation into the dorsum and after implantation into the residuum after below-knee amputation. However, deep ingrowth of skin into the porous cladding of the SBIP was achieved better in the dorsal procedure, while implantation to the residuum sometimes developed a stoma, probably due to the high mobility of the skin and soft tissues in the pig's thigh. Uncontrolled high skin mobility during the first week after implantation constituted a limitation for the porcine animal model, which we tried to address in the current study. As our previous studies showed that casting of the leg residuum did not sufficiently limit the skin's movement around the implant, we tested a modified protocol of the implantation, which included injection of botulinum toxin into the thigh muscles. During the course of the study, we identified proper botulinum toxin componentry, dosage, and the period after injections to achieve a maximal effect of immobilization of the muscles affecting skin movements. To verify the immobilization, we used kinetic data on the asymmetry of loading during gait with the Strideway System, Tekscan, Inc., Boston, MA, USA. We found that injections in the four muscles of the distal thigh of the left hind leg with MYOBLOC® (rimabotulinumtoxinB; 5,000 units/muscle) were sufficient to provide noticeable immobilization by the fourth week after the procedure. This conclusion was made based on the analysis of the dynamics of asymmetry in vertical ground reactions on the injected (left hind) and uninvolved (right hind) legs during gait over an instrumented walkway.
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Affiliation(s)
- Zachary Bohart
- Department of Orthopaedics and Physical Medicine and Rehabilitation, Tufts University School of Medicine, Boston, MA, United States
| | - Charles Cassidy
- Department of Orthopaedics and Physical Medicine and Rehabilitation, Tufts University School of Medicine, Boston, MA, United States
| | - David Merrill
- DaVinci Biomedical Research Products, Lancaster, MA, United States
| | - Mario Villani
- DaVinci Biomedical Research Products, Lancaster, MA, United States
| | - Rosanna Villani
- DaVinci Biomedical Research Products, Lancaster, MA, United States
| | - Leo Cappabianca
- DaVinci Biomedical Research Products, Lancaster, MA, United States
| | - Mark Pitkin
- Department of Orthopaedics and Physical Medicine and Rehabilitation, Tufts University School of Medicine, Boston, MA, United States
- Poly-Orth International, Sharon, MA, United States
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Neuschäfer-Rube F, Pathe-Neuschäfer-Rube A, Püschel GP. Discrimination of the Activity of Low-Affinity Wild-Type and High-Affinity Mutant Recombinant BoNT/B by a SIMA Cell-Based Reporter Release Assay. Toxins (Basel) 2022; 14:toxins14010065. [PMID: 35051041 PMCID: PMC8780439 DOI: 10.3390/toxins14010065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 12/12/2022] Open
Abstract
Botulinum neurotoxin (BoNT) is used for the treatment of a number of ailments. The activity of the toxin that is isolated from bacterial cultures is frequently tested in the mouse lethality assay. Apart from the ethical concerns inherent to this assay, species-specific differences in the affinity for different BoNT serotypes give rise to activity results that differ from the activity in humans. Thus, BoNT/B is more active in mice than in humans. The current study shows that the stimulus-dependent release of a luciferase from a differentiated human neuroblastoma–based reporter cell line (SIMA-hPOMC1-26-Gluc) was inhibited by clostridial and recombinant BoNT/A to the same extent, whereas both clostridial and recombinant BoNT/B inhibited the release to a lesser extent and only at much higher concentrations, reflecting the low activity of BoNT/B in humans. By contrast, the genetically modified BoNT/B-MY, which has increased affinity for human synaptotagmin, and the BoNT/B protein receptor inhibited luciferase release effectively and with an EC50 comparable to recombinant BoNT/A. This was due to an enhanced uptake into the reporter cells of BoNT/B-MY in comparison to the recombinant wild-type toxin. Thus, the SIMA-hPOMC1-26-Gluc cell assay is a versatile tool to determine the activity of different BoNT serotypes providing human-relevant dose-response data.
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Ojardias E, Ollier E, Lafaie L, Celarier T, Giraux P, Bertoletti L. Time course response after single injection of botulinum toxin to treat spasticity after stroke: Systematic review with pharmacodynamic model-based meta-analysis. Ann Phys Rehabil Med 2021; 65:101579. [PMID: 34634514 DOI: 10.1016/j.rehab.2021.101579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The time-course response after a single injection of botulinum toxin (BoNT) for post-stroke spasticity is debated. We addressed this issue by conducting a systematic review and a pharmacodynamic model-based meta-analysis. METHODS We searched Medline, PeDro and Google Scholar databases up to March 2020, selecting randomized controlled trials of post-stroke and traumatic brain injury patients with arm or leg muscle hypertonia, comparing BoNT to placebo, or different BoNT preparations. The main outcome was change in Modified Ashworth Scale (MAS) score. A non-linear mixed effect model was used to estimate maximal toxin and placebo effects (Emax and EPlacebo), the effect disappearance half-life (T1/2off) of BoNT and the doses achieving 50 and 80% of Emax (D50 and D80). The equivalence ratios between different BoNT preparations were calculated from D50 values. Adverse events were recorded. RESULTS Altogether, 2,236 unique records were screened by 2 independent reviewers: 35 eligible trials including 3011 patients (95% post-stroke) were identified. For all BoNT preparations, the BoNT Emax of -1.11 (95% credible interval -1.31; -0.29) was reached at 5 weeks; the maximal placebo effect was -0.30 (-0.37; -0.22). Both D50 and D80 differed significantly by muscle volume. At D50, the equivalence ratio was significantly higher for abobotulinumtoxinA (3.35) than onabotulinumtoxinA and lower for letibotulinumtoxinA (0.41). T1/2off was longer for abobotulinumtoxinA than for onabotulinumtoxinA and the other preparations (13.1 weeks [95% credible interval 7.7; 19.3] vs 8.6 weeks [7.1; 10.1]). Adverse events were minor, with a weak, but significant, dose-response relation for muscle weakness. CONCLUSIONS This first pharmacodynamic model-based meta-analysis of individuals with stroke revealed that for all BoNT-A preparations, BoNT-A injections to treat spasticity have maximal effect at 5 weeks. The T1/2off was longer for abobotulinumtoxinA than other preparations. Differences between certain BoNT unit scales were also confirmed.
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Affiliation(s)
- Etienne Ojardias
- Clinical Gerontology Department, University Hospital of Saint-Étienne, Saint-Étienne, France; U1059 INSERM - SAINBIOSE, Innovation Campus, Saint-Étienne, France + INSERM CIC1408, University Hospital of Saint-Étienne, Saint-Etienne, France.
| | - Edouard Ollier
- U1059 INSERM - SAINBIOSE, Innovation Campus, Saint-Étienne, France + INSERM CIC1408, University Hospital of Saint-Étienne, Saint-Etienne, France; Clinical Research, Innovation and Pharmacology Unit, North Hospital, University Hospital of Saint-Étienne, France
| | - Ludovic Lafaie
- Clinical Gerontology Department, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Thomas Celarier
- Clinical Gerontology Department, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Pascal Giraux
- Physical Medicine and Rehabilitation Department, University Hospital of Saint-Étienne, Saint-Étienne, France; Lyon Neuroscience Research Center, Trajectoires team (Inserm UMR-S 1028, CNRS UMR 5292, Lyon1 & Saint-Etienne Universities), France
| | - Laurent Bertoletti
- Vascular and Therapeutic Medicine Department, North Hospital, University Hospital of Saint-Étienne, Saint-Étienne, France; U1059 INSERM - SAINBIOSE, Innovation Campus, Saint-Étienne, France + INSERM CIC1408, University Hospital of Saint-Étienne, Saint-Etienne, France
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Immunogenicity of Botulinum Toxin Formulations: Potential Therapeutic Implications. Adv Ther 2021; 38:5046-5064. [PMID: 34515975 PMCID: PMC8478757 DOI: 10.1007/s12325-021-01882-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/02/2021] [Indexed: 12/21/2022]
Abstract
Botulinum neurotoxins (BoNTs) are proteins produced by bacteria of the Clostridium family. Upon oral ingestion, BoNT causes the neuroparalytic syndrome botulism. There are seven serotypes of BoNT (serotypes A-G); BoNT-A and BoNT-B are the botulinum toxin serotypes utilized for therapeutic applications. Treatment with BoNT injections is used to manage chronic medical conditions across multiple indications. As with other biologic drugs, immunogenicity after long-term treatment with BoNT formulations may occur, and repeated use can elicit antibody formation leading to clinical nonresponsiveness. Thus, approaching BoNT treatment of chronic conditions with therapeutic formulations that minimize stimulating the host immune response while balancing patient responsiveness to therapy is ideal. Immunogenicity is a clinical limitation in many settings that use biologic drugs for treatment, and clinically relevant immunogenicity reduction has been achieved through engineering smaller protein constructs and reducing unnecessary formulation components. A similar approach has influenced the evolution of BoNT formulations. Three BoNT-A products and one BoNT-B product have been approved by the Food and Drug Administration (FDA) for therapeutic use: onabotulinumtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, and rimabotulinumtoxinB; a fourth BoNT-A product, daxibotulinumtoxinA, is currently under regulatory review. Additionally, prabotulinumtoxinA is a BoNT-A product that has been approved for aesthetic indications but not therapeutic use. Here, we discuss the preclinical and clinical immunogenicity data that exist within the scientific literature and provide a perspective for considering immunogenicity as a key factor in choice of BoNT formulation.
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Low-Dose Neubotulinum Toxin A versus Low-Dose Abobotulinum Toxin A Injection for the Treatment of Cervical Dystonia: A Multicenter, 48-Week, Prospective, Double-Blinded, Randomized Crossover Design Study. Toxins (Basel) 2021; 13:toxins13100694. [PMID: 34678987 PMCID: PMC8541224 DOI: 10.3390/toxins13100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
Various types of botulinum toxin (BoNT) have been studied to treat cervical dystonia (CD). Although high-dose BoNT has proven efficacy, it increases the risk of adverse events. For this reason, this study was planned to identify the non-inferiority efficacy, tolerability, and safety of low-dose neubotulinum toxin A (Neu-BoNT-A) versus low-dose abobotulinum toxin A (Abo-BoNT-A) in CD treatment. The 48-week, prospective, randomized, controlled crossover design study of CD treatment, with 50-unit Neu-BoNT-A and 250-unit Abo-BoNT-A injections at 12-week intervals, was conducted over a 24-week treatment period. This study used the following standardized rating scales to assess the efficacy of BoNT: the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS); health-related quality of life (HRQoL); the Cervical Dystonia Impact Profile (CDIP-58); the Short Form 36 health survey questionnaire (SF-36); and, for the depressive symptoms of CD patients, the Center for Epidemiological Studies-Depression Scale (CES-D) and the Patient Health Questionnaire-9 (PHQ-9). Fifty-two CD patients were enrolled from October 2019 to January 2021. The mean scores of the TWSTRS total at the post-treatments in both Neu-BoNT-A and Abo-BoNT-A had a significant reduction from baseline (p = 0.008 and 0.002, respectively). However, the mean changes of the TWSTRS total at the 12- and 24-week treatments between the two treatment groups were not significantly different (p = 0.284 and 0.129, respectively). The mean scores of the HRQoL questionnaires (the CIDP-58 and the SF-36) and the depressive symptoms (the CES-D and the PHQ-9) in both treated groups at the post-treatments did not significantly decrease from baseline and were comparable. Two patients treated with Abo-BoNT-A (250 units) reported cervical tension and benign paroxysmal positional vertigo (BPPV). There were no serious adverse events reported. Though both low-dose BoNT-As were effective at improving clinical symptoms without significant side effects, both treatments did not predict change in quality of life and depression. With the non-inferiority criteria, low-dose Neu-BoNT-A has a similar efficacy, safety, and tolerability to Abo-BoNT-A.
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Rauso R, Lo Giudice G, Tartaro G, Zerbinati N, Nicoletti GF, Fragola R. Botulinum toxin type A injections for masticatory muscles hypertrophy: A systematic review. J Craniomaxillofac Surg 2021; 50:7-18. [PMID: 34620536 DOI: 10.1016/j.jcms.2021.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 09/13/2021] [Accepted: 09/26/2021] [Indexed: 12/27/2022] Open
Abstract
The aim of this study is to compare the efficacy of single-point injection of botulinum toxin A versus multi-point operative protocols found in the literature in reducing hypertrophy in patients with masticatory muscle hypertrophy. A systematic review was performed in accordance with the Park et al., 2018 guidelines, selecting articles from PubMed, Google Scholar, Web of Science and Ovid databases up to July 8, 2020.28 studies met the eligibility criteria. 748 patients were treated for masseter hypertrophy (MH) and 4 patients for temporal muscle hypertrophy. As for MH: in 45.2% of cases 3 injection sites (IS) were used, in 18.8% 1 IS, in 16.2% 2 IS, in 13% 5 IS, in 4.1% 6 IS, 2.7% 4 IS. At three months, the mean reduction in masseter muscle thickness is 26-31% when 1 IS was used, 28% in 2 IS, 12-27% in 3 IS and 22-30% in 6 IS. Heterogeneity of results, high bias level and selective reports led to a difficult efficacy comparison of the injection techniques described. Data suggest that the lowest number of IS possible should be used until stronger evidences are presented. Homogeneity in pre- and post-operative protocols is needed to establish a reliable setting for the condition under study.
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Affiliation(s)
- Raffaele Rauso
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio 6, 80138, Naples, Italy
| | - Giorgio Lo Giudice
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Maxillofacial Surgery Unit, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy.
| | - Gianpaolo Tartaro
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio 6, 80138, Naples, Italy
| | - Nicola Zerbinati
- Dermatology Department, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy
| | - Giovanni Francesco Nicoletti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio 6, 80138, Naples, Italy
| | - Romolo Fragola
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio 6, 80138, Naples, Italy
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Vova JA, Green MM, Brandenburg JE, Davidson L, Paulson A, Deshpande S, Oleszek JL, Inanoglu D, McLaughlin MJ. A consensus statement on the use of botulinum toxin in pediatric patients. PM R 2021; 14:1116-1142. [PMID: 34558213 DOI: 10.1002/pmrj.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 08/12/2021] [Accepted: 09/10/2021] [Indexed: 11/10/2022]
Abstract
Botulinum toxin has been used in medicine for the past 30 years. However, there continues to be controversy about the appropriate uses and dosing, especially in the pediatric population. A panel of nine pediatric physiatrists from different regions and previous training programs in the United States were nominated based on institutional reputation and botulinum toxin (BoNT) experience. Based on a review of the current literature, the goal was to provide the rationale for recommendations on the administration of BoNT in the pediatric population. The goal was not only to review safety, dosing, and injection techniques but also to develop a consensus on the appropriate uses in the pediatric population. In addition to upper and lower limb spasticity, the consensus also provides recommendations for congenital muscular torticollis, cervical dystonia, sialorrhea, and brachial plexus palsies.
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Affiliation(s)
- Joshua A Vova
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael M Green
- University of Utah/Primary Children's Hospital, Salt Lake City, Utah, USA
| | | | - Loren Davidson
- University of California Davis, Sacramento, California, USA
| | - Andrea Paulson
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Gillette Children's Specialty Healthcare, Minneapolis, Minnesota, USA
| | - Supreet Deshpande
- Gillette Children's Specialty Healthcare, Minneapolis, Minnesota, USA
| | | | - Didem Inanoglu
- Children's Health Specialty Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Botulinum Toxin A Salvage of Ischemic Hand Trauma. Plast Reconstr Surg 2021; 147:702e-704e. [PMID: 33776051 DOI: 10.1097/prs.0000000000007736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Reply: Botulinum Toxin A Salvage of Ischemic Hand Trauma. Plast Reconstr Surg 2021; 147:704e. [PMID: 33764906 DOI: 10.1097/prs.0000000000007737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Human-Relevant Sensitivity of iPSC-Derived Human Motor Neurons to BoNT/A1 and B1. Toxins (Basel) 2021; 13:toxins13080585. [PMID: 34437455 PMCID: PMC8402508 DOI: 10.3390/toxins13080585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 01/31/2023] Open
Abstract
The application of botulinum neurotoxins (BoNTs) for medical treatments necessitates a potency quantification of these lethal bacterial toxins, resulting in the use of a large number of test animals. Available alternative methods are limited in their relevance, as they are based on rodent cells or neuroblastoma cell lines or applicable for single toxin serotypes only. Here, human motor neurons (MNs), which are the physiological target of BoNTs, were generated from induced pluripotent stem cells (iPSCs) and compared to the neuroblastoma cell line SiMa, which is often used in cell-based assays for BoNT potency determination. In comparison with the mouse bioassay, human MNs exhibit a superior sensitivity to the BoNT serotypes A1 and B1 at levels that are reflective of human sensitivity. SiMa cells were able to detect BoNT/A1, but with much lower sensitivity than human MNs and appear unsuitable to detect any BoNT/B1 activity. The MNs used for these experiments were generated according to three differentiation protocols, which resulted in distinct sensitivity levels. Molecular parameters such as receptor protein concentration and electrical activity of the MNs were analyzed, but are not predictive for BoNT sensitivity. These results show that human MNs from several sources should be considered in BoNT testing and that human MNs are a physiologically relevant model, which could be used to optimize current BoNT potency testing.
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Martina E, Diotallevi F, Radi G, Campanati A, Offidani A. Therapeutic Use of Botulinum Neurotoxins in Dermatology: Systematic Review. Toxins (Basel) 2021; 13:toxins13020120. [PMID: 33562846 PMCID: PMC7915854 DOI: 10.3390/toxins13020120] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 12/21/2022] Open
Abstract
Botulinum toxin is a superfamily of neurotoxins produced by the bacterium Clostridium Botulinum with well-established efficacy and safety profile in focal idiopathic hyperhidrosis. Recently, botulinum toxins have also been used in many other skin diseases, in off label regimen. The objective of this manuscript is to review and analyze the main therapeutic applications of botulinum toxins in skin diseases. A systematic review of the published data was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Botulinum toxins present several label and off-label indications of interest for dermatologists. The best-reported evidence concerns focal idiopathic hyperhidrosis, Raynaud phenomenon, suppurative hidradenitis, Hailey–Hailey disease, epidermolysis bullosa simplex Weber–Cockayne type, Darier’s disease, pachyonychia congenita, aquagenic keratoderma, alopecia, psoriasis, notalgia paresthetica, facial erythema and flushing, and oily skin. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and doses protocols for off label applications.
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Abstract
Botulinum neurotoxin (BoNT) is an effective treatment for many neurologic disorders. This article gives a comprehensive overview of the clinical applications of BoNT across the field of neurology.
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Affiliation(s)
- Shannon Y Chiu
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, 3009 SW Williston Road, Gainesville, FL 32608, USA
| | - Matthew R Burns
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, 3009 SW Williston Road, Gainesville, FL 32608, USA
| | - Irene A Malaty
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, 3009 SW Williston Road, Gainesville, FL 32608, USA.
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20
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Sialorrhea in Parkinson's Disease. Toxins (Basel) 2020; 12:toxins12110691. [PMID: 33142833 PMCID: PMC7692771 DOI: 10.3390/toxins12110691] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022] Open
Abstract
Sialorrhea, or excessive saliva beyond the margin of the lip, is a common problem in many neurological diseases. Previously, sialorrhea has been underrecognized in Parkinson’s disease (PD) patients. Despite this, many patients rank sialorrhea as one of the most debilitating complaints of Parkinson’s disease. Previous treatment for sialorrhea has been suboptimal and has been plagued by significant side effects that are bothersome and can be dangerous in patients with a concurrent neurodegenerative disease. This review sought to review the anatomy, function, and etiology of sialorrhea in PD. It then sought to examine the evidence for the different treatments of sialorrhea in PD, and further examined newer evidence for safety and efficacy in minimally invasive treatment such as botulinum toxin.
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21
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Brent MB, Lodberg A, Thomsen JS, Brüel A. Rodent model of disuse-induced bone loss by hind limb injection with botulinum toxin A. MethodsX 2020; 7:101079. [PMID: 33083241 PMCID: PMC7551361 DOI: 10.1016/j.mex.2020.101079] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022] Open
Abstract
Bone loss materializes rapidly after immobilization or mechanical unloading. Hind limb injection with botulinum toxin A (BTX) is a highly reproducible animal model for disuse-induced bone loss. Here we describe an easy-to-use and enhanced version of the method employing multiple hind limb injections with BTX to induce a pervasive muscle paralysis and thereby disuse of the hind limb. Thirty-six 12-14-week-old female Wistar rats were stratified into three groups: Baseline (Base), Control (Ctrl), and BTX. Disuse was achieved by injecting BTX directly into the right quadriceps femoris muscle, the hamstring muscles, and the posterior calf muscles. The rats were sacrificed after six weeks, and the right rectus femoris muscle and femur were isolated and analyzed. Hind limb disuse resulted in a significant and substantial loss of both muscle mass and bone mass. The loss of bone mass was accompanied by a reduction of trabecular bone mass and a deterioration of the trabecular micro-architecture with a reduction of trabecular thickness and trabecular number compared to Ctrl. In addition, the trabeculae changed from a more plate-like towards a more rod-like shape as indicated by an increase in the structure model index.•Multiple injections with BTX targeting muscles on both the anterior and posterior thigh and the calf ensure a uniform and pervasive muscle paralysis and hind limb disuse.•Hind limb injections with BTX results in a substantial loss of muscle and bone mass and deterioration of the trabecular micro-architecture.•The induction of hind limb disuse with BTX is highly reproducible.
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Grimstad Ø, Kvammen BØ, Swartling C. Botulinum Toxin Type B for Hidradenitis Suppurativa: A Randomised, Double-Blind, Placebo-Controlled Pilot Study. Am J Clin Dermatol 2020; 21:741-748. [PMID: 32761500 PMCID: PMC7473957 DOI: 10.1007/s40257-020-00537-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Botulinum toxin (BTX) is a potent neurotoxin with a long history of therapeutic application in neurological and dermatological conditions, with a strong efficacy and safety profile. Objective Our aim was to assess whether intradermal injection with BTX-B is an effective treatment for hidradenitis suppurativa (HS). Methods Twenty patients with HS stage I–III disease, according to Hurley’s classification, were consecutively included for treatment with either a placebo or BTX-B. At the next intervention after 3 months, all participants received the active substance and another follow-up at 6 months. The primary outcome was quality of life, measured using the Dermatology Life Quality Index (DLQI), while secondary outcomes were the visual analogue scale (VAS) for pain in the worst boil and HS-related impairment of general health (VAS), as well as changes in physician-reported disease activity assessed as the number of total lesions, and reported adverse effects of treatment. Results The DLQI improved from a median of 17 at baseline to 8 at 3 months in the BTX-B group, compared with a reduction from 13.5 to 11 in the placebo group (p <0.05). Improvement of the patients’ own ratings of symptoms and a reduction in total lesions supplemented the primary outcome. Fifty-five percent of the study population reported some degree of hyperhidrosis. Conclusion BTX-B improves the quality of life in patients with HS. Furthermore, comorbidity between HS and hyperhidrosis is suggested. Trial Registration ClinicalTrials.gov identifier: NCT03103074.
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Affiliation(s)
- Øystein Grimstad
- Department of Dermatology, University Hospital of North Norway, Tromsö, Norway.
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsö, Norway.
| | - Bjørn Øivind Kvammen
- Department of Dermatology, University Hospital of North Norway, Tromsö, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsö, Norway
| | - Carl Swartling
- Hidrosis Clinic, Stockholm, Sweden
- Department of Medical Sciences, Dermatology and Venereology, Uppsala University, Uppsala, Sweden
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23
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Cohn JE, Greco TM. Advanced Techniques for the Use of Neurotoxins in Non-Surgical Facial Rejuvenation. Aesthetic Plast Surg 2020; 44:1788-1799. [PMID: 32239250 DOI: 10.1007/s00266-020-01691-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neurotoxins initially were used to treat hyperfunctional rhytids of the face, but now have been expanded to improve facial shaping, correct facial asymmetry and even improve skin texture and tone. METHODS The clinical approach to non-surgical facial rejuvenation is approached into four anatomical regions: the upper face, midface, lower face and neck. RESULTS The key muscles of the upper face include frontalis, orbicularis oculi, corrugator supercilii, procerus, depressor supercilii and temporalis. The muscles in the midface to be discussed include the levator labii superioris, levator labii superioris alaeque nasi, depressor anguli oris, depressor septi nasi and nasalis. Treatment of the lower face focuses on the orbicularis oris, mentalis, depressor anguli oris and masseter muscles. Finally, treatment of the neck region will be reviewed with emphasis on platysmal bands and necklace lines as well as the Nefertiti lift. CONCLUSIONS Non-surgical facial rejuvenation using neurotoxins should be performed safely and effectively in order to avoid and treat complications. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic Reconstructive Surgery, Philadelphia College of Osteopathic Medicine, 4190 City Line Avenue, Philadelphia, PA, 19131, USA.
| | - Timothy M Greco
- Center of Excellence in Facial Cosmetic Surgery, 2 Bala Plaza, PL-15, Bala Cynwyd, PA, 19004, USA
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Isaacson SH, Ondo W, Jackson CE, Trosch RM, Molho E, Pagan F, Lew M, Dashtipour K, Clinch T, Espay AJ. Safety and Efficacy of RimabotulinumtoxinB for Treatment of Sialorrhea in Adults: A Randomized Clinical Trial. JAMA Neurol 2020; 77:461-469. [PMID: 31930364 PMCID: PMC6990829 DOI: 10.1001/jamaneurol.2019.4565] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Question Are rimabotulinumtoxinB injections safe and effective for management of sialorrhea in adults? Findings In this randomized clinical trial of 187 adults with sialorrhea, rimabotulinumtoxinB injections (2500 U and 3500 U) appeared to statistically significantly reduce sialorrhea vs placebo (treatment effect, −0.30 for both doses vs placebo, P < .001). Therapeutic benefits were seen as early as 1 week after injection and persisted for 11 to 15 weeks. Meaning RimabotulinumtoxinB is a safe, effective, and well-tolerated treatment for sialorrhea in adults. Importance RimabotulinumtoxinB (RIMA) may be preferable as an anti-sialorrhea treatment compared with current oral anticholinergic drugs in people with neurological disorders. Objective To assess the safety, efficacy, and tolerability of RIMA injections for the treatment of sialorrhea in adults. Design, Setting, and Participants This randomized, parallel, double-blind, placebo-controlled clinical trial of RIMA 2500 U and 3500 U was conducted from November 14, 2013, to January 23, 2017. A total of 249 adult patients with troublesome sialorrhea secondary to any disorder or cause were screened. Of them, 13 refused further participation in the study or were lost to follow-up and 49 did not fulfill the criteria for participation; 187 were ultimately enrolled. Patients had to have a minimum unstimulated salivary flow rate (USFR) of 0.2 g/min and a minimum Drooling Frequency and Severity Scale score of 4. Exposures Patients were randomized 1:1:1 to RIMA, 2500 U (n = 63); RIMA, 3500 U (n = 64); or placebo (n = 60). Main Outcomes and Measures Primary outcomes were the change in USFR from baseline to week 4 and the Clinical Global Impression of Change (CGI-C) at week 4. The CGI-C scores were recorded on a 7-point scale ranging from very much improved to very much worse. Adverse events were recorded throughout the trial period. Results Of 187 patients enrolled (147 men [78.6%]; mean [SD] age, 63.9 [13.3] years), 122 patients had Parkinson disease (65.2%), 13 (7.0%) were stroke survivors, 12 had amyotrophic lateral sclerosis (6.4%), 6 had medication-induced sialorrhea (3.2%), 4 had adult cerebral palsy (2.1%), and 30 had sialorrhea owing to other causes (16.0%). A total of 176 completed the study. Treatment with both doses of RIMA significantly reduced USFR at week 4 vs placebo (mean treatment difference, −0.30 g/min [95% CI, −0.39 to −0.21] for both doses vs placebo, P < .001). The CGI-C scores were statistically significantly improved at week 4 for both treatment groups vs placebo (−1.21 [95% CI, −1.56 to −0.87] for 2500 U, −1.14 [95% CI, −1.49 to −0.80] for 3500 U, both P < .001). Treatment benefits were seen as early as 1 week after injection and were maintained over the treatment cycle of approximately 13 weeks. The RIMA injections were well tolerated compared with placebo. The most common adverse events were self-limited mild to moderate dry mouth, dysphagia, and dental caries. Conclusions and Relevance Treatment with RIMA (2500 U and 3500 U) in adults was well tolerated and reduced sialorrhea, with the onset of the effect at 1 week after the injection. These data support the clinical use of RIMA in the management of sialorrhea in adults. Trial Registration ClinicalTrials.gov Identifier: NCT01994109
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Affiliation(s)
- Stuart H Isaacson
- Parkinson's Disease and Movement Disorder Center of Boca Raton, Boca Raton, Florida
| | - William Ondo
- Houston Methodist Neurological Institute, Houston, Texas.,Weill Cornell Medicine, Houston, Texas
| | | | | | - Eric Molho
- Parkinson's Disease and Movement Disorder Center, Albany Medical Center, Albany, New York
| | | | - Mark Lew
- Keck School of Medicine of University of Southern California, Los Angeles
| | | | | | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
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Hsu PC, Wu WT, Han DS, Chang KV. Comparative Effectiveness of Botulinum Toxin Injection for Chronic Shoulder Pain: A Meta-Analysis of Randomized Controlled Trials. Toxins (Basel) 2020; 12:toxins12040251. [PMID: 32290577 PMCID: PMC7232231 DOI: 10.3390/toxins12040251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/16/2022] Open
Abstract
Botulinum toxin (BoNT) injection is regarded as a promising treatment for musculoskeletal pain. However, its efficacy for treating chronic shoulder pain remains unclear. We investigated the effectiveness of BoNT injections for chronic shoulder pain by conducting a systematic search of electronic databases up to March 2020 for randomized control trials (RCTs) that used BoNT injections for chronic shoulder pain treatment. The primary outcome was the between-group comparison of pain reduction, quantified by the standardized mean difference (SMD). Nine RCTs comprising 666 patients were included and divided into two groups: one group with shoulder joint pain (n = 182) and the other group with shoulder myofascial pain (n = 484). Regarding shoulder joint pain, the efficacy of BoNT injections was similar to that of the reference treatment (SMD: −0.605, 95% confidence level [CI]: −1.242 to 0.032 versus saline; SMD: −0.180, 95% CI: −0.514 to 0.153 versus corticosteroids) at one month post-intervention, and was superior (SMD: −0.648, 95% CI: −0.1071 to −0.225 versus corticosteroids) between one and three months. Likewise, in terms of shoulder myofascial pain, the effectiveness of BoNT injections did not differ from the reference treatment (SMD: −0.212, 95% CI: −0.551 to 0.127 versus saline; SMD: 0.665, 95% CI: −0.260 to 1.590 versus dry needling and SMD: 1.093; 95% CI: 0.128 to 2.058 versus lidocaine) at one month post- intervention, and appeared superior (SMD: −0.314, 95% CI: −0.516 to −0.111 versus saline) between one and three months. Our meta-analysis revealed that BoNT injections could be a safe and effective alternative for patients with chronic shoulder pain.
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Affiliation(s)
- Po-Cheng Hsu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (P.-C.H.); (W.-T.W.); (D.-S.H.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 11221, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (P.-C.H.); (W.-T.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (P.-C.H.); (W.-T.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (P.-C.H.); (W.-T.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan
- Correspondence: ; Tel.: +886-2-2371-7101
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Moya‐Díaz J, Bayonés L, Montenegro M, Cárdenas AM, Koch H, Doi A, Marengo FD. Ca 2+ -independent and voltage-dependent exocytosis in mouse chromaffin cells. Acta Physiol (Oxf) 2020; 228:e13417. [PMID: 31769918 DOI: 10.1111/apha.13417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/11/2022]
Abstract
AIM It is widely accepted that the exocytosis of synaptic and secretory vesicles is triggered by Ca2+ entry through voltage-dependent Ca2+ channels. However, there is evidence of an alternative mode of exocytosis induced by membrane depolarization but lacking Ca2+ current and intracellular Ca2+ increase. In this work we investigated if such a mechanism contributes to secretory vesicle exocytosis in mouse chromaffin cells. METHODS Exocytosis was evaluated by patch-clamp membrane capacitance measurements, carbon fibre amperometry and TIRF. Cytosolic Ca2+ was estimated using epifluorescence microscopy and fluo-8 (salt form). RESULTS Cells stimulated by brief depolatizations in absence of extracellular Ca+2 show moderate but consistent exocytosis, even in presence of high cytosolic BAPTA concentration and pharmacological inhibition of Ca+2 release from intracellular stores. This exocytosis is tightly dependent on membrane potential, is inhibited by neurotoxin Bont-B (cleaves the v-SNARE synaptobrevin), is very fast (saturates with time constant <10 ms), it is followed by a fast endocytosis sensitive to the application of an anti-dynamin monoclonal antibody, and recovers after depletion in <5 s. Finally, this exocytosis was inhibited by: (i) ω-agatoxin IVA (blocks P/Q-type Ca2+ channel gating), (ii) in cells from knock-out P/Q-type Ca2+ channel mice, and (iii) transfection of free synprint peptide (interferes in P/Q channel-exocytic proteins association). CONCLUSION We demonstrated that Ca2+ -independent and voltage-dependent exocytosis is present in chromaffin cells. This process is tightly coupled to membrane depolarization, and is able to support secretion during action potentials at low basal rates. P/Q-type Ca2+ channels can operate as voltage sensors of this process.
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Affiliation(s)
- José Moya‐Díaz
- Instituto de Fisiología, Biología Molecular y Neurociencias Departamento de Fisiología y Biología Molecular y Celular Facultad de Ciencias Exactas y Naturales Universidad de Buenos AiresConsejo Nacional de Investigaciones Científicas y Técnicas Buenos Aires Argentina
| | - Lucas Bayonés
- Instituto de Fisiología, Biología Molecular y Neurociencias Departamento de Fisiología y Biología Molecular y Celular Facultad de Ciencias Exactas y Naturales Universidad de Buenos AiresConsejo Nacional de Investigaciones Científicas y Técnicas Buenos Aires Argentina
| | - Mauricio Montenegro
- Instituto de Fisiología, Biología Molecular y Neurociencias Departamento de Fisiología y Biología Molecular y Celular Facultad de Ciencias Exactas y Naturales Universidad de Buenos AiresConsejo Nacional de Investigaciones Científicas y Técnicas Buenos Aires Argentina
| | - Ana M. Cárdenas
- Centro Interdisciplinario de Neurociencia de Valparaíso Facultad de Ciencias Universidad de Valparaíso Valparaíso Chile
| | - Henner Koch
- Center for Integrative Brain Research Seattle Children's Research Institute Seattle WA USA
- Department of Neurology and Epileptology Hertie‐Institute for Clinical Brain ResearchUniversity of Tübingen Tübingen Germany
| | - Atsushi Doi
- Department of Rehabilitation Graduate School of Health Science Kumamoto Health Science University Kumamoto Japan
| | - Fernando D. Marengo
- Instituto de Fisiología, Biología Molecular y Neurociencias Departamento de Fisiología y Biología Molecular y Celular Facultad de Ciencias Exactas y Naturales Universidad de Buenos AiresConsejo Nacional de Investigaciones Científicas y Técnicas Buenos Aires Argentina
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Yin L, Masuyer G, Zhang S, Zhang J, Miyashita SI, Burgin D, Lovelock L, Coker SF, Fu TM, Stenmark P, Dong M. Characterization of a membrane binding loop leads to engineering botulinum neurotoxin B with improved therapeutic efficacy. PLoS Biol 2020; 18:e3000618. [PMID: 32182233 PMCID: PMC7077807 DOI: 10.1371/journal.pbio.3000618] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/12/2020] [Indexed: 11/25/2022] Open
Abstract
Botulinum neurotoxins (BoNTs) are a family of bacterial toxins with seven major serotypes (BoNT/A–G). The ability of these toxins to target and bind to motor nerve terminals is a key factor determining their potency and efficacy. Among these toxins, BoNT/B is one of the two types approved for medical and cosmetic uses. Besides binding to well-established receptors, an extended loop in the C-terminal receptor-binding domain (HC) of BoNT/B (HC/B) has been proposed to also contribute to toxin binding to neurons by interacting with lipid membranes (termed lipid-binding loop [LBL]). Analogous loops exist in the HCs of BoNT/C, D, G, and a chimeric toxin DC. However, it has been challenging to detect and characterize binding of LBLs to lipid membranes. Here, using the nanodisc system and biolayer interferometry assays, we find that HC/DC, C, and G, but not HC/B and HC/D, are capable of binding to receptor-free lipids directly, with HC/DC having the highest level of binding. Mutagenesis studies demonstrate the critical role of consecutive aromatic residues at the tip of the LBL for binding of HC/DC to lipid membranes. Taking advantage of this insight, we then create a “gain-of-function” mutant HC/B by replacing two nonaromatic residues at the tip of its LBL with tryptophan. Cocrystallization studies confirm that these two tryptophan residues do not alter the structure of HC/B or the interactions with its receptors. Such a mutated HC/B gains the ability to bind receptor-free lipid membranes and shows enhanced binding to cultured neurons. Finally, full-length BoNT/B containing two tryptophan mutations in its LBL, together with two additional mutations (E1191M/S1199Y) that increase binding to human receptors, is produced and evaluated in mice in vivo using Digit Abduction Score assays. This mutant toxin shows enhanced efficacy in paralyzing local muscles at the injection site and lower systemic diffusion, thus extending both safety range and duration of paralysis compared with the control BoNT/B. These findings establish a mechanistic understanding of LBL–lipid interactions and create a modified BoNT/B with improved therapeutic efficacy. Botulinum neurotoxins are a family of bacterial toxins, some of which are approved for medical and cosmetic uses. This study shows that introducing aromatic residues to a lipid binding loop improved therapeutic efficacy of botulinum neurotoxin B by enhancing its ability to bind to lipid membranes at motor nerve terminals.
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Affiliation(s)
- Linxiang Yin
- Department of Urology, Boston Children’s Hospital, Department of Microbiology and Department of Surgery, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Geoffrey Masuyer
- Department of Biochemistry and Biophysics, Stockholm University, Stockholm, Sweden
| | - Sicai Zhang
- Department of Urology, Boston Children’s Hospital, Department of Microbiology and Department of Surgery, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jie Zhang
- Department of Urology, Boston Children’s Hospital, Department of Microbiology and Department of Surgery, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shin-Ichiro Miyashita
- Department of Urology, Boston Children’s Hospital, Department of Microbiology and Department of Surgery, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | | | - Tian-min Fu
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Program in Cellular and Molecular Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Pål Stenmark
- Department of Biochemistry and Biophysics, Stockholm University, Stockholm, Sweden
- Department of Experimental Medical Science, Lund University, Lund, Sweden
- * E-mail: (PS); (MD)
| | - Min Dong
- Department of Urology, Boston Children’s Hospital, Department of Microbiology and Department of Surgery, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail: (PS); (MD)
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Eleopra R, Rinaldo S, Montecucco C, Rossetto O, Devigili G. Clinical duration of action of different botulinum toxin types in humans. Toxicon 2020; 179:84-91. [PMID: 32184153 DOI: 10.1016/j.toxicon.2020.02.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 02/04/2020] [Accepted: 02/26/2020] [Indexed: 12/21/2022]
Abstract
The Botulinum NeuroToxin (BoNT) comprises several serotypes with distinct properties, mechanisms of action, sensitivity and duration of effect in different species. The serotype A (BoNT/A) is the prevalent neurotoxin applied in human's disease. In this paper we present an overview of the current knowledge regarding the duration of effect and the neuromuscular sprouting of different BoNT serotypes in humans. Then, we report the original results of a study in healthy subjects treated with BoNT/A, B, C and F using different neurophysiological techniques. Twelve healthy volunteers (7 men, 5 women) are treated with BoNT/A, B, C and F or placebo in Abductor digiti minimi (ADM) muscle of the hand. Before and after injections, an extensive neurophysiological study is performed with the CMAP amplitude variation, Multi-Motor Unit Action Potentials (MUAPs) analysis, the Turns/Amplitude ratio of interference pattern (IP) and determination of jitter and Fiber Density (FD) at single-fiber electromyography (SFEMG), at week 2 (w2), 4 (w4), 6 (w6) and 8 (w8). A maximal neuromuscular block is obtained at w2 for all the serotypes. Afterwards, the CMAP trend appear similar for BoNT/A, B, and C while, BoNT/F shows a faster recover. Multi-MUAPs analysis and IP detect mild changes at w2 for all serotypes, except for BoNT/F that shows a greater change since w4. SFEMG have minimal changes in FD while, Jitter increase at w2 with a slower decrease over the time for all BoNTs. In conclusion, BoNT/F has earlier sprouting and complete recovery at w8. Other serotypes present a slower and similar profile. The EMG appear useful to study the functional recovery in humans, and these results should provide new evidence for assessing different serotypes. These findings improve our knowledge regarding the methods to evaluate duration of effects and dose equivalents in different serotypes, that in the future could change the clinicians strategy for disease-tailored BoNT therapies.
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Affiliation(s)
- Roberto Eleopra
- Neurological Unit 1, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, 20133, Milan, Italy.
| | - Sara Rinaldo
- Neurological Unit 1, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, 20133, Milan, Italy.
| | - Cesare Montecucco
- Biochemical Science Department University of Padua, 35121, Padova, Italy.
| | - Ornella Rossetto
- Biochemical Science Department University of Padua, 35121, Padova, Italy.
| | - Grazia Devigili
- Neurological Unit 1, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, 20133, Milan, Italy.
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29
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Use of Botulinum Toxin in Orofacial Clinical Practice. Toxins (Basel) 2020; 12:toxins12020112. [PMID: 32053883 PMCID: PMC7076767 DOI: 10.3390/toxins12020112] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/22/2020] [Accepted: 02/05/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction: Botulinum neurotoxin (BoNT) is a potent biological toxin and powerful therapeutic tool for a growing number of clinical orofacial applications. BoNT relaxes striated muscle by inhibiting acetylcholine’s release from presynaptic nerve terminals, blocking the neuromuscular junction. It also has an antinociceptive effect on sensory nerve endings, where BoNT and acetylcholine are transported axonally to the central nervous system. In dentistry, controlled clinical trials have demonstrated BoNT’s efficiency in pathologies such as bruxism, facial paralysis, temporomandibular joint (TMJ) disorders, neuropathic pain, sialorrhea, dystonia and more. Aim: This study’s aim was to conduct a systematic literature review to assess the most recent high-level clinical evidence for BoNT’s efficacy and for various protocols (the toxin used, dilution, dosage and infiltration sites) used in several orofacial pathologies. Materials and methods: We systematically searched the MedLine database for research papers published from 2014 to 2019 with randomly allocated studies on humans. The search included the following pathologies: bruxism, dislocation of the TMJ, orofacial dystonia, myofascial pain, salivary gland disease, orofacial spasm, facial paralysis, sialorrhea, Frey syndrome and trigeminal neuralgia. Results: We found 228 articles, of which only 20 met the inclusion criteria: bruxism (four articles), orofacial dystonia (two articles), myofascial pain (one article), salivary gland disease (one article), orofacial spasm (two articles), facial paralysis (three articles), sialorrhea (four articles) or trigeminal neuralgia (three articles). Discussion: The clinical trials assessed showed variations in the dosage, application sites and musculature treated. Thus, applying BoNT can reduce symptoms related to motor muscular activity in the studied pathologies efficiently enough to satisfy patients. We did not identify the onset of any important side effects in the literature reviewed. We conclude that treatment with BoNT seems a safe and effective treatment for the reviewed pathologies.
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Moritz MS, Tepp WH, Inzalaco HN, Johnson EA, Pellett S. Comparative functional analysis of mice after local injection with botulinum neurotoxin A1, A2, A6, and B1 by catwalk analysis. Toxicon 2019; 167:20-28. [PMID: 31181297 PMCID: PMC6688953 DOI: 10.1016/j.toxicon.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/20/2019] [Accepted: 06/03/2019] [Indexed: 01/10/2023]
Abstract
Botulinum neurotoxins (BoNTs) are potent neurotoxins and are the causative agent of botulism, as well as valuable pharmaceuticals. BoNTs are divided into seven serotypes that comprise over 40 reported subtypes. BoNT/A1 and BoNT/B1 are currently the only subtypes approved for pharmaceutical use in the USA. While several other BoNT subtypes including BoNT/A2 and/A6 have been proposed as promising pharmaceuticals, detailed characterization using in vivo assays are essential to determine their pharmaceutical characteristics compared to the currently used BoNT/A1 and/B1. Several methods for studying BoNTs in mice are being used, but no objective and quantitative assay for assessment of functional outcomes after injection has been described. Here we describe the use of CatWalk XT as a new analytical tool for the objective and quantitative analysis of the paralytic effect after local intramuscular injection of BoNT subtypes A1, A2, A6, and B1. Catwalk is a sophisticated gait and locomotion analysis system that quantitatively analyzes a rodent's paw print dimensions and footfall patterns while traversing a glass plate during unforced walk. Significant changes were observed in several gait parameters in mice after local intramuscular injection of all tested BoNT subtypes, however, no changes were observed in mice injected intraperitoneally with the same BoNTs. While a clear difference in time to peak paralysis was observed between BoNT/A1 and/B1, injection of all four toxins resulted in a deficit in the injected limb with the other limbs functionally compensating and with no qualitative differences between the four BoNT subtypes. The presented data demonstrate the utility of CatWalk as a tool for functional outcomes after local BoNT injection through its ability to collect large amounts of quantitative data and objectively analyze sensitive changes in static and dynamic gait parameters.
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Affiliation(s)
- Molly S Moritz
- University of Wisconsin-Madison, Dept. of Bacteriology, USA
| | - William H Tepp
- University of Wisconsin-Madison, Dept. of Bacteriology, USA
| | | | - Eric A Johnson
- University of Wisconsin-Madison, Dept. of Bacteriology, USA
| | - Sabine Pellett
- University of Wisconsin-Madison, Dept. of Bacteriology, USA.
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31
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Elliott M, Favre-Guilmard C, Liu SM, Maignel J, Masuyer G, Beard M, Boone C, Carré D, Kalinichev M, Lezmi S, Mir I, Nicoleau C, Palan S, Perier C, Raban E, Zhang S, Dong M, Stenmark P, Krupp J. Engineered botulinum neurotoxin B with improved binding to human receptors has enhanced efficacy in preclinical models. SCIENCE ADVANCES 2019; 5:eaau7196. [PMID: 30746458 PMCID: PMC6357751 DOI: 10.1126/sciadv.aau7196] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/06/2018] [Indexed: 05/10/2023]
Abstract
Although botulinum neurotoxin serotype A (BoNT/A) products are common treatments for various disorders, there is only one commercial BoNT/B product, whose low potency, likely stemming from low affinity toward its human receptor synaptotagmin 2 (hSyt2), has limited its therapeutic usefulness. We express and characterize two full-length recombinant BoNT/B1 proteins containing designed mutations E1191M/S1199Y (rBoNT/B1MY) and E1191Q/S1199W (rBoNT/B1QW) that enhance binding to hSyt2. In preclinical models including human-induced pluripotent stem cell neurons and a humanized transgenic mouse, this increased hSyt2 affinity results in high potency, comparable to that of BoNT/A. Last, we solve the cocrystal structure of rBoNT/B1MY in complex with peptides of hSyt2 and its homolog hSyt1. We demonstrate that neuronal surface receptor binding limits the clinical efficacy of unmodified BoNT/B and that modified BoNT/B proteins have promising clinical potential.
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MESH Headings
- Animals
- Botulinum Toxins, Type A/chemistry
- Botulinum Toxins, Type A/genetics
- Botulinum Toxins, Type A/metabolism
- Botulinum Toxins, Type A/pharmacology
- Crystallography, X-Ray
- Female
- Glycine/metabolism
- Humans
- Induced Pluripotent Stem Cells/drug effects
- Male
- Mice, Inbred C57BL
- Mice, Transgenic
- Muscle, Skeletal/drug effects
- Muscle, Smooth/drug effects
- Mutation
- Neurons/drug effects
- Neurons/metabolism
- Protein Engineering
- Rabbits
- Rats, Sprague-Dawley
- Recombinant Proteins/genetics
- Recombinant Proteins/metabolism
- Recombinant Proteins/pharmacology
- Static Electricity
- Synaptotagmin II/chemistry
- Synaptotagmin II/genetics
- Synaptotagmin II/metabolism
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Affiliation(s)
- Mark Elliott
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon OX14 4RY, UK
| | | | - Sai Man Liu
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon OX14 4RY, UK
| | - Jacquie Maignel
- Ipsen Innovation, 5 Avenue du Canada, 91940 Les Ulis, France
| | - Geoffrey Masuyer
- Department of Biochemistry and Biophysics, Stockholm University, Stockholm SE-106 91, Sweden
| | - Matthew Beard
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon OX14 4RY, UK
| | - Christopher Boone
- Department of Urology, Boston Children’s Hospital, Department of Microbiology and Immunobiology and Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Denis Carré
- Ipsen Innovation, 5 Avenue du Canada, 91940 Les Ulis, France
| | | | - Stephane Lezmi
- Ipsen Innovation, 5 Avenue du Canada, 91940 Les Ulis, France
| | - Imran Mir
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon OX14 4RY, UK
| | | | - Shilpa Palan
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon OX14 4RY, UK
| | - Cindy Perier
- Ipsen Innovation, 5 Avenue du Canada, 91940 Les Ulis, France
| | - Elsa Raban
- Ipsen Innovation, 5 Avenue du Canada, 91940 Les Ulis, France
| | - Sicai Zhang
- Department of Urology, Boston Children’s Hospital, Department of Microbiology and Immunobiology and Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Min Dong
- Department of Urology, Boston Children’s Hospital, Department of Microbiology and Immunobiology and Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Pål Stenmark
- Department of Biochemistry and Biophysics, Stockholm University, Stockholm SE-106 91, Sweden
- Department of Experimental Medical Science, Lund University, 221 00 Lund, Sweden
| | - Johannes Krupp
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon OX14 4RY, UK
- Ipsen Innovation, 5 Avenue du Canada, 91940 Les Ulis, France
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32
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Evander Emeltan Tjoa S, Maria Vianney Y, Emantoko Dwi Putra S. In silico mutagenesis: decreasing the immunogenicity of botulinum toxin type A. J Biomol Struct Dyn 2018; 37:4767-4778. [PMID: 30558486 DOI: 10.1080/07391102.2018.1559100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Botulinum toxin serotype A is a prominent therapeutic enzyme, for both clinical and cosmetic uses. Since this protein is produced by bacteria, it exhibits an allergenic effect when subjected to human therapy. Protein mutagenesis is one method to improve the characteristics of protein. However, in silico study is needed to give suggestion of which amino acid should be mutated. Hence, a lot of money and time can be saved. This study initially screened which residue of the Botulinum toxin serotype A is B-cell epitopes both linearly and conformationally. By overlapping the B-cell epitopes with the excluded conserve sequence, seven residues were allowed to be mutated. There were two proposed muteins showing a reduction in the antigenicity probability: ΔE147, E510F, T1062F, ΔE1080, N1089M and ΔQ1090; and ΔE147, E510F, T1062F, E1080W, N1089M and ΔQ1090. Molecular dynamics simulation of the 3D proposed muteins indicated an increase of flexibility in both muteins compared to that in the native protein. Both muteins have lower antigenicity. In addition, they are similar in structure, stability and functionality compared to the native protein.
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Affiliation(s)
| | - Yoanes Maria Vianney
- Faculty of Biotechnology, University of Surabaya , Surabaya , East Java , Indonesia
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33
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Injection technique in neurotoxins and fillers: Indications, products, and outcomes. J Am Acad Dermatol 2018; 79:423-435. [DOI: 10.1016/j.jaad.2018.01.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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34
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Behrensdorf-Nicol HA, Wild E, Bonifas U, Klimek J, Hanschmann KM, Krämer B, Kegel B. In vitro potency determination of botulinum neurotoxin serotype A based on its receptor-binding and proteolytic characteristics. Toxicol In Vitro 2018; 53:80-88. [PMID: 30016653 DOI: 10.1016/j.tiv.2018.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/22/2018] [Accepted: 07/13/2018] [Indexed: 11/26/2022]
Abstract
Botulinum neurotoxins (BoNTs) inhibit the release of the neurotransmitter acetylcholine from motor neurons, resulting in highly effective muscle relaxation. In clinical and aesthetic medicine, serotype BoNT/A, which is most potent for humans, is widely used to treat a continuously increasing spectrum of disorders associated with muscle overactivity. Because of the high toxicity associated with BoNTs, it is mandatory to precisely determine the potency of every batch produced for pharmaceutical purposes. Here we report a new quantitative functional in vitro assay for BoNT/A. In this binding and cleavage (BINACLE) assay, the toxin is first bound to specific receptor molecules. Then a chemical reduction is performed, thereby releasing the light chain of BoNT/A and activating its proteolytic domain. The activated light chain is finally exposed to its substrate protein SNAP-25, and the fragment resulting from the proteolytic cleavage of this protein is quantified in an antibody-mediated reaction. The BoNT/A BINACLE assay offers high specificity and sensitivity with a detection limit below 0.5 mouse lethal dose (LD50)/ml. In conclusion, this new in vitro assay for determining BoNT/A toxicity represents an alternative to the LD50 test in mice, which is the "gold standard" method for the potency testing of BoNT/A products.
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Affiliation(s)
- Heike A Behrensdorf-Nicol
- Veterinary Medicine Division, Paul-Ehrlich-Institut (Federal Institute for Vaccines and Biomedicals), Langen, Germany.
| | - Emina Wild
- Veterinary Medicine Division, Paul-Ehrlich-Institut (Federal Institute for Vaccines and Biomedicals), Langen, Germany
| | - Ursula Bonifas
- Veterinary Medicine Division, Paul-Ehrlich-Institut (Federal Institute for Vaccines and Biomedicals), Langen, Germany
| | - Jolanta Klimek
- Veterinary Medicine Division, Paul-Ehrlich-Institut (Federal Institute for Vaccines and Biomedicals), Langen, Germany
| | - Kay-Martin Hanschmann
- Microbiology Division, Paul-Ehrlich-Institut (Federal Institute for Vaccines and Biomedicals), Langen, Germany
| | - Beate Krämer
- Veterinary Medicine Division, Paul-Ehrlich-Institut (Federal Institute for Vaccines and Biomedicals), Langen, Germany
| | - Birgit Kegel
- Veterinary Medicine Division, Paul-Ehrlich-Institut (Federal Institute for Vaccines and Biomedicals), Langen, Germany
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35
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Botulinum Toxin Induced Atrophy: An Uncharted Territory. Toxins (Basel) 2018; 10:toxins10080313. [PMID: 30072597 PMCID: PMC6115806 DOI: 10.3390/toxins10080313] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 11/29/2022] Open
Abstract
Botulinum neurotoxins (BoNTs) produce local chemo-denervation by cleaving soluble N-ethylmaleimide-sensitive factor activating protein receptor (SNARE) proteins. Botulinum neurotoxins are therapeutically indicated in several neurological disorders and have been in use for three decades. The long-term efficacy, safety, and side effects of BoNTs have been well documented in the literature. However, the development of muscle atrophy following chronic exposure to BoNTs has not received sufficient attention. Muscle atrophy is not only cosmetically distressing, but also has an impact on future injections. An extensive literature search was conducted on atrophy and mechanisms of atrophy. Five hundred and four relevant articles in the English language were reviewed. This review revealed the surprising lack of documentation of atrophy within the literature. In addition, as demonstrated in this review, the mechanisms and the clinical factors that may lead to atrophy have also been poorly studied. However, even with this limited information it is possible to indicate factors that could modify the clinical approach to botulinum toxin injections. This review highlights the need for further study of atrophy following BoNT injections.
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36
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Pirazzini M, Carle S, Barth H, Rossetto O, Montecucco C. Primary resistance of human patients to botulinum neurotoxins A and B. Ann Clin Transl Neurol 2018; 5:971-975. [PMID: 30128321 PMCID: PMC6093845 DOI: 10.1002/acn3.586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/08/2018] [Indexed: 11/13/2022] Open
Abstract
Botulinum neurotoxin serotypes A and B are successfully used to treat a variety of human diseases characterized by hyperactive peripheral nerve terminals. However, a number of patients are primary resistant to these pharmaceuticals, without having antitoxin‐neutralizing antibodies. A straightforward explanation of this phenomenon posits that mutations of the toxin sites of interaction with their receptors or protein substrates prevent their neuroparalytic action. After a careful investigation of available human genomic databases, we conclude that it is very unlikely that humans are resistant to these two therapeutic neurotoxins because of mutations that would affect their binding or intracellular proteolytic actions.
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Affiliation(s)
- Marco Pirazzini
- Department of Biomedical Sciences University of Padova Via Ugo Bassi 58/B 35131 Padova Italy
| | - Stefan Carle
- Institute of Pharmacology and Toxicology University of Ulm Medical Center Albert-Einstein-Allee 11 89081 Ulm Germany
| | - Holger Barth
- Institute of Pharmacology and Toxicology University of Ulm Medical Center Albert-Einstein-Allee 11 89081 Ulm Germany
| | - Ornella Rossetto
- Department of Biomedical Sciences University of Padova Via Ugo Bassi 58/B 35131 Padova Italy
| | - Cesare Montecucco
- Department of Biomedical Sciences University of Padova Via Ugo Bassi 58/B 35131 Padova Italy.,Institute for Neuroscience National Research Council Via Ugo Bassi 58/B 35131 Padova Italy
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37
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Sachdev A, Costello D, Madge S. Botulinum toxin-B injection into the lacrimal gland and posterior cricoarytenoid muscle for the treatment of epiphora and abductor spasmodic dysphonia secondary to Parkinson's disease. Orbit 2018; 38:248-251. [PMID: 29939826 DOI: 10.1080/01676830.2018.1490443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In ophthalmology, there have been few reports of botulinum toxin type-A (BTX-A) injection into the lacrimal gland to treat epiphora. In ENT, adductor and abductor (ABSD) spasmodic dysphonia are often treated with BTX-A injections into the respective overacting vocal cord muscles. We describe a 53-year old male with Parkinson's disease who did not respond to BTX-A injections to either the lacrimal gland, for epiphora secondary to Parkinsonian-related blink lagophthalmos, or posterior cricoarytenoid (PCA) muscles for ABSD. Subsequent BTX type-B (BTX-B) injections into the lacrimal gland remarkably improved his epiphora. BTX-B injections into the PCA muscle also greatly improved his dysphonia. We describe the first reported case of (1) BTX-B injection into the lacrimal gland for epiphora, (2) use of Botox in treating epiphora due to blink lagophthalmos/reduced blink frequency secondary to Parkinson's disease, (3) BTX-B use in treating ABSD, and (4) association between ABSD and Parkinson's disease.
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Affiliation(s)
- Amun Sachdev
- a Department of Ophthalmology , Hereford County Hospital, Wye Valley NHS Trust , Hereford , United Kingdom
| | - Declan Costello
- b Department of ENT , Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust , Birmingham , United Kingdom
| | - Simon Madge
- a Department of Ophthalmology , Hereford County Hospital, Wye Valley NHS Trust , Hereford , United Kingdom
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38
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Feltrup TM, Patel K, Kumar R, Cai S, Singh BR. A novel role of C-terminus in introducing a functionally flexible structure critical for the biological activity of botulinum neurotoxin. Sci Rep 2018; 8:8884. [PMID: 29891845 PMCID: PMC5995822 DOI: 10.1038/s41598-018-26764-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 05/17/2018] [Indexed: 02/06/2023] Open
Abstract
Botulinum neurotoxin (BoNT) is responsible for botulism, a clinical condition resulting in flaccid muscle paralysis and potentially death. The light chain is responsible for its intracellular toxicity through its endopeptidase activity. Available crystal structures of BoNT/A light chains (LCA) are based on various truncated versions (tLCA) of the full-length LCA (fLCA) and do not necessarily reflect the true structure of LCA in solution. The understanding of the mechanism of action, longevity of intoxication, and an improved development of endopeptidase inhibitors are dependent on first having a better insight into the structure of LCA in solution. Using an array of biophysical techniques, we report that the fLCA structure is significantly more flexible than tLCA in solution, which may be responsible for its dramatically higher enzymatic activity. This seems to be achieved by a much stronger, more rapid binding to substrate (SNAP-25) of the fLCA compared to tLCA. These results suggest that the C-terminus of LCA plays a critical role in introducing a flexible structure, which is essential for its biological function. This is the first report of such a massive structural role of the C-terminus of a protein being critical for maintaining a functional state.
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Affiliation(s)
- Thomas M Feltrup
- Department of Chemistry & Biochemistry, University of Massachusetts Dartmouth, North Dartmouth, MA, 02747, USA
| | - Kruti Patel
- Department of Chemistry & Biochemistry, University of Massachusetts Dartmouth, North Dartmouth, MA, 02747, USA
| | - Raj Kumar
- Botulinum Research Center, Institute of Advanced Sciences, North Dartmouth, MA, 02747, USA
| | - Shuowei Cai
- Department of Chemistry & Biochemistry, University of Massachusetts Dartmouth, North Dartmouth, MA, 02747, USA
| | - Bal Ram Singh
- Botulinum Research Center, Institute of Advanced Sciences, North Dartmouth, MA, 02747, USA.
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39
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Tehran DA, Pirazzini M. Novel Botulinum Neurotoxins: Exploring Underneath the Iceberg Tip. Toxins (Basel) 2018; 10:toxins10050190. [PMID: 29748471 PMCID: PMC5983246 DOI: 10.3390/toxins10050190] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/05/2018] [Accepted: 05/08/2018] [Indexed: 12/26/2022] Open
Abstract
Botulinum neurotoxins (BoNTs), the etiological agents of botulism, are the deadliest toxins known to humans. Yet, thanks to their biological and toxicological features, BoNTs have become sophisticated tools to study neuronal physiology and valuable therapeutics for an increasing number of human disorders. BoNTs are produced by multiple bacteria of the genus Clostridium and, on the basis of their different immunological properties, were classified as seven distinct types of toxin. BoNT classification remained stagnant for the last 50 years until, via bioinformatics and high-throughput sequencing techniques, dozens of BoNT variants, novel serotypes as well as BoNT-like toxins within non-clostridial species have been discovered. Here, we discuss how the now “booming field” of botulinum neurotoxin may shed light on their evolutionary origin and open exciting avenues for future therapeutic applications.
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Affiliation(s)
- Domenico Azarnia Tehran
- Department of Biomedical Sciences, University of Padova, Via Ugo Bassi 58/B, 35131 Padova, Italy.
| | - Marco Pirazzini
- Department of Biomedical Sciences, University of Padova, Via Ugo Bassi 58/B, 35131 Padova, Italy.
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40
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Finocchiaro A, Marinelli S, De Angelis F, Vacca V, Luvisetto S, Pavone F. Botulinum Toxin B Affects Neuropathic Pain but Not Functional Recovery after Peripheral Nerve Injury in a Mouse Model. Toxins (Basel) 2018; 10:toxins10030128. [PMID: 29562640 PMCID: PMC5869416 DOI: 10.3390/toxins10030128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 12/12/2022] Open
Abstract
Clinical use of neurotoxins from Clostridium botulinum is well established and is continuously expanding, including in treatment of pain conditions. Background: The serotype A (BoNT/A) has been widely investigated, and current data demonstrate that it induces analgesia and modulates nociceptive processing initiated by inflammation or nerve injury. Given that data concerning the serotype B (BoNT/B) are limited, the aim of the present study was to verify if also BoNT/B is able not only to counteract neuropathic pain, but also to interfere with inflammatory and regenerative processes associated with the nerve injury. Methods: As model of neuropathic pain, chronic constriction injury (CCI) of the sciatic nerve was performed in CD1 male mice. Mice were intraplantarly injected with saline (control) or BoNT/B (5 or 7.5 pg/mouse) into the injured hindpaw. For comparison, another mouse group was injected with BoNT/A (15 pg/mouse). Mechanical allodynia and functional recovery of the injured paw was followed for 101 days. Spinal cords and sciatic nerves were collected at day 7 for immunohistochemistry. Results and Conclusions: The results of this study show that BoNT/B is a powerful biological molecule that, similarly to BoNT/A, can reduce neuropathic pain over a long period of time. However, the analgesic effects are not associated with an improvement in functional recovery, clearly highlighting an important difference between the two serotypes for the treatment of this chronic pain state.
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Affiliation(s)
- Alba Finocchiaro
- National Research Council of Italy-CNR, Institute of Cell Biology and Neurobiology-IBCN, 00143 Roma, Italy.
- Department of Psycology, PhD School of Behavioural Neuroscience, Sapienza University, 00185 Roma, Italy.
| | - Sara Marinelli
- National Research Council of Italy-CNR, Institute of Cell Biology and Neurobiology-IBCN, 00143 Roma, Italy.
- IRCCS Santa Lucia Foundation, 00143-Roma, Italy.
| | | | - Valentina Vacca
- National Research Council of Italy-CNR, Institute of Cell Biology and Neurobiology-IBCN, 00143 Roma, Italy.
- IRCCS Santa Lucia Foundation, 00143-Roma, Italy.
| | - Siro Luvisetto
- National Research Council of Italy-CNR, Institute of Cell Biology and Neurobiology-IBCN, 00143 Roma, Italy.
- IRCCS Santa Lucia Foundation, 00143-Roma, Italy.
| | - Flaminia Pavone
- National Research Council of Italy-CNR, Institute of Cell Biology and Neurobiology-IBCN, 00143 Roma, Italy.
- IRCCS Santa Lucia Foundation, 00143-Roma, Italy.
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Diverse exocytic pathways for mast cell mediators. Biochem Soc Trans 2018; 46:235-247. [PMID: 29472369 DOI: 10.1042/bst20170450] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/23/2017] [Accepted: 01/04/2018] [Indexed: 12/14/2022]
Abstract
Mast cells play pivotal roles in innate and adaptive immunities but are also culprits in allergy, autoimmunity, and cardiovascular diseases. Mast cells respond to environmental changes by initiating regulated exocytosis/secretion of various biologically active compounds called mediators (e.g. proteases, amines, and cytokines). Many of these mediators are stored in granules/lysosomes and rely on intricate degranulation processes for release. Mast cell stabilizers (e.g. sodium cromoglicate), which prevent such degranulation processes, have therefore been clinically employed to treat asthma and allergic rhinitis. However, it has become increasingly clear that different mast cell diseases often involve multiple mediators that rely on overlapping but distinct mechanisms for release. This review illustrates existing evidence that highlights the diverse exocytic pathways in mast cells. We also discuss strategies to delineate these pathways so as to identify unique molecular components which could serve as new drug targets for more effective and specific treatments against mast cell-related diseases.
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Elliott M, Maignel J, Liu SM, Favre-Guilmard C, Mir I, Farrow P, Hornby F, Marlin S, Palan S, Beard M, Krupp J. Augmentation of VAMP-catalytic activity of botulinum neurotoxin serotype B does not result in increased potency in physiological systems. PLoS One 2017; 12:e0185628. [PMID: 28982136 PMCID: PMC5628846 DOI: 10.1371/journal.pone.0185628] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/15/2017] [Indexed: 11/19/2022] Open
Abstract
Botulinum neurotoxins (BoNTs) are used extensively as therapeutic agents. Serotypes A and B are available as marketed products. Higher doses of BoNT/B are required to reach an efficacy similar to that of products containing BoNT/A. Advances in our understanding of BoNT/B mechanism of action have afforded the opportunity to make rational modifications to the toxin aimed at increasing its activity. Recently, a mutation in the light chain of BoNT/B (S201P) was described that increases the catalytic activity of the isolated BoNT/B light chain in biochemical assays. In this study, we have produced two full-length recombinant BoNT/B toxins in E.coli-one wild type (rBoNT/B1) and one incorporating the S201P mutation (rBoNT/B1(S201P)). We have compared the activity of these two molecules along with a native BoNT/B1 in biochemical cell-free assays and in several biological systems. In the cell-free assay, which measured light-chain activity alone, rBoNT/B1(S201P) cleaved VAMP-2 and VAMP-1 substrate with an activity 3-4-fold higher than rBoNT/B1. However, despite the enhanced catalytic activity of rBoNT/B1(S201P), there was no significant difference in potency between the two molecules in any of the in vitro cell-based assays, using either rodent spinal cord neurons or cortical neurons. Similarly in ex vivo tissue preparations rBoNT/B1(S201P) was not significantly more potent than rBoNT/B1 at inhibiting either diaphragm or detrusor (bladder) muscle activity in C57BL/6N and CD1 mice. Finally, no differences between rBoNT/B1 and rBoNT/B1(S201P) were observed in an in vivo digit abduction score (DAS) assay in C57BL/6N mice, either in efficacy or safety parameters. The lack of translation from the enhanced BoNT/B1(S201P) catalytic activity to potency in complex biological systems suggests that the catalytic step is not the rate-limiting factor for BoNT/B to reach maximum efficacy. In order to augment the efficacy of BoNT/B in humans, strategies other than enhancing light chain activity may need to be considered.
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Affiliation(s)
- Mark Elliott
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon, United Kingdom
- * E-mail:
| | | | - Sai Man Liu
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon, United Kingdom
| | | | - Imran Mir
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon, United Kingdom
| | - Paul Farrow
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon, United Kingdom
| | - Fraser Hornby
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon, United Kingdom
| | - Sandra Marlin
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon, United Kingdom
| | - Shilpa Palan
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon, United Kingdom
| | - Matthew Beard
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon, United Kingdom
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Abstract
INTRODUCTION Hyperhidrosis affects 4.8% of the U.S. population and has been underestimated by physicians for long time despite considerable interference with quality of life. Many patients suffer from primary (idiopathic) hyperhidrosis which results from over-activity of sympathetic nerves and is restricted to specific body areas, mostly the axillae, palms, soles, or head. Secondary hyperhidrosis is caused by an underlying disease or the intake of medications and often involves large parts of the body. Numerous effective therapies with topical or systemic drugs and surgical options are available. Areas covered: Efficacy and safety data on aluminum salts, anticholinergic drugs for topical or systemic application, and on intradermal botulinum toxin injections used to treat hyperhidrosis are critically evaluated, including data from clinical trials with focus on possible side effects and long-term complications in dispute. Expert opinion: Hyperhidrosis often responds well to available therapies. Depending on the type of hyperhidrosis treatment should be topical/local or systemic. Most of the side effects are mild, transient and easily manageable. In case of systemic treatment with anticholinergics low dosing and up-titration of medication is necessary to avoid severe adverse effects. Concerns about the promotion of breast cancer and Alzheimer disease by topical aluminum salts are unsolved.
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Affiliation(s)
- Christine Hosp
- a Department of Dermatology, Venereology and Allergology , University Hospital Würzburg , Würzburg , Germany
| | - Henning Hamm
- a Department of Dermatology, Venereology and Allergology , University Hospital Würzburg , Würzburg , Germany
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Abstract
PURPOSE OF REVIEW Rhinitis is a common clinical entity. Besides nasal obstruction, itching, and sneezing, one of the most important symptoms of rhinitis is nasal hypersecretion produced by nasal glands and exudate from the nasal vascular bed. Allergic rhinitis is an IgE-mediated inflammatory reaction of nasal mucosa after exposure to environmental allergens. Idiopathic rhinitis describes rhinitis symptoms that occur after non-allergic, noninfectious irritants. Specific allergen avoidance, topical nasal decongestants, nasal corticosteroids, immunotherapy, and sinonasal surgery are the main treatment options. Because the current treatment modalities are not enough for reducing rhinorrhea in some patients, novel treatment options are required to solve this problem. RECENT FINDINGS Botulinum toxin is an exotoxin generated by Clostridium botulinum. It disturbs the signal transmission at the neuromuscular and neuroglandular junction by inhibiting the acetylcholine release from the presynaptic nerve terminal. It has been widely used in neuromuscular, hypersecretory, and autonomic nerve system disorders. There have been a lot of published articles concerning the effect of this toxin on rhinitis symptoms. Based on the results of these reports, intranasal botulinum toxin A administration appears to be a safe and effective treatment method for decreasing rhinitis symptoms in rhinitis patients with a long-lasting effect. Botulinum toxin type A will be a good treatment option for the chronic rhinitis patients who are resistant to other treatment methods.
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Affiliation(s)
- Cengiz Ozcan
- Department of Otorhinolaryngology, School of Medicine, Mersin University, Mersin, Turkey.
| | - Onur Ismi
- Department of Otorhinolaryngology, School of Medicine, Mersin University, Mersin, Turkey
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Tao L, Peng L, Berntsson RPA, Liu SM, Park S, Yu F, Boone C, Palan S, Beard M, Chabrier PE, Stenmark P, Krupp J, Dong M. Engineered botulinum neurotoxin B with improved efficacy for targeting human receptors. Nat Commun 2017; 8:53. [PMID: 28674381 PMCID: PMC5495808 DOI: 10.1038/s41467-017-00064-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/26/2017] [Indexed: 11/25/2022] Open
Abstract
Botulinum neurotoxin B is a Food and Drug Administration-approved therapeutic toxin. However, it has lower binding affinity toward the human version of its major receptor, synaptotagmin II (h-Syt II), compared to mouse Syt II, because of a residue difference. Increasing the binding affinity to h-Syt II may improve botulinum neurotoxin B’s therapeutic efficacy and reduce adverse effects. Here we utilized the bacterial adenylate cyclase two-hybrid method and carried out a saturation mutagenesis screen in the Syt II-binding pocket of botulinum neurotoxin B. The screen identifies E1191 as a key residue: replacing it with M/C/V/Q enhances botulinum neurotoxin B binding to human synaptotagmin II. Adding S1199Y/W or W1178Q as a secondary mutation further increases binding affinity. Mutant botulinum neurotoxin B containing E1191M/S1199Y exhibits ~11-fold higher efficacy in blocking neurotransmission than wild-type botulinum neurotoxin B in neurons expressing human synaptotagmin II, demonstrating that enhancing receptor binding increases the overall efficacy at functional levels. The engineered botulinum neurotoxin B provides a platform to develop therapeutic toxins with improved efficacy. Humans are less sensitive to the therapeutic effects of botulinum neurotoxin B (BoNT/B) than the animal models it is tested on due to differences between the human and the mouse receptors. Here, the authors engineer BoNT/B to improve its affinity to human receptors and enhance its therapeutic efficacy.
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Affiliation(s)
- Liang Tao
- Department of Urology, Boston Children's Hospital, Department of Microbiology and Immunobiology, Department of Surgery, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA
| | - Lisheng Peng
- Department of Urology, Boston Children's Hospital, Department of Microbiology and Immunobiology, Department of Surgery, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA.,Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, 510630, China
| | - Ronnie P-A Berntsson
- Department of Biochemistry and Biophysics, Stockholm University, Stockholm, SE-106 91, Sweden.,Department of Medical Biochemistry and Biophysics, Umeå University, Umeå, SE-901 87, Sweden
| | | | - SunHyun Park
- Department of Urology, Boston Children's Hospital, Department of Microbiology and Immunobiology, Department of Surgery, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA.,Division of Predictive Toxicological Research, Predictive model Research Center, Korea Institute of Toxicology, 141 Gajeong-ro, Yuseong-gu, Daejeon, 34114, South Korea
| | - Feifan Yu
- Department of Urology, Boston Children's Hospital, Department of Microbiology and Immunobiology, Department of Surgery, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA
| | - Christopher Boone
- Department of Urology, Boston Children's Hospital, Department of Microbiology and Immunobiology, Department of Surgery, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA
| | | | | | | | - Pål Stenmark
- Department of Biochemistry and Biophysics, Stockholm University, Stockholm, SE-106 91, Sweden.
| | - Johannes Krupp
- IPSEN Bioinnovation, Abingdon, OX14 4RY, UK. .,IPSEN Innovation, Les Ulis, 91940, France.
| | - Min Dong
- Department of Urology, Boston Children's Hospital, Department of Microbiology and Immunobiology, Department of Surgery, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts, 02115, USA.
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Pirazzini M, Rossetto O, Eleopra R, Montecucco C. Botulinum Neurotoxins: Biology, Pharmacology, and Toxicology. Pharmacol Rev 2017; 69:200-235. [PMID: 28356439 PMCID: PMC5394922 DOI: 10.1124/pr.116.012658] [Citation(s) in RCA: 410] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The study of botulinum neurotoxins (BoNT) is rapidly progressing in many aspects.
Novel BoNTs are being discovered owing to next generation sequencing, but their
biologic and pharmacological properties remain largely unknown. The molecular
structure of the large protein complexes that the toxin forms with accessory
proteins, which are included in some BoNT type A1 and B1 pharmacological
preparations, have been determined. By far the largest effort has been dedicated to
the testing and validation of BoNTs as therapeutic agents in an ever increasing
number of applications, including pain therapy. BoNT type A1 has been also exploited
in a variety of cosmetic treatments, alone or in combination with other agents, and
this specific market has reached the size of the one dedicated to the treatment of
medical syndromes. The pharmacological properties and mode of action of BoNTs have
shed light on general principles of neuronal transport and protein-protein
interactions and are stimulating basic science studies. Moreover, the wide array of
BoNTs discovered and to be discovered and the production of recombinant BoNTs endowed
with specific properties suggest novel uses in therapeutics with increasing
disease/symptom specifity. These recent developments are reviewed here to provide an
updated picture of the biologic mechanism of action of BoNTs, of their increasing use
in pharmacology and in cosmetics, and of their toxicology.
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Affiliation(s)
- Marco Pirazzini
- Department of Biomedical Sciences, University of Padova, Italy (M.P., O.R., C.M.); Neurologic Department, University-Hospital S. Maria della Misericordia, Udine, Italy (R.E.); and Consiglio Nazionale delle Ricerche, Institute of Neuroscience, University of Padova, Italy (C.M.)
| | - Ornella Rossetto
- Department of Biomedical Sciences, University of Padova, Italy (M.P., O.R., C.M.); Neurologic Department, University-Hospital S. Maria della Misericordia, Udine, Italy (R.E.); and Consiglio Nazionale delle Ricerche, Institute of Neuroscience, University of Padova, Italy (C.M.)
| | - Roberto Eleopra
- Department of Biomedical Sciences, University of Padova, Italy (M.P., O.R., C.M.); Neurologic Department, University-Hospital S. Maria della Misericordia, Udine, Italy (R.E.); and Consiglio Nazionale delle Ricerche, Institute of Neuroscience, University of Padova, Italy (C.M.)
| | - Cesare Montecucco
- Department of Biomedical Sciences, University of Padova, Italy (M.P., O.R., C.M.); Neurologic Department, University-Hospital S. Maria della Misericordia, Udine, Italy (R.E.); and Consiglio Nazionale delle Ricerche, Institute of Neuroscience, University of Padova, Italy (C.M.)
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McGeachan AJ, Mcdermott CJ. Management of oral secretions in neurological disease. Pract Neurol 2017; 17:96-103. [DOI: 10.1136/practneurol-2016-001515] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 12/12/2022]
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Focal task specific dystonia: a review and update. J Neurol 2016; 264:1536-1541. [PMID: 28039522 PMCID: PMC5502053 DOI: 10.1007/s00415-016-8373-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 11/15/2022]
Abstract
In this review, we summarize recent advances in understanding the etiology, risk factors and pathophysiology of focal task specific dystonia (FTSD), movement disorders characterized by abnormal motor activation during the performance of specific, repetitive actions. We focus on two common FTSD, musician’s dystonia and writer’s cramp. FTSD may pose a threat to the patient’s livelihood, and improved therapeutic treatments are needed.
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Grabell DA, Hebert AA. Current and Emerging Medical Therapies for Primary Hyperhidrosis. Dermatol Ther (Heidelb) 2016; 7:25-36. [PMID: 27787745 PMCID: PMC5336423 DOI: 10.1007/s13555-016-0148-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Indexed: 11/08/2022] Open
Abstract
Hyperhidrosis is defined as the production of sweat beyond what is physiologically necessary to maintain thermal homeostasis. This disease state may (and typically does) have a significant impact on the patient’s quality of life. Medications including antiperspirants, anticholinergics, and botulinum toxin have been shown to be effective in the management of hyperhidrosis. Several medical device technologies have also proven to be effective. This review article will explore the current and emerging pharmacological and medical device treatments for hyperhidrosis and provide a framework for treating patients who suffer with primary forms of hyperhidrosis.
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Affiliation(s)
- Daniel A Grabell
- Department of Dermatology, UTHealth McGovern Medical School, Houston, TX, USA
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth McGovern Medical School, Houston, TX, USA. .,Department of Pediatrics, UTHealth McGovern Medical School, Houston, TX, USA.
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Duarte GS, Castelão M, Rodrigues FB, Marques RE, Ferreira J, Sampaio C, Moore AP, Costa J. Botulinum toxin type A versus botulinum toxin type B for cervical dystonia. Cochrane Database Syst Rev 2016; 10:CD004314. [PMID: 27782297 PMCID: PMC6461154 DOI: 10.1002/14651858.cd004314.pub3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This is an update of a Cochrane review first published in 2003. Cervical dystonia is the most common form of focal dystonia and is a disabling disorder characterised by painful involuntary head posturing. There are two available formulations of botulinum toxin, with botulinum toxin type A (BtA) usually considered the first line therapy for this condition. Botulinum toxin type B (BtB) is an alternative option, with no compelling theoretical reason why it might not be as- or even more effective - than BtA. OBJECTIVES To compare the efficacy, safety and tolerability of botulinum toxin type A (BtA) versus botulinum toxin type B (BtB) in people with cervical dystonia. SEARCH METHODS To identify studies for this review we searched the Cochrane Movement Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, reference lists of articles and conference proceedings. All elements of the search, with no language restrictions, were last run in October 2016. SELECTION CRITERIA Double-blind, parallel, randomised, placebo-controlled trials (RCTs) comparing BtA versus BtB in adults with cervical dystonia. DATA COLLECTION AND ANALYSIS Two independent authors assessed records, selected included studies, extracted data using a paper pro forma, and evaluated the risk of bias. We resolved disagreements by consensus or by consulting a third author. We performed meta-analyses using the random-effects model, for the comparison BtA versus BtB to estimate pooled effects and corresponding 95% confidence intervals (95% CI). No prespecified subgroup analyses were carried out. The primary efficacy outcome was improvement on any validated symptomatic rating scale, and the primary safety outcome was the proportion of participants with adverse events. MAIN RESULTS We included three RCTs, all new to this update, of very low to low methodological quality, with a total of 270 participants.Two studies exclusively enrolled participants with a known positive response to BtA treatment. This raises concerns of population enrichment, with a higher probability of benefit from BtA treatment. None of the trials were free of for-profit bias, nor did they provide information regarding registered study protocols. All trials evaluated the effect of a single Bt treatment session, and not repeated treatment sessions, using doses from 100 U to 250 U of BtA (all onabotulinumtoxinA, or Botox, formulations) and 5000 U to 10,000 U of BtB (rimabotulinumtoxinB, or Myobloc/Neurobloc).We found no difference between the two types of botulinum toxin in terms of overall efficacy, with a mean difference of -1.44 (95% CI -3.58 to 0.70) points lower on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) for BtB-treated participants, measured at two to four weeks after injection. The proportion of participants with adverse events was also not different between BtA and BtB (BtB versus BtA risk ratio (RR) 1.40; 95% CI 1.00 to 1.96). However, when compared to BtA, treatment with BtB was associated with an increased risk of one adverse events of special interest, namely treatment-related sore throat/dry mouth (BtB versus BtA RR of 4.39; 95% CI 2.43 to 7.91). Treatment-related dysphagia (swallowing difficulties) was not different between BtA and BtB (RR 2.89; 95% CI 0.80 to 10.41). The two types of botulinum toxin were otherwise clinically non-distinguishable in all the remaining outcomes. AUTHORS' CONCLUSIONS The previous version of this review did not include any trials, since these were still ongoing at the time. Therefore, with this update we are able to change the conclusions of this review. There is low quality evidence that a single treatment session of BtA (specifically onabotulinumtoxinA) and a single treatment session of BtB (rimabotulinumtoxinB) are equally effective and safe in the treatment of adults with certain types of cervical dystonia. Treatment with BtB appears to present an increased risk of sore throat/dry mouth, compared to BtA. Overall, there is no clinical evidence from these single-treatment trials to support or contest the preferential use of one form of botulinum toxin over the other.
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Affiliation(s)
- Gonçalo S Duarte
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaAvenida Professor Egas MonizLisboaLisboaPortugal1649‐028
- Instituto de Medicina MolecularClinical Pharmacology UnitAv. Prof. Egas MonizLisboaPortugal1649‐028
| | - Mafalda Castelão
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaAvenida Professor Egas MonizLisboaLisboaPortugal1649‐028
- Instituto de Medicina MolecularClinical Pharmacology UnitAv. Prof. Egas MonizLisboaPortugal1649‐028
| | - Filipe B Rodrigues
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaAvenida Professor Egas MonizLisboaLisboaPortugal1649‐028
- Instituto de Medicina MolecularClinical Pharmacology UnitAv. Prof. Egas MonizLisboaPortugal1649‐028
| | - Raquel E Marques
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaAvenida Professor Egas MonizLisboaLisboaPortugal1649‐028
- Instituto de Medicina MolecularClinical Pharmacology UnitAv. Prof. Egas MonizLisboaPortugal1649‐028
| | - Joaquim Ferreira
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaAvenida Professor Egas MonizLisboaLisboaPortugal1649‐028
- Instituto de Medicina MolecularClinical Pharmacology UnitAv. Prof. Egas MonizLisboaPortugal1649‐028
| | - Cristina Sampaio
- CHDI Foundation155 Village BoulevardSuite 200PrincetonNJUSA08540
| | - Austen P Moore
- The Walton Centre NHS Foundation TrustLower LaneLiverpoolUKL9 7LJ
| | - João Costa
- Faculdade de Medicina de LisboaLaboratório de Farmacologia Clínica e TerapêuticaAvenida Professor Egas MonizLisboaLisboaPortugal1649‐028
- Instituto de Medicina MolecularClinical Pharmacology UnitAv. Prof. Egas MonizLisboaPortugal1649‐028
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