Toxins

20 pages, 1936 KiB

Open AccessReview

Intravesical Onabotulinum Toxin A Injection Paradigms for Idiopathic Overactive Bladder: A Scoping Review of Clinical Outcomes, Techniques, and Implications for Practice and Future Research

by Ekene Enemchukwu, Hodan Mohamud, Shada Sinclair, Victoria Harbour, Raveen Syan, Michael Kennelly and Susanna Gunamany

Toxins 2025, 17(5), 211; https://doi.org/10.3390/toxins17050211 (registering DOI) - 23 Apr 2025

Abstract

Introduction and Objectives: Onabotulinum toxin A (BTXA) is an effective treatment for refractory idiopathic overactive bladder (iOAB). Given the wide spectrum of patient factors and combination of symptoms, a tailored approach to management is needed. This scoping review assesses injection paradigms for iOAB. Prior studies have established the safety and efficacy of BTXA injections, and this review focuses on exploring variations in injection techniques that may inform more tailored approaches and support future research toward optimizing patient outcomes. Methods: We conducted a systematic literature search. Inclusion criteria included full-text English language and primary research studies assessing outcomes in adults undergoing BTXA for iOAB. Findings are summarized using narrative synthesis. Results: Forty-three articles were identified. Key findings include fewer injections (1–10 vs. 20–40) maintains efficacy while reducing procedure time, discomfort, and retreatment hesitancy. Durability appears to be lower with suburothelial and bladder base injections and higher with detrusor and bladder body injections, though these may carry an increased risk of urinary retention requiring clean intermittent catheterization. Trigone inclusion appears safe and effective without increased vesicoureteral reflux risk. Conclusions: Study heterogeneity and inconsistent reporting limit strong conclusions. Included injection paradigms demonstrated efficacy, high tolerability, symptom relief, and quality-of-life improvements with few adverse events. Further research is needed to refine optimal injection strategies to enhance patient comfort, maximize efficacy, and minimize adverse events. Future studies should ensure comprehensive data collection to clarify these associations. Full article

(This article belongs to the Special Issue Botulinum Toxin for Urinary Tract Disease: After a Decade from Approval)

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19 pages, 1929 KiB

Open AccessArticle

Molecular Diversity and Isoform Evolution in Tityus obscurus Venom: Insights from Proteomic Analysis

by Kemellyn Cristina Panchera, Lais Campelo Mendes, Ana Leonor Abrahão Nencioni, Daniel Carvalho Pimenta and Emídio Beraldo-Neto

Toxins 2025, 17(5), 210; https://doi.org/10.3390/toxins17050210 (registering DOI) - 23 Apr 2025

Abstract

Over millions of years of evolution, natural selection has driven the specialization of predatory and defensive mechanisms in various animal species through the development of poisons and venoms. These venoms contain highly specific and selective molecules for several different targets according to the habitat and behavior of each species. In this work, we performed a comprehensive proteomic analysis of Tityus obscurus venom, identifying 45 proteins, including 8 toxins targeting K⁺ channels, 22 targeting Na⁺ channels, and 15 other venom components. Our study reveals seven novel isoforms of ion channel-targeting peptides characterized by amino acid substitutions which may influence their bioactivity and pharmacological properties. These findings contribute to our understanding of venom molecular diversity and evolution, providing new insights into peptide structure–function relationships. Considering the biomedical relevance of ion channel-modulating toxins, our work expands the repertoire of potential candidates for future drug development, particularly in the context of neuropharmacology and ion channel disorders. Full article

(This article belongs to the Special Issue New Insights into Structure and Function of Arthropod Toxins and Other Toxins: Tribute to Professor Hervé Rochat)

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14 pages, 3649 KiB

Open AccessArticle

Effectiveness of Unfocused vs. Focal Shock Waves Combined with Botulinum Toxin on Spasticity in Brain-Damaged Patients

by Antonio Déniz, Pedro Saavedra, Isabel Marrero, Samuel Barrera, Raúl Domínguez, Raúl Mendoza and Jorge Rodríguez

Toxins 2025, 17(5), 209; https://doi.org/10.3390/toxins17050209 - 22 Apr 2025

Abstract

Spasticity is a common complication in patients with neurological disorders, increasing disability and hampering quality of life. Combined treatment with focused shock waves (fESWT) and botulinum toxin (BoNT-A) has been shown to increase the effectiveness and duration of the effect of BoNT-A on spasticity in patients with brain injuries. We studied the effectiveness of the combination of unfocused shock waves (uESWT) and BoNT-A on spasticity. This prospective study with systematic randomization included 24 patients with brain injury, a small sample size due to clinical limitations, and spasticity was measured using the Ashworth scale (AS) for those with lower limb involvement; gait speed was assessed using the 10-m gait test (10MWT). To judge patient satisfaction with treatment, we used the Consumer Reports Effectiveness Scale-4 (CRES-4). Both uESWT and fESWT with BoNT-A resulted in a 3-point improvement in the median spasticity score, which was maintained from week 2 to week 26, and a statistically significant reduction in the 10MWT was observed. Furthermore, the proportion of patients who were very satisfied with the treatment was higher with uESWT (91%) than with fESWT (69.2%). To the authors’ knowledge, this is the first study to evaluate the added benefit of concurrent and combined treatment with uESWT and BoNT-A injections to improve spasticity in patients with stroke or multiple sclerosis and show higher patient satisfaction with the treatment. Full article

(This article belongs to the Special Issue Botulinum Toxins: New Uses in the Treatment of Diseases (2nd Edition))

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Toxins, Volume 17, Issue 5 (May 2025) – 3 articles

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