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Werner RM, Soffa AN. Considerations for the development of a field-based medical device for the administration of adjunctive therapies for snakebite envenoming. Toxicon X 2023; 20:100169. [PMID: 37661997 PMCID: PMC10474190 DOI: 10.1016/j.toxcx.2023.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/27/2023] [Accepted: 08/12/2023] [Indexed: 09/05/2023] Open
Abstract
The timely administration of antivenom is the most effective method currently available to reduce the burden of snakebite envenoming (SBE), a neglected tropical disease that most often affects rural agricultural global populations. There is increasing interest in the development of adjunctive small molecule and biologic therapeutics that target the most problematic venom components to bridge the time-gap between initial SBE and the administration antivenom. Unique combinations of these therapeutics could provide relief from the toxic effects of regional groupings of medically relevant snake species. The application a PRISMA/PICO literature search methodology demonstrated an increasing interest in the rapid administration of therapies to improve patient symptoms and outcomes after SBE. Advice from expert interviews and considerations regarding the potential routes of therapy administration, anatomical bite location, and species-specific venom delivery have provided a framework to identify ideal metrics and potential hurdles for the development of a field-based medical device that could be used immediately after SBE to deliver adjunctive therapies. The use of subcutaneous (SC) or intramuscular (IM) injection were identified as potential routes of administration of both small molecule and biologic therapies. The development of a field-based medical device for the delivery of adjunctive SBE therapies presents unique challenges that will require a collaborative and transdisciplinary approach to be successful.
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Calvopiña M, Guamán-Charco E, Ramírez K, Dávalos F, Chiliquinga P, Villa-Soxo S, Oña-Vistin R, Romero-Álvarez D. Epidemiology and clinical features of venomous snake bites in the Northern Amazon of Ecuador (2017-2021). BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:93-106. [PMID: 37167468 PMCID: PMC10484069 DOI: 10.7705/biomedica.6587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 03/04/2023] [Indexed: 05/13/2023]
Abstract
Introduction: In Ecuador, poisonous snakebites are a public health problem. However, there is no recent hospital information from the Amazon. Objective: To retrospectively analyse the clinical-epidemiological characteristics of snakebites in patients admitted to a hospital in the Ecuadorian Amazon. Materials and methods: This is a cross-sectional study conducted at the Nueva Loja-Sucumbíos Provincial Hospital, bordering Colombia (2017-2021). Demographic, epidemiological and clinical variables, and condition at hospital discharge, were obtained from the epidemiological file of the Ministerio de Salud Pública. Results: In 5 years, 147 patients (29.4 per year) were hospitalized with no mortality. They corresponded to 26, 34, 32, 29 and 26 cases, in 2017, 2018, 2019, 2020 and 2021, respectively. Men with 99 (67.3%), aged 21-30 years with 28, mixed race with 94 cases, students, and farmers, were the most affected. The most affected (99; 67.3%) were men, people 21 to 30 years-old (28; 19.0%), mestizos (94; 63.9%), students, and farmers. The median age was 28 (range: 4-81) years. Prevalence was higher in April, June, and September. All accidents were caused by Viperidae snakes. Twenty (13.6%) cases were mild, (61.2%) were moderate and 37 (25.2%) were severe. The feet with 45 were the most bitten. Pre-hospitalization anti-venom serum was received by 53.1% and tourniquet by 19.8% patients. Median hospital arrival time was 5 (range 1-192) hours, mostly between 2-3 hours with 41 cases. No statistically significant differences were found considering the severity. Conclusions: A high prevalence of snakebites was evidenced in the north of the Amazon in Ecuador, with a higher incidence in the rainy season and all by Viperidae species. It is important to highlight the null mortality. Information campaigns on prevention and first aid, such as discouraging the use of tourniquets, especially among vulnerable groups.
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Affiliation(s)
- Manuel Calvopiña
- One Health Research Group, Facultad de Medicina, Universidad de las Américas, Quito, Ecuador.
| | - Elías Guamán-Charco
- One Health Research Group, Facultad de Medicina, Universidad de las Américas, Quito, Ecuador; Centro de Salud Tipo A "Santa Cecilia", Ministerio de Salud Pública, Nueva Loja, Sucumbíos, Ecuador.
| | - Karen Ramírez
- One Health Research Group, Facultad de Medicina, Universidad de las Américas, Quito, Ecuador.
| | - Felipe Dávalos
- One Health Research Group, Facultad de Medicina, Universidad de las Américas, Quito, Ecuador.
| | - Paola Chiliquinga
- One Health Research Group, Facultad de Medicina, Universidad de las Américas, Quito, Ecuador.
| | - Sergio Villa-Soxo
- Hospital General "Marco Vinicio Iza", Ministerio de Salud Pública, Nueva Loja, Sucumbíos, Ecuador.
| | - René Oña-Vistin
- Hospital General "Marco Vinicio Iza", Ministerio de Salud Pública, Nueva Loja, Sucumbíos, Ecuador.
| | - Daniel Romero-Álvarez
- One Health Research Group, Facultad de Medicina, Universidad de las Américas, Quito, Ecuador; Biodiversity Institute and Department of Ecology & Evolutionary Biology, University of Kansas, Lawrence, KS, USA.
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Patiño RSP, Salazar-Valenzuela D, Robles-Loaiza AA, Santacruz-Ortega P, Almeida JR. A retrospective study of clinical and epidemiological characteristics of snakebite in Napo Province, Ecuadorian Amazon. Trans R Soc Trop Med Hyg 2023; 117:118-127. [PMID: 35917814 DOI: 10.1093/trstmh/trac071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/31/2022] [Accepted: 07/07/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Snakebite envenoming remains a relevant public health problem in tropical and subtropical countries. In Ecuador, this is particularly true in an area of great diversity like the Amazon region. Nevertheless, there is scarce information about epidemiological and clinical characteristics of these accidents in this area. METHODS This was a descriptive and retrospective study of snakebite cases treated at a tertiary hospital in the Napo Province, Ecuadorian Amazon, from 2015 to 2019. We collected sociodemographic and snakebite-related information, clinical aspects and the use of antivenom and antibiotics from medical records. RESULTS Information from 133 snakebite accidents was reviewed in this time period. Reports of snakebite envenoming decreased over the years. In total, 67% of those bitten were from nearby indigenous communities, which were the most affected groups. When a species was identified, Bothrops atrox was responsible for the highest number of cases registered. Local clinical manifestations were more frequent than systemic signs, in keeping with the typical effects produced by bothropic venoms. Additionally, data showed that more antivenom vials were given than those suggested by the protocol of the Ecuadorian Ministry of Health, in proportion to the grade of severity. Finally, we identified a low incidence of adverse reactions with antivenom administration, as well as a frequent use of antibiotics. CONCLUSIONS The profile of snakebite accidents in the Napo Province is very similar to that described for other localities in the Amazon region of Ecuador and neighboring countries, with its challenges and limitations. Such aspects underlie the importance of establishing a robust and science-based public health program to respond to this frequent, but neglected, tropical disease.
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Affiliation(s)
- Ricardo S P Patiño
- Universidad Regional Amazónica Ikiam, Km 7 Via Muyuna, Tena, Napo 150150, Ecuador.,Escuela Superior Politécnica del Litoral (ESPOL), Centro Nacional de Acuicultura e Investigaciones Marinas (CENAIM), Guayaquil 090211, Ecuador
| | - David Salazar-Valenzuela
- Centro de Investigación de la Biodiversidad y Cambio Climático (BioCamb) e Ingeniería en Biodiversidad y Recursos Genéticos, Facultad de Ciencias de Medio Ambiente, Universidad Tecnológica Indoamérica, Quito 170103, Ecuador
| | | | - Paola Santacruz-Ortega
- Escola de Educação Permanente, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403010, Brasil
| | - José R Almeida
- Universidad Regional Amazónica Ikiam, Km 7 Via Muyuna, Tena, Napo 150150, Ecuador
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Romo E, Torres M, Martin-Solano S. Current situation of snakebites envenomation in the Neotropics: Biotechnology, a versatile tool in the production of antivenoms. BIONATURA 2022. [DOI: 10.21931/rb/2022.07.04.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Snakebite envenomation is a neglected tropical disease that affects millions of people around the world with a great impact on health and the economy. Unfortunately, public health programs do not include this kind of disease as a priority in their social programs. Cases of snakebite envenomations in the Neotropics are inaccurate due to inadequate disease management from medical records to the choice of treatments. Victims of snakebite envenomation are primarily found in impoverished agricultural areas where remote conditions limit the availability of antivenom. Antivenom serum is the only Food and Drug Administration-approved treatment used up to date. However, it has several disadvantages in terms of safety and effectiveness. This review provides a comprehensive insight dealing with the current epidemiological status of snakebites in the Neotropics and technologies employed in antivenom production. Also, modern biotechnological tools such as transcriptomic, proteomic, immunogenic, high-density peptide microarray and epitope mapping are highlighted for producing new-generation antivenom sera. These results allow us to propose strategic solutions in the Public Health Sector for managing this disease.
Keywords: antivenom, biotechnology, neglected tropical disease, omics, recombinant antibody.
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Affiliation(s)
- Elizabeth Romo
- Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Sangolquí, Ecuador
| | - Marbel Torres
- Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Sangolquí, Ecuador, Grupo de Investigación en Sanidad Animal y Humana (GISAH), Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Immunology and Virology Laboratory, Nanoscience and Nanotechnology Center, Universidad de las Fuerzas Armadas, ESPE, Sangolquí, Ecuador
| | - Sarah Martin-Solano
- Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Sangolquí, Ecuador, Grupo de Investigación en Sanidad Animal y Humana (GISAH), Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Grupo de Investigación en Biodiversidad, Zoonosis y Salud Pública, Universidad Central del Ecuador
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Gutierres PG, Pereira DR, Vieira NL, Arantes LF, Silva NJ, Torres-Bonilla KA, Hyslop S, Morais-Zani K, Nogueira RMB, Rowan EG, Floriano RS. Action of Varespladib (LY-315920), a Phospholipase A 2 Inhibitor, on the Enzymatic, Coagulant and Haemorrhagic Activities of Lachesis muta rhombeata (South-American Bushmaster) Venom. Front Pharmacol 2022; 12:812295. [PMID: 35095526 PMCID: PMC8790531 DOI: 10.3389/fphar.2021.812295] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/09/2021] [Indexed: 01/08/2023] Open
Abstract
Varespladib (VPL) was primarily developed to treat inflammatory disturbances associated with high levels of serum phospholipase A2 (PLA2). VPL has also demonstrated to be a potential antivenom support agent to prevent PLA2-dependent effects produced by snake venoms. In this study, we examined the action of VPL on the coagulant, haemorrhagic and enzymatic activities of Lachesis muta rhombeata (South-American bushmaster) venom. Conventional colorimetric enzymatic assays were performed for PLA2, caseinolytic and esterasic activities; in vitro coagulant activities for prothrombin time (PT) and activated partial thromboplastin time (aPTT) were performed in rat citrated plasma through a quick timer coagulometer, whereas the dimensions of haemorrhagic haloes obtained after i.d. injections of venom in Wistar rats were determined using ImageJ software. Venom (1 mg/ml) exhibited accentuated enzymatic activities for proteases and PLA2in vitro, with VPL abolishing the PLA2 activity from 0.01 mM; VPL did not affect caseinolytic and esterasic activities at any tested concentrations (0.001–1 mM). In rat citrated plasma in vitro, VPL (1 mM) alone efficiently prevented the venom (1 mg/ml)-induced procoagulant disorder associated to extrinsic (PT) pathway, whereas its association with a commercial antivenom successfully prevented changes in both intrinsic (aPTT) and extrinsic (PT) pathways; commercial antivenom by itself failed to avoid the procoagulant disorders by this venom. Venom (0.5 mg/kg)-induced hemorrhagic activity was slightly reduced by VPL (1 mM) alone or combined with antivenom (antivenom:venom ratio 1:3 ‘v/w’) in rats, with antivenom alone producing no protective action on this parameter. In conclusion, VPL does not inhibit other major enzymatic groups of L. m. rhombeata venom, with its high PLA2 antagonize activity efficaciously preventing the venom-induced coagulation disturbances.
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Affiliation(s)
- Pamella G Gutierres
- Laboratory of Toxinology and Cardiovascular Research, University of Western São Paulo, Presidente Prudente, Brazil
| | - Diego R Pereira
- Laboratory of Toxinology and Cardiovascular Research, University of Western São Paulo, Presidente Prudente, Brazil
| | - Nataly L Vieira
- Laboratory of Toxinology and Cardiovascular Research, University of Western São Paulo, Presidente Prudente, Brazil
| | - Lilian F Arantes
- Graduate Program in Zootechnics, Rural Federal University of Pernambuco, Recife, Brazil
| | - Nelson J Silva
- Graduate Program in Environmental Sciences and Health, School of Medical, Pharmaceutical and Biomedical Sciences, Pontifical Catholic University of Goiás, Goiânia, Brazil
| | - Kristian A Torres-Bonilla
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Stephen Hyslop
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
| | | | - Rosa M B Nogueira
- Laboratory of Toxinology and Cardiovascular Research, University of Western São Paulo, Presidente Prudente, Brazil
| | - Edward G Rowan
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Rafael S Floriano
- Laboratory of Toxinology and Cardiovascular Research, University of Western São Paulo, Presidente Prudente, Brazil
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Affiliation(s)
- Ravikar Ralph
- Department of Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | - Sanjib Kumar Sharma
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, 76500, Nepal
| | - Isabela Ribeiro
- Dynamic Portfolio, Drugs for Neglected Diseases initiative (DNDi), 15 Chemin Louis-Dunant, 1202, Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, Geneva, CH 1211, Switzerland
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Ortiz-Prado E, Yeager J, Andrade F, Schiavi-Guzman C, Abedrabbo-Figueroa P, Terán E, Gómez-Barreno L, Simbaña-Rivera K, Izquierdo-Condoy JS. Snake antivenom production in Ecuador: Poor implementation, and an unplanned cessation leads to a call for a renaissance. Toxicon 2021; 202:90-97. [PMID: 34571098 DOI: 10.1016/j.toxicon.2021.09.014] [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] [Received: 06/17/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 11/28/2022]
Abstract
Snakebite envenomation is a global health problem. This health problem asymmetrically affects rural populations in developing countries to such an extent that it recently has been listed as a priority neglected tropical disease (NTD). It is estimated that 5.4 million individuals are bitten by snakes each year, causing at least 2.7 million envenomations and more than 100,000 deaths each year. Ecuador has one of the highest snakebite envenomation incidence rates in Latin America, mostly in the coastal and Amazonian provinces. Envenomations in these regions are the result of bites primarily by species of snakes belonging to the Viperidae family. Ecuador was able to locally produce antivenoms, however serious flaws were revealed in the antivenom production process, leading to the decommissioning of the existing facility. In the interest of public health, we have summarized the political and social setbacks experienced by the antivenom serum production plant in Ecuador, while encouraging resuming local production of snake antivenom to improve the responsiveness of the already overburdened health system.
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Affiliation(s)
- Esteban Ortiz-Prado
- OneHealth Global Research Group, Universidad de las Américas, Quito, Ecuador.
| | - Justin Yeager
- Biodiversity, Environment, and Health (BIOMAS), Universidad de las Americas, Quito, Ecuador
| | - Felipe Andrade
- OneHealth Global Research Group, Universidad de las Américas, Quito, Ecuador
| | | | | | - Enrique Terán
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Lenin Gómez-Barreno
- OneHealth Global Research Group, Universidad de las Américas, Quito, Ecuador
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Leão-Torres AG, Pires CV, Ribelato AC, Zerbinatti MC, Santarém CL, Nogueira RMB, Giometti IC, Giuffrida R, Silva EO, Gerez JR, Silva NJ, Rowan EG, Floriano RS. Protective action of N-acetyl-L-cysteine associated with a polyvalent antivenom on the envenomation induced by Lachesis muta muta (South American bushmaster) in rats. Toxicon 2021; 198:36-47. [PMID: 33915137 DOI: 10.1016/j.toxicon.2021.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/14/2021] [Accepted: 04/20/2021] [Indexed: 02/05/2023]
Abstract
In this study, we examined the potential use of N-acetyl-L-cysteine (NAC) in association with a polyvalent antivenom and as stand-alone therapy to reduce the acute local and systemic effects induced by Lachesis muta muta venom in rats. Male Wistar rats (300-350 g) were exposed to L. m. muta venom (1.5 mg/kg - i.m.) and subsequently treated with anti-Bothrops/Lachesis serum (antivenom:venom ratio 1:3 'v/w' - i.p.) and NAC (150 mg/kg - i.p.) separately or in association; the animals were monitored for 120 min to assess changes in temperature, locomotor activity, local oedema formation and the prevalence of haemorrhaging. After this time, animals were anesthetized in order to collect blood samples through intracardiac puncture and then euthanized for collecting tissue samples; the hematological-biochemical and histopathological analyses were performed through conventional methods. L. m. muta venom produced pronounced local oedema, subcutaneous haemorrhage and myonecrosis, with both antivenom and NAC successfully reducing the extent of the myonecrotic lesion when individually administered; their association also prevented the occurrence of subcutaneous haemorrhage. Venom-induced creatine kinase (CK) release was significantly prevented by NAC alone or in combination with antivenom; NAC alone failed to reduce the release of hepatotoxic (alanine aminotransferase) and nephrotoxic (creatinine) serum biomarkers induced by L. m. muta venom. Venom induced significant increase of leucocytes which was also associated with an increase of neutrophils, eosinophils and monocytes; antivenom and NAC partially reduced these alterations, with NAC alone significantly preventing the increase of eosinophils whereas neither NAC or antivenom prevented the increase in monocytes. Venom did not induce changes in the erythrogram parameters. In the absence of a suitable antivenom, NAC has the potential to reduce a number of local and systemic effects caused by L. m. muta venom.
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Affiliation(s)
- Aline G Leão-Torres
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Rodovia Raposo Tavares Km 572, B2-205, 19067-175, Presidente Prudente, SP, Brazil
| | - Carina V Pires
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Rodovia Raposo Tavares Km 572, B2-205, 19067-175, Presidente Prudente, SP, Brazil
| | - Amanda C Ribelato
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Rodovia Raposo Tavares Km 572, B2-205, 19067-175, Presidente Prudente, SP, Brazil
| | - Maria C Zerbinatti
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Rodovia Raposo Tavares Km 572, B2-205, 19067-175, Presidente Prudente, SP, Brazil
| | - Cecília L Santarém
- Graduate Program in Animal Science, University of Western São Paulo (UNOESTE), Rodovia Raposo Tavares Km 572, B2-205, 19067-175, Presidente Prudente, SP, Brazil
| | - Rosa M B Nogueira
- Graduate Program in Animal Science, University of Western São Paulo (UNOESTE), Rodovia Raposo Tavares Km 572, B2-205, 19067-175, Presidente Prudente, SP, Brazil
| | - Inês C Giometti
- Graduate Program in Animal Science, University of Western São Paulo (UNOESTE), Rodovia Raposo Tavares Km 572, B2-205, 19067-175, Presidente Prudente, SP, Brazil
| | - Rogério Giuffrida
- Graduate Program in Animal Science, University of Western São Paulo (UNOESTE), Rodovia Raposo Tavares Km 572, B2-205, 19067-175, Presidente Prudente, SP, Brazil
| | - Elisangela O Silva
- Laboratory of Pathological Anatomy, Veterinary Hospital, University of Western São Paulo (UNOESTE), Rodovia Raposo Tavares Km 572, 19067-175, Presidente Prudente, SP, Brazil
| | - Juliana R Gerez
- Department of Histology, State University of Londrina, Rodovia Celso Garcia Cid Km 380, 86057-970, Londrina, PR, Brazil
| | - Nelson J Silva
- Graduate Program in Environmental Sciences and Health, School of Medical, Pharmaceutical and Biomedical Sciences, Pontifical Catholic University of Goiás (PUC Goiás), Rua 232, 128, 74605-140, Goiânia, GO, Brazil
| | - Edward G Rowan
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, G4 0RE, Glasgow, UK
| | - Rafael S Floriano
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Rodovia Raposo Tavares Km 572, B2-205, 19067-175, Presidente Prudente, SP, Brazil.
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