Botulinum toxin: issues and applications:

A neuronal cell-based botulinum neurotoxin assay for highly sensitive and specific detection of neutralizing serum antibodies

Clostridium botulinum neurotoxin (BoNT) serotypes A and B are widely used as pharmaceuticals to treat various neurological disorders and in cosmetic applications. The major adverse effect of these treatments has been resistance to treatment after multiple injections. Currently, patients receiving BoNT therapies and patients enrolled in clinical trials for new applications and/or new formulations of BoNTs are not routinely monitored for the formation of neutralizing antibodies, since no assay other than the mouse protection procedure is commercially available that reliably tests for the presence of such antibodies. This report presents a highly sensitive and specific neuronal cell-based assay that provides sensitive and specific detection of neutralizing antibodies to BoNT/A.

Botulinum Toxin, Immunologic Considerations with Long-Term Repeated Use, with Emphasis on Cosmetic Applications

Botulinum toxin is a unique pharmaceutical agent in wide-scale use for cosmetic and multiple therapeutic applications. Physicians using these agents for esthetic purpose must realize the potential for future therapeutic needs. Because most indications require repeated injections, the recipient is at risk for immunologic reactions with possible formation of neutralizing antibodies. An individual who is injected with botulinum toxin for cosmetic purposes could someday require an effective form of type A toxin for dystonia, pain, or spasticity.