Proteomic changes of botulinum neurotoxin injection on muscle growth in children with spastic cerebral palsy

Abstract Purpose The study aims to explore the proteomic profile and specific target proteins associated with muscle growth in response to botulinum neurotoxin A (BoNT‐A) treatment, in order to improve spasticity management in children with cerebral palsy (CP). Experimental design A total of 54 participants provided 60 plasma samples for proteomic analysis. Among them, six children were sampled before and after receiving their first BoNT‐A injection. In addition, 48 unrelated children were enrolled, among whom one group had never received BoNT‐A injections and another group was sampled after their first BoNT‐A injection. Differentially expressed proteins were identified using the data‐independent acquisition (DIA) mass spectrometry approach. Gene Ontology (GO), protein–protein interaction network, and Kyoto Encyclopedia of Genes and Genome analysis were conducted to explore the function and relationship among differentially expressed proteins. The expression levels of target proteins were verified by quantitative real‐time PCR and western blotting. Results Analysis identified significant differential expression of 90 proteins across two time points, including 48 upregulated and 42 downregulated proteins. The upregulated thioredoxin, α‐actinin‐1, and aggrecan, and the downregulated integrin beta‐1 may affect the growth of muscles affected by spasticity 3 months after BoNT‐A injection. This effect is potentially mediated through the activation or inhibition of PI3K‐Akt, focal adhesion, and regulation of actin cytoskeleton signaling pathways. Conclusion and clinical relevance BoNT‐A injection could lead to a disruption of protein levels and signaling pathways, a condition subsequently associated with muscle growth. This finding might aid clinicians in optimizing the management of spasticity in children with CP.