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Buzatu R, Luca MM, Castiglione L, Sinescu C. Efficacy and Safety of Botulinum Toxin in the Management of Temporomandibular Symptoms Associated with Sleep Bruxism: A Systematic Review. Dent J (Basel) 2024; 12:156. [PMID: 38920857 PMCID: PMC11203296 DOI: 10.3390/dj12060156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/11/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
Sleep bruxism, characterized by involuntary grinding or clenching of teeth during sleep, poses significant challenges in management due to its potential to induce temporomandibular joint disorders (TMDs) and other related symptoms. The use of Botulinum toxin Type A (BoNT-A), also known as Botox®, has been proposed as a therapeutic intervention. This systematic review aims to evaluate the efficacy and safety of BoNT-A in the management of sleep bruxism, focusing on pain reduction, improvement in jaw function, reduction in bruxism episodes, and the incidence of adverse effects. An exhaustive search was conducted across PubMed, Scopus, and Embase databases up to January 2024, adhering to the PRISMA guidelines. Nine randomized clinical trials (RCTs) involving 137 participants were analyzed for efficacy and safety outcomes. The studies demonstrated a significant reduction in mean pain scores (from 7.1 to 0.2 at 6 months and 1 year post-treatment in one study) and a notable decrease in the number of bruxism events (from 4.97/h to 1.70/h in the BoNT-A group in another study). Additionally, improvements were observed in jaw stiffness and total sleep time. Adverse effects varied but were generally mild and transient, including injection site pain in 20% of participants in one study and cosmetic changes in smile in 15.4% of patients in another. These findings suggest that BoNT-A injections may provide some benefits for treating nocturnal bruxism, potentially reducing TMD symptoms like pain and improving jaw function. However, these findings are preliminary due to variability in study designs and the absence of detailed statistical analysis.
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Affiliation(s)
- Roxana Buzatu
- Department of Dental Aesthetics, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Revolutiei Boulevard 9, 300041 Timisoara, Romania;
| | - Magda Mihaela Luca
- Department of Pediatric Dentistry, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Luca Castiglione
- Doctoral School, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Cosmin Sinescu
- Department of Prostheses Technology and Dental Materials, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
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Wang Y, Yang X, Ji X, Liu M, Zhou C. Clinical efficacy of escitalopram combined with botulinum toxin A in patients with generalized anxiety disorder and comorbid headache. Psychopharmacology (Berl) 2023; 240:2061-2070. [PMID: 37481677 DOI: 10.1007/s00213-023-06423-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/10/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is a common mental disorder that happens comorbidly with other diseases. Headache is a common anxiety comorbidity. Previous reports have shown that the selection of therapeutic drugs for GAD patients and comorbid headache is challenging. Therefore, our study aimed to investigate the clinical efficacy of escitalopram combined with botulinum toxin A (BoNT/A) in patients with GAD and comorbid headache and seek an alternative treatment strategy for the comorbidity of GAD and headache. METHODS A prospective, randomized controlled, double-blind study was performed. The eligible GAD patients with comorbid headache were randomly assigned to the BoNT/A group and the placebo group. All the patients were given oral escitalopram therapy (10-20 mg/day) for the whole duration of the study. The BoNT/A group was given local injections of BoNT/A (50 U per person), whereas the placebo group was given local saline (0.9% NaCl) injections at the beginning and 3 months after the experiments. All participants were followed up for 6 months and relevant information was collected at months 0, 1, 2, 3, and 6. Primary outcomes included the following: (1) the Generalized Anxiety Disorder 7 (GAD-7); (2) the Self-rating Anxiety Scale (SAS); (3) the Hamilton Anxiety Rating Scales (HAMA); (4) days with headache per month; (5) visual analogue scale (VAS). RESULTS A total of 101 patients (the sex ratio of female to male: 3.39:1) were finally included. Compared with the placebo group, the BoNT/A group showed a significant decrease in GAD-7 scores, SAS scores, HAMA scores, days with headache per month, and VAS scores at months 1, 2, 3, and 6 of follow-up (all p < 0.05). The average time to complete remission of anxiety symptoms (HAMA< 7 points) in the BoNT/A group was less than the placebo group (2 months vs. 3 months). At the same time, the results of the survival analysis showed a clear beneficial effect of BoNT/A relative to placebo on the time to remission of anxiety (log-rank test, p < 0.001). Mean daily doses of escitalopram at the sixth month in the BoNT/A group was smaller than the placebo group (12.5 mg vs. 16.04 mg, p < 0.001). The number of patients who relapsed (HAMA total score ≥ 14 points) at 6 months of follow-up in the BoNT/A group was less than the placebo group (2.2% vs. 14.9%, p < 0.05). The rates of response (HAMA subtraction rate ≥ 50%) were 93.8% for the BoNT/A group and 75.5% for the placebo group (p < 0.05), and the rates of remission (HAMA < 7 points) were 87.5% for the BoNT/A group and 64.2% for the placebo group (p < 0.01) at the sixth month. CONCLUSION The combination of escitalopram with BoNT/A is a significantly effective intervention in improving clinical efficacy and reducing the recurrence in patients with GAD and comorbid headache, and we believe that this approach will be an additional treatment strategy for future treatment of comorbid headache in GAD. Therefore, we recommend that escitalopram combined with BoNT/A should be given as early as possible in GAD patients and comorbid headache.
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Affiliation(s)
- Yao Wang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Number 16 Jiangsu Road, Qingdao, 266003, Shandong Province, China
| | - Xiaoyu Yang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Number 16 Jiangsu Road, Qingdao, 266003, Shandong Province, China
| | - Xiaojun Ji
- Department of Neurology, The Affiliated Hospital of Qingdao University, Number 16 Jiangsu Road, Qingdao, 266003, Shandong Province, China
| | - Min Liu
- Department of Neurology, The Affiliated Hospital of Qingdao University, Number 16 Jiangsu Road, Qingdao, 266003, Shandong Province, China
| | - Chang Zhou
- Department of Neurology, The Affiliated Hospital of Qingdao University, Number 16 Jiangsu Road, Qingdao, 266003, Shandong Province, China.
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Mastrorilli V, De Angelis F, Vacca V, Pavone F, Luvisetto S, Marinelli S. Xeomin®, a Commercial Formulation of Botulinum Neurotoxin Type A, Promotes Regeneration in a Preclinical Model of Spinal Cord Injury. Toxins (Basel) 2023; 15:toxins15040248. [PMID: 37104185 PMCID: PMC10142820 DOI: 10.3390/toxins15040248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Xeomin® is a commercial formulation of botulinum neurotoxin type A (BoNT/A) clinically authorized for treating neurological disorders, such as blepharospasm, cervical dystonia, limb spasticity, and sialorrhea. We have previously demonstrated that spinal injection of laboratory purified 150 kDa BoNT/A in paraplegic mice, after undergoing traumatic spinal cord injury (SCI), was able to reduce excitotoxic phenomena, glial scar, inflammation, and the development of neuropathic pain and facilitate regeneration and motor recovery. In the present study, as proof of concept in view of a possible clinical application, we studied the efficacy of Xeomin® in the same preclinical SCI model in which we highlighted the positive effects of lab-purified BoNT/A. Data comparison shows that Xeomin® induces similar pharmacological and therapeutic effects, albeit with less efficacy, to lab-purified BoNT/A. This difference, which can be improved by adjusting the dose, can be attributable to the different formulation and pharmacodynamics. Although the mechanism by which Xeomin® and laboratory purified BoNT/A induce functional improvement in paraplegic mice is still far from being understood, these results open a possible new scenario in treatment of SCI and are a stimulus for further research.
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Ågren M, Nanchaipruek Y, Phumariyapong P, Apinuntham C, Rakchart S, Pettersson M, Wanitphakdeedecha R. Duration of bite force reduction following a single injection of botulinum toxin in the masseter muscle bilaterally: A one-year non-randomized trial. J Oral Rehabil 2023; 50:343-350. [PMID: 36810787 DOI: 10.1111/joor.13434] [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: 03/14/2022] [Revised: 11/07/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Previous studies concerning the effect of botulinum toxin in masseter muscle have mainly reported effects observed through inspection of facial features or differences in pain levels. One systematic review of studies utilizing objective measurements reported that long-term muscular effect of botulinum neurotoxin injections into masseter muscle was inconclusive. OBJECTIVE To evaluate the duration of reduced maximal voluntary bite force (MVBF) after botulinum toxin intervention. METHODS The intervention group was comprised of individuals seeking aesthetic treatment for masseter reduction (n = 20), the reference group (n = 12) comprised of individuals with no intervention. Intervention through 25 units of Xeomin® (Merz Pharma GmbH & Co KGaA, Frankfurt am Main, Germany) botulinum neurotoxin type A injected into the masseter muscles bilaterally (totalling 50 units). A reference group did not receive any intervention. MVBF was measured in Newtons using a strain gauge meter at the incisors and first molars. MVBF was measured at baseline, at 4 weeks, 3 months, 6 months, and after 1 year. RESULTS Both groups were similar in terms of bite force, sex and age at baseline. MVBF remained similar compared to baseline in the reference group. At 3 months, a significant reduction at all measurement points was observed in the intervention group; at 6 months, this reduction was no longer significant. CONCLUSION A single intervention of 50 units of botulinum neurotoxin results in a reversible MVBF reduction of at least 3 months, although a visually discernable reduction may be more long-lasting.
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Affiliation(s)
- Martin Ågren
- Department of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden.,Prosthodontic Specialist Clinic, Region Västerbotten, Umeå, Sweden
| | - Yanisorn Nanchaipruek
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phumithep Phumariyapong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalermkwan Apinuntham
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Mattias Pettersson
- Department of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden
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Long-Term Effects of a Single Application of Botulinum Toxin Type A in Temporomandibular Myofascial Pain Patients: A Controlled Clinical Trial. Toxins (Basel) 2022; 14:toxins14110741. [PMID: 36355991 PMCID: PMC9721314 DOI: 10.3390/toxins14110741] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 01/26/2023] Open
Abstract
This study assessed the long-term effects of botulinum toxin type A (BoNT-A) in subjective pain, pain sensibility, and muscle thickness in persistent myofascial temporomandibular-disorder pain (MFP-TMD) patients. Fourteen female subjects with persistent MFP received BoNT-A treatment with different doses (10U-25U for temporalis muscle and 30U-75U for masseter muscle). The treatment was injected bilaterally in the masseter and anterior temporalis muscles in a single session. Clinical measurements included: self-perceived pain (VAS), pain sensibility (PPT), and muscles thickness (ultrasonography). Follow-up occurred 1, 3, 6, and 72 months after treatment for VAS and PPT and 1, 3, and 72 months for ultrasonography. For statistical analysis, the Friedman test with the Bonferroni test for multiple comparisons as a post hoc test was used for non-parametric repeated measures comparisons among the evaluation times. A 5% probability level was considered significant in all tests. VAS values presented a significant decrease throughout the study (p < 0.05). Regarding PPT values, a significant increase was found when comparing baseline data with post-treatment follow-ups (p < 0.05), and even though a significant decrease was found in muscle thickness when baseline values were compared with the 1- and 3-months assessments, no differences were found when compared with the 72 months follow-up (p > 0.05). A single injection of BoNT-A presents long-term effects in reducing pain in persistent MFP-TMD patients, and a reversibility of adverse effects on masticatory-muscle thickness.
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Gazerani P. How Does Botulinum Toxin Inhibit Itch? Toxins (Basel) 2022; 14:toxins14100701. [PMID: 36287970 PMCID: PMC9610088 DOI: 10.3390/toxins14100701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 12/04/2022] Open
Abstract
Two decades after reports of the anti-pruritic effects of botulinum neurotoxins (BoNTs), there is still no approved product for the anti-itch indication of BoNTs, and most clinical case reports still focus on the off-label use of BoNTs for various itchy conditions. Few randomized clinical trials have been conducted with controversial results, and the beneficial effects of BoNTs against itch are mainly based on case studies and case series. These studies are valuable in presenting the potential application of BoNTs in chronic pruritic conditions, but due to the nature of these studies, they are categorized as providing lower levels of evidence or lower grades of recommendation. To obtain approval for the anti-pruritic indication of BoNTs, higher levels of evidence are required, which can be achieved through conducting large-scale and well-designed studies with proper control groups and established careful and reliable primary and secondary outcomes. In addition to clinical evidence, presenting the mechanism-based antipruritic action of BoNTs can potentially strengthen, accelerate, and facilitate the current efforts towards further investments in accelerating the field towards the potential approval of BoNTs for itchy conditions. This review, therefore, aimed to provide the state-of-the-art mechanisms underlying the anti-itch effect of BoNTs from basic studies that resemble various clinical conditions with itch as a hallmark. Evidence of the neuronal, glial, and immune modulatory actions of BoNTs in reducing the transmission of itch are presented, and future potential directions are outlined.
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Affiliation(s)
- Parisa Gazerani
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; or
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg East, Denmark
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Abstract
AB toxins are protein virulence factors secreted by many bacterial pathogens, contributing to the pathogenicity of the cognate bacteria. AB toxins consist of two functionally distinct components: the enzymatic "A" component for pathogenicity and the receptor-binding "B" component for toxin delivery. Consistently, unlike other virulence factors such as effectors, AB toxins do not require additional systems to deliver them to the target host cells. Target host cells are located in the infection site and/or located distantly from infected host cells. The first part of this review discusses the structural and functional features of single-peptide and multiprotein AB toxins in the context of host-microbe interactions, using several well-characterized examples. The second part of this review discusses toxin neutralization strategies, as well as applications of AB toxins relevant to developing intervention strategies against diseases.
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Wang J, Li Y, Wang M, Yang S. Localization of the Center of the Intramuscular Nerve Dense Region of the Suboccipital Muscles: An Anatomical Study. Front Neurol 2022; 13:863446. [PMID: 35463128 PMCID: PMC9019081 DOI: 10.3389/fneur.2022.863446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This study aimed to determine the body surface puncture position and depth of the center of the intramuscular nerve dense region in the suboccipital muscle to provide morphological guidance for accurate botulinum toxin A injection to treat headaches caused by increased suboccipital muscle tension. Methods Twenty-four cadavers aged 66.5 ± 5.3 years were studied. The curve line connecting occipital eminence or mastoid process and spinous process of the 7th cervical vertebrae was considered the longitudinal reference line (L) and horizontal reference line (H), respectively. Sihler's staining, barium sulfate labeling, and CT were employed. The body surface projection point of the center of the intramuscular nerve dense region was designated as P. The projection of the center of the intramuscular nerve dense region was in the opposite direction across the transverse plane and was recorded as P'. The intersections of the vertical line through point P and lines L and H were designated as PL and PH. The percentage position of the PH and PL points on the H and L lines and the depths of the center of intramuscular nerve dense regions were identified. Results Sihler's staining showed one intramuscular nerve-dense region in each suboccipital muscle. The PH of the center of the intramuscular nerve dense region was located at 51.40, 45.55, 20.55, and 43.50%. The PL was located at 31.38, 30.08, 16.91, and 52.94%. The depth of the center of the intramuscular nerve dense region was at 22.26, 22.54, 13.14, and 27.30%. These percentage values are all the means. Conclusion Accurately defining the body surface position and depth of the center of intramuscular nerve dense region in suboccipital muscles will help to improve botulinum toxin A to target localization efficiency for treating tension-type headache.
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Affiliation(s)
- Jie Wang
- Department of Pain, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yanrong Li
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Meng Wang
- Department of Anatomy, Zunyi Medical University, Zunyi, China
| | - Shengbo Yang
- Department of Anatomy, Zunyi Medical University, Zunyi, China
- *Correspondence: Shengbo Yang
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Yunfeng G, Fei L, Junbo L, Dingyuan Y, Chaoyou H. An indirect comparison meta-analysis of noninvasive intravesical instillation and intravesical injection of botulinum toxin-A in bladder disorders. Int Urol Nephrol 2022; 54:479-491. [PMID: 35044552 DOI: 10.1007/s11255-022-03107-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/09/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Botulinum toxin type A (BTX-A) intravesical instillation and BTX-A intravesical injection are both effective treatments or overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS), but direct comparative studies of the two treatments are lacking. METHODS We conducted a pairs-comparison meta-analysis and an adjusted indirect comparison meta-analysis extracting published data from randomized controlled trials in literature databases from the inception of each database to Aug. 31, 2021, evaluating efficacy and safety of BTX-A intravesical instillation and BTX-A intravesical injection. We also carried out a subgroup analysis. RESULTS We identified 24 trials in 21 studies were included in our study, of which 18 trials in 17 studies were BTX-A intravesical injections, 6 trials in 4 studies were BTX-A intravesical instillation. Compared with the normal saline injection, BTX-A intravesical injections for patients with OAB and IC/ BPS can obviously improve the symptoms of urinary frequency, urgency episode, UI and UUI, but BTX-A significantly increased the rate of urinary retention and urinary tract infection and increased PVR (p < 0.05). Adjusted indirect comparison meta-analysis showed that BTX-A intravesical injections was more effective than BTX-A intravesical instillation (p > 0.05). Surprisingly, BTX-A intravesical instillation had fewer side effects than BTX-A intravesical injections (p < 0.05). CONCLUSIONS Although BTX-A intravesical injections of OAB and IC/BPS has been significantly superior the BTX-A intravesical instillation, it has major side effects, but this needs to be confirmed by more large-scale, multicenter, direct comparison randomized controlled trials.
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Affiliation(s)
- Gao Yunfeng
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China
| | - Lai Fei
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China
| | - Liu Junbo
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China
| | - Yang Dingyuan
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China
| | - Huang Chaoyou
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China.
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Luvisetto S. Botulinum Neurotoxins in Central Nervous System: An Overview from Animal Models to Human Therapy. Toxins (Basel) 2021; 13:toxins13110751. [PMID: 34822535 PMCID: PMC8622321 DOI: 10.3390/toxins13110751] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 01/04/2023] Open
Abstract
Botulinum neurotoxins (BoNTs) are potent inhibitors of synaptic vesicle fusion and transmitter release. The natural target of BoNTs is the peripheral neuromuscular junction (NMJ) where, by blocking the release of acetylcholine (ACh), they functionally denervate muscles and alter muscle tone. This leads them to be an excellent drug for the therapy of muscle hyperactivity disorders, such as dystonia, spasticity, and many other movement disorders. BoNTs are also effective in inhibiting both the release of ACh at sites other than NMJ and the release of neurotransmitters other than ACh. Furthermore, much evidence shows that BoNTs can act not only on the peripheral nervous system (PNS), but also on the central nervous system (CNS). Under this view, central changes may result either from sensory input from the PNS, from retrograde transport of BoNTs, or from direct injection of BoNTs into the CNS. The aim of this review is to give an update on available data, both from animal models or human studies, which suggest or confirm central alterations induced by peripheral or central BoNTs treatment. The data will be discussed with particular attention to the possible therapeutic applications to pathological conditions and degenerative diseases of the CNS.
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Affiliation(s)
- Siro Luvisetto
- National Research Council of Italy-CNR, Institute of Biochemistry and Cell Biology (IBBC), Via Ercole Ramarini 32, Monterotondo Scalo, 00015 Roma, Italy
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Butrón D, Zamora-Carreras H, Devesa I, Treviño MA, Abian O, Velázquez-Campoy A, Bonache MÁ, Lagartera L, Martín-Martínez M, González-Rodríguez S, Baamonde A, Fernández-Carvajal A, Ferrer-Montiel A, Jiménez MÁ, González-Muñiz R. DD04107-Derived neuronal exocytosis inhibitor peptides: Evidences for synaptotagmin-1 as a putative target. Bioorg Chem 2021; 115:105231. [PMID: 34388485 DOI: 10.1016/j.bioorg.2021.105231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/19/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022]
Abstract
The analgesic peptide DD04107 (Pal-EEMQRR-NH2) and its acetylated analogue inhibit α-calcitonin gene-related peptide (α-CGRP) exocytotic release from primary sensory neurons. Examining the crystal structure of the SNARE-Synaptotagmin-1(Syt1) complex, we hypothesized that these peptides could inhibit neuronal exocytosis by binding to Syt1, hampering at least partially its interaction with the SNARE complex. To address this hypothesis, we first interrogate the role of individual side-chains on the inhibition of α-CGRP release, finding that E1, M3, Q4 and R6 residues were crucial for activity. CD and NMR conformational analysis showed that linear peptides have tendency to adopt α-helical conformations, but the results with cyclic analogues indicated that this secondary structure is not needed for activity. Isothermal titration calorimetry (ITC) measurements demonstrate a direct interaction of some of these peptides with Syt1-C2B domain, but not with Syt7-C2B region, indicating selectivity. As expected for a compound able to inhibit α-CGRP release, cyclic peptide derivative Pal-E-cyclo[EMQK]R-NH2 showed potent in vivo analgesic activity, in a model of inflammatory pain. Molecular dynamics simulations provided a model consistent with KD values for the interaction of peptides with Syt1-C2B domain, and with their biological activity. Altogether, these results identify Syt1 as a potential new analgesic target.
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Affiliation(s)
- Daniel Butrón
- Instituto de Química Médica (IQM-CSIC), Juan de la Cierva 3, 28006 Madrid, Spain
| | | | - Isabel Devesa
- IDiBE, Universidad Miguel Hernández, Avda. de la Universidad s/n, 03202 Elche, Spain
| | - Miguel A Treviño
- Instituto de Química Física Rocasolano (IQFR-CSIC), Serrano 119, 28006 Madrid, Spain
| | - Olga Abian
- Institute of Biocomputation and Physics of Complex Systems (BIFI), Joint Units IQFR-CSIC-BIFI, and GBsC-CSIC-BIFI, Universidad de Zaragoza, 50018 Zaragoza, Spain; Departamento de Bioquímica y Biología Molecular y Celular, Universidad de Zaragoza, 50009 Zaragoza, Spain; Biomedical Research Networking Centre for Liver and Digestive Diseases (CIBERehd), Madrid, Spain; Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain; Aragon Health Sciences Institute (IACS), 50009 Zaragoza, Spain
| | - Adrián Velázquez-Campoy
- Institute of Biocomputation and Physics of Complex Systems (BIFI), Joint Units IQFR-CSIC-BIFI, and GBsC-CSIC-BIFI, Universidad de Zaragoza, 50018 Zaragoza, Spain; Departamento de Bioquímica y Biología Molecular y Celular, Universidad de Zaragoza, 50009 Zaragoza, Spain; Biomedical Research Networking Centre for Liver and Digestive Diseases (CIBERehd), Madrid, Spain; Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain; ARAID Foundation, Government of Aragon, 50018 Zaragoza, Spain
| | - M Ángeles Bonache
- Instituto de Química Médica (IQM-CSIC), Juan de la Cierva 3, 28006 Madrid, Spain
| | - Laura Lagartera
- Instituto de Química Médica (IQM-CSIC), Juan de la Cierva 3, 28006 Madrid, Spain
| | | | | | - Ana Baamonde
- Facultad de Medicina, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Universidad de Oviedo, Julián Clavería 6, 33006 Oviedo, Asturias, Spain
| | | | | | - M Ángeles Jiménez
- Instituto de Química Física Rocasolano (IQFR-CSIC), Serrano 119, 28006 Madrid, Spain.
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Strohl MP, Chang C, Ryan WR, Chang JL. Botulinum toxin for chronic parotid sialadenitis: A case series and systematic review. Laryngoscope Investig Otolaryngol 2021; 6:404-413. [PMID: 34195360 PMCID: PMC8223475 DOI: 10.1002/lio2.558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate salivary gland chemodenervation with botulinum toxin in chronic parotid sialadenitis. METHODS Patients who underwent parotid gland chemodenervation for chronic sialadenitis due to duct stenosis refractory to siaendoscopy were reviewed (case series). Additionally, a systematic review of the literature on botulinum toxin injection for chronic parotid sialadenitis was performed. Inclusion criteria included studies containing original data on botulinum toxin injections in patients with chronic sialadenitis symptoms. RESULTS Sialadenitis symptoms from 10 patients with 13 affected parotid glands were examined. All had duct stenosis diagnosed on sialendoscopy, refractory sialadenitis symptoms, and received parotid onabotulinum toxin injection(s) (median dose 65U). Of patients with 3-month follow-up, 78% reported significant improvement in symptoms. Mean Chronic Obstructive Sialadenitis Symptoms (COSS) Score improved at 3 months post-injection (47-25.9, P = .039) with significant reduction in gland pain frequency and gland swelling severity. No patients had a facial nerve paralysis or increased xerostomia. With the systematic review, 518 abstracts were reviewed and 11 studies met inclusion criteria and included case series or case reports with a total of 40 patients treated with botulinum toxin for chronic parotitis. Thirty-four out of a total of 35 patients in the studies (97%) reported complete (9, 26%) or partial (25, 71%) improvement in sialadenitis symptoms with minimal complications. CONCLUSION Parotid gland chemodenervation with botulinum toxin is a minimally invasive treatment option for symptomatic chronic sialadenitis refractory to medical treatment or sialendoscopy. Botulinum toxin injections alleviate gland pain and swelling associated with salivary obstruction and provide an alternative to parotidectomy for recurrent sialadenitis.Level of evidence: 4.
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Affiliation(s)
- Madeleine P. Strohl
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Chia‐Fan Chang
- Department of Otorhinolaryngology‐Head and Neck SurgeryTaipei Veterans General Hospital and Faculty of Medicine, School of Medicine, National Yang‐Ming UniversityTaipeiTaiwan
| | - William R. Ryan
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Jolie L. Chang
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Zirovich MD, Pangarkar SS, Manh C, Chen L, Vangala S, Elashoff DA, Izuchukwu IS. Botulinum Toxin Type A for the Treatment of Post-traumatic Headache: A Randomized, Placebo-Controlled, Cross-over Study. Mil Med 2021; 186:493-499. [PMID: 33241323 DOI: 10.1093/milmed/usaa391] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Botulinum toxin type A (BoNT/A) is an approved treatment for chronic migraine and has been shown to be effective in reducing number, days, and severity of headache in other headache disorders. Whether botulinum toxin is a safe and effective treatment specifically for post-traumatic headache (PTH), however, is unknown. This study sought to determine whether treatment with BoNT/A improved symptoms of PTH in military veterans. MATERIALS AND METHODS Forty subjects with PTH were randomized to receive treatment of either BoNT/A or a saline placebo. Sixteen weeks post-treatment or at return to baseline headache severity, subjects were crossed over to receive treatment with the other medication than previously treated with in the first session. Subjects recorded number of headaches, number of headache days, and headache pain severity in daily diaries. Outcome measures included change in the weekly number of headaches, number of headache days per week, and headache pain severity compared to baseline, and the change in number of headaches and number of headaches days at baseline compared to the rating scores averaged across weeks 6-11. RESULTS The number of headaches per week significantly decreased by 2.24 (43.3%) with BoNT/A treatment (P < .001) and significantly increased by 1.28 (35.1%) with placebo (P = .02) at the end of the 16 weeks and the difference between groups was also significant (P < .001). The number of headache days per week also significantly decreased by 2.24 (44.4%) at the end of 16 weeks with BoNT/A treatment (P < .001), was not significantly changed with placebo, and the difference between the two groups was significant (P < .001). Both the change in number of headaches and number of headache days averaged across weeks 6-11 compared to baseline were significantly decreased in the BoNT/A group (1.6 and 1.4, respectively) compared to a significant increase of 0.3 in number of weekly headaches and a nonsignificant decrease of 0.1 in number of headache days for the placebo group (P = .048 and P = .005, respectively). Headache pain severity was significantly reduced by 0.06 with botulinum toxin treatment (P = .02) and was not significantly increased by 0.04 in the placebo group with a significant difference between groups (P = .006). CONCLUSIONS Treatment with BoNT/A clinically and significantly improved the frequency and pain severity of PTH compared to placebo in military veterans. Limitations of the study include subject dropout, adherence to documenting variables daily in the dairy, and only one treatment of BoNT/A. Strengths include the cross-over study design, which demonstrated that BoNT/A was effective regardless of treatment order. This dataset is the first prospective study to evaluate BoNT/A as an intervention for symptoms of PTH and provides evidence that larger-scale and multiple treatment studies evaluating BoNT/A for this headache type are warranted.
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Affiliation(s)
- Milena D Zirovich
- Physical Medicine and Rehabilitation Service, VA Greater Los Angeles Healthcare Service, Los Angeles, CA 90073, USA.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Sanjog S Pangarkar
- Physical Medicine and Rehabilitation Service, VA Greater Los Angeles Healthcare Service, Los Angeles, CA 90073, USA.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Christina Manh
- Physical Medicine and Rehabilitation Service, VA Greater Los Angeles Healthcare Service, Los Angeles, CA 90073, USA
| | - Lucia Chen
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA
| | - David A Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA.,Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA 90095, USA.,Clinical Translational Science Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA
| | - Ifeoma Stella Izuchukwu
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.,Internal Medicine Service, VA Greater Los Angeles Healthcare Service, Los Angeles, CA 90073, USA
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Schröder P, Gaul C, Drabik A, Molsberger A. Pain localization in cluster headache patients: Onset, peak, and radiation. Acta Neurol Scand 2021; 143:441-449. [PMID: 33523462 DOI: 10.1111/ane.13396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/23/2020] [Accepted: 01/14/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE AND AIM To describe differences in pain locations for onset, peak, and radiation aspects of cluster headache (CH) attacks. METHODS AND MATERIALS Data were collected for 23 months using a cross-sectional online survey composed of 117 questions on pain location, demographics, and clinical features. 5260 datapoints on 44 pain locations from 631 respondents were analyzed. RESULTS During the onset and peak of attacks, pain is concentrated periorbitally. Pain locations outside the periorbital region were reported more frequently for radiation than for onset and peak of attacks. Dorsal (occipital, neck, shoulder) pain was reported more frequently in connection with onset and radiation than during peak: onset (13%) versus peak (6%), p < 0.001, and radiation (22%) versus peak (6%), p < 0.001. There was no significant difference in dorsal pain frequencies for onset (13%) vs. radiation (22%), p = 0.552. Furthermore, the frequency with which individual pain locations were reported differed significantly for onset, peak, and radiation in CH. CONCLUSIONS Analysis of the pain location data shows specific frequencies and distributions of pain location for three aspects of CH attacks. The frequency with which individual pain points were reported differed significantly for onset, peak, and radiation. In general, dorsal pain points were reported more frequently for onset and radiation than for peak pain. Pain locations beyond the eye (extraorbital points) were more frequently reported in connection with radiating pain. Our findings could serve as a basis for future research, correlating CH pain patterns with the outcome of treatment approaches.
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Affiliation(s)
| | - Charly Gaul
- Migraine and Headache Clinic Königstein Königstein Germany
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Xie HM, Guo TT, Sun X, Ge HX, Chen XD, Zhao KJ, Zhang LN. Effectiveness of Botulinum Toxin A in Treatment of Hemiplegic Shoulder Pain: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 102:1775-1787. [PMID: 33454279 DOI: 10.1016/j.apmr.2020.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 12/06/2020] [Accepted: 12/17/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of botulinum toxin A (BTX-A) in the treatment of hemiplegic shoulder pain. DATA SOURCES PubMed, EMBASE, Elsevier, Springer, Cochrane Library, Physiotherapy Evidence Database, CNKI, and VIP were researched from the earliest records to September 1, 2020. STUDY SELECTION Randomized controlled trials that compared shoulder BTX-A injections vs a control intervention in patients with a history of hemiplegic shoulder pain after stroke were selected. Among the 620 records screened, 9 trials with 301 eligible patients were included. DATA EXTRACTION Outcome data were pooled according to follow-up intervals (1, 2, 4, and 12 wk). The primary evaluation indices were pain reduction (visual analog scale [VAS] score) and range of motion (ROM) improvement. The second evaluation indices were upper limb functional improvement, spasticity improvement, and incidence of adverse events. Cochrane risk-of-bias was used to assess the methodological quality of studies independently by 2 evaluators. DATA SYNTHESIS Meta-analysis revealed a statistically significant decrease in the VAS score in the BTX group vs the control group at 1, 4, and 12 weeks postinjection (wk 1: standardized mean difference [SMD], 0.91; 95% confidence interval [CI], 0.27 to 1.54; wk 4: SMD, 1.63; 95% CI, 0.76 to 2.51; wk 12: SMD, 1.96; 95% CI, 1.44 to 2.47). Furthermore, the meta-analysis demonstrated a statistically significant increase in abduction at 1, 4, and 12 weeks postinjection (wk 1: SMD, 3.71; 95% CI, 0 to 7.41; wk 4: SMD, 8.8; 95% CI, 2.22 to 15.37; wk 12: SMD, 19.59; 95% CI, 9.05 to 30.13) and external rotation at 1, 2, 4 weeks postinjection (wk 1: SMD, 5.67; 95% CI, 0.88 to 10.47; wk 2: SMD, 9.62; 95% CI, 5.57 to 13; wk 4: SMD, 6.89; 95% CI, 2.45 to 11.33) in the BTX group. CONCLUSIONS BTX-A injection provided greater analgesic effects and increased shoulder abduction and external rotation ROM compared with steroid or placebo injection for the treatment of HSP.
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Affiliation(s)
- Hui-Min Xie
- Department of Rehabilitation, Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Ting-Ting Guo
- Department of Neurology, the Second Affiliated Hospital of Shanxi Medical University, Shanxi, China
| | - Xuan Sun
- Geriatric Neurological Department, the Second Medical Centre and National Clinical Research Center of Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Han-Xiao Ge
- Department of Rehabilitation, Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xue-Dan Chen
- Department of Rehabilitation, Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Ke-Jia Zhao
- Department of Rehabilitation, Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Li-Ning Zhang
- Department of Rehabilitation, Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.
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Pinto MJ, Guerrero AL, Costa A. Botulinum toxin as a novel therapeutic approach for auriculotemporal neuralgia. Headache 2021; 61:392-395. [PMID: 33433917 DOI: 10.1111/head.14043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/BACKGROUND Auriculotemporal neuralgia is a rare headache disorder. Anesthetic nerve blockade seems to be effective in most cases; however, literature is scarce about the management of refractory cases. METHODS Case report. RESULTS We report a 44-year-old woman with migraine without aura presented with moderate-to-severe right temporoparietal headache. The pain was refractory to multiple pharmacological strategies, including intravenous analgesia. A more throughout examination lead to the diagnosis of auriculotemporal neuralgia and anesthetic nerve blocks were performed. Due to early pain recrudescence, botulinum toxin (BoNT) was tried with better and longstanding pain control. CONCLUSION BoNT may be a useful treatment option in refractory auriculotemporal neuralgia. The best approach is yet to be established; however, the "follow-the-pain" protocol may be a reasonable option.
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Affiliation(s)
- Maria J Pinto
- Department of Neurology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Angel L Guerrero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain.,Department of Medicine, University of Valladolid, Valladolid, Spain
| | - Andreia Costa
- Department of Neurology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
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Tian F, Cheng W, Hu J, Huang S, Sun S. Effects of botulinum toxin A on endometriosis‑associated pain and its related mechanism. Mol Med Rep 2020; 22:4351-4359. [PMID: 33000241 PMCID: PMC7533527 DOI: 10.3892/mmr.2020.11501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 08/14/2020] [Indexed: 11/30/2022] Open
Abstract
Endometriosis (EMS) is a common disease in women aged 25–45 years, and pain is the main clinical symptom. The primary clinical treatment is surgical excision and drug therapy targeting the ectopic lesions, but these have not been very effective. Botulinum neurotoxin serotype A (BTX-A) has been reported to be useful in the treatment of pain in a variety of diseases. Based on this, the aim of the present study was to explore the therapeutic effect and mechanism of BTX-A on EMS. A model of nerve injury induced by oxygen glucose deprivation (OGD) was constructed in PC12 cells and EMS mice. Model cells and mice were treated with different concentrations of BTX-A to observe the changes in pain behavior, to detect cell viability and the secretion of norepinephrine (NE) and methionine enkephalin (M-EK) in cells and the spinal cord, and to evaluate the expression of apoptosis-related molecules in spinal cord nerves. The results revealed that BTX-A significantly reduced the amount of writhing in model mice, enhanced the activity of PC12 OGD cells, increased the secretion of NE and M-EK in model cells and the spinal cord of mice, and decreased the apoptosis of neural cells in the spinal cord of the model mice. Therefore, it was hypothesized that BTX-A may alleviate the pain induced by EMS by increasing the secretion of analgesic substances and promoting the repair of nerve injury. The present study provided a theoretical basis for the treatment of pain induced by EMS.
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Affiliation(s)
- Fubo Tian
- Department of Anesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200090, P.R. China
| | - Wuzhong Cheng
- Massage Department, Beijing Traditional Chinese Medicine Hospital, Capital Medical University, Beijing 100010, P.R. China
| | - Jianying Hu
- Department of Anesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200090, P.R. China
| | - Shaoqiang Huang
- Department of Anesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200090, P.R. China
| | - Shen Sun
- Department of Anesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200090, P.R. China
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Abstract
AIMS To conduct a review of the literature on the use of botulinum toxin for the treatment of pediatric chronic migraine. METHODS A review of the literature was performed using EMBASE, PubMed, and Cochrane/Ovid. Using our inclusion and exclusion criteria, we targeted any study, published before April 2020, evaluating the efficacy of botulinum toxin in migraineurs younger than 18 years. RESULTS Seven studies were included: 2 retrospective analyses, 3 case series, a case report, and a randomized control trial. Studies included 1 to 125 patients, with the number of botulinum toxin treatments ranging from 1 to 11 treatments. The results of the randomized controlled trial showed nonsuperiority between placebo and botulinum toxin. Results of the other studies were generally favorable but were difficult to compare because of lack of standardization of botulinum toxin dosing, injection paradigm, frequency and duration of treatment, usage of accompanying prophylaxis, and variation in outcome measures across studies. There was low-quality evidence that botulinum toxin improved headache frequency and intensity, though some studies demonstrated efficacy in treatment with botulinum toxin. CONCLUSION This review is the first of its kind, updating the literature on the efficacy of botulinum toxin in pediatric patients. Given evidence of its utility in treating pediatric migraines, off-label use should be considered in certain cases. Further study is warranted to better characterize injection paradigms and patient selection because of the limited and inconsistent data available.
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Affiliation(s)
- Raymundo Marcelo
- 158147Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brin Freund
- 158147Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Department of Neurology, 1501Johns Hopkins Hospital, Baltimore, MD, USA
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Santos-Lasaosa S, Cuadrado M, Gago-Veiga A, Guerrero-Peral A, Irimia P, Láinez J, Leira R, Pascual J, Porta-Etessam J, Sánchez del Río M, Viguera Romero J, Pozo-Rosich P. Evidencia y experiencia del uso de onabotulinumtoxinA en neuralgia del trigémino y cefaleas primarias distintas de la migraña crónica. Neurologia 2020; 35:568-578. [DOI: 10.1016/j.nrl.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/20/2022] Open
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Evidence of and experience with the use of onabotulinumtoxinA in trigeminal neuralgia and primary headaches other than chronic migraine. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2017.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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21
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Roldan CJ, Chung M, Mc C, Cata J, B H. High-flow oxygen and pro-serotonin agents for non-interventional treatment of post-dural-puncture headache. Am J Emerg Med 2020; 38:2625-2628. [PMID: 33041133 DOI: 10.1016/j.ajem.2020.07.076] [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: 06/03/2020] [Revised: 07/07/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Post dural puncture headache (PDPH) is a common complication in patients following diagnostic or therapeutic lumbar puncture, procedures requiring epidural access, and spinal surgery. Epidural blood patch (EBP), the gold standard for the treatment of this pathology requires training not provided to emergency physicians. In addition, the presence of concomitant pathology and abnormal laboratory values are contraindications to perform EBP. In presence of these limitations, we sought for a non-interventional management of PDPH utilizing high-flow oxygen and pro-serotonin agents. We reviewed the mechanism of action of this therapy METHODS: To illustrate our proposal, we report a series of twelve consecutive patients with PDPH treated with high-flow oxygen therapy at 12 L/min via a non-rebreathing mask and intravenous metoclopramide. RESULTS All patients were treated with this conservative therapy, no adverse reactions were observed. After the intervention, the headache resolved without further indications for PDPH. CONCLUSION Our series suggests that combining high-flow oxygen and pro-serotonin agents such metoclopramide in the ED might be a feasible option as effective as the invasive methods used in treating PDPH. This therapy appears to be efficient and to minimize risk, cost and side effects. It presents an easily accessible alternative that should be considered when PDPH is not a viable option.
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Affiliation(s)
- Carlos J Roldan
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America; Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX, South America.
| | - Matthew Chung
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Correa Mc
- CES Medical School, Medellin, Colombia, South America
| | - J Cata
- Department of Anesthesia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Huh B
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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Luvisetto S. Botulinum Toxin and Neuronal Regeneration after Traumatic Injury of Central and Peripheral Nervous System. Toxins (Basel) 2020; 12:toxins12070434. [PMID: 32630737 PMCID: PMC7404966 DOI: 10.3390/toxins12070434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022] Open
Abstract
Botulinum neurotoxins (BoNTs) are toxins produced by the bacteria Clostridiumbotulinum, the causing agent for botulism, in different serotypes, seven of which (A–G) are well characterized, while others, such as H or FA, are still debated. BoNTs exert their action by blocking SNARE (soluble N-ethylmale-imide-sensitive factor-attachment protein receptors) complex formation and vesicle release from the neuronal terminal through the specific cleavage of SNARE proteins. The action of BoNTs at the neuromuscular junction has been extensively investigated and knowledge gained in this field has set the foundation for the use of these toxins in a variety of human pathologies characterized by excessive muscle contractions. In parallel, BoNTs became a cosmetic drug due to its power to ward off facial wrinkles following the activity of the mimic muscles. Successively, BoNTs became therapeutic agents that have proven to be successful in the treatment of different neurological disorders, with new indications emerging or being approved each year. In particular, BoNT/A became the treatment of excellence not only for muscle hyperactivity conditions, such as dystonia and spasticity, but also to reduce pain in a series of painful states, such as neuropathic pain, lumbar and myofascial pain, and to treat various dysfunctions of the urinary bladder. This review summarizes recent experimental findings on the potential efficacy of BoNTs in favoring nerve regeneration after traumatic injury in the peripheral nervous system, such as the injury of peripheral nerves, like sciatic nerve, and in the central nervous system, such as spinal cord injury.
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Affiliation(s)
- Siro Luvisetto
- Institute of Biochemistry and Cell Biology, National Research Council of Italy, via Ramarini 32, Monterotondo Scalo, 00015 Rome, Italy
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Ågren M, Sahin C, Pettersson M. The effect of botulinum toxin injections on bruxism: A systematic review. J Oral Rehabil 2019; 47:395-402. [PMID: 31769044 DOI: 10.1111/joor.12914] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/31/2019] [Accepted: 11/20/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To systematize evidence on the efficacy of botulinum toxin type A (BTA) in the treatment of bruxism measured through bite force or electromyography (EMG) at the masseter muscle. METHOD Identification of relevant articles through databases PubMed, Web of Science, SCOPUS, Ovid and EBSCO and manual search were performed for sources from review articles. Studies scoring less than 3 on the Jadad Scale were excluded. RESULTS Four articles were included after an exclusion of 333 articles. 3 articles measured EMG and 1 bite force. 1 article did not record a significant drop of activity, 1 article recorded reduction midway and at final endpoint. 2 articles recorded initial reduction, but a non significant difference at later follow up. CONCLUSION The available research is inconclusive and does not show enough evidence that bruxism can be treated with BTA injections. However, promising results have been shown in individual studies and further research in this area is needed.
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Affiliation(s)
- Martin Ågren
- Prosthodontic specialist clinic, Region Västerbotten, Umeå, Sweden
| | - Christofer Sahin
- Department of Dermatology and Venerology, Linköping university hospital and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Mattias Pettersson
- Department of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden
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Early Postoperative Application of Botulinum Toxin Type A Prevents Hypertrophic Scarring after Epicanthoplasty. Plast Reconstr Surg 2019; 144:835-844. [DOI: 10.1097/prs.0000000000006069] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Jia C, Lucchese S, Zhang F, Govindarajan R. The Role of Onabotulinum Toxin Type A in the Management of Chronic Non-migraine Headaches. Front Neurol 2019; 10:1009. [PMID: 31616362 PMCID: PMC6763695 DOI: 10.3389/fneur.2019.01009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives: FDA has approved Onabotulinum toxin type A (BoNTA) for prophylactic treatment of chronic migraines. Recent studies have explored its potential new indications, like treating post-traumatic headaches. Patients and Methods: This is a retrospective chart review of 717 patients, who had failed at least two prophylactic treatments and received BoNTA injections at University of Missouri Hospital from July 2014 to June 2017. Patient demographics, headache type, associated symptoms, prophylaxes tried were reported. Patient's pain severity (numeric pain scale) and frequency (number of headache days/month) pretreatment, at 6 months, and at 12 months were collected. Results: For a single headache type, post-traumatic headaches showed reduction in headache pain severity at 6 months (2.9 ± 0.7) compared to pre-treatment (7 ± 0.7). Headache frequency for post-traumatic headaches was also reduced at 6 months (10.6 ± 2.3) and 12 months (5.1 ± 1.2) compared to pre-treatment (25 ± 1.8). For pseudotumor cerebri headaches, pain severity at pretreatment was 6.4 ± 0.6 compared to 2 ± 0.8 at 6 months, and headache days reduced at 6 months (9.8 ± 2.5) and 12 months (6 ± 4) compared to pretreatment (26 ± 2.9). Opioid use reduced by 67 ± 55.4 at 6 months and 133.3 ± 106.6 at 12 months in morphine equivalent units. Conclusions: Onabotulinum toxin type A is effective in treating multiple types of chronic non-migraine headaches.
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Giannantoni A, Gubbiotti M, Bini V. Botulinum Neurotoxin A Intravesical Injections in Interstitial Cystitis/Bladder Painful Syndrome: A Systematic Review with Meta-Analysis. Toxins (Basel) 2019; 11:toxins11090510. [PMID: 31480323 PMCID: PMC6784147 DOI: 10.3390/toxins11090510] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/21/2019] [Accepted: 08/28/2019] [Indexed: 12/14/2022] Open
Abstract
Botulinum neurotoxin A (BoNT/A) appears to be one of the best intravesical treatments for interstitial cystitis/bladder painful syndrome (IC/BPS). We aimed to point out what the evidence is regarding the effects of BoNT/A intravesically injected in patients with IC/BPS. We performed a systematic review of all randomized controlled trials (RCTs) assessing BoNT/A for IC/BPS by using Medline, EMBASE, CINAHL, CENTRAL and MetaRegister of Controlled Trials. Standardized mean differences (SMD) were extracted from the available trials and combined in a meta-analysis applying a random effect model, including heterogeneity of effects. Twelve trials were identified. Significant benefits from BoNT/A injections were detected in: Interstitial Cystitis Symptom Index and Problem Index (ICSI, ICPI) (small to medium effect size: SMD = -0.302; p = 0.007 and -0.430, p = 0.004, respectively); Visual Analog Scale (VAS) for pain and day-time urinary frequency (medium effect size: SMD = -0.576, p < 0.0001 and -0.546, p = 0.013, respectively). A great effect size was detected for post-void residual volume (PVR, SMD = 0.728; p =0.002) although no clinically relevant in most cases. Great heterogeneity was observed in treatments' methodologies and symptoms assessment. Overall, BoNT/A intravesical injections significantly improve some of the most relevant symptoms affecting IC/BPS patients.
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Affiliation(s)
- Antonella Giannantoni
- Department of Medical and Surgical Sciences and Neurosciences, Functional and Surgical Urology Unit, University of Siena, 53100 Siena, Italy.
| | - Marilena Gubbiotti
- Department of Urology, San Donato Hospital, 52100 Arezzo, Italy
- Serafico Institute of Assisi, Research centre "InVita", Assisi, 06081 Perugia, Italy
| | - Vittorio Bini
- Department of Medicine, University of Perugia, 06123 Perugia, Italy
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Wu S, Lian Y, Zhang H, Chen Y, Wu C, Li S, Zheng Y, Wang Y, Cheng W, Huang Z. Botulinum Toxin Type A for refractory trigeminal neuralgia in older patients: a better therapeutic effect. J Pain Res 2019; 12:2177-2186. [PMID: 31410051 PMCID: PMC6643497 DOI: 10.2147/jpr.s205467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/27/2019] [Indexed: 12/31/2022] Open
Abstract
Background Some studies have indicated that a local injection of Botulinum Toxin Type A (BTX-A) is a promising therapy for trigeminal neuralgia (TN). However, BTX-A treatment is still ineffective for approximately 10-43% of patients. We therefore investigated which factors are associated with the therapeutic effect in BTX-A treatment of medically refractory, classical TN. Methods We performed a retrospective cohort study with a total of 104 patients who were receiving BTX-A injection for medically refractory classical TN between August 2013 and October 2016. A VAS score, pain attack frequency per day as well as patients' overall response to treatment and side effects were evaluated in 104 patients with TN who were receiving BTX-A. Results A total of 87 patients reported successful results; 41 stated that their pain was completely controlled while 46 reported adequate pain relief, totaling 83.7%. Our study suggests that treatment success was higher in patients 50 or older (OR=3.66, 95% CI: 1.231-10.885). Univariate and multivariate analyses demonstrated that the patient's age was independently associated with treatment outcome (OR=1.72, 95% CI: 1.063-2.282), with ≥50 years being a significant predictor of pain relief (P=0.020 and P=0.033, respectively). Seventeen patients (16.3%) reported mild side effects. Conclusion A local injection of BTX-A may be a safe and efficient treatment for classical TN which lasts for several months. BTX-A is a novel strategy which is particularly worth trying for particularly middle-aged and elderly patients who cannot tolerate drug side effects and may be afraid of serious complications from microvascular decompression.
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Affiliation(s)
- Shouyi Wu
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Haifeng Zhang
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yuan Chen
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Chuanjie Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shuang Li
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yake Zheng
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yuhan Wang
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Wenchao Cheng
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Zhi Huang
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
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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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Araújo-Filho HG, Pereira EWM, Campos AR, Quintans-Júnior LJ, Quintans JSS. Chronic orofacial pain animal models - progress and challenges. Expert Opin Drug Discov 2018; 13:949-964. [PMID: 30220225 DOI: 10.1080/17460441.2018.1524458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Chronic orofacial pain is one of the most common pain conditions experienced by adults. Animal models are often selected as the most useful scientific methodology to explore the pathophysiology of the disorders that cause this disabling pain to facilitate the development of new treatments. The creation of new models or the improvement of existing ones is essential for finding new ways to approach the complex neurobiology of this type of pain. Areas covered: The authors describe and discuss a variety of animal models used in chronic orofacial pain (COFP). Furthermore, they examine in detail the mechanisms of action involved in orofacial neuropathic pain and orofacial inflammatory pain. Expert opinion: The use of animal models has several advantages in chronic orofacial pain drug discovery. Choosing an animal model that most closely represents the human disease helps to increase the chances of finding effective new therapies and is key to the successful translation of preclinical research to clinical practice. Models using genetically modified animals seem promising but have not yet been fully developed for use in chronic orofacial pain research. Although animal models have provided significant advances in the pharmacological treatment of orofacial pain, several barriers still need to be overcome for better treatment options.
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Affiliation(s)
- Heitor G Araújo-Filho
- a Laboratory of Neuroscience and Pharmacological Assays (LANEF), Department of Physiology , Federal University of Sergipe , São Cristóvão , Brazil
| | - Erik W M Pereira
- a Laboratory of Neuroscience and Pharmacological Assays (LANEF), Department of Physiology , Federal University of Sergipe , São Cristóvão , Brazil
| | - Adriana Rolim Campos
- b Experimental Biology Centre (NUBEX) , University of Fortaleza (UNIFOR) , Fortaleza , Brazil
| | - Lucindo J Quintans-Júnior
- a Laboratory of Neuroscience and Pharmacological Assays (LANEF), Department of Physiology , Federal University of Sergipe , São Cristóvão , Brazil
| | - Jullyana S S Quintans
- a Laboratory of Neuroscience and Pharmacological Assays (LANEF), Department of Physiology , Federal University of Sergipe , São Cristóvão , Brazil
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Evidence on botulinum toxin in selected disorders. Toxicon 2018; 147:134-140. [DOI: 10.1016/j.toxicon.2018.01.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/29/2017] [Accepted: 01/28/2018] [Indexed: 11/19/2022]
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Monocentric Prospective Study into the Sustained Effect of Incobotulinumtoxin A (XEOMIN ®) Botulinum Toxin in Chronic Refractory Migraine. Toxins (Basel) 2018; 10:toxins10060221. [PMID: 29857565 PMCID: PMC6024863 DOI: 10.3390/toxins10060221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 12/21/2022] Open
Abstract
Refractory chronic migraine is a disabling disorder impacting quality of life. BOTOX® (Onabotulinumtoxin A) is approved as a prophylactic treatment of chronic migraine in patients unresponsive to at least three prior preventive treatments. The objective of this study was to determine the prophylactic effect of 145 U XEOMIN® (Incobotulinumtoxin A) injected at 31 specific sites in adult patients with refractory chronic migraine. Sixty-one patients (8 men and 53 women, mean age 50) with migraine were recruited, including 20 patients with isolated chronic migraine, 18 patients with chronic migraine associating tension-type headache, 12 patients with migraine associating medication overuse headache, and 11 patients with episodic disabling migraine. The mean number of injections and duration of treatment per patient was 3.5 (range 2–13) and 21 (6–68) months, respectively. From baseline to first injection, 44 patients (73%) had >50% reduction in frequency of migraine episodes, 29 patients (48%) showed >50% reduction in number of headache days, and 28 patients (46%) had a >50% reduction in drug intake. Stable response for all three parameters was observed after the last injection. XEOMIN® thus seems to represent an effective and sustained prophylactic treatment of chronic migraine.
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Abstract
An intramuscular formulation of onabotulinumtoxinA (onabotA; Botox®) is currently the only therapy specifically approved for the prevention of headaches in adults with chronic migraine (CM) in the EU and North America. This article provides a narrative review of relevant data on the drug in this indication from an EU perspective. OnabotA was originally approved on the basis of pooled data from two phase III studies (PREEMPT 1 and 2). In these pivotal studies, injection of up to five cycles of onabotA (155-195 U/cycle) at 12-week intervals was generally well tolerated and effective in producing statistically significant and clinically meaningful improvements in headache symptoms, acute headache pain medication usage, headache impact and health-related quality of life in adults with CM, of whom approximately two-thirds were acute medication overusers and approximately one-third had failed to respond to ≥ 3 prior oral prophylactic therapies. More recently, the efficacy and tolerability of onabotA over a period of 1 year in the PREEMPT programme has been substantiated and extended by the results of a long-term phase IV study (COMPEL), in which patients received up to nine treatment cycles over a period of 2 years, and by findings from several real-world clinical practice studies from Europe, including the prospective multinational REPOSE and CM-PASS studies. In conclusion, the totality of evidence from clinical trials and real-world studies indicates that onabotA is an effective and generally well tolerated option for the prevention of CM that may be particularly useful for patients who have previously failed to respond to or are intolerant of commonly prescribed oral prophylactics.
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Affiliation(s)
- James E Frampton
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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Antipruritic Effects of Botulinum Neurotoxins. Toxins (Basel) 2018; 10:toxins10040143. [PMID: 29596343 PMCID: PMC5923309 DOI: 10.3390/toxins10040143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 12/20/2022] Open
Abstract
This review explores current evidence to demonstrate that botulinum neurotoxins (BoNTs) exert antipruritic effects. Both experimental and clinical conditions in which botulinum neurotoxins have been applied for pruritus relief will be presented and significant findings will be highlighted. Potential mechanisms underlying antipruritic effects will also be discussed and ongoing challenges and unmet needs will be addressed.
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Maroccia Z, Loizzo S, Travaglione S, Frank C, Fabbri A, Fiorentini C. New therapeutics from Nature: The odd case of the bacterial cytotoxic necrotizing factor 1. Biomed Pharmacother 2018; 101:929-937. [PMID: 29635902 DOI: 10.1016/j.biopha.2018.02.140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 12/13/2022] Open
Abstract
Natural products may represent a rich source of new drugs. The enthusiasm toward this topic has recently been fueled by the 2015 Nobel Prize in Physiology or Medicine, awarded for the discovery of avermectin and artemisinin, natural products from Bacteria and Plantae, respectively, which have targeted one of the major global health issues, the parasitic diseases. Specifically, bacteria either living in the environment or colonizing our body may produce compounds of unexpected biomedical value with the potentiality to be employed as therapeutic drugs. In this review, the fascinating history of CNF1, a protein toxin produced by pathogenic strains of Escherichia coli, is divulged. Even if produced by bacteria responsible for a variety of diseases, CNF1 can behave as a promising benefactor to mankind. By modulating the Rho GTPases, this bacterial product plays a key role in organizing the actin cytoskeleton, enhancing synaptic plasticity and brain energy level, rescuing cognitive deficits, reducing glioma growth in experimental animals. These abilities strongly suggest the need to proceed with the studies on this odd drug in order to pave the way toward clinical trials.
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Affiliation(s)
- Zaira Maroccia
- Italian Centre for Global Health, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - Stefano Loizzo
- Italian Centre for Global Health, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - Sara Travaglione
- Italian Centre for Global Health, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - Claudio Frank
- Italian Centre for Rare Diseases, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - Alessia Fabbri
- Italian Centre for Global Health, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - Carla Fiorentini
- Italian Centre for Global Health, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy.
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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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Investigating CRISPR-Cas systems in Clostridium botulinum via bioinformatics tools. INFECTION GENETICS AND EVOLUTION 2017; 54:355-373. [DOI: 10.1016/j.meegid.2017.06.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/19/2017] [Accepted: 06/27/2017] [Indexed: 12/22/2022]
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Sokolov AY, Murzina AA, Osipchuk AV, Lyubashina OA, Amelin AV. Cholinergic mechanisms of headaches. NEUROCHEM J+ 2017. [DOI: 10.1134/s1819712417020131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Pingel J, Hultborn H, Näslund-Koch L, Jensen DB, Wienecke J, Nielsen JB. Muscle disuse caused by botulinum toxin injection leads to increased central gain of the stretch reflex in the rat. J Neurophysiol 2017; 118:1962-1969. [PMID: 28724781 DOI: 10.1152/jn.00276.2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/05/2017] [Accepted: 07/05/2017] [Indexed: 12/26/2022] Open
Abstract
Botulinum toxin (Btx) is used in children with cerebral palsy and in other neurological patients to diminish spasticity and reduce the risk of development of contractures. We investigated changes in the central gain of the stretch reflex circuitry in response to Btx injection in the triceps surae muscle in rats. Experiments were performed in 21 rats. Eight rats were a control group, and 13 rats were injected with 6 IU of Btx in the left triceps surae muscle. Two weeks after Btx injection, larger monosynaptic reflexes (MSR) were recorded from the left (injected) than the right (noninjected) L4 + L5 ventral roots following stimulation of the corresponding dorsal roots. A similar increase on the left side was observed in response to stimulation of descending motor tracts, suggesting that increased excitability of spinal motor neurons may at least partly explain the increased reflexes. However, significant changes were also observed in postactivation depression of the MSR, suggesting that plastic changes in transmission from Ia afferent to the motor neurons also may be involved. The data demonstrate that muscle paralysis induced by Btx injection is accompanied by plastic adaptations in the central stretch reflex circuitry, which counteract the antispastic effect of Btx.NEW & NOTEWORTHY Injection of botulinum toxin into ankle muscles causes increased gain of stretch reflex. This is caused by adaptive changes in regulation of transmitter release from Ia afferents and increased excitability of spinal motor neurons.
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Affiliation(s)
- Jessica Pingel
- Neural Control of Movement Research Group, Center for Neuroscience, University of Copenhagen, Denmark
| | - Hans Hultborn
- Neural Control of Movement Research Group, Center for Neuroscience, University of Copenhagen, Denmark
| | - Lui Näslund-Koch
- Neural Control of Movement Research Group, Center for Neuroscience, University of Copenhagen, Denmark
| | - Dennis B Jensen
- Neural Control of Movement Research Group, Center for Neuroscience, University of Copenhagen, Denmark
| | - Jacob Wienecke
- Neural Control of Movement Research Group, Center for Neuroscience, University of Copenhagen, Denmark.,Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Jens Bo Nielsen
- Neural Control of Movement Research Group, Center for Neuroscience, University of Copenhagen, Denmark; .,Elsass Institute, Charlottenlund, Denmark; and
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Cobianchi S, Jaramillo J, Luvisetto S, Pavone F, Navarro X. Botulinum neurotoxin A promotes functional recovery after peripheral nerve injury by increasing regeneration of myelinated fibers. Neuroscience 2017; 359:82-91. [PMID: 28716587 DOI: 10.1016/j.neuroscience.2017.07.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 12/28/2022]
Abstract
The injection of safe doses of botulinum neurotoxin A (BoNT/A) have been reported to be useful for the treatment of neuropathic pain, but it is still unknown how functional recovery is induced after peripheral nerve injury. We evaluated the effects of intranerve application of BoNT/A, on regeneration and sensorimotor functional recovery in partial and complete peripheral nerve injuries in the mouse. After sciatic nerve crush (SNC) and intranerve delivery of BoNT/A (15pg), axonal regeneration was measured by nerve pinch test at different days. Regeneration of myelinated and unmyelinated fibers was assessed by immunohistochemical double labeling for NF200/GAP43 and CGRP/GAP43. S100 was used as Schwann cells marker. Medial footpad skin reinnervation was assessed by PGP staining. Motor functions were assessed by means of nerve conduction tests. In other mice groups, nerve conduction tests were performed also after chronic constriction injury (CCI) of the sciatic nerve and intraplantar injection of BoNT/A (15pg). In SNC mice, BoNT/A increased the rate of axonal regeneration. The advantage of regrowing myelinated axons after BoNT/A injection was evidenced by longer NF200+ nerve profiles and confirmed by nerve histology. We observed also a higher expression of S100 in the distal portion of BoNT/A-injected regenerated nerves. In CCI mice, BoNT/A induced an increase in reinnervation of gastrocnemius and plantar muscles. These results show that a low dose of BoNT/A, insufficient to produce muscular dysfunction, conversely speeds up sensorimotor recovery by stimulating myelinated axonal regeneration, and points out its application as a multipotent treatment for peripheral neuropathies.
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Affiliation(s)
- Stefano Cobianchi
- Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autonoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain.
| | - Jessica Jaramillo
- Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autonoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Siro Luvisetto
- CNR-National Research Council, Institute of Cell Biology and Neurobiology, Rome, Italy; IRCCS Santa Lucia Foundation, Rome, Italy
| | - Flaminia Pavone
- CNR-National Research Council, Institute of Cell Biology and Neurobiology, Rome, Italy; IRCCS Santa Lucia Foundation, Rome, Italy
| | - Xavier Navarro
- Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autonoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
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Ding XD, Wang W, Ding ZG, Liu YP, Zhong J, Chen HX. Impact of Botox-A SNAP-25 protein expression and the mechanism of inhibitory neurotransmitter imbalance in chronic sciatic nerve pain rat model. Exp Ther Med 2017; 13:2783-2786. [PMID: 28588664 PMCID: PMC5450774 DOI: 10.3892/etm.2017.4351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 03/16/2017] [Indexed: 12/17/2022] Open
Abstract
The Botox-A impact on the expression of SNAP-25 protein in rat chronic sciatic nerve pain model was assessed and the mechanism of inhibitory neurotransmitter imbalance was studied. A chronic constriction injury (CCI) model consisted of 30 healthy male rats. The rats were randomly divided into the sham-operated group, CCI group and BoNT/A intervention group, and during 1, 7 and 14 days we conducted mechanical withdrawal threshold (MWT) test and thermal withdrawal latency (TWL) test before and after operation. After 14 days, the animals were sacrificed. SNAP-25 protein expression level, mRNA subunit NR2B within excitatory neurotransmitter glutamate GLT and protein expression level, as well as GAT mRNA, the inhibitory GABA neurotransmitter transporter and protein expression level were studied by RT-polymerase chain reaction and western blot analysis. The difference between MWT and TWL at each point in time before and after operation showed no statistical significance (P>0.05) in the sham-operated group. For the CCI group at each time point, MWT and TWL were obviously lower than the sham-operated group and the difference was statistically significant (P<0.05) while the internal difference at each time point showed no statistical significance (P>0.05). The expression level of protein of SNAP-25 and NR2B mRNA in the CCI group was clearly higher than sham-operated group. Additionally, the expression level of GAT-1 mRNA and protein in CCI group was apparently lower than the sham-operated group. In conclusion, Botox-A helped reduce SNAP-25 within rat chronic sciatic nerve pain model thereby relieving pain.
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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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Nugent M, Wang J, Lawrence G, Zurawski T, Geoghegan JA, Dolly JO. Conjugate of an IgG Binding Domain with Botulinum Neurotoxin A Lacking the Acceptor Moiety Targets Its SNARE Protease into TrkA-Expressing Cells When Coupled to Anti-TrkA IgG or Fc-βNGF. Bioconjug Chem 2017; 28:1684-1692. [PMID: 28489355 DOI: 10.1021/acs.bioconjchem.7b00157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Numerous naturally occurring toxins can perturb biological systems when they invade susceptible cells. Coupling of pertinent targeting ligands to the active domains of such proteins provides a strategy for directing these to particular cellular populations implicated in disease. A novel approach described herein involved fusion of one mutated immunoglobulin G (IgG) binding moiety of staphylococcal protein A to the SNARE protease and translocation domain of botulinum neurotoxin A (BoNT/A). This chimera could be monovalently coupled to IgG or via its Fc region to recombinant targeting ligands. The utility of the resulting conjugates is demonstrated by the delivery of a SNARE protease into a cell line expressing tropomyosin receptor kinase A (TrkA) through coupling to anti-TrkA IgG or a fusion of Fc and nerve-growth factor. Thus, this is a versitile and innovative technology for conjugating toxins to diverse ligands for retargeted cell delivery of potential therapeutics.
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Affiliation(s)
- Marc Nugent
- International Centre for Neurotherapeutics, Dublin City University , Glasnevin, Dublin 9, Ireland
| | - Jiafu Wang
- International Centre for Neurotherapeutics, Dublin City University , Glasnevin, Dublin 9, Ireland
| | - Gary Lawrence
- International Centre for Neurotherapeutics, Dublin City University , Glasnevin, Dublin 9, Ireland
| | - Tomas Zurawski
- International Centre for Neurotherapeutics, Dublin City University , Glasnevin, Dublin 9, Ireland
| | - Joan A Geoghegan
- Department of Microbiology, Moyne Institute of Preventive Medicine, School of Genetics and Microbiology, Trinity College Dublin , Dublin 2, Ireland
| | - J Oliver Dolly
- International Centre for Neurotherapeutics, Dublin City University , Glasnevin, Dublin 9, Ireland
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Zychowska M, Rojewska E, Makuch W, Luvisetto S, Pavone F, Marinelli S, Przewlocka B, Mika J. Participation of pro- and anti-nociceptive interleukins in botulinum toxin A-induced analgesia in a rat model of neuropathic pain. Eur J Pharmacol 2016; 791:377-388. [DOI: 10.1016/j.ejphar.2016.09.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 12/28/2022]
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Khalifeh M, Mehta K, Varguise N, Suarez-Durall P, Enciso R. Botulinum toxin type A for the treatment of head and neck chronic myofascial pain syndrome: A systematic review and meta-analysis. J Am Dent Assoc 2016; 147:959-973.e1. [PMID: 27737756 DOI: 10.1016/j.adaj.2016.08.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND The authors conducted a systematic review to study the efficacy of botulinum toxin type A (BoTN-A) in the treatment of myofascial pain syndrome. TYPES OF STUDIES REVIEWED The authors identified randomized, double-masked, placebo-controlled studies on June 1, 2016, from PubMed, Web of Science, and the Cochrane Library. Three of the authors assessed the studies for risk of bias. Outcomes included pain reduction on a visual analog scale, the number of responders, and the posttreatment pain threshold to applied pressure using algometry. RESULTS The initial search strategy yielded 253 unduplicated references, which the authors reduced to 13 relevant studies. The authors included 11 studies in the meta-analyses as the investigators of those studies had reported similar outcomes. Pooled results showed a nonsignificant improvement in the posttreatment intensity of pain in the BoTN-A group compared with the placebo group at 4 to 6 weeks (standardized difference in means [SDM], -0.110; 95% confidence interval [CI], -0.344 to 0.124; P = .356) and a significant improvement at 2 to 6 months (SDM, -0.360; 95% CI, -0.623 to -0.096; P = .008). The number of study participants who responded to treatment was not statistically significantly different between the groups (risk ratio, 1.346; 95% CI, 0.922-1.964; P = .123) nor was the increase of pain threshold to pressure (algometry) at 2 months (SDM, 0.131; 95% CI, -0.178 to 0.440; P = .405). The study investigators reported no major adverse events. CONCLUSIONS AND PRACTICAL IMPLICATIONS Pain was reduced significantly in the group that received BoTN-A compared with the placebo group at 2 to 6 months but not at 4 to 6 weeks (with moderate quality of the evidence). Additional studies with larger numbers of participants are needed to confirm these results.
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Matak I, Lacković Z, Relja M. Botulinum toxin type A in motor nervous system: unexplained observations and new challenges. J Neural Transm (Vienna) 2016; 123:1415-1421. [PMID: 27586162 DOI: 10.1007/s00702-016-1611-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/25/2016] [Indexed: 12/16/2022]
Abstract
In the motor system, botulinum toxin type A (BoNT/A) actions were classically attributed to its well-known peripheral anticholinergic actions in neuromuscular junctions. However, the enzymatic activity of BoNT/A, assessed by the detection of cleaved synaptosomal-associated protein 25 (SNAP-25), was recently detected in motor and sensory regions of the brainstem and spinal cord after toxin peripheral injection in rodents. In sensory regions, the function of BoNT/A activity is associated with its antinociceptive effects, while in motor regions we only know that BoNT/A activity is present. Is it possible that BoNT/A presence in central motor nuclei is without any function? In this brief review, we analyze this question. Limited data available in the literature warrant further investigations of BoNT/A actions in motor nervous system.
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Affiliation(s)
- I Matak
- Department of Pharmacology, University of Zagreb School of Medicine, Šalata 11, 10000, Zagreb, Croatia.
| | - Z Lacković
- Department of Pharmacology, University of Zagreb School of Medicine, Šalata 11, 10000, Zagreb, Croatia
| | - M Relja
- Department of Neurology, Movement Disorders Centre, Clinical Medical Centre, University of Zagreb School of Medicine, Zagreb, Croatia
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Wu C, Xie N, Lian Y, Xu H, Chen C, Zheng Y, Chen Y, Zhang H. Central antinociceptive activity of peripherally applied botulinum toxin type A in lab rat model of trigeminal neuralgia. SPRINGERPLUS 2016; 5:431. [PMID: 27104119 PMCID: PMC4828356 DOI: 10.1186/s40064-016-2071-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 03/27/2016] [Indexed: 12/25/2022]
Abstract
Background BoNT-A is often used in the clinical treatment for movement disorders. In recent years, various clinical studies suggest that BoNT-A can effectively alleviate pain caused by trigeminal neuralgia (TN); however, its mechanism remains unclear. Methods In this study, we used a lab rat model for TN produced by chronic constriction injury of the infraorbital nerve (ION-CCI). Restrained rats were injected subcutaneously with BoNT-A into the whisker pad tissue (ipsilaterally to the nerve injury) 14 days after the ION-CCI. Allodynia was tested by Von Frey filaments and TRPs and cSNAP-25 were tested by western blot. Results Peripheral application of BoNT-A (3, 10 U/kg) significantly increased the pain threshold of ION-CCI rats. Rota-rod test showed that BoNT-A administration at doses tested did not significantly affect rat motor coordination. By probing for a specific marker for BoNT-A, cleaved synaptosomal-associated protein 25 (cSNAP-25), we found that peripheral application of BoNT-A (10 U/kg) affected brainstem Vc, which could be blocked by the axonal transport blocker colchicine. In addition, western blot analysis showed that in the Vc region of ION-CCI rats, the expression levels of TRPA1, TRPV1, TRPV2 and TRPM8 increased, whereas peripheral application of BoNT-A significantly lowered the high expression of TRPA1, TRPV1 and TRPV2, but not TRPM8 at 7 days after BoNT-A injection. Conclusions The finding of this study suggest that peripherally applied BoNT-A can produce antinociceptive effects in ION-CCI model. The underlying mechanisms may be BoNT-A acts on the Vc via axonal transport, inhibits the high expression of TRPA1, TRPV1 and TRPV2, and reduces central sensitization.
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Affiliation(s)
- Chuanjie Wu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Nanchang Xie
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Yajun Lian
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Hongliang Xu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Chen Chen
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Yake Zheng
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Yuan Chen
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Haifeng Zhang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
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Frisan T, Sebo P. Editorial: Why still study bacterial toxins in the third millennium? Pathog Dis 2016; 74:ftw009. [PMID: 26818621 DOI: 10.1093/femspd/ftw009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Teresa Frisan
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Sebo
- Laboratory of Molecular Biology of Bacterial Pathogens, Institute of Microbiology of the ASCR, v.v.i., Czech Academy of Sciences, Czech Republic
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