肉毒杆菌毒素 Botulinum Toxin

神经肌肉接头阻断剂 / 神经肌肉接头阻断剂：A 型轻链裂解 SNAP-25，阻断乙酰胆碱囊泡释放使局部肌肉暂时性麻痹，从而抚平动态纹、瘦脸并抑制汗腺分泌

肉毒杆菌毒素。阻断乙酰胆碱释放，使局部肌肉暂时麻痹，临床用于彻底抚平动态皱纹、瘦脸及治疗多汗症。

Botulinum toxin, botulinum neurotoxin, or botox® is a neurotoxic protein produced by the bacterium Clostridium botulinum and related species, and it is considered the deadliest known natural substance ever recorded in chemical literature. It prevents the release of the neurotransmitter acetylcholine from axon endings at the neuromuscular junction, thus causing flaccid paralysis. The toxin causes the disease botulism. Botulinum toxin is an acetylcholine release inhibitor and a neuromuscular blocking agent. Botulinum toxin was developed as a biological agent by the Soviet, United States, and Iraqi biological weapons programs. In strongly diluted form, the toxin is also used for medical and cosmetic purposes.

The seven main types of botulinum toxin are named types A to G (A, B, C1, C2, D, E, F and G). New types are occasionally found. Types A and B are capable of causing disease in humans, and are also used commercially and medically. Types C–G are less common.

In 2025, the structure of the complete 14 subunit botulinum neurotoxin complex (L-PTC) was solved.

Intoxication can occur naturally as a result of either wound or intestinal infection or by ingesting formed toxin in food. The estimated human median lethal dose of type A toxin is 1.3–2.1 ng/kg intravenously or intramuscularly, 10–13 ng/kg when inhaled, or 1 μg/kg when taken by mouth.

Source: English Wikipedia, "Botulinum toxin".

Target molecules of botulinum neurotoxin (abbreviated BoNT) and tetanus neurotoxin (TeNT), toxins acting inside the axon terminal The toxin cleaves SNARE proteins, preventing the release of acetylcholine at the neuromuscular junction and producing flaccid paralysis.

Botulinum toxin exerts its effect by cleaving key proteins required for nerve activation. First, the toxin binds specifically to presynaptic surface of neurons that use the neurotransmitter acetylcholine. Once bound to the nerve terminal, the neuron takes up the toxin into a vesicle by receptor-mediated endocytosis. As the vesicle moves farther into the cell, it acidifies, activating a portion of the toxin that triggers it to push across the vesicle membrane and into the cell cytoplasm. Botulinum neurotoxins recognize distinct classes of receptors simultaneously (gangliosides, synaptotagmin and SV2). Once inside the cytoplasm, the toxin cleaves SNARE proteins (proteins that mediate vesicle fusion, with their target membrane bound compartments) meaning that the acetylcholine vesicles cannot bind to the intracellular cell membrane, preventing the cell from releasing vesicles of neurotransmitter. This stops nerve signaling, leading to flaccid paralysis.

The toxin itself is released from the bacterium as a single chain, then becomes activated when cleaved by its own proteases. The active form consists of a two-chain protein composed of a 100-kDa heavy chain polypeptide joined via disulfide bond to a 50-kDa light chain polypeptide. The heavy chain contains domains with several functions; it has the domain responsible for binding specifically to presynaptic nerve terminals, as well as the domain responsible for mediating translocation of the light chain into the cell cytoplasm as the vacuole acidifies. The light chain is a M27-family zinc metalloprotease and is the active part of the toxin. It is translocated into the host cell cytoplasm where it cleaves the host protein SNAP-25, a member of the SNARE protein family, which is responsible for fusion. The cleaved SNAP-25 cannot mediate fusion of vesicles with the host cell membrane, thus preventing the release of the neurotransmitter acetylcholine from axon endings. This blockage is slowly reversed as the toxin loses activity and the SNARE proteins are slowly regenerated by the affected cell.

Blepharospasm and strabismus University-based ophthalmologists in the US and Canada further refined the use of botulinum toxin as a therapeutic agent. By 1985, a scientific protocol of injection sites and dosage had been empirically determined for treatment of blepharospasm and strabismus. Side effects in treatment of this condition were deemed to be rare, mild and treatable. The beneficial effects of the injection lasted only four to six months. Thus, blepharospasm patients required re-injection two or three times a year.

In 1986, Scott's micromanufacturer and distributor of Botox was no longer able to supply the drug because of an inability to obtain product liability insurance. People became desperate, as supplies of Botox were gradually consumed, forcing him to abandon people who would have been due for their next injection. For a period of four months, American blepharospasm patients had to arrange to have their injections performed by participating doctors at Canadian eye centers until the liability issues could be resolved.

In December 1989, Botox was approved by the US FDA for the treatment of strabismus, blepharospasm, and hemifacial spasm in people over 12 years old.

In the case of treatment of infantile esotropia in people younger than 12 years of age, several studies have yielded differing results.

Upper motor neuron syndrome Botulinum toxin type-A is now a common treatment for muscles affected by the upper motor neuron syndrome (UMNS), such as cerebral palsy, for muscles with an impaired ability to effectively lengthen. Muscles affected by UMNS frequently are limited by weakness, loss of reciprocal inhibition, decreased movement control, and hypertonicity (including spasticity). In January 2014, botulinum toxin was approved by UK's Medicines and Healthcare products Regulatory Agency (MHRA) for the treatment of ankle disability due to lower limb spasticity associated with stroke in adults. Joint motion may be restricted by severe muscle imbalance related to the syndrome, when some muscles are markedly hypertonic, and lack effective active lengthening. Injecting an overactive muscle to decrease its level of contraction can allow improved reciprocal motion, so improved ability to move and exercise.