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Innovations and Challenges in Clinical Toxicology and Therapeutic Drug Monitoring
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Innovations and Challenges in Clinical Toxicology and Therapeutic Drug Monitoring

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pharmacology".

Deadline for manuscript submissions: 31 October 2025 | Viewed by 2482

Special Issue Editor

Dr. Zhicheng Jin

E-Mail Website
Guest Editor
Department of Pathology and Laboratory Medicine, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792, USA
Interests: therapeutic drug monitoring; clinical toxicology; mass spectrometry; chromatography; clinical chemistry

Special Issue Information

Dear Colleagues,

Toxicology is an interdisciplinary field that studies toxic substances and their effects on the human body. Clinical toxicology laboratories play an important role in supporting physicians during emergencies, such as accidental poisoning and drug overdoses, where quick and accurate lab tests and intervention can save lives. Therapeutic drug monitoring (TDM) measures the drug concentration in a patient’s blood to ensure that the optimal dosage is used and toxicity is prevented. Toxicology laboratories employ various analytical techniques, including immunoassays, chromatographic separation, and mass spectrometry methods. These laboratories possess the flexibility to develop clinical assays that are tailored to the needs of healthcare teams. In this Special Issue, we invite authors to submit papers that address a range of topics related to TDM and clinical toxicology, discussing challenges faced by clinical toxicology laboratories, contemporary practice, and the development and validation of innovative methods.

Dr. Zhicheng Jin
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • toxicology screen
  • therapeutic drug monitoring
  • mass spectrometry
  • immunoassays
  • pain management
  • opioids

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (1 paper)

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Review

27 pages, 1629 KiB  
Review
Botulinum Toxin Therapy: A Comprehensive Review on Clinical and Pharmacological Insights
by Nahla Ayoub
J. Clin. Med. 2025, 14(6), 2021; https://doi.org/10.3390/jcm14062021 - 16 Mar 2025
Viewed by 2342
Abstract
Background: Botulinum toxin (BoNT), produced by Clostridium botulinum, has transitioned from being a lethal neurotoxin to a versatile therapeutic agent. Its ability to inhibit neurotransmitter release by targeting Soluble N-ethylmaleimide-sensitive factor Attachment Protein Receptor (SNARE) proteins underpins its applications in treating conditions such [...] Read more.
Background: Botulinum toxin (BoNT), produced by Clostridium botulinum, has transitioned from being a lethal neurotoxin to a versatile therapeutic agent. Its ability to inhibit neurotransmitter release by targeting Soluble N-ethylmaleimide-sensitive factor Attachment Protein Receptor (SNARE) proteins underpins its applications in treating conditions such as spasticity, dystonia, chronic pain, and overactive bladder. The clinical and pharmacological properties of BoNT have been extensively studied, with significant advancements in its therapeutic use, safety profile, and understanding of associated adverse effects. Objective: This comprehensive review aims to consolidate historical developments, molecular mechanisms, clinical applications, and challenges associated with BoNT, with a focus on expanding its therapeutic scope while ensuring safety and efficacy. Method: A narrative approach was used to analyze and synthesize insights from 155 references spanning experimental studies, clinical trials, and reviews. Key topics included BoNT’s historical milestones, mechanisms of action, therapeutic applications, and adverse events. Findings: BoNT demonstrates remarkable efficacy in a wide range of medical and cosmetic applications. In movement disorders such as dystonia and spasticity, it reduces muscle overactivity and improves functional outcomes. In chronic pain management, including migraines and neuropathic pain, BoNT significantly alleviates symptoms by modulating neurotransmitter activity. Cosmetic use for conditions like glabellar lines and hyperhidrosis highlights its precision and safety when administered appropriately. For conditions like strabismus and blepharospasm, BoNT effectively restores muscle control, reducing involuntary contractions. In urological applications, BoNT has proven to be an effective therapy for overactive bladder, offering significant symptom relief in refractory cases. However, concerns about long-distance effects, where the toxin may spread beyond the injection site to affect distant muscles or systems, have been reported in certain high-dose or sensitive populations. These findings emphasize the importance of dose optimization and patient-specific approaches. Adverse effects such as localized pain, hematoma, dysphagia, and systemic effects, particularly in high-risk groups, underscore the need for careful monitoring. The development of immunogenicity, leading to neutralizing antibodies, remains a challenge that impacts long-term therapeutic efficacy. Emerging research on novel serotypes, including BoNT/X, and innovations in delivery mechanisms, offer promising avenues to address current limitations. Advances in optimizing dosing regimens and refining injection techniques have also contributed to minimizing complications and improving outcomes across diverse patient populations. Conclusions: BoNT remains a cornerstone in neurology and cosmetic medicine, with its therapeutic potential still expanding. The balance between efficacy and safety, driven by innovations in formulation and application, underscores the importance of continued research. Future directions should focus on minimizing adverse effects, reducing immunogenicity, and exploring novel indications to further enhance its clinical utility. Full article
(This article belongs to the Special Issue Innovations and Challenges in Clinical Toxicology and Therapeutic Drug Monitoring)
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