Journal
TOXINS
Volume 13, Issue 1, Pages -Publisher
MDPI
DOI: 10.3390/toxins13010058
Keywords
botulinum toxin; dystonia; recombinant botulinum toxin; acetylcholine; neuromuscular blockade
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Botulinum toxin has evolved from a treatment for strabismus to the first-line treatment for focal dystonia, with at least six FDA-approved formulations available for diverse indications. These formulations have varying toxo-pharmacological properties and should not be used interchangeably. Synthetic and non-clostridial sources of BoNT are also nearing clinical use, and studies on mutations in natural toxins have led to modifications in the toxo-pharmacokinetic properties of BoNTs.
Since its introduction as a treatment for strabismus, botulinum toxin (BoNT) has had a phenomenal journey and is now recommended as first-line treatment for focal dystonia, despite short-term clinical benefits and the risks of adverse effects. To cater for the high demand across various medical specialties, at least six US Food and Drug Administration (FDA)-approved formulations of BoNT are currently available for diverse labelled indications. The toxo-pharmacological properties of these formulations are not uniform and thus should not be used interchangeably. Synthetic BoNTs and BoNTs from non-clostridial sources are not far from clinical use. Moreover, the study of mutations in naturally occurring toxins has led to modulation in the toxo-pharmacokinetic properties of BoNTs, including the duration and potency. We present an overview of the toxo-pharmacology of conventional and novel BoNT preparations, including those awaiting imminent translation from the laboratory to the clinic.
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