Purification, from Australian elapid venoms, and properties of phospholipases A which cause myoglobinuria in mice

Investigating myotoxicity following Australian red-bellied black snake (Pseudechis porphyriacus) envenomation

Background

Myotoxicity is one of the common clinical manifestations of red-bellied black snake (Pseudechis porphyriacus) envenomation characterised by elevated creatine kinase (CK) concentrations of greater than 1000 U/L. This study aimed to investigate the occurrence of myotoxicity in patients following envenomation.

Methods/Principal findings

Patient characteristics and serial blood samples (timed venom concentrations and CK concentrations, pre- and post- antivenom) from 114 patients (median age 41, 2-90y; 80 male) were extracted from the Australian Snakebite Project database. Patients were categorised into three groups based on peak CK concentrations [no myotoxicity (<1000 U/L), mild (1000–10,000 U/L) and severe (>10,000 U/L)]. The odds of (mild or severe) myotoxicity was lower in patients that received early antivenom (within 6 hours post-bite) compared to those that received late or no antivenom (odd ratio was 0.186; 95% confidence interval, 0.052–0.664). A population pharmacokinetic-pharmacodynamic (PKPD) model was developed to describe the relationship between the time course of venom (a mixture of toxins) and effect (elevated CK). In addition, a kinetic-pharmacodynamic (KPD) model was developed to describe the relationship between time course of a theoretical toxin and effect. Model development and parameter estimation was performed using NONMEM v7.3. No single set of parameter values from either the PKPD or KPD models were found that could accurately describe the time course of different levels of severity of myotoxicity. The predicted theoretical toxin half-life from the KPD model was 11 ± 3.9 hours compared to the half-life of venom of 5.3 ± 0.36 hours. This indicates that the putative causative toxin’s concentration-time profile does not parallel that of venom.

Conclusion

Early antivenom administration reduces the incidence of myotoxicity. The venom concentration profile does not appear to be the driver for myotoxicity following envenomation. Additional factors that affect the sensitivity of the patient to snake venom/toxins must be explored to understand the relationship with myotoxicity.

Pathology of Fatal Australian Black Snake (Pseudechis sp) Envenomation in Two Adult Dogs

Black snakes (Pseudechis spp) are a genus of venomous Australian elapid snakes that can cause major clinical envenomation in companion animals, which may be fatal, even with appropriate antivenom treatment. Despite its clinical significance, there is little published information on the pathology of black snake envenomation. We report the gross and microscopic lesions associated with black snake envenomation in two dogs, one with a definitive immunological species identification of red-bellied black snake (RBBS; Pseudechis porphyriacus), the other with a black snake immunotype on a venom detection kit. Both dogs were located in a geographical area where the RBBS is found. The prominent gross findings in both cases included icterus, localized facial oedema in the region of the presumed bite wound, pigmenturia and multicavitary serosanguineous effusions. Histopathology of the confirmed RBBS case revealed acute renal tubular necrosis with haemosiderosis, marked splenic haemosiderosis and centrilobular to midzonal hepatocellular necrosis with severe cholestasis. Defining the spectrum of lesions of elapid snake envenomation improves understanding of the pathogenesis, which may lead to improved patient outcomes and post-mortem diagnosis.

Australian snakebite myotoxicity (ASP-23)

BACKGROUND

Myotoxicity is a recognised but poorly characterised effect of snake envenoming worldwide. We aimed to describe the clinical effects, complications and effectiveness of antivenom in myotoxicity from Australian snake envenoming.

METHODS

Patients were recruited to the Australian Snakebite Project (ASP), a prospective, observational study of patients with suspected or proven snakebite countrywide. After informed consent data is collected and stored in a dedicated database and blood samples are taken and stored. We included patients with envenoming and biochemical evidence of myotoxicity (peak creatine kinase [CK] > 1000 U/L). Snake species was determined by expert identification or venom specific enzyme immunoassay. Analysis included patient demographics, clinical findings, pathology results, treatment and outcomes (length of hospital stay, complications).

RESULTS

1638 patients were recruited January 2003-December 2016, 935 (57%) were envenomed, 148 developed myotoxicity (16%). Snake species most commonly associated with myotoxicity were Notechis spp. (30%), Pseudechis porphyriacus (20%) and Pseudechis australis (13%). Bite site effects occurred in 19 patients. Non-specific systemic symptoms occurred in 135 patients (91%), specific signs and symptoms in 83. In 120 patients with early serial CK results, the median peak CK was 3323 U/L (IQR;1050-785100U/L), the median time to first CK >500 U/L was 11.1 h and median time to peak CK of 34.3 h. White cell count was elevated in 136 patients (93%; median time to elevation, 4.9 h). 37 patients had elevated creatinine, six were dialysed. Two patients died from complications of severe myotoxicity. Antivenom given before the first abnormal CK (>500 U/L) was associated with less severe myotoxicity (2976 versus 7590 U/L). Non-envenomed patients with elevated CK had rapid rise to abnormal CK (median 3.5 h) and less had elevated WCC (32%).

CONCLUSION

Myotoxicity from Australian snakes is relatively common and has systemic effects, with significant associated morbidity and mortality. CK is not a good early biomarker of mytoxicity. Early antivenom may play a role in reducing severity.

Differential myotoxic and cytotoxic activities of pre-synaptic neurotoxins from Papuan taipan (Oxyuranus scutellatus) and Irian Jayan death adder (Acanthophis rugosus) venoms

Pre-synaptic PLA(2) neurotoxins are important components of many Australasian elapid snake venoms. These toxins disrupt neurotransmitter release. Taipoxin, a pre-synaptic neurotoxin isolated from the venom of the coastal taipan (Oxyuranus scutellatus), causes necrosis and muscle degeneration. The present study examined the myotoxic and cytotoxic activities of venoms from the Papuan taipan (O. scutellatus) and Irian Jayan death adder (Acanthophis rugosus), and also tested their pre-synaptic neurotoxins: cannitoxin and P-EPTX-Ar1a. Based on size-exclusion chromatography analysis, cannitoxin represents 16% of O. scutellatus venom, while P-EPTX-Ar1a represents 6% of A. rugosus venom. In the chick biventer cervicis nerve-muscle preparation, A. rugosus venom displayed significantly higher myotoxic activity than O. scutellatus venom as indicated by inhibition of direct twitches, and an increase in baseline tension. Both cannitoxin and P-EPTX-Ar1a displayed marked myotoxic activity. A. rugosus venom (50-300 μg/ml) produced concentration-dependent inhibition of cell proliferation in a rat skeletal muscle cell line (L6), while 300 μg/ml of O. scutellatus venom was required to inhibit cell proliferation, following 24-hr incubation. P-EPTX-Ar1a had greater cytotoxicity than cannitoxin, inhibiting cell proliferation after 24-hr incubation in L6 cells. Lactate dehydrogenase levels were increased after 1-hr incubation with A. rugosus venom (100-250 μg/ml), O. scutellatus venom (200-250 μg/ml) and P-EPTX-Ar1a (1-2 μM), but not cannitoxin (1-2 μM), suggesting venoms/toxin generated cell necrosis. Thus, A. rugosus and O. scutellatus venoms possess different myotoxic and cytotoxic activities. The proportion of pre-synaptic neurotoxin in the venoms and PLA(2) activity of the whole venoms are unlikely to be responsible for these activities.

Characterisation of the heterotrimeric presynaptic phospholipase A(2) neurotoxin complex from the venom of the common death adder (Acanthophis antarcticus)

While Australo-Papuan death adder neurotoxicity is generally considered to be due to the actions of reversible competitive postsynaptic alpha-neurotoxins, the neurotoxic effects are often poorly reversed by antivenom or anticholinesterases. This suggests that the venom may contain a snake presynaptic phospholipase A(2) (PLA(2)) neurotoxin (SPAN) that binds irreversibly to motor nerve terminals to inhibit neurotransmitter release. Using size-exclusion liquid chromatography under non-reducing conditions, we report the isolation and characterisation of a high molecular mass SPAN complex, P-elapitoxin-Aa1a (P-EPTX-Aa1a), from the venom of the common death adder Acanthophis antarcticus. Using the chick biventer-cervicis nerve-muscle preparation, P-EPTX-Aa1a (44,698Da) caused inhibition of nerve-evoked twitch contractions while responses to cholinergic agonists and KCl remained unaffected. P-EPTX-Aa1a also produced significant fade in tetanic contractions and a triphasic timecourse of neuromuscular blockade. These actions are consistent with other SPANs that inhibit acetylcholine release. P-EPTX-Aa1a was found to be a heterotrimeric complex composed of alpha, beta and gamma-subunits in a 1:1:1 stoichiometry with each subunit showing significant N-terminal sequence homology to the subunits of taipoxin, a SPAN from Oxyuranus s. scutellatus. Like taipoxin, only the alpha-chain produced any signs of neurotoxicity or displayed significant PLA(2) enzymatic activity. Preincubation with monovalent death adder antivenom or suramin, or inhibition of PLA(2) activity by incubation with 4-bromophenacyl bromide, either prevented or significantly delayed the onset of toxicity by P-EPTX-Aa1a. However, antivenom failed to reverse neurotoxicity. Early intervention with antivenom may therefore be important in severe cases of envenomation by A. antarcticus, given the presence of potent irreversible presynaptic neurotoxins.

Snake venoms and their toxins: An Australian perspective

Australia is home to a vast collection of highly venomous terrestrial and marine snakes. As such, Australia has proven to be an excellent source of investigative material for both local and international toxinologists. Research on snake venoms initially focussed on identifying the most lethal species, and the venom components responsible for the lethality, so that treatment strategies could be implemented. Since then, the focus of research has included the isolation and characterisation of toxins (primarily neurotoxins), examination of the efficacy of commercially available antivenoms and, more recently, the use of liquid chromatography/mass spectrometry (LCMS) to aid in the analysis of whole venoms. Given the vast quantity of research undertaken over the past 70 yr we have tried to provide a short insight into some of this excellent work and identify areas requiring further examination.

Anuric renal failure in a dog after Red-bellied Black snake (Pseudechis porphyriacus) envenomation

A case of Red-bellied Black snake envenomation resulting in intravascular haemolytic anaemia, rhabdomyolysis and anuric renal failure is described in the dog. A 12-year-old female desexed Golden Retriever was presented with a 15 hour history of profuse salivation, progressive lethargy, obtundence, inappetence and collapse. Significant findings on clinical examination were pallor, icterus, tachypnoea and dyspnoea with increased respiratory sounds and crackles in all lung fields. Generalised abdominal and muscular pain was apparent and dark red-brown urine was present around the perineal region. A diagnosis of Red-bellied Black snake (Pseudechis porphyriacus) envenomation was made and the dog was treated with intravenous fluid therapy, Tiger/Brown snake antivenom, packed red cell transfusions and Intermittent Positive Pressure Ventilation. Continued clinical deterioration occurred and a diagnosis of acute renal failure secondary to myohaemoglobinuric pigmenturia was made 12 hours after admission. Intensive treatment was attempted with diuresis and volume expansion. Oliguria and subsequent anuria ensued and the dog was euthanased due to a grave prognosis and lack of clinical response to treatment. Necropsy examination revealed muscular necrosis, accumulation of fluid in the thoracic and peritoneal cavities, and marked renal tubular necrosis with intraluminal occlusion secondary to pigmentary casts.

Collett's snake (Pseudechis colletti) envenoming in snake handlers

BACKGROUND

Collett's snake (Pseudechis colletti) is a member of the black snake genus and occurs in a warm temperate to sub-tropical region of central Queensland, Australia. There are no reports of bites occurring in the wild, and bites were previously thought to cause only minor effects. They are a popular snake among zoos and exotic snake keepers.

AIM

To investigate the clinical effects of severe envenoming by Collett's snake, and possible treatment options.

DESIGN

Case series.

METHODS

Clinical and laboratory features are described for six bites, all in snake handlers.

RESULTS

All six bites were from captive snakes, resulting in severe envenoming in four. Two patients were treated early with black snake antivenom, and only developed an anticoagulant coagulopathy and mild myolysis. Two developed anticoagulant coagulopathy and severe rhabdomyolysis associated with acute renal failure, requiring haemodialysis; both received antivenom >10 h after the bite, and initially received minimal fluid replacement. Other effects included thrombocytopenia, non-immune haemolytic anaemia and a marked leukocytosis.

DISCUSSION

Collett's snake envenoming is characterized by early generalized systemic effects (nausea, vomiting, abdominal pain, diarrhoea and headache) and an anticoagulant coagulopathy, followed in some cases by rhabdomyolysis and acute renal failure in untreated patients within 24 h. Early initiation of fluid therapy and treatment with black snake antivenom should be undertaken in all envenomed patients.

Skeletal muscle degeneration induced by venom phospholipases A2: insights into the mechanisms of local and systemic myotoxicity

Local and systemic skeletal muscle degeneration is a common consequence of envenomations due to snakebites and mass bee attacks. Phospholipases A2 (PLA2) are important myotoxic components in these venoms, inducing a similar pattern of degenerative events in muscle cells. Myotoxic PLA2s bind to acceptors in the plasma membrane, which might be lipids or proteins and which may differ in their affinity for the PLA2s. Upon binding, myotoxic PLA2s disrupt the integrity of the plasma membrane by catalytically dependent or independent mechanisms, provoking a pronounced Ca2+ influx which, in turn, initiates a complex series of degenerative events associated with hypercontraction, activation of calpains and cytosolic Ca(2+)-dependent PLA2s, and mitochondrial Ca2+ overload. Cell culture models of cytotoxicity indicate that some myotoxic PLA2s affect differentiated myotubes in a rather selective fashion, whereas others display a broad cytolytic effect. A model is presented to explain the difference between PLA2s that induce predominantly local myonecrosis and those inducing both local and systemic myotoxicity. The former bind not only to muscle cells, but also to other cell types, thereby precluding a systemic distribution of these PLA2s and their action on distant muscles. In contrast, PLA2s that bind muscle cells in a more selective way are not sequestered by non-specific interactions with other cells and, consequently, are systemically distributed and reach muscle cells in other locations.

Group IB phospholipase A2 from Pseudonaja textilis

Pseudonaja textilis, an Australian Elapid, is known to produce a highly toxic venom. Both protein profiling and N-terminal sequence analysis showed the presence of four new phospholipases A(2) in this venom. Besides being non-lethal, the phospholipase A(2) proteins were found to be moderately active enzymes and they showed procoagulant property. cDNA cloning and characterization indicated the presence of two isoforms of PLA(2) proteins in a single snake, each containing the "pancreatic loop," characteristic of group IB phospholipase A(2). The genomic cloning also confirmed the presence of two genes each containing four exons that are interrupted by three introns. Phylogenetic analysis showed that the venom group IB PLA(2) gene is primitive and could have evolved from the same ancestor as the mammalian and venom group IA PLA(2) genes. In the present study, we report that the Pt-PLA2 gene could be responsible for the production of PL1, 2, and 3 possibly via RNA editing process.

Species-dependent variations in the in vitro myotoxicity of death adder (Acanthophis) venoms

Based on early studies on Acanthophis antarcticus (common death adder) venom, it has long been thought that death adder snake venoms are devoid of myotoxicity. However, a recent clinical study reported rhabdomyolysis in patients following death adder envenomations, in Papua New Guinea, by a species thought to be different to A. antarcticus. Subsequently, a myotoxic phospholipase A2 component was isolated from A. rugosus (Irian Jayan death adder) venom. The present study examined the venoms of A. praelongus (northern), A. pyrrhus (desert), A. hawkei (Barkly Tableland), A. wellsi (black head), A. rugosus, A. sp. Seram and the regional variants of A. antarcticus for in vitro myotoxicity. Venoms (10-50 microg/ml) were examined for myotoxicity using the chick directly (0.1 Hz, 2 ms, supramaximal V) stimulated biventer cervicis nerve-muscle preparation. A significant contracture of skeletal muscle and/or inhibition of direct twitches were considered signs of myotoxicity. This was confirmed by histological examination. All venoms displayed high phospholipase A2 activity. The venoms (10-50 microg/ml) of A. sp. Seram, A. praelongus, A. rugosus,and A. wellsi caused a significant inhibition of direct twitches and an increase in baseline tension compared to the vehicle (n=4-6; two-way ANOVA, p<0.05). Furthermore, these venoms caused dose-dependent morphological changes in skeletal muscle. In contrast, the venoms (10-50 microg/ml; n=3-6) of A. hawkei, A. pyrrhus, and regional variants of A. antarcticus were devoid of myotoxicity. Prior incubation (10 min) of CSL death adder antivenom (5 U/ml) prevented the myotoxicity caused by A. sp. Seram, A. praelongus, A. rugosus, and A. wellsi venoms (50 microg/ml; n=4-7). In conclusion, clinicians may need to be mindful of possible myotoxicity following envenomations by A. praelongus, A. rugosus, A. sp. Seram, and A. wellsi species.

Isolation and pharmacological characterization of a phospholipase A2 myotoxin from the venom of the Irian Jayan death adder (Acanthophis rugosus)

1. It has long been thought that death adder venoms are devoid of myotoxic activity based on studies done on Acanthophis antarcticus (Common death adder) venom. However, a recent clinical study reported rhabdomyolysis in patients following death adder envenomations, in Papua New Guinea, by a species thought to be different to A. antarcticus. Consequently, the present study examined A. rugosus (Irian Jayan death adder) venom for myotoxicity, and isolated the first myotoxin (acanmyotoxin-1) from a death adder venom. 2. A. rugosus (10-50 micro g ml(-1)) and acanmyotoxin-1 (MW 13811; 0.1-1 micro M) were screened for myotoxicity using the chick directly (0.1 Hz, 2 ms, supramaximal V) stimulated biventer cervicis nerve-muscle (CBCNM) preparation. A significant contracture of skeletal muscle and/or inhibition of direct twitches were considered signs of myotoxicity. This was confirmed by histological examination. 3. High phospholipase A(2) (PLA(2)) activity was detected in both A. rugosus venom (140.2+/-10.4 micro mol min(-1) mg(-1); n=6) and acanmyotoxin-1 (153.4+/-11 micro mol min(-1) mg(-1); n=6). Both A. rugosus venom (10-50 micro g ml(-1)) and acanmyotoxin-1 (0.1-1 micro M) caused dose-dependent inhibition of direct twitches and increase in baseline tension (n=4-6). In addition, dose-dependent morphological changes in skeletal muscle were observed. 4. Prior incubation (10 min) of CSL death adder antivenom (5 units ml(-1); n=4) or inactivation of PLA(2) activity with 4-bromophenacyl bromide (1.8 mM; n=4) prevented the myotoxicity caused by acanmyotoxin-1 (1 micro M). 5. Acanmyotoxin-1 (0.1 micro M; n=4) displayed no significant neurotoxicity when it was examined using the indirectly (0.1 Hz, 0.2 ms, supramaximal V) stimulated CBCNM preparation. 6. In conclusion, clinicians may need to be mindful of possible myotoxicity following death adder envenomation in Irian Jaya.

A pharmacological examination of venoms from three species of death adder (Acanthophis antarcticus, Acanthophis praelongus and Acanthophis pyrrhus)

The common (A. antarcticus), northern (A. praelongus) and desert (A. pyrrhus) death adders are species belonging to the Acanthophis genus. The present study compared some pharmacological aspects of the venoms of these species and examined the in vitro efficacy of death adder antivenom. Neurotoxicity was determined by the time to produce 90% inhibition (t(90)) of indirect (0.1 Hz, 0.2 ms, supramaximal voltage) twitches in the chick biventer cervicis nerve-muscle (3-10 microg/ml) and mouse phrenic nerve-diaphragm (10 microg/ml) preparations. A. praelongus venom was significantly less neurotoxic than A. antarcticus venom but was not significantly different from A. pyrrhus venom. In the biventer muscle, all three venoms (3-10 microg/ml) abolished responses to exogenous ACh (1 mM) and carbachol (20 microM), but not KCl (40 mM), indicating activity at post-synaptic nicotinic receptors. All venoms (30 microg/ml) failed to produce significant inhibition of direct twitches (0.1 Hz, 2.0 ms, supramaximal voltage) in the chick biventer cervicis nerve-muscle preparation. However, A. praelongus (30 microg/ml) venom initiated a significant direct contracture of muscle, indicative of some myotoxic activity. The prior (10 min) administration of death adder antivenom (1 unit/ml), which is raised against A. antarcticus venom, markedly attenuated the twitch blockade produced by all venoms (10 microg/ml). Administration of antivenom (1.5 units/ml) at t(90) markedly reversed, over a period of 4 h, the inhibition of twitches produced by A. praelongus (3 microg/ml, 72+/-6% recovery) and A. pyrrhus (3 microg/ml, 51+/-9% recovery) but was less effective against A. antarcticus venom (3 microg/ml, 22+/-7% recovery). These results suggest that all three venoms contain postsynaptic neurotoxins. Death adder antivenom displayed differing efficacy against the in vitro neurotoxicity of the three venoms.

The envenomation syndrome caused by the Australian Red-bellied Black Snake Pseudechis porphyriacus

The Australian elapids inject venom which is characteristic of each species; and which cause characteristic and specific envenomation syndromes in human victims of snakebite. Because many of the medically significant Australian elapids look similar, when glimpsed in the field by snakebite victims, defining human envenomation syndromes with secure species identification has been a slow process. Correlations between securely identified species and the human envenomation syndromes which they produce are still evolving. The genus Pseudechis is the most widespread in Australia of the dangerous Australian elapid genera; and P. porphyriacus, the Red-bellied Black Snake, was the first terrestrial Australian elapid to be described and illustrated and the first to be the subject of experimental study. We present here five previously unreported cases of human envenomation in which the species diagnosis is secure. From these and with the perspective of a selected literature review, we describe the full envenomation syndrome of this species. Until the development of the Commonwealth Serum Laboratories' Venom Detection Kit in 1979 and the occasional case report of victims of securely identified species, envenomation syndromes for most Australian snake species have remained indeterminate, because of the lack of professional expertise in the identification of the species involved. Symptoms of the P. porphyriacus envenomation syndrome include those of bite-site pain, nausea and vomiting, generalised pruritus, chest pain, prostration and abnormalities of taste and smell. Signs include local necrosis and scarring of tissue at the bite-site, gross inflammation of surrounding tissues and, at least in one case, epilepsy. Although envenomation by the Red-bellied Black Snake is not lethal in adults, the correct therapy is Tiger Snake antivenom, administered with judgement, taking into account knowledge of the specific envenomation syndrome of this species and the clinical status of the victim.

Purification, properties, and amino acid sequence of a hemoglobinuria-inducing phospholipase A(2), MiPLA-1, from Micropechis ikaheka venom

Dark-colored urine is one of the clinical symptoms of envenomation by Micropechis ikaheka (New Guinea small-eyed snake). We have purified a phospholipase A(2), MiPLA-1, which induces dark-colored urine in experimental mice, to homogeneity. The analysis of the dark-colored urine by electrophoresis and N-terminal sequence determination indicated that the color of mouse urine is due to hemoglobin in the urine but not myoglobin. MiPLA-1 is the first hemoglobinuria-inducing toxin. Insignificant hemolytic activity of MiPLA-1 indicates that hemoglobinuria is not due to lysis of erythrocytes by MiPLA-1. This suggests that hemoglobinuria induced by MiPLA-1 may be due to kidney leakage caused by unknown mechanisms. MiPLA-1 also showed other biological effects, including myotoxicity as well as anticoagulant and antiplatelet effects. Structural studies show that MiPLA-1 is a basic protein with a molecular mass of 14041.60 +/- 1.78 as determined by electrospray mass spectrometry. We have determined the complete amino acid sequence of MiPLA-1. It is a 124-amino-acid protein with a "pancreatic loop" and belongs to group IB phospholipase A(2) enzymes. Two short segments flanked by proline brackets are found in the sequence of MiPLA-1. These segments are on the surface of the molecule and hence may be involved in protein-protein recognition.

Structure-function properties of venom components from Australian elapids

A comprehensive review of venom components isolated thus far from Australian elapids. Illustrated is that a tremendous structural homology exists among the components but this homology is not representative of the functional diversity. Further, the review illuminates the overlooked species and areas of research.

Sir Charles James Martin MB FRS: Australian serpents and Indian plague, one-hundred years ago

In 1891 as Demonstrator in Physiology at the University of Sydney, Charles Martin began the first systematic study of the chemical and physiological properties of the venoms of the Australian elapid species, Pseudechis porphyriacus and Notechis scutatus. Two major constituents were detected: a large coagulable protein which was associated with intravascular clotting, and a small proteinaceous molecule, an albumose, associated with neurotoxicity. Martin designed and constructed a high-pressure gelatin membrane ultrafilter for fractionation of venom. His studies indicated that certain physiological actions and clinical symptoms were related to the faster rate of diffusion within the tissue space of a neurotoxic constituent relative to a clotting constituent. Extending this work to toxin-antitoxin relationships, Martin provided evidence that antitoxin was a large molecule with slow diffusibility in tissue and advised the administration of curative serum (including diphtheria antitoxin) by intravenous injection. In 1903, Martin returned to London as Director of the Lister Institute of Preventive Medicine. He was soon involved in the planning of scientific work to be undertaken by the Commission for Investigation of Plague in India as the disease continued to ravage the subcontinent. Detailed epidemiological studies of possible factors involved in the spread of Pasteurella pestis showed, unequivocally, that infected rat fleas were the vector of transmission from rats to humans.

Renal lesions in rhabdomyolysis caused by Pseudechis australis snake myotoxin

The renal lesions at various time intervals after i.m. injection of Pseudechis australis myotoxin (PA myotoxin) causing myoglobinuria in mice was studied. Biochemical assay of serum creatine phosphokinase (CK) and lactate dehydrogenase (LDH) showed marked elevations [7166 +/- 2064 IU and 1626 +/- 211 Berger-Broida U/ml (B-B U/ml)] six hours after injection, indicative of rhabdomyolysis. Serum creatinine (1.6 +/- 0.39) and urea (147 +/- 40) showed significant rise by 48 hours indicative of acute renal failure (ARF). Immunodiffusion showed the presence of myoglobin in the urine (myoglobinuria) of experimental animals. Light microscopic (LM) and scanning electron microscopic (SEM) studies of the urinary sediments from experimental mice revealed granular casts of varying size and shape. LM of kidney showed casts from one hour and tubulopathy with degenerated tubular epithelial cell from 12 hours onwards. Focal glomerular changes, such as dilated Bowman's space with poorly stained substance and reduction in number of glomerular tufts were observed. Immunofluorescence microscopy for myoglobin showed fluorescence of the casts in the tubules. Transmission electron microscopy (TEM) showed electron dense casts occupying the entire lumen of the distal convoluted tubules (DCT). The proximal convoluted tubules (PCT) showed features of proximal tubular necrosis (PTN). There was reduction in the basal infolding with activation of lysosomal system in the PCT. The glomeruli showed changes in the visceral epithelium that included intracellular edema, vesiculation and occasional fusion of the podocytes. Numerous granular materials were observed in the Bowman's space as well as in the lumen of the capillaries from 1 to 24 hours. Electron dense deposits of the glomerular basement membrane (GBM) capillaries were observed from 1 to 24 hours. SEM study revealed loss of microvilli of the PCT and some tubular lumen were filled with cast like material. Some glomeruli displayed a relatively flattened podocytes with thickened major foot processes. Regeneration of the tubules were seen from three weeks onwards.

Pathological changes induced by an acidic phospholipase A2 from Ophiophagus hannah venom on heart and skeletal muscle of mice after systemic injection

An acidic phospholipase A2 (OHV A-PLA2) isolated from the venom of the king cobra (Ophiophagus hannah) was tested for its ability to cause pathological changes to myocardium, skeletal muscle and cardiac ganglia. White mice were injected intravenously with dose of 8 mg/kg or 4 mg/kg of OHV A-PLA2 and tissue samples were taken at 6 or 24 hr. Light microscopic examination failed to show significant changes in cardiac muscle and ganglia. Skeletal muscle showed myofibre degeneration and necrosis. Electron microscopic study revealed myodegeneration in cardiac and skeletal muscles, and reduction in synaptic vesicle population of preganglionic nerve terminals in cardiac ganglia. Ultrastructural changes in tissues were dose related. The lower dose (4 mg/kg) of OHV A-PLA2 produced mild myocardial changes, the myofilaments were intact but contracted, and the A band and I band were skewed. OHV A-PLA2 caused myocardial degeneration at a higher dose of 8 mg/kg. The changes included dissolution of actin and myosin filaments, dilatation and disorganization of sarcoplasmic reticulum and degeneration of mitochondria. The skeletal muscle lesions were more severe than the myocardial changes. Some of the myofibrils were severely disorganized and lack typical striated appearance, sarcomeres disrupted, most of mitochondria were vesiculated and destroyed.

Morphological changes induced by a generalized myotoxin (myoglobinuria-inducing toxin) from the venom of Pseudechis australis (king brown snake) in skeletal muscle and kidney of mice

A myotoxin causing myoglobinuria was isolated from the venom of Pseudechis australis (PA myotoxin). Myoglobinuria was observed in mice 60 min post-injection (4.5 mg/kg i.m.) into calf muscles. Light microscopic observation revealed hypercontraction of muscle fibres with delta lesions and vacuolation. Severe necrosis was observed as early as 30 min. Infiltration of the muscle fibres with macrophages was seen by 3 hr with peak infiltration by 12-48 hr. Electron microscopic study showed pathological changes in skeletal muscle as early as 5 min. Electron microscopic study showed disruption of the sarcolemma with dissolution and degeneration of the Z-band. Degeneration of the I-band was followed by degenerative changes in the A-band. Regeneration of muscle was evident by 3-5 days by the presence of many myotubes containing central nuclei. Regeneration was almost complete by 3 weeks. Contralateral soleus muscle which was not injected with toxin also showed degeneration followed by regeneration with central nuclei. Light microscopic studies of kidney showed myoglobin casts in both proximal and distal tubules, collecting ducts and loops of Henle. We conclude that this myotoxin probably acts on the Z-disc structures and also causes renal damage due to 'myoglobin cast nephropathy'.

European viper venoms: haemorrhagic and myotoxic activities

Thirty-one venom samples from European vipers (genera Vipera and Daboia) were tested for haemorrhagic and myotoxic activity by intramuscular injection into mice. Most venoms exhibited haemorrhagic activity and fewer had myotoxic activity, both of which are not strictly related.

Comparative characterization of two toxic phospholipases A2 from Indian cobra (Naja naja naja) venom

Indian cobra venom contains many phospholipase A2 (PLA2) toxins. In the present study two toxic PLA2s have been purified from the Indian cobra (Naja naja naja) venom by column chromatography. The NN-XIa-and NN-XIb-PLA2s have mol. wts between 10,700 and 15,000. The NN-XIa-PLA2 induces myotoxic effects, oedema and neurotoxicity in mice and has an i.p. LD50 of 8.5 mg/kg body weight. The NN-XIa-PLA2 is also cytotoxic to Ehrlich ascites tumour cells. The other PLA2, NN-XIb, in contrast has an i.p. LD50 of 0.22 mg/kg body weight, and it induces acute neurotoxicity. The NN-XIb-PLA2 is devoid of the other biological activities which are exhibited by NN-XIa-PLA2.

Pathologic changes induced by phospholipase A2 isolated from the venom of Collett's snake, Pseudechis colletti: a light and electron microscopic study

Pseudechis colletti is an Australian elapid snake with a range limited to central Queensland, Australia. The venom of this snake, as well as that of several other Australian elapids, has been shown to contain a phospholipase A2 (PLA2) which can cause a marked myoglobinuria in mice. Few studies have described the histopathologic and ultrastructural changes that result from myotoxic PLA2-induced damage. Our investigation demonstrated that the isolated PLA2 induced myodegeneration and necrosis in myocardium in a dose-related manner, with subsequent myoglobinuria and myoglobinuric nephropathy.

The amino acid sequence and properties of an edema-inducing Lys-49 phospholipase A2 homolog from the venom of Trimeresurus mucrosquamatus

Three phospholipase A2 enzymes or homologs were purified from the venom of Trimeresurus mucrosquamatus (Taiwan habu). The most abundant one was found to be a phospholipase homolog without enzyme activity, and its complete amino acid sequence was determined using oligopeptide fragments derived from digestion by endopeptidases Glu-C, Asp-N, Lys-C and alpha-chymotrypsin, and by means of gas-phase sequencing. The sequence revealed that the protein belonged to the Lys-49 family of snake venom phospholipase A2. This protein's function was characterized as edema-inducing. The Lys-49 protein has the potential to bind membrane phospholipid and Ca2+ (Kd = 1.6 x 10(-4) M) as shown by ultraviolet difference spectra; however, the catalytic site appeared to be inactive and the edematous response was independent of the protein's hydrolytic activity. Mast cells and platelets were shown to be subject to activation by the Lys-49 protein.

Myotoxic components of snake venoms: their biochemical and biological activities

Necrosis of skeletal muscle is produced by two types of snake venom components: single chain peptides consisting of 42-44 amino acid residues and phospholipases A2 representing either single chain proteins or existing as complexes of several enzyme subunits or combined with other nonenzymatic proteins. Vacuolation, lysis and necrosis of skeletal muscle cells are the major pathological effects of these myotoxins. Although the exact mode of action of these toxins is not clear, interactions with the plasma membrane leading to permeability changes for ions and to their complete destruction is evident. The high specificities of some venom phospholipases A2 for skeletal muscle cells suggest a specific binding to certain membrane receptors; however, an enzymatic action on membranes may also be involved.

Myonecrosis induced in mice by a basic myotoxin isolated from the venom of the snake Bothrops nummifer (jumping viper) from Costa Rica

The mode of action of a basic myotoxin isolated from Bothrops nummifer venom was studied. This myotoxin is a basic polypeptide of 13,000 mol.wt, with a high content of lysine and aspartate, as well as of hydrophobic amino acids. It lacked phospholipase A2 activity when tested on several substrates at different pH values. Upon i.m. injection into mice, the toxin induced early morphological alterations typified by 'delta lesions' in the periphery of muscle fibers, an indication that the plasma membrane was the first cellular structure to be affected. Afterwards, necrotic cells had a clumped appearance, which then changed to a more hyaline histological pattern. Removal of necrotic material by phagocytes was followed by skeletal muscle regeneration, with the presence of myoblasts, myotubes and fully regenerated myofibers. The toxin induced a rapid and drastic drop in muscle creatine and creatine kinase contents of injected muscle, as well as an increase in serum levels of the enzymes lactic dehydrogenase and creatine kinase. Moreover, total muscle calcium increased significantly after toxin administration. Myotoxin induced a dose-dependent release of peroxidase entrapped in liposomes made from muscle phospholipids. The lack of phospholipase A2 activity in this toxin, together with the observation that it behaved as an amphiphilic protein in charge-shift electrophoresis, suggests that it might penetrate and disorganize muscle plasma membrane by means of a hydrophobic interaction.

Purification and characterization of a myotoxic phospholipase A2 from Indian cobra (Naja naja naja) venom

A major phospholipase A2 (NN-XIII-PLA2) which constitutes 20% of the whole Naja naja naja venom was purified to homogeneity on CM-Sephadex C-25 column chromatography. NN-XIII-PLA2 is a basic protein with a mol. wt of 11,200 by SDS-PAGE. This enzyme has low enzymatic activity but is more toxic to mice than the whole venom. The LD50 value (i.p.) of NN-XIII-PLA2 is 2.4 mg/kg body weight (whole venoms LD50 is 2.8 mg/kg body weight). It induces neurotoxic-like signs in experimental animals. It induces myotoxicity when injected i.m. into the thigh muscle of mice and edema when injected into the foot pads of mice. This enzyme has a fluorescence maxima between 310-316 nm which is typical of tyrosine residues.

Neuromuscular effects of three phospholipases A2 from the venom of the Australian king brown snake Pseudechis australis

Three single chain phospholipases A2 (Pa-10A, Pa-11 and Pa-13) isolated from Australian king brown snake (Pseudechis australis) venom were tested for effects on neuromuscular transmission and muscle contractility on chick biventer cervicis and mouse diaphragm preparations. At 1 microgram/ml (about 85 nM) and higher, Pa-10A and Pa-11 reduced responses of both preparations to indirect stimulation in a concentration-dependent manner. Responses to direct muscle stimulation were generally reduced more slowly. Pa-11 also decreased membrane potentials of chick biventer muscle fibres and caused damage visible by light microscopy. Pa-13, which is about 50 times less active as a phospholipase A2, was also less potent in its pharmacological effects: 20 micrograms Pa-13 per ml were required to reduce responses of either preparation. The phospholipases A2 also caused a slow contracture. After block of responses to nerve stimulation, responses of the chick preparation to acetylcholine, carbachol and KCl could be obtained, although they were smaller than control and highly variable in different preparations. It is concluded that Pa-10A and Pa-11 produce muscle paralysis by reducing acetylcholine release and by a direct blockade of muscle fibre contractility. Pa-13 has similar, though less pronounced, activities.

Isolation and characterization of a phospholipase B from venom of Collett's snake, Pseudechis colletti

Phospholipase B in the venom of the Australian elapid snake, Pseudechis colletti, was purified to near homogeneity. By means of gel filtration it had an Mr of about 35,000, and by SDS-polyacrylamide gel electrophoresis an Mr of about 16,500. These presumably are dimeric and monomeric forms of the enzyme. It was isoelectric at pH 6.2 as compared to 7.8 for phospholipase A2 from which it was readily separated. It was relatively thermostable. As determined by release of water-soluble phosphorous, it degraded phosphatidylcholine and phosphatidylethanolamine, but did not degrade other phospholipids tested. The purified enzyme was strongly hemolytic in vitro for rabbit and human erythrocytes, but not for bovine or ovine erythrocytes. Hemolysis of rabbit erythrocytes gave rise to membranes showing ultrastructural changes that may be unique for this enzyme. The protein was highly active in producing turbidity in dilute solutions of egg yolk. It was cytotoxic for cultured rhabdomyosarcoma cells and was lethal for mice in which death was preceded by massive myoglobinuria.

A study of the pathogenesis of local skin necrosis induced by Naja nigricollis (spitting cobra) venom using simple histological staining techniques

The course of degeneration and regeneration of mouse skin following intradermal injection of spitting cobra (N. nigricollis) venom was investigated using simple histological staining techniques. Early changes observed were vascular congestion, oedema and degeneration of the skeletal muscle cell layer (panniculus carnosus) in the area local to the injection site. Fuchsin staining of degenerative muscle cells in haematoxylin-basic fuchsin-picric acid (HBFP) stained sections appeared long before any detectable change was obvious in serial sections stained with haematoxylin and eosin (H and E). Positive reactions were apparent as early as 5 min after venom injection. Infiltration by a mixed population of cells was observed 1 hr after injection. Twenty four hours after injection large numbers of neutrophils, eosinophils, macrophages and mast cells were observed in and around the necrotic tissue and there was evidence of fibrin deposition in the blood vessels. A newly formed epithelium and muscle cell layer was visible after 18 days. The destroyed tissue tended to slough, leaving behind granular scar tissue. Dense granular scar tissue had generally replaced the damaged tissue after 28 days. It appears likely that myonecrosis was due to the direct myolytic action of one or more venom components, since signs of damage were apparent as early as 5 min after injection. However, the venom also caused fibrin deposition, suggesting possible thrombus formation later, and so it is also probable that some contribution to the degenerative state may be attributable to ischaemia brought about by a diminished blood supply.

Skeletal muscle necrosis induced by a phospholipase A2 isolated from the venom of the coral snake Micrurus nigrocinctus nigrocinctus

1. The venom of the coral snake Micrurus nigrocinctus nigrocinctus was fractionated by reverse-phase high performance liquid chromatography and an acidic myotoxic phospholipase A2 was purified to homogeneity. 2. After intramuscular injection, the toxin induced rapid and drastic myonecrosis, as serum creatine kinase levels increased markedly, reaching their highest values by 1.5 hr. 3. Ultrastructural observations indicate that the plasma membrane was the first structure to be affected, with the presence of focal disruptions in its integrity. 4. Myofilaments were hypercontracted and formed dense clumps. Sarcoplasmic reticulum integrity was lost, as evidenced by the presence of many small vesicles in the cellular space. 5. Some mitochondria were swollen, whereas others contained dense intracristal spaces and flocculent densities. Moreover, some had only one membrane. 6. In conclusion, pathogenesis of myonecrosis induced by this phospholipase A2 is similar to that induced by crude Micrurus nigrocinctus nigrocinctus venom.

Structure-function relationships of phospholipases. II: Charge density distribution and the myotoxicity of presynaptically neurotoxic phospholipases

The charge density distribution of 24 phospholipases A2 has been examined to identify the involvement of charged amino acid residues in the determination of the pharmacological properties of these proteins. There is no characteristic difference between the presynaptically neurotoxic and non-neurotoxic phospholipases, however, presynaptically neurotoxic phospholipases which are also myotoxic have a distinct charge distribution pattern. There is a characteristic cationic site around residues 79-87. This site has a relatively fixed position with respect to the hydrophobic 'neurotoxic' region, on the NH2 terminal side. This cationic region is located on the outer surface in the three-dimensional structure of phospholipase, just before hydrophobic helix E, and is available for interaction with membranes. Such a characteristic region is absent in non-myotoxic phospholipases which are either presynaptically active or inactive. On the other hand, myotoxins, a group of non-enzymatic proteins inducing myotoxicity, also possess such characteristic regions of cationic and hydrophobic sites.

Isolation and characterization of myotoxic phospholipases A2 from crotalid venoms

Phospholipases A2 producing myonecrosis when injected i.m. into mice were isolated from venoms of Trimeresurus flavoviridis, Agkistrodon bilineatus, A. c. contortrix, A. c. mokeson, A. p. piscivorus and Bothrops asper by gels filtration on Sephadex G-75 followed by ion-exchange chromatography on CM-cellulose. They are basic enzymes with molecular weights between 14,000 and 15,000 containing 120-129 amino acid residues and exhibit relatively low enzymatic activity when tested on egg yolk suspension. Local myonecrosis is induced even at doses of 1.25 micrograms per mouse.

Isolation of a myotoxin from Bothrops asper venom: partial characterization and action on skeletal muscle

A myotoxic phospholipase has been isolated from Bothrops asper venom by ion-exchange chromatography on CM-Sephadex followed by gel filtration on Sephadex G-75. The toxin is a basic polypeptide with an estimated molecular weight of 10,700. It has both phospholipase A and indirect hemolytic activities, but is devoid of proteolytic, direct hemolytic and hemorrhagic effects. When injected i.m. into mice the toxin induces a rapid increase in plasma creatine kinase levels and a series of degenerative events in skeletal muscle which lead to myonecrosis. The toxin induces an increase in intracellular calcium levels and is able to hydrolyze muscle phospholipids in vivo. Pretreatment with the calcium antagonist verapamil failed to prevent the myotoxic activity. It is proposed that B. asper myotoxin causes cell injury by disrupting the integrity of skeletal muscle plasma membrane and that myotoxicity is at least partially due to the phospholipase A activity of the toxin.

Local effects induced by coral snake venoms: evidence of myonecrosis after experimental inoculations of venoms from five species

The local effects induced by intramuscular inoculations of venoms from six species of coral snakes were studied in mice. Venoms of Micrurus nigrocinctus nigrocinctus, M. n. mosquitensis, M. alleni, M. frontalis, M. carinicauda and M. surinamensis induced prominent myonecrosis which was observed histologically. From a morphological point of view all these venoms induced a similar pattern of myonecrosis, characterized by a conspicuous alteration of the intracellular structure. This myotoxic activity was corroborated by an increase in plasma creatine kinase levels 3 hr after i.m. injection of M. n. nigrocinctus, M. n. mosquitensis, M. frontalis and M. carinicauda venoms. M. mipartitus venom did not induce myonecrosis. None of the venoms induced edema or hemorrhage at the site of injection.

Local necrotizing effect of snake venoms on skin and muscle: relationship to serum creatine kinase

Twenty-five snake venoms were tested for their ability to induce an increase of serum creatine kinase (CK) level after i.m. injection (0.125-1.0 mg/kg) into rates. Of six Australian elapid venoms only those from Pseudechis colletti guttatus and P. australis produced a steep rise of CK-activity (30-70 times the normal value) 4 and 16 hr after injection (0.5 mg/kg). Viperid and crotalid venoms had only slight effects (2-5 times the normal value) even in doses of 1.0 mg/kg except for a sample of Crotalus adamanteus venom which caused a 20 fold increase in CK-level. From this venom a toxin of 5800 mol. wt. consisting of 50 amino acid residues was isolated. This toxin exhibited similarities in amino acid composition and in lethality to crotamine from Crotalus durissus terrificus and to a toxin from C. horridus horridus. The toxin from C. adamanteus induced some increase of CK-level in rats, but this does not account entirely for the activity of the crude venom, whereas crotamine and the toxin from C. horridus horridus were ineffective. Phospholipase A2 (fraction II) from Pseudechis colletti guttatus venom caused a dose-dependent increase of CK-level and myoglobinuria. Intradermal injection of snake venoms into mice is useful for testing hemorrhagic activity, but is too insensitive to measure necrotizing effects. Venom induced myonecrosis can be evaluated by assaying the CK-serum level and by histological examination.

Studies on hemoglobinuria produced by venom from the Australian snake Tropidechis carinatus (rough-scaled snake)

Hemoglobinuria occurs in rats, but not in mice, after i.p. application of Tropidechis carinatus venom. By gel filtration on Sephadex G-75 and G-50 and chromatography on SP-Sephadex C-25 and DEAE-cellulose, a coagulant factor and a phospholipase A were isolated from the venom which in combination only, produced hemoglobinuria.

A study of the major Australian snake venoms in the monkey (Macaca fascicularis). II. Myolytic and haematological effects of venoms

Rhesus monkeys were kept in a restraining apparatus and while conscious injected with the venoms of a range of Australian snakes. Although the action of restraining itself caused an elevation of the animals' plasma creatine kinase (C.K.), the rise was up to 5 times greater in envenomed monkeys. The venoms of the Tiger snake, Mulga, Beaked Sea snake, Rough-Scaled, Copperhead and Red-Bellied snakes were all powerfully myolytic, and those of the Taipan and Small-Eyed snake less so. No myolytic activity was found in the venoms of the Common Brown snake and Death Adder, and the results with Dugite, Gwardar and Small-Scaled snake venom were equivocal. Significant coagulation disturbances were produced by all venoms studied except those of the Small-Eyed and Rough-Scaled snakes. When first aid measures were used, the coagulation disturbances which developed after the release of the injected venom were significantly less than when no first aid was used. This finding, which was observed with all snake venoms studied, suggests that the procoagulant factor may be subject to some inactivation whilst immobilized at the injection site.