Toxins

Animal venoms, complex mixtures of molecules refined over thousands of years of evolution, represent far more than a simple defense or predatory system in venomous animals. [...]

Temporomandibular disorders (TMDs) are common musculoskeletal chronic orofacial pain conditions involving peripheral and central sensitization within trigeminal nociceptive pathways, manifesting as mechanical allodynia and functional impairment. Botulinum toxin type A (BoNT-A) has been explored as a treatment targeting both muscle hyperactivity and nociceptive modulation. Preclinical and clinical evidence demonstrate that BoNT-A reduces peripheral neurotransmitter release, neurogenic inflammation, and central neuronal excitability, leading to attenuation of mechanical allodynia in TMD models and patients. Clinical trials show modest and variable analgesic effects, with patients displaying sensory sensitization appearing to respond more favorably, though methodological heterogeneity limits definitive conclusions. Safety concerns related to muscle weakening, changes in bone density, and structural changes underscore the need for standardized protocols optimizing dosing and monitoring, in addition to prospective studies. These findings suggest that BoNT-A may serve as an adjunctive, mechanism-based therapy within multimodal TMD management. Future research should focus on standardized sensory phenotyping and trial design to clarify BoNT-A’s role in modulating central sensitization and improving patient outcomes.

Repeat-in-toxin (RTX) toxins are calcium-dependent exoproteins secreted by diverse Gram-negative bacteria and play central roles in cytotoxicity, immune modulation, and tissue colonization. While their structure and secretion mechanisms are well-characterized, the regulation of RTX toxin expression remains complex and species-specific. This review provides a comprehensive overview of the regulatory networks governing RTX gene expression, highlighting both conserved mechanisms and niche-specific adaptations. RTX genes are controlled by multilayered regulatory systems that integrate global transcriptional control, metabolic regulation, and environmental sensing. Expression is further shaped by host-derived signals, physical contact with host cells, and population-dependent cues. Quorum sensing, post-transcriptional regulation by small RNAs, and post-translational activation mechanisms contribute additional layers of control to ensure precise regulation of toxin production. We also explore how RTX regulation varies across anatomical niches, including the gut, lung, bloodstream, and biofilms, and how it is co-regulated with broader bacterial virulence. Finally, we discuss emerging insights from omics-based approaches and the potential of anti-virulence strategies targeting RTX regulatory pathways. Together, these topics underscore RTX regulation as a model for adaptive virulence control in bacterial pathogens.