1
|
Homan M, Thomson M, Bontems P, Saccomani MD, Dias JA, Faraci S, Furlano R, Hojsak I, Ledder O, Slae M, Narula P, Nita AF, Norsa L, Oliva S, Papadopoulou A, Romano C, Rybak A, Spyropoulou V, Tambucci R, Tzivinikos C, van Wijk M, Borrelli O. Drugs in focus: Botulinum toxin in the therapy of gastrointestinal disorders in children. J Pediatr Gastroenterol Nutr 2024; 79:1096-1105. [PMID: 39315663 PMCID: PMC11615126 DOI: 10.1002/jpn3.12376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 08/10/2024] [Accepted: 09/05/2024] [Indexed: 09/25/2024]
Abstract
What is Known Botulinum toxin (BoNT) causes muscle relaxation by inhibiting acetylcholine release from presynaptic motor neurons at the neuromuscular junction. What is New In children with achalasia, BoNT can be considered only in patients in whom rapid weight gain is important to improve surgical outcomes. BoNT has been suggested for treating cricopharyngeal achalasia and delayed gastric emptying. Anal achalasia and constipation after Hirschsprung disease corrective surgery are very promising indications for BoNT use. In selected children with resistant type of functional constipation and chronic anal fissure, BoNT is a viable option for treating.
Collapse
Affiliation(s)
- Matjaž Homan
- Department of Gastroenterology, Hepatology, and Nutrition, University Children's Hospital, Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Mike Thomson
- Department of Paediatric GastroenterologySheffield Children's Hospital NHS FT and University of SheffieldSheffieldUK
| | - Patrick Bontems
- Paediatric Gastroenterology, Hôpital Universitaire des Enfants Reine FabiolaUniversité Libre de BruxellesBrusselsBelgium
| | | | - Jorge Amil Dias
- Department of GastroenterologyHospital LusíadasPortoPortugal
| | - Simona Faraci
- Gastroenterology and Nutrition UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Raoul Furlano
- Department of GastroenterologyUniversity Children's Hospital Basel (UKBB), University of BaselBaselSwitzerland
| | - Iva Hojsak
- Children's Hospital ZagrebUniversity of Zagreb Medical SchoolZagrebCroatia
| | - Oren Ledder
- Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical CenterHebrew University of JerusalemJerusalemIsrael
| | - Mordechai Slae
- Pediatric Gastroenterology, Hepatology and Nutrition UnitHadassah University HospitalJerusalemIsrael
| | - Priya Narula
- Department of Paediatric GastroenterologySheffield Children's Hospital NHS FT and University of SheffieldSheffieldUK
| | | | - Lorenzo Norsa
- Pediatric Department, Children's Hospital Vittore BuzziUniversity of MilanMilanItaly
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health DepartmentSapienza—University of RomeRomeItaly
| | - Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department of PediatricsUniversity of Athens, Children's Hospital Agia SofiaAthensGreece
| | - Claudio Romano
- Claudio Romano Pediatric Gastroenterology and Cystic Fibrosis UnitUniversity of MessinaMessinaItaly
| | - Anna Rybak
- Paediatric Gastroenterology DepartmentGreat Ormond Street HospitalLondonUK
| | - Vasiliki Spyropoulou
- Division of Gastroenterology, Hepatology and NutritionUniversity Children's Hospital ZurichZurichSwitzerland
| | - Renato Tambucci
- Gastroenterology and Nutrition UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Christos Tzivinikos
- Pediatric Gastroenterology Department, Al Jalila Children's Specialty HospitalMohammed Bin Rashid University of Medicine and Health SciencesDubaiUnited Arab Emirates
| | - Michiel van Wijk
- Emma Children's Hospital‐Amsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Osvaldo Borrelli
- Paediatric Gastroenterology DepartmentGreat Ormond Street HospitalLondonUK
| | | |
Collapse
|
2
|
Ezaizi Y, Hasan B, Manini ML, Absah I. Intrapyloric Botulinum Toxin A Injection for Gastroparesis and Functional Upper Gastrointestinal Symptoms in Children: Mayo Clinic Experience, Review of the Literature, and Meta-analysis. Paediatr Drugs 2022; 24:539-545. [PMID: 35768647 DOI: 10.1007/s40272-022-00518-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to assess the efficacy of intrapyloric botulinum toxin A injection (IPBTI) in children with and without gastroparesis and to perform a meta-analysis and review of the literature. METHODS We retrospectively searched our electronic health records to identify children (aged < 18 years) who underwent an esophagogastroduodenoscopy with IPBTI between 2007 and 2018 for persistent upper gastrointestinal tract symptoms. We included children with and without gastroparesis and excluded children with a history of gastrointestinal surgery, gastrointestinal obstruction, or mucosal disease that could explain their symptoms. A meta-analysis including our study findings was performed. RESULTS We identified 20 children (mean [standard deviation] age, 9.7 [5.8] years; 14 [70%] girls) with upper gastrointestinal symptoms who underwent IPBTI at our institution during the study period. Of the 20 children, 17 (85%) underwent gastric emptying scintigraphy, only nine (53%) of whom had gastroparesis. Response to IPBTI was reported in ten children (50%). Response to IPBTI did not differ by the presence of gastroparesis in included children (p = 0.64). Repeated IPBTI was performed in four children who had a response to the first injection; all four reported no benefit from the second IPBTI. There were no reported complications of IPBTI in our cohort. The meta-analysis indicated that 68% (95% confidence interval 59-78) of patients had a response to IPBTI, regardless of the presence of gastroparesis; 66% (95% confidence interval 53-78) of patients who had gastroparesis had a response to IPBTI. CONCLUSIONS Intrapyloric botulinum toxin A injection is safe in children and can offer transient relief for patients with refractory upper gastrointestinal symptoms with and without gastroparesis.
Collapse
Affiliation(s)
- Yamen Ezaizi
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. .,Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. .,Pediatric Gastroenterology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Bashar Hasan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Mhd Louai Manini
- Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Imad Absah
- Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
3
|
Marques ICDS, Minto SB, Marques MQ, Ribeiro J, Moraes PC, Sbragia Neto L, Garcia SB. Botulinum toxin as a treatment for short bowel syndrome in rats. Acta Cir Bras 2019; 34:e201900705. [PMID: 31531527 PMCID: PMC6756011 DOI: 10.1590/s0102-865020190070000005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/11/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose: The denervation of the intestine with benzalkonium chloride (BAC) reduces mortality and improves weight gain in rats with short bowel syndrome (SBS). Nevertheless, translating these promising findings from bench to bedside is not feasible because BAC promotes peritonitis and irreversible denervation which may be followed by an uncontrolled dilatation of the viscera. The use of botulinum toxin (BT) instead of BAC to achieve the denervation of the remaining small intestine in SBS could be an interesting option because it leads to a mild and transient denervation of the intestine. Methods: Here we evaluated the effects of the ileal denervation with BT in rats with SBS by verifying the body weight variation and intestinal morphological parameters. Four groups with 6 animals each were submitted to enterectomy with an ileal injection of saline (group E) or BT (group EBT). Control groups were submitted to simulated surgery with an ileal injection of BT (group BT) or saline (group C - control). Results: We observed that the treatment of the remaining ileum with BT completely reversed the weight loss associated to extensive small bowel resection. Conclusion: This may provide a new promising approach to the surgical treatment of SBS.
Collapse
Affiliation(s)
- Isabela Cristina de Souza Marques
- Fellow PhD degree, Postgraduate Program in Pathology, Department of Pathology and Legal Medicine, School of Medicine of Ribeirao Preto, Universidade de São Paulo (USP), Ribeirao Preto-SP, Brazil. Conception, design, and scientific content of the study
| | - Stefânia Bovo Minto
- Fellow PhD degree, Postgraduate Program in Pathology, Department of Pathology and Legal Medicine, School of Medicine of Ribeirao Preto, USP, Ribeirao Preto-SP, Brazil. Histopathological examinations, statistical analysis
| | - Mariane Quaglio Marques
- Graduate student, Department of Pathology and Legal Medicine, School of Medicine of Ribeirao Preto, USP, Ribeirao Preto-SP, Brazil. Design and scientific content of the study
| | - Juliana Ribeiro
- Fellow PhD degree, Postgraduate Program in Veterinary Surgery, Faculty of Veterinary Medicine, Universidade Estadual Paulista (UNESP), Jaboticabal-SP, Brazil. Design and scientific content of the study
| | - Paola Castro Moraes
- PhD, Assistant Professor, Faculty of Veterinary Medicine, UNESP, Jaboticabal-SP, Brazil. Conception, design, intellectual and scientific content of the study
| | - Lourenço Sbragia Neto
- PhD, Associated Professor, Department of Surgery and Anatomy, School of Medicine of Ribeirao Preto, USP, Sao Paulo-SP, Brazil. Conception, design, intellectual and scientific content of the study; critical revision
| | - Sérgio Britto Garcia
- PhD, Full Professor, Department of Pathology and Legal Medicine, School of Medicine of Ribeirao Preto, USP, Sao Paulo-SP, Brazil. Conception, design, intellectual and scientific content of the study; critical revision; final approval
| |
Collapse
|
4
|
Botulinum Toxin Type A-A Modulator of Spinal Neuron-Glia Interactions under Neuropathic Pain Conditions. Toxins (Basel) 2018; 10:toxins10040145. [PMID: 29614835 PMCID: PMC5923311 DOI: 10.3390/toxins10040145] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 03/27/2018] [Accepted: 03/30/2018] [Indexed: 12/29/2022] Open
Abstract
Neuropathic pain represents a significant clinical problem because it is a chronic condition often refractory to available therapy. Therefore, there is still a strong need for new analgesics. Botulinum neurotoxin A (BoNT/A) is used to treat a variety of clinical diseases associated with pain. Glia are in continuous bi-directional communication with neurons to direct the formation and refinement of synaptic connectivity. This review addresses the effects of BoNT/A on the relationship between glia and neurons under neuropathic pain. The inhibitory action of BoNT/A on synaptic vesicle fusion that blocks the release of miscellaneous pain-related neurotransmitters is known. However, increasing evidence suggests that the analgesic effect of BoNT/A is mediated through neurons and glial cells, especially microglia. In vitro studies provide evidence that BoNT/A exerts its anti-inflammatory effect by diminishing NF-κB, p38 and ERK1/2 phosphorylation in microglia and directly interacts with Toll-like receptor 2 (TLR2). Furthermore, BoNT/A appears to have no more than a slight effect on astroglia. The full activation of TLR2 in astroglia appears to require the presence of functional TLR4 in microglia, emphasizing the significant interaction between those cell types. In this review, we discuss whether and how BoNT/A affects the spinal neuron–glia interaction and reduces the development of neuropathy.
Collapse
|
5
|
Zhang M, Huang F, Wang G, Liu X, Wen J, Zhang X, Huang Y, Xia Y. Geographic distribution of cadmium and its interaction with the microbial community in the Longjiang River: risk evaluation after a shocking pollution accident. Sci Rep 2017; 7:227. [PMID: 28331217 PMCID: PMC5427973 DOI: 10.1038/s41598-017-00280-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/17/2017] [Indexed: 12/14/2022] Open
Abstract
A shocking Longjiang River cadmium pollution accident occurred in 2012, the effects of which on microbial communities remain unclear. Alkaline precipitation technology was applied for remediation, but concerns rose about the stability of this technology. To understand the geographic distribution of cadmium and its correlation with microbes, in this study, 39 water samples and 39 sludge samples from this river and 2 soil samples from the nearby farmland were collected for chemical and microbial analyses. The Cd concentrations of all water samples were lower than 0.005 mg/L and reached the quality standards for Chinese surface water. A ranking of sludge samples based on Cd contents showed sewage outfall > dosing sites > farmland, all of which were higher than the quality standard for soil. Alkaline precipitation technology was effective for Cd precipitation. Cd was unstable; it was constantly dissolving and being released from the sludge. The Cd content of each phase was mainly influenced by the total Cd content. Over 40,000 effective sequences were detected in each sample, and a total of 59,833 OTUs and 1,273 genera were found using Illumina MiSeq sequencing. Two phyla and 39 genera were notably positively correlated with the Cd distribution, while the cases of 10 phyla and 6 genera were the opposite.
Collapse
Affiliation(s)
- MingJiang Zhang
- National Engineering Laboratory of Biohydrometallurgy, General Research Institute for Nonferrous Metals, No. 2 Xinjiekouwai Street, Beijing, 100088, China
| | - FuKe Huang
- Institute of HeChi Scientific-Technical Information, No. 385 West Ring Road of HeChi City, GuangXi Zhuang Autonomous Region, 547000, China
| | - GuangYuan Wang
- National Engineering Laboratory of Biohydrometallurgy, General Research Institute for Nonferrous Metals, No. 2 Xinjiekouwai Street, Beijing, 100088, China
| | - XingYu Liu
- National Engineering Laboratory of Biohydrometallurgy, General Research Institute for Nonferrous Metals, No. 2 Xinjiekouwai Street, Beijing, 100088, China.
| | - JianKang Wen
- National Engineering Laboratory of Biohydrometallurgy, General Research Institute for Nonferrous Metals, No. 2 Xinjiekouwai Street, Beijing, 100088, China
| | - XiaoSheng Zhang
- Institute of HeChi Scientific-Technical Information, No. 385 West Ring Road of HeChi City, GuangXi Zhuang Autonomous Region, 547000, China
| | - YaoSi Huang
- Institute of HeChi Scientific-Technical Information, No. 385 West Ring Road of HeChi City, GuangXi Zhuang Autonomous Region, 547000, China
| | - Yu Xia
- National Engineering Laboratory of Biohydrometallurgy, General Research Institute for Nonferrous Metals, No. 2 Xinjiekouwai Street, Beijing, 100088, China
| |
Collapse
|