Botulinum a toxin therapy: Neutralizing and nonneutralizing antibodies-therapeutic consequences
Botulinum a toxin therapy: Neutralizing and nonneutralizing antibodies-therapeutic consequences
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DOI：
10.1006/exnr.1997.6580
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发表时间：
1997-09-01
影响因子：
5.3
通讯作者：
Bigalke, H
中科院分区：
文献类型：
--
作者：
Goschel, H;Wohlfarth, K;Bigalke, H
虽然A型肉毒杆菌毒素（BoNT/A）的肌肉松弛剂量通常低于刺激免疫系统的剂量，但在相当数量的患者中会产生特异性抗体。通常，这需要终止治疗。因此，一个可靠的确定特定的抗BoNT/A抗体是有帮助的，我们介绍了，为此目的，一种新的体外毒素中和试验的基础上的神经肌肉制备。我们测量了四组受试者的抗体滴度：第1组包括75名随机选择的患者，共295名患者在我们当地诊所对Dysport治疗有反应。第2组中有5例患者为无应答者。第3组由32名未接受治疗的志愿者组成，第4组由8名10年前接受过环形疫苗免疫的受试者组成。两个反应者有边际滴度的中和抗体，而他们都存在于所有无反应者。还通过ELISA检测所有应答者的血清中的非中和抗体。然而，它们的发生对治疗成功没有影响。志愿者的血液样本中没有特异性抗体，而抗体在免疫受试者中持续了十多年。来自不同诊所的患者接受了毒素治疗失败-14名患者接受了BOTOX治疗，7名患者接受了Dysport治疗，7名患者同时接受了两种产品-所有患者都有中和抗体。是否有抗体反应取决于毒素的量。然而，我们相信，有效的毒素剂量可以减少到使抗体的产生非常不可能。(C)北京：科学出版社.
Although muscle-relaxant doses of botulinum A toxin (BoNT/A) are generally lower than doses stimulating the immune system, specific antibodies are raised in a substantial number of patients. As a rule, this necessitates the termination of treatment. Therefore, a reliable determination of specific anti-BoNT/A antibodies is helpful and we introduced, for this purpose, a novel in vitro toxin-neutralizing assay based on a nerve-muscle preparation. We measured the antibody titers in four groups of subjects: Group 1 comprised 75 randomly selected patients of a total of 295 who responded to treatment with Dysport in our local clinic. Five patients, in group 2, were nonresponders. Group 3 consisted of 32 untreated volunteers and group 4 of 8 subjects immunized with a toroid more than 10 years ago. Two of the responders had marginal titers of neutralizing antibodies, while they were present in all nonresponders. The sera of all responders were also tested for nonneutralizing antibodies by ELISA. Their occurrence, however, was of no consequence to the therapeutic success. The blood samples of volunteers were free from specific antibodies, whereas antibodies persisted in the immunized subjects for longer than a decade. Patients from various clinics who had been treated unsuccessfully with the toxin-14 patients had received BOTOX, 7 had been treated with Dysport, and 7 with both products-all had neutralizing antibodies. Whether there was an antibody response depended on the amount of toxin administered. We believe, however, the effective toxin dose can be reduced by so much as to make antibody production highly improbable. (C) 1997 Academic Press.