Botulinum Toxin: An Update on Pharmacology and Newer Products in Development

Toxins (Basel). 2021 Jan 14;13(1):58. doi: 10.3390/toxins13010058.

Abstract

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.

Keywords: acetylcholine; botulinum toxin; dystonia; neuromuscular blockade; recombinant botulinum toxin.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Bacterial Toxins / pharmacology
  • Bacterial Toxins / therapeutic use
  • Botulinum Toxins / chemistry
  • Botulinum Toxins / pharmacology*
  • Botulinum Toxins / therapeutic use*
  • Drug Compounding*
  • Drug Development*
  • Drug Prescriptions
  • Humans
  • Nervous System Diseases / drug therapy
  • Neuromuscular Agents / pharmacology
  • Neuromuscular Agents / therapeutic use
  • Neuromuscular Junction / drug effects
  • Recombinant Proteins / pharmacology
  • Recombinant Proteins / therapeutic use

Substances

  • Bacterial Toxins
  • Neuromuscular Agents
  • Recombinant Proteins
  • Botulinum Toxins