New targets in the search for preventive and therapeutic agents for botulism

Abstract

Botulism is a severe neuroparalytic disease resulting from exposure to one of the most poisonous toxins to humans. Because of this high potency and the use of toxins as biological weapons, botulism is a public health concern and each case represents an emergency. Current therapy involves respiratory supportive care and anti-toxins administration. As a preventive measure, vaccination against toxins represents an effective strategy but is undesirable due the rarity of botulism and the effectiveness of toxins in treating several neuromuscular disorders. This paper summarizes the current issues in botulism treatment and prevention, highlighting the challenge for future researches.

Botulism in Italy, 1986 to 2015

“…Botulinum neurotoxins (BoNTs) are the most potent poisons known [1,2]. Due to their formidable potency BoNTs can be used as biological weapons.…”

“…Botulism onset may include a prodromal phase, characterised by gastrointestinal discomfort and anticholinergic symptoms such as xerostomia (dry mouth), while the typical final syndrome consists of a symmetrical cranial nerve palsy, followed by symmetrical descending flaccid paralysis of both voluntary and autonomic muscles [1-4]. The diagnosis of botulism is based on clinical examination and confirmed by laboratory testing [1,2]. The treatment of the disease includes administration of botulinum antitoxin serum and, when required, support of respiratory function [1,2].…”

“…The diagnosis of botulism is based on clinical examination and confirmed by laboratory testing [1,2]. The treatment of the disease includes administration of botulinum antitoxin serum and, when required, support of respiratory function [1,2]. Different formulations containing varying quantities and combinations of specific types of antitoxins are used worldwide.…”

“…Different formulations containing varying quantities and combinations of specific types of antitoxins are used worldwide. Serum available in Italy is distributed by the Ministry of Health (MoH) and consists of 250 ml of trivalent equine antitoxin, protecting against BoNTs of type A, B, and E. The recommended dose is two vials; each vial contains 187,500 IU against-BoNT/A, 125,000 IU against-BoNT/B and 12,500 IU against-BoNT/E [2]. …”

“…BoNTs are produced Clostridium botulinum and also by rare strains of Clostridium baratii and Clostridium butyricum [2-4]. …”