Botulinum toxin and Botulinum toxin A
May 16,2024
Introduction
Botulinum toxin (abbreviated either as BTX or BoNT) is produced by Clostridium botulinum, a gram-positive anaerobic bacterium. The clinical syndrome of botulism can occur following ingestion of contaminated food, from colonization of the infant gastrointestinal tract, or a wound infection.
BoNT is broken into 7 neurotoxins (labeled as types A, B, C [C1, C2], D, E, F, and G), antigenically and serologically distinct but structurally similar. Human botulism is caused mainly by types A, B, E, and (rarely) F. Types C and D cause toxicity only in animals.
Use method
Botulinum toxin is injected into affected muscles or glands using a 30-gauge 1-inch needle. Doses are tailored according to the mode of use and individual patients, and the dose depends on the muscle mass being injected: The larger the muscle mass, the higher the dose required. However, lower doses may be required in patients with preexisting weakness and females.
Toxin injections are given through hollow teflon-coated needles directly into affected/overactive muscles. In localized muscle overactivity, especially in delicate places such as strabismus, the injections are usually guided by electromyography.
Botulinum toxin A
Two preparations of botulinum toxin A exist Dysport? and Botox?. Unfortunately, there has been much confusion over the doses and units of potency of the two preparations[1]. Although doses are quoted in mouse units (which is the amount of toxin that kills 50% of a group of 18-20 g female Swiss-Webster mice), implying some standardization, Botox? seems more potent. Recently, it has been shown that a unit of Botox? is three times as potent as a unit of Dysport?.
Botox? is a sterile lyophilized form of botulinum toxin type A. It is produced from a culture of the Hall strain of C. botulinum and purified by a series of acid precipitations to a crystalline complex containing the toxin and other proteins. The FDA approved Botox? in December 1989 as an orphan drug for treating strabismus, hemifacial spasms, and blepharospasm. The specific activity of Botox? is approximately 20 Units/ nanogram of the neurotoxin protein complex. Each vial of Botox? contains 100 Units (U) of Clostridium botulinum type A neurotoxin complex, 0.5 milligrams of Albumin (Human), and 0.9 milligrams of sodium chloride in a sterile, vacuum-dried form without a preservative.
Dysport?, another formulation of botulinum toxin type A available in Europe and a few other countries, is prepared using column-based purification techniques and distributed in 500-unit vials that can be stored at room temperature. Botox? and Dysport? are both botulinum toxin type A preparations but are quite distinct from one another. Differences in these toxins may relate to differences in the strain of bacterium, preparation, diffusion, and potency testing.
References
[1] P K Nigam, Anjana Nigam. “Botulinum toxin.” Indian Journal of Dermatology 55 1 (2010): 8–14.
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