{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T22:48:14Z","timestamp":1788994094648,"version":"build-2803163510"},"reference-count":53,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Botulinum toxin type A (BoNT-A) is an established preventive therapy for chronic migraines; however, uncertainty remains regarding its comparative efficacy and safety. Thus, we aimed to summarize current evidence from high-quality systematic reviews of the therapeutic effects of BoNT-A in migraine management. An umbrella review was conducted following PRISMA guidelines and registered in PROSPERO. High-quality systematic reviews with meta-analysis evaluating BoNT-A efficacy were identified through five databases up to August 2024. Primary outcomes included monthly headache frequency and severity. Methodological quality and risk of bias were assessed using the umbrella review checklist. Fourteen articles were included. Overall, quantitative evidence indicated favorable effects of BoNT-A compared with placebo for chronic migraines, across headache frequency, headache severity, and acute medication use, but less efficacy than topiramate and the CGRP monoclonal antibodies (CGRPmAbs) galcanezumab and fremanezumab. Though the adverse events were frequent, BoNT-A was generally well-tolerated. Comparative data suggested superior tolerability versus topiramate and a safety profile like CGRPmAbs. Although botulinum toxin type A is widely used as a preventive treatment for chronic migraines, the available evidence supports its efficacy at a moderate level. Further head-to-head and long-term analyses are needed to clarify its comparative role alongside newer biologic treatments.<\/jats:p>","DOI":"10.3390\/toxins18010033","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T16:03:16Z","timestamp":1767974596000},"page":"33","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Botulinum Toxin Type A for the Prevention of Migraines: An Umbrella Review of Systematic Reviews"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5532-0541","authenticated-orcid":false,"given":"Goli","family":"Chamani","sequence":"first","affiliation":[{"name":"Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, SE-14104 Huddinge, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2352-8070","authenticated-orcid":false,"given":"Hajer","family":"Jasim","sequence":"additional","affiliation":[{"name":"Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, SE-14104 Huddinge, Sweden"},{"name":"Department of Orofacial Pain and Jaw Function, Public Dental Services, Folktandv\u00e5rden Stockholm, Eastmaninstitutet, SE-10231 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ava","family":"Minston","sequence":"additional","affiliation":[{"name":"Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, SE-14104 Huddinge, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7837-3024","authenticated-orcid":false,"given":"Marlon Ferreira","family":"Dias","sequence":"additional","affiliation":[{"name":"Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, SE-14104 Huddinge, Sweden"},{"name":"Department of Dental Materials and Prosthodontics, School of Dentistry, S\u00e3o Paulo State University (UNESP), Araraquara 14801-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7180-6448","authenticated-orcid":false,"given":"Rodrigo Lorenzi","family":"Poluha","sequence":"additional","affiliation":[{"name":"Department of Dentistry, State University of Maringa (UEM), Maring\u00e1 87083-170, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1987-1207","authenticated-orcid":false,"given":"Daniela A. Godoi","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Department of Dental Materials and Prosthodontics, School of Dentistry, S\u00e3o Paulo State University (UNESP), Araraquara 14801-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6804-6855","authenticated-orcid":false,"given":"Maria","family":"Christidis","sequence":"additional","affiliation":[{"name":"Department of Nursing Science, Sophiahemmet University, SE-114 86 Stockholm, Sweden"},{"name":"Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-14183 Huddinge, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3649-9662","authenticated-orcid":false,"given":"Essam Ahmed","family":"Al-Moraissi","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar 009676, Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8199-7863","authenticated-orcid":false,"given":"Nikolaos","family":"Christidis","sequence":"additional","affiliation":[{"name":"Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, SE-14104 Huddinge, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0921-342X","authenticated-orcid":false,"given":"Giancarlo","family":"De la Torre Canales","sequence":"additional","affiliation":[{"name":"Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, SE-14104 Huddinge, Sweden"},{"name":"Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4152-5439","authenticated-orcid":false,"given":"Malin","family":"Ernberg","sequence":"additional","affiliation":[{"name":"Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, SE-14104 Huddinge, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/s10194-020-01208-0","article-title":"Lifting The Burden: The Global Campaign Against Headache. Migraine remains second among the world\u2019s causes of disability, and first among young women: Findings from GBD2019","volume":"21","author":"Steiner","year":"2020","journal-title":"J. Headache Pain"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"American Headache Society (2019). The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache J. Head Face Pain, 59, 1\u201318.","DOI":"10.1111\/head.13456"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/0333102417738202","article-title":"Headache Classification Committee of the International Headache Society (IHS) the International Classification of Headache Disorders, 3rd edition","volume":"38","author":"Olesen","year":"2018","journal-title":"Cephalalgia"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s40122-024-00690-7","article-title":"The global burden of migraine: A 30-Year trend review and future projections by age, sex, country, and region","volume":"14","author":"Dong","year":"2025","journal-title":"Pain Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S1474-4422(16)30293-9","article-title":"Sex differences in the epidemiology, clinical features, and pathophysiology of migraine","volume":"16","author":"Vetvik","year":"2017","journal-title":"Lancet Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3331024241267309","DOI":"10.1177\/03331024241267309","article-title":"Migraine is the most disabling neurological disease among children and adolescents, and second after stroke among adults: A call to action","volume":"44","author":"Peres","year":"2024","journal-title":"Cephalalgia"},{"key":"ref_7","first-page":"CD011616","article-title":"Botulinum toxins for the prevention of migraine in adults","volume":"6","author":"Herd","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/01.JAA.0000000000000014","article-title":"An update on migraine: Current and new treatment options","volume":"37","author":"Hervias","year":"2024","journal-title":"JAAPA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s10194-019-1038-4","article-title":"Current and emerging evidence-based treatment options in chronic migraine: A narrative review","volume":"20","author":"Agostoni","year":"2019","journal-title":"J. Headache Pain"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5762","DOI":"10.1007\/s00415-024-12512-z","article-title":"Effectiveness and safety of pharmacological prophylaxis for chronic migraine: A systematic review and network meta-analysis","volume":"271","author":"Zhao","year":"2024","journal-title":"J. Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1212\/01.wnl.0000323925.29520.e7","article-title":"Chronic migraine in the population: Burden, diagnosis, and satisfaction with treatment","volume":"71","author":"Bigal","year":"2008","journal-title":"Neurology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1177\/0333102414547138","article-title":"Adherence to oral migraine-preventive medications among patients with chronic migraine","volume":"35","author":"Hepp","year":"2015","journal-title":"Cephalalgia"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/PRS.0000000000005111","article-title":"Botulinum toxin versus placebo: A meta-analysis of prophylactic treatment for migraine","volume":"143","author":"Bruloy","year":"2019","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"201","DOI":"10.31083\/j.jin.2020.01.1240","article-title":"Impact of the botulinum-A toxin on prevention of adult migraine disorders","volume":"19","author":"Shen","year":"2020","journal-title":"J. Integr. Neurosci."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Jabbari, B. (2015). Botulinum Toxin Treatment of Pain Disorders, Springer.","DOI":"10.1007\/978-1-4939-2501-8"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.pain.2006.04.014","article-title":"The effects of Botulinum Toxin type A on capsaicin-evoked pain, flare, and secondary hyperalgesia in an experimental human model of trigeminal sensitization","volume":"122","author":"Gazerani","year":"2006","journal-title":"Pain"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"111557","DOI":"10.1016\/j.biopha.2021.111557","article-title":"Genetics, pathophysiology, diagnosis, treatment, management, and prevention of migraine","volume":"139","author":"Khan","year":"2021","journal-title":"Biomed. Pharmacother."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1080\/14728222.2020.1724285","article-title":"Calcitonin gene-related peptide (CGRP): Role in migraine pathophysiology and therapeutic targeting","volume":"24","author":"Wattiez","year":"2020","journal-title":"Expert Opin. Ther. Targets"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1111\/j.1526-4610.2011.01955.x","article-title":"Pathophysiology of chronic migraine and mode of action of preventive medications","volume":"51","author":"Mathew","year":"2011","journal-title":"Headache J. Head Face Pain"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1177\/1073858414524633","article-title":"More than at the neuromuscular synapse: Actions of botulinum neurotoxin A in the central nervous system","volume":"21","author":"Mazzocchio","year":"2015","journal-title":"Neuroscientist"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.neuro.2005.01.017","article-title":"Review of a proposed mechanism for the antinociceptive action of botulinum toxin type A","volume":"26","author":"Aoki","year":"2005","journal-title":"Neurotoxicology"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Prudenzano, M.P. (2024). Botulinum Toxin and Migraine: Goals and Perspectives. Toxins, 16.","DOI":"10.3390\/toxins16120530"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1111\/head.14743","article-title":"Sustained benefits of onabotulinumtoxinA treatment in chronic migraine: An analysis of the pooled Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) randomized controlled trials","volume":"64","author":"Silberstein","year":"2024","journal-title":"Headache J. Head Face Pain"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Herd, C.P., Tomlinson, C.L., Rick, C., Scotton, W.J., Edwards, J., Ives, N.J., Clarke, C.E., and Sinclair, A. (2019). Cochrane systematic review and meta-analysis of botulinum toxin for the prevention of migraine. BMJ Open, 9.","DOI":"10.1136\/bmjopen-2018-027953"},{"key":"ref_25","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_26","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1592\/phco.29.7.784","article-title":"Efficacy of botulinum toxin type A for the prophylaxis of episodic migraine headaches: A meta-analysis of randomized, double-blind, placebo-controlled trials","volume":"29","author":"Shuhendler","year":"2009","journal-title":"Pharmacotherapy"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1001\/jama.2012.505","article-title":"Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults: A meta-analysis","volume":"307","author":"Jackson","year":"2012","journal-title":"JAMA"},{"key":"ref_28","unstructured":"Shamliyan, T.A., Kane, R.L., and Taylor, F.R. (2013). AHRQ Comparative Effectiveness Reviews, Migraine in Adults: Preventive Pharmacologic Treatments."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1111\/ane.13391","article-title":"Topiramate, acupuncture, and BoNT-A for chronic migraine: A network meta-analysis","volume":"143","author":"Zheng","year":"2021","journal-title":"Acta Neurol. Scand."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1186\/s12967-021-02801-w","article-title":"High efficacy of onabotulinumtoxinA treatment in patients with comorbid migraine and depression: A meta-analysis","volume":"19","author":"Affatato","year":"2021","journal-title":"J. Transl. Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Chen, Y.Y., Ye, X.Q., Tang, T.C., She, T.W., Chen, M., and Zheng, H. (2021). Calcitonin Gene-Related Peptide Monoclonal Antibodies Versus Botulinum Neurotoxin a in the Preventive Treatment of Chronic Migraine: An Adjusted Indirect Treatment Comparison Meta-Analysis. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.671845"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1177\/03331024211018137","article-title":"CGRP-antibodies, topiramate and botulinum toxin type A in episodic and chronic migraine: A systematic review and meta-analysis","volume":"41","author":"Frank","year":"2021","journal-title":"Cephalalgia"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1177\/03331024221123058","article-title":"Effectiveness of onabotulinumtoxinA (BOTOX\u00ae) for the preventive treatment of chronic migraine: A meta-analysis on 10 years of real-world data","volume":"42","author":"Ducros","year":"2022","journal-title":"Cephalalgia"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Corasaniti, M.T., Bagetta, G., Nicotera, P., Tarsitano, A., Tonin, P., Sandrini, G., Lawrence, G.W., and Scuteri, D. (2023). Safety of Onabotulinumtoxin A in Chronic Migraine: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Toxins, 15.","DOI":"10.3390\/toxins15050332"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1111\/head.14798","article-title":"The safety and efficacy of onabotulinumtoxinA injections for children and adolescents with chronic migraine: A systematic review and meta-analysis","volume":"64","author":"Lindsay","year":"2024","journal-title":"Headache"},{"key":"ref_36","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"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Matak, I., Bolcskei, K., Bach-Rojecky, L., and Helyes, Z. (2019). Mechanisms of Botulinum Toxin Type A Action on Pain. Toxins, 11.","DOI":"10.3390\/toxins11080459"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1111\/ane.12906","article-title":"Botulinum toxin: A review of the mode of action in migraine","volume":"137","author":"Do","year":"2018","journal-title":"Acta Neurol. Scand."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.molmed.2010.02.004","article-title":"TRPV1 in migraine pathophysiology","volume":"16","author":"Meents","year":"2010","journal-title":"Trends Mol. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s10194-015-0539-z","article-title":"Two TRPV1 receptor antagonists are effective in two different experimental models of migraine","volume":"16","author":"Meents","year":"2015","journal-title":"J. Headache Pain"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1016\/j.pain.2012.06.012","article-title":"Activation of TRPA1 on dural afferents: A potential mechanism of headache pain","volume":"153","author":"Edelmayer","year":"2012","journal-title":"Pain"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1093\/brain\/aww038","article-title":"TRPA1 mediates trigeminal neuropathic pain in mice downstream of monocytes\/macrophages and oxidative stress","volume":"139","author":"Trevisan","year":"2016","journal-title":"Brain"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1007\/s13238-017-0395-5","article-title":"TRPV1 and TRPA1 in cutaneous neurogenic and chronic inflammation: Pro-inflammatory response induced by their activation and their sensitization","volume":"8","author":"Gouin","year":"2017","journal-title":"Protein Cell"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/s10194-022-01492-y","article-title":"A systematic review of economic evaluations of pharmacological treatments for adults with chronic migraine","volume":"23","author":"Khanal","year":"2022","journal-title":"J. Headache Pain"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1111\/j.1365-2125.2012.04241.x","article-title":"Provision of medicines information: The example of the British National Formulary","volume":"73","author":"Kendall","year":"2012","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"877","DOI":"10.3111\/13696998.2013.802694","article-title":"The cost-effectiveness of onabotulinumtoxinA for the prophylaxis of headache in adults with chronic migraine in the UK","volume":"16","author":"Batty","year":"2013","journal-title":"J. Med. Econ."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1007\/s40265-024-02048-x","article-title":"Botulinum Toxin-A for the Treatment of Myogenous Temporomandibular Disorders: An Umbrella Review of Systematic Reviews","volume":"84","author":"Ernberg","year":"2024","journal-title":"Drugs"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/s10194-023-01696-w","article-title":"Clinical effectiveness of pharmacological interventions for managing chronic migraine in adults: A systematic review and network meta-analysis","volume":"24","author":"Naghdi","year":"2023","journal-title":"J. Headache Pain"},{"key":"ref_49","first-page":"195","article-title":"Improving the translation of search strategies using the Polyglot Search Translator: A randomized controlled trial","volume":"108","author":"Clark","year":"2020","journal-title":"J. Med. Libr. Assoc. JMLA"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan\u2014A web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1080\/1941126X.2018.1444339","article-title":"Rayyan for systematic reviews","volume":"30","author":"Johnson","year":"2018","journal-title":"J. Electron. Resour. Librariansh."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"240","DOI":"10.3163\/1536-5050.104.3.014","article-title":"De-duplication of database search results for systematic reviews in EndNote","volume":"104","author":"Bramer","year":"2016","journal-title":"J. Med. Libr. Assoc."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Shea, B.J., Grimshaw, J.M., Wells, G.A., Boers, M., Andersson, N., Hamel, C., Porter, A.C., Tugwell, P., Moher, D., and Bouter, L.M. (2007). Development of AMSTAR: A measurement tool to assess the methodological quality of systematic reviews. BMC Med. Res. Methodol., 7.","DOI":"10.1186\/1471-2288-7-10"}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/18\/1\/33\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T16:06:34Z","timestamp":1767974794000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/18\/1\/33"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":53,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["toxins18010033"],"URL":"https:\/\/doi.org\/10.3390\/toxins18010033","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]}}}