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Sy JJ, Wu R, Wan J, Kim S, Yi K. The efficacy and safety of neubotulinumtoxinA for the treatment of forehead horizontal lines in Asians - A clinical, prospective, interventional, split-face study. Skin Res Technol 2024; 30:e13644. [PMID: 38533764 PMCID: PMC10966542 DOI: 10.1111/srt.13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Botulinum toxin injections are widely sought after in the field of medical aesthetics, offering consumers a variety of brand choices. Two commonly available botulinum toxin products, onabotulinumtoxinA and neubotulinumtoxinA, are featured in numerous clinics, leading many to question whether there are discernible differences in results, given their varying price ranges. OBJECTIVE To evaluate the efficacy and safety of neubotulinumtoxinA for the treatment of forehead horizontal lines. METHODS A 12-week prospective, single-centre, interventional split-face study was conducted, including 30 subjects. These enrolled subjects received a single treatment session, with neubotulinumtoxinA applied to the left side of the forehead and onabotulinumtoxinA to the right side. A superficial injection was performed in all individuals, where the product was injected subdermally in the frontalis muscle. Evaluation was conducted at baseline, 7 days, 14, days and 4, 8, and 12 weeks after treatment, both when the eyebrows were at maximum lift and in a resting position. Treatment efficacy was assessed by two physicians and self-assessed by the patients, using the Fitzpatrick Wrinkle Classification system. Adverse events were documented to evaluate safety. RESULTS The study found no statistically significant difference in the efficacy of neubotulinum and onabotulinum for treating forehead wrinkles, as indicated by p-values above 0.05 for both static and dynamic conditions. No safety and adverse events were observed in both formulations. CONCLUSION This study has demonstrated that neither formulation is inferior to each other in the treatment of forehead horizontal lines.
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Affiliation(s)
| | - Raymond Wu
- Asia‐Pacific Aesthetic AcademySeoulHong Kong
| | - Jovian Wan
- Division in Anatomy and Developmental Biology, Department of Oral BiologyHuman Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50–1 Yonsei‐ro, Seodaemun‐guSeoulSouth Korea
| | - Soo‐Bin Kim
- Division in Anatomy and Developmental Biology, Department of Oral BiologyHuman Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50–1 Yonsei‐ro, Seodaemun‐guSeoulSouth Korea
| | - Kyu‐Ho Yi
- Division in Anatomy and Developmental Biology, Department of Oral BiologyHuman Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50–1 Yonsei‐ro, Seodaemun‐guSeoulSouth Korea
- Maylin Clinic (Apgujeong)SeoulSouth Korea
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Lara-Castillo N, Masunaga J, Brotto L, Vallejo JA, Javid K, Wacker MJ, Brotto M, Bonewald LF, Johnson ML. Muscle secreted factors enhance activation of the PI3K/Akt and β-catenin pathways in murine osteocytes. Bone 2023; 174:116833. [PMID: 37385426 PMCID: PMC10926931 DOI: 10.1016/j.bone.2023.116833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 07/01/2023]
Abstract
Skeletal muscle and bone interact at the level of mechanical loading through the application of force by muscles to the skeleton and more recently focus has been placed on molecular/biochemical coupling of these two tissues. We sought to determine if muscle and muscle-derived factors were essential to the osteocyte response to loading. Botox® induced muscle paralysis was used to investigate the role of muscle contraction during in vivo tibia compression loading. 5-6 month-old female TOPGAL mice had their right hindlimb muscles surrounding the tibia injected with either BOTOX® or saline. At four days post injections when muscle paralysis peaked, the right tibia was subjected to a single session of in vivo compression loading at ∼2600 με. At 24 h post-load we observed a 2.5-fold increase in β-catenin signaling in osteocytes in the tibias of the saline injected mice, whereas loading of tibias from Botox® injected mice failed to active β-catenin signaling in osteocytes. This suggests that active muscle contraction produces a factor(s) that is necessary for or conditions the osteocyte's ability to respond to load. To further investigate the role of muscle derived factors, MLO-Y4 osteocyte-like cells and a luciferase based β-catenin reporter (TOPflash-MLO-Y4) cell line we developed were treated with conditioned media (CM) from C2C12 myoblasts (MB) and myotubes (MT) and ex vivo contracted Extensor Digitorum Longus (EDL) and Soleus (Sol) muscles under static or loading conditions using fluid flow shear stress (FFSS). 10 % C2C12 myotube CM, but not myoblast or NIH3T3 fibroblast cells CM, induced a rapid activation of the Akt signaling pathway, peaking at 15 min and returning to baseline by 1-2 h under static conditions. FFSS applied to MLO-Y4 cells for 2 h in the presence of 10 % MT-CM resulted in a 6-8 fold increase in pAkt compared to a 3-4 fold increase under control or when exposed to 10 % MB-CM. A similar response was observed in the presence of 10 % EDL-CM, but not in the presence of 10 % Sol-CM. TOPflash-MLO-Y4 cells were treated with 10 ng/ml Wnt3a in the presence or absence of MT-CM. While MT-CM resulted in a 2-fold activation and Wnt3a produced a 10-fold activation, the combination of MT-CM + Wnt3a resulted in a 25-fold activation of β-catenin signaling, implying a synergistic effect of factors in MT-CM with Wnt3a. These data provide clear evidence that specific muscles and myotubes produce factors that alter important signaling pathways involved in the response of osteocytes to mechanical load. These data strongly suggest that beyond mechanical loading there is a molecular coupling of muscle and bone.
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Affiliation(s)
- N Lara-Castillo
- Department of Oral and Craniofacial Sciences, UMKC School of Dentistry, 650 East 25th Street, Kansas City, MO 64108, United States of America.
| | - J Masunaga
- Department of Oral and Craniofacial Sciences, UMKC School of Dentistry, 650 East 25th Street, Kansas City, MO 64108, United States of America
| | - L Brotto
- Bone-Muscle Research Center, College of Nursing and Health Innovation, University of Texas at Arlington, 411 S. Nedderman Dr, Arlington, TX 76019, United States of America
| | - J A Vallejo
- Department of Oral and Craniofacial Sciences, UMKC School of Dentistry, 650 East 25th Street, Kansas City, MO 64108, United States of America; Department of Biomedical Sciences, UMKC School of Medicine, 2411 Holmes, Kansas City, MO 64108, United States of America
| | - K Javid
- Department of Oral and Craniofacial Sciences, UMKC School of Dentistry, 650 East 25th Street, Kansas City, MO 64108, United States of America
| | - M J Wacker
- Department of Biomedical Sciences, UMKC School of Medicine, 2411 Holmes, Kansas City, MO 64108, United States of America
| | - M Brotto
- Department of Biomedical Sciences, UMKC School of Medicine, 2411 Holmes, Kansas City, MO 64108, United States of America
| | - L F Bonewald
- Department of Oral and Craniofacial Sciences, UMKC School of Dentistry, 650 East 25th Street, Kansas City, MO 64108, United States of America; Indiana Center for Musculoskeletal Health, Barnhill Drive, Indianapolis, IN 46202, United States of America
| | - M L Johnson
- Department of Oral and Craniofacial Sciences, UMKC School of Dentistry, 650 East 25th Street, Kansas City, MO 64108, United States of America
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Ioannou CI, Hodde-Chriske FL, Altenmüller E. Long-Term Muscular Atrophy and Weakness Following Cessation of Botulinum Toxin Type A Injections in the Flexor Digitorum Muscle of Musicians with Focal Hand Dystonia. Toxins (Basel) 2023; 15:toxins15040296. [PMID: 37104234 PMCID: PMC10144778 DOI: 10.3390/toxins15040296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
The present study assessed muscular atrophy and weakness of the flexor digitorum superficialis (FDS) and profundus (FDP) muscle as possible long-term side effects of botulinum toxin (BoNT) injections in hand dystonia patients after the termination of their treatment. For the assessment of both parameters, a group of 12 musicians diagnosed with focal hand dystonia was compared with a group of 12 healthy matched musicians. The minimum and maximum times since the last injection across patients were 0.5 to 3.5 years, respectively. The thickness and strength of the FDS and FDP were assessed via ultrasonography and a strength measurement device. Group differences were estimated through the calculation of the symmetry index between the dominant and non-dominant hand. The results revealed that compared to the control group, thickness and flexion strength of the injected FDS and FDP were decreased by 10.6% ± 5.3% (95% CI) and 12.5% ± 6.4% (95% CI), respectively, in the patient group. The amount of weakness and atrophy was predicted significantly by the total amount of BoNT injected throughout the entire treatment period. In contrast, the time after the last injection did not predict the amount of strength and muscle mass recovery after the cessation of the treatment. The current study revealed that even up to 3.5 years after the termination of BoNT injections, long-term side effects such as weakness and atrophy can still be observed. We suggest that the total BoNT dose should remain as small as possible to reduce long-lasting side effects to the minimum. Although side effects differ significantly among patients, a potential full recovery of atrophy and weakness after the cessation of BoNT treatment might be observed after periods longer than 3.5 years.
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Affiliation(s)
- Christos I Ioannou
- CYENS-Centre of Excellence, 1016 Nicosia, Cyprus
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, 30175 Hanover, Germany
| | - Franziska L Hodde-Chriske
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, 30175 Hanover, Germany
- Hanover Medical School, 30625 Hanover, Germany
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, 30175 Hanover, Germany
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Sundaresan S, Antoun J, Banan B, Adcock J, Johnson C, Claire B, Dixon K, Flynn J, Shibao CA, Abumrad N. Botulinum Injection Into the Proximal Intestinal Wall of Diet-Induced Obese Mice Leads to Weight Loss and Improves Glucose and Fat Tolerance. Diabetes 2022; 71:1424-1438. [PMID: 35476783 PMCID: PMC9490449 DOI: 10.2337/db21-0708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 04/13/2022] [Indexed: 11/13/2022]
Abstract
Botulinum neurotoxin (available commercially as BOTOX) has been used successfully for treatment of several neuromuscular disorders, including blepharospasm, dystonia, spasticity, and cerebral palsy in children. Our data demonstrate that injection of Botox into the proximal intestinal wall of diet-induced obese (DIO) mice induces weight loss and reduces food intake. This was associated with amelioration of hyperglycemia, hyperlipidemia, and significant improvement of glucose tolerance without alteration of energy expenditure. We also observed accelerated gastrointestinal transit and significant reductions in glucose and lipid absorption, which may account, at least in part, for the observed weight loss and robust metabolic benefits, although possible systemic effects occurring as a consequence of central and/or peripheral signaling cannot be ignored. The observed metabolic benefits were found to be largely independent of weight loss, as demonstrated by pair-feeding experiments. Effects lasted ∼8 weeks, for as long as the half-life of Botox as reported in prior rodent studies. These results have valuable clinical implications. If the observed effects are translatable in humans, this approach could lay the foundation for therapeutic approaches geared toward robust and sustained weight loss, mimicking some of the benefits of bariatric operations without its cost and complications.
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Affiliation(s)
- Sinju Sundaresan
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Physiology, Midwestern University, Downers Grove, IL
- Corresponding author: Sinju Sundaresan,
| | - Joseph Antoun
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Babak Banan
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jamie Adcock
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Connor Johnson
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Brendan Claire
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kala Dixon
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Joyce Flynn
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Cyndya A. Shibao
- Department of Physiology, Midwestern University, Downers Grove, IL
| | - Naji Abumrad
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
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Chen P, Chen Z, Mitchell C, Gao J, Chen L, Wang A, Leys T, Landao-Bassonga E, Zheng Q, Wang T, Zheng M. Intramuscular injection of Botox causes tendon atrophy by induction of senescence of tendon-derived stem cells. Stem Cell Res Ther 2021; 12:38. [PMID: 33413592 PMCID: PMC7791643 DOI: 10.1186/s13287-020-02084-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/07/2020] [Indexed: 01/04/2023] Open
Abstract
Background Botulinum toxin (Botox) injection is in widespread clinical use for the treatment of muscle spasms and tendinopathy but the mechanism of action is poorly understood. Hypothesis We hypothesised that the reduction of patellar-tendon mechanical-loading following intra-muscular injection of Botox results in tendon atrophy that is at least in part mediated by the induction of senescence of tendon-derived stem cells (TDSCs). Study design Controlled laboratory study Methods A total of 36 mice were randomly divided into 2 groups (18 Botox-injected and 18 vehicle-only control). Mice were injected into the right vastus lateralis of quadriceps muscles either with Botox (to induce mechanical stress deprivation of the patellar tendon) or with normal saline as a control. At 2 weeks post-injection, animals were euthanized prior to tissues being harvested for either evaluation of tendon morphology or in vitro studies. TDSCs were isolated by cell-sorting prior to determination of viability, differentiation capacity or the presence of senescence markers, as well as assessing their response to mechanical loading in a bioreactor. Finally, to examine the mechanism of tendon atrophy in vitro, the PTEN/AKT-mediated cell senescence pathway was evaluated in TDSCs from both groups. Results Two weeks after Botox injection, patellar tendons displayed several atrophic features including tissue volume reduction, collagen fibre misalignment and increased degradation. A colony formation assay revealed a significantly reduced number of colony forming units of TDSCs in the Botox-injected group compared to controls. Multipotent differentiation capacities of TDSCs were also diminished after Botox injection. To examine if mechanically deprived TDSC are capable of forming tendon tissue, we used an isolated bioreactor system to culture tendon constructs using TDSC. These results showed that TDSCs from the Botox-treated group failed to restore tenogenic differentiation after appropriate mechanical loading. Examination of the signalling pathway revealed that injection of Botox into quadriceps muscles causes PTEN/AKT-mediated cell senescence of TDSCs. Conclusion Intramuscular injection of Botox interferes with tendon homeostasis by inducing tendon atrophy and senescence of TDSCs. Botox injection may have long-term adverse consequences for the treatment of tendinopathy. Clinical relevance Intramuscular Botox injection for tendinopathy or tendon injury could result in adverse effects in human tendons and evaluation of its long-term efficacy is warranted.
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Affiliation(s)
- Peilin Chen
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia
| | - Ziming Chen
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia
| | - Christopher Mitchell
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia
| | - Junjie Gao
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Lianzhi Chen
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia
| | - Allan Wang
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia.,Medical School, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Toby Leys
- Department of Orthopaedics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Euphemie Landao-Bassonga
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia.,Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Qiujian Zheng
- Division of Orthopaedic Surgery, Department of Surgery, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China.
| | - Tao Wang
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia. .,Division of Orthopaedic Surgery, Department of Surgery, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China.
| | - Minghao Zheng
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia. .,Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia.
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6
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Sane S, Ali MJ, Naik MN. Comparison of Safety and Efficacy of Botox and Neuronox in the Management of Benign Essential Blepharospasm: A Split-face Study. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:430-435. [PMID: 31612653 PMCID: PMC6791955 DOI: 10.3341/kjo.2016.0123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the efficacy and safety of Botox and Neuronox in the management of benign essential blepharospasm (BEB). Methods We performed a triple-masked, randomized control study to compare Botox and Neuronox in 48 eyes of 24 patients with BEB. All 24 patients randomly received Botox or Neuronox in the periorbital region in a masked, randomized split-face manner, keeping the injection sites and doses uniform. The toxin preparation, injection, and clinical evaluations were done by three independent observers. Objective outcome measures included improvement in the severity of spasm, grading of the functional visual status, changes in palpebral fissure height, lagophthalmos, superficial punctate keratitis and Schirmer's test at 2 weeks, 6 weeks, and upon conclusion of the effect of the toxin. Subjective outcome measures included duration of the effect and a forced choice stating which half of the face was better. Evaluations were performed through clinical measurements, external digital photography, and high-definition videography. Results The mean duration of relief from spasms was 3.78 months (standard deviation, 1.58 months; range, 1 to 6 months). The improvement in the objective parameters like severity of spasm and functional visual status was statistically significant at the 2-week and 6-week follow-up visits (p < 0.001). The changes in palpebral fissure height, lagophthalmos, and superficial punctate keratitis were equally observed in both groups. At 2 and 6 weeks, three of 24 (12.5%) and one of 24 (4%) patients, respectively, reported an unequal effect between the two sides of the face, but this difference was not statistically significant. At final follow-up (conclusion of the toxin effect), patients reported equal effect with no preference for either hemiface. No statistically significant differences were found in the comparative analysis between the Neuronox and Botox groups. Conclusions Neuronox and Botox are comparable in terms of their safety and efficacy in the management of BEB.
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Affiliation(s)
- Sayali Sane
- Department of Ophthalmic Plastic Surgery, LV Prasad Eye Institute, Hyderabad, India
| | - Mohammad Javed Ali
- Department of Ophthalmic Plastic Surgery, LV Prasad Eye Institute, Hyderabad, India
| | - Milind N Naik
- Department of Ophthalmic Plastic Surgery, LV Prasad Eye Institute, Hyderabad, India.
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Seo MS, Kim YI, Kang KK, Oh SK, Sung SE, Jung YS, Cho JY, Song H, Hwang DY, Park SJ, Kim KS. Comparison study of the response with botulinum toxin muscle injection in the ICR mice from three different sources. Lab Anim Res 2019; 35:11. [PMID: 32257899 PMCID: PMC7081521 DOI: 10.1186/s42826-019-0010-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/04/2019] [Indexed: 11/10/2022] Open
Abstract
Botulinum-toxin A (BoNT/A) is a widely used not only for cosmetics but also for various experimental purposes including muscle-related research. In this study, we applied BoNT/A to mouse muscle of three different sources to compare and evaluate the biological and pathological response. The three different mouse sources consist of Korl:ICR (Korea FDA source), A:ICR (USA source) and B:ICR (Japan source) which were purchased from each different vendors. To compare the responses of ICR mice with BoNT/A muscle injection, we examined the body weight, hematological and serum biochemistry analysis. Also, we evaluated the muscle change by histopathological analysis and gene expression patterns of muscle-related target by qPCR. The body weight gain was decreased in the BoNT/A-treated group compared with the control group. In clinical pathologic analysis and gene expression patterns, the data showed that the responses in the BoNT/A-treated group were similar compared with the control group. Decreased muscle fiber was observed in BoNT/A-treated group compared with control group, while Korl:ICR showed a little low response with the other mouse sources. In conclusion, our results suggest that three different sources ICR mice (Korl:ICR, A:ICR and B:ICR) have a similar biological and pathological responses in BoNT/A muscle injection.
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Affiliation(s)
- Min-Soo Seo
- 1Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea
| | | | - Kyung-Ku Kang
- 1Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea
| | - Se-Kyung Oh
- 1Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea
| | - Soo-Eun Sung
- 1Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea
| | - Young-Suk Jung
- 3Department of Pharmacy, College of Pharmacy, Pusan National University, Busan, Korea
| | - Joon Yong Cho
- 4Department of Health and Exercise Science, Korea National Sport University, 88-15 Oryung-dong, Songpa-gu, Seoul, Korea
| | - HyunKeun Song
- Central Research Institute, Kine sciences, F1, Milovany, 28, Inchon-ro, Seongbuk-gu, Seoul, Korea
| | - Dae Youn Hwang
- 6Department of Biomaterials Science, College of Natural Resources & Life Science/Life and Industry Convergence Research Institute, Pusan National University, Miryang, Korea
| | - Sang-Joon Park
- 7Laboratory of Histology, College of Veterinary Medicine, Kyungpook National University, Daegu, Korea
| | - Kil Soo Kim
- 1Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea.,8College of Veterinary Medicine, Kyungpook National University, Daegu, Korea
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8
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Wong C, Gosvig K, Sonne-Holm S. The role of the paravertebral muscles in adolescent idiopathic scoliosis evaluated by temporary paralysis. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:33. [PMID: 29046898 PMCID: PMC5634821 DOI: 10.1186/s13013-017-0138-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/24/2017] [Indexed: 12/15/2022]
Abstract
Background Muscle imbalance has been suggested as implicated in the pathology of adolescent idiopathic scoliosis (AIS). The specific “pathomechanic” role of the paravertebral muscles as being scoliogenic (inducing scoliosis) or counteracting scoliosis in the initial development and maintenance of this spinal deformity has yet to be clarified in humans. In the present study, we investigated the radiographic changes of temporal paralysis using botulinum toxin A as localized injection therapy (ITB) in the psoas major muscle in AIS patients. Methods Nine patients with AIS were injected one time with ITB using ultrasonic and EMG guidance in the selected spine muscles. Radiographic and clinical examinations were performed before and 6 weeks after the injection. Primary outcome parameters of radiological changes were analyzed using Wilcoxon signed-rank test and binomial test, and secondary outcome parameters of short- and long-term clinical effects were obtained. Results Significant radiological corrective changes were seen in the frontal plane in the thoracic and lumbar spine as well as significant derotational corrective change in the lumbar spine according to Cobb’s angle measurements and to Nash and Moe’s classification, respectively. No serious adverse events were detected at follow-up. Conclusions In conclusion, this study demonstrated that the psoas major muscle do play a role into the pathology in adolescent idiopathic scoliosis by maintaining the curvature of the lumbar spine and thoracic spine. Trial registration EudraCT number 2008-004584-19
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Affiliation(s)
- Christian Wong
- Department of Orthopaedics, University Hospital of Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark
| | - Kasper Gosvig
- Department of Radiology, University Hospital of Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark
| | - Stig Sonne-Holm
- Department of Orthopaedics, University Hospital of Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark
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Shehata AS, Al-Ghonemy NM, Ahmed SM, Mohamed SR. Effect of mesenchymal stem cells on induced skeletal muscle chemodenervation atrophy in adult male albino rats. Int J Biochem Cell Biol 2017; 85:135-148. [PMID: 28232107 DOI: 10.1016/j.biocel.2017.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/25/2017] [Accepted: 01/29/2017] [Indexed: 12/11/2022]
Abstract
The present research was conducted to evaluate the effect of bone marrow derived mesenchymal stem cells (BM-MSCs) as a potential therapeutic tool for improvement of skeletal muscle recovery after induced chemodenervation atrophy by repeated local injection of botulinum toxin-A in the right tibialis anterior muscle of adult male albino rats. Forty five adult Wistar male albino rats were classified into control and experimental groups. Experimental group was further subdivided into 3 equal subgroups; induced atrophy, BM-MSCs treated and recovery groups. Biochemical analysis of serum LDH, CK and Real-time PCR for Bcl-2, caspase 3 and caspase 9 was measured. Skeletal muscle sections were stained with H and E, Mallory trichrome, and Immunohistochemical reaction for Bax and CD34. Improvement in the skeletal muscle histological structure was noticed in BM-MSCs treated group, however, in the recovery group, some sections showed apparent transverse striations and others still affected. Immunohistochemical reaction of Bax protein showed strong positive immunoreaction in the cytoplasm of muscle fibers in the induced atrophy group. BM-MSCs treated group showed weak positive reaction while the recovery group showed moderate reaction in the cytoplasm of muscle fibers. Immunohistochemical reaction for CD34 revealed occasional positive CD34 stained cells in the induced atrophy group. In BM-MSCs treated group, multiple positive CD34 stained cells were detected. However, recovery group showed some positive CD34 stained cells at the periphery of the muscle fibers. Marked improvement in the regenerative capacity of skeletal muscles after BM-MSCs therapy. Hence, stem cell therapy provides a new hope for patients suffering from myopathies and severe injuries.
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Affiliation(s)
| | | | - Samah M Ahmed
- Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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10
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Killian ML, Cavinatto LM, Ward SR, Havlioglu N, Thomopoulos S, Galatz LM. Chronic Degeneration Leads to Poor Healing of Repaired Massive Rotator Cuff Tears in Rats. Am J Sports Med 2015; 43:2401-10. [PMID: 26297522 PMCID: PMC4750378 DOI: 10.1177/0363546515596408] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chronic rotator cuff tears present a clinical challenge, often with poor outcomes after surgical repair. Degenerative changes to the muscle, tendon, and bone are thought to hinder healing after surgical repair; additionally, the ability to overcome degenerative changes after surgical repair remains unclear. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate healing outcomes of muscle, tendon, and bone after tendon repair in a model of chronic rotator cuff disease and to compare these outcomes to those of acute rotator cuff injuries and repair. The hypothesis was that degenerative rotator cuff changes associated with chronic multitendon tears and muscle unloading would lead to poor structural and mechanical outcomes after repair compared with acute injuries and repair. STUDY DESIGN Controlled laboratory study. METHODS Chronic rotator cuff injuries, induced via detachment of the supraspinatus (SS) and infraspinatus (IS) tendons and injection of botulinum toxin A into the SS and IS muscle bellies, were created in the shoulders of rats. After 8 weeks of injury, tendons were surgically reattached to the humeral head, and an acute, dual-tendon injury and repair was performed on the contralateral side. After 8 weeks of healing, muscles were examined histologically, and tendon-to-bone samples were examined microscopically, histologically, and biomechanically and via micro-computed tomography. RESULTS All repairs were intact at the time of dissection, with no evidence of gapping or ruptures. Tendon-to-bone healing after repair in our chronic injury model led to reduced bone quality and morphological disorganization at the repair site compared with acute injuries and repair. SS and IS muscles were atrophic at 8 weeks after repair of chronic injuries, indicating incomplete recovery after repair, whereas SS and IS muscles exhibited less atrophy and degeneration in the acute injury group at 8 weeks after repair. After chronic injuries and repair, humeral heads had decreased total mineral density and an altered trabecular structure, and the repair had decreased strength, stiffness, and toughness, compared with the acute injury and repair group. CONCLUSION Chronic degenerative changes in rotator cuff muscles, tendons, and bone led to inferior healing characteristics after repair compared with acute injuries and repair. The changes were not reversible after repair in the time course studied, consistent with clinical impressions. CLINICAL RELEVANCE High retear rates after rotator cuff repair are associated with tear size and chronicity. Understanding the mechanisms behind this association may allow for targeted tissue therapy for tissue degeneration that occurs in the setting of chronic tears.
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Affiliation(s)
- Megan L. Killian
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri, USA
| | - Leonardo M. Cavinatto
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri, USA,Orthopaedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | - Samuel R. Ward
- Department of Radiology, University of California, San Diego, La Jolla, California, USA,Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California, USA,Department of Bioengineering, University of California, San Diego, La Jolla, California, USA
| | - Necat Havlioglu
- John Cochran Division, St Louis Veterans Affairs Medical Center, St Louis, Missouri, USA
| | - Stavros Thomopoulos
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri, USA,Address correspondence to Stavros Thomopoulos, PhD, and Leesa M. Galatz, MD, Department of Orthopaedic Surgery, Washington University, 660 South Euclid, Campus Box 8233, St Louis, MO 63110, USA (; )
| | - Leesa M. Galatz
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri, USA,Address correspondence to Stavros Thomopoulos, PhD, and Leesa M. Galatz, MD, Department of Orthopaedic Surgery, Washington University, 660 South Euclid, Campus Box 8233, St Louis, MO 63110, USA (; )
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Neuronox versus BOTOX in the Treatment of Post-Stroke Upper Limb Spasticity: A Multicenter Randomized Controlled Trial. PLoS One 2015; 10:e0128633. [PMID: 26030192 PMCID: PMC4452301 DOI: 10.1371/journal.pone.0128633] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 04/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Botulinum toxin type A is widely used for treating spasticity. Neuronox (Neu-BoNT/A), a newly manufactured botulinum toxin a, has not yet been investigated for its efficacy and safety in the treatment of post-stroke upper limb spasticity. OBJECTIVE We evaluated the efficacy and safety of Neuronox (Neu-BoNT/A) compared with BOTOX (onabotulinum toxin A) for treating post-stroke upper limb spasticity. METHODS In total, 196 stroke patients with moderate to severe upper limb spasticity were randomly assigned to either Neuronox or BOTOX intervention. The wrist flexors were mandatory and elbow, finger, and thumb flexors were optional muscles to be injected. Assessments were performed at baseline and 4, 8, and 12 weeks after the intervention. The primary outcome measure was the change from baseline of the Modified Ashworth Scale (MAS) at the wrist flexors at week 4. Secondary outcome measures included the change of MAS at each visit, response rate, Disability Assessment Scale (DAS), Carer Burden Scale, and Global Assessment of treatment benefit. RESULTS Primary outcome measures were -1.39±0.79 and -1.56±0.81 in the Neuronox and BOTOX groups, respectively. The difference was within the noninferiority margin of 0.45 (95% upper limit=0.40). There were no significant differences between the groups in the secondary outcome and safety measures, except the change of the MAS at the elbow flexors at week 12 (-0.88±0.75 in the Neuronox group, -0.65±0.74 in the BOTOX group; P=0.0429). Both groups showed significant improvements in the MAS, DAS, and Carer Burden Scale at weeks 4, 8, and 12. CONCLUSION Neuronox showed equivalent efficacy and safety compared with BOTOX for treating post-stroke upper limb spasticity. TRIAL REGISTRATION ClinicalTrials.gov NCT01313767.
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Potter R, Havlioglu N, Thomopoulos S. The developing shoulder has a limited capacity to recover after a short duration of neonatal paralysis. J Biomech 2014; 47:2314-20. [PMID: 24831237 DOI: 10.1016/j.jbiomech.2014.04.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/18/2014] [Accepted: 04/20/2014] [Indexed: 11/26/2022]
Abstract
Mechanical stimuli are required for the proper development of the musculoskeletal system. Removal of muscle forces during fetal or early post-natal timepoints impairs the formation of bone, tendon, and their attachment (the enthesis). The goal of the current study was to examine the capacity of the shoulder to recover after a short duration of neonatal rotator cuff paralysis, a condition mimicking the clinical condition neonatal brachial plexus palsy. We asked if reapplication of muscle load to a transiently paralyzed muscle would allow for full recovery of tissue properties. CD-1 mice were injected with botulinum toxin A to paralyze the supraspinatus muscle from birth through 2 weeks and subsequently allowed to recover. The biomechanics of the enthesis was determined using tensile testing and the morphology of the shoulder joint was determined using microcomputed tomography and histology. A recovery period of at least 10 weeks was required to achieve control properties, demonstrating a limited capacity of the shoulder to recover after only two weeks of muscle paralysis. Although care must be taken when extrapolating results from an animal model to the human condition, the results of the current study imply that treatment of neonatal brachial plexus palsy should be aggressive, as even short periods of paralysis could lead to long-term deficiencies in enthesis biomechanics and shoulder morphology.
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Affiliation(s)
- Ryan Potter
- Department of Orthopaedic Surgery, Washington University, 660 South Euclid, Campus Box 8233, St. Louis, MO 63110, USA
| | - Necat Havlioglu
- Department of Pathology, St Louis University Hospital, St Louis, MO, USA
| | - Stavros Thomopoulos
- Department of Orthopaedic Surgery, Washington University, 660 South Euclid, Campus Box 8233, St. Louis, MO 63110, USA.
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Hulst JB, Minamoto VB, Lim MB, Bremner SN, Ward SR, Lieber RL. Systematic test of neurotoxin dose and volume on muscle function in a rat model. Muscle Nerve 2014; 49:709-15. [PMID: 23929710 DOI: 10.1002/mus.23983] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 07/23/2013] [Accepted: 07/25/2013] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Onabotulinum toxin serotype A (BT-A) is used for a variety of motor and sensory disorders related to abnormal muscle activity. METHODS We developed a high-resolution rodent model to allow precise determination of the effect of BT-A dose (measured in units) and injectate volume (measured in μl) on the efficacy of the injection and systemic side effects. Dorsiflexion is the best indicator of injected and contralateral muscle function. RESULTS One month after injection, dorsiflexion torque of BT-A-injected limbs was decreased significantly in all experimental groups compared with saline controls (P < 0.05). Torque was also compared among the BT-A groups, which demonstrated a significant effect of dose (P < 0.001), but no effect of volume (P > 0.2) and no dose × volume interaction (P > 0.3). Similar results were observed for other parameters measured. CONCLUSIONS These data demonstrate that injection dose and not volume or concentration is the primary determinant of neurotoxin efficacy in a rodent model.
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Affiliation(s)
- Jonah B Hulst
- Departments of Orthopaedic Surgery and Bioengineering, University of California San Diego, 9500 Gilman Drive, MC0863, La Jolla, California, 92093-0863, USA
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Kane MA. Commentary: Asian Consensus Recommendations on the Aesthetic Usage of Botulinum Toxin Type A. Dermatol Surg 2013; 39:1861-7. [DOI: 10.1111/dsu.12369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael A.C. Kane
- Plastic Surgery; Manhattan Eye, Ear & Throat Hospital; New York City New York
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15
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Ahn BK, Kim YS, Kim HJ, Rho NK, Kim HS. Consensus Recommendations on the Aesthetic Usage of Botulinum Toxin Type A in Asians. Dermatol Surg 2013; 39:1843-60. [DOI: 10.1111/dsu.12317] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Molecular mechanisms of treadmill therapy on neuromuscular atrophy induced via botulinum toxin A. Neural Plast 2013; 2013:593271. [PMID: 24327926 PMCID: PMC3845528 DOI: 10.1155/2013/593271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 09/13/2013] [Accepted: 10/01/2013] [Indexed: 01/09/2023] Open
Abstract
Botulinum toxin A (BoNT-A) is a bacterial zinc-dependent endopeptidase that acts specifically on neuromuscular junctions. BoNT-A blocks the release of acetylcholine, thereby decreasing the ability of a spastic muscle to generate forceful contraction, which results in a temporal local weakness and the atrophy of targeted muscles. BoNT-A-induced temporal muscle weakness has been used to manage skeletal muscle spasticity, such as poststroke spasticity, cerebral palsy, and cervical dystonia. However, the combined effect of treadmill exercise and BoNT-A treatment is not well understood. We previously demonstrated that for rats, following BoNT-A injection in the gastrocnemius muscle, treadmill running improved the recovery of the sciatic functional index (SFI), muscle contraction strength, and compound muscle action potential (CMAP) amplitude and area. Treadmill training had no influence on gastrocnemius mass that received BoNT-A injection, but it improved the maximal contraction force of the gastrocnemius, and upregulation of GAP-43, IGF-1, Myo-D, Myf-5, myogenin, and acetylcholine receptor (AChR) subunits α and β was found following treadmill training. Taken together, these results suggest that the upregulation of genes associated with neurite and AChR regeneration following treadmill training may contribute to enhanced gastrocnemius strength recovery following BoNT-A injection.
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Yang GH, Jung HH. A new botulinum toxin potentially bioequivalent to onabotulinumtoxinA: are there any differences at all? Dermatol Surg 2013; 39:165-70. [PMID: 23301820 DOI: 10.1111/dsu.12073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gi-Hyeok Yang
- Microbial Toxin Research Institute, Medytox Inc., Chungbuk, Korea
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18
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Chung ME, Song DH, Park JH. Comparative Study of Biological Activity of Four Botulinum Toxin Type A Preparations in Mice. Dermatol Surg 2013; 39:155-64. [DOI: 10.1111/dsu.12071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Andersson T, Eliasson P, Hammerman M, Sandberg O, Aspenberg P. Low-level mechanical stimulation is sufficient to improve tendon healing in rats. J Appl Physiol (1985) 2012; 113:1398-402. [PMID: 22936727 DOI: 10.1152/japplphysiol.00491.2012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Treatment of tendon injuries often involves immobilization. However, immobilization might not prevent mild involuntary isometric muscle contraction. The effect of weak forces on tendon healing is therefore of clinical interest. Studies of tendon healing with various methods for load reduction in rat Achilles tendon models show a consistent reduction in tendon strength by at least half, compared with voluntary cage activity. Unloading was not complete in any of these models, and the healing tendon was therefore still exposed to mild mechanical stimulation. By reducing the forces acting on the tendon even further, we now studied the effects of this mild stimulation. Rat Achilles tendons were transected and allowed to heal spontaneously under four different loading conditions: 1) normal cage activity; 2) calf muscle paralysis induced by botulinum toxin A (Botox); 3) tail suspension; 4) Botox and tail suspension, combined, to eliminate even mild stimulation. Healing was evaluated by mechanical testing after 8 days. Botox alone and suspension alone both reduced tendon callus size (transverse area), thereby impairing its strength compared with normal cage activity. The combination of Botox and suspension did not further reduce tendon callus size but drastically impaired the material properties of the tendon callus compared with each treatment alone. The peak force was only a fifth of that in the normal cage activity group. The results indicate that also the mild loading that occurs with either Botox or suspension alone stimulates tendon healing. This stimulation appears to affect mainly tissue quality, whereas stronger stimulation also increases callus size.
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Affiliation(s)
- Therese Andersson
- Experimental Orthopaedics, Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden.
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Haubruck P, Mannava S, Plate JF, Callahan MF, Wiggins WF, Schmidmaier G, Tuohy CJ, Saul KR, Smith TL. Botulinum Neurotoxin A injections influence stretching of the gastrocnemius muscle-tendon unit in an animal model. Toxins (Basel) 2012; 4:605-19. [PMID: 23012650 PMCID: PMC3446746 DOI: 10.3390/toxins4080605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/09/2012] [Accepted: 08/10/2012] [Indexed: 12/13/2022] Open
Abstract
Botulinum Neurotoxin A (BoNT-A) injections have been used for the treatment of muscle contractures and spasticity. This study assessed the influence of (BoNT-A) injections on passive biomechanical properties of the muscle-tendon unit. Mousegastrocnemius muscle (GC) was injected with BoNT-A (n = 18) or normal saline (n = 18) and passive, non-destructive, in vivo load relaxation experimentation was performed to examine how the muscle-tendon unit behaves after chemical denervation with BoNT-A. Injection of BoNT-A impaired passive muscle recovery (15% vs. 35% recovery to pre-stretching baseline, p < 0.05) and decreased GC stiffness (0.531 ± 0.061 N/mm vs. 0.780 ± 0.037 N/mm, p < 0.05) compared to saline controls. The successful use of BoNT-A injections as an adjunct to physical therapy may be in part attributed to the disruption of the stretch reflex; thereby modulating in vivo passive muscle properties. However, it is also possible that BoNT-A injection may alter the structure of skeletal muscle; thus modulating the in vivo passive biomechanical properties of the muscle-tendon unit.
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Affiliation(s)
- Patrick Haubruck
- UniversitätsKlinikum Heidelberg, Stiftung Orthopädische Universitätsklinik, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany;
- Authors to whom correspondence should be addressed; (P.H.); (J.F.P.); Tel.: +1-336-713-4025; Fax: +1-336-713-7310
| | - Sandeep Mannava
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
- The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Johannes F. Plate
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
- The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA
- Authors to whom correspondence should be addressed; (P.H.); (J.F.P.); Tel.: +1-336-713-4025; Fax: +1-336-713-7310
| | - Michael F. Callahan
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
| | - Walter F. Wiggins
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
- The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Gerhard Schmidmaier
- UniversitätsKlinikum Heidelberg, Stiftung Orthopädische Universitätsklinik, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany;
| | - Christopher J. Tuohy
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
| | - Katherine R. Saul
- Department of Biomedical Engineering, Wake Forest School of Medicine and VT-WFU School of Biomedical Engineering and Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA;
| | - Thomas L. Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
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Lin KF, Sun HH, Macewan MR, Mackinnon SE, Johnson PJ. GDNF overexpression fails to provoke muscle recovery from botulinum toxin poisoning: a preliminary study. Microsurgery 2012; 32:370-6. [PMID: 22473739 DOI: 10.1002/micr.21967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 01/05/2012] [Accepted: 01/09/2012] [Indexed: 11/11/2022]
Abstract
Glial cell line-derived neurotrophic factor (GDNF) has potent axonal growth and survival effects on motoneurons. This study used transgenic Myo-GDNF mice to assess the effects of targeted GDNF overexpression on functional recovery after botulinum toxin type A (BTxA) chemodenervation. BTxA (0.1 U) was injected into the tibialis anterior (TA) muscle of wild-type CF1 and transgenic Myo-GDNF mice. On days 1, 7, 14, and 21 after injection, evoked muscle force production and muscle mass were measured (n = 6, for each group at each time point). Greater maximal tetanic force and calculated specific force were evoked in Myo-GDNF animals when compared with control CF1 animals at days 1, 7, and 21. However, the differences were not statistically significant. Similarly, modest reductions in muscle atrophy in the Myo-GDNF group at all time points were not statistically significant. Targeted overexpression of GDNF in the muscles of Myo-GDNF mice did not improve motor recovery in the first 21 days after BTxA chemodenervation.
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Affiliation(s)
- Kenny F Lin
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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Stone AV, Koman LA, Callahan MF, Eckman DM, Smith BP, Plate JF, Smith TL. The effect of botulinum neurotoxin-A on blood flow in rats: a potential mechanism for treatment of Raynaud phenomenon. J Hand Surg Am 2012; 37:795-802. [PMID: 22386546 DOI: 10.1016/j.jhsa.2012.01.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Revised: 01/13/2012] [Accepted: 01/18/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Botulinum neurotoxin-A (BoNTA) is used to treat several disorders, including Raynaud phenomenon. Recent investigations cite toxin-induced increases in blood flow, but no mechanism for BoNTA's actions is proposed. This study hypothesized that local application of BoNTA causes arteriolar vasodilation through sympathetic blockade and results in increased blood flow. METHODS Microvascular effects of BoNTA were assessed using a rat cremaster preparation. Cremaster microvascular diameters were measured in the muscle before and after treatment with the muscle paralytic agent gallamine triethiodide. Preparations were then treated with one of the following: BoNTA (4, 6, or 10 units), BoNTA dilution vehicle, or denatured BoNTA. Arteriolar diameters were measured repeatedly over the observation period. Additional preparations were treated with either tetrodotoxin or prazosin and rauwolscine before BoNTA to confirm that the observed vasodilatory responses were the result of sympathetic neural inhibition. RESULTS The BoNTA application resulted in a significant dose-dependent vasodilation (13% to 15%) of observed cremaster arterioles. Control treatments did not cause vasodilation. Both tetrodotoxin and prazosin/rauwolscine treatments elicited similar vasodilatory effects, with no additional vasodilation elicited by BoNTA. Addition of sodium nitroprusside following BoNTA elicited further vasodilation. In addition, systemic arterial pressure was unaffected by the local administration of BoNTA. CONCLUSIONS Local application of BoNTA results in arteriolar dilation that yields an approximate 69% increase in blood flow, without changing systemic arterial pressure. A BoNTA-mediated vasodilation through sympathetic blockade is a likely mechanism to explain the increase in blood flow reported after treatment with the toxin. CLINICAL RELEVANCE The ability of BoNTA to inhibit sympathetic nervous input reduces vasoconstriction, which is the most likely mechanism for improvement seen in Raynaud phenomenon patients following BoNTA injection.
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Affiliation(s)
- Austin V Stone
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Hao Y, Ma Y, Wang X, Jin F, Ge S. Short-term muscle atrophy caused by botulinum toxin-A local injection impairs fracture healing in the rat femur. J Orthop Res 2012; 30:574-80. [PMID: 21919046 DOI: 10.1002/jor.21553] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 08/24/2011] [Indexed: 02/04/2023]
Abstract
Damaged bone is sensitive to mechanical stimulation throughout the remodeling phase of bone healing. Muscle damage and muscular atrophy associated with open fractures and subsequent fixation are not beneficial to maintaining optimum conditions for mechanical stability. The aim of this study was to investigate whether local muscle atrophy and dysfunction affect fracture healing in a rat femur fracture model. We combined the rat model of a short period atrophy of the quadriceps with femur fracture. Forty-four-month-old male Wistar rats were adopted for this study. Two units of botulinum toxin-A (BXTA) were administered locally into the right side of the quadriceps of each rat, while the same dose of saline was injected into the contralateral quadriceps. After BXTA had been fully absorbed by the quadriceps, osteotomy was performed in both femurs with intramedullary fixation. Gross observation and weighing of muscle tissue, X-ray analysis, callus histology, and bone biomechanical testing were performed at different time points up to 8 weeks post-surgery. Local injection of BXTA led to a significant decrease in the volume and weight of the quadriceps compared to the control side. At the eighth week, the left side femurs of the saline-injected quadriceps almost reached bony union, and fibrous calluses were completely calcified into woven bone. However, a gap was still visible in the BXTA-treated side on X-ray images. As showed by bone histology, there were no mature osseous calluses or woven bone on the BXTA-treated side, but a resorption pattern was evident. Biomechanical testing indicated that the femurs of the BXTA-treated side exhibited inferior mechanical properties compared with the control side. The inferior outcome following BXTA injection, compared with saline injection, in terms of callus resistance may be the consequence of unexpected load and mechanical unsteadiness caused by muscle atrophy and dysfunction.
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Affiliation(s)
- Yongqiang Hao
- Shanghai Key Laboratory of Orthopeadic Implant, Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China.
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Tsai SW, Chen CJ, Chen HL, Chen CM, Chang YY. Effects of treadmill running on rat gastrocnemius function following botulinum toxin A injection. J Orthop Res 2012; 30:319-324. [PMID: 21815203 DOI: 10.1002/jor.21509] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 06/30/2011] [Indexed: 02/04/2023]
Abstract
Exercise can improve and maintain neural or muscular function, but the effects of exercise in physiological adaptation to paralysis caused by botulinum toxin A has not been well studied. Twenty-four rats were randomly assigned into control and treadmill groups. The rats assigned to the treadmill group were trained on a treadmill three times per week with the running speed set at 15 m/min. The duration of training was 20 min/session. Muscle strength, nerve conduction study and sciatic functional index (SFI) were used for functional analysis. Treadmill training improved the SFI at 2, 3, and 4 weeks (p = 0.01, 0.004, and 0.01, respectively). The maximal contraction force of the gastrocnemius muscle in the treadmill group was greater than in the control group (p < 0.05). The percentage of activated fibers was higher in the treadmill botox group than the percentage for the control botox group, which was demonstrated by differences in amplitude and area of compound muscle action potential (CMAP) under the curve between the groups (p < 0.05). After BoNT-A injection, treadmill improved the physiological properties of muscle contraction strength, CMAP amplitude, and the recovery of SFI.
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Affiliation(s)
- Sen-Wei Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
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Stone AV, Ma J, Callahan MF, Smith BP, Garrett JP, Smith TL, Koman LA. Dose- and volume dependent-response to intramuscular injection of botulinum neurotoxin-A optimizes muscle force decrement in mice. J Orthop Res 2011; 29:1764-70. [PMID: 21491479 DOI: 10.1002/jor.21434] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 03/24/2011] [Indexed: 02/04/2023]
Abstract
Botulinum neurotoxin-A (BoNTA) is a potent neurotoxin used to alter muscle tone to manage spasticity and to provide tendon bioprotection; however, the appropriate dose and injection volume to administer is not defined. Male mice (n = 120) received BoNTA injections into one gastrocnemius with either a constant volume (10 µl) with a variable dose (1, 3, 6 U/kg) or a constant dose (3 U/kg) in a variable volume (2.5, 5, 10, 20, 30 µl). Electromyographic (EMG) examination, muscle force generation (MFG), and wet muscle mass were measured in the ipsilateral and contralateral limbs at 1, 2, 4, or 12 weeks post-injection. MFG and EMG responses decreased to approximately 40% of contralateral after a 1 U/kg injection and 0% of contralateral by 3 and 6 U/kg injection at 1 week after injection. Neuromuscular blockade was greatest with a 10 µl injection volume. MFG, EMG examination, and wet muscle mass reached contralateral values 12 weeks after injection for all injection doses and volumes tested. Effective injection doses and volumes were identified for producing full and partial neuromuscular blockade in the mouse gastrocnemius. These findings have important clinical implications in the intramuscular administration of BoNTA to manage muscle tone.
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Affiliation(s)
- Austin V Stone
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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Stone HF, Zhu Z, Thach TQ, Ruegg CL. Characterization of diffusion and duration of action of a new botulinum toxin type A formulation. Toxicon 2011; 58:159-67. [DOI: 10.1016/j.toxicon.2011.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 05/11/2011] [Accepted: 05/17/2011] [Indexed: 10/18/2022]
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Mannava S, Wiggins WF, Saul KR, Stitzel JD, Smith BP, Andrew Koman L, Smith TL, Tuohy CJ. Contributions of Neural Tone to In Vivo Passive Muscle–Tendon Unit Biomechanical Properties in a Rat Rotator Cuff Animal Model. Ann Biomed Eng 2011; 39:1914-24. [DOI: 10.1007/s10439-011-0301-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 03/15/2011] [Indexed: 10/18/2022]
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Kim K, Shin HI, Kwon BS, Kim SJ, Jung IY, Bang MS. Neuronox versus BOTOX for spastic equinus gait in children with cerebral palsy: a randomized, double-blinded, controlled multicentre clinical trial. Dev Med Child Neurol 2011; 53:239-44. [PMID: 21087238 DOI: 10.1111/j.1469-8749.2010.03830.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIM The aim of this study was to evaluate the efficacy and safety of a newly manufactured botulinum toxin, Neuronox, compared with BOTOX for the treatment of the spastic equinus gait in children with cerebral palsy. METHOD A total of 127 children with cerebral palsy, aged 2 to 10 years, who presented at three university hospitals with spastic equinus gait were assessed for eligibility to participate in this double-blinded, randomized, controlled trial. Of the 119 eligible participants (mean age 4.33 y; SD 2.07; 76 males and 43 females; 79 with diplegia and 40 with hemiplegia), 57 were classified as Gross Motor Function Classification System level I, 29 as level II, and 33 as level III. Participants were randomly assigned to receive an injection of Neuronox (n=60) or BOTOX (n=59) to the calf muscles at a dose of 4U/kg for those with hemiplegia and 6U/kg for those with diplegia. Assessments were performed at baseline (V1) and at 4 (V2), 12 (V3), and 24 (V4) weeks after the intervention. The primary outcome measure was response rate at V3, with a positive response being defined as at least a 2-point increase in the Physicians' Rating Scale (PRS) score. The non-inferiority margin was set as -20% for the difference in the response rate. The secondary outcome measures included PRS score, passive range of motion (PROM) of the ankle and knee, and Gross Motor Function Measure 88 (GMFM-88). Any adverse events were investigated for safety implications. RESULTS The response rate of the Neuronox group at V3 was not inferior to that of the BOTOX group (90% lower limit=-11.58%). There were significant improvements in PRS, PROM of ankle dorsiflexion, and GMFM scores at V2, V3, and V4 in both groups. The changes in PRS score were not statistically different between the two groups in serial evaluation (p=0.96). PROM of the ankle dorsiflexion increased without any significant difference between the two groups, either overall (p=0.56) or at each visit (V2, p=0.32; V3, p=0.66; V4, p=0.90). The increase in GMFM score in serial measurements were not significantly different between the two groups (p=0.16), whereas it was larger in the BOTOX group than in the Neuronox group at V2 and V4 (p=0.03 and 0.05 respectively). The frequency of adverse events was not significantly different between the two groups (p=0.97), and drug-related complications of Neuronox treatment were not addressed. INTERPRETATION The outcomes of Neuronox, based on PRS, proved to be as effective and safe as those of BOTOX for the treatment of spasticity in individuals with cerebral palsy.
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Affiliation(s)
- Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Rosalina D, Jason R, Mike KH, Audrey M, Stavros T. Effects of botulinum toxin-induced paralysis on postnatal development of the supraspinatus muscle. J Orthop Res 2011; 29:281-8. [PMID: 20803483 PMCID: PMC3608102 DOI: 10.1002/jor.21234] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Accepted: 07/02/2010] [Indexed: 02/04/2023]
Abstract
The mechanical environment plays an important role in musculoskeletal tissue development. The present study characterized changes in supraspinatus muscle due to removal of mechanical cues during postnatal development. An intramuscular injection of botulinum toxin type A (BTX) was used to induce and maintain paralysis in the left shoulders of mice since birth while the right shoulders received saline and served as contralateral controls. A separate group of animals was allowed to develop normally without any injections. Muscles were examined postnatally at various time points. The maximum isometric tetanic force generated by the muscle was significantly reduced in the BTX group compared to saline and normal groups. The paralyzed muscles were smaller and showed significant muscle atrophy and fat accumulation on histologic evaluation. Myogenic genes myogenin, myoD1, myf5, myf6, and fast type II myosin heavy chain (MHC) isoform were significantly upregulated while slow type I MHC isoform was significantly downregulated in the BTX group. Adipogenic genes C/EBPα, PPARγ2, leptin, and lipoprotein lipase were significantly upregulated in the BTX group. Results indicate that reduced muscle loading secondary to BTX-induced paralysis leads to fat accumulation and muscle degeneration in the developing muscle. Understanding the molecular and compositional changes in developing supraspinatus muscles may be useful for identifying and addressing the pathological changes that occur in shoulder injuries such as neonatal brachial plexus palsy.
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Affiliation(s)
- Das Rosalina
- Washington University, Department of Orthopaedic Surgery, St. Louis, MO
| | - Rich Jason
- Washington University, Department of Otolaryngology, St. Louis, MO
| | - Kim H. Mike
- Washington University, Department of Orthopaedic Surgery, St. Louis, MO
| | - McAlinden Audrey
- Washington University, Department of Orthopaedic Surgery, St. Louis, MO
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Mannava S, Callahan MF, Trach SM, Wiggins WF, Smith BP, Koman LA, Smith TL, Tuohy CJ. Chemical denervation with botulinum neurotoxin a improves the surgical manipulation of the muscle-tendon unit: an experimental study in an animal model. J Hand Surg Am 2011; 36:222-31. [PMID: 21276885 DOI: 10.1016/j.jhsa.2010.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 11/05/2010] [Accepted: 11/08/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The chemical denervation that results from botulinum neurotoxin A (BoNT-A) causes a temporary, reversible paresis that can result in easier surgical manipulation of the muscle-tendon unit in the context of tendon rupture and repair. The purpose of the study was to determine whether BoNT-A injections can be used to temporarily and reversibly modulate active and passive skeletal muscle properties. METHODS Male CD1 mice weighing 40-50 g were divided into a 1-week postinjection group (n = 13: n = 5 saline and n = 8 BoNT-A) and a 2-week postinjection group (n = 17: n = 7 saline and n = 10 BoNT-A). The animals had in vivo muscle force testing and in vivo biomechanical evaluation. RESULTS There was a substantial decline in the maximal single twitch amplitude (p < .05) and tetanic amplitude (p < .05) at one week and at 2 weeks after BoNT-A injection, when compared to saline-injected controls. BoNT-A injection significantly reduced the peak passive properties of the muscle-tendon unit as a function of displacement at one week (p < .05). Specifically, the stiffness of the BoNT-A injected muscle-tendon unit was 0.417 N/mm compared to the control saline injected group, which was 0.634 N/mm, a 35% reduction in stiffness (p < .05). CONCLUSIONS Presurgical treatment with BoNT-A might improve the surgical manipulation of the muscle-tendon unit, thus improving surgical outcomes. The results implicate neural tone as a substantial contributor to the passive repair tension of the muscle-tendon unit. The modulation of neural tone through temporary, reversible paresis is a novel approach that might improve intraoperative and postoperative passive muscle properties, allowing for progressive rehabilitation while protecting the surgical repair site.
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Affiliation(s)
- Sandeep Mannava
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1070, USA.
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Manske SL, Boyd SK, Zernicke RF. Vertical ground reaction forces diminish in mice after botulinum toxin injection. J Biomech 2011; 44:637-43. [DOI: 10.1016/j.jbiomech.2010.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 11/04/2010] [Accepted: 11/04/2010] [Indexed: 11/28/2022]
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Abstract
Since its initial approval by the US Food and Drug Administration (FDA) 20 years ago for the treatment of strabismus, hemifacial spasm, and blepharospasm in adults, botulinum toxin (BTX) has become one of the most frequently requested products in cosmetic rejuvenation around the world. After years of clinical success and consistent safety in the upper face, the use of BTX has expanded and evolved to include increasingly complicated indications. In the hands of adept injectors, the focus has shifted from the treatment of individual dynamic rhytides to shaping, contouring, and sculpting, alone or in combination with other cosmetic procedures, to enhance the aesthetic appearance of the face. Although recent reports have questioned the safety of BTX, 25 years of therapeutic and over 20 years of cosmetic use has demonstrated an impressive record of safety and efficacy when used appropriately by experienced injectors.
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Giannesini B, Vilmen C, Le Fur Y, Dalmasso C, Cozzone PJ, Bendahan D. A strictly noninvasive MR setup dedicated to longitudinal studies of mechanical performance, bioenergetics, anatomy, and muscle recruitment in contracting mouse skeletal muscle. Magn Reson Med 2010; 64:262-70. [PMID: 20572140 DOI: 10.1002/mrm.22386] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
MR techniques have proven their ability to investigate skeletal muscle function in situ. Their benefit in terms of noninvasiveness is, however, lost in animal research, given that muscle stimulation and force output measurements are usually achieved using invasive surgical procedures, thereby excluding repeated investigations in the same animal. This study describes a new setup allowing strictly noninvasive investigations of mouse gastrocnemius muscle function using (1)H-MRI and (31)P-MR spectroscopy. Its originality is to integrate noninvasive systems for inducing muscle contraction through transcutaneous stimulation and for measuring mechanical performance with a dedicated ergometer. In order to test the setup, muscle function was investigated using a fatiguing stimulation protocol (6 min of repeated isometric contractions at 1.7 Hz). T(2)-weighted imaging demonstrated that transcutaneous stimulation mainly activated the gastrocnemius. Moreover, investigations repeated twice with a 7-day interval between bouts did show a high reproducibility in measurements with regard to changes in isometric force and energy metabolism. In conclusion, this setup enables us for the first time to access mechanical performance, energy metabolism, anatomy, and physiology strictly noninvasively in contracting mouse skeletal muscle. The possibility for implementing longitudinal studies opens up new perspectives in many research areas, including ageing, pharmaceutical research, and gene and cell therapy.
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Affiliation(s)
- Benoît Giannesini
- Centre de Résonance Magnétique Biologique et Médicale (CRMBM) UMR 6612 CNRS - Université de la Méditerranée, Faculté de Médecine de Marseille, 27, bd Jean Moulin, 13385 Marseille Cedex 05, France.
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Ghosn S, Uthman I, Dahdah M, Kibbi AG, Rubeiz N. Treatment of pachydermoperiostosis pachydermia with botulinum toxin type A. J Am Acad Dermatol 2010; 63:1036-41. [PMID: 20933299 DOI: 10.1016/j.jaad.2009.08.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 08/04/2009] [Accepted: 08/12/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pachydermoperiostosis (PDP) is a rare hereditary disorder characterized by digital clubbing, periostosis, and pachydermia. Pachydermia results in leonine facies, a major cause of cosmetic and functional morbidity in these patients. Its treatment is usually surgical. So far, no medical treatment has been suggested to alleviate this morbidity. OBJECTIVE We sought to assess the role of botulinum toxin type A (BTX-A) in improving the cosmetic appearance of pachydermia in patients with PDP. METHODS Three patients with PDP were treated with BTX-A for their leonine facies. A total of 70 to 80 U were used to treat the upper third of the face. Photographs were taken at baseline and at 2 and 6 weeks after the injections. The patients were followed up periodically for at least 6 months. Wrinkle severity was assessed at relaxation using the 4-point facial wrinkle scale at baseline, week 6, and month 6. In addition, a subjective assessment of the improvement of the extent and depth of the facial rhytides/furrows over the upper third of the face was performed by the same investigator at week 6 and month 6. RESULTS Using the subjective assessment of the improvement of wrinkles, all 3 patients exhibited a fair to excellent response at week 6 that started manifesting 1 week after the BTX-A treatment. All patients demonstrated a residual effect 6 months after the treatment. One patient exhibited a mild exacerbation of his ptosis. LIMITATIONS Major limitations were the small number of patients and the administration of BTX-A injections and assessment of their response by a single unblinded physician. CONCLUSION BTX-A is a simple procedure that may be of value in temporarily improving the cosmetic appearance of pachydermia in patients with PDP.
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Affiliation(s)
- Samer Ghosn
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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Affiliation(s)
- Alexander G Robling
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Dr., MS 5045, Indianapolis, IN 46202, USA.
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Manske SL, Boyd SK, Zernicke RF. Muscle and bone follow similar temporal patterns of recovery from muscle-induced disuse due to botulinum toxin injection. Bone 2010; 46:24-31. [PMID: 19853070 DOI: 10.1016/j.bone.2009.10.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Revised: 09/18/2009] [Accepted: 10/13/2009] [Indexed: 10/20/2022]
Abstract
If muscle force is a primary source for triggering bone adaptation, with disuse and reloading, bone changes should follow muscle changes. We examined the timing and magnitude of changes in muscle cross-sectional area (MCSA) and bone architecture in response to muscle inactivity following botulinum toxin (BTX) injection. We hypothesized that MCSA would return to baseline levels sooner than bone properties following BTX injection. Female BALB mice (15 weeks old) were injected with 20 muL of BTX (1 U/100 g body mass, n=18) or saline (SAL, n=18) into the posterior calf musculature of one limb. The contralateral limb (CON) served as an internal control. MCSA and bone properties were assessed at baseline, 2, 4, 8, 12, and 16 weeks post-injection using in vivo micro-CT at the tibia proximal metaphysis (bone only) and diaphysis. Muscles were dissected and weighed after sacrifice. Significant GroupxLegxTime interactions indicated that the maximal decrease in MCSA (56%), proximal metaphyseal BV/TV (38%) and proximal diaphyseal Ct.Ar (7%) occurred 4 weeks after injection. There was no delay prior to bone recovery as both muscle and bone properties began to recover after this time, but MCSA and BV/TV remained 15% and 20% lower, respectively, in the BTX-injected leg than the BTX-CON leg 16 weeks post-injection. Gastrocnemius mass (primarily fast-twitch) was 14% lower in the BTX-injected leg than the SAL-injected leg, while soleus mass (primarily slow-twitch) was 15% greater in the BTX group than the SAL group. Our finding that muscle size and bone began to recover at similar times after BTX injection was unexpected. This suggested that partial weight-bearing and/or return of slow-twitch muscle activity in the BTX leg may have been sufficient to stimulate bone recovery. Alternatively, muscle function may have recovered sooner than MCSA. Our results indicated that muscle cross-sectional area, while important, may not be the primary factor associated with bone loss and recovery when muscle atrophy is induced through BTX injection. To understand the nature of the interaction between muscle and bone, future work should focus on the functional recovery of individual muscles in relation to bone.
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Affiliation(s)
- Sarah L Manske
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Yoon JS, Kim JC, Lee SY. Double-blind, randomized, comparative study of Meditoxin versus Botox in the treatment of essential blepharospasm. KOREAN JOURNAL OF OPHTHALMOLOGY 2009; 23:137-41. [PMID: 19794937 PMCID: PMC2739960 DOI: 10.3341/kjo.2009.23.3.137] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 07/20/2009] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To compare the efficacies and safeties of Meditoxin (Medy-Tox, Korea) and Botox in the treatment of essential blepharospasm. METHODS We performed a double-blind, randomized, comparative trial comparing Meditoxin and Botox for treatment of blepharospasm in 60 patients from the intention-to-treat (ITT) population and 52 patients from the per-protocol (PP) population. We analyzed the improvements in severity of spasm (SS) at four weeks post-injection as a primary efficacy outcome. Changes in eyelid closing force (CF) and functional visual status (FVS) after injection were analyzed for secondary efficacy outcomes, and adverse effects were demonstrated for the safety evaluation. RESULTS Improvement in SS was noted in 90.3% of the Meditoxin group and 86.2% of the Botox group. There were no significant differences between treatment groups in the changes of CF and FVS post-injection (p>0.05). Since the lower limit of the 95% confidence interval (-1.76% for ITT, -1.64% for PP) was over the -15% threshold, we determined that Meditoxin was not inferior to Botox in either the ITT or PP populations. Adverse effects developed in 16.1% of the Meditoxin group and 27.6% of the Botox group, but no serious adverse events were found in either group. CONCLUSIONS Meditoxin and Botox were comparable in efficacy and safety in the treatment of essential blepharospasm.
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Affiliation(s)
- Jin Sook Yoon
- Department of Ophthalmology, Institute of Vision Research, University of Yonsei, Seoul, Korea
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Abstract
Botulinum neurotoxin A was the first developed for therapeutic and then esthetic uses, Botox first and then Dysport. These two products differ on a few points, explaining their nonequivalence of units: American and British tests of the mouse LD50 units based on solutions that were not identical and 500microg vs 150microg serum albumin dose in the excipient. The neurotoxin- accessory protein complexes were also different: 900 kDa homogeneous for Botox, 500 kDa heterogeneous for Dysport, giving greater diffusion for Dysport, but this is under debate and could result from an excessive conversion ratio. Clinical comparative studies, often with weak methodology, have defined an ideal ratio between these two products, guaranteeing efficacy, but without an overly pronounced diffusion. In the first publications for neurological and ophthalmological indications, the conversion ratio between Dysport and Botox was high, 4:1, and sometimes higher. However, today, particularly for cosmetic indications, the trend is toward a much lower ratio, 2.5:1, or perhaps less for dyshidrosis. This lower ratio has an economic incidence: Dysport is less expensive and therefore more competitive. The price of Dysport's cosmetic product, Azzalure, compared to the price of Vistabel, which is Botox's cosmetic presentation, has not yet been defined in France. The other A toxins, Xeomin, and the Asian toxins, MyoBloc (botulinum toxin type B), tested compared to Botox, have a slightly lower efficacy.
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Affiliation(s)
- C Beylot
- Université Victor Segalen Bordeaux 2, 101, boulevard Wilson, 33200 Bordeaux.
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