Toxicity of scorpion (Buthus tamulus) venom in mammals is influenced by the age and species

Ethnomedicines for the treatment of scorpion stings: A perspective study

ETHNOPHARMACOLOGICAL RELEVANCE

Scorpion sting is a public health concern with limited clinical symptomatic treatment. The clinical treatment uses anti-scorpion antivenom and prazosin (α-adrenergic inhibitor), often in combination with insulin, to reduce scorpion venom-induced hyperglycemia and other complications. However, these therapies also possess some limitations, necessitating urgent exploration of ethnomedicines, mainly traditional medicinal plants, to treat scorpion stings. Unfortunately, several conventional treatments are not scientifically validated, thus raising questions about their quality and utility. Therefore, pharmacological re-assessment of such medicinal plants to alleviate scorpion stings' complications is essential.

AIM OF THE STUDY

The principal objectives of this study are to provide a brief overview of medically important scorpions of the world, outline the extant traditional practices, and comprehensively review plants used in conventional ethnic medicines to treat scorpion stings over time. Modern technological advances in identifying and characterizing plant bioactive molecules are also mentioned in this review.

MATERIALS AND METHODS

The traditionally used medicinal plants against scorpion stings were reviewed from the available literature in the database. The Plant List (http://www.theplantlist.org/) was used to validate the scientific names of the plants mentioned in this study. The search targeted literature on conventional treatments and crude plant extracts or their bioactive components with proven neutralization capacity against scorpion stings. Search words used were 'scorpion sting,' 'treatment for a scorpion sting,' 'antivenom and scorpion sting,' 'traditional treatment for scorpion stings, and 'natural compounds against scorpion stings'.

RESULTS

A list of more than 200 medicinal plants traditionally used in several countries for treating scorpion stings is presented in this review. Though some myth-based remedies are practiced to treat scorpion stings, no empirical evidence exists to validate this aspect of traditional knowledge. Only 38 traditional medicinal plant extracts have been tested under in-vivo and in-vitro conditions to determine their neutralization potency of scorpion envenomation. Although a few bioactive plant constituents showing scorpion venom neutralization potency have been characterized, they are not yet commercially available for clinical application.

CONCLUSIONS

There is tremendous potential locked in medicinal plants' traditional knowledge for scorpion envenomation treatment. Translating this knowledge into the clinical application will require pharmacological reassessment, in tandem with isolation and characterization of active compounds to prove their prophylactic prowess. Almost equally important would be the formulation of stringent strategies to conserve such medicinal plants from overexploitation.

Biochemical and Proteomic Characterization, and Pharmacological Insights of Indian Red Scorpion Venom Toxins

The Indian red scorpion (Mesobuthus tamulus) is one of the world's deadliest scorpions, with stings representing a life-threatening medical emergency. This species is distributed throughout the Indian sub-continent, including eastern Pakistan, eastern Nepal, and Sri Lanka. In India, Indian red scorpions are broadly distributed in western Maharashtra, Saurashtra, Kerala, Andhra Pradesh, Tamil Nadu, and Karnataka; however, fatal envenomations have been recorded primarily in the Konkan region of Maharashtra. The Indian red scorpion venom proteome comprises 110 proteins belonging to 13 venom protein families. The significant pharmacological activity is predominantly caused by the low molecular mass non-enzymatic Na+ and K+ ion channel toxins. Other minor toxins comprise 15.6% of the total venom proteome. Indian red scorpion stings induce the release of catecholamine, which leads to pathophysiological abnormalities in the victim. A strong correlation has been observed between venom proteome composition and local (swelling, redness, heat, and regional lymph node involvement) and systemic (tachycardia, mydriasis, hyperglycemia, hypertension, toxic myocarditis, cardiac failure, and pulmonary edema) manifestations. Immediate administration of antivenom is the preferred treatment for Indian red scorpion stings. However, scorpion-specific antivenoms have exhibited poor immunorecognition and neutralization of the low molecular mass toxins. The proteomic analysis also suggests that Indian red scorpion venom is a rich source of pharmacologically active molecules that may be envisaged as drug prototypes. The following review summarizes the progress made towards understanding the venom proteome of the Indian red scorpion and addresses the current understanding of the pathophysiology associated with its sting.

Correlation of Venom Toxinome Composition of Indian Red Scorpion (Mesobuthus tamulus) with Clinical Manifestations of Scorpion Stings: Failure of Commercial Antivenom to Immune-Recognize the Abundance of Low Molecular Mass Toxins of This Venom

The Indian red scorpion (Mesobuthus tamulus), with its life-threatening sting, is the world's most dangerous species of scorpion. The toxinome composition of M. tamulus venom was determined by tandem mass spectrometry (MS) analysis of venom protein bands separated by SDS-PAGE. A total of 110 venom toxins were identified from searching the MS data against the Buthidae family (taxid: 6855) of toxin entries in nonredundant protein databases. The Na⁺ and K⁺ ion channel toxins taken together are the most abundant toxins (76.7%) giving rise to the neurotoxic nature of this venom. The other minor toxin classes in the M. tamulus venom proteome are serine protease-like protein (2.9%), serine protease inhibitor (2.2%), antimicrobial peptide (2.3%), hyaluronidase (2.2%), makatoxin (2.1%), lipolysis potentiating peptides (1.2%), neurotoxin affecting Cl^- channel (1%), parabutoporin (0.6%), Ca²⁺ channel toxins (0.8%), bradykinin potentiating peptides (0.2%), HMG CoA reductase inhibitor (0.1%), and other toxins with unknown pharmacological activity (7.7%). Several of these toxins have been shown to be promising drug candidates. M. tamulus venom does not show enzymatic activity (phospholipase A₂, l-amino acid oxidase, adenosine tri-, di-, and monophosphatase, hyaluronidase, metalloproteinase, and fibrinogenolytic), in vitro hemolytic activity, interference with blood coagulation, or platelet modulation properties. The clinical manifestations post M. tamulus sting have been described in the literature and are well correlated with its venom proteome composition. An abundance of low molecular mass toxins (3-15 kDa) are responsible for exerting the major pharmacological effects of M. tamulus venom, though they are poorly immune-recognized by commercial scorpion antivenom. This is a major concern for the development of effective antivenom therapy against scorpion stings.

Different types of toxins targeting TRPV1 in pain

The transient receptor potential vanilloid 1(TRPV1) channels are members of the transient receptor potential (TRP) superfamily. Members of this family are expressed in primary sensory neurons and are best known for their role in nociception and sensory transmission. Multiple painful stimuli can activate these channels. In this review, we discussed the mechanisms of different types of venoms that target TRPV1, such as scorpion venom, botulinum neurotoxin, spider toxin, ciguatera fish poisoning (CFP) and neurotoxic shellfish poisoning (NSP). Some of these toxins activate TRPV1; however, some do not. Regardless of TRPV1 inhibition or activation, they occur through different pathways. For example, BoNT/A decreases TRPV1 expression levels by blocking TRPV1 trafficking to the plasma membrane, although the exact mechanism is still under debate. Vanillotoxins from tarantula (Psalmopoeus cambridgei) are proposed to activate TRPV1 via interaction with a region of TRPV1 that is homologous to voltage-dependent ion channels. Here, we offer a description of the present state of knowledge for this complex subject.

Role of serotonergic mechanism in gastric contractions induced by Indian Red Scorpion (Mesobuthus tamulus) venom

Aim:

Gastric dysfunctions are commonly seen after scorpion envenomation, and the underlying mechanisms are not clear. Therefore, the present study was undertaken to investigate the effect of Indian red scorpion (Mesobuthus tamulus, MBT) venom on gastric fundus muscle contraction and the underlying mechanisms involved.

Materials and Methods:

In vitro isometric contraction was recorded from gastric fundus muscle strips on a chart recorder. The tissue was exposed to different concentrations of serotonin or crude MBT venom. The contractile responses to venom were expressed as the percentage of maximum contraction produced by serotonin at the beginning of each experiment. The contractile responses to 1.0 μg/ml of crude MBT venom were ascertained in the absence or presence of serotonin antagonist, methysergide.

Results:

Serotonin produced concentration-dependent fundus contractions (0.004–4.0 μM), and maximum contractile response was observed at 4.0 μM of serotonin. Hence, the contractile response obtained at 4.0 μM of serotonin was taken for normalization. The crude MBT venom (0.1–1.0 μg/ml) produced a concentration-dependent increase in fundus contractions (as % of maximum fundus contraction produced by serotonin at 4.0 μM). The maximum response was observed at 1.0 μg/ml of crude venom and a further increase in the concentration, up to 3.0 μg/ml, did not increase the response. In a separate series of experiments, pre-treatment with methysergide (1.0 μM) significantly attenuated the contractile response elicited by the venom (1.0 μg/ml) (P<0.05) and blocked the serotonin (4.0 μM) response.

Conclusion:

The results suggest that the crude MBT venom produces gastric fundus contractions by partially involving serotonin.

Indian red scorpion venom depresses spinal synaptic transmission without involving NMDA receptors

Stings of Indian red scorpion (Mesobuthus tamulus, MBT) produce neurological abnormalities such as convulsions and paralysis. These parameters indicate the activity at alpha-motoneuron. The present study was therefore, undertaken to evaluate the effect of MBT-venom on spinal reflexes and the involvement of N-methyl-d-aspartate (NMDA) receptors. The experiments were performed on isolated hemisected spinal cords from 4 to 6 days old rats. Stimulation of a dorsal root with supramaximal strength at 0.1Hz evoked monosynaptic (MSR) and polysynaptic reflex (PSR) potentials in the corresponding segmental ventral root. Superfusion of MBT-venom depressed the spinal reflexes in a time- and a concentration-dependent (0.1-1microg/ml) manner. MBT-venom at 0.1, 0.3 and 1.0microg/ml produced maximal depression of 55, 75 and 90% at 30, 10 and 7min, respectively. The time required to produce 50% depression (T-50) of MSR was 19.0, 8.0, and 3.6min and for PSR was 15.0, 5.6, and 2.9min at 0.1, 0.3 and 1microg/ml of venom, respectively. Pre-treatment with DL-alpha-2-amino-5-phosphonovaleric acid (APV) decreased MSR by 26% and abolished PSR. In the presence of APV, the MBT-venom-induced depression of MSR was not different from the venom only group. The results indicate that venom-induced depression of spinal reflexes did not involve NMDA receptors.

Intra-arterial injection of Mesobuthus tamulus venom elicits cardiorespiratory reflexes involving perivascular afferents

Role of perivascular afferents for the cardiorespiratory alterations produced by Mesobuthus tamulus (BT) envenomation was examined in urethane-anaesthetized male rats. Blood pressure (BP), respiratory rate (RR) and heart rate (HR) were recorded after injecting BT venom/saline in the distal end of femoral artery for 60 min. In addition, paw oedema was also determined. Injection of venom produced an immediate (within 2 s) increase in RR followed by a decrease and finally a sustained increase up to 60 min. BP was increased (within 10 s) by 30-50%, which gradually declined but remained above the initial level up to 60 min. The bradycardiac response was late to occur (after 50 s) and the peak response was seen between 10 and 50 min, which remained at that level. There was oedema in the ipsilateral hind paw (venom injected side) as compared to contralateral side and saline control group. The oedema and cardiorespiratory changes were maximal at 1.0 mg/kg of venom. Pretreatment with indomethacin significantly attenuated the venom-induced responses and also blocked the paw oedema. Present experiments reveal that BT venom in a segment of an artery produces oedema by involving prostaglandins to sensitize the nociceptors present in perivascular tissues to evoke the cardiorespiratory reflexes.

Mortality and antibody responses of mice to three successive episodes of experimental scorpion (Centruroides limpidus limpidus) envenomation and immunological rescue

Mortality rates of mice and their levels of anti-venom and anti-F(ab')2 antibodies were assessed after three episodes of subcutaneous envenomations with or without treatment with horse F(ab')2. Soluble venom from the Mexican scorpion Centruroides limpidus limpidus was used for these experiments. Repetition of episodes did not induce different mortality rates in untreated mice. F(ab')2 rescued about 85% of the mice in the first two episodes and 66% in the third, without distinction of gender or ostensible side-effects: a suggestion of selection of the most resistant mice. Surviving mice produced in vitro neutralizing antibodies to the scorpion venom and also antibodies to F(ab')2, when injected alone but more so if combined: a possible immunological adjuvant or alarm effect of the venom or of the cascading physiopathology of envenomation. In the few surviving mice, both anti-venom and anti-F(ab')2 antibodies increased significantly after the first envenomation but not thereafter, showing no correlation with mortality rates: a suggestion of their clinical irrelevance, the few hard-to kill mice appeared to resist envenomation by mechanisms other than antibody response. Injection of F(ab')2 alone induced production of detectable anti-venom antibodies in a few mice and injection of venom alone induced that of anti-F(ab')2 antibodies, perhaps due to trace amounts of venom in the high affinity fraction of F(ab')2 and to anti-idiotypic antibodies or polyclonal activity in the envenomation episode, respectively.

Experimental envenoming of mice with venom from the scorpion Centruroides limpidus limpidus: differences in mortality and symptoms with and without antibody therapy relating to differences in age, sex and strain of mouse

C57Bl/6J and BALB/cAnN inbred strains of mice differed significantly in mortality and symptoms when intoxicated subcutaneously with one LD(50) of venom from Centruroides limpidus limpidus. Higher mortality was observed in C57Bl/6J than in BALB/cAnN. Also, C57Bl/6J mice more quickly developed muscular and respiratory collapse whilst BALB/cAnN mice were hyperactive before dying. Also, the symptoms in the survivors lasted for 24 h in C57Bl/6J and for 2 h in BALB/cAnN. The age and sex of mice were also related to mortality: younger mice were more resistant than older mice and females were more susceptible than males, especially in the younger groups. Antivenom (horse F(ab')(2)) administration 5-10 min after envenoming of mice with one LD(50) rescued 60% of BALB/cAnN and 52% of C57Bl/6J mice, respectively. Results indicate that genetic background, gender and age differences are of consequence in the pathogenesis of C. limpidus scorpion envenomation in mice, and that timely treatment with active antivenom F(ab')(2) saves a significant fraction of intoxicated mice without statistically significant distinction of strains.

Indian red scorpion (Buthus tamulus) venom-induced augmentation of cardiac reflexes is mediated through the involvement of peripheral 5-HT3 and central 5-HT1A receptor subtypes

The present study was undertaken to identify 5-HT receptor subtypes involved in Buthus tamulus (BT) venom-induced augmentation of cardiac reflexes elicited by phenyldiguanide (PDG). Intravenous injection of PDG (10 microg/kg) produced parallel decrease in mean arterial pressure (MAP) and heart rate (HR) in urethane anaesthetized rats (r=0.82; p < 0.001). Injection of PDG (1-40 microg/kg, i.v.) produced concentration-dependent decrease in time-response area of the HR. After BT venom (20 microg/kg) the concentration-response curve was shifted to the left. Further, fall of MAP and HR in response to submaximal concentration of PDG (10 microg/kg) were augmented significantly. Pretreatment with 5-HT3 receptor antagonist (ondansetron; 10 microg/kg) intravenously, blocked the BT venom-induced augmentation of PDG reflex but spiperone (100 microg/kg; 5-HT1A/5-HT2 antagonist) or ketanserin (300 microg/kg; 5-HT2 antagonist) failed to do so. Afferent discharges elicited by PDG (10 microg/kg) in vagus nerve were doubled after exposure to BT venom. Ondansetron (100 microg/kg, i.v.) totally abolished the discharges after exposure to BT venom but not by spiperone or ketanserin. Intracerebroventricular injection of spiperone (100 microg/kg) but not ketanserin or ondansetron, blocked the BT venom-induced augmentation of PDG reflex. Results show that the BT venom-induced augmentation of reflex elicited by PDG is mediated through the involvement of 5-HT3 receptors peripherally and 5-HT1A type of receptors centrally.

Indian red scorpion (Buthus tamulus) venom-induced augmentation of cardiac reflexes is mediated through the mechanisms involving kinins in urethane anaesthetized rats

The mechanism underlying the action of Indian red scorpion (Buthus tamulus; BT) venom on cardiac reflexes was examined in urethane anaesthetized adult albino rats of either sex. Intravenous injection of phenyldiguanide (PDG) produced reflex hypotension, bradycardia and apnea lasting for > 60 s. The PDG-induced reflex responses (blood pressure, heart rate and respiration) were augmented greatly (magnitude and time period) after exposure to BT venom (100 microg/kg, i.v., for 30 min). However, there were no great alterations in resting blood pressure, heart rate and respiratory rate. Pretreatment with kallikrein kinin inhibitor (aprotinin; 6000 kallikrein inactivating unit, i.v.) blocked the BT venom-induced augmentation of PDG reflex response. Further, pretreatment with indomethacin (prostaglandin synthetase inhibitor; 10 mg/kg) and heparin (1000 units/kg) also blocked the venom-induced potentiation of the reflex. Captopril (15 mg/kg), an agent known to increase endogenous kinins, also augmented the PDG induced-reflex to the same extent as in BT envenomed rats. The captopril-induced augmentation of the reflex was blocked by aprotinin and heparin, but not by indomethacin. The results indicate that kinins and prostaglandins are involved in the BT venom-induced augmentation of the cardiac reflexes.

Anxiogenic activity of centrally administered scorpion (Mesobuthus tamulus) venom in rats

The anxiogenic action of intracerebroventricularly (i.c.v.) administered Mesobuthus tamulus venom (MTV) was investigated in rats. MTV (1, 3 and 5 g/rat, i.c.v.) induced a dose-related anxiogenic response which was qualitatively comparable to that produced by yohimbine (2 mg/kp, i.p.), an established anxiogenic agent. Both MTV and yohimbine reduced exploratory activity and rears, while increasing immobility and defaecation, in the open-field test. Likewise, both the drugs decreased the number of entries and time spent on the open arms of the elevated plus-maze, reduced social interaction and increased feed-latency in a novel environment. Rat brain levels of tribulin, a postulated endocoid indicator of anxiety, assessed in terms of endogenous monoamine oxidase (MAO) A and B inhibitor activity, were increased by both MTV and yohimbine. The results indicate that the venom has significant anxiogenic activity, which is consonant with some of the clinical symptoms seen after scorpion sting.