Reflections - Botox caution / Bracha Reger

The discovery of a new toxin from the Botox family raises fears of biological terrorism as well as questions about the safety of cosmetic treatments

Clostridium botulinum, from which the botulinum toxin is produced, is a particularly cruel bacterium. The bacterium grows in anaerobic conditions (without oxygen), for example in deep wounds and cans and secretes some proteins that act as poisons mainly on the nervous system (neurotoxins). One gram of crystalline toxin can kill more than a million people. Botulinum is considered the most toxic toxin known to science. In addition to its high toxicity, the process of producing and transporting it is relatively easy and it is possible to spread it through the air or poison water and food sources. No wonder then that this toxin is considered a leading candidate in the biological weapons arsenal.

However, it turns out that this neurotoxin, despite its deadly toxicity, also has a positive side, which is the ability to treat the symptoms of neurological diseases, especially motor disorders accompanying diseases such as cerebral palsy, multiple sclerosis and stroke, by relaxing the contracted muscles. The botulinum toxin is actually the first toxin approved for this purpose. In 2008, the US Food and Drug Administration (FDA) even approved the use of Botox (the trade name of type A of the toxin) for cosmetic treatment in humans. Today there are at least 150 different indications for the use of the toxin, mainly in neurological diseases. One ampoule of clean Botox powder contains 100 units. A lethal dose of Botox ranges from 2,500 to 3,000 units for a person weighing 70 kg. The recommended amount for local injection for cosmetic purposes is 30 units. For medical treatment of large muscles, 100 to 400 units are used, and for small muscles, sometimes a few injections of 3 to 4 units are sufficient.

One of the difficulties in determining the dose of the toxin is the fact that each patient reacts to Botox differently. Also, after the first treatment, antibodies are formed and in order to get a response in subsequent treatments, it is necessary to increase the dose. Sometimes there is no response to additional treatments.

Despite the growing importance of the medical and cosmetic use of the botulinum toxin, one must exercise caution and suspicion regarding it due to its high toxicity and the dangers accompanying its use. Today, seven different types of the toxin are recognized, and even though there are substances that contradict the action of these toxins (antitoxins), their effectiveness depends on a quick and immediate response to the poisoning.

In an article published a few years ago in the Proceedings of the American Academy of Sciences (PNAS), a mathematical model was presented that simulates a terrorist event using milk poisoning by botulinum toxin. The imaging results showed that hundreds of thousands of people could be poisoned quickly in this way if the symptoms of poisoning were not quickly identified. Of course, this depends on the ability of the terrorists to obtain a sufficient amount of the toxin. But these days when Botox treatment is common and accessible, there is probably no obstacle to getting the sufficient amount.

Recently, the botulinum toxin made headlines again in this context. Researcher Steven Arnon from the Office of Public Health in California and his colleagues discovered for the first time in 40 years, a new, eighth type of botulinum toxin. The discovery of the new toxin naturally aroused great interest, and especially concerns that it might be used as a biological weapon. After all, for forty years there was relative silence on the subject thanks to the development of the antitoxins against all seven types of the toxin. But an antitoxin has not yet been developed against the new toxin and for that reason there is a real danger in it. Therefore, when the articles were sent for publication, the editors decided, with the consent of the scientists, not to publish the DNA sequence of the toxin. This decision received support from all bioterrorism experts.

Abuse of the new toxin for the purposes of biological terrorism has indeed been avoided, but some questions nevertheless arise. First, does the discovery of the new toxin herald the discovery of additional toxins hidden in the bacterium's arsenal? And also, are the Botox preparations that are used today for healing and cosmetic needs really completely clean? The discovery of the new toxin raises many questions regarding the safety of the preparations and this should be taken into account.

______________________________________________________________________________________________________________________________________________________________________________________

on the notebook

Bracha Reger, Emeritus Professor of Microbiology and Immunology at the Faculty of Health Sciences at Ben Gurion University, President of Ort Israel and Chairman of the Academic Council of Ort Israel. Served as the chief scientist of the Ministry of Health and was a member of the Council for Higher Education.

The article was published with the permission of Scientific American Israel