超越肉毒杆菌神经毒素 A 用于膀胱化学去神经支配。
Beyond botulinum neurotoxin A for chemodenervation of the bladder.
机构信息
Department of Urology, Boston Children's Hospital, Harvard Medical School.
Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
Curr Opin Urol. 2021 Mar 1;31(2):140-146. doi: 10.1097/MOU.0000000000000843.
PURPOSE OF REVIEW
Botulinum neurotoxin A (BoNT/A), or Botox, is a popular option for overactive bladder (OAB) and neurogenic bladder (NGB) with or without incontinence. This review aims to discuss the clinical outcomes of BoNT in adult and pediatric bladder conditions, and introduces the potential benefit of novel, engineered neurotoxins beyond BoNT/A.
RECENT FINDINGS
A large volume of evidence supports the use of Botox for OAB (to reduce urgency, frequency and incontinence episodes), and for NGB (to decrease incontinence and improve bladder capacity and detrusor pressures). Botox is now also Food & Drug Administration (FDA)-approved for pediatric neurogenic detrusor overactivity. However, urinary retention, diminished response over time and treatment failures are prevalent issues with Botox. Modifying natural BoNTs or forming chimeric toxins are alternatives to BoNT/A that may have higher efficacy and lower side-effect profile. One example is BoNT/BMY-WW. This novel engineered toxin binds to a more commonly expressed synaptotagmin receptor, with potentially more potent paralytic effect and less capacity for systemic diffusion.
SUMMARY
Novel engineered neurotoxins may be the next frontier in OAB and NGB therapy.
目的综述
肉毒毒素 A（BoNT/A），又称肉毒杆菌素，是治疗伴或不伴失禁的活动性膀胱（OAB）和神经性膀胱（NGB）的常用选择。本综述旨在讨论 BoNT 在成人和儿科膀胱疾病中的临床疗效，并介绍了新型工程神经毒素在 BoNT/A 之外的潜在益处。
最新发现
大量证据支持使用肉毒毒素治疗 OAB（减少尿急、尿频和失禁发作）和 NGB（减少失禁并提高膀胱容量和逼尿肌压力）。肉毒毒素现在也已获得美国食品和药物管理局（FDA）批准用于治疗小儿神经性逼尿肌过度活动症。然而，尿潴留、随时间推移反应减弱和治疗失败是肉毒毒素的常见问题。修饰天然 BoNTs 或形成嵌合毒素是 BoNT/A 的替代方法，可能具有更高的疗效和更低的副作用谱。其中一个例子是 BoNT/BMY-WW。这种新型工程毒素与更常见表达的突触结合蛋白受体结合，可能具有更强的麻痹作用和更小的全身扩散能力。
总结
新型工程神经毒素可能是 OAB 和 NGB 治疗的下一个前沿领域。
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