ABSTRACT
This chapter begins by analysing the synthesis and structure of botulinum toxins, citing its multimeric protein complexes and associated hemagglutin and non-hemagglutin proteins, and how they stabilize and protect the ∼150 kDa neurotoxin from degradation in the gastrointestinal tract. Seven different botulinum neurotoxin serotypes are recognised, each with reported differentiating preclinical in vivo profiles. The chapter progresses to study the general mechanism of action in botulinum neurotoxins, the binding of them to nerve cell membranes, internalization and translocation, enzymatic activity, clinical pharmacology, pharmacology in dermal conditions, hyperhidrosis and preliminary studies in other dermal conditions. Next, the chapter looks at the differences between botulinum neurotoxin products including: units of biological activity, regulatory approvals and unlicensed products. Finally, it looks at the immune response that can be elicited against the non-toxin proteins in botulinum toxins, although it does not appear to affect clinical responsiveness.
