Botulinum toxin science advances with new insights on binding and accessory proteins

Mark Nestor, M.D., Ph.D., director of SCA Dermatology in Aventura, Florida, spoke with Managed Healthcare Executive about the science behind botulinum toxin and how it’s advancing quickly, driven by new studies that take a closer look at how the toxin binds to nerve cells and how accessory proteins may play a more meaningful role past the traditional cosmetic and medical uses.

Nestor expressed that in the past, researchers thought the accessory proteins around the core toxin only acted as simple protection. But new data is starting to challenge that idea.

“It’s always been thought that the accessory proteins don’t do anything, but new science has shown that it can help by both allowing the toxin to survive better (and) even helping it bind to the neuron,” Nestor shared.

This new understanding could change how toxin products are made and how well they work over time. A key area of focus is how the toxin binds, according to Nestor. Researchers are paying close attention to how much toxin reaches the nerve cell and how many binding sites it can attach to. Nestor added this is where some of the most exciting new developments are happening.

For example, hybrid toxins—now in development in Europe and expected to reach the U.S. in the future—combine elements of type A and type B toxins. Type B’s heavy chain has far more binding sites, meaning hybrid A/B products could offer faster onset and longer-lasting results, Nestor explained.

Researchers are also exploring ways to increase receptor availability using postsynaptic inhibitors, which early data has suggested could significantly extend toxin duration. Nestor noted that these developments make the field "very exciting for the future," especially as companies test new formulations and mechanisms of action.

Botulinum toxin has come a long way since it was first used to treat strabismus (an eye misalignment) and later approved for cosmetic use in 2002. Today, it’s used across almost every medical specialty, and deeper scientific insight is guiding the next generation of products.

MHE spoke with Nestor prior to the recent Fall Clinical Dermatology meeting held in Las Vegas from October 23 to 26, where he shared these emerging insights and highlighted how ongoing research is shaping the science behind botulinum toxin.