Institute of Toxicology, Medical School of Hannover, 30625 Hannover, Germany.
Curr Top Microbiol Immunol. 2013;364:307-17. doi: 10.1007/978-3-642-33570-9_14.
Botulinum neurotoxin type A (BoNT/A), despite its high toxicity, is approved for therapy of many neurological (e.g., dystonia, spasticity) and non-neurological (e.g., achalasia, hyperhidrosis) disorders. Its mode of action is well understood. This has led to more and more indications (e.g., pain, gastrointestinal and urologic disorders), in which the toxin can reduce disturbing symptoms. In general the application is safe (pharmacological index 20-100, depending on indication). Few unwanted reactions may occur. In worst cases BoNT treated patients may develop neutralizing antibodies. These patients are excluded from further treatment. A more recently approved second serotype (BoNT/B) could be effective in those secondary non-responders, however, due to less potency in humans higher doses have to be applied leading to an only transient successful treatment. Other serotypes as BoNT/A and B, e.g., BoNT/C should be approved as medicines.
A型肉毒毒素（BoNT/A）尽管毒性很高，但已获准用于治疗许多神经（例如，肌张力障碍，痉挛）和非神经（例如，贲门失弛缓症，多汗症）疾病。其作用方式已被很好地理解。这导致越来越多的适应症（例如，疼痛，胃肠道和泌尿科疾病），其中毒素可以减轻令人困扰的症状。总体而言，该应用是安全的（药理指数为 20-100，取决于适应症）。可能会出现少数不良反应。在最坏的情况下，接受 BoNT 治疗的患者可能会产生中和抗体。这些患者被排除在进一步的治疗之外。最近批准的第二种血清型（BoNT/B）可能对那些继发性无反应者有效，但是，由于在人类中效力较低，因此必须使用更高的剂量，从而导致仅短暂的成功治疗。其他血清型，例如 BoNT/A 和 B，例如 BoNT/C，应被批准为药物。
