{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T23:07:31Z","timestamp":1790118451399,"version":"4.0.1"},"reference-count":60,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T00:00:00Z","timestamp":1684281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AbbVie"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Though the formation of neutralizing antibodies (NAbs) during treatment with botulinum neurotoxin is rare, their presence may nonetheless affect the biological activity of botulinum toxin and negatively impact clinical response. The goal of this updated meta-analysis was to evaluate and characterize the rate of NAb formation using an expanded dataset composed of 33 prospective placebo-controlled and open-label clinical trials with nearly 30,000 longitudinal subject records prior to and following onabotulinumtoxinA treatment in 10 therapeutic and aesthetic indications. Total onabotulinumtoxinA doses per treatment ranged from 10 U to 600 U administered in \u226415 treatment cycles. The NAb formation at baseline and post-treatment was tested and examined for impact on clinical safety and efficacy. Overall, 27 of the 5876 evaluable subjects (0.5%) developed NAbs after onabotulinumtoxinA treatment. At study exit, 16 of the 5876 subjects (0.3%) remained NAb positive. Due to the low incidence of NAb formation, no clear relationship was discernable between positive NAb results and gender, indication, dose level, dosing interval, treatment cycles, or the site of injection. Only five subjects who developed NAbs post-treatment were considered secondary nonresponders. Subjects who developed NAbs revealed no other evidence of immunological reactions or clinical disorders. This comprehensive meta-analysis confirms the low NAb formation rate following onabotulinumtoxinA treatment across multiple indications, and its limited clinical impact on treatment safety and efficacy.<\/jats:p>","DOI":"10.3390\/toxins15050342","type":"journal-article","created":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T07:03:58Z","timestamp":1684393438000},"page":"342","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Neutralizing Antibody Formation with OnabotulinumtoxinA (BOTOX\u00ae) Treatment from Global Registration Studies across Multiple Indications: A Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"given":"Joseph","family":"Jankovic","sequence":"first","affiliation":[{"name":"Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Carruthers","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"},{"name":"Jean Carruthers Cosmetic Surgery Inc., Vancouver, BC V5Z 4E1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Naumann","sequence":"additional","affiliation":[{"name":"Department of Neurology and Clinical Neurophysiology, University Hospital, 86156 Augsburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4908-6787","authenticated-orcid":false,"given":"Patricia","family":"Ogilvie","sequence":"additional","affiliation":[{"name":"Skin Concept, 80333 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry","family":"Boodhoo","sequence":"additional","affiliation":[{"name":"AbbVie, Irvine, CA 92612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayssa","family":"Attar","sequence":"additional","affiliation":[{"name":"AbbVie, Irvine, CA 92612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swati","family":"Gupta","sequence":"additional","affiliation":[{"name":"AbbVie, Irvine, CA 92612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritu","family":"Singh","sequence":"additional","affiliation":[{"name":"AbbVie, Irvine, CA 92612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Soliman","sequence":"additional","affiliation":[{"name":"AbbVie, Irvine, CA 92612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Yushmanova","sequence":"additional","affiliation":[{"name":"AbbVie, Irvine, CA 92612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell F.","family":"Brin","sequence":"additional","affiliation":[{"name":"AbbVie, Irvine, CA 92612, USA"},{"name":"Department of Neurology, University of California, Irvine, CA 92697, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Shen","sequence":"additional","affiliation":[{"name":"AbbVie, Irvine, CA 92612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,17]]},"reference":[{"key":"ref_1","unstructured":"(2021). Botox (OnabotulinumtoxinA) [Package Insert], Allergan."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1152\/physrev.2000.80.2.717","article-title":"Neurotoxins affecting neuroexocytosis","volume":"80","author":"Schiavo","year":"2000","journal-title":"Physiol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1124\/pr.116.012658","article-title":"Botulinum neurotoxins: Biology, pharmacology, and toxicology","volume":"69","author":"Pirazzini","year":"2017","journal-title":"Pharmacol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1002\/mds.23254","article-title":"Meta-analysis of neutralizing antibody conversion with onabotulinumtoxinA (BOTOX\u00ae) across multiple indications","volume":"25","author":"Naumann","year":"2010","journal-title":"Mov. Disord."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1111\/head.13849","article-title":"Mechanism of action of onabotulinumtoxinA in chronic migraine: A narrative review","volume":"60","author":"Burstein","year":"2020","journal-title":"Headache"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Bellows, S., and Jankovic, J. (2019). Immunogenicity associated with botulinum toxin treatment. Toxins, 11.","DOI":"10.3390\/toxins11090491"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1007\/s00415-016-8136-x","article-title":"Botulinum toxin treatment failures in cervical dystonia: Causes, management, and outcomes","volume":"263","author":"Jinnah","year":"2016","journal-title":"J. Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e48","DOI":"10.1212\/WNL.0000000000006688","article-title":"High prevalence of neutralizing antibodies after long-term botulinum neurotoxin therapy","volume":"92","author":"Albrecht","year":"2019","journal-title":"Neurology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e2109","DOI":"10.1212\/WNL.0000000000009444","article-title":"Frequency and risk factors of antibody-induced secondary failure of botulinum neurotoxin therapy","volume":"94","author":"Walter","year":"2020","journal-title":"Neurology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1002\/mds.22157","article-title":"Long-term treatment with botulinum toxin type A in cervical dystonia has low immunogenicity by mouse protection assay","volume":"23","author":"Brin","year":"2008","journal-title":"Mov. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Bellows, S., and Jankovic, J. (2020). Reply to comment on re-visiting immunogenicity associated with botulinum toxin treatment. Toxins 2019, 11, 491. Toxins, 12.","DOI":"10.3390\/toxins12020072"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1067\/mjd.2002.121356","article-title":"MBAd BOTOX Glabellar Lines I Study Group. A multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines","volume":"46","author":"Carruthers","year":"2002","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_13","first-page":"1","article-title":"One-year, randomised, multicenter, two-period study of the safety and efficacy of repeated treatments with botulinum toxin type A in patients with glabellar lines","volume":"7","author":"Carruthers","year":"2004","journal-title":"J. Clin. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"21S","DOI":"10.1097\/01.PRS.0000076504.79727.62","article-title":"Double-blind, placebo-controlled study of the safety and efficacy of botulinum toxin type A for patients with glabellar lines","volume":"112","author":"Carruthers","year":"2003","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1111\/j.1365-4632.2009.04071.x","article-title":"An open-label, randomized, 64-week study repeating 10- and 20-U doses of botulinum toxin type A for treatment of glabellar lines in Japanese subjects","volume":"48","author":"Kawashima","year":"2009","journal-title":"Int. J. Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.jaad.2007.01.009","article-title":"Botulinum toxin type A in the treatment of primary axillary hyperhidrosis: A 52-week multicenter double-blind, randomized, placebo-controlled study of efficacy and safety","volume":"56","author":"Lowe","year":"2007","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_17","first-page":"AB61","article-title":"Four-year longitudinal data on the efficacy and safety of repeated botulinum toxin type A therapy for primary axillary hyperhidrosis [abstract]","volume":"56","author":"Glaser","year":"2007","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1111\/pde.12620","article-title":"A prospective, nonrandomized, open-label study of the efficacy and safety of onabotulinumtoxinA in adolescents with primary axillary hyperhidrosis","volume":"32","author":"Glaser","year":"2015","journal-title":"Pediatr. Dermatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1136\/bmj.323.7313.596","article-title":"Botulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: Randomised, parallel group, double blind, placebo controlled trial","volume":"323","author":"Naumann","year":"2001","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1001\/archderm.139.6.731","article-title":"Botulinum toxin type a is a safe and effective treatment for axillary hyperhidrosis over 16 months: A prospective study","volume":"139","author":"Naumann","year":"2003","journal-title":"Arch. Dermatol."},{"key":"ref_21","unstructured":"Pariser, D., Kowalski, J., Ravelo, A., and Ill, D. (2005, January 18\u201322). Work productivity impairment in patients with severe primary axillary hyperhidrosis: Initial results from the work limitations questionnaire [poster]. Proceedings of the Annual Meeting of the American Academy of Dermatology, New Orleans, LA, USA."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/j.1526-4610.2005.05066.x","article-title":"Botulinum toxin type A (BOTOX) for the prophylactic treatment of chronic daily headache: A randomized, double-blind, placebo-controlled trial","volume":"45","author":"Mathew","year":"2005","journal-title":"Headache"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.4065\/80.9.1126","article-title":"Botulinum toxin type A for the prophylactic treatment of chronic daily headache: A randomized, double-blind, placebo-controlled trial","volume":"80","author":"Silberstein","year":"2005","journal-title":"Mayo Clin. Proc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1111\/j.1526-4610.2006.00624.x","article-title":"Botulinum toxin type A prophylactic treatment of episodic migraine: A randomized, double-blind, placebo-controlled exploratory study","volume":"47","author":"Aurora","year":"2007","journal-title":"Headache"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1056\/NEJMoa011892","article-title":"Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke","volume":"347","author":"Brashear","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.1212\/01.WNL.0000144349.95487.91","article-title":"Repeated dosing of botulinum toxin type A for upper limb spasticity following stroke","volume":"63","author":"Gordon","year":"2004","journal-title":"Neurology"},{"key":"ref_27","first-page":"R47","article-title":"Double-blind, randomized, dose-ranging study of BOTOX purified neurotoxin complex for treating focal spasticity post-stroke [abstract 155]","volume":"365","author":"Turkel","year":"2002","journal-title":"Naunyn. Shmiedebergs Arch. Pharmacol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1016\/j.apmr.2008.01.007","article-title":"Repeated treatments with botulinum toxin type A produce sustained decreases in the limitations associated with focal upper-limb poststroke spasticity for caregivers and patients","volume":"89","author":"Elovic","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1097\/01.ju.0000162035.73977.1c","article-title":"Botulinum toxin type a is a safe and effective treatment for neurogenic urinary incontinence: Results of a single treatment, randomized, placebo controlled 6-month study","volume":"174","author":"Schurch","year":"2005","journal-title":"J. Urol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1007\/s12325-013-0054-z","article-title":"OnabotulinumtoxinA is effective in patients with urinary incontinence due to neurogenic detrusor overactivity [corrected] regardless of concomitant anticholinergic use or neurologic etiology","volume":"30","author":"Ginsberg","year":"2013","journal-title":"Adv Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1016\/j.juro.2012.01.125","article-title":"Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity","volume":"187","author":"Ginsberg","year":"2012","journal-title":"J. Urol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.eururo.2011.07.002","article-title":"Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: A randomised, double-blind, placebo-controlled trial","volume":"60","author":"Cruz","year":"2011","journal-title":"Eur. Urol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1002\/nau.22934","article-title":"Efficacy and safety of onabotulinumtoxinA therapy are sustained over 4 years of treatment in patients with neurogenic detrusor overactivity: Final results of a long-term extension study","volume":"36","author":"Kennelly","year":"2015","journal-title":"Neurourol. Urodyn."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1097\/DSS.0000000000000128","article-title":"Efficacy and safety of onabotulinumtoxinA for the treatment of crow\u2019s feet lines: A multicenter, randomized, controlled trial","volume":"40","author":"Carruthers","year":"2014","journal-title":"Dermatol. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/DSS.0000000000000357","article-title":"Efficacy and safety of onabotulinumtoxinA for treating crow\u2019s feet lines alone or in combination with glabellar lines: A multicenter, randomized, controlled trial","volume":"41","author":"Carruthers","year":"2015","journal-title":"Dermatol. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1097\/DSS.0000000000000357","article-title":"A multicenter, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of repeated onabotulinumtoxinA treatments in subjects with crow\u2019s feet lines and glabellar lines","volume":"41","author":"Carruthers","year":"2015","journal-title":"Dermatol. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.eururo.2013.04.001","article-title":"OnabotulinumtoxinA 100 U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: A randomised, double-blind, placebo-controlled trial","volume":"64","author":"Chapple","year":"2013","journal-title":"Eur. Urol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2186","DOI":"10.1016\/j.juro.2012.12.022","article-title":"OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: Results of a phase 3, randomized, placebo controlled trial","volume":"189","author":"Nitti","year":"2013","journal-title":"J. Urol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/j.juro.2016.03.146","article-title":"Durable efficacy and safety of long-term onabotulinumtoxinA treatment in patients with overactive bladder syndrome: Final results of a 3.5-year study","volume":"196","author":"Nitti","year":"2016","journal-title":"J. Urol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/j.juro.2017.05.068","article-title":"Long-term treatment with onabotulinumtoxinA results in consistent, durable improvements in health related quality of life in patients with overactive bladder","volume":"198","author":"Ginsberg","year":"2017","journal-title":"J. Urol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"33","DOI":"10.3233\/NRE-210070","article-title":"Efficacy and safety of onabotulinumtoxinA with standardized physiotherapy for the treatment of pediatric lower limb spasticity: A randomized, placebo-controlled, phase III clinical trial","volume":"50","author":"Dimitrova","year":"2022","journal-title":"Neurorehabilitation"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"469","DOI":"10.3233\/NRE-210071","article-title":"Efficacy and safety of onabotulinumtoxinA with standardized occupational therapy for treatment of pediatric upper limb spasticity: Phase III placebo-controlled randomized trial","volume":"49","author":"Dimitrova","year":"2021","journal-title":"Neurorehabilitation"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1093\/ptj\/67.2.206","article-title":"interrater reliability of a modified Ashworth scale of muscle spasticity","volume":"67","author":"Bohannon","year":"1987","journal-title":"Phys. Ther."},{"key":"ref_44","unstructured":"(2020). Botox Cosmetic [Package Insert], Allergan plc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1002\/mds.870120116","article-title":"The EBD test\u2014A clinical test for the detection of antibodies to botulinum toxin type A","volume":"12","author":"Kessler","year":"1997","journal-title":"Mov. Disord."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1002\/mds.21051","article-title":"Secondary nonresponsiveness to botulinum toxin A in cervical dystonia: The role of electromyogram-guided injections, botulinum toxin A antibody assay, and the extensor digitorum brevis test","volume":"21","author":"Cordivari","year":"2006","journal-title":"Mov. Disord."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1136\/jnnp.66.5.612","article-title":"Comparison of mouse bioassay and immunoprecipitation assay for botulinum toxin antibodies","volume":"66","author":"Hanna","year":"1999","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1212\/WNL.45.9.1743","article-title":"Response and immunoresistance to botulinum toxin injections","volume":"45","author":"Jankovic","year":"1995","journal-title":"Neurology"},{"key":"ref_49","unstructured":"(2021). Aimovig [package Insert], Novartis Pharmaceuticals Corporation."},{"key":"ref_50","unstructured":"(2021). Ajovy [Package Insert], Teva Pharmaceuticals USA, Inc."},{"key":"ref_51","unstructured":"(2021). Emgality [Package Insert], Eli Lilly and Company."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1111\/j.1526-4610.2010.01678.x","article-title":"OnabotulinumtoxinA for treatment of chronic migraine: Pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program","volume":"50","author":"Dodick","year":"2010","journal-title":"Headache, J. Head Face Pain"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s10194-018-0840-8","article-title":"Long-term study of the efficacy and safety of onabotulinumtoxinA for the prevention of chronic migraine: COMPEL study","volume":"19","author":"Blumenfeld","year":"2018","journal-title":"J. Headache Pain"},{"key":"ref_54","unstructured":"(2021). Vyepti [Package Insert], Lundbeck Seattle BioPharmaceuticals, Inc."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1586\/ern.12.61","article-title":"Onabotulinum toxin A for the treatment of neurogenic detrusor overactivity due to spinal cord injury or multiple sclerosis","volume":"12","author":"Goessaert","year":"2012","journal-title":"Expert Rev. Neurother."},{"key":"ref_56","first-page":"1025","article-title":"Treatment of multiple sclerosis","volume":"28","author":"Cross","year":"2022","journal-title":"Continuum (Minneap Minn)."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"5046","DOI":"10.1007\/s12325-021-01882-9","article-title":"Immunogenicity of botulinum toxin formulations: Potential therapeutic implications","volume":"38","author":"Carr","year":"2021","journal-title":"Adv. Ther."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1212\/WNL.0000000000008378","article-title":"Author response: High prevalence of neutralizing antibodies after long-term botulinum neurotoxin therapy","volume":"93","author":"Albrecht","year":"2019","journal-title":"Neurology"},{"key":"ref_59","unstructured":"(2021). Xeomin [Package Insert], Merz Pharmaceuticals."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1002\/mds.870090216","article-title":"Development of resistance to botulinum toxin type A in patients with torticollis","volume":"9","author":"Greene","year":"1994","journal-title":"Mov. Disord."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/15\/5\/342\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:36:58Z","timestamp":1760125018000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/15\/5\/342"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,17]]},"references-count":60,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["toxins15050342"],"URL":"https:\/\/doi.org\/10.3390\/toxins15050342","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,17]]}}}