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Montisano DA, Giossi R, Canella M, Altamura C, Marcosano M, Vernieri F, Raggi A, Grazzi L. Reducing the Impact of Headache and Allodynia Score in Chronic Migraine: An Exploratory Analysis from the Real-World Effectiveness of Anti-CGRP Monoclonal Antibodies Compared to Onabotulinum Toxin A (RAMO) Study. Toxins (Basel) 2024; 16:178. [PMID: 38668603 PMCID: PMC11054793 DOI: 10.3390/toxins16040178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Chronic migraine (CM) is a disabling and hard-to-treat condition, associated with high disability and high cost. Among the preventive treatments, botulinum toxin A (BoNT-a) and monoclonal antibodies against the calcitonin gene-related protein (anti-CGRP mAbs) are the only disease-specific ones. The assessment of the disease burden is complex, and among others, tools such as the allodynia symptoms checklist (ASC-12) and headache impact test (HIT-6) are very useful. This exploratory study analysed the impact of these two therapies on migraine burden. METHODS The RAMO study was a multicentre, observational, retrospective investigation conducted in two headache centres: the Fondazione IRCCS Istituto Neurologico Carlo Besta (Milan) and the Fondazione Policlinico Campus Bio-Medico (Rome). This study involved patients with chronic migraine treated with mAbs or BoNT-A. We conducted a subgroup exploratory analysis on HIT-6 and ASC-12 scores in the two groups. The Wilcoxon rank-sum test, Fisher's exact test, and ANOVA were performed. RESULTS Of 126 patients, 36 on mAbs and 90 on BoNT-A had at least one available follow-up. mAbs resulted in a mean reduction of -11.1 and -11.4 points, respectively, in the HIT-6 at 6 and 12 months, while BoNT-A was reduced -3.2 and -3.6 points, respectively; the mAbs arm resulted in mean reductions in ASC-12 at 6 and 12 months of follow-up of -5.2 and -6.0 points, respectively, while BoNT-A showed lesser mean changes of -0.5 and -0.9 points, respectively. The adjusted analysis confirmed our results. CONCLUSIONS In this exploratory analysis, anti-CGRP mAbs showed superior effectiveness for HIT-6 and ASC12 compared to BoNT-A. Reductions in terms of month headache days (MHD), migraine disability assessment test (MIDAS), and migraine acute medications (MAM) were clinically relevant for both treatments.
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Affiliation(s)
- Danilo Antonio Montisano
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133 Milan, Italy
| | - Riccardo Giossi
- Poison Control Center and Clinical Pharmacology Unit, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Research and Clinical Development, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133 Milan, Italy
| | - Mattia Canella
- Department of Medical Biotechnology and Translational Medicine, Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, Via Vanvitelli, 32, 20129 Milan, Italy
- Neuroimmunology and Neuromuscular Disease Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - Claudia Altamura
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Marilena Marcosano
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Fabrizio Vernieri
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20131 Milan, Italy
| | - Licia Grazzi
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133 Milan, Italy
- SC Neuroalgologia–Centro Cefalee, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
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Guo X, Li T, Wang Y, Jin X. Sub-acute hypersensitive reaction to botulinum toxin type A following Covid-19 vaccination: Case report and literature review. Medicine (Baltimore) 2021; 100:e27787. [PMID: 34889230 PMCID: PMC8663829 DOI: 10.1097/md.0000000000027787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/29/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Botulinum toxin type A (BTA) is one of the most widely used injectable agents in cosmetic surgery. Corona virus disease 2019 (Covid-19) infection and vaccination, which can induce specific and nonspecific activation of the immune system, has been reported to induce delayed inflammatory reactions to previously injected hyaluronic acid fillers. However, there are no reports about the interaction between BTA and Covid-19. We aimed to report 2 sub-acute cases of allergic reactions to BTA in facial cosmesis following the Covid-19 vaccination. PATIENT CONCERN A 35-year-old and a 34-year-old female who has several previous BTA injections without any adverse effects experienced facial swelling, flu-like symptoms after BTA treatment following the Covid-19 vaccination. DIAGNOSE According to the typical clinical manifestation, a hypersensitive reaction to BTA was considered. INTERVENTION Corticosteroids and antihistamine were administered empirically. OUTCOMES The flu-like symptoms recovered over the next day, but the facial swelling gradually faded within 1 to 2 weeks. LESSONS A literature review was also conducted to summarize the hypersensitive actions to cosmesis related to Covid-19. We recommend BTA injection be administered at least 2 to 3 months after Covid-19 vaccination.
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Tiburtius C, Böthig R, Kowald B, Hirschfeld S, Thietje R. Can clinical and urodynamic parameters predict the occurrence of neutralizing antibodies in therapy failure of intradetrusor onabotulinumtoxin A injections in patients with spinal cord injury? BMC Urol 2020; 20:113. [PMID: 32741365 PMCID: PMC7397590 DOI: 10.1186/s12894-020-00683-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 07/23/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The aim of the study was to clarify whether clinical and/or urodynamic parameters could be used to infer the probability of neutralizing antibody (NAb) formation as a possible cause of therapy failure (non-response, NR) in patients with neurogenic detrusor overactivity (NDO) due to acquired spinal cord injury/disease (SCI/D) treated with intradetrusor botulinum neurotoxin A (BoNT-A) injections. METHODS A retrospective chart review was performed of all patients with SCI/D who underwent both intradetrusor onabotulinumtoxin A injections and the determination of neutralizing antibodies against BoNT-A between January 1, 2002, and December 31, 2018. NR was defined as urodynamically confirmed persistent or reappearing NDO. RESULTS A total of 2700 BoNT-A injections in 414 patients were ascertained. In 69 patients with primary NR after the first BoNT-A injection (n = 6) or with secondary NR after more than one BoNT-A injection (n = 63), an antibody analysis was performed. Antibody examination showed 36 (52.2%) negative, 5 (7.2%) borderline and 14 (each 20.3%) each of positive and highly positive values. Subgroup analysis indicated a correlation between NAb formation and the duration of BoNT-A therapy (p = 0.015), the mean number of BoNT-A injections (p = 0.011) and the time interval between BoNT-A applications (< 7 months, p = 0.022). Urodynamic data analysis indicate significant differences with cut-off values of MCC (< 225 ml, p = 0.038) and MDP (> 45 cmH2O, p = 0.040). However, in the regression analysis models, the predictive value for the occurrence of NAb was too low (MCC: ROC AUC 0.62, MDP: ROC AUC 0.52) to distinguish with sufficient certainty between NAb-positive and NAb-negative NR patients. CONCLUSIONS Despite significant correlations, clinical and urodynamic parameters are only partially suitable for predicting antibody formation against BoNT-A.
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Affiliation(s)
- Christian Tiburtius
- Centre for Spinal Injuries, Department Neuro-Urology, BG Trauma Hospital Hamburg, Bergedorfer Str. 10 Germany, 21033, Hamburg, Germany.
| | - Ralf Böthig
- Centre for Spinal Injuries, Department Neuro-Urology, BG Trauma Hospital Hamburg, Bergedorfer Str. 10 Germany, 21033, Hamburg, Germany
| | - Birgitt Kowald
- Biomechanical Laboratory, BG Trauma Hospital Hamburg, Hamburg, Germany
| | - Sven Hirschfeld
- Centre for Spinal Injuries, BG Trauma Hospital Hamburg, Hamburg, Germany
| | - Roland Thietje
- Centre for Spinal Injuries, BG Trauma Hospital Hamburg, Hamburg, Germany
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Matsumura T, Amatsu S, Misaki R, Yutani M, Du A, Kohda T, Fujiyama K, Ikuta K, Fujinaga Y. Fully Human Monoclonal Antibodies Effectively Neutralizing Botulinum Neurotoxin Serotype B. Toxins (Basel) 2020; 12:toxins12050302. [PMID: 32392791 PMCID: PMC7291131 DOI: 10.3390/toxins12050302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 01/12/2023] Open
Abstract
Botulinum neurotoxin (BoNT) is the most potent natural toxin known. Of the seven BoNT serotypes (A to G), types A, B, E, and F cause human botulism. Treatment of human botulism requires the development of effective toxin-neutralizing antibodies without side effects such as serum sickness and anaphylaxis. In this study, we generated fully human monoclonal antibodies (HuMAbs) against serotype B BoNT (BoNT/B1) using a murine–human chimera fusion partner cell line named SPYMEG. Of these HuMAbs, M2, which specifically binds to the light chain of BoNT/B1, showed neutralization activity in a mouse bioassay (approximately 10 i.p. LD50/100 µg of antibody), and M4, which binds to the C-terminal of heavy chain, showed partial protection. The combination of two HuMAbs, M2 (1.25 µg) and M4 (1.25 µg), was able to completely neutralize BoNT/B1 (80 i.p. LD50) with a potency greater than 80 i.p. LD50/2.5 µg of antibodies, and was effective both prophylactically and therapeutically in the mouse model of botulism. Moreover, this combination showed broad neutralization activity against three type B subtypes, namely BoNT/B1, BoNT/B2, and BoNT/B6. These data demonstrate that the combination of M2 and M4 is promising in terms of a foundation for new human therapeutics for BoNT/B intoxication.
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Affiliation(s)
- Takuhiro Matsumura
- Department of Bacteriology, Graduate School of Medical Sciences, Kanazawa University, Takara-machi, Kanazawa, Ishikawa 920-8640, Japan; (T.M.); (S.A.); (M.Y.)
| | - Sho Amatsu
- Department of Bacteriology, Graduate School of Medical Sciences, Kanazawa University, Takara-machi, Kanazawa, Ishikawa 920-8640, Japan; (T.M.); (S.A.); (M.Y.)
| | - Ryo Misaki
- Applied Microbiology Laboratory, International Center for Biotechnology, Osaka University, Yamadaoka, Suita, Osaka 565-0871, Japan; (R.M.); (K.F.)
| | - Masahiro Yutani
- Department of Bacteriology, Graduate School of Medical Sciences, Kanazawa University, Takara-machi, Kanazawa, Ishikawa 920-8640, Japan; (T.M.); (S.A.); (M.Y.)
| | - Anariwa Du
- Department of Virology, Center for Infectious Disease Control, Research Institute for Microbial Diseases, Osaka University, Yamadaoka, Suita, Osaka 565-0871, Japan; (A.D.); (K.I.)
| | - Tomoko Kohda
- Department of Veterinary Sciences, School of Life and Environmental Sciences, Osaka Prefecture University, Rinkuouraikita, Izumisano, Osaka 598-8531, Japan;
| | - Kazuhito Fujiyama
- Applied Microbiology Laboratory, International Center for Biotechnology, Osaka University, Yamadaoka, Suita, Osaka 565-0871, Japan; (R.M.); (K.F.)
| | - Kazuyoshi Ikuta
- Department of Virology, Center for Infectious Disease Control, Research Institute for Microbial Diseases, Osaka University, Yamadaoka, Suita, Osaka 565-0871, Japan; (A.D.); (K.I.)
- The Japan Science and Technology Agency/Japan International Cooperation Agency, Science and Technology Research Partnership for Sustainable Development, Tokyo 102-0076, Japan
| | - Yukako Fujinaga
- Department of Bacteriology, Graduate School of Medical Sciences, Kanazawa University, Takara-machi, Kanazawa, Ishikawa 920-8640, Japan; (T.M.); (S.A.); (M.Y.)
- Correspondence: ; Tel.: +81-76-265-2200
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Hefter H, Brauns R, Ürer B, Rosenthal D, Albrecht P. Effective long-term treatment with incobotulinumtoxin (Xeomin®) without neutralizing antibody induction: a monocentric, cross-sectional study. J Neurol 2020; 267:1340-1347. [PMID: 31960136 PMCID: PMC7184051 DOI: 10.1007/s00415-019-09681-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 11/25/2022]
Abstract
Background Among the spectrum of licensed botulinum neurotoxin preparations incobotulinumtoxin (incoBoNT/A; Xeomin®) is the only one which does not contain complex proteins. Therefore, incoBoNT/A has been suggested to have a low antigenicity, but precise estimations on incidence and prevalence of neutralizing antibody formation during long-term treatment are outstanding so far. Methods For the present cross-sectional study, 59 patients having exclusively been treated with incoBoNT/A (mono group) and 32 patients having been treated with other BoNT/A preparations less than nine times and who were then switched to at least 14 sessions of incoBoNT/A treatment (switch group) were recruited from one botulinum toxin outpatient clinic. Side effects and doses were extracted from the charts, and the efficacy of treatment was assessed by the patients using a visual analogue scale (0–100). The prevalence of neutralizing antibodies was tested by means of the mouse hemi-diaphragm assay (MHDA). Findings None of the patients in the mono and only two in the switch group had a positive MHDA-test. Across all indications and patients, mean improvement exceeded 67%. Improvement did not depend on age at onset, sex, change of dose or duration of treatment, but on disease entity. In patients with cervical dystonia, improvement was about the same in the mono and switch subgroup, but the last dose was different. Conclusions The present study confirms the low antigenicity of incoBoNT/A, which has immediate consequences for patient management, and the use of higher doses and shorter durations of reinjection intervals in botulinum toxin therapy.
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Affiliation(s)
- Harald Hefter
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Raphaela Brauns
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Beyza Ürer
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Dietmar Rosenthal
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
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Godakova SA, Noskov AN, Vinogradova ID, Ugriumova GA, Solovyev AI, Esmagambetov IB, Tukhvatulin AI, Logunov DY, Naroditsky BS, Shcheblyakov DV, Gintsburg AL. Camelid VHHs Fused to Human Fc Fragments Provide Long Term Protection Against Botulinum Neurotoxin A in Mice. Toxins (Basel) 2019; 11:E464. [PMID: 31394847 PMCID: PMC6723419 DOI: 10.3390/toxins11080464] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/29/2019] [Accepted: 08/02/2019] [Indexed: 12/11/2022] Open
Abstract
The bacterium Clostridium botulinum is the causative agent of botulism-a severe intoxication caused by botulinum neurotoxin (BoNT) and characterized by damage to the nervous system. In an effort to develop novel C. botulinum immunotherapeutics, camelid single-domain antibodies (sdAbs, VHHs, or nanobodies) could be used due to their unique structure and characteristics. In this study, VHHs were produced using phage display technology. A total of 15 different monoclonal VHHs were selected based on their comlementarity-determining region 3 (CDR3) sequences. Different toxin lethal dose (LD50) challenges with each selected phage clone were conducted in vivo to check their neutralizing potency. We demonstrated that modification of neutralizing VHHs with a human immunoglobulin G (IgG)1 Fc (fragment crystallizable) fragment (fusionbody, VHH-Fc) significantly increased the circulation time in the blood (up to 14 days). At the same time, VHH-Fc showed the protective activity 1000 times higher than monomeric form when challenged with 5 LD50. Moreover, VHH-Fcs remained protective even 14 days after antibody administration. These results indicate that this VHH-Fc could be used as an effective long term antitoxin protection against botulinum type A.
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Affiliation(s)
- Svetlana A Godakova
- Department of Genetics and Bacteria Molecular Biology, Gamaleya Research Center of Epidemiology and Microbiology, 18 Gamaleya Street, Moscow 123098, Russia
| | - Anatoly N Noskov
- Department of Bacteriology, Gamaleya Research Center of Epidemiology and Microbiology, 18 Gamaleya Street, Moscow 123098, Russia
| | - Irina D Vinogradova
- Department of Bacteriology, Gamaleya Research Center of Epidemiology and Microbiology, 18 Gamaleya Street, Moscow 123098, Russia
| | - Galina A Ugriumova
- Department of Bacteriology, Gamaleya Research Center of Epidemiology and Microbiology, 18 Gamaleya Street, Moscow 123098, Russia
| | - Andrey I Solovyev
- Department of Bacteriology, Gamaleya Research Center of Epidemiology and Microbiology, 18 Gamaleya Street, Moscow 123098, Russia
| | - Ilias B Esmagambetov
- Department of Genetics and Bacteria Molecular Biology, Gamaleya Research Center of Epidemiology and Microbiology, 18 Gamaleya Street, Moscow 123098, Russia
| | - Amir I Tukhvatulin
- Department of Medical Microbiology, Gamaleya Research Center of Epidemiology and Microbiology, 18 Gamaleya Street, Moscow 123098, Russia
| | - Denis Y Logunov
- Department of Medical Microbiology, Gamaleya Research Center of Epidemiology and Microbiology, 18 Gamaleya Street, Moscow 123098, Russia
| | - Boris S Naroditsky
- Department of Genetics and Bacteria Molecular Biology, Gamaleya Research Center of Epidemiology and Microbiology, 18 Gamaleya Street, Moscow 123098, Russia
| | - Dmitry V Shcheblyakov
- Department of Genetics and Bacteria Molecular Biology, Gamaleya Research Center of Epidemiology and Microbiology, 18 Gamaleya Street, Moscow 123098, Russia.
| | - Aleksandr L Gintsburg
- Department of Genetics and Bacteria Molecular Biology, Gamaleya Research Center of Epidemiology and Microbiology, 18 Gamaleya Street, Moscow 123098, Russia
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Kerscher M, Wanitphakdeedecha R, Trindade de Almeida A, Maas C, Frevert J. IncobotulinumtoxinA: A Highly Purified and Precisely Manufactured Botulinum Neurotoxin Type A. J Drugs Dermatol 2019; 18:52-57. [PMID: 30681794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aesthetic dermatologic applications of botulinum neurotoxin (BoNT), including treatment of glabellar lines, horizontal forehead lines, and crow’s feet, were the most common non-surgical cosmetic procedures in the US in 2017, with high levels of subject satisfaction. Since the first BoNT type A (BoNT-A) formulation was approved in 1989, the number of formulations available on the world’s commercial markets has increased and new approvals are expected. BoNT is produced by Clostridium botulinum in nature as part of a large protein complex. However, the unnecessary clostridial proteins, which dissociate from BoNT under physiological conditions with a half-life of <1 minute, have no role in clinical applications. Data demonstrate that BoNT administration can elicit an immunological response, leading to production of neutralizing antibodies that can be associated with reduced efficacy or treatment non-response. As repeat treatments are required to maintain efficacy, clinicians should be aware of the possibility of antibody development and choose a BoNT with the lowest risk of immunogenicity. IncobotulinumtoxinA is manufactured using advanced technology to precisely isolate the pure BoNT without unnecessary clostridial proteins, and with low immunogenicity and high specific activity. In incobotulinumtoxinA clinical studies, no previously BoNT-naïve subjects developed neutralizing antibodies, and there was no secondary non-response to incobotulinumtoxinA treatment. Here we review the role of unnecessary clostridial proteins in BoNT-A and discuss the unique incobotulinumtoxinA manufacturing and purification process with a focus on the implications for use in aesthetic medicine. J Drugs Dermatol. 2019;18(1):52-57.
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Tam CC, Flannery AR, Cheng LW. A Rapid, Sensitive, and Portable Biosensor Assay for the Detection of Botulinum Neurotoxin Serotype A in Complex Food Matrices. Toxins (Basel) 2018; 10:toxins10110476. [PMID: 30445734 PMCID: PMC6266793 DOI: 10.3390/toxins10110476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 12/14/2022] Open
Abstract
Botulinum neurotoxin (BoNT) intoxication can lead to the disease botulism, characterized by flaccid muscle paralysis that can cause respiratory failure and death. Due to the significant morbidity and mortality costs associated with BoNTs high toxicity, developing highly sensitive, rapid, and field-deployable assays are critically important to protect the nation’s food supply against either accidental or intentional contamination. We report here that the B-cell based biosensor assay CANARY® (Cellular Analysis and Notification of Antigen Risks and Yields) Zephyr detects BoNT/A holotoxin at limits of detection (LOD) of 10.0 ± 2.5 ng/mL in assay buffer. Milk matrices (whole milk, 2% milk and non-fat milk) with BoNT/A holotoxin were detected at similar levels (7.4–7.9 ng/mL). BoNT/A complex was positive in carrot, orange, and apple juices at LODs of 32.5–75.0 ng/mL. The detection of BoNT/A complex in solid complex foods (ground beef, smoked salmon, green bean baby puree) ranged from 14.8 ng/mL to 62.5 ng/mL. Detection of BoNT/A complex in the viscous liquid egg matrix required dilution in assay buffer and gave a LOD of 171.9 ± 64.7 ng/mL. These results show that the CANARY® Zephyr assay can be a highly useful qualitative tool in environmental and food safety surveillance programs.
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Affiliation(s)
- Christina C Tam
- Foodborne Toxin Detection and Prevention Research Unit, Western Regional Research Center, Agricultural Research Services, United States Department of Agriculture, 800 Buchanan Street, Albany, CA 94710, USA.
| | | | - Luisa W Cheng
- Foodborne Toxin Detection and Prevention Research Unit, Western Regional Research Center, Agricultural Research Services, United States Department of Agriculture, 800 Buchanan Street, Albany, CA 94710, USA.
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Li M, Lee D, Obi CR, Freeberg JK, Farr-Jones S, Tomic MT. An ambient temperature-stable antitoxin of nine co-formulated antibodies for botulism caused by serotypes A, B and E. PLoS One 2018; 13:e0197011. [PMID: 29746518 PMCID: PMC5944936 DOI: 10.1371/journal.pone.0197011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/24/2018] [Indexed: 12/11/2022] Open
Abstract
Safe and effective antitoxins to treat and prevent botulism are needed for biodefense. We have developed recombinant antibody-based therapeutics for botulinum neurotoxin (BoNT) serotypes A, B, and E. The mechanism of action of this antitoxin requires that three mAbs bind one toxin molecule to achieve clearance. Here we present a co-formulation of an antitoxin to the three most important serotypes. Combining these antibodies obviates the need to identify the serotype causing intoxication prior to drug administration, which would facilitate administration. The lyophilized powder formulation contains nine mAbs, three mAbs for each of the three serotypes (A, B, E). The formulation was stored as a liquid and lyophilized powder for up to one year, and characterized by binding affinity and multiple physicochemical methods. No significant increase in soluble higher order aggregates, cleavage products, or change in charge isoforms was measured after storage as a lyophilized powder at 50°C for one year. Furthermore, toxin-domain binding ELISA data indicated that each of the individual antibodies in the lyophilized drug product showed essentially full binding capability to their respective toxin domains after being stored at 50°C for one year. Physicochemical characterization of the formulation demonstrated the nine individual mAbs were remarkably stable. This work demonstrates feasibility of lyophilized, oligoclonal antibody therapies for biodefense with ambient temperature stability, that would facilitate stockpiling, distribution, and administration.
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Affiliation(s)
- Mingxiang Li
- XOMA Corp., Berkeley, CA, United States of America
| | - Dennis Lee
- XOMA Corp., Berkeley, CA, United States of America
| | - Chidi R. Obi
- XOMA Corp., Berkeley, CA, United States of America
| | | | - Shauna Farr-Jones
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, United States of America
| | - Milan T. Tomic
- XOMA Corp., Berkeley, CA, United States of America
- * E-mail:
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Garcia-Ruiz PJ, Sanz-Cartagena P, Martinez-Castrillo JC, Ares-Pensado B, Aviles-Olmos I, Blazquez-Estrada M, Fanjul-Arbos S, Garcia-Caldentey J, Gazulla J, Gutierrez-Garcia J, Huete-Anton B, Lucas-Rodenas C, Luquin MR, Martinez-Torres I, Medialdea-Natera P, Mendoza-Rodriguez A, Mir-Rivera P, Posada IJ, Ruiz-Martinez J, Sanchez-Alonso P, Trejo-Gabriel Y Galan JM, Vela L, Pena-Segura JL. [Myths and evidence on the use of botulinum toxin: neuropharmacology and dystonia]. Rev Neurol 2018; 66:163-172. [PMID: 29480513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Botulinum toxin type A (BTA) is a bacterial endotoxin, whose therapeutic use has had a dramatic impact on different neurological disorders, such as dystonia and spasticity. AIM To analyze and summarize different questions about the use of BTA in our clinical practice. DEVELOPMENT A group of experts in neurology developed a list of topics related with the use of BTA. Two groups were considered: neuropharmacology and dystonia. A literature search at PubMed, mainly for English language articles published up to June 2016 was performed. The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt. The initial draft was reviewed by the expert panel members to allow modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated. Different questions about diverse aspects of neuropharmacology, such as mechanism of action, bioequivalence of the different preparations, immunogenicity, etc. were included. Regarding dystonia, the document included questions about methods of evaluation, cervical dystonia, blepharospasm, etc. CONCLUSION This review does not pretend to be a guide, but rather a tool for continuous training of residents and specialists in neurology, about different specific areas of the management of BTA.
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Affiliation(s)
| | - P Sanz-Cartagena
- Hospital de Mataro. Consorci Sanitari del Maresme, 08304 Mataro, Espana
| | | | - B Ares-Pensado
- Hospital Clinico de Santiago de Compostela, 15706 Santiago de Compostela, Espana
| | - I Aviles-Olmos
- Hospital Universitario Ramon y Cajal, 28034 Madrid, Espana
| | | | | | | | - J Gazulla
- HUMS. Hospital Universitario Miguel Servet, Zaragoza, Espana
| | | | | | - C Lucas-Rodenas
- Hospital Universitario Virgen de la Arrixaca, Murcia, Espana
| | - M R Luquin
- Clinica Universitaria de Navarra, 31008 Pamplona, Espana
| | | | | | | | - P Mir-Rivera
- Hospitales Universitarios Virgen del Rocio, 41013 Sevilla, Espana
| | - I J Posada
- Hospital Universitario 12 de Octubre, Madrid, Espana
| | | | - P Sanchez-Alonso
- Hospital Universitario Puerta de Hierro-Majadahonda, 28035 Majadahonda, Espana
| | | | - L Vela
- Hospital Universitario Fundacion Alcorcon, 28922 Alcorcon, Espana
| | - J L Pena-Segura
- HUMS. Hospital Universitario Miguel Servet, 50009 Zaragoza, Espana
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11
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Yu CH, Song DH, Choi JY, Joe HE, Jeong WH, Hur GH, Shin YK, Jeong ST. A mutated recombinant subunit vaccine protects mice and guinea pigs against botulinum type A intoxication. Hum Vaccin Immunother 2018; 14:329-336. [PMID: 29140753 PMCID: PMC5806659 DOI: 10.1080/21645515.2017.1405201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/17/2017] [Accepted: 11/09/2017] [Indexed: 02/08/2023] Open
Abstract
Botulinum neurotoxins (BoNTs) are the most potent toxins to mammals. A toxoid vaccine was previously used for prevention of botulinum intoxication; however, this vaccine is no longer available. Currently, no approved botulinum vaccines are available from the Food and Drug Administration (FDA). Recently, a recombinant host cell receptor-binding subunit created for use as a potential vaccine completed phase 2 clinical trials. The current study designed a vaccine candidate against BoNT type A (BoNT/A) using a structural design. Our vaccine candidate was the BoNT/A heavy chain C-terminal region (HCR) that contained the point mutation BA15 (R1269A) within the ganglioside-binding site. A Biacore affinity test showed that the affinity of BA15 for ganglioside GT1b was 100 times lower than that of the HCR. A SNAP25 cleavage assay revealed that immunized sera blocked SNAP25 cleavage of the BoNT/A toxin via BA15. In an in vivo experiment, mice and guinea pigs immunized with BA15 produced neutralizing antibodies that protected against 3,000 LD50 of BoNT/A. In conclusion, the results of both in vitro and in vivo assays showed that our BA15 vaccine candidate was similar to the recombinant host cell receptor-binding subunit vaccine. The inability of BA15to bind ganglioside shows that BA15 is a potential safe vaccine candidate.
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Affiliation(s)
- Chi Ho Yu
- Agency for Defense Development, Yuseong, Daejeon, Republic of Korea
| | - Dong Hyun Song
- Agency for Defense Development, Yuseong, Daejeon, Republic of Korea
| | - Jun Young Choi
- Abion R&D Institute, Hanhwa Biz-Metro, Guro-gu, Seoul, Republic of Korea
| | - Hae Eun Joe
- Agency for Defense Development, Yuseong, Daejeon, Republic of Korea
| | - Woo Hyeon Jeong
- Agency for Defense Development, Yuseong, Daejeon, Republic of Korea
| | - Gyeung Haeng Hur
- Agency for Defense Development, Yuseong, Daejeon, Republic of Korea
| | - Young Kee Shin
- Department of Pharmacy, College of Pharmacy, Seoul National University, Dajeon, Seoul, Republic of Korea
| | - Seong Tae Jeong
- Agency for Defense Development, Yuseong, Daejeon, Republic of Korea
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12
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Miethe S, Mazuet C, Liu Y, Tierney R, Rasetti-Escargueil C, Avril A, Frenzel A, Thullier P, Pelat T, Urbain R, Fontayne A, Sesardic D, Hust M, Popoff MR. Development of Germline-Humanized Antibodies Neutralizing Botulinum Neurotoxin A and B. PLoS One 2016; 11:e0161446. [PMID: 27560688 PMCID: PMC4999263 DOI: 10.1371/journal.pone.0161446] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/07/2016] [Indexed: 12/20/2022] Open
Abstract
Botulinum neurotoxins (BoNTs) are counted among the most toxic substances known and are responsible for human botulism, a life-threatening disease characterized by flaccid muscle paralysis that occurs naturally by food poisoning or colonization of the gastrointestinal tract by BoNT-producing clostridia. To date, 7 serologically distinct serotypes of BoNT (serotype A-G) are known. Due to the high toxicity of BoNTs the Centers for Disease Control and Prevention (CDC) have classified BoNTs as category A agent, including the six biological agents with the highest potential risk of use as bioweapons. Well tolerated antibodies neutralizing BoNTs are required to deal with the potential risk. In a previous work, we described the development of scFv and scFv-Fc (Yumab) from macaque origin (Macaca fascicularis) neutralizing BoNT/A and B by targeting the heavy and light chain of each serotype. In the present study, we humanized the macaque antibodies SEM120-IIIC1 (anti-BoNT/A light chain), A1HC38 (anti-BoNT/A heavy chain), BLC3 (anti-BoNT/B light chain) and B2-7 (anti-BoNT/B heavy chain) by germline-humanization to obtain a better potential immunotolerance in humans. We increased the Germinality Index (GI) of SEM120-IIIC1 to 94.5%, for A1HC38, to 95% for BLC3 and to 94.4% for B2-7. Furthermore, the neutralization efficacies of the germline-humanized antibodies were analyzed in lethal and non-lethal in vivo mouse assays as full IgG. The germline-humanized IgGs hu8SEM120-IIIC1, hu8A1HC38, hu8BLC3 and hu8B2-7 were protective in vivo, when anti-heavy and anti-light chain antibodies were combined. The synergistic effect and high humanness of the selected IgGs makes them promising lead candidates for further clinical development.
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Affiliation(s)
- Sebastian Miethe
- Technische Universität Braunschweig, Institut für Biochemie, Biotechnologie und Bioinformatik, Abteilung Biotechnologie, Braunschweig, Germany
| | - Christelle Mazuet
- Institut Pasteur, Unité des Bactéries anaérobies et Toxines, Paris, France
| | - Yvonne Liu
- National Institute for Biological Standards and Control (NIBSC), Division of Bacteriology, Potters Bar, United Kingdom
| | - Robert Tierney
- National Institute for Biological Standards and Control (NIBSC), Division of Bacteriology, Potters Bar, United Kingdom
| | - Christine Rasetti-Escargueil
- National Institute for Biological Standards and Control (NIBSC), Division of Bacteriology, Potters Bar, United Kingdom
| | - Arnaud Avril
- Institut de Recherche Biomédicale des Armées (IRBA) Département des Maladies Infectieuses, Unité Interaction Hôte-Pathogène, Brétigny-sur-Orge, France
| | - André Frenzel
- Technische Universität Braunschweig, Institut für Biochemie, Biotechnologie und Bioinformatik, Abteilung Biotechnologie, Braunschweig, Germany
| | - Philippe Thullier
- Institut de Recherche Biomédicale des Armées (IRBA) Département des Maladies Infectieuses, Unité Interaction Hôte-Pathogène, Brétigny-sur-Orge, France
| | - Thibaut Pelat
- Institut de Recherche Biomédicale des Armées (IRBA) Département des Maladies Infectieuses, Unité Interaction Hôte-Pathogène, Brétigny-sur-Orge, France
| | - Remi Urbain
- LFB Biotechnologies, Therapeutic Innovation Department, Lille, France
| | | | - Dorothea Sesardic
- National Institute for Biological Standards and Control (NIBSC), Division of Bacteriology, Potters Bar, United Kingdom
| | - Michael Hust
- Technische Universität Braunschweig, Institut für Biochemie, Biotechnologie und Bioinformatik, Abteilung Biotechnologie, Braunschweig, Germany
- * E-mail: (MRP); (MH)
| | - Michel Robert Popoff
- Institut Pasteur, Unité des Bactéries anaérobies et Toxines, Paris, France
- * E-mail: (MRP); (MH)
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Taysse L, Daulon S, Calvet J, Delamanche S, Hilaire D, Bellier B, Breton P. Induction of Acute Lung Injury after Intranasal Administration of Toxin Botulinum A Complex. Toxicol Pathol 2016; 33:336-42. [PMID: 15814363 DOI: 10.1080/01926230590922884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The inhalation of aerozolized botulinum toxin may represent a potential significant hazard to both military and civilian personnel. Since the lung is the primary target organ for inhaled toxin, the investigation reported herein was conducted to examine lung function in mice exposed to botulinum toxin A complex by intranasal route. Data includes lethality, symptomatology, measurement of respiratory function (minute ventilation, respiratory frequency, and tidal volume), and histopathology of the lungs. The clinical signs of intoxication are similar to those observed in foodborne botulism. Plethysmography revealed severe impairment of all respiratory parameters tested from 7 hours postexposure. Severe lung lesions, possibly secondary to the intoxication, were observed in mice who survived 14 days after the toxin challenge. These included intra-alveolar hemorrhage and interstitial edema. Mice immunized by the pentavalent (ABCDE) toxoid were protected against the neurotoxin (4 LD50) as revealed by the decrease of lethality and severity of nervous signs of intoxication, but not against histopathological changes in the lungs. These effects are nonspecific and require further experiments in order to specify the relationships between the pathology and the inflammatory process in the lung due to mediators such as cytokines, and possibly permanent physiological sequelae.
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Affiliation(s)
- L Taysse
- Centre d'Etudes du Bouchet (Defense Research Center) BP No. 3, 91710 Vert le Petit France.
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14
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Cheng LW, Henderson TD, Lam TI, Stanker LH. Use of Monoclonal Antibodies in the Sensitive Detection and Neutralization of Botulinum Neurotoxin Serotype B. Toxins (Basel) 2015; 7:5068-78. [PMID: 26633496 PMCID: PMC4690113 DOI: 10.3390/toxins7124863] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/06/2015] [Accepted: 11/12/2015] [Indexed: 02/06/2023] Open
Abstract
Botulinum neurotoxins (BoNT) are some of nature’s most potent toxins. Due to potential food contamination, and bioterrorism concerns, the development of detection reagents, therapeutics and countermeasures are of urgent interest. Recently, we have developed a sensitive electrochemiluminescent (ECL) immunoassay for BoNT/B, using monoclonal antibodies (mAbs) MCS6-27 and anti-BoNT/B rabbit polyclonal antibodies as the capture and detector. The ECL assay detected as little as 1 pg/mL BoNT/B in the buffer matrix, surpassing the detection sensitivities of the gold standard mouse bioassays. The ECL assay also allowed detection of BoNT/B in sera matrices of up to 100% sera with negligible matrix effects. This highly-sensitive assay allowed the determination of the biological half-lives of BoNT/B holotoxin in vivo. We further tested the toxin neutralization potential of our monoclonal antibodies using the mouse systemic and oral intoxication models. A combination of mAbs protected mice in both pre- and post-exposure models to lethal doses of BoNT/B. MAbs were capable of increasing survival of animals when administered even 10 h post-intoxication in an oral model, suggesting a likely time for BoNT/B complexes to reach the blood stream. More sensitive detection assays and treatments against BoNT intoxication will greatly enhance efforts to combat botulism.
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Affiliation(s)
- Luisa W Cheng
- Foodborne Toxin Detection and Prevention Research Unit, Western Regional Research Center, Agricultural Research Service, United States Department of Agriculture, Albany, CA 94710, USA.
| | - Thomas D Henderson
- Foodborne Toxin Detection and Prevention Research Unit, Western Regional Research Center, Agricultural Research Service, United States Department of Agriculture, Albany, CA 94710, USA.
| | - Tina I Lam
- Gilead Sciences, Inc., Foster City, CA 94404, USA.
| | - Larry H Stanker
- Foodborne Toxin Detection and Prevention Research Unit, Western Regional Research Center, Agricultural Research Service, United States Department of Agriculture, Albany, CA 94710, USA.
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15
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Simon S, Fiebig U, Liu Y, Tierney R, Dano J, Worbs S, Endermann T, Nevers MC, Volland H, Sesardic D, Dorner MB. Recommended Immunological Strategies to Screen for Botulinum Neurotoxin-Containing Samples. Toxins (Basel) 2015; 7:5011-34. [PMID: 26703727 PMCID: PMC4690110 DOI: 10.3390/toxins7124860] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 12/16/2022] Open
Abstract
Botulinum neurotoxins (BoNTs) cause the life-threatening neurological illness botulism in humans and animals and are divided into seven serotypes (BoNT/A–G), of which serotypes A, B, E, and F cause the disease in humans. BoNTs are classified as “category A” bioterrorism threat agents and are relevant in the context of the Biological Weapons Convention. An international proficiency test (PT) was conducted to evaluate detection, quantification and discrimination capabilities of 23 expert laboratories from the health, food and security areas. Here we describe three immunological strategies that proved to be successful for the detection and quantification of BoNT/A, B, and E considering the restricted sample volume (1 mL) distributed. To analyze the samples qualitatively and quantitatively, the first strategy was based on sensitive immunoenzymatic and immunochromatographic assays for fast qualitative and quantitative analyses. In the second approach, a bead-based suspension array was used for screening followed by conventional ELISA for quantification. In the third approach, an ELISA plate format assay was used for serotype specific immunodetection of BoNT-cleaved substrates, detecting the activity of the light chain, rather than the toxin protein. The results provide guidance for further steps in quality assurance and highlight problems to address in the future.
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Affiliation(s)
- Stéphanie Simon
- CEA Saclay, Institute of Biology and Technologies of Saclay, Laboratory for Immunoanalytical Researches, Gif-sur-Yvette 91191 cedex, France.
| | - Uwe Fiebig
- Biological Toxins, Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Seestrasse 10, 13353 Berlin, Germany.
| | - Yvonne Liu
- Division of Bacteriology, National Institute for Biological Standards and Control, a Centre of Medicines & Healthcare Products Regulatory Agency, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK.
| | - Rob Tierney
- Division of Bacteriology, National Institute for Biological Standards and Control, a Centre of Medicines & Healthcare Products Regulatory Agency, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK.
| | - Julie Dano
- CEA Saclay, Institute of Biology and Technologies of Saclay, Laboratory for Immunoanalytical Researches, Gif-sur-Yvette 91191 cedex, France.
| | - Sylvia Worbs
- Biological Toxins, Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Seestrasse 10, 13353 Berlin, Germany.
| | - Tanja Endermann
- Biological Toxins, Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Seestrasse 10, 13353 Berlin, Germany.
| | - Marie-Claire Nevers
- CEA Saclay, Institute of Biology and Technologies of Saclay, Laboratory for Immunoanalytical Researches, Gif-sur-Yvette 91191 cedex, France.
| | - Hervé Volland
- CEA Saclay, Institute of Biology and Technologies of Saclay, Laboratory for Immunoanalytical Researches, Gif-sur-Yvette 91191 cedex, France.
| | - Dorothea Sesardic
- Division of Bacteriology, National Institute for Biological Standards and Control, a Centre of Medicines & Healthcare Products Regulatory Agency, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK.
| | - Martin B Dorner
- Biological Toxins, Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Seestrasse 10, 13353 Berlin, Germany.
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Ravichandran E, Janardhanan P, Patel K, Riding S, Cai S, Singh BR. In Vivo Toxicity and Immunological Characterization of Detoxified Recombinant Botulinum Neurotoxin Type A. Pharm Res 2015; 33:639-52. [PMID: 26530460 DOI: 10.1007/s11095-015-1816-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/26/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE A double-mutant E224A/E262A full-length botulinum neurotoxin (BoNT) Type A with structural similarity to native BoNT/A but lacking the endopeptidase activity provides an ideal surrogate for testing pharmacokinetics and immunochemical characteristics of BoNT. METHODS We determined lethality (LD50) of deactivated recombinant botulinum neurotoxin (drBoNT/A) to be 24.0 μg by intraperitoneal route (i.p). The polypeptide drBoNT/A labeled with near infra-red dye 800 (NIR 800) was used to examine its distribution to different organs using whole body imaging when administered to mice via intravenous (i.v) or i.p route. Also, drBoNT/A was used to evaluate its immunogenicity in Balb/C mice model. RESULTS drBoNT/A was found to be highly immunogenic when tested under various in vivo conditions in Balb/C mice model. For the first time we have demonstrated that a full length 150 kDa drBoNT/A, by administering via inhalation route in mice model, has evoked both circulating immunoglobulin levels of IgG and secretory IgA at the mucosal surface. The immunoglobulin levels were sufficient enough to protect against the challenge dose of native BoNT toxin in mice model. Tissue distribution of drBoNT/A seems to be similar to that of native toxin. CONCLUSIONS Based on the characteristics described in this report this nontoxic holotoxin protein will assist us to explore the window of opportunity available for therapeutic treatment in case of unnatural poisoning, and also it can be an effective vaccine candidate.
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Affiliation(s)
- Easwaran Ravichandran
- Department of Chemistry and Biochemistry, University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, Massachusetts, 02747, USA
- Aurobindo Pharma USA Inc, 6 Wheeling Road, Dayton, New Jersey, 08810, USA
| | - Pavithra Janardhanan
- Department of Chemistry and Biochemistry, University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, Massachusetts, 02747, USA
| | - Kruti Patel
- Department of Chemistry and Biochemistry, University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, Massachusetts, 02747, USA
| | - Stephen Riding
- Department of Chemistry and Biochemistry, University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, Massachusetts, 02747, USA
| | - Shuowei Cai
- Department of Chemistry and Biochemistry, University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, Massachusetts, 02747, USA
| | - Bal Ram Singh
- Department of Chemistry and Biochemistry, University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, Massachusetts, 02747, USA.
- Botulinum Research Center, Institute of Advanced Sciences, Dartmouth, Massachusetts, 02747, USA.
- Prime Bio, Inc., Dartmouth, Massachusetts, 02747, USA.
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Fan Y, Dong J, Lou J, Wen W, Conrad F, Geren IN, Garcia-Rodriguez C, Smith TJ, Smith LA, Ho M, Pires-Alves M, Wilson BA, Marks JD. Monoclonal Antibodies that Inhibit the Proteolytic Activity of Botulinum Neurotoxin Serotype/B. Toxins (Basel) 2015; 7:3405-23. [PMID: 26343720 PMCID: PMC4591640 DOI: 10.3390/toxins7093405] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/10/2015] [Accepted: 08/18/2015] [Indexed: 12/19/2022] Open
Abstract
Existing antibodies (Abs) used to treat botulism cannot enter the cytosol of neurons and bind to botulinum neurotoxin (BoNT) at its site of action, and thus cannot reverse paralysis. However, Abs targeting the proteolytic domain of the toxin could inhibit the proteolytic activity of the toxin intracellularly and potentially reverse intoxication, if they could be delivered intracellularly. As such, antibodies that neutralize toxin activity could serve as potent inhibitory cargos for therapeutic antitoxins against botulism. BoNT serotype B (BoNT/B) contains a zinc endopeptidase light chain (LC) domain that cleaves synaoptobrevin-2, a SNARE protein responsible for vesicle fusion and acetylcholine vesicle release. To generate monoclonal Abs (mAbs) that could reverse paralysis, we targeted the protease domain for Ab generation. Single-chain variable fragment (scFv) libraries from immunized mice or humans were displayed on yeast, and 19 unique BoNT/B LC-specific mAbs isolated by fluorescence-activated cell sorting (FACS). The equilibrium dissociation constants (KD) of these mAbs for BoNT/B LC ranged from 0.24 nM to 14.3 nM (mean KD 3.27 nM). Eleven mAbs inhibited BoNT/B LC proteolytic activity. The fine epitopes of selected mAbs were identified by alanine-scanning mutagenesis, revealing that inhibitory mAbs bound near the active site, substrate-binding site or the extended substrate-binding site. The results provide mAbs that could prove useful for intracellular reversal of paralysis and identify epitopes that could be targeted by small molecules inhibitors.
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Affiliation(s)
- Yongfeng Fan
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco General Hospital, Room 3C-38, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
| | - Jianbo Dong
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco General Hospital, Room 3C-38, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
| | - Jianlong Lou
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco General Hospital, Room 3C-38, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
| | - Weihua Wen
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco General Hospital, Room 3C-38, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
| | - Fraser Conrad
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco General Hospital, Room 3C-38, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
| | - Isin N Geren
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco General Hospital, Room 3C-38, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
| | - Consuelo Garcia-Rodriguez
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco General Hospital, Room 3C-38, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
| | - Theresa J Smith
- Molecular and Translational Sciences Division, United States Army Medical Institute of Infectious Diseases, Fort Detrick, MD 21702, USA.
| | - Leonard A Smith
- Medical Countermeasures Technology, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702-5011, USA.
| | - Mengfei Ho
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | - Melissa Pires-Alves
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | - Brenda A Wilson
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | - James D Marks
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco General Hospital, Room 3C-38, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
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Aun MV, Chung TM, Santos KS, Battistella LMR, Rizzo LV, Kalil J, Giavina-Bianchi P. Is age associated with the development of antibodies against botulinum toxin? Allergol Immunopathol (Madr) 2013; 41:276-9. [PMID: 23031658 DOI: 10.1016/j.aller.2012.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 05/07/2012] [Accepted: 05/17/2012] [Indexed: 11/29/2022]
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Mukherjee J, McCann C, Ofori K, Hill J, Baldwin K, Shoemaker CB, Harrison P, Tzipori S. Sheep monoclonal antibodies prevent systemic effects of botulinum neurotoxin A1. Toxins (Basel) 2013; 4:1565-81. [PMID: 23342681 PMCID: PMC3528263 DOI: 10.3390/toxins4121565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Botulinum neurotoxin (BoNT) is responsible for causing botulism, a potentially fatal disease characterized by paralysis of skeletal muscle. Existing specific treatments include polyclonal antisera derived from immunized humans or horses. Both preparations have similar drawbacks, including limited supply, risk of adverse effects and batch to batch variation. Here, we describe a panel of six highly protective sheep monoclonal antibodies (SMAbs) derived from sheep immunized with BoNT/A1 toxoid (SMAbs 2G11, 4F7) or BoNT/A1 heavy chain C-terminus (HcC) (SMAbs 1G4, 5E2, 5F7, 16F9) with or without subsequent challenge immunization with BoNT/A1 toxin. Although each SMAb bound BoNT/A1 toxin, differences in specificity for native and recombinant constituents of BoNT/A1 were observed. Structural differences were suggested by pI (5E2 = 8.2; 2G11 = 7.1; 4F7 = 8.8; 1G4 = 7.4; 5F7 = 8.0; 16F9 = 5.1). SMAb protective efficacy vs. 10,000 LD50 BoNT/A1 was evaluated using the mouse lethality assay. Although not protective alone, divalent and trivalent combinations of SMabs, IG4, 5F7 and/or 16F9 were highly protective. Divalent combinations containing 0.5–4 μg/SMAb (1–8 μg total SMAb) were 100% protective against death with only mild signs of botulism observed; relative efficacy of each combination was 1G4 + 5F7 > 1G4 + 16F9 >> 5F7 + 16F9. The trivalent combination of 1G4 + 5F7 + 16F9 at 0.25 μg/SMAb (0.75 μg total SMAb) was 100% protective against clinical signs and death. These results reflect levels of protective potency not reported previously.
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Affiliation(s)
- Jean Mukherjee
- Tufts Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
| | - Chase McCann
- Tufts Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
| | - Kwasi Ofori
- Tufts Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
| | | | - Karen Baldwin
- Tufts Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
| | | | | | - Saul Tzipori
- Tufts Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-508-839-7955; Fax: +1-508-839-7911
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Cheng LW, Stanker LH. Detection of botulinum neurotoxin serotypes A and B using a chemiluminescent versus electrochemiluminescent immunoassay in food and serum. J Agric Food Chem 2013; 61:755-60. [PMID: 23265581 PMCID: PMC3598631 DOI: 10.1021/jf3041963] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Botulinum neurotoxins (BoNTs) are some of the most potent biological toxins. High-affinity monoclonal antibodies (mAbs) have been developed for the detection of BoNT serotypes A and B using a chemiluminescent capture enzyme-linked immunosorbent assay (ELISA). In an effort to improve toxin detection levels in complex matrices such as food and sera, we evaluated the performance of existing antitoxin mAbs using a new electrochemiluminescence (ECL) immunoassay platform developed by Meso Scale Discovery. In side-by-side comparisons, the limits of detection (LODs) observed for ELISA and the ECL immunoassay for BoNT/A were 12 and 3 pg/mL, and for BoNT/B, they were 17 and 13 pg/mL, respectively. Both the ELISA and the ECL method were more sensitive than the "gold standard" mouse bioassay. The ECL assay outperformed ELISA in detection sensitivity in most of the food matrices fortified with BoNT/A and in some foods spiked with BoNT/B. Both the ELISA and the ECL immunoassay platforms are fast, simple alternatives for use in the routine detection of BoNTs in food and animal sera.
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Affiliation(s)
- Luisa W. Cheng
- Corresponding author (L.W.C.) Tel: 510-559-6337; Fax: 510-559-5880; ; (L.H.S)
| | - Larry H. Stanker
- Corresponding author (L.W.C.) Tel: 510-559-6337; Fax: 510-559-5880; ; (L.H.S)
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21
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Titov AA, Shilenko IV, Morozov AA, Iarkov SP, Zlobin VN. [Development and optimization of immunoassays for the detection of botulinum toxins]. Prikl Biokhim Mikrobiol 2012; 48:249-256. [PMID: 22586920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Monoparametric immunoassay tests for detecting botulinum toxins types A and B and multiparametric assays for simultaneous detection of botulinum toxins type A and B have been developed. It is shown that the sensitivity of assays is affected by the size of nanoparticles of colloidal gold used as a marker of antibodies, load intensity of antibodies of colloidal gold in conjugates, the type of analytical membranes, as well as the chemical composition of buffer solutions used for the storage of conjugates and immunoassay analysis. The detection limit of monoparametric immunoassay tests is 0.5 ng/ml; that of multiparametric assays, 5.0 ng/ml. The developed immunoassay can be used for rapid assay of product quality, for grade control of botulinum toxins in pharmaceuticals, and environmental monitoring.
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22
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Zhao H, Nakamura K, Kohda T, Mukamoto M, Kozaki S. Characterization of the monoclonal antibody response to botulinum neurotoxin type A in the complexed and uncomplexed forms. Jpn J Infect Dis 2012; 65:138-145. [PMID: 22446121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Clostridium botulinum produces large complex toxins, which include botulinum neurotoxin (BoNT) and auxiliary non-toxic proteins. We prepared monoclonal antibodies (mAbs) from mice that were immunized several times with BoNT/A after basal immunization with toxoid. We then examined the reactivities of these mAbs to BoNT and toxoid and showed that some mAbs reacted to only BoNT. This result indicates that the antigenicity of BoNT/A partially disappeared with formalin treatment. Some mAbs that specifically recognized either BoNT/A1 or BoNT/A2 were considered useful as detection antibodies specific for the BoNT/A subtype. Results of a neutralizing test with mAbs against either BoNT/A1 or BoNT/A2 showed that neutralizing antibody recognition sites were present in the light chain, heavy chain (N-terminal half), and heavy chain (C-terminal half) domains. Investigation of the different binding capabilities of the mAbs to BoNT and the complex toxin by immunoprecipitation suggested that the light chain of BoNT is exposed at the molecular surface of the complex toxin since there was no difference in the binding of light chain-specific mAb to BoNT and the complex toxin. The heavy chain is related to BoNT binding to non-toxic components, because the reactivity of the heavy chain to some mAbs was influenced by non-toxic components.
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Affiliation(s)
- Haiyang Zhao
- Department of Veterinary Science, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka 598-8531, Japan
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23
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Atassi MZ, Jankovic J, Steward LE, Aoki KR, Dolimbek BZ. Molecular immune recognition of botulinum neurotoxin B. The light chain regions that bind human blocking antibodies from toxin-treated cervical dystonia patients. Antigenic structure of the entire BoNT/B molecule. Immunobiology 2011; 217:17-27. [PMID: 21962573 DOI: 10.1016/j.imbio.2011.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 08/15/2011] [Accepted: 08/21/2011] [Indexed: 11/18/2022]
Abstract
We recently mapped the regions on the heavy (H) chain of botulinum neurotoxin, type B (BoNT/B) recognized by blocking antibodies (Abs) from cervical dystonia (CD) patients who develop immunoresistance during toxin treatment. Since blocking could also be effected by Abs directed against regions on the light (L) chain, we have mapped here the L chain, using the same 30 CD antisera. We synthesized, purified and characterized 32 19-residue L chain peptides that overlapped successively by 5 residues (peptide L32 overlapped with peptide N1 of the H chain by 12 residues). In a given patient, Abs against the L chain seemed less intense than those against H chain. Most sera recognized a limited set of L chain peptides. The levels of Abs against a given region varied with the patient, consistent with immune responses to each epitope being under separate MHC control. The peptides most frequently recognized were: L13, by 30 of 30 antisera (100%); L22, by 23 of 30 (76.67%); L19, by 15 of 30 (50.00%); L26, by 11 of 30 (36.70%); and L14, by 12 of 30 (40.00%). The activity of L14 probably derives from its overlap with L13. The levels of Ab binding decreased in the following order: L13 (residues 169-187), L22 (295-313), L19 (253-271), and L26 (351-369). Peptides L12 (155-173), L18 (239-257), L15 (197-215), L1 (1-19) and L23 (309-327) exhibited very low Ab binding. The remaining peptides had little or no Ab-binding activity. The antigenic regions are analyzed in terms of their three-dimensional locations and the enzyme active site. With the previous localization of the antigenic regions on the BoNT/B H chain, the human Ab recognition of the entire BoNT/B molecule is presented and compared to the recognition of BoNT/A by human blocking Abs.
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MESH Headings
- Amino Acid Sequence
- Animals
- Antibodies, Bacterial/blood
- Antibodies, Bacterial/chemistry
- Antibodies, Bacterial/immunology
- Antibodies, Blocking/blood
- Antibodies, Blocking/genetics
- Antibodies, Blocking/immunology
- Binding Sites, Antibody/genetics
- Binding Sites, Antibody/immunology
- Botulinum Toxins/administration & dosage
- Botulinum Toxins/blood
- Botulinum Toxins/chemistry
- Botulinum Toxins/immunology
- Botulinum Toxins, Type A/blood
- Botulinum Toxins, Type A/chemistry
- Botulinum Toxins, Type A/immunology
- Clostridium botulinum/chemistry
- Clostridium botulinum/immunology
- Epitope Mapping
- Humans
- Immune Sera/immunology
- Immunity, Humoral
- Mice
- Mice, Inbred ICR
- Molecular Sequence Data
- Neurotoxins/administration & dosage
- Neurotoxins/blood
- Neurotoxins/chemistry
- Neurotoxins/immunology
- Peptide Fragments/chemistry
- Peptide Fragments/immunology
- Peptide Fragments/metabolism
- Protein Binding/genetics
- Protein Binding/immunology
- Torticollis/blood
- Torticollis/drug therapy
- Torticollis/genetics
- Torticollis/immunology
- Treatment Failure
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Affiliation(s)
- M Zouhair Atassi
- Verna and Marrs Mclean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX 77030, United States.
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Atassi MZ, Deitiker PR. Does Clostridium botulinum neurotoxin A exhibit molecular mimicry with thyroid autoantigens and cause thyroid complications in predisposed persons? Endocrine 2011; 40:140-1; author reply 142-3. [PMID: 21541651 DOI: 10.1007/s12020-011-9481-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Adekar SP, Segan AT, Chen C, Bermudez R, Elias MD, Selling BH, Kapadnis BP, Simpson LL, Simon PM, Dessain SK. Enhanced neutralization potency of botulinum neurotoxin antibodies using a red blood cell-targeting fusion protein. PLoS One 2011; 6:e17491. [PMID: 21399689 PMCID: PMC3047547 DOI: 10.1371/journal.pone.0017491] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 02/03/2011] [Indexed: 01/17/2023] Open
Abstract
Botulinum neurotoxin (BoNT) potently inhibits cholinergic signaling at the neuromuscular junction. The ideal countermeasures for BoNT exposure are monoclonal antibodies or BoNT antisera, which form BoNT-containing immune complexes that are rapidly cleared from the general circulation. Clearance of opsonized toxins may involve complement receptor-mediated immunoadherence to red blood cells (RBC) in primates or to platelets in rodents. Methods of enhancing immunoadherence of BoNT-specific antibodies may increase their potency in vivo. We designed a novel fusion protein (FP) to link biotinylated molecules to glycophorin A (GPA) on the RBC surface. The FP consists of an scFv specific for murine GPA fused to streptavidin. FP:mAb:BoNT complexes bound specifically to the RBC surface in vitro. In a mouse model of BoNT neutralization, the FP increased the potency of single and double antibody combinations in BoNT neutralization. A combination of two antibodies with the FP gave complete neutralization of 5,000 LD50 BoNT in mice. Neutralization in vivo was dependent on biotinylation of both antibodies and correlated with a reduction of plasma BoNT levels. In a post-exposure model of intoxication, FP:mAb complexes gave complete protection from a lethal BoNT/A1 dose when administered within 2 hours of toxin exposure. In a pre-exposure prophylaxis model, mice were fully protected for 72 hours following administration of the FP:mAb complex. These results demonstrate that RBC-targeted immunoadherence through the FP is a potent enhancer of BoNT neutralization by antibodies in vivo.
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Affiliation(s)
- Sharad P. Adekar
- Lankenau Institute for Medical Research,
Wynnewood, Pennsylvania, United States of America
- Immunome, Inc., Wynnewood, Pennsylvania,
United States of America
- Augmenta Biologicals, LLC, Wynnewood,
Pennsylvania, United States of America
| | - Andrew T. Segan
- Lankenau Institute for Medical Research,
Wynnewood, Pennsylvania, United States of America
| | - Cindy Chen
- Lankenau Institute for Medical Research,
Wynnewood, Pennsylvania, United States of America
| | - Rodney Bermudez
- Immunome, Inc., Wynnewood, Pennsylvania,
United States of America
| | - M. D. Elias
- Division of Infectious Diseases and
Environmental Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania,
United States of America
| | - Bernard H. Selling
- Impact Biologicals, Inc. Wallingford,
Pennsylvania, United States of America
| | - B. P. Kapadnis
- Department of Microbiology, University of
Pune, Pune, India
| | - Lance L. Simpson
- Division of Infectious Diseases and
Environmental Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania,
United States of America
| | - Paul M. Simon
- Augmenta Biologicals, LLC, Wynnewood,
Pennsylvania, United States of America
- * E-mail: (SKD); (PMS)
| | - Scott K. Dessain
- Lankenau Institute for Medical Research,
Wynnewood, Pennsylvania, United States of America
- * E-mail: (SKD); (PMS)
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Gregoric E, Gregoric JA, Guarneri F, Benvenga S. Injections of Clostridium botulinum neurotoxin A may cause thyroid complications in predisposed persons based on molecular mimicry with thyroid autoantigens. Endocrine 2011; 39:41-7. [PMID: 21061092 DOI: 10.1007/s12020-010-9410-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 10/04/2010] [Indexed: 12/21/2022]
Abstract
A woman with Hashimoto's thyroiditis, under replacement L-T4, repeatedly experienced, over a 10-year period, elevations of serum TSH after eyelid injections of Clostridium botulinum neurotoxin A (Btx). We hypothesized a link between Btx injections and TSH elevations via molecular mimicry, and aimed to verify our hypothesis. Using an in silico approach, we searched first for amino acid sequence homology between Btx and thyroid autoantigens, and next for HLA binding motifs within homologous segments. We found that (i) Btx and thyroid autoantigens share amino acid sequence homology; (ii) some homologous regions contain epitopes of both Btx and thyroid autoantigens; (iii) some of such regions contain HLA-DR3 and/or HLA-DR7 binding motifs, which predominate over other HLA-DRs. This is relevant because the patient's HLA-DR haplotype was DR3/DR7. In conclusion, clinical and bioinformatics data suggest a possible pathogenetic link between Btx and autoimmune thyroid diseases. Considering the wide and increasing medical and dermocosmetic use of Btx, and the frequently subclinical course of autoimmune thyroid diseases, we think that thyroid "complications" may pass frequently undetected in Btx-treated persons.
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Affiliation(s)
- Edvina Gregoric
- Department of Nuclear Medicine, Hospital Izola, Izola, Slovenia
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27
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Staats HF, Fielhauer JR, Thompson AL, Tripp AA, Sobel AE, Maddaloni M, Abraham SN, Pascual DW. Mucosal targeting of a BoNT/A subunit vaccine adjuvanted with a mast cell activator enhances induction of BoNT/A neutralizing antibodies in rabbits. PLoS One 2011; 6:e16532. [PMID: 21304600 PMCID: PMC3029387 DOI: 10.1371/journal.pone.0016532] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 12/17/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We previously reported that the immunogenicity of Hcβtre, a botulinum neurotoxin A (BoNT/A) immunogen, was enhanced by fusion to an epithelial cell binding domain, Ad2F, when nasally delivered to mice with cholera toxin (CT). This study was performed to determine if Ad2F would enhance the nasal immunogenicity of Hcβtre in rabbits, an animal model with a nasal cavity anatomy similar to humans. Since CT is not safe for human use, we also tested the adjuvant activity of compound 48/80 (C48/80), a mast cell activating compound previously determined to safely exhibit nasal adjuvant activity in mice. METHODS New Zealand White or Dutch Belted rabbits were nasally immunized with Hcβtre or Hcβtre-Ad2F alone or combined with CT or C48/80, and serum samples were tested for the presence of Hcβtre-specific binding (ELISA) or BoNT/A neutralizing antibodies. RESULTS Hcβtre-Ad2F nasally administered with CT induced serum anti-Hcβtre IgG ELISA and BoNT/A neutralizing antibody titers greater than those induced by Hcβtre + CT. C48/80 provided significant nasal adjuvant activity and induced BoNT/A-neutralizing antibodies similar to those induced by CT. CONCLUSIONS Ad2F enhanced the nasal immunogenicity of Hcβtre, and the mast cell activator C48/80 was an effective adjuvant for nasal immunization in rabbits, an animal model with a nasal cavity anatomy similar to that in humans.
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Affiliation(s)
- Herman F Staats
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, United States of America.
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28
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Kenis VM, Baindurashvili AG, Dovbeshko AG, Korol'kova TN, Ivanov AM, Stepanova IA, Protasov OV. [Botulinum toxine treatment and the formation of antibodies to botulotoxin in patients with cerebral palsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2011; 111:48-51. [PMID: 22027670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim of the study was to search for the association between efficacy of botulinum treatment (dysport) and the formation of antibodies to botulinum toxin in children with cerebral palsy (CP). Fourteen children with CP received dysport, 42 children (29 with CP and 13 patients with paresises of other etiologies) were not treated with this drug. No association between the presence of antibodies in blood serum and efficacy of treatment was found. However, further research of the role of antibody genesis as a factor influencing the formation of reaction to treatment is needed.
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29
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Atassi MZ, Dolimbek BZ, Jankovic J, Steward LE, Aoki KR. Regions of botulinum neurotoxin A light chain recognized by human anti-toxin antibodies from cervical dystonia patients immunoresistant to toxin treatment. The antigenic structure of the active toxin recognized by human antibodies. Immunobiology 2010; 216:782-92. [PMID: 21281977 DOI: 10.1016/j.imbio.2010.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 12/15/2010] [Accepted: 12/19/2010] [Indexed: 11/16/2022]
Abstract
This work was aimed at determining the BoNT/A L-chain antigenic regions recognized by blocking antibodies in human antisera from cervical dystonia patients who had become immunoresistant to BoNT/A treatment. Antisera from 28 immunoresistant patients were analyzed for binding to each of 32 overlapping synthetic peptides that spanned the entire L-chain. A mixture of the antisera showed that antibodies bound to three peptides, L11 (residues 141-159), L14 (183-201) and L18 (239-257). When mapped separately, the antibodies were bound only by a limited set of peptides. No peptide bound antibodies from all the patients and amounts of antibodies bound to a given peptide varied with the patient. Peptides L11, L14 and L18 were recognized predominantly. A small but significant number of patients had antibodies to peptides L27 (365-383) and L29 (379-397). Other peptides were recognized at very low and perhaps insignificant antibody levels by a minority (15% or less) of patients or had no detectable antibody with any of the sera. In the 3-dimensional structure, antibody-binding regions L11, L14 and L18 of the L-chain occupy surface areas and did not correlate with electrostatic potential, hydrophilicity/hydrophobicity, or temperature factor. These three antigenic regions reside in close proximity to the belt of the heavy chain. The regions L11 and L18 are accessible in both the free light chain and the holotoxin forms, while L14 appears to be less accessible in the holotoxin. Antibodies against these regions could prevent delivery of the L-chain into the neurons by inhibition of the translocation.
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Affiliation(s)
- M Zouhair Atassi
- Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX 77030, USA.
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30
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Prigent J, Mazuet C, Boquet D, Lamourette P, Volland H, Popoff MR, Créminon C, Simon S. Production and characterisation of a neutralising chimeric antibody against botulinum neurotoxin A. PLoS One 2010; 5:e13245. [PMID: 20967241 PMCID: PMC2953832 DOI: 10.1371/journal.pone.0013245] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 09/07/2010] [Indexed: 12/28/2022] Open
Abstract
Botulinum neurotoxins, produced by Clostridium botulinum bacteria, are the causative agent of botulism. This disease only affects a few hundred people each year, thus ranking it among the orphan diseases. However, botulinum toxin type A (BoNT/A) is the most potent toxin known to man. Due to their potency and ease of production, these toxins were classified by the Centers for Disease Control and Prevention (CDC) as Category A biothreat agents. For several biothreat agents, like BoNT/A, passive immunotherapy remains the only possible effective treatment allowing in vivo neutralization, despite possible major side effects. Recently, several mouse monoclonal antibodies directed against a recombinant fragment of BoNT/A were produced in our laboratory and most efficiently neutralised the neurotoxin. In the present work, the most powerful one, TA12, was selected for chimerisation. The variable regions of this antibody were thus cloned and fused with the constant counterparts of human IgG1 (kappa light and gamma 1 heavy chains). Chimeric antibody production was evaluated in mammalian myeloma cells (SP2/0-Ag14) and insect cells (Sf9). After purifying the recombinant antibody by affinity chromatography, the biochemical properties of chimeric and mouse antibody were compared. Both have the same very low affinity constant (close to 10 pM) and the chimeric antibody exhibited a similar capacity to its parent counterpart in neutralising the toxin in vivo. Its strong affinity and high neutralising potency make this chimeric antibody interesting for immunotherapy treatment in humans in cases of poisoning, particularly as there is a probable limitation of the immunological side effects observed with classical polyclonal antisera from heterologous species.
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Affiliation(s)
- Julie Prigent
- CEA, iBiTec-S, Service de Pharmacologie et d'Immunoanalyse, CEA Saclay, Gif sur Yvette, France
| | - Christelle Mazuet
- Unité des Toxines et des Bactéries Anaérobies, Institut Pasteur, Paris, France
| | - Didier Boquet
- CEA, iBiTec-S, Service de Pharmacologie et d'Immunoanalyse, CEA Saclay, Gif sur Yvette, France
| | - Patricia Lamourette
- CEA, iBiTec-S, Service de Pharmacologie et d'Immunoanalyse, CEA Saclay, Gif sur Yvette, France
| | - Hervé Volland
- CEA, iBiTec-S, Service de Pharmacologie et d'Immunoanalyse, CEA Saclay, Gif sur Yvette, France
| | - Michel R. Popoff
- Unité des Toxines et des Bactéries Anaérobies, Institut Pasteur, Paris, France
| | - Christophe Créminon
- CEA, iBiTec-S, Service de Pharmacologie et d'Immunoanalyse, CEA Saclay, Gif sur Yvette, France
| | - Stéphanie Simon
- CEA, iBiTec-S, Service de Pharmacologie et d'Immunoanalyse, CEA Saclay, Gif sur Yvette, France
- * E-mail:
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31
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Sattler G. Current and future botulinum neurotoxin type A preparations in aesthetics: a literature review. J Drugs Dermatol 2010; 9:1065-1071. [PMID: 20865836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Botulinum neurotoxin type A (BTX-A) preparations are well established for cosmetic use. BTX-A inhibits the release of acetylcholine, resulting in temporary muscle paralysis, which has been utilized successfully to treat glabellar frown lines, periorbital wrinkles and other facial enhancement procedures. Two BTX-A products are approved for aesthetic procedures in the United States (U.S.) and Europe, and a next generation of preparations free from complexing proteins has recently been approved in Germany. Despite established efficacy profiles, concerns remain regarding the propensity for immunogenic reactions, which can lead to premature loss of effect and secondary therapy failure. NT 201 is a BTX-A preparation that is free from complexing proteins and is in the advanced stages of aesthetic development. Pivotal clinical studies in therapeutic indications demonstrate noneriority and comparable safety of NT 201 to another available BTX-A preparation. This article reviews the pharmacologic and clinical profiles of BTX-A preparations currently available and in development. Novel BTX-A preparations may offer advantages over existing products in terms of handling and immunogenicity.
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Kalb SR, Garcia-Rodriguez C, Lou J, Baudys J, Smith TJ, Marks JD, Smith LA, Pirkle JL, Barr JR. Extraction of BoNT/A, /B, /E, and /F with a single, high affinity monoclonal antibody for detection of botulinum neurotoxin by Endopep-MS. PLoS One 2010; 5:e12237. [PMID: 20808925 PMCID: PMC2923190 DOI: 10.1371/journal.pone.0012237] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 07/24/2010] [Indexed: 11/19/2022] Open
Abstract
Botulinum neurotoxins (BoNTs) are extremely potent toxins that are capable of causing respiratory failure leading to long-term intensive care or death. The best treatment for botulism includes serotype-specific antitoxins, which are most effective when administered early in the course of the intoxication. Early confirmation of human exposure to any serotype of BoNT is an important public health goal. In previous work, we focused on developing Endopep-MS, a mass spectrometry-based endopeptidase method for detecting and differentiating the seven serotypes (BoNT/A-G) in buffer and BoNT/A, /B, /E, and /F (the four serotypes that commonly affect humans) in clinical samples. We have previously reported the success of antibody-capture to purify and concentrate BoNTs from complex matrices, such as clinical samples. However, to check for any one of the four serotypes of BoNT/A, /B, /E, or /F, each sample is split into 4 aliquots, and tested for the specific serotypes separately. The discovery of a unique monoclonal antibody that recognizes all four serotypes of BoNT/A, /B, /E and /F allows us to perform simultaneous detection of all of them. When applied in conjunction with the Endopep-MS assay, the detection limit for each serotype of BoNT with this multi-specific monoclonal antibody is similar to that obtained when using other serotype-specific antibodies.
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Affiliation(s)
- Suzanne R. Kalb
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Consuelo Garcia-Rodriguez
- Department of Anesthesia and Pharmaceutical Chemistry, University of California San Francisco, San Francisco, California, United States of America
| | - Jianlong Lou
- Department of Anesthesia and Pharmaceutical Chemistry, University of California San Francisco, San Francisco, California, United States of America
| | - Jakub Baudys
- Battelle Memorial Institute at the Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Theresa J. Smith
- Integrated Toxicology, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), Ft. Detrick, Maryland, United States of America
| | - James D. Marks
- Department of Anesthesia and Pharmaceutical Chemistry, University of California San Francisco, San Francisco, California, United States of America
| | - Leonard A. Smith
- Integrated Toxicology, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), Ft. Detrick, Maryland, United States of America
| | - James L. Pirkle
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John R. Barr
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
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Lawrence I, Moy R. An evaluation of neutralizing antibody induction during treatment of glabellar lines with a new US formulation of botulinum neurotoxin type A. Aesthet Surg J 2009; 29:S66-71. [PMID: 19945007 DOI: 10.1016/j.asj.2009.09.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 08/31/2009] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The induction of neutralizing antibodies during the aesthetic application of botulinum neurotoxin type A is rare, but of potential clinical concern. Phase III studies of a new US formulation of botulinum neurotoxin type A, Dysport (BoNTA-ABO [abobotulinumtoxinA]; Medicis Aesthetics, Scottsdale, AZ), have not identified any cases of neutralizing antibody formation during the treatment of glabellar lines in patients who received up to nine treatments. OBJECTIVE To provide an in-depth analysis of the potential for induction of neutralizing antibodies in the study population enrolled in phase III trials of BoNTA-ABO in the treatment of glabellar lines. METHODS First and last available serum samples from patients in the BoNTA-ABO Glabellar Lines Development Program were screened for BoNTA-ABO antibodies with a radioimmunoprecipitation assay (RIPA), followed by a confirmatory competitive assay (RIPA-C). Confirmed RIPA-C-positive samples were further evaluated for the presence of neutralizing antibodies using a mouse protection assay (MPA), a highly specific bioassay for neutralizing antibodies. We conducted safety and efficacy evaluations, including day 30 responder rate (a rating of no or mild glabellar lines) and duration of response in the last treatment cycle. RESULTS Of 1554 patients who received at least one BoNTA-ABO treatment (10 units at five injection points, for a total dose of 50 units/treatment; range one to nine treatments), five (0.32%) were antibody positive on the RIPA-C assay-two at baseline and three at the last treatment cycle. None of the RIPA-C-positive samples tested positive for neutralizing antibodies upon further evaluation using the highly specific MPA. Of note, the RIPA-C-positive group had a responder rate of 100% and a mean response of 103.3 days, while the RIPA-C-negative group had a responder rate of 90% and a mean response of 89.4 days. The safety of BoNTA-ABO did not appear to be altered in the RIPA-C-positive group. CONCLUSIONS At the dose and treatment interval used in the correction of glabellar lines, induction of neutralizing antibodies to BoNTA-ABO was not observed. None of the five samples that initially gave positive results in a RIPA-C assay were positive when further evaluated using the MPA. Clinically, RIPA-C-positive status did not correlate with any reduction in efficacy or an altered safety profile, although the small numbers prevent definitive conclusions. These data suggest that the five RIPA-C-positive samples represented false positives.
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Affiliation(s)
- Ira Lawrence
- Medicis Pharmaceutical Corporation, Scottsdale, AZ, USA
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Monheit GD, Cohen JL. Long-term safety of repeated administrations of a new formulation of botulinum toxin type A in the treatment of glabellar lines: interim analysis from an open-label extension study. J Am Acad Dermatol 2009; 61:421-5. [PMID: 19577326 DOI: 10.1016/j.jaad.2009.03.049] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 03/12/2009] [Accepted: 03/21/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND A new formulation of botulinum toxin type A (BoNT-A) (Dysport) has recently been approved in the United States for the treatment of glabellar lines. OBJECTIVE We sought to evaluate the long-term safety of repeated administrations of this BoNT-A formulation. METHODS In all, 768 individuals (1500 planned) from phase III clinical trials received as many as 6 repeated treatments of open-label BoNT-A (50 U) over 17 months, with a minimum of 85 days between treatments. Participants received a telephone call at day 7 postinjection to check for adverse event (AE), with clinical evaluations on days 14 and 30, and monthly until retreatment, study completion, or early termination. Safety end points were AEs, changes in vital signs, and assessment of serum-neutralizing antibodies to BoNT-A. RESULTS Of the 285 participants reporting at least one treatment-emergent AE at the interim analysis cutoff, only 74 (26%) reported at least one possibly or probably related event after 2259 treatments with BoNT-A. The incidence of treatment-emergent AEs around the injection sites and eyes was low (< or = 3%). Ten participants (1%) experienced 10 instances of ptosis. No participants developed neutralizing antibodies to BoNT-A or clinically significant changes in vital signs. LIMITATIONS This is an interim analysis of a larger multicenter extension study. CONCLUSIONS Multiple treatments with BoNT-A (50 U) over 17 months were well tolerated.
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Affiliation(s)
- Gary D Monheit
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Kalb SR, Lou J, Garcia-Rodriguez C, Geren IN, Smith TJ, Moura H, Marks JD, Smith LA, Pirkle JL, Barr JR. Extraction and inhibition of enzymatic activity of botulinum neurotoxins/A1, /A2, and /A3 by a panel of monoclonal anti-BoNT/A antibodies. PLoS One 2009; 4:e5355. [PMID: 19399171 PMCID: PMC2670495 DOI: 10.1371/journal.pone.0005355] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 03/25/2009] [Indexed: 11/18/2022] Open
Abstract
Botulinum neurotoxins (BoNTs) are extremely potent toxins that are capable of causing death or respiratory failure leading to long-term intensive care. Treatment includes serotype-specific antitoxins, which must be administered early in the course of the intoxication. Rapidly determining human exposure to BoNT is an important public health goal. In previous work, our laboratory focused on developing Endopep-MS, a mass spectrometry-based endopeptidase method for detecting and differentiating BoNT/A–G serotypes in buffer and BoNT/A, /B, /E, and /F in clinical samples. We have previously reported the effectiveness of antibody-capture to purify and concentrate BoNTs from complex matrices, such as clinical samples. Because some antibodies inhibit or neutralize the activity of BoNT, the choice of antibody with which to extract the toxin is critical. In this work, we evaluated a panel of 16 anti-BoNT/A monoclonal antibodies (mAbs) for their ability to inhibit the in vitro activity of BoNT/A1, /A2, and /A3 complex as well as the recombinant LC of A1. We also evaluated the same antibody panel for the ability to extract BoNT/A1, /A2, and /A3. Among the mAbs, there were significant differences in extraction efficiency, ability to extract BoNT/A subtypes, and inhibitory effect on BoNT catalytic activity. The mAbs binding the C-terminal portion of the BoNT/A heavy chain had optimal properties for use in the Endopep-MS assay.
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Affiliation(s)
- Suzanne R. Kalb
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Atlanta, Georgia, United States of America
| | - Jianlong Lou
- Department of Anesthesia and Pharmaceutical Chemistry, University of California at San Francisco, San Francisco General Hospital, San Francisco, California, United States of America
| | - Consuelo Garcia-Rodriguez
- Department of Anesthesia and Pharmaceutical Chemistry, University of California at San Francisco, San Francisco General Hospital, San Francisco, California, United States of America
| | - Isin N. Geren
- Department of Anesthesia and Pharmaceutical Chemistry, University of California at San Francisco, San Francisco General Hospital, San Francisco, California, United States of America
| | - Theresa J. Smith
- Integrated Toxicology, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), Ft. Detrick, Maryland, United States of America
| | - Hercules Moura
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Atlanta, Georgia, United States of America
| | - James D. Marks
- Department of Anesthesia and Pharmaceutical Chemistry, University of California at San Francisco, San Francisco General Hospital, San Francisco, California, United States of America
| | - Leonard A. Smith
- Integrated Toxicology, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), Ft. Detrick, Maryland, United States of America
| | - James L. Pirkle
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Atlanta, Georgia, United States of America
| | - John R. Barr
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Atlanta, Georgia, United States of America
- * E-mail:
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Benohanian A. What stands in the way of treating palmar hyperhidrosis as effectively as axillary hyperhidrosis with botulinum toxin type A. Dermatol Online J 2009; 15:12. [PMID: 19450405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Botulinum Toxin type A (BTX-A) has revolutionized the treatment of focal hyperhidrosis (HH) in recent years and has dramatically reduced the invasive surgical techniques that have been performed in the past to control severe focal HH unresponsive to topical therapies. Whereas BTX-A injections are easily performed to control axillary HH with little or no analgesia, pain management is a must during the injection of palmar and plantar HH with BTX-A because of the intense pain generated with the 30 to 40 needle punctures needed on each hand or foot through the densely innervated skin present in those areas. For that reason, many physicians who contentedly treat axillary HH with BTX-A injections, refuse to do so for palmar and plantar HH. Although pain is the major stumbling block deterring patients and physicians from choosing this treatment option, it is not the only one. Many other factors may play a role in deciding whether or not to treat palmar and plantar HH with BTX-A injections. This article reviews these factors and presents some personal data from patients who have already been treated with BTX-A injections on the palms and soles and who came back once or more for repeat treatments when the effect of BTX-A started to fade away. "Jet Anesthesia" was the pain management method used in this group.
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MESH Headings
- Administration, Cutaneous
- Anesthesia, Local/methods
- Anesthetics, Local/administration & dosage
- Antibodies, Bacterial/biosynthesis
- Axilla
- Botulinum Toxins, Type A/administration & dosage
- Botulinum Toxins, Type A/adverse effects
- Botulinum Toxins, Type A/immunology
- Botulinum Toxins, Type A/therapeutic use
- Cryoanesthesia/methods
- Data Collection
- Foot
- Hand
- Humans
- Hyperhidrosis/drug therapy
- Injections/adverse effects
- Injections, Jet/instrumentation
- Injections, Jet/methods
- Lidocaine/administration & dosage
- Muscle Weakness/chemically induced
- Nerve Block/adverse effects
- Organ Specificity
- Pain/etiology
- Patient Satisfaction
- Treatment Outcome
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37
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Scotcher MC, McGarvey JA, Johnson EA, Stanker LH. Epitope characterization and variable region sequence of f1-40, a high-affinity monoclonal antibody to botulinum neurotoxin type a (Hall strain). PLoS One 2009; 4:e4924. [PMID: 19290051 PMCID: PMC2654115 DOI: 10.1371/journal.pone.0004924] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 02/02/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Botulism, an often fatal neuroparalytic disease, is caused by botulinum neurotoxins (BoNT) which consist of a family of seven serotypes (A-H) produced by the anaerobic bacterium Clostridium botulinum. BoNT, considered the most potent biological toxin known, is a 150 kDa protein consisting of a 100 kDa heavy-chain (Hc) and a 50 kDa light-chain (Lc). F1-40 is a mouse-derived, IgG1 monoclonal antibody that binds the light chain of BoNT serotype A (BoNT/A) and is used in a sensitive immunoassay for toxin detection. We report the fine epitope mapping of F1-40 and the deduced amino acid sequence of the variable regions of the heavy and light chains of the antibody. METHODS AND FINDINGS To characterize the binding epitope of F1-40, three complementary experimental approaches were selected. Firstly, recombinant peptide fragments of BoNT/A light-chain were used in Western blots to identify the epitope domains. Secondly, a peptide phage-display library was used to identify the specific amino acid sequences. Thirdly, the three-dimensional structure of BoNT/A was examined in silico, and the amino acid sequences determined from the phage-display studies were mapped onto the three-dimensional structure in order to visualize the epitope. F1-40 was found to bind a peptide fragment of BoNT/A, designated L1-3, which spans from T125 to L200. The motif QPDRS was identified by phage-display, and was mapped to a region within L1-3. When the three amino acids Q138, P139 and D140 were all mutated to glycine, binding of F1-40 to the recombinant BoNT/A light chain peptide was abolished. Q-138, P-139 and D-140 form a loop on the external surface of BoNT/A, exposed to solvent and accessible to F1-40 binding. CONCLUSIONS The epitope of F1-40 was localized to a single exposed loop (ss4, ss5) on the Lc of BoNT. Furthermore amino acids Q138, P139 and D140 forming the tip of the loop appear critical for binding.
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Affiliation(s)
- Miles C Scotcher
- United States Department of Agriculture, Agricultural Research Service, Western Regional Research Center, Albany, California, United States of America
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Atassi MZ, Jankovic J, Dolimbek BZ. Neutralizing antibodies in dystonic patients who still respond well to botulinum toxin type A. Neurology 2008; 71:1040; author reply 1040-1. [PMID: 18809844 DOI: 10.1212/01.wnl.0000327865.05877.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Choi WH, Song CW, Kim YB, Ha CS, Yang GH, Woo HD, Jung HH, Koh WS. Skeletal Muscle Atrophy Induced by Intramuscular Repeated Dose of Botulinum Toxin Type A in Rats. Drug Chem Toxicol 2008; 30:217-27. [PMID: 17613007 DOI: 10.1080/01480540701375091] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Botulinum toxin type A was intramuscularly administered to Sprague-Dawley rats once a day for 28 days at doses of 1, 3, and 9 ng kg-1 day-1 to investigate the possibility of unanticipated toxicity of repeated dose. A dose-related decrease in body weight gain was noted and lasted throughout the 4-week recovery period. Paralytic gait was a common clinical sign observed in the animals dosed at >or=3 ng kg-1 day-1 and muscle atrophy at 9 ng kg-1 day-1. Decreased creatinine was monitored in both males and females treated at 9 ng kg-1 day-1. Microscopic examination of the quadriceps femoris muscle, the test article application site, confirmed the muscle atrophy with a decrease in myofiber diameter and an increase of myofiber nuclei and intermyofiber connective tissue. Although antibody against botulinum toxin type A was detected in the sera from both males and females at 9 ng kg-1 day-1, no immunogenicity-related changes or lesions were noted. In conclusion, no other side effects of the botulinum toxin type A injection except the decrease in body weight gain and the muscle atrophy at the administration site were noted in the 28-day intramuscular repeated dose study.
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Affiliation(s)
- Woo H Choi
- Korea Institute of Toxicology, Yusung-gu, Daejeon, Korea
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40
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Dressler D. [Clinical relevance of botulinum toxin antibodies]. Nervenarzt 2008; 79 Suppl 1:36-40. [PMID: 18927965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Botulinum toxin antibodies (BT-AB) can be neutralising and non-neutralising, their titres therapy-relevant and non-therapy-relevant. Botulinum toxin (BT) and BT-AB form a functional balance, thus explaining partial and complete therapy failure. Antibody-induced BT therapy failure (ATF) is rare. Clinically it tends to follow a three-phase reaction. Complete ATF occurs in a typical time window. Risk factors for ATF are the amount of BT given at each injection series, duration of the interval between injections, quality of the BT preparation, and individual particularities of the patient's immune system. The detection of BT-AB is complicated. It always needs interpretation and is of major importance for the further treatment strategy.
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Affiliation(s)
- D Dressler
- Klinik für Neurologie, Universität Rostock.
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Yu YZ, Zhang SM, Sun ZW, Wang S, Yu WY. Enhanced immune responses using plasmid DNA replicon vaccine encoding the Hc domain of Clostridium botulinum neurotoxin serotype A. Vaccine 2007; 25:8843-50. [PMID: 18022294 DOI: 10.1016/j.vaccine.2007.10.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 09/14/2007] [Accepted: 10/07/2007] [Indexed: 11/19/2022]
Abstract
In current study, the immunogenicity of a plasmid DNA replicon vaccine (pSCARSHc) encoding the Hc domain of Clostridium botulinum neurotoxin serotype A (AHc) was investigated and compared with a conventional plasmid DNA vaccine (pcDNASHc) encoding the same antigen. In vitro, pSCARSHc incorporating Semliki Forest virus (SFV) replicon could express AHc protein and induce apoptosis of transfected cells. Comparison with the conventional plasmid DNA vaccine (pcDNASHc) yielded several interesting results. First, our self-designed pSCARSHc could induce relatively higher AHc-specific antibodies and lymphocyte proliferative responses in immunized Balb/c mice, especially at low doses. Second, while both pSCARSHc and pcDNASHc induced Th2-type immune responses, the ratio of IgG1 to IgG2a was lower in pSCARSHc groups and the Th2- and Th1-type humoral immune responses induced by pSCARSHc were also stronger than that of the pcDNASHc vaccine. Third, it was shown that the sera from pSCARSHc-vaccinated mice conferred more efficient protection than those from pcDNASHc-vaccinated mice by BoNT/A neutralization assay. Finally, mice immunized with pSCARSHc could also elicit more efficient protection against BoNT/A than pcDNASHc. These results indicate that our plasmid DNA replicon vaccine can provide strong immunogenicity and should be a potential alternative strategy to conventional DNA vaccines in developing an efficacious vaccine against C. botulinum neurotoxin serotype A.
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Affiliation(s)
- Yun-Zhou Yu
- Beijing Institute of Biotechnology, 20 Dong Dajie Street, Fengtai District, Beijing 100071, China
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42
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Pellett S, Tepp WH, Clancy CM, Borodic GE, Johnson EA. A neuronal cell-based botulinum neurotoxin assay for highly sensitive and specific detection of neutralizing serum antibodies. FEBS Lett 2007; 581:4803-8. [PMID: 17889852 PMCID: PMC2748649 DOI: 10.1016/j.febslet.2007.08.078] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 08/29/2007] [Accepted: 08/31/2007] [Indexed: 11/24/2022]
Abstract
Clostridium botulinum neurotoxin (BoNT) serotypes A and B are widely used as pharmaceuticals to treat various neurological disorders and in cosmetic applications. The major adverse effect of these treatments has been resistance to treatment after multiple injections. Currently, patients receiving BoNT therapies and patients enrolled in clinical trials for new applications and/or new formulations of BoNTs are not routinely monitored for the formation of neutralizing antibodies, since no assay other than the mouse protection procedure is commercially available that reliably tests for the presence of such antibodies. This report presents a highly sensitive and specific neuronal cell-based assay that provides sensitive and specific detection of neutralizing antibodies to BoNT/A.
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Affiliation(s)
- Sabine Pellett
- Food Research Institute, Department of Bacteriology, University of Wisconsin, Madison, Madison, WI, 53706, 1-(608) 263-7944, 1-(608) 263-1114 (fax),
| | - William H. Tepp
- Food Research Institute, Department of Bacteriology, University of Wisconsin, Madison, Madison, WI, 53706, 1-(608) 263-7944, 1-(608) 263-1114 (fax),
| | - Colin M. Clancy
- Food Research Institute, Department of Bacteriology, University of Wisconsin, Madison, Madison, WI, 53706, 1-(608) 263-7944, 1-(608) 263-1114 (fax),
| | - Gary E. Borodic
- Department of Ophthalmology, Harvard Medical School, Ocular Plastic and Reconstructive Surgery Division, 5 Cambridge Center, 8th Floor, Cambridge, MA
| | - Eric A Johnson
- Food Research Institute, Department of Bacteriology, University of Wisconsin, Madison, Madison, WI, 53706, 1-(608) 263-7944, 1-(608) 263-1114 (fax),
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Schulte-Baukloh H, Knispel HH. [How come? What for? Why? Questions on the topic of "Botulinum toxin in urology"]. Urologe A 2007; 46:1210-1. [PMID: 17690862 DOI: 10.1007/s00120-007-1453-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- H Schulte-Baukloh
- Klinik für Urologie, St. Hedwig-Krankenhaus, Akademisches Lehrkrankenhaus der Charité, Universitätsmedizin Berlin, Grosse Hamburger Strasse 5-11, 10115 Berlin.
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Yablon SA, Brashear A, Gordon MF, Elovic EP, Turkel CC, Daggett S, Liu J, Brin MF. Formation of neutralizing antibodies in patients receiving botulinum toxin type A for treatment of poststroke spasticity: a pooled-data analysis of three clinical trials. Clin Ther 2007; 29:683-90. [PMID: 17617291 DOI: 10.1016/j.clinthera.2007.04.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the incidence of neutralizing antibody (NAb) formation in patients with poststroke spasticity treated with a specific formulation of botulinum toxin type A (BoNTA). METHODS Data from 3 previous clinical trials of BoNTA in patients with upper and/or lower limb spasticity were pooled and evaluated. Study 1 was a randomized, double-blind, placebo-controlled, multicenter trial of BoNTA in patients aged >/=21 years who had experienced a stroke >6 months before the initiation of the study. Study 2 was an open-label extension of study 1. Study 3 was a randomized, double-blind, multicenter trial of a specific BoNTA formulation in patients aged >/= 21 years who had experienced a stroke >/=6 weeks before study entry. Patients with a fixed contracture of the studied limb were excluded from participation in studies 1 and 2. Serum samples were obtained from each patient before each BoNTA treatment and at the end of each study. The mouse protection assay (MPA) was used for detection of NAbs to BoNTA in serum. RESULTS A total of 235 individual patients with post-stroke spasticity were enrolled in the 3 trials, including 126, 111 (all of whom participated in study 1), and 109 in studies 1, 2, and 3, respectively. Study 1 had an equal (50.0%) distribution of male and female patients (63/63). The distribution of male and female patients was 56 (50.5%) and 55 (49.5%), respectively, in study 2, and 55 (50.5%) and 54 (49.5), respectively, in study 3. The mean (SD) ages of patients in studies 1, 2, and 3 were 61.4 (13.8), 61.5 (14.1), and 58.5 (13.9) years, respectively. The MPA was used for detection of NAbs to BoNTA in the serum samples of 191 patients, including 64 from study 1, 111 from study 2 (55 of these patients were placebo recipients and 56 received their first BoNTA injection in study 1), and 72 (a sample was not obtained for 1 patient who had not received an injection) from study 3. The median number of BoNTA treatments received by these patients was 2 (range, 1-4 treatments) over a period lasting from 12 to 42 weeks. The mean dose of BoNTA was 241 U (range, 100-400 U), with a maximum dose of 960 U in any 1 patient. NAbs to BoNTA were detected in the serum sample of 1/191 (0.5%) patient who had participated in studies 1 and 2. Based on muscle-tone scores (3 and 4 for wrist and fingers, respectively) on a 5-point Ashworth Scale (0 = none to 4 = severe), the patient did not appear to exhibit a clinical response to BoNTA at any time during the studies. CONCLUSION Formation of NAbs was rare (1/191) in this group of adults with poststroke spasticity from three 12- to 42-week clinical trials who received >/=1 treatment with a specific BoNTA formulation at doses ranging from 100 to 400 U.
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Affiliation(s)
- Stuart A Yablon
- Brain Injury Program, Methodist Rehabilitation Center, Jackson, Mississippi 39216, USA.
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Attrée O, Guglielmo-Viret V, Gros V, Thullier P. Development and comparison of two immunoassay formats for rapid detection of botulinum neurotoxin type A. J Immunol Methods 2007; 325:78-87. [PMID: 17659299 DOI: 10.1016/j.jim.2007.06.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Revised: 06/05/2007] [Accepted: 06/07/2007] [Indexed: 11/22/2022]
Abstract
We have evaluated two formats of immunoassays for the rapid detection of Clostridium botulinum neurotoxin type A (BoNT/A), in assay buffer and various matrices (human serum and nasal swabs, fresh milk, sugar, flour and talcum). The two formats, a vertical-flow strip immunochromatography (ICT) and a small disposable immunoaffinity column (IAC), were selected because they are both rapid and readily usable in the field without sophisticated equipment. We utilised the same critical reagents to develop and optimise both assays, making it possible to compare the corresponding technologies on the same toxin preparations, without interference due to the properties of the antibodies. Results were interpreted using a standard statistical test (ANOVA) and showed little difference of sensitivity between matrices. Though both assays were completed in 40 min, the sensitivity of the IAC, evaluated at 0.45 pM (5 mouse LD50 units/ml), was 40 to 80 times better than that of the ICT. Furthermore, the sensitivity of the IAC assay was improved to 0.09 pM (1 mouse LD50 unit/ml) when performed on a 5-ml volume of human serum. Thus, the IAC appears to be one of the most sensitive and rapid assays for the detection of BoNT/A reported to date and, because it is also highly transportable, it is amongst the best suited for field diagnosis of BoNT/A poisoning.
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Affiliation(s)
- Olivier Attrée
- Département Biologie des agents transmissibles, Centre de Recherches du Service de Santé des Armées, La Tronche cedex, France.
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Morbiato L, Carli L, Johnson EA, Montecucco C, Molgó J, Rossetto O. Neuromuscular paralysis and recovery in mice injected with botulinum neurotoxins A and C. Eur J Neurosci 2007; 25:2697-704. [PMID: 17561839 DOI: 10.1111/j.1460-9568.2007.05529.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Botulinum neurotoxin type A (BoNT/A) is commonly used in human therapy. This treatment may induce immunoresistance and preliminary evaluation of other botulinum neurotoxin serotypes suggested botulinum neurotoxin type C (BoNT/C) to be a good alternative to BoNT/A. Here, we have further characterized the biological activities of BoNT/C using a variety of experimental approaches. Muscle paralysis and time of recovery of mouse hind limb injected with BoNT/A or BoNT/C were assayed with the Digit Abduction Scoring assay. The extent and duration of paralysis were similar with the two toxin serotypes. Extensor digitorum longus or tibialis anterior muscles were dissected at times of complete paralysis and of complete recovery. Muscle weight and force were significantly reduced in mice injected with BoNT/A and BoNT/C, and some atrophy persisted for a long time. In BoNT/C-treated junctions, nerve terminal sprouting was prominent, indicating that the capacity to extend the field of innervation is not hampered by BoNT/C. BoNT/C induced a marked decrease in the frequency of miniature endplate potentials and in the amplitude of endplate potentials. 3,4-diaminopyridine reversed the effect of BoNT/C by increasing the amplitude of synchronized endplate potentials. The present study shows an extensive similarity in the biological activities of BoNT/A and BoNT/C, further supporting the suggestion that BoNT/C is a valid alternative to BoNT/A.
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Affiliation(s)
- Laura Morbiato
- Dipartimento di Scienze Biomediche and Istituto CNR di Neuroscienze, Università di Padova, Padova, Italy
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Ravichandran E, Al-Saleem FH, Ancharski DM, Elias MD, Singh AK, Shamim M, Gong Y, Simpson LL. Trivalent vaccine against botulinum toxin serotypes A, B, and E that can be administered by the mucosal route. Infect Immun 2007; 75:3043-54. [PMID: 17371853 PMCID: PMC1932861 DOI: 10.1128/iai.01893-06] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Most reports dealing with vaccines against botulinum toxin have focused on the injection route of administration. This is unfortunate, because a mucosal vaccine is likely to be more efficacious for patients and pose fewer risks to health care workers and to the environment. Therefore, efforts were made to generate a mucosal vaccine that provides protection against the botulinum serotypes that typically cause human illness (serotypes A, B, and E). This work demonstrated that carboxy-terminal peptides derived from each of the three serotypes were able to bind to and penetrate human epithelial barriers in vitro, and there was no cross inhibition of membrane binding and transcytosis. The three polypeptides were then tested in vivo as a trivalent vaccine that could be administered to mice by the intranasal route. The results indicated that the mucosal vaccine evoked high secretory titers of immunoglobulin A (IgA), as well as high circulating titers of IgG and IgA, and it also evoked a high level of resistance to challenge with toxin. The immunoglobulin responses and the levels of resistance to challenge were increased by coadministration of adjuvants, such as chitosan and vitamin E. At least three mechanisms were identified to account for the antibody-induced resistance: (i) blockade of toxin absorption across epithelial cells, (ii) enhanced clearance of toxin from the circulation, and (iii) blockade of toxin action at the neuromuscular junction. These results are a compelling demonstration that a mucosal vaccine against multiple serotypes of botulinum toxin has been identified.
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Affiliation(s)
- Easwaran Ravichandran
- Department of Medicine, Jefferson Medical College, 1020 Locust Street, Philadelphia, PA 19107, USA
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Schulte-Baukloh H, Bigalke H, Heine G, Pape D, Stuerzebecher B, Miller K, Knispel HH. Antibodies Against Botulinum Neurotoxin Type A as a Cause of Treatment Failure After the First Detrusor Injection. Urology 2007; 69:575.e13-5. [PMID: 17382174 DOI: 10.1016/j.urology.2007.01.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 10/07/2006] [Accepted: 01/09/2007] [Indexed: 11/22/2022]
Abstract
Botulinum neurotoxins are increasingly used in treatment for hyperactive detrusor and sphincter function. Although reported results are promising, conditions in some patients are refractory. We report what we believe to be the first urologic case of therapy failure possibly induced by botulinum toxin antibodies after just one injection and discuss treatment alternatives based on experience in other fields.
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Affiliation(s)
- Heinrich Schulte-Baukloh
- Department of Urology, St. Hedwig Hospital, Charité Medical School, Humboldt University, Berlin, Germany.
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Abstract
BACKGROUND With the expanding use of botulinum toxin, much concern about the antibody against botulinum toxin is arising. Unlike neurologic indications such as cervical dystonia, antibody-induced failure of botulinum toxin therapy has never been reported in the cosmetic field. OBJECTIVE The objective was to describe a case of an antibody-induced failure of botulinum toxin type A (BTX-A) therapy (BOTOX, Allergan, Inc.) that occurred in a patient with masseteric hypertrophy. METHODS AND MATERIALS We present a 20-year-old girl who developed antibody-induced therapy failure after the fourth injection series. Sixty units of toxin was injected at each series and the intertreatment interval was four to five months. RESULTS Frontalis test revealed no paresis of muscle after a unilateral injection of BTX-A. Circulating antibodies against BTX-A were detected by indirect enzyme-linked immunosorbent assay and mouse protection assay. CONCLUSION This case is unique in that, first, immunoresistance developed in a patient of cosmetic indication where only a small dose of BTX-A was administered and, second, antibodies developed on the so-called new formulation of BOTOX. Our case alerts cosmetic surgeons to the importance of antibody against the botulinum toxin.
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Affiliation(s)
- Soo-Keun Lee
- Mein Skin Clinic, 1306-1 Seocho-4-dong, Seocho-ku, Seoul 137-855, South Korea.
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Maddaloni M, Staats HF, Mierzejewska D, Hoyt T, Robinson A, Callis G, Kozaki S, Kiyono H, McGhee JR, Fujihashi K, Pascual DW. Mucosal vaccine targeting improves onset of mucosal and systemic immunity to botulinum neurotoxin A. J Immunol 2007; 177:5524-32. [PMID: 17015739 DOI: 10.4049/jimmunol.177.8.5524] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Absence of suitable mucosal adjuvants for humans prompted us to consider alternative vaccine designs for mucosal immunization. Because adenovirus is adept in binding to the respiratory epithelium, we tested the adenovirus 2 fiber protein (Ad2F) as a potential vaccine-targeting molecule to mediate vaccine uptake. The vaccine component (the host cell-binding domain to botulinum toxin (BoNT) serotype A) was genetically fused to Ad2F to enable epithelial binding. The binding domain for BoNT was selected because it lies within the immunodominant H chain as a beta-trefoil (Hcbetatre) structure; we hypothesize that induced neutralizing Abs should be protective. Mice were nasally immunized with the Hcbetatre or Hcbetatre-Ad2F, with or without cholera toxin (CT). Without CT, mice immunized with Hcbetatre produced weak secretory IgA (sIgA) and plasma IgG Ab response. Hcbetatre-Ad2F-immunized mice produced a sIgA response equivalent to mice coimmunized with CT. With CT, Hcbetatre-Ad2F-immunized mice showed a more rapid onset of sIgA and plasma IgG Ab responses that were supported by a mixed Th1/Th2 cells, as opposed to mostly Th2 cells by Hcbetatre-dosed mice. Mice immunized with adjuvanted Hcbetatre-Ad2F or Hcbetatre were protected against lethal BoNT serotype A challenge. Using a mouse neutralization assay, fecal Abs from Hcbetatre-Ad2F or Hcbetatre plus CT-dosed mice could confer protection. Parenteral immunization showed that the inclusion of Ad2F enhances anti-Hcbetatre Ab titers even in the absence of adjuvant. This study shows that the Hcbetatre structure can confer protective immunity and that use of Hcbetatre-Ad2F gives more rapid and sustained mucosal and plasma Ab responses.
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Affiliation(s)
- Massimo Maddaloni
- Veterinary Molecular Biology, Montana State University, Bozeman, MT 59717-3610, USA
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