Excitation-Contraction-Coupling Inhibitors potentiate the Activity of
Botulinum Neurotoxin Type A at the Neuromuscular Junction
Abstract
Background and Purpose Botulinum Neurotoxin type A1 (BoNT/A) is one of
the most potent neurotoxins known. At the same time, it is also one of
the safest therapeutic agents used for the treatment of several human
disorders and in aesthetic medicine. Notwithstanding great
effectiveness, strategies to accelerate the onset and prolong BoNT/A
action would significantly ameliorate its pharmacological effects with
beneficial repercussions on clinical use. Experimental Approach Here, we
combined BoNT/A with two fast-acting inhibitors of
excitation-contraction coupling (ECCI), either the µ-conotoxin CnIIIC or
dantrolene, and tested the effect of their co-injection on a model of
hind-limb paralysis in rodents using behavioral, biochemical, imaging
and electrophysiology assays. Key Results We report that the BoNT/A-ECCI
combination accelerated the onset of muscle relaxation. Surprisingly, it
also potentiated the peak effect and extended the duration of the three
BoNT/A commercial preparations onabotulinumtoxinA, abobotulinumtoxinA
and incobotulinumtoxinA. We found that ECCI co-injection increased the
number of BoNT/A molecules entering motoneuron terminals, which induced
a faster and larger cleavage of SNAP-25 during the onset and peak
phases, and prolonged the attenuation of nerve-muscle neurotransmission
during the recovery phase. We estimate that ECCI co-injection yields a
three-fold potentiation in BoNT/A pharmacological activity. Conclusions
and Implications Overall, our results show that the pharmacological
activity of BoNT/A can be combined and synergized with other bioactive
molecules and uncover a novel strategy to enhance BoNT/A neuromuscular
effects without altering the neurotoxin moiety or intrinsic activity,
thus maintaining its exceptional safety profile.