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Jati SR, dos Anjos Martins TA, Rocha AM, Melo-dos-Santos G, de Oliveira IS, Ferreira IG, de Farias AS, Filardi ETM, Cerni FA, Sartim MA, de Almeida Gonçalves Sachett J, Monteiro WM, Pucca MB. The State-of-the-Art of the Humoral Memory Response to Snakebites: Insights from the Yanomami Population. Toxins (Basel) 2023; 15:638. [PMID: 37999502 PMCID: PMC10675402 DOI: 10.3390/toxins15110638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
Snakebite envenomation (SBE)-induced immunity refers to individuals who have been previously bitten by a snake and developed a protective immune response against subsequent envenomations. The notion stems from observations of individuals, including in the indigenous population, who present only mild signs and symptoms after surviving multiple SBEs. Indeed, these observations have engendered scientific interest and prompted inquiries into the potential development of a protective immunity from exposure to snake toxins. This review explores the evidence of a protective immune response developing following SBE. Studies suggest that natural exposure to snake toxins can trigger protection from the severity of SBEs, mediated by specific antibodies. However, the evaluation of the immune memory response in SBE patients remains challenging. Further research is needed to elucidate the immune response dynamics and identify potential targets for therapeutic interventions. Furthermore, the estimation of the effect of previous exposures on SBE epidemiology in hyperendemic areas, such as in the indigenous villages of the Amazon region (e.g., the Yanomami population) is a matter of debate.
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Affiliation(s)
- Sewbert Rodrigues Jati
- Graduate Program in Tropical Medicine (PPGMT), State University of Amazonas, Manaus 69850-000, Brazil; (S.R.J.); (T.A.d.A.M.); (A.M.R.); (A.S.d.F.); (F.A.C.); (M.A.S.); (J.d.A.G.S.); (W.M.M.)
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69850-000, Brazil
- Department of Education and Sports of Roraima, Boa Vista 69301-130, Brazil
| | - Thais Andréa dos Anjos Martins
- Graduate Program in Tropical Medicine (PPGMT), State University of Amazonas, Manaus 69850-000, Brazil; (S.R.J.); (T.A.d.A.M.); (A.M.R.); (A.S.d.F.); (F.A.C.); (M.A.S.); (J.d.A.G.S.); (W.M.M.)
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69850-000, Brazil
| | - Anderson Maciel Rocha
- Graduate Program in Tropical Medicine (PPGMT), State University of Amazonas, Manaus 69850-000, Brazil; (S.R.J.); (T.A.d.A.M.); (A.M.R.); (A.S.d.F.); (F.A.C.); (M.A.S.); (J.d.A.G.S.); (W.M.M.)
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69850-000, Brazil
| | - Guilherme Melo-dos-Santos
- Graduate Program in Bioscience and Biotechnology Applied to Pharmacy, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Campus Araraquara, São Paulo 19060-900, Brazil; (G.M.-d.-S.); (E.T.M.F.)
| | - Isadora Sousa de Oliveira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 19040-903, Brazil; (I.S.d.O.); (I.G.F.)
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
| | - Isabela Gobbo Ferreira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 19040-903, Brazil; (I.S.d.O.); (I.G.F.)
| | - Altair Seabra de Farias
- Graduate Program in Tropical Medicine (PPGMT), State University of Amazonas, Manaus 69850-000, Brazil; (S.R.J.); (T.A.d.A.M.); (A.M.R.); (A.S.d.F.); (F.A.C.); (M.A.S.); (J.d.A.G.S.); (W.M.M.)
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69850-000, Brazil
| | - Eloise T. M. Filardi
- Graduate Program in Bioscience and Biotechnology Applied to Pharmacy, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Campus Araraquara, São Paulo 19060-900, Brazil; (G.M.-d.-S.); (E.T.M.F.)
| | - Felipe Augusto Cerni
- Graduate Program in Tropical Medicine (PPGMT), State University of Amazonas, Manaus 69850-000, Brazil; (S.R.J.); (T.A.d.A.M.); (A.M.R.); (A.S.d.F.); (F.A.C.); (M.A.S.); (J.d.A.G.S.); (W.M.M.)
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69850-000, Brazil
| | - Marco Aurélio Sartim
- Graduate Program in Tropical Medicine (PPGMT), State University of Amazonas, Manaus 69850-000, Brazil; (S.R.J.); (T.A.d.A.M.); (A.M.R.); (A.S.d.F.); (F.A.C.); (M.A.S.); (J.d.A.G.S.); (W.M.M.)
- Pro-Rectory of Research and Graduate Studies, Nilton Lins University, Manaus 69850-000, Brazil
| | - Jacqueline de Almeida Gonçalves Sachett
- Graduate Program in Tropical Medicine (PPGMT), State University of Amazonas, Manaus 69850-000, Brazil; (S.R.J.); (T.A.d.A.M.); (A.M.R.); (A.S.d.F.); (F.A.C.); (M.A.S.); (J.d.A.G.S.); (W.M.M.)
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69850-000, Brazil
| | - Wuelton Marcelo Monteiro
- Graduate Program in Tropical Medicine (PPGMT), State University of Amazonas, Manaus 69850-000, Brazil; (S.R.J.); (T.A.d.A.M.); (A.M.R.); (A.S.d.F.); (F.A.C.); (M.A.S.); (J.d.A.G.S.); (W.M.M.)
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69850-000, Brazil
| | - Manuela Berto Pucca
- Graduate Program in Tropical Medicine (PPGMT), State University of Amazonas, Manaus 69850-000, Brazil; (S.R.J.); (T.A.d.A.M.); (A.M.R.); (A.S.d.F.); (F.A.C.); (M.A.S.); (J.d.A.G.S.); (W.M.M.)
- Graduate Program in Bioscience and Biotechnology Applied to Pharmacy, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Campus Araraquara, São Paulo 19060-900, Brazil; (G.M.-d.-S.); (E.T.M.F.)
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University, Araraquara 19060-900, Brazil
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Lower levels of CXCL-8 and IL-2 on admission as predictors of early adverse reactions to Bothrops antivenom in the Brazilian Amazon. Cytokine 2022; 152:155825. [DOI: 10.1016/j.cyto.2022.155825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 12/13/2022]
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Rivera-de-Torre E, Rimbault C, Jenkins TP, Sørensen CV, Damsbo A, Saez NJ, Duhoo Y, Hackney CM, Ellgaard L, Laustsen AH. Strategies for Heterologous Expression, Synthesis, and Purification of Animal Venom Toxins. Front Bioeng Biotechnol 2022; 9:811905. [PMID: 35127675 PMCID: PMC8811309 DOI: 10.3389/fbioe.2021.811905] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
Animal venoms are complex mixtures containing peptides and proteins known as toxins, which are responsible for the deleterious effect of envenomations. Across the animal Kingdom, toxin diversity is enormous, and the ability to understand the biochemical mechanisms governing toxicity is not only relevant for the development of better envenomation therapies, but also for exploiting toxin bioactivities for therapeutic or biotechnological purposes. Most of toxinology research has relied on obtaining the toxins from crude venoms; however, some toxins are difficult to obtain because the venomous animal is endangered, does not thrive in captivity, produces only a small amount of venom, is difficult to milk, or only produces low amounts of the toxin of interest. Heterologous expression of toxins enables the production of sufficient amounts to unlock the biotechnological potential of these bioactive proteins. Moreover, heterologous expression ensures homogeneity, avoids cross-contamination with other venom components, and circumvents the use of crude venom. Heterologous expression is also not only restricted to natural toxins, but allows for the design of toxins with special properties or can take advantage of the increasing amount of transcriptomics and genomics data, enabling the expression of dormant toxin genes. The main challenge when producing toxins is obtaining properly folded proteins with a correct disulfide pattern that ensures the activity of the toxin of interest. This review presents the strategies that can be used to express toxins in bacteria, yeast, insect cells, or mammalian cells, as well as synthetic approaches that do not involve cells, such as cell-free biosynthesis and peptide synthesis. This is accompanied by an overview of the main advantages and drawbacks of these different systems for producing toxins, as well as a discussion of the biosafety considerations that need to be made when working with highly bioactive proteins.
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Affiliation(s)
- Esperanza Rivera-de-Torre
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
- *Correspondence: Esperanza Rivera-de-Torre, ; Andreas H. Laustsen,
| | - Charlotte Rimbault
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Timothy P. Jenkins
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Christoffer V. Sørensen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Anna Damsbo
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Natalie J. Saez
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, Australia
| | - Yoan Duhoo
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, Australia
| | - Celeste Menuet Hackney
- Department of Biology, Linderstrøm-Lang Centre for Protein Science, University of Copenhagen, Copenhagen, Denmark
| | - Lars Ellgaard
- Department of Biology, Linderstrøm-Lang Centre for Protein Science, University of Copenhagen, Copenhagen, Denmark
| | - Andreas H. Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
- *Correspondence: Esperanza Rivera-de-Torre, ; Andreas H. Laustsen,
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Nikfarjam U, Grabbe S, Butsch F. [Snake bite of western hognose snake (Heterodon nasicus)]. Hautarzt 2021; 73:718-721. [PMID: 34860256 PMCID: PMC9427898 DOI: 10.1007/s00105-021-04923-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/27/2022]
Abstract
Es gibt bisher wenige beschriebene Fälle von Bissen durch die Hakennasennatter (Heterodon nasicus), die meist zu einer Lokalreaktion führten. Wir berichten über eine ausgeprägte Lokalreaktion nach dem Biss einer als Haustier gehaltenen Hakennasennatter (Heterodon nasicus). Eine antiseptische Lokaltherapie und Antibiose zur Infektionsprophylaxe sind zu empfehlen, ebenfalls Laborkontrollen zum Ausschluss einer systemischen Beteiligung. An die Überprüfung des Tetanusschutzes sollte gedacht werden.
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Affiliation(s)
- Ulrike Nikfarjam
- Hautklinik der Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - Stephan Grabbe
- Hautklinik der Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Florian Butsch
- Hautklinik der Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Ligabue-Braun R. Hello, kitty: could cat allergy be a form of intoxication? J Venom Anim Toxins Incl Trop Dis 2020; 26:e20200051. [PMID: 33456448 PMCID: PMC7781471 DOI: 10.1590/1678-9199-jvatitd-2020-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The relationship between slow loris (Nycticebus spp.) venom (BGE protein) and the major cat allergen (Fel d 1) from domestic cat (Felis catus) is known for about two decades. Along this time, evidence was accumulated regarding convergences between them, including their almost identical mode of action. Methods Large-scale database mining for Fel d 1 and BGE proteins in Felidae and Nycticebus spp., alignment, phylogeny proposition and molecular modelling, associated with directed literature review were assessed. Results Fel d 1 sequences for 28 non-domestic felids were identified, along with two additional loris BGE protein sequences. Dimer interfaces are less conserved among sequences, and the chain 1 shows more sequence similarity than chain 2. Post-translational modification similarities are highly probable. Conclusions Fel d 1 functions beyond allergy are discussed, considering the great conservation of felid orthologs of this protein. Reasons for toxicity being found only in domestic cats are proposed in the context of domestication. The combination of the literature review, genome-derived sequence data, and comparisons with the venomous primate slow loris may point to domestic cats as potentially poisonous mammals.
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Affiliation(s)
- Rodrigo Ligabue-Braun
- Department of Pharmacosciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Kato K, Kato H, Morita A. A case of Western hognose snake bite. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2019. [DOI: 10.1002/cia2.12041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Kasumi Kato
- Department of Geriatric and Environmental Dermatology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
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Brandehoff N, Smith CF, Buchanan JA, Mackessy SP, Bonney CF. First reported case of thrombocytopenia from a Heterodon nasicus envenomation. Toxicon 2018; 157:12-17. [PMID: 30465776 DOI: 10.1016/j.toxicon.2018.11.295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/09/2018] [Accepted: 11/11/2018] [Indexed: 10/27/2022]
Abstract
CONTEXT The vast majority of the 2.5 million annual worldwide venomous snakebites are attributed to Viperidae or Elapidae envenomations. Of the nearly 2000 Colubridae species described, only a handful are known to cause medically significant envenomations. Considered medically insignificant, Heterodon nasicus (Western Hognose Snake) is a North American rear-fanged colubrid common in the legal pet trading industry. Previously reported cases of envenomations describe local pain, swelling, edema, and blistering. However, there are no reported cases of systemic or hematologic toxicity. CASE DETAILS A 20-year-old female sustained a bite while feeding a captive H. nasicus causing local symptoms and thrombocytopenia. On day three after envenomation, the patient was seen in the emergency department for persistent pain, swelling, and blistering. At that time, she was found to have a platelet count of 90 × 109/L. Previous routine platelet counts ranged from 315 to 373 × 109/L during the prior two years. Local symptoms peaked on day seven post envenomation. Her local symptoms and thrombocytopenia improved on evaluation four months after envenomation. DISCUSSION We report the first Heterodon nasicus envenomation causing both local toxicity and thrombocytopenia. Potential mechanisms based on H. nasicus venom composition are discussed in detail. Treatment is largely supportive. Bites by H. nascius should be evaluated by a toxicologist familiar with Colubridae species. This represents the first reported case of hematologic toxicity from envenomation by a North American colubrid snake.
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Affiliation(s)
- Nicklaus Brandehoff
- Rocky Mountain Poison and Drug Center - Denver Health and Hospital Authority, Denver, CO, USA; University of California, San Francisco-Fresno, Fresno, CA, USA.
| | - Cara F Smith
- School of Biological Sciences, University of Northern Colorado, Greeley, CO, USA
| | - Jennie A Buchanan
- Rocky Mountain Poison and Drug Center - Denver Health and Hospital Authority, Denver, CO, USA
| | - Stephen P Mackessy
- School of Biological Sciences, University of Northern Colorado, Greeley, CO, USA
| | - Caitlin F Bonney
- Rocky Mountain Poison and Drug Center - Denver Health and Hospital Authority, Denver, CO, USA
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Yang H, Yang L, Wang DW, Wei JF, He S. Anaphylactic shock caused by haemocoagulase injection in China. Exp Ther Med 2017; 13:1547-1553. [PMID: 28413507 DOI: 10.3892/etm.2017.4121] [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: 07/15/2015] [Accepted: 09/15/2016] [Indexed: 11/06/2022] Open
Abstract
Haemocoagulase injection is a mixture of purified enzymes isolated from the venom of Bothrops atrox, which is used for the prevention and treatment of haemorrhage. It is a relatively safe pharmacological agent that does not require a skin test prior to administration. However, following a literature search, 14 reported cases of anaphylactic shock caused by haemocoagulase injection were identified, including one lethal case in China. Using SDS-PAGE and protein identification, four primary components in haemocoagulase injection were characterized, including one metalloproteinase, which may be a thromboplastin-like enzyme, and two serine proteinases, which may be thrombin-like enzymes. Administering concentrated haemocoagulase injections failed to provoke a positive skin reaction in allergic patients. Basophil activation tests revealed that haemocoagulase injections did not upregulate cluster of differentiation 63 or C-C chemokine receptor type 3 expression. These findings suggest that haemocoagulase injection may cause fetal anaphylaxis. Although it is difficult to determine a clear conclusion without being able to evaluate the patients that underwent haemocoagulase injection-induced shock, it is unlikely that the venomous components of haemocoagulase injection cross-react with common allergens in allergic patients. It is possible that haemocoagulase injection-induced anaphylaxis is caused by its additive components, such as mannitol and succinylated gelatin.
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Affiliation(s)
- Haiwei Yang
- Allergy and Clinical Immunology Research Centre, The First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning 121001, P.R. China.,Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Liming Yang
- School of Life Sciences, Huaiyin Normal University, Huai'an, Jiangsu 223001, P.R. China
| | - De-Wang Wang
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Ji-Fu Wei
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Shaoheng He
- Allergy and Clinical Immunology Research Centre, The First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning 121001, P.R. China.,Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Hu Y, Yang L, Yang H, He S, Wei JF. Identification of snake venom allergens by two-dimensional electrophoresis followed by immunoblotting. Toxicon 2017; 125:13-18. [DOI: 10.1016/j.toxicon.2016.11.251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/10/2016] [Accepted: 11/16/2016] [Indexed: 11/29/2022]
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de Pontes LG, Cavassan NRV, Creste CFZ, Junior AL, Arcuri HA, Ferreira RS, Barraviera B, Gagete E, Dos Santos LD. Crotoxin: a novel allergen to occupational anaphylaxis. Ann Allergy Asthma Immunol 2016; 116:579-581.e1. [PMID: 27061138 DOI: 10.1016/j.anai.2016.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/07/2016] [Accepted: 03/14/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Leticia Gomes de Pontes
- Graduate Program in Tropical Diseases, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | | | | | - Airton Lourenço Junior
- Center for the Studies of Venoms and Venomous Animals, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Helen Andrade Arcuri
- Institute of Biosciences of Rio Claro, Universidade Estadual Paulista, Rio Claro, Brazil, and National Institutes for Science and Technology, São Paulo, Brazil
| | - Rui Seabra Ferreira
- Graduate Program in Tropical Diseases, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil; Center for the Studies of Venoms and Venomous Animals, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Benedito Barraviera
- Graduate Program in Tropical Diseases, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil; Center for the Studies of Venoms and Venomous Animals, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Elaine Gagete
- Anaphylaxis Committee of the Brazilian Association of Allergy and Immunology, São Paulo, Brazil
| | - Lucilene Delazari Dos Santos
- Graduate Program in Tropical Diseases, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil; Center for the Studies of Venoms and Venomous Animals, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil.
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Starkl P, Marichal T, Gaudenzio N, Reber LL, Sibilano R, Tsai M, Galli SJ. IgE antibodies, FcεRIα, and IgE-mediated local anaphylaxis can limit snake venom toxicity. J Allergy Clin Immunol 2015; 137:246-257.e11. [PMID: 26410782 DOI: 10.1016/j.jaci.2015.08.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 06/25/2015] [Accepted: 08/05/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Type 2 cytokine-related immune responses associated with development of antigen-specific IgE antibodies can contribute to pathology in patients with allergic diseases and to fatal anaphylaxis. However, recent findings in mice indicate that IgE also can enhance defense against honeybee venom. OBJECTIVE We tested whether IgE antibodies, IgE-dependent effector mechanisms, and a local anaphylactic reaction to an unrelated antigen can enhance defense against Russell viper venom (RVV) and determined whether such responses can be influenced by immunization protocol or mouse strain. METHODS We compared the resistance of RVV-immunized wild-type, IgE-deficient, and Fcer1a-deficient mice after injection of a potentially lethal dose of RVV. RESULTS A single prior exposure to RVV enhanced the ability of wild-type mice, but not mice lacking IgE or functional FcεRI, to survive challenge with a potentially lethal amount of RVV. Moreover, IgE-dependent local passive cutaneous anaphylaxis in response to challenge with an antigen not naturally present in RVV significantly enhanced resistance to the venom. Finally, we observed different effects on resistance to RVV or honeybee venom in BALB/c versus C57BL/6 mice that had received a second exposure to that venom before challenge with a high dose of that venom. CONCLUSION These observations illustrate the potential benefit of IgE-dependent effector mechanisms in acquired host defense against venoms. The extent to which type 2 immune responses against venoms can decrease pathology associated with envenomation seems to be influenced by the type of venom, the frequency of venom exposure, and the genetic background of the host.
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Affiliation(s)
- Philipp Starkl
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Thomas Marichal
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Nicolas Gaudenzio
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Laurent Lionel Reber
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Riccardo Sibilano
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Mindy Tsai
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Stephen Joseph Galli
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, Calif.
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Siracusa A, Folletti I, Gerth van Wijk R, Jeebhay MF, Moscato G, Quirce S, Raulf M, Ruëff F, Walusiak-Skorupa J, Whitaker P, Tarlo SM. Occupational anaphylaxis--an EAACI task force consensus statement. Allergy 2015; 70:141-52. [PMID: 25369880 DOI: 10.1111/all.12541] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 12/26/2022]
Abstract
Anaphylaxis is a systemic allergic reaction, potentially life-threatening that can be due to nonoccupational or, less commonly, to occupational triggers. Occupational anaphylaxis (OcAn) could be defined as anaphylaxis arising out of triggers and conditions attributable to a particular work environment. Hymenoptera stings and natural rubber latex are the commonest triggers of OcAn. Other triggers include food, medications, insect/mammal/snake bites, and chemicals. The underlying mechanisms of anaphylactic reactions due to occupational exposure are usually IgE-mediated and less frequently non-IgE-mediated allergy or nonallergic. Some aspects of work-related allergen exposure, such as route and frequency of exposure, type of allergens, and cofactors may explain the variability of symptoms in contrast to the nonoccupational setting. When assessing OcAn, both confirmation of the diagnosis of anaphylactic reaction and identification of the trigger are required. Prevention of further episodes is important and is based on removal from further exposure. Workers with a history of OcAn should immediately be provided with a written emergency management plan and an adrenaline auto-injector and educated to its use. Immunotherapy is recommended only for OcAn due to Hymenoptera stings.
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Affiliation(s)
- A. Siracusa
- Formerly professor of Occupational Medicine; University of Perugia; Perugia Italy
| | - I. Folletti
- Occupational Medicine; Terni Hospital; University of Perugia; Perugia Italy
| | - R. Gerth van Wijk
- Section of Allergology; Department of Internal Medicine; Erasmus Medical Center; Rotterdam the Netherlands
| | - M. F. Jeebhay
- Centre for Occupational and Environmental Health Research; School of Public Health and Family Medicine; University of Cape Town; Cape Town South Africa
| | - G. Moscato
- Department of Public Health; Experimental and Forensic Medicine of the University of Pavia; Pavia Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER of Respiratory Diseases CIBERES; Madrid Spain
| | - M. Raulf
- Institute of Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr University Bochum; Bochum Germany
| | - F. Ruëff
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | | | - P. Whitaker
- Department of Respiratory Medicine; Leeds Teaching Hospitals NHS Trust; Leeds UK
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13
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Kounis NG, Soufras GD. Coronary stent thrombosis: beware of an allergic reaction and of Kounis syndrome. Indian Heart J 2013; 66:153-5. [PMID: 24814107 DOI: 10.1016/j.ihj.2013.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 12/04/2013] [Indexed: 12/11/2022] Open
Affiliation(s)
- Nicholas G Kounis
- Department of Medical Sciences, Patras Highest Institute of Education and Technology, Patras, Achaia, Greece.
| | - George D Soufras
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
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Abstract
BACKGROUND Snakebites in snake handlers are an important clinical problem that may differ to bites in the general population. AIM To investigate the epidemiology and clinical presentation of bites in snake handlers. DESIGN Prospective observational study. METHODS Bites in snake handlers recruited as part of the Australian Snakebite Project (ASP) from 2004 to 2011 were included in the study. Data were extracted from the ASP database, which included demographic and clinical information, laboratory tests and antivenom treatment. RESULTS From 1089 snake bites recruited to ASP, there were 106 (9.7%) bites in snake handlers. The median age was 40 years (range: 16-81 years) and 104 (98%) were males. The commonest circumstances of the bites were handling snakes (47), catching snakes (22), feeding snakes (18) and cleaning cages (11). Bites were to the upper limb in 103 cases. Bites were most commonly by Red-bellied black snakes (20), Brown snakes (17), Taipan (15), Tiger snakes (14) and Death adders (14). Envenoming occurred in 77 patients: venom-induced consumption coagulopathy in 45 patients (58%), neurotoxicity in 10 (13%) and myotoxicity in 13 (17%). Systemic hypersensitivity reactions (SHSRs) to venom occurred in eight, satisfying clinical criteria for anaphylaxis in five, of which three were hypotensive. Antivenom was administered in 60 envenomed patients. SHSRs to antivenom occurred in 15 (25%; 95% CI:15-38%), including 2 (3%:1-13%) with severe (hypotensive) reactions. CONCLUSION Bites in snake handlers remain a common, important problem involving a broad range of snakes. Neurotoxicity and myotoxicity are relatively common, consistent with the snakes involved. Venom anaphylaxis occured, despite previously being a poorly recognized problem in snake handlers. The incidence of SHSRs to antivenoms, including anaphylaxis, was not higher than that observed in non-snake handlers.
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Affiliation(s)
- Geoffrey K Isbister
- Discipline of Clinical Pharmacology, University of Newcastle, Calvary Mater Newcastle, Waratah NSW 2298, Australia.
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Bury D, Langlois N, Byard RW. Animal-Related Fatalities-Part II: Characteristic Autopsy Findings and Variable Causes of Death Associated with Envenomation, Poisoning, Anaphylaxis, Asphyxiation, and Sepsis. J Forensic Sci 2011; 57:375-80. [DOI: 10.1111/j.1556-4029.2011.01932.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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16
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Hayes WK, Mackessy SP. Sensationalistic journalism and tales of snakebite: are rattlesnakes rapidly evolving more toxic venom? Wilderness Environ Med 2010; 21:35-45. [PMID: 20591352 DOI: 10.1016/j.wem.2010.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent reports in the lay press have suggested that bites by rattlesnakes in the last several years have been more severe than those in the past. The explanation, often citing physicians, is that rattlesnakes are evolving more toxic venom, perhaps in response to anthropogenic causes. We suggest that other explanations are more parsimonious, including factors dependent on the snake and factors associated with the bite victim's response to envenomation. Although bites could become more severe from an increased proportion of bites from larger or more provoked snakes (ie, more venom injected), the venom itself evolves much too slowly to explain the severe symptoms occasionally seen. Increased snakebite severity could also result from a number of demographic changes in the victim profile, including age and body size, behavior toward the snake (provocation), anatomical site of bite, clothing, and general health including asthma prevalence and sensitivity to foreign antigens. Clinical management of bites also changes perpetually, rendering comparisons of snakebite severity over time tenuous. Clearly, careful study taking into consideration many factors will be essential to document temporal changes in snakebite severity or venom toxicity. Presently, no published evidence for these changes exists. The sensationalistic coverage of these atypical bites and accompanying speculation is highly misleading and can produce many detrimental results, such as inappropriate fear of the outdoors and snakes, and distraction from proven snakebite management needs, including a consistent supply of antivenom, adequate health care, and training. We urge healthcare providers to avoid propagating misinformation about snakes and snakebites.
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Affiliation(s)
- William K Hayes
- Department of Earth and Biological Sciences, Loma Linda University, Loma Linda, CA, USA.
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17
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Weinstein SA, Keyler DE. Local envenoming by the Western hognose snake (Heterodon nasicus): A case report and review of medically significant Heterodon bites. Toxicon 2009; 54:354-60. [DOI: 10.1016/j.toxicon.2009.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 04/13/2009] [Accepted: 04/14/2009] [Indexed: 10/20/2022]
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