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Patra A, Banerjee D, Dasgupta S, Mukherjee AK. The in vitro laboratory tests and mass spectrometry-assisted quality assessment of commercial polyvalent antivenom raised against the ‘Big Four’ venomous snakes of India. Toxicon 2021; 192:15-31. [DOI: 10.1016/j.toxicon.2020.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/06/2020] [Accepted: 12/27/2020] [Indexed: 12/22/2022]
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52
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Koh CY, Bendre R, Kini RM. Repurposed drug to the rescue of snakebite victims. Sci Transl Med 2021; 12:12/542/eabb6700. [PMID: 32376770 DOI: 10.1126/scitranslmed.abb6700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/26/2020] [Indexed: 12/23/2022]
Abstract
Preclinical data suggest the possibility of repurposing a drug for early intervention in envenoming by snake venom rich in metalloproteinases (Albulescu et al., this issue).
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Affiliation(s)
- Cho Yeow Koh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Rohan Bendre
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore 117558, Singapore
| | - R Manjunatha Kini
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore 117558, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore
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53
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Sanchez-Castro EE, Pajuelo-Reyes C, Tejedo R, Soria-Juan B, Tapia-Limonchi R, Andreu E, Hitos AB, Martin F, Cahuana GM, Guerra-Duarte C, de Assis TCS, Bedoya FJ, Soria B, Chávez-Olórtegui C, Tejedo JR. Mesenchymal Stromal Cell-Based Therapies as Promising Treatments for Muscle Regeneration After Snakebite Envenoming. Front Immunol 2021; 11:609961. [PMID: 33633730 PMCID: PMC7902043 DOI: 10.3389/fimmu.2020.609961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022] Open
Abstract
Snakebite envenoming is a global neglected disease with an incidence of up to 2.7 million new cases every year. Although antivenoms are so-far the most effective treatment to reverse the acute systemic effects induced by snakebite envenoming, they have a limited therapeutic potential, being unable to completely neutralize the local venom effects. Local damage, such as dermonecrosis and myonecrosis, can lead to permanent sequelae with physical, social, and psychological implications. The strong inflammatory process induced by snake venoms is associated with poor tissue regeneration, in particular the lack of or reduced skeletal muscle regeneration. Mesenchymal stromal cells (MSCs)-based therapies have shown both anti-inflammatory and pro-regenerative properties. We postulate that using allogeneic MSCs or their cell-free products can induce skeletal muscle regeneration in snakebite victims, improving all the three steps of the skeletal muscle regeneration process, mainly by anti-inflammatory activity, paracrine effects, neovascularization induction, and inhibition of tissue damage, instrumental for microenvironment remodeling and regeneration. Since snakebite envenoming occurs mainly in areas with poor healthcare, we enlist the principles and potential of MSCs-based therapies and discuss regulatory issues, good manufacturing practices, transportation, storage, and related-procedures that could allow the administration of these therapies, looking forward to a safe and cost-effective treatment for a so far unsolved and neglected health problem.
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Affiliation(s)
| | - Cecilia Pajuelo-Reyes
- Institute of Tropical Diseases, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas, Peru
| | - Rebeca Tejedo
- Faculty of Medicine, Universidad Privada San Juan Bautista, Lima, Peru
| | - Bárbara Soria-Juan
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain.,Department of Surgery, Fundación Jiménez Díaz, Unidad de Terapias Avanzadas, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rafael Tapia-Limonchi
- Institute of Tropical Diseases, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas, Peru
| | - Etelvina Andreu
- ISABIAL-Hospital General y Universitario de Alicante, Alicante, Spain.,Departmento de Fisica Aplicadas, University Miguel Hernández, Alicante, Spain
| | - Ana B Hitos
- Department of Cell Regeneration and Advanced Therapies, Andalusian Center of Molecular Biology and Regenerative Medicine-CABIMER, University of Pablo de Olavide-University of Sevilla-CSIC, Seville, Spain.,Biomedical Research Network for Diabetes and Related Metabolic Diseases-CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
| | - Franz Martin
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain.,Department of Cell Regeneration and Advanced Therapies, Andalusian Center of Molecular Biology and Regenerative Medicine-CABIMER, University of Pablo de Olavide-University of Sevilla-CSIC, Seville, Spain.,Biomedical Research Network for Diabetes and Related Metabolic Diseases-CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
| | - Gladys M Cahuana
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain.,Department of Cell Regeneration and Advanced Therapies, Andalusian Center of Molecular Biology and Regenerative Medicine-CABIMER, University of Pablo de Olavide-University of Sevilla-CSIC, Seville, Spain
| | - Clara Guerra-Duarte
- Center of Research and Development, Fundação Ezequiel Dias, Belo Horizonte, Brazil
| | - Thamyres C Silva de Assis
- Departament of Biochemistry and Immunology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Francisco J Bedoya
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain.,Department of Cell Regeneration and Advanced Therapies, Andalusian Center of Molecular Biology and Regenerative Medicine-CABIMER, University of Pablo de Olavide-University of Sevilla-CSIC, Seville, Spain.,Biomedical Research Network for Diabetes and Related Metabolic Diseases-CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
| | - Bernat Soria
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain.,ISABIAL-Hospital General y Universitario de Alicante, Alicante, Spain.,Biomedical Research Network for Diabetes and Related Metabolic Diseases-CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain.,Institute of Bioengineering, University Miguel Hernandez de Elche, Alicante, Spain
| | - Carlos Chávez-Olórtegui
- Departament of Biochemistry and Immunology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Juan R Tejedo
- Institute of Tropical Diseases, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas, Peru.,Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain.,Department of Cell Regeneration and Advanced Therapies, Andalusian Center of Molecular Biology and Regenerative Medicine-CABIMER, University of Pablo de Olavide-University of Sevilla-CSIC, Seville, Spain.,Biomedical Research Network for Diabetes and Related Metabolic Diseases-CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
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54
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Structural, enzymatic and pharmacological profiles of AplTX-II - A basic sPLA 2 (D49) isolated from the Agkistrodon piscivorus leucostoma snake venom. Int J Biol Macromol 2021; 175:572-585. [PMID: 33529631 DOI: 10.1016/j.ijbiomac.2021.01.187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 12/18/2022]
Abstract
A basic sPLA2 (D49) from the venom of snake Agkistrodon piscivorus leucostoma (AplTX-II) was isolated, purified and characterized. We determined the enzymatic and pharmacological profiles of this toxin. AplTX-II was isolated with a high level of purity through reverse phase chromatography and molecular exclusion. The enzyme showed pI 9.48 and molecular weight of 14,003 Da. The enzymatic activity of the AplTX-II depended on Ca2+ pH and temperature. The comparison of the primary structure with other sPLA2s revealed that AplTX-II presented all the structural reasons expected for a basic sPLA2s. Additionally, we have resolved its structure with the docked synthetic substrate NOBA (4-nitro-3-octanoyloxy benzoic acid) by homology modeling, and performed MD simulations with explicit solvent. Structural similarities were found between the enzyme's modeled structure and other snake sPLA2 X-Ray structures, available in the PDB database. NOBA and active-site water molecules spontaneously adopted stable positions and established interactions in full agreement with the reaction mechanism, proposed for the physiological substrate, suggesting that NOBA hydrolysis is an excellent model to study phospholipid hydrolysis.
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55
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Wong KY, Tan KY, Tan NH, Tan CH. A Neurotoxic Snake Venom without Phospholipase A 2: Proteomics and Cross-Neutralization of the Venom from Senegalese Cobra, Naja senegalensis (Subgenus: Uraeus). Toxins (Basel) 2021; 13:toxins13010060. [PMID: 33466660 PMCID: PMC7828783 DOI: 10.3390/toxins13010060] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 11/16/2022] Open
Abstract
The Senegalese cobra, Naja senegalensis, is a non-spitting cobra species newly erected from the Naja haje complex. Naja senegalensis causes neurotoxic envenomation in Western Africa but its venom properties remain underexplored. Applying a protein decomplexation proteomic approach, this study unveiled the unique complexity of the venom composition. Three-finger toxins constituted the major component, accounting for 75.91% of total venom proteins. Of these, cardiotoxin/cytotoxin (~53%) and alpha-neurotoxins (~23%) predominated in the venom proteome. Phospholipase A2, however, was not present in the venom, suggesting a unique snake venom phenotype found in this species. The venom, despite the absence of PLA2, is highly lethal with an intravenous LD50 of 0.39 µg/g in mice, consistent with the high abundance of alpha-neurotoxins (predominating long neurotoxins) in the venom. The hetero-specific VINS African Polyvalent Antivenom (VAPAV) was immunoreactive to the venom, implying conserved protein antigenicity in the venoms of N. senegalensis and N. haje. Furthermore, VAPAV was able to cross-neutralize the lethal effect of N. senegalensis venom but the potency was limited (0.59 mg venom completely neutralized per mL antivenom, or ~82 LD50 per ml of antivenom). The efficacy of antivenom should be further improved to optimize the treatment of cobra bite envenomation in Africa.
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Affiliation(s)
- Kin Ying Wong
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Kae Yi Tan
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (K.Y.T.); (N.H.T.)
| | - Nget Hong Tan
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (K.Y.T.); (N.H.T.)
| | - Choo Hock Tan
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
- Correspondence: ; Tel.: +60-3-7967-6685
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56
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Noutsos T, Currie BJ, Lek RA, Isbister GK. Snakebite associated thrombotic microangiopathy: a systematic review of clinical features, outcomes, and evidence for interventions including plasmapheresis. PLoS Negl Trop Dis 2020; 14:e0008936. [PMID: 33290400 PMCID: PMC7748274 DOI: 10.1371/journal.pntd.0008936] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/18/2020] [Accepted: 10/30/2020] [Indexed: 02/06/2023] Open
Abstract
Snakebite is a neglected tropical disease with significant morbidity and mortality. Thrombotic microangiopathy (TMA) is an important but poorly understood complication of snakebite associated with acute kidney injury (AKI). Numerous treatments have been attempted based on limited evidence. We conducted a systematic review of TMA following snakebite using a pre-determined case definition of blood film red cell schistocytes or histologically diagnosed TMA. The search strategy included major electronic databases and grey literature. We present a descriptive synthesis for the outcomes of AKI, dialysis free survival (DFS), other end-organ damage, overall survival, and interventions with antivenom and therapeutic plasmapheresis (TPE). This study was prospectively registered with PROSPERO (CRD42019121436). Seventy-two studies reporting 351 cases were included, predominantly small observational studies. Heterogeneity for study selection, design, reporting and outcomes were observed. The commonest envenoming species were hump-nosed vipers (Hypnale spp.), Russell's viper (Daboia russelii) and Australian brown snakes (Pseudechis spp.). The prevalence of TMA was at least 5.4% in proven and probable Hypnale bites, and 10-15% of Australian elapid envenomings, AKI occurred in 94% (293/312) of TMA cases, excluding case reports. The majority of cases with AKI required dialysis. Included prospective and retrospective cohort studies reporting interventions and renal outcomes showed no evidence for benefit from antivenom or TPE with respect to DFS in dialysis dependant AKI. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment for quality of accumulated evidence for interventions was low. The major complication of TMA following snakebite is AKI. AKI improves in most cases. We found no evidence to support benefit from antivenom in snakebite associated TMA, but antivenom remains the standard of care for snake envenoming. There was no evidence for benefit of TPE in snakebite associated TMA, so TPE cannot be recommended. The quality of accumulated evidence was low, highlighting a need for high quality larger studies.
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Affiliation(s)
- Tina Noutsos
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Flinders Health and Medical Research Institute, Flinders University, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Bart J. Currie
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Rachel A. Lek
- Flinders Health and Medical Research Institute, Flinders University, Australia
| | - Geoffrey K. Isbister
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia
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57
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Rasoulinasab F, Rasoulinasab M, Shahbazzadeh D, Asadi A, Kaboli M. Comparison of venom from wild and long-term captive Gloydius caucasicus and the neutralization capacity of antivenom produced in rabbits immunized with captive venom. Heliyon 2020; 6:e05717. [PMID: 33364492 PMCID: PMC7750379 DOI: 10.1016/j.heliyon.2020.e05717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/07/2020] [Accepted: 12/09/2020] [Indexed: 12/02/2022] Open
Abstract
Gloydius caucasicus (NIKOLSKY, 1916) is a member of the Viperidae family in Iran. Comprehensive understanding of the toxigenic characteristics of snake venom is important for clinical monitoring of snakebite patients and effective therapy. We compared the toxic activities of venoms and the neutralization capacity of antivenoms produced with venoms from wild adult (WA) with long-term captive adult (LCA) of G. caucasicus in order to obtain more effective antivenom from LCA in therapy, and subsequently protect G. caucasicus from overharvesting for its venom, which poses a real threat of extinction for the species. Our results showed that LD50 of WA and LCA were 16.8 μg/dose and 17.7 μg/dose, respectively. Lower hemorrhagic and necrotic (p ≥ 0.05), and higher coagulative and edematogenic activities (p ≤ 0.05) were observed in WA compared with LCA venom. Also, captive-born neonates exhibited weaker toxic activities compared with captive adult snakes, which could be an age-related difference. Study data illustrated that effective capacity of LCA antivenom to neutralize the toxic activities of WA viper venom. According to the results, about 0.4-4 μl of LCA antivenom is required to neutralize the toxic activities of 1 μg of WA venom, indicating its efficacy in treatment of snakebites in humans. On this basis, it is recommended that capture of wild snakes for their venom be discontinued to reduce their future extinction risk.
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Affiliation(s)
- Fatemeh Rasoulinasab
- Department of Environmental Science, Faculty of Natural Resources, College of Agriculture & Natural Resources, University of Tehran, Iran
| | - Masoumeh Rasoulinasab
- Department of Bacteriology, Pasteur Institute of Iran, No. 69, Pasteur Ave, Tehran, Iran
| | - Delavar Shahbazzadeh
- Biotechnology Research Center (BRC), Pasteur Institute of Iran, No. 69, Pasteur Ave, Tehran, Iran
| | - Atefeh Asadi
- CEFE, University of Montpellier, University of Paul Valéry Montpellier 3, PSL-EPHE (Biogéographie et Ecologie des Vertébrés), CNRS, IRD, Montpellier, France
| | - Mohammad Kaboli
- Department of Environmental Science, Faculty of Natural Resources, College of Agriculture & Natural Resources, University of Tehran, Iran
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Atamna R, Kelmer E, Aroch I, Klainbart S. Echis coloratus envenomation in a dog: clinical, hemostatic and thromboelastometric findings and treatment. Clin Toxicol (Phila) 2020; 59:639-643. [PMID: 33196299 DOI: 10.1080/15563650.2020.1839663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONTEXT Echis coloratus is endemic to the Middle East. Clinical reports describing E. coloratus envenomation in humans are scarce, while natural envenomations of animals were not reported. Such envenomations may induce systemic coagulopathy. This report describes a confirmed E. coloratus envenomation in a dog, with assessment of the global hemostasis by thromboelastometry. CASE DETAILS A 6-year old Belgian Shepherd dog was presented in shock, mucosal bleeding and swelling due to snakebite. Laboratory tests showed prolonged prothrombin and activated partial thromboplastin times. Because Daboia palaestinae is the most common venomous snake in Israel, immunoglobulin-G monovalent D. palaestinae antivenom was administered, with supportive care. The dog improved clinically, was discharged, and was readmitted, with active bleeding from the bite site. The dead snake was only then identified as E. coloratus. Thromboelastometry demonstrated severe hypocoagulability. The dog was treated with polyvalent antivenom directed against venoms of several Middle Eastern snakes, fresh-frozen plasma and packed red blood cells. Bleeding completely ceased, and thromboelastometry results improved. The dog was discharged. 3 days later, all hemostatic test results had normalized. DISCUSSION Thromboelastometry is useful for assessing the hemostatic status in E. coloratus envenomation, and for monitoring and managing the venom-induced coagulopathy, and guide plasma and polyvalent antivenom treatment.
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Affiliation(s)
- Raya Atamna
- Department of Small Animal Surgery, Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Efrat Kelmer
- Department of Emergency and Critical Care, Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Itamar Aroch
- Department of Internal Medicine, Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Sigal Klainbart
- Department of Emergency and Critical Care, Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
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59
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Watson JA, Lamb T, Holmes J, Warrell DA, Thwin KT, Aung ZL, Oo MZ, Nwe MT, Smithuis F, Ashley EA. A Bayesian phase 2 model based adaptive design to optimise antivenom dosing: Application to a dose-finding trial for a novel Russell's viper antivenom in Myanmar. PLoS Negl Trop Dis 2020; 14:e0008109. [PMID: 33196672 PMCID: PMC7704047 DOI: 10.1371/journal.pntd.0008109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 11/30/2020] [Accepted: 10/10/2020] [Indexed: 01/15/2023] Open
Abstract
For most antivenoms there is little information from clinical studies to infer the relationship between dose and efficacy or dose and toxicity. Antivenom dose-finding studies usually recruit too few patients (e.g. fewer than 20) relative to clinically significant event rates (e.g. 5%). Model based adaptive dose-finding studies make efficient use of accrued patient data by using information across dosing levels, and converge rapidly to the contextually defined 'optimal dose'. Adequate sample sizes for adaptive dose-finding trials can be determined by simulation. We propose a model based, Bayesian phase 2 type, adaptive clinical trial design for the characterisation of optimal initial antivenom doses in contexts where both efficacy and toxicity are measured as binary endpoints. This design is illustrated in the context of dose-finding for Daboia siamensis (Eastern Russell's viper) envenoming in Myanmar. The design formalises the optimal initial dose of antivenom as the dose closest to that giving a pre-specified desired efficacy, but resulting in less than a pre-specified maximum toxicity. For Daboia siamensis envenoming, efficacy is defined as the restoration of blood coagulability within six hours, and toxicity is defined as anaphylaxis. Comprehensive simulation studies compared the expected behaviour of the model based design to a simpler rule based design (a modified '3+3' design). The model based design can identify an optimal dose after fewer patients relative to the rule based design. Open source code for the simulations is made available in order to determine adequate sample sizes for future adaptive snakebite trials. Antivenom dose-finding trials would benefit from using standard model based adaptive designs. Dose-finding trials where rare events (e.g. 5% occurrence) are of clinical importance necessitate larger sample sizes than current practice. We will apply the model based design to determine a safe and efficacious dose for a novel lyophilised antivenom to treat Daboia siamensis envenoming in Myanmar.
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Affiliation(s)
- James A. Watson
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Thomas Lamb
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Myanmar-Oxford Clinical Research Unit, Yangon, Myanmar
| | - Jane Holmes
- Centre for Statistics in Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - David A. Warrell
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Min Zaw Oo
- University of Medicine 2, Yangon, Myanmar
| | - Myat Thet Nwe
- Myanmar-Oxford Clinical Research Unit, Yangon, Myanmar
| | - Frank Smithuis
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Myanmar-Oxford Clinical Research Unit, Yangon, Myanmar
| | - Elizabeth A. Ashley
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Myanmar-Oxford Clinical Research Unit, Yangon, Myanmar
- Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit, Vientiane, Laos
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60
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Stazi M, D’Este G, Mattarei A, Negro S, Lista F, Rigoni M, Megighian A, Montecucco C. An agonist of the CXCR4 receptor accelerates the recovery from the peripheral neuroparalysis induced by Taipan snake envenomation. PLoS Negl Trop Dis 2020; 14:e0008547. [PMID: 32898186 PMCID: PMC7537909 DOI: 10.1371/journal.pntd.0008547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/06/2020] [Accepted: 06/19/2020] [Indexed: 01/15/2023] Open
Abstract
Envenomation by snakes is a major neglected human disease. Hospitalization and use of animal-derived antivenom are the primary therapeutic supports currently available. There is consensus that additional, not expensive, treatments that can be delivered even long after the snake bite are needed. We recently showed that the drug dubbed NUCC-390 shortens the time of recovery from the neuroparalysis caused by traumatic or toxic degeneration of peripheral motor neurons. These syndromes are characterized by the activation of a pro-regenerative molecular axis, consisting of the CXCR4 receptor expressed at the damaged site in neuronal axons and by the release of its ligand CXCL12α, produced by surrounding Schwann cells. This intercellular signaling axis promotes axonal growth and functional recovery from paralysis. NUCC-390 is an agonist of CXCR4 acting similarly to CXCL12α. Here, we have tested its efficacy in a murine model of neuroparalytic envenoming by a Papuan Taipan (Oxyuranus scutellatus) where a degeneration of the motor axon terminals caused by the presynaptic PLA2 toxin Taipoxin, contained in the venom, occurs. Using imaging of the neuromuscular junction and electrophysiological analysis, we found that NUCC-390 administration after injection of either the purified neuroparalytic Taipoxin or the whole Taipan venom, significantly accelerates the recovery from paralysis. These results indicate that NUCC-390, which is non-toxic in mice, should be considered for trials in humans to test its efficacy in accelerating the recovery from the peripheral neuroparalysis induced by Taipans. NUCC-390 should be tested as well in the envenomation by other snakes that cause neuroparalytic syndromes in humans. NUCC-390 could become an additional treatment, common to many snake envenomings, that can be delivered after the bite to reduce death by respiratory deficits and to shorten and improve functional recovery.
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Affiliation(s)
- Marco Stazi
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Giorgia D’Este
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Andrea Mattarei
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Samuele Negro
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Florigio Lista
- Department of Medical and Veterinary Research, the Ministry of Defense, Rome, Italy
| | - Michela Rigoni
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Aram Megighian
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Cesare Montecucco
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- CNR Institute of Neuroscience, Department of Biomedical Sciences, Padua, Italy
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61
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Knudsen C, Casewell NR, Lomonte B, Gutiérrez JM, Vaiyapuri S, Laustsen AH. Novel Snakebite Therapeutics Must Be Tested in Appropriate Rescue Models to Robustly Assess Their Preclinical Efficacy. Toxins (Basel) 2020; 12:toxins12090528. [PMID: 32824899 PMCID: PMC7551497 DOI: 10.3390/toxins12090528] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 11/25/2022] Open
Abstract
In the field of antivenom research, development, and manufacture, it is often advised to follow the World Health Organization’s (WHO) guidelines for the production, control, and regulation of snake antivenom immunoglobulins, which recommend the use of preincubation assays to assess the efficacy of snakebite therapeutics. In these assays, venom and antivenom are mixed and incubated prior to in vivo administration to rodents, which allows for a standardizable comparison of antivenoms with similar characteristics. However, these assays are not necessarily sufficient for therapeutics with significantly different pharmacological properties than antibody-based antivenoms, such as small molecule inhibitors, nanoparticles, and other modalities. To ensure that the in vivo therapeutic utility of completely novel toxin-neutralizing molecules with no history of use in envenoming therapy and variable pharmacokinetics is properly evaluated, such molecules must also be tested in preclinical rescue assays, where rodents are first challenged with appropriate doses of venoms or toxins, followed by the administration of neutralizing modalities after an appropriate time delay to better mimic the real-life scenarios faced by human snakebite victims. Such an approach takes the venom (or toxin) toxicokinetics, the drug pharmacokinetics, and the drug pharmacodynamics into consideration. If new modalities are only assessed in preincubation assays and not subjected to evaluation in rescue assays, the publication of neutralization data may unintentionally misrepresent the actual therapeutic efficacy and suitability of the modality being tested, and thus potentially misguide strategic decision making in the research and development of novel therapies for snakebite envenoming.
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Affiliation(s)
- Cecilie Knudsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
- BioPorto Diagnostics, 2900 Hellerup, Denmark
- Correspondence: (C.K.); (A.H.L.); Tel.: +45-29881134 (A.H.L.)
| | - Nicholas R. Casewell
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK;
| | - Bruno Lomonte
- Instituto Clodomiro Picado, Facultad de Microbiologia, Universidad de Costa Rica, 11501 San José, Costa Rica; (B.L.); (J.M.G.)
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiologia, Universidad de Costa Rica, 11501 San José, Costa Rica; (B.L.); (J.M.G.)
| | | | - Andreas H. Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
- Correspondence: (C.K.); (A.H.L.); Tel.: +45-29881134 (A.H.L.)
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62
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Nait Mohamed FA, Laraba-Djebari F. Scorpion envenomation: a deadly illness requiring an effective therapy. TOXIN REV 2020. [DOI: 10.1080/15569543.2020.1800746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | - Fatima Laraba-Djebari
- USTHB, Faculty of Biological Sciences, Laboratory of Cellular and Molecular Biology, Algiers, Algeria
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63
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Ainsworth S, Menzies SK, Casewell NR, Harrison RA. An analysis of preclinical efficacy testing of antivenoms for sub-Saharan Africa: Inadequate independent scrutiny and poor-quality reporting are barriers to improving snakebite treatment and management. PLoS Negl Trop Dis 2020; 14:e0008579. [PMID: 32817682 PMCID: PMC7462309 DOI: 10.1371/journal.pntd.0008579] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/01/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The World Health Organization's strategy to halve snakebite mortality and morbidity by 2030 includes an emphasis on a risk-benefit process assessing the preclinical efficacy of antivenoms manufactured for sub-Saharan Africa. To assist this process, we systematically collected, standardised and analysed all publicly available data on the preclinical efficacy of antivenoms designed for sub-Saharan Africa. METHODOLOGY/PRINCIPAL FINDINGS Using a systematic search of publication databases, we focused on publicly available preclinical reports of the efficacy of 16 antivenom products available in sub Saharan Africa. Publications since 1999 reporting the industry standard intravenous pre-incubation method of murine in vivo neutralisation of venom lethality (median effective dose [ED50]) were included. Eighteen publications met the criteria. To permit comparison of the several different reported ED50 values, it was necessary to standardise these to microlitre of antivenom resulting in 50% survival of mice challenged per milligram of venom (μl/mg). We were unable to identify publicly available preclinical data on four antivenoms, whilst data for six polyspecific antivenoms were restricted to a small number of venoms. Only four antivenoms were tested against a wide range of venoms. Examination of these studies for the reporting of key metrics required for interpreting antivenom ED50s were highly variable, as evidenced by eight different units being used for the described ED50 values. CONCLUSIONS/SIGNIFICANCE There is a disturbing lack of (i) preclinical efficacy testing of antivenom for sub Saharan Africa, (ii) publicly available reports and (iii) independent scrutiny of this medically important data. Where reports do exist, the methods and metrics used are highly variable. This prevents comprehensive meta-analysis of antivenom preclinical efficacy, and severely reduces the utility of antivenom ED50 results in the decision making of physicians treating patients and of national and international health agencies. Here, we propose the use of a standardised result reporting checklist to resolve this issue. Implementation of these straightforward steps will deliver uniform evaluation of products across laboratories, facilitate meta-analyses, and contribute vital information for designing the clinical trials needed to achieve the WHO target of halving snakebite morbidity and mortality by 2030.
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Affiliation(s)
- Stuart Ainsworth
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Stefanie K. Menzies
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Nicholas R. Casewell
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Robert A. Harrison
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
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64
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Ochoa-Avilés A, Heredia-Andino OS, Escandón SA, Celorio-Carvajal CA, Arias-Peláez MC, Zaruma-Torres F, Caldeira CADS, Soares AM, Da Silva SL. Viperidae snakebites in Ecuador: A review of epidemiological and ecological aspects. Toxicon X 2020; 7:100051. [PMID: 32760910 PMCID: PMC7393321 DOI: 10.1016/j.toxcx.2020.100051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 01/25/2023] Open
Abstract
Snakebite envenoming is a neglected disease of public health concern. Most snakebite accidents occur in developing countries. In Ecuador, 17 viper species are responsible for 99% of official accidents, and ten species are in critical conservation states. This report analyzes the snakebite incident cases and mortality rates in Ecuador between 2014 and 2019. The data obtained from the national surveillance system suggests that the incidence and mortality rates remained constant. The geographic region with the highest incidence rates is the Amazonian region. National policies are urgently needed to prevent snakebite accidents and to protect snakes in danger of extinction. Snakebite national incidence (2014–2019): 7.7–11.0 cases/100.000 inhabitants/year. Mortality national incidence (2014–2019): 0.03–0.10 deaths/100.000 inhabitants/year. 1400–1800 snakebites caused by Bothrops asper, Bothrops atrox and Lachesis muta. Ten species of the Viperidae family in Ecuador are critically endangered.
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Affiliation(s)
- Angélica Ochoa-Avilés
- Department of Biosciences, Faculty of Chemical Sciences, University of Cuenca, Cuenca, Azuay, Ecuador.,College of Biochemistry and Pharmacy, Faculty of Chemical Sciences, University of Cuenca, Cuenca, Azuay, Ecuador
| | - Odalys S Heredia-Andino
- College of Biochemistry and Pharmacy, Faculty of Chemical Sciences, University of Cuenca, Cuenca, Azuay, Ecuador
| | - Samuel A Escandón
- College of Biochemistry and Pharmacy, Faculty of Chemical Sciences, University of Cuenca, Cuenca, Azuay, Ecuador
| | | | - María C Arias-Peláez
- College of Biochemistry and Pharmacy, Faculty of Chemical Sciences, University of Cuenca, Cuenca, Azuay, Ecuador
| | - Fausto Zaruma-Torres
- College of Biochemistry and Pharmacy, Faculty of Chemical Sciences, University of Cuenca, Cuenca, Azuay, Ecuador.,Health Innovation Center - (CIS), Cuenca, Azuay, Ecuador
| | - Cleópatra A da S Caldeira
- Biotechnology Laboratory for Proteins and Bioactive Compounds from the Western Amazon, Oswaldo Cruz Foundation Rondonia, Porto Velho, Rondonia, Brazil.,Graduate Program in Experimental Biology (PGBIOEXP), Federal University of Rondonia (UNIR), Porto Velho, Rondonia, Brazil
| | - Andreimar M Soares
- Biotechnology Laboratory for Proteins and Bioactive Compounds from the Western Amazon, Oswaldo Cruz Foundation Rondonia, Porto Velho, Rondonia, Brazil.,Graduate Program in Experimental Biology (PGBIOEXP), Federal University of Rondonia (UNIR), Porto Velho, Rondonia, Brazil
| | - Saulo L Da Silva
- College of Biochemistry and Pharmacy, Faculty of Chemical Sciences, University of Cuenca, Cuenca, Azuay, Ecuador.,Health Innovation Center - (CIS), Cuenca, Azuay, Ecuador.,LAQV - REQUIMTE, University of Porto, Porto, Portugal
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65
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Ainsworth S, Menzies S, Pleass RJ. Animal derived antibodies should be considered alongside convalescent human plasma to deliver treatments for COVID-19. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.15990.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Published data on the first 5,000 coronavirus patients to receive plasma shows promise in the United States. However, delivering convalescent plasma therapies in low- and even middle-income countries is both difficult and costly. Here we discuss the advantages and disadvantages of antisera raised in animals that may allow poorer countries to control the devastating effects of COVID-19.
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66
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Krause KE, Jenkins TP, Skaarup C, Engmark M, Casewell NR, Ainsworth S, Lomonte B, Fernández J, Gutiérrez JM, Lund O, Laustsen AH. An interactive database for the investigation of high-density peptide microarray guided interaction patterns and antivenom cross-reactivity. PLoS Negl Trop Dis 2020; 14:e0008366. [PMID: 32579606 PMCID: PMC7313730 DOI: 10.1371/journal.pntd.0008366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/06/2020] [Indexed: 12/19/2022] Open
Abstract
Snakebite envenoming is a major neglected tropical disease that affects millions of people every year. The only effective treatment against snakebite envenoming consists of unspecified cocktails of polyclonal antibodies purified from the plasma of immunized production animals. Currently, little data exists on the molecular interactions between venom-toxin epitopes and antivenom-antibody paratopes. To address this issue, high-density peptide microarray (hdpm) technology has recently been adapted to the field of toxinology. However, analysis of such valuable datasets requires expert understanding and, thus, complicates its broad application within the field. In the present study, we developed a user-friendly, and high-throughput web application named "Snake Toxin and Antivenom Binding Profiles" (STAB Profiles), to allow straight-forward analysis of hdpm datasets. To test our tool and evaluate its performance with a large dataset, we conducted hdpm assays using all African snake toxin protein sequences available in the UniProt database at the time of study design, together with eight commercial antivenoms in clinical use in Africa, thus representing the largest venom-antivenom dataset to date. Furthermore, we introduced a novel method for evaluating raw signals from a peptide microarray experiment and a data normalization protocol enabling intra-microarray and even inter-microarray chip comparisons. Finally, these data, alongside all the data from previous similar studies by Engmark et al., were preprocessed according to our newly developed protocol and made publicly available for download through the STAB Profiles web application (http://tropicalpharmacology.com/tools/stab-profiles/). With these data and our tool, we were able to gain key insights into toxin-antivenom interactions and were able to differentiate the ability of different antivenoms to interact with certain toxins of interest. The data, as well as the web application, we present in this article should be of significant value to the venom-antivenom research community. Knowledge gained from our current and future analyses of this dataset carry the potential to guide the improvement and optimization of current antivenoms for maximum patient benefit, as well as aid the development of next-generation antivenoms.
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Affiliation(s)
- Kamille E. Krause
- Department of Bio and Health Informatics, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Timothy P. Jenkins
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Carina Skaarup
- Department of Bio and Health Informatics, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Mikael Engmark
- Department of Bio and Health Informatics, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Nicholas R. Casewell
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Stuart Ainsworth
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Bruno Lomonte
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Julián Fernández
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - José M. Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Ole Lund
- Department of Bio and Health Informatics, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Andreas H. Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
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67
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Tan KY, Wong KY, Tan NH, Tan CH. Quantitative proteomics of Naja annulifera (sub-Saharan snouted cobra) venom and neutralization activities of two antivenoms in Africa. Int J Biol Macromol 2020; 158:S0141-8130(20)33035-X. [PMID: 32339578 DOI: 10.1016/j.ijbiomac.2020.04.173] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 12/27/2022]
Abstract
Envenomation by Naja annulifera (snouted cobra), a non-spitting African cobra, can result in local tissue damage and fatal paralysis but a species-specific antivenom treatment is currently lacking. In this study, we investigated the quantitative proteome of N. annulifera venom, incorporating HPLC and LC-MS/MS to elucidate the venom toxicity. The immunoreactivities and in vivo neutralization activities of two hetero-specific antivenom products (Premium Serums Pan Africa polyvalent antivenom, PANAF and VINS African polyvalent antivenom, VAPAV) against the venom were subsequently examined. N. annulifera venom comprises 10 toxin families, with three-finger toxin (3FTx) being the most abundantly expressed (~78%). Within 3FTx, cytotoxin is the most dominant form and made up three-quarter of the venom bulk (~74%), whereas alpha-neurotoxins constitute <4% of the total venom proteins. Phospholipase A2 was undetected in the venom proteome, consistent with the unusual absence of PLA2 from the venoms of cobras in the Uraeus subgenus. In ELISA, PANAF and VAPAV showed comparable immunoreactivity toward the protein antigens of N. annulifera venom. These antivenoms, despite being raised against hetero-specific venoms, were capable of cross-neutralizing the lethal effect of N. annulifera venom in mice, with PANAF being marginally more potent.
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Affiliation(s)
- Kae Yi Tan
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Kin Ying Wong
- Department of Pharmacology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Nget Hong Tan
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Choo Hock Tan
- Department of Pharmacology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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68
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Souza JB, Cardoso R, Almeida-Souza HO, Carvalho CP, Correia LIV, Faria PCB, Araujo GR, Mendes MM, Rodrigues RS, Rodrigues VM, Dandekar AM, Goulart LR, Nascimento R. Generation and In-planta expression of a recombinant single chain antibody with broad neutralization activity on Bothrops pauloensis snake venom. Int J Biol Macromol 2020; 149:1241-1251. [PMID: 32035152 DOI: 10.1016/j.ijbiomac.2020.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/26/2022]
Abstract
The main systemic alterations present in bothropic envenomation are hemostasis disorders, for which the conventional treatment is based on animal-produced antiophidic sera. We have developed a neutralizing antibody against Bothrops pauloensis (B. pauloensis) venom, which is member of the genus most predominant in snakebite accidents in Brazil. Subsequently, we expressed this antibody in plants to evaluate its enzymatic and biological activities. The ability of single-chain variable fragment (scFv) molecules to inhibit fibrinogenolytic, azocaseinolytic, coagulant and hemorrhagic actions of snake venom metalloproteinases (SVMPs) contained in B. pauloensis venom was verified through proteolytic assays. The antibody neutralized the toxic effects of envenomation, particularly those related to systemic processes, by interacting with one of the predominant classes of metalloproteinases. This novel molecule is a potential tool with great antivenom potential and provides a biotechnological antidote to snake venom due to its broad neutralizing activity.
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Affiliation(s)
- Jessica B Souza
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil.
| | - Rone Cardoso
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Hebréia O Almeida-Souza
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Camila P Carvalho
- Department of Plant Pathology, University of Sao Paulo, Av. Padua Dias 11, 13418-310 Piracicaba, SP, Brazil
| | - Lucas Ian Veloso Correia
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Paula Cristina B Faria
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Galber R Araujo
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Mirian M Mendes
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Renata Santos Rodrigues
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Veridiana M Rodrigues
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Abhaya M Dandekar
- Plant Sciences Department, University of California, Davis, 1 Shields Ave, Davis, CA 95616, USA
| | - Luiz Ricardo Goulart
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil.
| | - Rafael Nascimento
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
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69
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Liu CC, Chou YS, Chen CY, Liu KL, Huang GJ, Yu JS, Wu CJ, Liaw GW, Hsieh CH, Chen CK. Pathogenesis of local necrosis induced by Naja atra venom: Assessment of the neutralization ability of Taiwanese freeze-dried neurotoxic antivenom in animal models. PLoS Negl Trop Dis 2020; 14:e0008054. [PMID: 32032357 PMCID: PMC7032728 DOI: 10.1371/journal.pntd.0008054] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 02/20/2020] [Accepted: 01/14/2020] [Indexed: 02/07/2023] Open
Abstract
Naja atra envenomation is one of the most significant clinical snakebite concerns in Taiwan. Taiwanese freeze-dried neurotoxic antivenom (FNAV) is currently used clinically for the treatment of cobra snakebite, and has been shown to limit the mortality of cobra envenomation to less than 1%. However, more than half of victims (60%) require surgery because of local tissue necrosis, a major problem in patients with cobra envenomation. Although the importance of evaluating the neutralizing effect of FNAV on this pathology is recognized, whether FNAV is able to prevent the local necrosis extension induced by N. atra venom has not been investigated in detail. Cytotoxins (CTXs) are considered as the major components of N. atra venom that cause necrosis. In the current study, we isolated CTXs from whole cobra venom and used both whole venom and purified CTXs to develop animal models for assessing the neutralization potential of FNAV against venom necrotizing activity. Local necrotic lesions were successfully produced in mice using CTXs in place of whole N. atra venom. FNAV was able to rescue mice from a subcutaneously injected lethal dose of cobra venom; however, it was unable to prevent CTX-induced dermo-necrosis. Furthermore, using the minimal necrosis dose (MND) of CTXs and venom proteome data, we found a dose of whole N. atra venom suitable for FNAV and developed a workable protocol for inducing local necrosis in rodent models that successfully imitated the clinical circumstance of cobra envenoming. This information provides a more comprehensive understanding of the pathophysiology of N. atra envenomation, and serves as a guide for improving current antivenom strategies and advancing clinical snakebite management in Taiwan. Naja atra envenomation is an important public health issue in Taiwan. Although the mortality rate of cobra snakebite is controlled using antivenom, more than half of victims develop symptoms of local necrosis and require surgical intervention. Whether the Taiwanese freeze-dried neurotoxic antivenom (FNAV) currently in clinical use is able to prevent the local necrosis extension induced by N. atra venom is still unclear. In this study, we developed a dermo-necrosis animal model using purified cytotoxins (CTXs), the major necrosis-related proteins from N. atra venom. We found that FNAV was able to neutralize the lethality of whole cobra venom, but was unable to neutralize the necrosis induced by CTXs in vivo. This finding introduced an example that supplementary quality control assays may be necessary to determine the effectiveness of antivenoms in neutralizing specific pathology induced by the venom; only evaluating the rodent lethality prevention is insufficient. Our results provide insights that should help improve current antivenoms and advance cobra snakebite management in Taiwan.
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Affiliation(s)
- Chien-Chun Liu
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shao Chou
- Department of Emergency Medicine, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Chun-Yu Chen
- Department of Emergency Medicine, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Kuei-Lin Liu
- Faculty of Biotechnology and Laboratory Science in Medicine, School of Medical Technology and Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Guo-Jen Huang
- Department and Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jau-Song Yu
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Cell and Molecular Biology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Liver Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- Research Center for Food and Cosmetic Safety, Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Cho-Ju Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Geng-Wang Liaw
- Department of Emergency Medicine, Yeezen General Hospital, Taoyuan, Taiwan
| | - Cheng-Hsien Hsieh
- Department of Emergency Medicine, En Chu Kong Hospital, New Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail: (CHH); (CKC)
| | - Chun-Kuei Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- * E-mail: (CHH); (CKC)
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70
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Suryamohan K, Krishnankutty SP, Guillory J, Jevit M, Schröder MS, Wu M, Kuriakose B, Mathew OK, Perumal RC, Koludarov I, Goldstein LD, Senger K, Dixon MD, Velayutham D, Vargas D, Chaudhuri S, Muraleedharan M, Goel R, Chen YJJ, Ratan A, Liu P, Faherty B, de la Rosa G, Shibata H, Baca M, Sagolla M, Ziai J, Wright GA, Vucic D, Mohan S, Antony A, Stinson J, Kirkpatrick DS, Hannoush RN, Durinck S, Modrusan Z, Stawiski EW, Wiley K, Raudsepp T, Kini RM, Zachariah A, Seshagiri S. The Indian cobra reference genome and transcriptome enables comprehensive identification of venom toxins. Nat Genet 2020; 52:106-117. [PMID: 31907489 PMCID: PMC8075977 DOI: 10.1038/s41588-019-0559-8] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/22/2019] [Indexed: 12/30/2022]
Abstract
Snakebite envenoming is a serious and neglected tropical disease that kills ~100,000 people annually. High-quality, genome-enabled comprehensive characterization of toxin genes will facilitate development of effective humanized recombinant antivenom. We report a de novo near-chromosomal genome assembly of Naja naja, the Indian cobra, a highly venomous, medically important snake. Our assembly has a scaffold N50 of 223.35 Mb, with 19 scaffolds containing 95% of the genome. Of the 23,248 predicted protein-coding genes, 12,346 venom-gland-expressed genes constitute the ‘venom-ome’ and this included 139 genes from 33 toxin families. Among the 139 toxin genes were 19 ‘venom-ome-specific toxins’ (VSTs) that showed venom-gland-specific expression, and these probably encode the minimal core venom effector proteins. Synthetic venom reconstituted through recombinant VST expression will aid in the rapid development of safe and effective synthetic antivenom. Additionally, our genome could serve as a reference for snake genomes, support evolutionary studies and enable venom-driven drug discovery. Analysis of a near-chromosomal genome assembly and transcriptome profiling of the Indian cobra identifies genes expressed in the venom glands. These data should help develop a new antivenom.
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Affiliation(s)
- Kushal Suryamohan
- Molecular Biology Department, Genentech, Inc., South San Francisco, CA, USA.,MedGenome Inc., Foster City, CA, USA
| | - Sajesh P Krishnankutty
- AgriGenome Labs Private Ltd, Kochi, India.,SciGenom Research Foundation, Bangalore, India
| | - Joseph Guillory
- Molecular Biology Department, Genentech, Inc., South San Francisco, CA, USA
| | - Matthew Jevit
- Molecular Cytogenetics laboratory, Texas A&M University, College Station, TX, USA
| | - Markus S Schröder
- Molecular Biology Department, Genentech, Inc., South San Francisco, CA, USA
| | - Meng Wu
- Molecular Biology Department, Genentech, Inc., South San Francisco, CA, USA
| | | | | | | | - Ivan Koludarov
- Ecology and Evolution Unit, Okinawa Institute of Science and Technology, Onna-son, Japan
| | - Leonard D Goldstein
- Molecular Biology Department, Genentech, Inc., South San Francisco, CA, USA.,Department of Bioinformatics and Computational Biology, Genentech, Inc., South San Francisco, CA, USA
| | - Kate Senger
- Molecular Biology Department, Genentech, Inc., South San Francisco, CA, USA
| | | | | | - Derek Vargas
- Molecular Biology Department, Genentech, Inc., South San Francisco, CA, USA.,MedGenome Inc., Foster City, CA, USA
| | - Subhra Chaudhuri
- Molecular Biology Department, Genentech, Inc., South San Francisco, CA, USA
| | | | - Ridhi Goel
- AgriGenome Labs Private Ltd, Kochi, India
| | - Ying-Jiun J Chen
- Molecular Biology Department, Genentech, Inc., South San Francisco, CA, USA
| | - Aakrosh Ratan
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | - Peter Liu
- Department of Microchemistry Proteomics, and Lipidomics, Genentech, Inc., South San Francisco, CA, USA
| | - Brendan Faherty
- Department of Microchemistry Proteomics, and Lipidomics, Genentech, Inc., South San Francisco, CA, USA
| | - Guillermo de la Rosa
- The Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, Ontario, Canada
| | - Hiroki Shibata
- Division of Genomics, Medical Institute of Bioregulation, Kyushu University, Fukuouka, Japan
| | - Miriam Baca
- Department of Pathology, Genentech, Inc., South San Francisco, CA, USA
| | - Meredith Sagolla
- Department of Pathology, Genentech, Inc., South San Francisco, CA, USA
| | - James Ziai
- Department of Pathology, Genentech, Inc., South San Francisco, CA, USA
| | - Gus A Wright
- College of Veterinary Medicine, Flow Cytometry Shared Resource Laboratory, Texas A&M University, College Station, TX, USA
| | - Domagoj Vucic
- Department of Early Discovery Biochemistry, Genentech, Inc., South San Francisco, CA, USA
| | - Sangeetha Mohan
- Department of Molecular Biology, SciGenom Labs, Kochi, India
| | - Aju Antony
- Department of Molecular Biology, SciGenom Labs, Kochi, India
| | - Jeremy Stinson
- Molecular Biology Department, Genentech, Inc., South San Francisco, CA, USA
| | - Donald S Kirkpatrick
- Department of Microchemistry Proteomics, and Lipidomics, Genentech, Inc., South San Francisco, CA, USA
| | - Rami N Hannoush
- Department of Early Discovery Biochemistry, Genentech, Inc., South San Francisco, CA, USA
| | - Steffen Durinck
- Molecular Biology Department, Genentech, Inc., South San Francisco, CA, USA.,Department of Bioinformatics and Computational Biology, Genentech, Inc., South San Francisco, CA, USA
| | - Zora Modrusan
- Molecular Biology Department, Genentech, Inc., South San Francisco, CA, USA
| | - Eric W Stawiski
- Molecular Biology Department, Genentech, Inc., South San Francisco, CA, USA.,MedGenome Inc., Foster City, CA, USA
| | | | - Terje Raudsepp
- Molecular Cytogenetics laboratory, Texas A&M University, College Station, TX, USA
| | - R Manjunatha Kini
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Arun Zachariah
- SciGenom Research Foundation, Bangalore, India.,Wayanad Wildlife Sanctuary, Sultan Bathery, India
| | - Somasekar Seshagiri
- Molecular Biology Department, Genentech, Inc., South San Francisco, CA, USA. .,SciGenom Research Foundation, Bangalore, India.
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Resiere D, Villalta M, Arias AS, Kallel H, Nèviére R, Vidal N, Mehdaoui H, Gutiérrez JM. Snakebite envenoming in French Guiana: Assessment of the preclinical efficacy against the venom of Bothrops atrox of two polyspecific antivenoms. Toxicon 2020; 173:1-4. [DOI: 10.1016/j.toxicon.2019.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/13/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
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72
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Fan HW, Natal Vigilato MA, Augusto Pompei JC, Gutiérrez JM. [Situation of public laboratories manufacturing antivenoms in Latin AmericaA situação dos laboratórios públicos produtores de soros antivenenos na América Latina]. Rev Panam Salud Publica 2019; 43:e92. [PMID: 31772565 PMCID: PMC6863067 DOI: 10.26633/rpsp.2019.92] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/10/2019] [Indexed: 11/25/2022] Open
Abstract
Se analiza la situación de los laboratorios públicos productores de antivenenos en América Latina, con base a los resultados de en un taller coordinado por el Centro Panamericano de Fiebre Aftosa (PANAFTOSA) de la Organización Panamericana de la Salud (OPS). Nueve países en la región poseen doce laboratorios públicos que producen y distribuyen antivenenos contra venenos de diferentes animales ponzoñosos. Se discutió la situación de cada laboratorio, se analizó el escenario actual caracterizado por las crecientes demandas regulatorias y la heterogeneidad de estos en términos de infraestructura y capacidad productiva y se planteó la necesidad de concertar procesos de cooperación regional dirigidos a mejorar la disponibilidad de antivenenos, incluyendo proyectos de investigación y desarrollo para el mejoramiento de los procesos y las tecnologías; estudios del perfil de la capacidad neutralizante de los antivenenos contra diferentes venenos, y programas de capacitación técnica de profesionales y personal técnico. En el contexto actual, en el que la Organización Mundial de la Salud elaboró una estrategia global para la prevención y el control de los envenenamientos ofídicos, el Centro PANAFTOSA de la OPS ha asumido la coordinación de estas acciones en las Américas, mejorar la disponibilidad de antivenenos es prioritaria. Como resultado de ese taller, se creó la Red de Laboratorios Públicos Productores de Antivenenos de América Latina (RELAPA), con el objetivo de fortalecer estos laboratorios y de aumentar la disponibilidad y accesibilidad de antivenenos eficaces y seguros a toda América Latina.
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Affiliation(s)
- Hui Wen Fan
- Instituto Butantan Instituto Butantan São Paulo Brazil Instituto Butantan, São Paulo. Brazil
| | - Marco Antonio Natal Vigilato
- Centro Panamericano de Fiebre Aftosa Organización Panamericana de la Salud Rio de Janeiro Brasil Centro Panamericano de Fiebre Aftosa, Organización Panamericana de la Salud, Rio de Janeiro. Brasil
| | - Julio Cesar Augusto Pompei
- Centro Panamericano de Fiebre Aftosa Organización Panamericana de la Salud Rio de Janeiro Brasil Centro Panamericano de Fiebre Aftosa, Organización Panamericana de la Salud, Rio de Janeiro. Brasil
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología Universidad de Costa Rica San José Costa Rica Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
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73
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Abd El-Aziz TM, Shoulkamy MI, Hegazy AM, Stockand JD, Mahmoud A, Mashaly AMA. Comparative study of the in vivo toxicity and pathophysiology of envenomation by three medically important Egyptian snake venoms. Arch Toxicol 2019; 94:335-344. [DOI: 10.1007/s00204-019-02619-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/06/2019] [Indexed: 12/29/2022]
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74
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de Castro KLP, Lopes-de-Souza L, de Oliveira D, Machado-de-Ávila RA, Paiva ALB, de Freitas CF, Ho PL, Chávez-Olórtegui C, Guerra-Duarte C. A Combined Strategy to Improve the Development of a Coral Antivenom Against Micrurus spp. Front Immunol 2019; 10:2422. [PMID: 31695693 PMCID: PMC6816313 DOI: 10.3389/fimmu.2019.02422] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/27/2019] [Indexed: 01/08/2023] Open
Abstract
Accidents involving Micrurus snakes are not the most common ones but are noteworthy due to their severity. Victims envenomed by Micrurus snakes are at high risk of death and therefore must be treated with coral antivenom. In Brazil, the immunization mixture used to fabricate coral antivenom contains Micrurus frontalis and Micrurus corallinus venoms, which are difficult to be obtained in adequate amounts. Different approaches to solve the venom limitation problem have been attempted, including the use of synthetic and recombinant antigens as substitutes. The present work proposes a combined immunization protocol, using priming doses of M. frontalis venom and booster doses of synthetic B-cell epitopes derived from M. corallinus toxins (four three-finger toxins-3FTX; and one phospholipase A2-PLA2) to obtain coral antivenom in a rabbit model. Immunized animals elicited a humoral response against both M. frontalis and M. corallinus venoms, as detected by sera reactivity in ELISA and Western Blot. Relevant cross-reactivity of the obtained sera with other Micrurus species (Micrurus altirostris, Micrurus lemniscatus, Micrurus spixii, Micrurus surinamensis) venoms was also observed. The elicited antibodies were able to neutralize PLA2 activity of both M. frontalis and M. corallinus venoms. In vivo, immunized rabbit sera completely protected mice from a challenge with 1.5 median lethal dose (LD50) of M. corallinus venom and 50% of mice challenged with 1.5 LD50 of M. frontalis venom. These results show that this combined protocol may be a suitable alternative to reduce the amount of venom used in coral antivenom production in Brazil.
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Affiliation(s)
| | - Letícia Lopes-de-Souza
- Departamento de Bioquímica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | | - Carlos Chávez-Olórtegui
- Departamento de Bioquímica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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75
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Lopes-de-Souza L, Costal-Oliveira F, Stransky S, Fonseca de Freitas C, Guerra-Duarte C, Braga VMM, Chávez-Olórtegui C. Development of a cell-based in vitro assay as a possible alternative for determining bothropic antivenom potency. Toxicon 2019; 170:68-76. [PMID: 31494208 DOI: 10.1016/j.toxicon.2019.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/22/2019] [Accepted: 09/03/2019] [Indexed: 12/21/2022]
Abstract
Accidents with venomous snakes are a major health hazard in tropical countries. Bothrops genus is responsible for almost 80% of snakebites in Brazil. Immunotherapy is the only approved specific treatment against snake toxins and the production of therapeutic antivenoms requires quality control tests to determine their neutralizing potency. Currently, these controls are performed by in vivo lethality neutralization, however, the inhibition of particular events produced by bothropic venoms such as coagulopathy, hemorrhage, edema or cytotoxic effects are also required. The aim of this work is to develop an in vitro alternative assay for antivenom pre-clinical evaluation. In this sense, we designed a cell viability assay using different amounts (0.2-10 μL/well) of low and high potency anti-bothropic sera, previously classified by the traditional in vivo test, for assessing the antivenom capacity to protect the cells against B. jararaca venom cytotoxicity (5xEC50 = 58.95 μg/mL). We found that high potency sera are more effective in neutralizing B. jararaca venom cytotoxicity when compared to low potency sera, which is in accordance to their pre-determined in vivo potency. Considering sera in vitro inhibitory concentration able to prevent 50% cell death (IC50) and their known in vivo potency, a cut-off point was determined to discriminate low and high potency sera. Our data provide insights for the development of an in vitro method which can determine the anti-bothropic antivenom potency during its production.
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Affiliation(s)
- Letícia Lopes-de-Souza
- Departamento de Bioquímica e Imunologia, ICB, Universidade Federal de Minas Gerais (UFMG), 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda Costal-Oliveira
- Departamento de Bioquímica e Imunologia, ICB, Universidade Federal de Minas Gerais (UFMG), 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | - Stephanie Stransky
- Departamento de Bioquímica e Imunologia, ICB, Universidade Federal de Minas Gerais (UFMG), 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | | | - Clara Guerra-Duarte
- Diretoria de Pesquisa e Desenvolvimento, Fundação Ezequiel Dias, 30510-010, Belo Horizonte, MG, Brazil
| | - Vania M M Braga
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, Sir Alexander Fleming Building, SW7 2AZ, London, UK
| | - Carlos Chávez-Olórtegui
- Departamento de Bioquímica e Imunologia, ICB, Universidade Federal de Minas Gerais (UFMG), 31270-901, Belo Horizonte, Minas Gerais, Brazil.
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76
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Ochola FO, Okumu MO, Gikunju JK, Mbaria JM, Muchemi GM, Nderitu JG. Neutralization of the lethality of the venom of Dendroaspis polylepis (black mamba) in mice by two polyvalent antivenoms used in Kenyan hospitals: Results of a 2009–2011 study. SCIENTIFIC AFRICAN 2019. [DOI: 10.1016/j.sciaf.2019.e00118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Knudsen C, Ledsgaard L, Dehli RI, Ahmadi S, Sørensen CV, Laustsen AH. Engineering and design considerations for next-generation snakebite antivenoms. Toxicon 2019; 167:67-75. [DOI: 10.1016/j.toxicon.2019.06.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/22/2019] [Accepted: 06/03/2019] [Indexed: 11/27/2022]
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Neurotoxicity of Micrurus lemniscatus lemniscatus (South American coralsnake) venom in vertebrate neuromuscular preparations in vitro and neutralization by antivenom. Arch Toxicol 2019; 93:2065-2086. [PMID: 31123802 DOI: 10.1007/s00204-019-02476-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
We investigated the effect of South American coralsnake (Micrurus lemniscatus lemniscatus) venom on neurotransmission in vertebrate nerve-muscle preparations in vitro. The venom (0.1-30 µg/ml) showed calcium-dependent PLA2 activity and caused irreversible neuromuscular blockade in chick biventer cervicis (BC) and mouse phrenic nerve-diaphragm (PND) preparations. In BC preparations, contractures to exogenous acetylcholine and carbachol (CCh), but not KCl, were abolished by venom concentrations ≥ 0.3 µg/ml; in PND preparations, the amplitude of the tetanic response was progressively attenuated, but with little tetanic fade. In low Ca2+ physiological solution, venom (10 µg/ml) caused neuromuscular blockade in PND preparations within ~ 10 min that was reversible by washing; the addition of Ca2+ immediately after the blockade temporarily restored the twitch responses, but did not prevent the progression to irreversible blockade. Venom (10 µg/ml) did not depolarize diaphragm muscle, prevent depolarization by CCh, or cause muscle contracture or histological damage. Venom (3 µg/ml) had a biphasic effect on the frequency of miniature end-plate potentials, but did not affect their amplitude; there was a progressive decrease in the amplitude of evoked end-plate potentials. The amplitude of compound action potentials in mouse sciatic nerve was unaffected by venom (10 µg/ml). Pre-incubation of venom with coralsnake antivenom (Instituto Butantan) at the recommended antivenom:venom ratio did not neutralize the neuromuscular blockade in PND preparations, but total neutralization was achieved with a tenfold greater volume of antivenom. The addition of antivenom after 50% and 80% blockade restored the twitch responses. These results show that M. lemniscatus lemniscatus venom causes potent, irreversible neuromuscular blockade, without myonecrosis. This blockade is apparently mediated by pre- and postsynaptic neurotoxins and can be reversed by coralsnake antivenom.
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79
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Leiva CL, Cangelosi A, Mariconda V, Farace M, Geoghegan P, Brero L, Fernández-Miyakawa M, Chacana P. IgY-based antivenom against Bothrops alternatus: Production and neutralization efficacy. Toxicon 2019; 163:84-92. [DOI: 10.1016/j.toxicon.2019.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/11/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
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80
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Castillo-Beltrán MC, Hurtado-Gómez JP, Corredor-Espinel V, Ruiz-Gómez FJ. A polyvalent coral snake antivenom with broad neutralization capacity. PLoS Negl Trop Dis 2019; 13:e0007250. [PMID: 30856180 PMCID: PMC6428337 DOI: 10.1371/journal.pntd.0007250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/21/2019] [Accepted: 02/19/2019] [Indexed: 01/08/2023] Open
Abstract
Coral snakes of the genus Micrurus have a high diversity and wide distribution in the Americas. Despite envenomings by these animals being uncommon, accidents are often severe and may result in death. Producing an antivenom to treat these envenomings has been challenging since coral snakes are difficult to catch, produce small amounts of venom, and the antivenoms produced have shown limited cross neutralization. Here we present data of cross neutralization among monovalent antivenoms raised against M. dumerilii, M. isozonus, M. mipartitus and M. surinamensis and the development of a new polyvalent coral snake antivenom, resulting from the mix of monovalent antivenoms. Our results, show that this coral snake antivenom has high neutralizing potency and wide taxonomic coverage, constituting a possible alternative for a long sought Pan-American coral snake antivenom.
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Affiliation(s)
- María Carlina Castillo-Beltrán
- Grupo de Investigación en Animales Ponzoñosos y sus Venenos, Grupo de Producción y Desarrollo Tecnológico, Dirección de Producción, Instituto Nacional de Salud, Bogotá, Colombia
| | - Juan Pablo Hurtado-Gómez
- Grupo de Investigación en Animales Ponzoñosos y sus Venenos, Grupo de Producción y Desarrollo Tecnológico, Dirección de Producción, Instituto Nacional de Salud, Bogotá, Colombia
| | - Vladimir Corredor-Espinel
- Parasitology Laboratory, Department of Public Health, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Francisco Javier Ruiz-Gómez
- Grupo de Investigación en Animales Ponzoñosos y sus Venenos, Grupo de Producción y Desarrollo Tecnológico, Dirección de Producción, Instituto Nacional de Salud, Bogotá, Colombia
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81
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Paniagua D, Vergara I, Román R, Romero C, Benard-Valle M, Calderón A, Jiménez L, Bernas MJ, Witte MH, Boyer LV, Alagón A. Antivenom effect on lymphatic absorption and pharmacokinetics of coral snake venom using a large animal model. Clin Toxicol (Phila) 2019; 57:727-734. [PMID: 30773936 DOI: 10.1080/15563650.2018.1550199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Context: Historically, administration and dosing of antivenom (AV) have been guided primarily by physician judgment because of incomplete understanding of the envenomation process. As demonstrated previously, lymphatic absorption plays a major role in the availability and pharmacokinetics (PK) of coral snake venom injected subcutaneously, which suggests that absorption from subcutaneous tissue is the limiting step for venom bioavailability, supporting the notion that the bite site is an ongoing venom depot. This feature may underlie the recurrence phenomena reported in viperid envenomation that appear to result from a mismatch between venom and AV PK. The role of lymphatic absorption in neutralization of venom by AV administered intravenously remains unclear. Methods: The effect of AV on systemic bioavailability and neutralization of Micrurus fulvius venom was assessed using a central lymph-cannulated sheep model. Venom was administered by subcutaneous injection in eight sheep, four with and four without thoracic duct cannulation and drainage. Two hours after venom injection, AV was administered intravenously. Venom and AV concentrations in serum and lymph were determined by ELISA assay from samples collected over a 6-h period and in tissues harvested post-mortem. Results: After AV injection, venom levels in serum fell immediately to undetectable with a subsequent increase in concentration attributable to non-toxic venom proteins. In lymph, AV became detectable 6 min after treatment; venom levels dropped concurrently but remained detectable 4 h later. Post-mortem samples from the venom injection site confirmed the presence of venom near the point of injection. Neither venom nor AV was detected at significant concentrations in major organs or contralateral skin. Conclusions: Intravenous AV immediately neutralizes venom in the bloodstream and can extravasate to neutralize venom absorbed by lymph but this neutralization seems to be slow and incomplete. Residual venom in the inoculation site demonstrates that this site functions as a depot where it is not neutralized by AV, which allows the venom to remain active with slow delivery to the bloodstream for ongoing systemic distribution.
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Affiliation(s)
- D Paniagua
- a Departamento de Biología Molecular y Bioprocesos , Instituto de Biotecnología Universidad Nacional Autónoma de México , Cuernavaca , México
| | - I Vergara
- b Department of Chemical and Biological Sciences, Sciences School , Universidad de las Américas Puebla , Cholula , México
| | - R Román
- a Departamento de Biología Molecular y Bioprocesos , Instituto de Biotecnología Universidad Nacional Autónoma de México , Cuernavaca , México
| | - C Romero
- c Centro Universitario UAEM Amecameca, Universidad Autónoma del Estado de México , Amecameca de Juarez , México
| | - M Benard-Valle
- a Departamento de Biología Molecular y Bioprocesos , Instituto de Biotecnología Universidad Nacional Autónoma de México , Cuernavaca , México
| | - A Calderón
- a Departamento de Biología Molecular y Bioprocesos , Instituto de Biotecnología Universidad Nacional Autónoma de México , Cuernavaca , México
| | - L Jiménez
- a Departamento de Biología Molecular y Bioprocesos , Instituto de Biotecnología Universidad Nacional Autónoma de México , Cuernavaca , México
| | - M J Bernas
- d Department of Medical Education , TCU and UNTHSC School of Medicine , Fort Worth , TX , USA.,e Department of Surgery , University of Arizona , Tucson , AZ , USA
| | - M H Witte
- e Department of Surgery , University of Arizona , Tucson , AZ , USA
| | - L V Boyer
- f Venom Immunochemistry, Pharmacology, and Emergency Response (VIPER) Institute, University of Arizona , Tucson , AZ , USA
| | - A Alagón
- a Departamento de Biología Molecular y Bioprocesos , Instituto de Biotecnología Universidad Nacional Autónoma de México , Cuernavaca , México
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82
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Neri-Castro E, Hernández-Dávila A, Olvera-Rodríguez A, Cardoso-Torres H, Bénard-Valle M, Bastiaans E, López-Gutierrez O, Alagón A. Detection and quantification of a β-neurotoxin (crotoxin homologs) in the venom of the rattlesnakes Crotalus simus, C. culminatus and C. tzabcan from Mexico. Toxicon X 2019; 2:100007. [PMID: 32550564 PMCID: PMC7286086 DOI: 10.1016/j.toxcx.2019.100007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/10/2019] [Accepted: 02/03/2019] [Indexed: 11/30/2022] Open
Abstract
Snake venom may vary in composition and toxicity across the geographic distribution of a species. In the case of the three species of the Neotropical rattlesnakes Crotalus simus, C. culminatus and C. tzabcan recent research has revealed that their venoms can contain a neurotoxic component (crotoxin homologs), but is not always the case. In the present work, we detected and quantified crotoxin homologs in venom samples from three species distributed across Mexico, to describe variation at the individual and subspecific levels, using slot blot and ELISA immunoassays. We found that all C. simus individuals analyzed had substantial percentages of crotoxin homologs in their venoms (7.6–44.3%). In contrast, C. culminatus lacked them completely and six of ten individuals of the species C. tzabcan had low percentages (3.0–7.7%). We also found a direct relationship between the lethality of a venom and the percentage of crotoxin homologs it contained, indicating that the quantity of this component influences venom lethality in the rattlesnake C. simus. Monoclonal antibodies were produced that specifically recognized crotoxin homologs in venoms of Crotalus species. Crotoxin homologs were quantified in three species of Crotalus: C. simus, C. culminatus and C. tzabcan. All specimens of C. simus contained crotoxin homologs at different levels, while C. culminatus venoms lacked them completely. In C. tzabcan, some venoms possess and other lack crotoxin homologs.
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Affiliation(s)
- Edgar Neri-Castro
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, Mexico.,Posgrado en Ciencias Biomédicas, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, Mexico
| | - Arely Hernández-Dávila
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, Mexico
| | - Alejandro Olvera-Rodríguez
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, Mexico
| | - Héctor Cardoso-Torres
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, Mexico
| | - Melisa Bénard-Valle
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, Mexico
| | - Elizabeth Bastiaans
- Department of Biology, State University of New York at Oneonta, Oneonta, NY, USA
| | - Oswaldo López-Gutierrez
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, Mexico
| | - Alejandro Alagón
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, Mexico
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Vipera berus berus Venom from Russia: Venomics, Bioactivities and Preclinical Assessment of Microgen Antivenom. Toxins (Basel) 2019; 11:toxins11020090. [PMID: 30717298 PMCID: PMC6409582 DOI: 10.3390/toxins11020090] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/27/2019] [Accepted: 01/29/2019] [Indexed: 12/20/2022] Open
Abstract
The common European adder, Vipera berus berus, is a medically relevant species, which is widely distributed in Russia and thus, is responsible for most snakebite accidents in Russia. We have investigated the toxic and enzymatic activities and have determined the proteomic composition of its venom. Phospholipases A2 (PLA2, 25.3% of the venom proteome), serine proteinases (SVSP, 16.2%), metalloproteinases (SVMP, 17.2%), vasoactive peptides (bradykinin-potentiating peptides (BPPs), 9.5% and C-type natriuretic peptides (C-NAP, 7.8%), cysteine-rich secretory protein (CRISP, 8%) and L-amino acid oxidase (LAO, 7.3%) represent the major toxin classes found in V. b. berus (Russia) venom. This study was also designed to assess the in vivo and in vitro preclinical efficacy of the Russian Microgen antivenom in neutralizing the main effects of V. b. berus venom. The results show that this antivenom is capable of neutralizing the lethal, hemorrhagic and PLA2 activities. Third-generation antivenomics was applied to quantify the toxin-recognition landscape and the maximal binding capacity of the antivenom for each component of the venom. The antivenomics analysis revealed that 6.24% of the anti-V. b. berus F(ab’)2 molecules fraction are toxin-binding antibodies, 60% of which represent clinically relevant antivenom molecules.
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84
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Pla D, Rodríguez Y, Resiere D, Mehdaoui H, Gutiérrez JM, Calvete JJ. Third-generation antivenomics analysis of the preclinical efficacy of Bothrofav® antivenom towards Bothrops lanceolatus venom. Toxicon X 2019; 1:100004. [PMID: 32831345 PMCID: PMC7286001 DOI: 10.1016/j.toxcx.2018.100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/13/2018] [Accepted: 12/21/2018] [Indexed: 11/11/2022] Open
Abstract
Bothrops lanceolatus inflicts severe envenomings in the Lesser Caribbean island of Martinique. Bothrofav®, a monospecific antivenom against B. lanceolatus venom, has proven highly effective at the preclinical and clinical levels. Here, we report a detailed third-generation antivenomics quantitative analysis of Bothrofav®. With the exception of poorly-immunogenic peptides, Bothrofav® immunocaptured all the major protein components. These results, along with previous preclinical and clinical observations, underscore the high neutralizing efficacy of the antivenom against B. lanceolatus venom. The immunoreactivity of the monospecific antivenom Bothrofav® was evaluated against Bothrops lanceolatus venom. Third Generation Antivenomics approach was used in this study. Antivenom immunocaptured all major venom components. Results agree with previous preclinical studies and demonstrate the efficacy of this antivenom.
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85
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Gutiérrez JM. Global Availability of Antivenoms: The Relevance of Public Manufacturing Laboratories. Toxins (Basel) 2018; 11:toxins11010005. [PMID: 30586868 PMCID: PMC6356591 DOI: 10.3390/toxins11010005] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/14/2018] [Accepted: 12/20/2018] [Indexed: 11/25/2022] Open
Abstract
Snakebite envenoming is a serious global public health problem, and international initiatives, under the coordination of the World Health Organization and its regional offices, are being developed to reduce the impact of this neglected tropical disease. The global availability of safe and effective antivenoms is one of the key aspects in this global strategy. This review discusses the role of public antivenom manufacturing laboratories for ensuring the supply of antivenoms. The difficulties faced by public laboratories are discussed, together with some tasks that need to be implemented for strengthening them. In addition, the concept of ‘redundancy’ in the supply of antivenoms is emphasized, as a way to cope with the risks associated with the provision of antivenoms by few manufacturers. In general, the public sector should play a leading role, in antivenom availability and other aspects as well, within the global struggle to reduce the mortality and morbidity caused by snakebite envenoming.
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Affiliation(s)
- José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José 11501-2060, Costa Rica.
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86
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Dhiman A, Anand A, Malhotra A, Khan E, Santra V, Kumar A, Sharma TK. Rational truncation of aptamer for cross-species application to detect krait envenomation. Sci Rep 2018; 8:17795. [PMID: 30542057 PMCID: PMC6290766 DOI: 10.1038/s41598-018-35985-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/02/2018] [Indexed: 11/12/2022] Open
Abstract
In majority of snakebite cases, the snake responsible for the bite remains unidentified. The traditional snakebite diagnostics method relies upon clinical symptoms and blood coagulation assays that do not provide accurate diagnosis which is important for epidemiological as well as diagnostics point of view. On the other hand, high batch-to-batch variations in antibody performance limit its application for diagnostic assays. In recent years, nucleic acid aptamers have emerged as a strong chemical rival of antibodies due to several obvious advantages, including but not limited to in vitro generation, synthetic nature, ease of functionalization, high stability and adaptability to various diagnostic formats. In the current study, we have rationally truncated an aptamer developed for α-Toxin of Bungarus multicinctus and demonstrated its utility for the detection of venom of Bungarus caeruleus. The truncated aptamer α-Tox-T2 (26mer) is found to have greater affinity than its 40-mer parent counterpart α-Tox-FL. The truncated aptamers are characterized and compared with parent aptamer for their binding, selectivity, affinity, alteration in secondary structure and limit of detection. Altogether, our findings establish the cross-species application of a DNA aptamer generated for α-Toxin of Bungarus multicinctus (a snake found in Taiwan and China) for the reliable detection of venom of Bungarus caeruleus (a snake found in the Indian subcontinent).
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Affiliation(s)
- Abhijeet Dhiman
- Department of Biotechnology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.,Faculty of Pharmacy, Uttarakhand Technical University (UTU), Dehradun, 248007, Uttarakhand, India
| | - Anjali Anand
- Centre for Biodesign and Diagnostics, Translational Health Science and Technology Institute (THSTI), Faridabad, 121001, Haryana, India
| | - Anita Malhotra
- School of Biological Sciences, College of Natural Sciences, Bangor University, Bangor, LL57 2UW, UK
| | - Eshan Khan
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol, Indore, 453552, India
| | - Vishal Santra
- Simultala Conservationists (Foundation for Wildlife), Nalikul, Hooghly, 712407, West Bengal, India
| | - Amit Kumar
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol, Indore, 453552, India
| | - Tarun Kumar Sharma
- Centre for Biodesign and Diagnostics, Translational Health Science and Technology Institute (THSTI), Faridabad, 121001, Haryana, India.
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87
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Wang H, Chen X, König E, Zhou M, Wang L, Chen T, Shaw C. Comparative Profiling of Three Atheris Snake Venoms: A. squamigera, A. nitschei and A. chlorechis. Protein J 2018; 37:353-360. [PMID: 30014259 DOI: 10.1007/s10930-018-9781-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A proteomic and transcriptomic comparative analysis of the venoms of three Atheris species (A. squamigera, A. nitschei and A. chlorechis) was carried out by size exclusion liquid chromatography, gel electrophoresis, mass spectrometry, and mRNA sequencing. The improved proteomic profiling utilised in this work was combined with transcript studies, advancing our insights into venom composition, protein distribution and inter-species variation among the three bush vipers. Crude venoms of all three samples contained at least 10-20 protein components, ranging in size from ≤ 3 to > 98 kDa. Both approaches yielded converging overall information, pointing to phospholipases, disintegrins, serine proteases and metalloproteases as the major toxin classes, which are likely to explain the local and systemic symptoms observed in envenomation by Atheris genus. Being considered as the main factors involved in the distinct venom-induced pathologies, these identified snake venom proteins are of particular interest in terms of understanding their physiological and biological function as well as for their contribution in potential medical treatments.
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Affiliation(s)
- He Wang
- School of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
| | - Xiaole Chen
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China.
| | - Enrico König
- Laboratory of Synthetic and Structural Vaccinology, University of Trento, Trento, Trentino, Italy
| | - Mei Zhou
- Natural Drug Discovery Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Lei Wang
- Natural Drug Discovery Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Tianbao Chen
- Natural Drug Discovery Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Chris Shaw
- Natural Drug Discovery Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
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88
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Defining the pathogenic threat of envenoming by South African shield-nosed and coral snakes (genus Aspidelaps), and revealing the likely efficacy of available antivenom. J Proteomics 2018; 198:186-198. [PMID: 30290233 DOI: 10.1016/j.jprot.2018.09.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/15/2018] [Accepted: 09/30/2018] [Indexed: 12/15/2022]
Abstract
While envenoming by the southern African shield-nosed or coral snakes (genus Aspidelaps) has caused fatalities, bites are uncommon. Consequently, this venom is not used in the mixture of snake venoms used to immunise horses for the manufacture of regional SAIMR (South African Institute for Medical Research) polyvalent antivenom. Aspidelaps species are even excluded from the manufacturer's list of venomous snakes that can be treated by this highly effective product. This leaves clinicians, albeit rarely, in a therapeutic vacuum when treating envenoming by these snakes. This is a significantly understudied small group of nocturnal snakes and little is known about their venom compositions and toxicities. Using a murine preclinical model, this study determined that the paralysing toxicity of venoms from Aspidelaps scutatus intermedius, A. lubricus cowlesi and A. l. lubricus approached that of venoms from highly neurotoxic African cobras and mambas. This finding was consistent with the cross-genus dominance of venom three-finger toxins, including numerous isoforms which showed extensive interspecific variation. Our comprehensive analysis of venom proteomes showed that the three Aspidelaps species possess highly similar venom proteomic compositions. We also revealed that the SAIMR polyvalent antivenom cross-reacted extensively in vitro with venom proteins of the three Aspidelaps. Importantly, this cross-genus venom-IgG binding translated to preclinical (in a murine model) neutralisation of A. s. intermedius venom-induced lethality by the SAIMR polyvalent antivenom, at doses comparable with those that neutralise venom from the cape cobra (Naja nivea), which the antivenom is directed against. Our results suggest a wider than anticipated clinical utility of the SAIMR polyvalent antivenom, and here we seek to inform southern African clinicians that this readily available antivenom is likely to prove effective for victims of Aspidelaps envenoming. BIOLOGICAL SIGNIFICANCE: Coral and shield-nosed snakes (genus Aspidelaps) comprise two species and several subspecies of potentially medically important venomous snakes distributed in Namibia, Botswana, Zimbabwe, Mozambique and South Africa. Documented human fatalities, although rare, have occurred from both A. lubricus and A. scutatus. However, their venom proteomes and the pathological effects of envenomings by this understudied group of nocturnal snakes remain uncharacterised. Furthermore, no commercial antivenom is made using venom from species of the genus Aspidelaps. To fill this gap, we have conducted a transcriptomics-guided comparative proteomics analysis of the venoms of the intermediate shield-nose snake (A. s. intermedius), southern coral snake (A. l. lubricus), and Cowle's shield snake (A. l. cowlesi); investigated the mechanism of action underpinning lethality by A. s. intermedius in the murine model; and assessed the in vitro immunoreactivity of the SAIMR polyvalent antivenom towards the venom toxins of A. l. lubricus and A. l. cowlesi, and the in vivo capability of this antivenom at neutralising the lethal effect of A. s. intermedius venom. Our data revealed a high degree of conservation of the global composition of the three Aspidelaps venom proteomes, all characterised by the overwhelming predominance of neurotoxic 3FTxs, which induced classical signs of systemic neurotoxicity in mice. The SAIMR polyvalent antivenom extensively binds to Aspidelaps venom toxins and neutralised, with a potency of 0.235 mg venom/mL antivenom, the lethal effect of A. s. intermedius venom. Our data suggest that the SAIMR antivenom could be a useful therapeutic tool for treating human envenomings by Aspidelaps species.
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89
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Antibody Cross-Reactivity in Antivenom Research. Toxins (Basel) 2018; 10:toxins10100393. [PMID: 30261694 PMCID: PMC6215175 DOI: 10.3390/toxins10100393] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 12/04/2022] Open
Abstract
Antivenom cross-reactivity has been investigated for decades to determine which antivenoms can be used to treat snakebite envenomings from different snake species. Traditionally, the methods used for analyzing cross-reactivity have been immunodiffusion, immunoblotting, enzyme-linked immunosorbent assay (ELISA), enzymatic assays, and in vivo neutralization studies. In recent years, new methods for determination of cross-reactivity have emerged, including surface plasmon resonance, antivenomics, and high-density peptide microarray technology. Antivenomics involves a top-down assessment of the toxin-binding capacities of antivenoms, whereas high-density peptide microarray technology may be harnessed to provide in-depth knowledge on which toxin epitopes are recognized by antivenoms. This review provides an overview of both the classical and new methods used to investigate antivenom cross-reactivity, the advantages and disadvantages of each method, and examples of studies using the methods. A special focus is given to antivenomics and high-density peptide microarray technology as these high-throughput methods have recently been introduced in this field and may enable more detailed assessments of antivenom cross-reactivity.
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90
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León G, Vargas M, Segura Á, Herrera M, Villalta M, Sánchez A, Solano G, Gómez A, Sánchez M, Estrada R, Gutiérrez JM. Current technology for the industrial manufacture of snake antivenoms. Toxicon 2018; 151:63-73. [DOI: 10.1016/j.toxicon.2018.06.084] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/28/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
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91
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Laustsen AH, Dorrestijn N. Integrating Engineering, Manufacturing, and Regulatory Considerations in the Development of Novel Antivenoms. Toxins (Basel) 2018; 10:E309. [PMID: 30065185 PMCID: PMC6115708 DOI: 10.3390/toxins10080309] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 07/23/2018] [Accepted: 07/27/2018] [Indexed: 12/20/2022] Open
Abstract
Snakebite envenoming is a neglected tropical disease that requires immediate attention. Conventional plasma-derived snakebite antivenoms have existed for more than 120 years and have been instrumental in saving thousands of lives. However, both a need and an opportunity exist for harnessing biotechnology and modern drug development approaches to develop novel snakebite antivenoms with better efficacy, safety, and affordability. For this to be realized, though, development approaches, clinical testing, and manufacturing must be feasible for any novel treatment modality to be brought to the clinic. Here, we present engineering, manufacturing, and regulatory considerations that need to be taken into account for any development process for a novel antivenom product, with a particular emphasis on novel antivenoms based on mixtures of monoclonal antibodies. We highlight key drug development challenges that must be addressed, and we attempt to outline some of the important shifts that may have to occur in the ways snakebite antivenoms are designed and evaluated.
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Affiliation(s)
- Andreas Hougaard Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark.
| | - Netty Dorrestijn
- Utrecht Center for Affordable Biotherapeutics, Department of Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands.
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92
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Bulfone TC, Samuel SP, Bickler PE, Lewin MR. Developing Small Molecule Therapeutics for the Initial and Adjunctive Treatment of Snakebite. J Trop Med 2018; 2018:4320175. [PMID: 30154870 PMCID: PMC6091453 DOI: 10.1155/2018/4320175] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/03/2018] [Indexed: 01/19/2023] Open
Abstract
The World Health Organization (WHO) recently added snakebite envenoming to the priority list of Neglected Tropical Diseases (NTD). It is thought that ~75% of mortality following snakebite occurs outside the hospital setting, making the temporal gap between a bite and antivenom administration a major therapeutic challenge. Small molecule therapeutics (SMTs) have been proposed as potential prereferral treatments for snakebite to help address this gap. Herein, we discuss the characteristics, potential uses, and development of SMTs as potential treatments for snakebite envenomation. We focus on SMTs that are secretory phospholipase A2 (sPLA2) inhibitors with brief exploration of other potential drug targets on venom molecules.
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Affiliation(s)
- Tommaso C. Bulfone
- California Academy of Sciences, San Francisco, 94118 CA, USA
- Ophirex, Inc., Corte Madera, 94925 CA, USA
- University of California, San Francisco, 94118 CA, USA
| | - Stephen P. Samuel
- California Academy of Sciences, San Francisco, 94118 CA, USA
- General Medicine, Queen Elizabeth Hospital, King's Lynn, PE30 4ET, Norfolk, UK
| | | | - Matthew R. Lewin
- California Academy of Sciences, San Francisco, 94118 CA, USA
- Ophirex, Inc., Corte Madera, 94925 CA, USA
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93
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Williams DJ, Habib AG, Warrell DA. Clinical studies of the effectiveness and safety of antivenoms. Toxicon 2018; 150:1-10. [PMID: 29746978 DOI: 10.1016/j.toxicon.2018.05.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 10/17/2022]
Abstract
In the 1890s, hyperimmune sera proved effective in animals against challenge by the snake venom against which they had been raised. They were first used, apparently successfully, in a human patient in about 1895. Since then, antivenoms have become accepted as the only reliable specific treatment for snake-bite envenoming. Despite decades of accumulated clinical experience and a number of published randomized comparative and observational studies, the clinical effectiveness and safety of some antivenoms remain open to question, due to a lack of robust randomized controlled trial data. Antivenoms in some poorly regulated markets may have high rates of potentially fatal adverse effects and their use must be balanced by demonstrable effectiveness. Even those manufactured to strict regulatory requirements may pose a rare risk of severe adverse reactions. Most antivenoms currently marketed around the world were registered without first being studied clinically. There is increasing pressure to subject antivenoms, even those that are long-established, to the same protocols of rigorous pre-clinical and clinical assessment that are standard regulatory requirements for other drugs. Conventional clinical testing progresses through Phases I, II, III to IV. Most authorities consider antivenoms too dangerous to be used in Phase I studies in healthy volunteers. An alternative method for preliminary estimation of safety, dose-finding and effectiveness, is proposed - the "3 + 3" dose escalation or de-escalation design, in volunteer patients, as used in oncology to test cytotoxic drugs. Antivenoms are so widely used and well trusted, that there are few ethical justifications for placebo controls. However, placebo might be ethically justified if there were no proven effective treatment and or if withholding or delaying treatment posed acceptably negligible risks to the participants. Antivenom trials are most urgently needed in low-to middle-income countries where there are many practical, logistical and funding challenges. Basic requirements for clinical trials include identification of the biting species of snake in every case; the use of objective, clinically-relevant endpoints, such as restoration of blood coagulability; definition of inclusion, exclusion and withdrawal criteria; assurance of antivenom safety; ethical considerations; inclusion of one or more control (comparator) groups; and analysis based on intention to treat. The highest quality evidence comes from Phase II and larger Phase III studies that have been designed as statistically powerful, randomized, controlled trials (RCTs), ideally with blinding of patients and investigators to avoid bias. Because of the challenges to carrying out clinical trials of antivenoms, Phase IV trials (post-marketing surveillance) are potentially more important and useful than for most other drugs.
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Affiliation(s)
- David J Williams
- Australian Venom Research Unit, Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, VIC, 3010, Australia; Charles Campbell Toxinology Centre, School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, NCD, 121, Papua New Guinea.
| | - Abdulrazaq G Habib
- Department of Medicine, Bayero University Kano, Aminu Kano Teaching Hospital, PMB 3452, Kano, Nigeria.
| | - David A Warrell
- Australian Venom Research Unit, Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, VIC, 3010, Australia; Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 9DU, UK.
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94
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95
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Preclinical assessment of the neutralizing efficacy of snake antivenoms in Latin America and the Caribbean: A review. Toxicon 2018; 146:138-150. [DOI: 10.1016/j.toxicon.2018.02.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/28/2018] [Indexed: 11/19/2022]
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96
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Calvete JJ, Rodríguez Y, Quesada-Bernat S, Pla D. Toxin-resolved antivenomics-guided assessment of the immunorecognition landscape of antivenoms. Toxicon 2018; 148:107-122. [PMID: 29704534 DOI: 10.1016/j.toxicon.2018.04.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/26/2018] [Accepted: 04/22/2018] [Indexed: 01/23/2023]
Abstract
Snakebite envenoming represents a major issue in rural areas of tropical and subtropical regions across sub-Saharan Africa, South to Southeast Asia, Latin America and Oceania. Antivenoms constitute the only scientifically validated therapy for snakebite envenomings, provided they are safe, effective, affordable, accessible and administered appropriately. However, the lack of financial incentives in a technology that has remained relatively unchanged for more than a century, has contributed to some manufacturers leaving the market and others downscaling production or increasing the prices, leading to a decline in the availability and accessibility for these life-saving antidotes to millions of rural poor most at risk from snakebites in low income countries. The shortage of antivenoms can be significantly alleviated by optimizing the use of current antivenoms (through the assessment of their specific and paraspecific efficacy against the different medically relevant homologous and heterologous snake venoms) and by generating novel polyspecific antivenoms exhibiting broad clinical spectrum and wide geographic distribution range. Research on venoms has been continuously enhanced by advances in technology. Particularly, the last decade has witnessed the development of omics strategies for unravelling the toxin composition of venoms ("venomics") and to assess the immunorecognition profile of antivenoms ("antivenomics"). Here, we review recent developments and reflect on near future innovations that promise to revolutionize the mutually enlightening relationship between evolutionary and translational venomics.
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Affiliation(s)
- Juan J Calvete
- Evolutionary and Translational Venomics Laboratory, Consejo Superior de Investigaciones Científicas (CSIC), Valencia, Spain.
| | - Yania Rodríguez
- Evolutionary and Translational Venomics Laboratory, Consejo Superior de Investigaciones Científicas (CSIC), Valencia, Spain
| | - Sarai Quesada-Bernat
- Evolutionary and Translational Venomics Laboratory, Consejo Superior de Investigaciones Científicas (CSIC), Valencia, Spain
| | - Davinia Pla
- Evolutionary and Translational Venomics Laboratory, Consejo Superior de Investigaciones Científicas (CSIC), Valencia, Spain.
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97
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Farias IBD, Morais-Zani KD, Serino-Silva C, Sant'Anna SS, Rocha MMD, Grego KF, Andrade-Silva D, Serrano SM, Tanaka-Azevedo AM. Functional and proteomic comparison of Bothrops jararaca venom from captive specimens and the Brazilian Bothropic Reference Venom. J Proteomics 2018; 174:36-46. [DOI: 10.1016/j.jprot.2017.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/01/2017] [Accepted: 12/17/2017] [Indexed: 01/22/2023]
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98
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Morais V. Antivenom therapy: efficacy of premedication for the prevention of adverse reactions. J Venom Anim Toxins Incl Trop Dis 2018; 24:7. [PMID: 29507580 PMCID: PMC5831611 DOI: 10.1186/s40409-018-0144-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/07/2018] [Indexed: 11/29/2022] Open
Abstract
Antivenoms or antitoxins have been effectively used for more than a century. During this time, these products have always proven to be highly effective in the treatment of infections and envenomations. However, antivenoms did not exhibit good safety results in their initial applications. After many improvements, antivenoms have substantially better safety profiles but still have some side effects. Due to the occurrence of adverse reactions, the practice of using premedication with the intent to decrease side effects has become accepted or mandatory in many countries. The drugs used for premedication belong to the histamine H1 antagonist, glucocorticoid and catecholamine groups. Currently, this practice is being questioned due to low or controversial efficacies in clinical assays. In this article, we discuss the causes of adverse reactions, the mechanisms of drugs that block the undesired effects and the results obtained in clinical trials. Although these three families of drugs could have positive effects on reducing adverse reactions, only adrenaline has demonstrated positive results in clinical assays.
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Affiliation(s)
- Victor Morais
- Department of Biotechnology, Institute of Hygiene, Faculty of Medicine, University of the Republic, Uruguay, Av. Alfredo Navarro, 3051 Montevideo, Uruguay
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99
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Hatakeyama DM, de Morais-Zani K, Serino-Silva C, Grego KF, Sant'Anna SS, Fernandes W, Aniz PA, Torquato RJ, Tanaka AS, Sanz L, Calvete JJ, Tanaka-Azevedo AM. Examination of biochemical and biological activities of Bothrops jararaca (Serpentes: Viperidae; Wied-Neuwied 1824) snake venom after up to 54 years of storage. Toxicon 2018; 141:34-42. [DOI: 10.1016/j.toxicon.2017.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/18/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022]
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100
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Jenkins TP, Sánchez A, Segura Á, Vargas M, Herrera M, Stewart TK, León G, Gutiérrez JM. An improved technique for the assessment of venom-induced haemorrhage in a murine model. Toxicon 2017; 139:87-93. [DOI: 10.1016/j.toxicon.2017.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/23/2017] [Accepted: 10/08/2017] [Indexed: 10/18/2022]
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