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Page 1 of 3

  • Chapter 4 - Immunological Properties of Botulinum Neurotoxins

  • Edited by Daniel Truong, University of California, Riverside, Dirk Dressler, Hannover Medical School, Mark Hallett, National Institutes of Health (NIH), Christopher Zachary, University of California, Irvine, Mayank Pathak, Truong Neuroscience Institute
  • Book:
    Manual of Botulinum Toxin Therapy
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 18-22

  • Summary

    Botulinum neurotoxin is used to treat a large number of muscle hyperactivity disorders, including dystonia, spasticity, and tremor; autonomic disorders such as hyperhidrosis, hypersalivation and various bladder disorders; and pain conditions, especially chronic migraine. Aesthetic applications have also become a large indication. Commercially available preparations of Bont/A and BoNT/B are listed.

    The active component in all products is BoNT, a di-chain protein of 150 000 daltons. BoNT/A inhibits release of acetylcholine by cleaving the SNARE protein SNAP-25 while BoNT/B cleaves VAMP II. Since BoNT is a foreign protein, the human immune system may respond to it with the production of specific anti-BoNT antibodies (BoNT-AB).

    The probability of developing BoNT-AB increases with the amount of BoNT applied at each injection series. Other drug- and patient-related factors might contribute to the immune response. Unspecific activation of the immune system as a possible risk factor for BoNT-AB formation is currently been discussed in connection with COVID-19 vaccination programs. A pre-activation of lymphocytes may have triggered BoNT/A-AB formation. In this chapter, a method is presented for the quantification of BoNT-AB in sera, the immune cell reactions to antigens are described and drug related immune responses are discussed.

Manual of Botulinum Toxin Therapy
  • 3rd edition
  • Edited by Daniel Truong, Dirk Dressler, Mark Hallett, Christopher Zachary, Mayank Pathak
  • Published online:
    02 November 2023
    Print publication:
    23 November 2023
  • Providing practical, visually oriented guidance on the benefits of botulinum toxin in a wide variety of disorders, some new and unexpected, this new edition of Manual of Botulinum Toxin Therapy is fully updated in scope and detail. Chapters discuss the pathophysiology of each condition, summarizing the rationale for botulinum toxin, and describing the injection approach. Clear illustrations of the injection sites are included, using a 'clinician's eye' perspective, which allows physicians to readily identify anatomical landmarks and approach angles for injection. Dosing tables for available toxin formulations are included. The Manual covers cosmetic treatment of the upper and lower face, as well as aesthetic smile correction. Extensive guidance on how to use ultrasound and how cadaveric dissections can assist localization and targeting of injections is provided. Designed for teaching and bedside guidance, the Manual is useful to a diverse range of clinicians looking to use botulinum toxin in their practice.

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