Botox: Wrinkle Killers on the Tramp

25. August 2008

For many years the application of Botox was considered safe and nearly free of any side effects. If dosed correctly the bacteria poison works solely locally. Results of Italian neurologists are now raising this fact to question.

During a shopping spree a short stop-over at the Botox shop to rid off a few wrinkles. “Botox-to-go”. “Free of Wrinkles in 20 Minutes”. Or the like. These are the teasers used by esthetic surgeons as they smell morning air in the lucrative business with mainly female walk-in customers. A survey made in the sleepy little Italian townlet of Padua has now startled those salesmen of “bottled youth”. Matteo Caleo and his colleagues found the strong nerve poison not only at the injection spot but also “where it is not supposed to be” as Caleo pointed out in his online appearance at the economic professional magazine “Science“.

Potent synapse blocker

In the opinion of neurologists, a few molecules of the toxin clostridium botulinum are enough to shut down a synapse for several days. The ample safety of application for many years all of a sudden seems to stand on rather wobbly legs. Because just a few weeks before Caleo’s article in the Journal of Neuroscience, the U. S. Food And Drug Administration FDA published a warning advising about systemic side effects after local application of botulinum toxin, especially for children. For now the results of the Italian researchers are based on experiments with mice and rats. Different from earlier studies, the scientists did not analyse radioactive marked toxin to test the effect of the clostridien toxin on epilepsy, but followed the traces of its activities in the brain with antibodies against the reacting partner SNAP-25. The intact protein plays an important role in fusion of synaptic vesicals.
Much to Caleo’s surprise, splitted SNAP-25, injected into the hippocampus, appeared in the according area of the contralateral half of the brain and blocked the function of the untreated hippocampus there. When the researchers injected the toxin into the muscles of the whiskers, they were able to prove SNAP-25 in the brainstem within three days. In accordance with the test results of the Italian neurologists the central neurones transport the toxin retrograde via the closest synapse into the medulla or the central nervous system (CNS).

Consequences for the hospitals?

The results of the group in Padua do not seem to be all that new. During a meeting with DocCheck, Reiner Benecke of the University of Rostock and chairman of the working group Botulinumtoxin of the Deutschen Gesellschaft für Neurologie (German Association for Neurology), that he had similar results many years ago. For the studies on the rodents, they used at least tenfold the toxin dose normally applied by neurologists for spasms or dystonia. In addition the evidence of antibodies of the reaction product has not been validated reliably yet. Thus the neurologist does not believe that the results will have an effect on clinical every day’s life. And his American colleagues, for example Joseph Jankovic, professor for neurology at Baylor College of Medicine in Texas/USA think down similar lanes. “After thousands of patients treated, he never came across any side effects of the toxin in either brain or medulla” as the professional magazine “Neurology today” quotes.

Certificate for toxin-application

Still, the working group takes the discussion about the new test results and in particular the concerns of the FDA very seriously. If misapplied, the toxin spreads in the body. Respiratory problems which might even lead to death are some of the side effects in particular with children and during “off label” application in the cosmetic field. According to the beliefs of the working group, Botulimum toxin, the therapy with the bacteria poison should be handled by experienced specialists only. Only people with an according training and education as well as practical experience qualify for a certificate. Since firstly used in the eighties of the last century, millions of people have benefited from the healing effect of the deadly poison, especially in cases of neurological problems. Nonetheless the results of the working group in Padua made massive waves and activated many Botox opponents. If nerve cords really transport the toxin to other areas of their network, there might come up new opportunities for application of the drug, but at the same time therapists loose some of their control over the poison. Many physicians forecasted a career á la Aspirin for Botox and buddies due to their manifold application fields. But similar to Acetylsalicyl acid, its processing in the body is a far cry from being completely clear.

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