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Review
. 2019 Aug 26;11(9):491.
doi: 10.3390/toxins11090491.

Immunogenicity Associated with Botulinum Toxin Treatment

Steven Bellows  1 , Joseph Jankovic  2
Affiliations
Review

Immunogenicity Associated with Botulinum Toxin Treatment

Steven Bellows et al. Toxins (Basel). .

Abstract

Botulinum toxin (BoNT) has been used for the treatment of a variety of neurologic, medical and cosmetic conditions. Two serotypes, type A (BoNT-A) and type B (BoNT-B), are currently in clinical use. While considered safe and effective, their use has been rarely complicated by the development of antibodies that reduce or negate their therapeutic effect. The presence of antibodies has been attributed to shorter dosing intervals (and booster injections), higher doses per injection cycle, and higher amounts of antigenic protein. Other factors contributing to the immunogenicity of BoNT include properties of each serotype, such as formulation, manufacturing, and storage of the toxin. Some newer formulations with purified core neurotoxin devoid of accessory proteins may have lower overall immunogenicity. Several assays are available for the detection of antibodies, including both structural assays such as ELISA and mouse-based bioassays, but there is no consistent correlation between these antibodies and clinical response. Prevention and treatment of antibody-associated non-responsiveness is challenging and primarily involves the use of less immunogenic formulations of BoNT, waiting for the spontaneous disappearance of the neutralizing antibody, and switching to an immunologically alternate type of BoNT.

Keywords: bioassays; botulinum toxin; clinical resistance testing; immunogenicity; immunoresistance; neutralizing antibodies.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Unilateral brow injection (UBI) right medial eyebrow weakened by botulinium toxin (BoNT), hence the patient is responding (no immunoresistance). Legend: By convention the following dosages are injected into the right medial eyebrow: 20 U of onabotulinumtoxinA; incobotulinumtoxinA, 50 U of abobotulinumtoxinA, or 1000 U of rimabotulinumtoxinB. About 2 weeks after BoNT injection the patient is instructed to frown and describe whether the frown is symmetric or asymmetric and then send a picture of the upper face depicting the frown to the treating physician.
Figure 2
Figure 2
Proprosed secondary non-responsive (SNR) detection and management pathway.
Figure 3
Figure 3
Proposed primary non-responsive (PNR) dectection and management pathway.
See this image and copyright information in PMC

Comment in

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