Research and Innovation Hub, Innovation Aesthetics, London, United Kingdom.
Department of Ophthalmology, University of British Columbia, Vancouver, British Columbia, Canada.
Dermatol Surg. 2024 Sep 1;50(9S):S117-S126. doi: 10.1097/DSS.0000000000004293. Epub 2024 Jun 28.
Botulinum toxin A (BoNT-A) is widely used in treating dystonia and spasticity to managing chronic migraine and cosmetic applications. However, its immunogenic potential presents challenges, such as the development of neutralizing antibodies that lead to diminished therapeutic efficacy over time, known as secondary nonresponse.
This review aims to bridge the knowledge gap regarding the immunogenic mechanisms of BoNT-A and to explore effective management strategies to mitigate these immune responses.
The authors conducted a systematic search in databases including PubMed, Embase, and Web of Science, using keywords related to BoNT-A's immunogenicity. The selection process refined 157 initial articles down to 23 relevant studies, which underwent analysis to investigate the underlying mechanisms of immunogenicity and the factors influencing it.
The analysis revealed that both the neurotoxin component and the neurotoxin-associated proteins could elicit an immune response. However, only antibodies against the core toxin influence therapeutic outcomes. Various patient-specific factors such as genetic predispositions and prior immune experiences, along with treatment-related factors such as dosage and frequency, play crucial roles in shaping these responses.
Understanding the specific immunogenic triggers and responses to BoNT-A is critical for optimizing treatment protocols and improving patient outcomes.
肉毒毒素 A（BoNT-A）广泛用于治疗肌张力障碍和痉挛，以管理慢性偏头痛和美容应用。然而，其免疫原性潜力带来了挑战，例如产生中和抗体，随着时间的推移导致治疗效果减弱，即称为继发性无应答。
本综述旨在弥合关于 BoNT-A 免疫原性机制的知识差距，并探讨有效的管理策略来减轻这些免疫反应。
作者在包括 PubMed、Embase 和 Web of Science 在内的数据库中进行了系统搜索，使用与 BoNT-A 免疫原性相关的关键词。通过选择过程，将最初的 157 篇文章精炼至 23 篇相关研究，对这些研究进行分析，以研究免疫原性的潜在机制以及影响因素。
分析表明，神经毒素成分和神经毒素相关蛋白都可能引发免疫反应。然而，只有针对核心毒素的抗体影响治疗效果。各种患者特异性因素，如遗传易感性和先前的免疫经验，以及治疗相关因素，如剂量和频率，在塑造这些反应中起着关键作用。
了解 BoNT-A 的特定免疫原性触发因素和反应对于优化治疗方案和改善患者结局至关重要。
