Australian venomous jellyfish, envenomation syndromes, toxins and therapy

A Survey of Jellyfish Sting Knowledge among Naval Personnel in Northeast China

BACKGROUND

Jellyfish envenomation is common along the coastal area, and can cause severe consequences. Naval personnel are among the high-risk population for this injury. The aim of this study was to assess knowledge regarding jellyfish envenomation among naval personnel in a navy unit in northeast China.

METHODS

A predesigned questionnaire was distributed to 120 naval members in January 2015. The data of 108 respondents were included in the statistical analysis.

RESULTS

We found that 38.0% of the respondents selected jellyfish sting as the common wound in their units, and 13.0% had experienced or observed this injury. In addition, 63.0% of the participants rated their own knowledge as "low" or "none". The average score they got was 5.77 ± 2.50, with only 16.7% getting a score above 60% of the full score. The correct rates of five questions were below 60%. No statistical differences existed in the knowledge score among different groups of respondents defined by socio-demographic variables.

CONCLUSIONS

Jellyfish sting is common in this navy unit, but personnel got a low score on the knowledge assessment. They also lacked confidence in first aid. Medical education and training should be implemented to address this issue.

Ocular Jellyfish Stings: Report of 2 Cases and Literature Review

An ocular jellyfish sting is an ophthalmic emergency and is rarely reported in the medical literature. With the evolution of aquatic activities and entertainment in recent decades, we anticipate that more patients with ocular jellyfish stings may be taken to the emergency department. However, most physicians are unaware of the typical presentations, suitable treatments, prognosis, and possible complications of ocular jellyfish stings. We reported 2 cases with ocular jellyfish stings and collected cases series from literature review. The most common clinical features of ocular jellyfish stings were pain, conjunctival injection, corneal lesion, and photophobia. All patients who sustained ocular stings did so during aquatic activities, and the best management at the scene was proper analgesics and copious irrigation of affected eyes with seawater or saline. The ocular lesions were treated with topical cycloplegics, topical steroids, topical antibiotics, topical antihistamines, and removal of nematocysts. The prognosis was good, and all patients recovered without any permanent sequelae. However, symptoms in some patients may last longer than 1 week. Reported complications included iritis, increased intraocular pressures, mydriasis, decreased accommodation, and peripheral anterior synechiae.

To Pee, or Not to Pee: A Review on Envenomation and Treatment in European Jellyfish Species

There is a growing cause for concern on envenoming European species because of jellyfish blooms, climate change and globalization displacing species. Treatment of envenomation involves the prevention of further nematocyst release and relieving local and systemic symptoms. Many anecdotal treatments are available but species-specific first aid response is essential for effective treatment. However, species identification is difficult in most cases. There is evidence that oral analgesics, seawater, baking soda slurry and 42-45 °C hot water are effective against nematocyst inhibition and giving pain relief. The application of topical vinegar for 30 s is effective on stings of specific species. Treatments, which produce osmotic or pressure changes can exacerbate the initial sting and aggravate symptoms, common among many anecdotal treatments. Most available therapies are based on weak evidence and thus it is strongly recommended that randomized clinical trials are undertaken. We recommend a vital increase in directed research on the effect of environmental factors on envenoming mechanisms and to establish a species-specific treatment. Adequate signage on jellyfish stings and standardized first aid protocols with emphasis on protective equipment and avoidance of jellyfish to minimize cases should be implemented in areas at risk.

Heated Debates: Hot-Water Immersion or Ice Packs as First Aid for Cnidarian Envenomations?

Cnidarian envenomations are an important public health problem, responsible for more deaths than shark attacks annually. For this reason, optimization of first-aid care is essential. According to the published literature, cnidarian venoms and toxins are heat labile at temperatures safe for human application, which supports the use of hot-water immersion of the sting area(s). However, ice packs are often recommended and used by emergency personnel. After conducting a systematic review of the evidence for the use of heat or ice in the treatment of cnidarian envenomations, we conclude that the majority of studies to date support the use of hot-water immersion for pain relief and improved health outcomes.

The magnitude of severe box jellyfish cases on Koh Samui and Koh Pha-ngan in the Gulf of Thailand

BACKGROUND

Despite recent deaths caused by box jellyfish envenomation occurring on the islands of Samui and Pha-ngan in the Gulf of Thailand, many people do not believe box jellyfish can kill humans and many people dismiss the problem as insignificant. More evidence has been requested from the communities in order to evaluate the need for and the implementation of sustainable prevention measures. We aimed to determine the magnitude of cases of severe stinging by box jellyfish and describe the characteristics of these cases on the islands of Samui and Pha-ngan in Surat Thani Province from 1997 to 2015.

METHODS

Various strategies were integrated prospectively. Toxic jellyfish networks and surveillance system were established. Outbreak investigations were conducted retrospectively and prospectively from 2008 to 2015.

RESULTS

There were 15 box jellyfish cases. A small majority of them were women (60.0) with a median age of 26.0 years (range 5.0-45.0 years). The highest incidence by month were August (33.3%), September and October (20.0%), and July (13.3%). Eight cases occurred on Samui (53.3%), 6 cases on Pha-ngan island (40.0%), and one case on the boat. All cases developed symptoms and signs immediately after being stung. More than half of the cases were unconscious. There were six fatal cases (46.7%). The wound characteristics had an appearance similar to caterpillar tracks or step ladder-like burn marks. Almost all cases involved Chirodropidae. One fatal case received fresh water and ice packs applied to the wounds (16.7%). Among the cases with known first aid, only one out of six fatal cases had vinegar applied to the wounds (16.7%), while haft of six surviving cases received the vinegar treatment.

CONCLUSIONS

The islands of Samui and Pha-ngan have the highest incidence of fatal and near fatal box jellyfish cases in Thailand. There is an urgent need for informed pre-clinical emergent care. Optimal pre-clinical care is an area of active research.

Efficacy of Topical Treatments for Chrysaora chinensis Species: A Human Model in Comparison with an In Vitro Model

OBJECTIVES

This study sought to create a model for testing topical treatment of jellyfish stings. It sought to determine which treatments 1) stimulate/inhibit nematocyst discharge; 2) decrease pain; and 3) decrease skin inflammation; it also sought to discover whether there is a clinical correlation between stimulated nematocyst discharge observed in vitro to the pain and erythema experienced by humans stung by a particular species of jellyfish, C chinensis.

METHODS

Chrysaora chinensis stung 96 human subjects, who were then treated with isopropyl alcohol, hot water, acetic acid, papain meat tenderizer, lidocaine, or sodium bicarbonate. Pain and erythema were measured. In a separate experiment, nematocysts were examined microscopically after exposure to the same topical treatments used in the human experiment.

RESULTS

Forearms treated with papain showed decreased mean pain over the first 30 minutes after being stung, relative to placebo, although only by a small amount. The other topical treatments tested did not reach statistical significance. Sodium bicarbonate may reduce erythema after 30 minutes of treatment; sodium bicarbonate and papain may reduce erythema at 60 minutes. The other topical treatments tested did not reach statistical significance. Nematocyst discharge in vitro occurred when tentacles of C chinensis were exposed to acetic acid or isopropyl alcohol. Sodium bicarbonate, papain, heated water, and lidocaine did not induce nematocyst discharge.

CONCLUSIONS

Papain-containing meat tenderizer used as a topical treatment for C chinensis stings may decrease pain. Although there is published experimental support for the concept that in vitro nematocyst discharge correlates with in vivo human pain perception, no definitive randomized controlled trial, including ours, has yet provided incontrovertible evidence of this assertion. Despite this study's limitations, it presents a viable basis for future human studies looking at the efficacy of topical treatments for jellyfish stings.

Experimental Assays to Assess the Efficacy of Vinegar and Other Topical First-Aid Approaches on Cubozoan (Alatina alata) Tentacle Firing and Venom Toxicity

Despite the medical urgency presented by cubozoan envenomations, ineffective and contradictory first-aid management recommendations persist. A critical barrier to progress has been the lack of readily available and reproducible envenomation assays that (1) recapitulate live-tentacle stings; (2) allow quantitation and imaging of cnidae discharge; (3) allow primary quantitation of venom toxicity; and (4) employ rigorous controls. We report the implementation of an integrated array of three experimental approaches designed to meet the above-stated criteria. Mechanistically overlapping, yet distinct, the three approaches comprised (1) direct application of test solutions on live tentacles (termed tentacle solution assay, or TSA) with single image- and video-microscopy; (2) spontaneous stinging assay using freshly excised tentacles overlaid on substrate of live human red blood cells suspended in agarose (tentacle blood agarose assays, or TBAA); and (3) a “skin” covered adaptation of TBAA (tentacle skin blood agarose assay, or TSBAA). We report the use and results of these assays to evaluate the efficacy of topical first-aid approaches to inhibit tentacle firing and venom activity. TSA results included the potent stimulation of massive cnidae discharge by alcohols but only moderate induction by urine, freshwater, and “cola” (carbonated soft drink). Although vinegar, the 40-year field standard of first aid for the removal of adherent tentacles, completely inhibited cnidae firing in TSA and TSBAA ex vivo models, the most striking inhibition of both tentacle firing and subsequent venom-induced hemolysis was observed using newly-developed proprietary formulations (Sting No More™) containing copper gluconate, magnesium sulfate, and urea.

Global Transcriptome Analysis of the Tentacle of the Jellyfish Cyanea capillata Using Deep Sequencing and Expressed Sequence Tags: Insight into the Toxin- and Degenerative Disease-Related Transcripts

BACKGROUND

Jellyfish contain diverse toxins and other bioactive components. However, large-scale identification of novel toxins and bioactive components from jellyfish has been hampered by the low efficiency of traditional isolation and purification methods.

RESULTS

We performed de novo transcriptome sequencing of the tentacle tissue of the jellyfish Cyanea capillata. A total of 51,304,108 reads were obtained and assembled into 50,536 unigenes. Of these, 21,357 unigenes had homologues in public databases, but the remaining unigenes had no significant matches due to the limited sequence information available and species-specific novel sequences. Functional annotation of the unigenes also revealed general gene expression profile characteristics in the tentacle of C. capillata. A primary goal of this study was to identify putative toxin transcripts. As expected, we screened many transcripts encoding proteins similar to several well-known toxin families including phospholipases, metalloproteases, serine proteases and serine protease inhibitors. In addition, some transcripts also resembled molecules with potential toxic activities, including cnidarian CfTX-like toxins with hemolytic activity, plancitoxin-1, venom toxin-like peptide-6, histamine-releasing factor, neprilysin, dipeptidyl peptidase 4, vascular endothelial growth factor A, angiotensin-converting enzyme-like and endothelin-converting enzyme 1-like proteins. Most of these molecules have not been previously reported in jellyfish. Interestingly, we also characterized a number of transcripts with similarities to proteins relevant to several degenerative diseases, including Huntington's, Alzheimer's and Parkinson's diseases. This is the first description of degenerative disease-associated genes in jellyfish.

CONCLUSION

We obtained a well-categorized and annotated transcriptome of C. capillata tentacle that will be an important and valuable resource for further understanding of jellyfish at the molecular level and information on the underlying molecular mechanisms of jellyfish stinging. The findings of this study may also be used in comparative studies of gene expression profiling among different jellyfish species.

Protective effects of batimastat against hemorrhagic injuries in delayed jellyfish envenomation syndrome models

Previously, we established delayed jellyfish envenomation syndrome (DJES) models and proposed that the hemorrhagic toxins in jellyfish tentacle extracts (TE) play a significant role in the liver and kidney injuries of the experimental model. Further, we also demonstrated that metalloproteinases are the central toxic components of the jellyfish Cyanea capillata (C. capillata), which may be responsible for the hemorrhagic effects. Thus, metalloproteinase inhibitors appear to be a promising therapeutic alternative for the treatment of hemorrhagic injuries in DJES. In this study, we examined the metalloproteinase activity of TE from the jellyfish C. capillata using zymography analyses. Our results confirmed that TE possessed a metalloproteinase activity, which was also sensitive to heat. Then, we tested the effect of metalloproteinase inhibitor batimastat (BB-94) on TE-induced hemorrhagic injuries in DJES models. Firstly, using SR-based X-ray microangiography, we found that BB-94 significantly improved TE-induced hepatic and renal microvasculature alterations in DJES mouse model. Secondly, under synchrotron radiation micro-computed tomography (SR-μCT), we also confirmed that BB-94 reduced TE-induced hepatic and renal microvasculature changes in DJES rat model. In addition, being consistent with the imaging results, histopathological and terminal deoxynucleotidyl transferase-mediated UTP end labeling (TUNEL)-like staining observations also clearly corroborated this hypothesis, as BB-94 was highly effective in neutralizing TE-induced extensive hemorrhage and necrosis in DJES rat model. Although it may require further clinical studies in the near future, the current study opens up the possibilities for the use of the metalloproteinase inhibitor, BB-94, in the treatment of multiple organ hemorrhagic injuries in DJES.

Use of an Inverse Method for Time Series to Estimate the Dynamics of and Management Strategies for the Box Jellyfish Carybdea marsupialis

Frequently, population ecology of marine organisms uses a descriptive approach in which their sizes and densities are plotted over time. This approach has limited usefulness for design strategies in management or modelling different scenarios. Population projection matrix models are among the most widely used tools in ecology. Unfortunately, for the majority of pelagic marine organisms, it is difficult to mark individuals and follow them over time to determine their vital rates and built a population projection matrix model. Nevertheless, it is possible to get time-series data to calculate size structure and densities of each size, in order to determine the matrix parameters. This approach is known as a “demographic inverse problem” and it is based on quadratic programming methods, but it has rarely been used on aquatic organisms. We used unpublished field data of a population of cubomedusae Carybdea marsupialis to construct a population projection matrix model and compare two different management strategies to lower population to values before year 2008 when there was no significant interaction with bathers. Those strategies were by direct removal of medusae and by reducing prey. Our results showed that removal of jellyfish from all size classes was more effective than removing only juveniles or adults. When reducing prey, the highest efficiency to lower the C. marsupialis population occurred when prey depletion affected prey of all medusae sizes. Our model fit well with the field data and may serve to design an efficient management strategy or build hypothetical scenarios such as removal of individuals or reducing prey. TThis This sdfsdshis method is applicable to other marine or terrestrial species, for which density and population structure over time are available.

Comparative study of the toxic effects of Chrysaora quinquecirrha (Cnidaria: Scyphozoa) and Chironex fleckeri (Cnidaria: Cubozoa) venoms using cell-based assays

The venoms of jellyfish cause toxic effects in diverse biological systems that can trigger local and systemic reactions. In this study, the cytotoxic and cytolytic effects of Chrysaora quinquecirrha and Chironex fleckeri venoms were assessed and compared using three in vitro assays. Venoms from both species were cytotoxic to fish gill cells and rat cardiomyocytes, and cytolytic in sheep erythrocytes. Both venoms decreased cell viability in a concentration-dependent manner; however, the greatest difference in venom potencies was observed in the fish gill cell line, wherein C. fleckeri was 12.2- (P = 0.0005) and 35.7-fold (P < 0.0001) more potently cytotoxic than C. quinquecirrha venom with 30 min and 120 min cell exposure periods, respectively. Gill cells and rat cardiomyocytes exposed to venoms showed morphological changes characterised by cell shrinkage, clumping and detachment. The cytotoxic effects of venoms may be caused by a group of toxic proteins that have been previously identified in C. fleckeri and other cubozoan jellyfish species. In this study, proteins homologous to CfTX-1 and CfTX-2 toxins from C. fleckeri and CqTX-A toxin from Chironex yamaguchii were identified in C. quinquecirrha venom using tandem mass spectrometry. The presence and relative abundance of these proteins may explain the differences in venom potency between cubozoan and scyphozoan jellyfish and may reflect their importance in the action of venoms.

Intracellular Ca(2+) overload induced by extracellular Ca(2+) entry plays an important role in acute heart dysfunction by tentacle extract from the jellyfish Cyanea capillata

The exact mechanism of acute heart dysfunction caused by jellyfish venom remains unclear for the moment. In the present study, we examined the problem caused by the tentacle extract (TE) from the jellyfish Cyanea capillata at the levels of whole animal, isolated heart, primarily cultured cardiomyocytes, and intracellular Ca(2+). The heart indexes, including HR, APs, LVPs, and MMLs, were all decreased significantly by TE in both whole animal and Langendorff-perfused isolated heart model. Imbalance of cardiac oxygen supply and demand also took place. In both Ca(2+)-containing and Ca(2+)-free bathing solutions, TE could cause obvious cytoplasmic Ca(2+) overload in NRVMs, but the cytoplasmic Ca(2+) increased faster, Ca(2+) overload peaks arrived earlier, and the morphological changes were more severe under the extracellular Ca(2+)-containing condition. L-type Ca(2+) channel blockers, as well as the inhibitor of ryanodine receptor (ryanodine), could improve the viability of NRVMs. Moreover, diltiazem significantly inhibited the acute heart dysfunction caused by TE in both Langendorff isolated heart model and whole animal. These results suggested that intracellular Ca(2+) overload induced by extracellular Ca(2+) entry plays an important role in acute heart failure by TE from the jellyfish C. capillata. Inhibition of extracellular Ca(2+) influx is a promising antagonistic alternative for heart damage by jellyfish venom.

Exploring the therapeutic potential of jellyfish venom

The venom of certain jellyfish has long been known to be potentially fatal to humans, but it is only recently that details of the proteomes of these fascinating creatures are emerging. The molecular contents of the nematocysts from several jellyfish species have now been analyzed using proteomic MS approaches and include the analysis of Chironex fleckeri, one of the most venomous jellyfish known. These studies suggest that some species contain toxins related to peptides and proteins found in other venomous creatures. The detailed characterization of jellyfish venom is likely to provide insight into the diversification of toxins and might be a valuable resource in drug design.

[Jellyfish sting injuries]

BACKGROUND

Jellyfish are distributed worldwide; they cause local skin injuries upon contact which are often followed by systemic signs of envenoming.

OBJECTIVES

Which jellyfish species are of medical importance, which skin reactions and systemic symptoms occur, which first-aid measures and treatment options exist?

METHODS

Review of the medical literature and discussion of first-aid and therapeutic options.

RESULTS

Jellyfish capable of causing skin injuries occur in almost all oceans. Several jellyfish species may cause severe, potentially lethal, systemic symptoms; they include the Portuguese man-of-war (Physalia physalis) and box jellyfish (Chironex fleckeri, Carukia barnesi, Chiropsalmus quadrigatus).

CONCLUSIONS

Among the injuries and envenoming symptoms caused by marine organisms, jellyfish dermatitis should not be underestimated. Skin reactions may not only a dermatological problem, but also be accompanied by complex systemic toxic symptoms which are a challenge for internists.

Jellyfish Stings: A Practical Approach

Jellyfish have a worldwide distribution. Their stings can cause different reactions, ranging from cutaneous, localized, and self-limited to serious systemic or fatal ones, depending on the envenoming species. Several first aid treatments are used to manage such stings but few have evidence behind their use. This review of the literature describes and discusses the different related first aid and treatment recommendations, ending with a summarized practical approach. Further randomized controlled trials in this field are needed.

Water envenomations and stings

Marine envenomations are an important part of sports medicine. Marine sport is practiced widely, and many aquatic envenomations require quick recognition and timely action to ensure the safety and recovery of victims. Even a basic knowledge of treatments of various envenomations could help clinicians be more effective in acute treatment. The purpose of this article is to review known literature and expand on recent progress in the field of aquatic envenomations.

Bioactive toxins from stinging jellyfish

Jellyfish blooms occur throughout the world. Human contact with a jellyfish induces a local reaction of the skin, which can be painful and leave scaring. Systemic symptoms are also observed and contact with some species is lethal. A number of studies have evaluated the in vitro biological activity of whole jellyfish venom or of purified fractions. Hemolytic, cytotoxic, neurotoxic or enzymatic activities are commonly observed. Some toxins have been purified and characterized. A family of pore forming toxins specific to Medusozoans has been identified. There remains a need for detailed characterization of jellyfish toxins to fully understand the symptoms observed in vivo.

Nematocyst discharge in Pelagia noctiluca (Cnidaria, Scyphozoa) oral arms can be affected by lidocaine, ethanol, ammonia and acetic acid

Nematocyst discharge and concomitant delivery of toxins is triggered to perform both defence and predation strategies in Cnidarians, and may lead to serious local and systemic reactions in humans. Pelagia noctiluca (Cnidaria, Scyphozoa) is a jellyfish particularly abundant in the Strait of Messina (Italy). After accidental contact with this jellyfish, not discharged nematocysts or even fragments of tentacles or oral arms may tightly adhere to the human skin and, following discharge, severely increase pain and the other adverse consequences of the sting. The aim of the present study is to verify if the local anesthetic lidocaine and other compounds, like alcohols, acetic acid and ammonia, known to provide pain relief after jellyfish stings, may also affect in situ discharge of nematocysts. Discharge was induced by a combined physico-chemical stimulation of oral arms by chemosensitizers (such as N-acetylated sugars, aminoacids, proteins and nucleotides), in the presence or absence of 1% lidocaine, 70% ethanol, 5% acetic acid or 20% ammonia, followed by mechanical stimulation by a non-vibrating test probe. The above mentioned compounds failed to induce discharge per se, and dramatically impaired the chemosensitizer-induced discharge response. We therefore suggest that prompt local treatment of the stung epidermis with lidocaine, acetic acid, ethanol and ammonia may provide substantial pain relief and help in reducing possible harmful local and systemic adverse reaction following accidental contact with P. noctiluca specimens.

Detection of microvasculature alterations by synchrotron radiation in murine with delayed jellyfish envenomation syndrome

Using the tentacle extract (TE) from the jellyfish Cyanea capillata, we have previously established a delayed jellyfish envenomation syndrome (DJES) model, which is meaningful for clinical interventions against jellyfish stings. However, the mechanism of DJES still remains unclear. Thus, this study aimed to explore its potential mechanism by detecting TE-induced microvasculature alterations in vivo and ex vivo. Using a third-generation synchrotron radiation facility, we, for the first time, directly observed the blood vessel alterations induced by jellyfish venom in vivo and ex vivo. Firstly, microvasculature imaging of whole-body mouse in vivo indicated that the small blood vessel branches in the liver and kidney in the TE-treated group, seemed much thinner than those in the control group. Secondly, 3D imaging of kidney ex vivo showed that the kidneys in the TE-treated group had incomplete vascular trees where distal vessel branches were partly missing and disorderly disturbed. Finally, histopathological analysis found that obvious morphological changes, especially hemorrhagic effects, were also present in the TE-treated kidney. Thus, TE-induced microvasculature changes might be one of the important mechanisms of multiple organ dysfunctions in DJES. In addition, the methods we employed here will probably facilitate further studies on developing effective intervention strategies against DJES.

Isolated severe median mononeuropathy caused by a jellyfish sting

Neuropathies caused by jellyfish stings are extremely rare and poorly studied. A 20-year-old female patient was stung on the volar aspect of the right forearm by an unidentified species of jellyfish. Local cutaneous reaction was followed within few days by severe median mononeuropathy, involving the motor and sensory branches to the hand and forearm but sparing the palmar branch. The patient had neuropathic pain relieved by pregabaline. Electrodiagnostic studies confirmed a demyelinating lesion. Ultrasound and magnetic resonance imaging of the median nerve revealed uniform swelling with mild uptake of contrast along the forearm. Within 2 months, strength improved significantly, pain subsided, and numbness partially resolved. Literature review and discussion of the possible mechanisms and implications of this rare effect of marine animal envenomation is presented. Jellyfish sting may cause focal mononeuropathies most probably because of the local effects of the toxins.

protective effect of tetracycline against dermal toxicity induced by Jellyfish venom

BACKGROUND

Previously, we have reported that most, if not all, of the Scyphozoan jellyfish venoms contain multiple components of metalloproteinases, which apparently linked to the venom toxicity. Further, it is also well known that there is a positive correlation between the inflammatory reaction of dermal tissues and their tissue metalloproteinase activity. Based on these, the use of metalloproteinase inhibitors appears to be a promising therapeutic alternative for the treatment of jellyfish envenomation.

METHODOLOGY AND PRINCIPAL FINDINGS

Tetracycline (a metalloproteinase inhibitor) has been examined for its activity to reduce or prevent the dermal toxicity induced by Nemopilema nomurai (Scyphozoa: Rhizostomeae) jellyfish venom (NnV) using in vitro and in vivo models. HaCaT (human keratinocyte) and NIH3T3 (mouse fibroblast) incubated with NnV showed decreases in cell viability, which is associated with the inductions of metalloproteinase-2 and -9. This result suggests that the use of metalloproteinase inhibitors, such as tetracycline, may prevent the jellyfish venom-mediated local tissue damage. In vivo experiments showed that comparing with NnV-alone treatment, tetracycline pre-mixed NnV demonstrated a significantly reduced progression of dermal toxicity upon the inoculation onto rabbit skin.

CONCLUSIONS/SIGNIFICANCE

It is believed that there has been no previous report on the therapeutic agent of synthetic chemical origin for the treatment of jellyfish venom-induced dermonecrosis based on understanding its mechanism of action except the use of antivenom treatment. Furthermore, the current study, for the first time, has proposed a novel mechanism-based therapeutic intervention for skin damages caused by jellyfish stings.

Biochemical and electrophysiological characterization of two sea anemone type 1 potassium toxins from a geographically distant population of Bunodosoma caissarum

Sea anemone (Cnidaria, Anthozoa) venom is an important source of bioactive compounds used as tools to study the pharmacology and structure-function of voltage-gated K+ channels (KV). These neurotoxins can be divided into four different types, according to their structure and mode of action. In this work, for the first time, two toxins were purified from the venom of Bunodosoma caissarum population from Saint Peter and Saint Paul Archipelago, Brazil. Sequence alignment and phylogenetic analysis reveals that BcsTx1 and BcsTx2 are the newest members of the sea anemone type 1 potassium channel toxins. Their functional characterization was performed by means of a wide electrophysiological screening on 12 different subtypes of KV channels (KV1.1-KV1.6; KV2.1; KV3.1; KV4.2; KV4.3; hERG and Shaker IR). BcsTx1 shows a high affinity for rKv1.2 over rKv1.6, hKv1.3, Shaker IR and rKv1.1, while Bcstx2 potently blocked rKv1.6 over hKv1.3, rKv1.1, Shaker IR and rKv1.2. Furthermore, we also report for the first time a venom composition and biological activity comparison between two geographically distant populations of sea anemones.

Jellyfish stings and their management: a review

Jellyfish (cnidarians) have a worldwide distribution. Despite most being harmless, some species may cause local and also systemic reactions. Treatment of jellyfish envenomation is directed at: alleviating the local effects of venom, preventing further nematocyst discharges and controlling systemic reactions, including shock. In severe cases, the most important step is stabilizing and maintaining vital functions. With some differences between species, there seems to be evidence and consensus on oral/topical analgesics, hot water and ice packs as effective painkillers and on 30 s application of domestic vinegar (4%-6% acetic acid) to prevent further discharge of unfired nematocysts remaining on the skin. Conversely, alcohol, methylated spirits and fresh water should be carefully avoided, since they could massively discharge nematocysts; pressure immobilization bandaging should also be avoided, as laboratory studies show that it stimulates additional venom discharge from nematocysts. Most treatment approaches are presently founded on relatively weak evidence; therefore, further research (especially randomized clinical trials) is strongly recommended. Dissemination of appropriate treatment modalities should be deployed to better inform and educate those at risk. Adequate signage should be placed at beaches to notify tourists of the jellyfish risk. Swimmers in risky areas should wear protective equipment.

Cubozoan venom-induced cardiovascular collapse is caused by hyperkalemia and prevented by zinc gluconate in mice

Chironex fleckeri (Australian box jellyfish) stings can cause acute cardiovascular collapse and death. We developed methods to recover venom with high specific activity, and evaluated the effects of both total venom and constituent porins at doses equivalent to lethal envenomation. Marked potassium release occurred within 5 min and hemolysis within 20 min in human red blood cells (RBC) exposed to venom or purified venom porin. Electron microscopy revealed abundant ∼12-nm transmembrane pores in RBC exposed to purified venom porins. C57BL/6 mice injected with venom showed rapid decline in ejection fraction with progression to electromechanical dissociation and electrocardiographic findings consistent with acute hyperkalemia. Recognizing that porin assembly can be inhibited by zinc, we found that zinc gluconate inhibited potassium efflux from RBC exposed to total venom or purified porin, and prolonged survival time in mice following venom injection. These findings suggest that hyperkalemia is the critical event following Chironex fleckeri envenomation and that rapid administration of zinc could be life saving in human sting victims.

Cardiovascular effect is independent of hemolytic toxicity of tentacle-only extract from the jellyfish Cyanea capillata

Our previous studies have confirmed that the crude tentacle-only extract (cTOE) from the jellyfish Cyanea capillata (Cyaneidae) exhibits hemolytic and cardiovascular toxicities simultaneously. So, it is quite difficult to discern the underlying active component responsible for heart injury caused by cTOE. The inactivation of the hemolytic toxicity from cTOE accompanied with a removal of plenty of precipitates would facilitate the separation of cardiovascular component and the investigation of its cardiovascular injury mechanism. In our research, after the treatment of one-step alkaline denaturation followed by twice dialysis, the protein concentration of the treated tentacle-only extract (tTOE) was about 1/3 of cTOE, and SDS-PAGE showed smaller numbers and lower density of protein bands in tTOE. The hemolytic toxicity of tTOE was completely lost while its cardiovascular toxicity was well retained. The observations of cardiac function, histopathology and ultrastructural pathology all support tTOE with significant cardiovascular toxicity. Blood gas indexes and electrolytes changed far less by tTOE than those by cTOE, though still with significant difference from normal. In summary, the cardiovascular toxicity of cTOE can exist independently of the hemolytic toxicity and tTOE can be employed as a better venom sample for further purification and mechanism research on the jellyfish cardiovascular toxic proteins.

Review of Fatal and Severe Cases of Box Jellyfish Envenomation in Thailand

The study aimed to describe severe and fatal cases of box jellyfish stings in Thailand. Medical records were reviewed and patients, relatives, health staffs, and witnesses were interviewed. The pictures of suspected box jellyfish were sent via e-mail to experts in the toxic jellyfish network for further identification. There were at least 8 cases of box jellyfish envenomation, with 4 fatal and 4 near-fatal cases. There were an equal number of male and female patients from 4 to 26 years of age. In each case, there was immediate severe pain followed by systemic reactions. Immediately after exposure to the sting, 7 victims collapsed experiencing severe pain at the tentacle marks, respiratory failure, and cardiac arrest. All patients had tentacle marks on their bodies. In none of the fatal cases was vinegar applied to the tentacle marks as first aid, but 3 out of the 4 near-fatal cases were treated with a vinegar application.

Evidence-based treatment of jellyfish stings in North America and Hawaii

We performed a systematic review of the evidence supporting various treatments for envenomation by jellyfish (cnidarian) and related organisms in North America and Hawaii. Our review produced 19 pertinent primary articles. Current research demonstrates variable response to treatment, often with conflicting results according to species studied, which contributes to considerable confusion about what treatment is warranted and efficacious. Our review suggests that vinegar causes pain exacerbation or nematocyst discharge in the majority of species. Hot water and topical lidocaine appear more widely beneficial in improving pain symptoms and are preferentially recommended. Unfortunately, they may be difficult to obtain at the site of envenomation, such as the beach or diving sites. In these instances, removing the nematocysts and washing the area with saltwater may be considered. If the envenomation is thought to be due to the bluebottle (Physalia), vinegar may be beneficial.

Cardiotoxic effects of venom fractions from the Australian box jellyfish Chironex fleckeri on human myocardiocytes

An investigation into the cardiotoxic effects in human cardiomyocytes of different fractions (as produced from an FPLC) of the venom from Chironex fleckeri showed that whole venom caused cardiac cell death in minutes, measured as cell detachment using xCELLigence technology. However, only one fraction of the venom was responsible for this effect. When all extracted venoms were recombined a similar result was seen for the toxic fraction, however these effects were slower than unfractionated venom alone even though the concentrations were similar. The difference in the results between fractioned and unfractionated venom may have been caused by compounds remaining in the FPLC column, which may interact with the toxic fraction to cause rapid cell detachment or death.

Nematocytes' activation in Pelagia noctiluca (Cnidaria, Scyphozoa) oral arms

Nematocytes' discharge is triggered to perform both defense and predation strategies in cnidarians and occurs under chemico-physical stimulation. In this study, different compounds such as amino acids and proteins (mucin, albumin, poly-L: -lysine, trypsin), sugars and N-acetylate sugars (N-acetyl neuraminic acid, N-acetyl galactosamine, sucrose, glucose, agarose and trehalose), nucleotides (ATP and cAMP), were tested as chemosensitizers of nematocyte discharge in the oral arms of the scyphozoan Pelagia noctiluca, particularly abundant in the Strait of Messina (Italy). Excised oral arms were submitted to a combined chemico-physical stimulation by treatment with different compounds followed by mechanical stimulation by a non-vibrating test probe. Discharge induced by a chemico-physical stimulation was more significant than that obtained after mechanical stimulation alone. A chemosensitizing mechanism, with a dose-dependent effect, was observed after treatment with sugars, amino compounds such as glutathione, nucleotides and mucin, according to that already seen in sea anemones. Such findings suggest that, though Anthozoa and Scyphozoa exhibit different divergence times during the evolutionary process, the discharge activation exhibits common features, probably derived from their last common ancestor.

Occupational health issues in marine and freshwater research

Marine and freshwater scientists are potentially exposed to a wide variety of occupational hazards. Depending on the focus of their research, risks may include animal attacks, physiological stresses, exposure to toxins and carcinogens, and dangerous environmental conditions. Many of these hazards have been investigated amongst the general population in their recreational use of the environment; however, very few studies have specifically related potential hazards to occupational exposure. For example, while the incidence of shark and crocodile attacks may invoke strong emotions and the occupational risk of working with these animals is certainly real, many more people are stung by jellyfish or bitten by snakes or dogs each year. Furthermore, a large proportion of SCUBA-related injuries and deaths are incurred by novice or uncertified divers, rather than professional divers using aquatic environments. Nonetheless, marine and freshwater research remains a potentially risky occupation, and the likelihood of death, injury and long-term health impacts still needs to be seriously considered.

Neurotoxin localization to ectodermal gland cells uncovers an alternative mechanism of venom delivery in sea anemones

Jellyfish, hydras, corals and sea anemones (phylum Cnidaria) are known for their venomous stinging cells, nematocytes, used for prey and defence. Here we show, however, that the potent Type I neurotoxin of the sea anemone Nematostella vectensis, Nv1, is confined to ectodermal gland cells rather than nematocytes. We demonstrate massive Nv1 secretion upon encounter with a crustacean prey. Concomitant discharge of nematocysts probably pierces the prey, expediting toxin penetration. Toxin efficiency in sea water is further demonstrated by the rapid paralysis of fish or crustacean larvae upon application of recombinant Nv1 into their medium. Analysis of other anemone species reveals that in Anthopleura elegantissima, Type I neurotoxins also appear in gland cells, whereas in the common species Anemonia viridis, Type I toxins are localized to both nematocytes and ectodermal gland cells. The nematocyte-based and gland cell-based envenomation mechanisms may reflect substantial differences in the ecology and feeding habits of sea anemone species. Overall, the immunolocalization of neurotoxins to gland cells changes the common view in the literature that sea anemone neurotoxins are produced and delivered only by stinging nematocytes, and raises the possibility that this toxin-secretion mechanism is an ancestral evolutionary state of the venom delivery machinery in sea anemones.

Target organ identification of jellyfish envenomation using systemic and integrative analyses in anesthetized dogs

Proper treatment of jellyfish envenomed patients can be successfully achieved only from an understanding of the overall functional changes and alterations in physiological parameters under its envenomation. The majority of previous investigations on jellyfish venoms have covered only a couple of parameters at a time. Unlike most other fragmentary jellyfish studies, we employed an integrative toxicological approach, including hemodynamics, clinical chemistry and hematology analyses, using N. nomurai jellyfish venom (NnV) in dogs. After the baseline measurements for mean arterial pressure (MAP), cardiac output (CO) and heart rate (HR), NnV was intravenously administered to the dogs at doses of 0.1 or 0.3mg/kg body weight. The dogs showed significant decreases in MAP (-27.4±3.7 and -48.1±9.9 mmHg), CO (-1.1±0.1 L/min and -1.0±0.2 L/min), and HR (-4.5±0.3 and -9.9±3.1 beats/min) comparing with the respective baseline controls. The onset of systemic hypotension and bradycardia occurred within 1 min of NnV injection and they lasted for 1-35 min, depending on the NnV doses. Interestingly, serum biochemical analyses of envenomed dogs exhibited dramatic increases of alkaline phosphatase (ALP), creatine phosphokinase (CPK), alanine aminotransferase (ALT) and aspartate aminotransferase (AST), indicating its possible target organs. In conclusion, we have demonstrated simultaneously, for the first time, the multiple organ toxicities (cardiotoxic, myotoxic and hepatotoxic) of a scyphozoan jellyfish venom. Based on these results, an integrative toxinological approach using dogs appears to be effective in predicting jellyfish venom toxicities and designing their therapeutic strategies. We expect this method can be applied to other jellyfish venom research as well.

Comparison of haemolytic activity of tentacle-only extract from jellyfish Cyanea capillata in diluted whole blood and erythrocyte suspension: diluted whole blood is a valid test system for haemolysis study

In this paper, we utilized two different test systems to compare the haemolysis of tentacle-only extract (TOE) devoid of nematocysts from jellyfish Cyanea capillata, the 1% whole blood and 0.45% erythrocyte suspension approximately with the same erythrocyte concentration from the blood samples of sheep, rabbit, mouse, rat and human, respectively. Without exception, the haemolytic activity of TOE was dose-dependent in both test systems from all the five kinds of blood samples, while it was generally stronger in erythrocyte suspension than that in diluted whole blood at the relatively high concentration of TOE. When various aliquots of plasma were added into the erythrocyte suspension test system, the haemolytic activity of TOE was declined with the plasma quantity increasing, and dropped to about 20% at the presence of two aliquots of plasma. If serum albumin of 0.5 mg/ml, approximately the same albumin content in 1% whole blood, was added into the erythrocyte suspension test system instead, the haemolysis of TOE was similarly inhibited. The effects of GSH, ascorbic acid and protease inhibitor on the haemolytic activity of TOE were detected in the erythrocyte suspension and diluted whole blood simultaneously, and the test results were coincident between the two systems. These results suggested that the inconsistency of TOE haemolysis between the erythrocyte suspension and diluted whole blood is a universal occurrence in the mammals, and blood plasma plays a dose-dependent protective role against haemolysis which may be due to serum albumin. Diluted whole blood is a valid and convenient test system for haemolysis study in vitro.

The acute toxicity and hematological characterization of the effects of tentacle-only extract from the jellyfish Cyanea capillata

To investigate the hematologic changes and the activities of jellyfish venoms other than hemolytic and cardiovascular toxicities, the acute toxicity of tentacle-only extract (TOE) from the jellyfish Cyanea capillata was observed in mice, and hematological indexes were examined in rats. The median lethal dose (LD₅₀) of TOE was 4.25 mg/kg, and the acute toxicity involved both heart- and nervous system-related symptoms. Arterial blood gas indexes, including pH, PCO₂, HCO₃⁻, HCO₃std, TCO₂, BEecf and BE (B), decreased significantly. PO₂ showed a slight increase, while SO₂c (%) had no change at any time. Na⁺ and Ca²⁺ decreased, but K⁺ increased. Biochemical indexes, including LDH, CK, CK-MB, ALT, AST and sCr, significantly increased. Other biochemical indexes, including BUN and hemodiastase, remained normal. Lactic acid significantly increased, while glucose, Hct% and THbc showed slight temporary increases and then returned to normal. These results on the acute toxicity and hematological changes should improve our understanding of the in vivo pathophysiological effects of TOE from C. capillata and indicate that it may also have neurotoxicity, liver toxicity and muscular toxicity in addition to hemolytic and cardiovascular toxicities, but no kidney or pancreatic toxicity.

Jellyfish as vectors of bacterial disease for farmed salmon (Salmo salar)

Swarms or blooms of jellyfish are increasingly problematic and can result in high mortality rates of farmed fish. Small species of jellyfish, such as Phialella quadrata (13 mm in diameter), are capable of passing through the mesh of sea cages and being sucked into the mouth of fish during respiration. Results of the current study show that the initial damage to gills of farmed Atlantic salmon, likely produced by nematocyst-derived toxins from the jellyfish, was compounded by secondary bacterial infection with Tenacibaculum maritimum. Results also demonstrate that these filamentous bacteria were present on the mouth of the jellyfish and that their DNA sequences were almost identical to those of bacteria present on the salmon gills. This suggests that the bacterial lesions were not the result of an opportunistic infection of damaged tissue, as previously thought. Instead, P. quadrata is probably acting as a vector for this particular bacterial pathogen, and it is the first time that evidence to support such a link has been presented. No prior literature describing the presence of bacteria associated with jellyfish, except studies about their decay, could be found. It is not known if all jellyfish of this and other species carry similar bacteria or the relationship to each other. Their source, the role they play under other circumstances, and indeed whether the jellyfish were themselves diseased are also not known. The high proteolytic capabilities of T. maritimum mean that partially digested gill tissues were readily available to the jellyfish, which rely heavily on intracellular digestion for their nutrition.

Jellyfish blooms in China: Dominant species, causes and consequences

Three jellyfish species, Aurelia aurita, Cyanea nozakii and Nemopilema nomurai, form large blooms in Chinese seas. We report on the distribution and increasing incidence of jellyfish blooms and their consequences in Chinese coastal seas and analyze their relationship to anthropogenically derived changes to the environment in order to determine the possible causes. A. aurita, C. nozakii and N. nomurai form blooms in the temperate Chinese seas including the northern East China Sea, Yellow Sea and Bohai Sea. N. nomurai forms offshore blooms while the other two species bloom mainly in inshore areas. Eutrophication, overfishing, habitat modification for aquaculture and climate change are all possible contributory factors facilitating plausible mechanisms for the proliferation of jellyfish blooms. In the absence of improvement in coastal marine ecosystem health, jellyfish blooms could be sustained and may even spread from the locations in which they now occur.

Evaluation of the effects of various chemicals on discharge of and pain caused by jellyfish nematocysts

Jellyfish tentacles in contact with human skin can produce pain swelling and redness. The pain is due to discharge of jellyfish nematocysts and associated toxins and discharge can be caused by a variety of mechanical and chemical stimuli. A series of tests were carried out with chemicals traditionally used to treat jellyfish stings e.g. acetic acid ammonia meat tenderizer baking soda and urea to determine if these chemicals stimulated or inhibited nematocyst discharge and if they brought relief to testers who were exposed to jellyfish tentacles. Chrysaora quinquecirrha (sea nettle) Chiropsalmus quadrumanus (sea wasp) and Physalia physalis (Portuguese man-of-war) were used in the study. It was found that many of the chemicals traditionally used to treat jellyfish stings stimulated nematocyst discharge and did not relieve the pain. However there was immediate relief when a common anesthetic lidocaine was sprayed on the skin of testers in contact with jellyfish tentacles. Initial exposure of tentacle suspensions to lidocaine prevented the nematocyst discharge by subsequent exposure to acetic acid ethanol ammonia or bromelain. Thus lidocaine in addition to acting as an anesthetic on skin in contact with jellyfish tentacles inhibited nematocyst discharge possibly by blocking sodium and/or calcium channels of the nematocytes.