1. Cholinergic System – Botulinum Toxin (BTX)
Acts as Parasympatholytic
Seven types of BTX, named type A–G
BTX purified from Clostridium botulinum (gram-positive; anaerobic) = BOTOX®
Blocks release of Ach from presynaptic nerve terminals at NMJ
Deadliest (neuro)toxin known – 2 ng/kg is lethal !!
=> Biological weapon
Clinical uses:
Involuntary muscle contractions (spasticity)
Treatment of GI smooth muscle disorders
Anal fissures (spasm of sphincter muscle prevent healing => BTX relaxes)
Reduction of skin wrinkles - moderate to severe frown lines between eyebrows-

2. Cholinergic System – Botulinum Toxin (BTX)

3. Diabetes mellitus SGLT2 inhibitors: Novel concepts (cont’d):
Sodium-Glucose-Linked-Transporter 2 (SGLT2) :
SGLT2 responsible for 90% glucose reuptake in the proximal convoluted tubes
If capacity is exceeded, glucose excreted in urine (= diabetes)
Na+ gradient created by Na+/K+ ATPase acts as driving force
SGLT2 inhibitors:
Reduce glucose levels without risk of hypoglycemia
Glucose excretion might also benefit weight loss (~300 kCal/day)
Associated loss of water via osmosis => lowering of blood pressure
Work independent of insulin
High risk of urinary tract infections
Canagliflozin
Approved 2013
Dapagliflozin
Empagliflozin