On the Study of Botulinum Toxin A Actions: Beyond the Neuromodulation Induced by SNAP-25 Cleavage

The present review is focused on a range of BoNT/A molecular targets and the subsequent modulation of cellular signaling pathways focused on gene regulation, skin and nerve regeneration, vascular effects, and contributions to pain relief. This brings fresh insights to the diversity of BoNT/A mechanisms of action, opening new avenues of research into therapeutic options for patients. A summary of the mechanisms of action of BoNT/A formulations will be presented in parallel with their specific indications, showing the versatility of the BoNTs' efficiency through different pathways well beyond the canonical SNARE cleavage mechanism. The current research progress is summarized, ranging from the molecular mechanism of BoNT/A involved in the treatment of inflammation, pathological scars, pain, and a range of neurological and vascular disorders via clinical investigations and experimental studies.