In vivo effects of the purified thrombin-like and anticoagulant principles of Agkistrodon acutus (hundred pace snake) venom

The effect of composite PHB coating on the biological properties of a magnesium based alloy

Magnesium alloys have been widely investigated as biodegradable cardiovascular temporal implants due to their better mechanical properties and biocompatibility, but the rapid degradation limited its application. In this study, the anodic oxidation-Cu structure was used to improve the adhesive strength and stability between poly-β-hydroxybutyrate (PHB) and magnesium alloys, and the effects of anodic oxidation magnesium alloys with copper film and PHB film (MACP) on human umbilical vein endothelial cells (HUVECs), blood compatibility and antibacterial properties were investigated in this research. As the result, the MACP structure had a stable structure and better corrosion resistance, and significant antibacterial properties. The coating would not affect the original excellent biocompatibility of the magnesium alloy. It was indicated that MACP was a potential surface modification strategy for vascular stents candidate material.

Basal but divergent: Clinical implications of differential coagulotoxicity in a clade of Asian vipers

Envenomations by Asian pitvipers can induce multiple clinical complications resulting from coagulopathic and neuropathic effects. While intense research has been undertaken for some species, functional coagulopathic effects have been neglected. As these species' venoms affect the blood coagulation cascade we investigated their effects upon the human clotting cascade using venoms of species from the Azemiops, Calloselasma, Deinagkistrodon and Hypnale genera. Calloselasma rhodostoma, Deinagkistrodon acutus, and Hypnale hypnale produced net anticoagulant effects through pseudo-procoagulant clotting of fibrinogen, resulting in weak, unstable, transient fibrin clots. Tropidolaemus wagleri was only weakly pseudo-procoagulant, clotting fibrinogen with only a negligible net anticoagulant effect. Azemiops feae and Tropidolaemus subannulatus did not affect clotting. This is the first study to examine in a phylogenetic context the coagulotoxic effects of related genera of basal Asiatic pit-vipers. The results reveal substantial variation between sister genera, providing crucial information about clinical effects and implications for antivenom cross-reactivity.

Clinical and laboratory features distinguishing between Deinagkistrodon acutus and Daboia siamensis envenomation

Background

There are 6 species of venomous snakes in Taiwan. Two of them, Deinagkistrodon acutus (D. acutus) and Daboia siamensis (D. siamensis), can cause significant coagulopathy. However, a significant proportion of patients with snakebites cannot identify the correct snake species after envenomation, which hampers the application of antivenom. Hence, the differential diagnosis between the two snakebites by clinical presentations is important. This study aims to compare their clinical and laboratory features for the purpose of differential diagnosis between the two snakebites.

Methods

We retrospectively reviewed the medical records of patients who arrived at the emergency department due to D. acutus or D. siamensis envenomation, between 2003 and 2016, in one medical center in eastern Taiwan. Since these snakebites are rare, we also included 3 cases reported from another hospital in central Taiwan.

Results

In total, 15 patients bitten by D. acutus and 12 patients by D. siamensis were analyzed. Hemorrhagic bulla formation and the need for surgical intervention only presented for D. acutus envenomation cases (Both 53.3% vs. 0.0%, P = 0.003). As to laboratory features, lower platelet counts (20.0 ×  10³/μL [interquartile range, 14–66 × 10³/μL] vs. 149.0 × 10³/μL [102.3–274.3 × 10³/μL], P = 0.001), lower D-dimer level (1423.4 μg/L [713.4–4212.3 μg/L] vs. 12,500.0 μg/L [2351.4–200,000 μg/L], P = 0.008), higher proportion of patients with moderate-to-severe thrombocytopenia (platelet count < 100 × 10³/μL) (80% vs. 16.7%, odds ratio (OR) = 20.0, 95% CI, 2.77–144.31; P = 0.002), and lower proportion of patients with extremely high D-dimer (> 5000 ng/mL) (16.7% vs. 66.7%, adjusted OR = 0.1 (95% CI, 0.01–0.69; P = 0.036) were found among cases of D. acutus envenomation compared to D. siamensis envenomation. The combination of hemorrhagic bulla, thrombocytopenia, and a lack of extremely high D-dimer had good discriminatory power (area under the curve (AUC) = 0.965; 95% CI, 0.904–1.00) for distinguishing D. acutus from D. siamensis envenomation.

Conclusions

The presentation of moderate to severe thrombocytopenia (platelet count < 100 × 10³/μL) and hemorrhagic bulla formation may indicate D. acutus envenomation. However, the envenomed patient with extremely high D-dimer levels may indicate a D. siamensis envenomation. These findings may help diagnose and select the right antivenom in patients with unknown snakebites who present significant coagulopathy.

Deinagkistrodon acutus envenomation: a report of three cases

Background

Deinagkistrodon acutus envenomation is associated with severe hematological and wound complications but is rarely described.

Case presentation

Herein, we report three cases of victims bitten by D. acutus and indicate that rapid-onset severe coagulopathy and thrombocytopenia are distinct features of D. acutus snakebite, which are not observed in other crotaline snakebites (i.e., Trimeresurus stejnegeri and Protobothrops mucrosquamatus) in Taiwan. The toxic effects could occur as early as 2 to 3 h following D. acutus envenomation and persist if the administration of specific antivenom is delayed or even not commenced. Based on our findings, 2 to 4 vials of specific antivenom as the first dose should be administered to victims and repeated at 6 to 8 h intervals if coagulopathy or thrombocytopenia persists. Fresh frozen plasma or platelet replacement is probably safe as an adjunct therapy for D. acutus bite in the presence of venom-induced consumptive coagulopathy.

Conclusion

Severe coagulopathy and thrombocytopenia could occur as early as 2 to 3 h after D. acutus envenomation. The current recommendation for antivenom is 2 to 4 vials as the first dose and repeated every 6– to 8 h if coagulopathy or thrombocytopenia persists. These cases studied may be helpful to first-line medical personnel in the early diagnosis and management of D. acutus envenomation among other crotaline snakebites in Taiwan.

Coagulation factor X inhibitor from hundred-pace snake (Deinagkistrodon acutus) venom

Deinagkistrodon acutus venom contains a collection of anticoagulant proteins that has been reported to prevent prothrombinase assembly (Teng and Seegers, 1981, Thromb. Res. 23, 255). A partial sequence indicates that these proteins are related to the functionally equivalent protein in Trimeresurus flavoviridis (Atoda et al., 1991, J. Biochem. 106, 808). Inhibition of prothrombinase, the complex of Factors Xa and Va combined with phospholipids, is expressed in bovine, human, and rat plasmas as indicated by an assay dependent on only prothrombinase activity. The concentration dependence of inhibition of prothrombin conversion by different combinations of the components of bovine prothrombinase under the same conditions yielded estimates of apparent dissociation constants of 104 nM and 2 nM for complexes of the inhibitor with Factor Xa and with Factors Xa and Va, respectively. Because this inhibitor does not prevent Factor Xa alone from converting prothrombin, but blocks the other combinations, we conclude the inhibitor prevents the complex of Factors Xa and Va from binding to phospholipid surfaces and to prothrombin. The inhibitor also blocks the activation of Factor X by Factor VIIa and thromboplastin as well. However, the inhibitor has no effect on thrombin-induced clotting or fibrinolysis induced by either plasminogen activator or streptokinase. Therefore, this inhibitor has several properties required of an anticoagulant, therapeutic agent.

Characterization of snake venom components acting on blood coagulation and platelet function

Snake venoms can affect blood coagulation and platelet function in various ways. The physicochemical properties and the mechanisms of actions of the snake venom components affecting blood coagulation and platelet function are discussed.

Alpha and beta-fibrinogenases from Trimeresurus gramineus snake venom

By means of DEAE-Sephadex A-50 Column chromatography, Trimeresurus gramineus venom was separated into twelve fractions. The fibrinogenolytic activities were distributed in Fractions 1 and 10. These enzymes were further purified by gel filtration and were homogeneous as judged by cellulose acetate membrane, sodium dodecyl sulfate polyacrylamide gel electrophoresis and ultracentrifugal analysis. Both of them were single peptide chains. The sedimentation constants of alpha- (Fraction 1) and beta-fibrinogenases (Fraction 10) were 2.20 and 3.60, respectively. The molecular weights of alpha- and beta-fibrinogenases were 23 500 and 25 000 respectively. The contents of proline and glycine were higher in beta-fibrinogenase than in alpha-fibrinogenase. The isoelectric points of alpha-fibrinogenase and beta-fibrinogenase were pH greater than 10 and 4.5, respectively. The optimal pH of alpha-fibrinogenase was approx. 7.4 and that of beta-fibrinogenase was approx. 9.0. The activity of alpha-fibrinogenase was completely destroyed after 30 min at 60 degrees C, pH 5.4, 7.4 and 9.0, while that of beta-fibrinogenase was much less affected by the same treatment. The specific fibrinogenolytic activity alpha-fibrinogenase was 31 mg fibrinogen/min per mg protein, while that of beta-fibrinogenase was 9 mg fibrinogen/min per mg protein. alpha-Fibrinogenase cleaved specifically the alpha(A) chain of monomeric fibrinogen without cleaving the beta(B) chain and gamma-chain. beta-fibrinogenase preferentially cleaved the beta(B) chain, and the alpha(A) chain was also partially cleaved by beta-fibrinogenase, if the incubation time was prolonged. Both enzymes showed proteolytic activities toward fibrinogen, fibrin and casein, but were devoid of phospholipase A, alkaline phosphomonoesterase and phosphodiesterase activities found in the crude venom. The tosyl-L-arginine methylester esterase activity of beta-fibrinogenase was about 14 times that of crude venom, while alpha-fibrinogenase was completely devoid of this activity. The fibrinogenolytic activity of alpha-fibrinogenase was markedly inhibited by EDTA and cysteine, while that of beta-fibrinogenase was inhibited markedly by phenylmethanesulfonylfluoride. alpha- and beta-fibrinogenases exert their fibrinogenolytic activity by a direct action on fibrinogen or fibrin without activation of plasminogen.