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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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Use of adjuvant ISA VG 71 to produce neutralizing egg yolk antibodies against bothropic venom. Appl Microbiol Biotechnol 2023; 107:1947-1957. [PMID: 36723703 DOI: 10.1007/s00253-023-12409-3] [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: 06/27/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 02/02/2023]
Abstract
The use of egg yolk antibodies-IgY technology-represents an alternative to the production of mammalian immunoglobulins and has several advantages regarding animal welfare and lower costs of production. The use of adjuvants to achieve the hyperimmunization of laying hens plays a key role in the success of the production of high levels of the antibodies. In the present work, two different adjuvant systems (Freund's adjuvants and MontanideTM ISA 71 VG) were compared to produce IgY anti-Bothrops alternatus. For the first immunization, formalin-inactivated Salmonella was added to MontanideTM ISA 71 VG to emulate Freund's complete adjuvant which includes a mycobacteria antigen. After eight immunizations, IgY produced by using either adjuvant was able to neutralize the lethal activity of the venom in a mouse model, but differences were found regarding the recognition of components of the venom between the two adjuvants tested. Overall, MontanideTM adjuvant used in this work could be a good alternative choice to produce antibodies capable of neutralizing the lethality of complex antigens. This adjuvant is commercially available and used in the formulation of several poultry vaccines and could be used for the IgY technology instead of traditional immunomodulators such as Freund's adjuvants. Key points • IgY extracts recognized major components of the venom.• Avidity indexes of the IgY extracts increased after the successive immunizations.• IgY obtained by two adjuvant systems neutralized the lethal activity of the venom.
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Tylan C, Engler HI, Villar G, Langkilde T. Consumption of fire ants, an invasive predator and prey of native lizards, may enhance immune functions needed to combat envenomation. Biol Invasions 2022. [DOI: 10.1007/s10530-022-02939-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Early Adverse Reactions to Snake Antivenom: Poison Center Data Analysis. Toxins (Basel) 2022; 14:toxins14100694. [PMID: 36287963 PMCID: PMC9608579 DOI: 10.3390/toxins14100694] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Antivenom is an essential treatment for snake envenomation; however, early adverse reactions (EARs) are major limitations to its use. We performed a retrospective cross-sectional study using Ramathibodi Poison Center data (January 2016 to December 2017) to clarify the incidence and severity of EARs following different F(ab’)2 antivenoms. Among 1006 envenomed patients, 684 (68%) received antivenom therapy with a total of 1157 doses, mostly green pit viper antivenom. The overall EAR incidence and rate were 22. 5% (154/684) and 15% (173/1157), respectively. The EAR rate following each type of antivenom was >10%, except for Russell’s viper antivenom (2.9%); the severe reaction rate was 2.6% (30/1157). Malayan pit viper bites caused a high incidence of EARs (37.8%) and the highest EAR rate (22.3%). Fifty-two cases developed anaphylaxis. All EARs occurred within 2 h after treatment initiation. No deaths were attributed to EARs. The duration of administration was significantly different between doses of antivenom that induced EARs and those that did not. In conclusion, all types and every dose of antivenom should be infused for 30−60 min. Preparation of resuscitation equipment and continuous clinical observation are crucial for at least 2 h after administration, and prompt treatment should be provided when EARs occur.
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Manson EZ, Mutinda KC, Gikunju JK, Bocian A, Hus KK, Petrílla V, Legáth J, Kimotho JH. Development of an Inhibition Enzyme-Linked Immunosorbent Assay (ELISA) Prototype for Detecting Cytotoxic Three-Finger Toxins (3FTxs) in African Spitting Cobra Venoms. Molecules 2022; 27:molecules27030888. [PMID: 35164152 PMCID: PMC8838685 DOI: 10.3390/molecules27030888] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
The administration of toxin-specific therapy in snake envenoming is predicated on improved diagnostic techniques capable of detecting specific venom toxins. Various serological tests have been used in detecting snakebite envenoming. Comparatively, enzyme-linked immunosorbent assay (ELISA) has been shown to offer a wider practical application. We report an inhibition ELISA for detecting three-finger toxin (3FTx) proteins in venoms of African spitting cobras. The optimized assay detected 3FTxs in N. ashei (including other Naja sp.) venoms, spiked samples, and venom-challenged mice samples. In venoms of Naja sp., the assay showed inhibition, implying the detection of 3FTxs, but showed little or no inhibition in non-Naja sp. In mice-spiked samples, one-way ANOVA results showed that the observed inhibition was not statistically significant between spiked samples and negative control (p-value = 0.164). Similarly, the observed differences in inhibition between venom-challenged and negative control samples were not statistically significant (p-value = 0.9109). At an LOD of 0.01 µg/mL, the assay was able to confirm the presence of 3FTxs in the samples. Our results show a proof of concept for the use of an inhibition ELISA model as a tool for detecting 3FTxs in the venoms of African spitting cobra snakes.
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Affiliation(s)
- Ernest Z. Manson
- Institute for Basic Sciences, Technology & Innovation, Pan African University, Nairobi 00100, Kenya
- Correspondence:
| | - Kyama C. Mutinda
- Department of Medical Laboratory Science, College of Health Sciences, Jomo Kenyatta University of Agriculture & Technology, Nairobi 00100, Kenya; (K.C.M.); (J.K.G.)
| | - Joseph K. Gikunju
- Department of Medical Laboratory Science, College of Health Sciences, Jomo Kenyatta University of Agriculture & Technology, Nairobi 00100, Kenya; (K.C.M.); (J.K.G.)
| | - Aleksandra Bocian
- Department of Biotechnology and Bioinformatics, Faculty of Chemistry, Rzeszow University of Technology, 35-959 Rzeszow, Poland; (A.B.); (K.K.H.); (J.L.)
| | - Konrad K. Hus
- Department of Biotechnology and Bioinformatics, Faculty of Chemistry, Rzeszow University of Technology, 35-959 Rzeszow, Poland; (A.B.); (K.K.H.); (J.L.)
| | - Vladimír Petrílla
- Department of Biology and Physiology, University of Veterinary Medicine and Pharmacy, 041 81 Košice, Slovakia;
- Zoological Department, Zoological Garden Košice, Široká 31, 040 06 Košice-Kavečany, Slovakia
| | - Jaroslav Legáth
- Department of Biotechnology and Bioinformatics, Faculty of Chemistry, Rzeszow University of Technology, 35-959 Rzeszow, Poland; (A.B.); (K.K.H.); (J.L.)
- Department of Pharmacology and Toxicology, University of Veterinary Medicine and Pharmacy, 041 81 Košice, Slovakia
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Patra A, Herrera M, Gutiérrez JM, Mukherjee AK. The application of laboratory-based analytical tools and techniques for the quality assessment and improvement of commercial antivenoms used in the treatment of snakebite envenomation. Drug Test Anal 2021; 13:1471-1489. [PMID: 34089574 DOI: 10.1002/dta.3108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/18/2022]
Abstract
Snakebite envenomation is a public health problem of high impact, particularly for the developing world. Antivenom, which contains whole or protease-digested immunoglobulin G, purified from the plasma of hyper-immunized animals (mainly horses), is the mainstay for the treatment of snakebite envenomation. The success of antivenom therapy depends upon its ability to abrogate or reduce the local and systemic toxicity of envenomation. In addition, antivenom administration must be safe for the patients. Therefore, antivenom manufacturers must ensure that these products are effective and safe in the treatment of envenomations. Antivenom efficacy and safety are determined by the physicochemical characteristics of formulations, purity of the immunoglobulin fragments and antibodies, presence of protein aggregates, endotoxin burden, preservative load, and batch to batch variation, as well as on the ability to neutralize the most important toxins of the venoms against which the antivenom is designed. In this context, recent studies have shown that laboratory-based simple analytical techniques, for example, size exclusion chromatography, sodium dodecyl sulphate polyacrylamide gel electrophoresis, mass spectrometry, immunological profiling including immuno-turbidimetry and enzyme-linked immunosorbent assays, Western blotting, immune-chromatographic technique coupled to mass spectrometry analysis, reverse-phase high performance liquid chromatography, spectrofluorometric analysis, in vitro neutralization of venom enzymatic activities, and other methodologies, can be applied for the assessment of antivenom quality, safety, stability, and efficacy. This article reviews the usefulness of different analytical techniques for the quality assessment of commercial antivenoms. It is suggested that these tests should be applied for screening the quality of commercial antivenoms before their preclinical and clinical assessment.
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Affiliation(s)
- Aparup Patra
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, India
| | - María Herrera
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Ashis K Mukherjee
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, India.,Life Science Division, Institute of Advanced Study in Science and Technology, Vigyan Path, Garchuk, Paschim Boragaon, Guwahati, 781035, India
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Shim JS, Kang H, Cho Y, Shin H, Lee H. Adverse Reactions after Administration of Antivenom in Korea. Toxins (Basel) 2020; 12:E507. [PMID: 32781766 PMCID: PMC7472312 DOI: 10.3390/toxins12080507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 11/16/2022] Open
Abstract
Kovax® antivenom is the main treatment for toxins produced by the Gloydius species. However, research on adverse reactions after Kovax® antivenom administration is scarce. We aimed to identify the incidence and characteristics of adverse reactions after Kovax® antivenom administration. We conducted a retrospective review of the medical records of snakebite patients in Korea between January 2008 and September 2019. We identified the frequency, characteristics, and treatments of adverse reactions to Kovax® antivenom. There were 150 patients with snakebites, of whom 121 (80.7%) patients received Kovax® antivenom. Adverse reactions occurred in five patients (4.1%). Acute adverse reactions within 24 h of antivenom administration occurred in two patients (1.7%). The symptoms of patients with acute adverse reactions were nausea, diaphoresis, dizziness, and hypotension. Delayed adverse reactions that occurred 24 h after antivenom administration were reported in three patients (2.5%). One patient had a skin rash after 10 days, and two patients had fever 37 and 48 h after antivenom use. In conclusion, most patients were managed safely after Kovax® antivenom, and the incidence of adverse reactions was low. Severe adverse reactions occurred in a small percentage of patients, and there were no deaths.
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Affiliation(s)
- Jin Seok Shim
- Department of Emergency Medicine, College of Medicine, Hanyang University Hospital, Hanyang University, 04763 Seoul, Korea; (J.S.S.); (H.L.)
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University Hospital, Hanyang University, 04763 Seoul, Korea; (J.S.S.); (H.L.)
| | - Yongil Cho
- Department of Emergency Medicine, College of Medicine, Hanyang University Hospital, Hanyang University, 04763 Seoul, Korea; (J.S.S.); (H.L.)
| | - Hyungoo Shin
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Hanyang University, 11923 Guri, Korea;
| | - Heekyung Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University Hospital, Hanyang University, 04763 Seoul, Korea; (J.S.S.); (H.L.)
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de Brito Sousa JD, Sachett JAG, de Oliveira SS, Mendonça-da-Silva I, Marques HO, de Lacerda MVG, Fan HW, Monteiro WM. Accuracy of the Lee-White Clotting Time Performed in the Hospital Routine to Detect Coagulopathy in Bothrops atrox Envenomation. Am J Trop Med Hyg 2018; 98:1547-1551. [PMID: 29611503 DOI: 10.4269/ajtmh.17-0992] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Snake envenomation is a major public health problem in Brazil. Systemic complications that may arise from snakebites are mainly related to coagulopathy. The Lee-White clotting time (LWCT) is a simple and inexpensive test and available even in remote health facilities. However, the diagnostic value of such test needs to be evaluated to accurately diagnose coagulopathy in the clinical practice. This study aimed to assess the reliability of the LWCT performed in hospital routine to diagnose venom-induced coagulopathy. We studied 186 patients admitted at the Tropical Medicine Foundation Dr. Heitor Vieira Dourado in Manaus, Amazonas, Brazil, with Bothrops envenomation diagnosis. At admission, blood samples were collected for performing LWCT and the concentration of fibrinogen. Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, diagnostic odds ratio, and accuracy were calculated with 95% confidence intervals. From the total, 85.5% had hypofibrinogenemia. The sensitivity of the LWCT to the diagnosis of hypofibrinogenemia was 78.0% and the specificity 40.7%. The accuracy of the test was 72.6%, and patients with a prolonged LWCT had 2.4 higher odds of developing hypofibrinogenemia. In addition, the LWCT was also compared with venom antigen levels and systemic hemorrhage. The LWCT showed moderate sensitivity to detect consumption coagulopathy and constitutes a valuable tool for the diagnosis of Bothrops snake envenomation and indication of antivenom therapy.
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Affiliation(s)
- Jose Diego de Brito Sousa
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Jacqueline Almeida Gonçalves Sachett
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Sâmella Silva de Oliveira
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Iran Mendonça-da-Silva
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Marcus Vinicius Guimarães de Lacerda
- Instituto de Pesquisas Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Wuelton Marcelo Monteiro
- Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
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Morais V. Antivenom therapy: efficacy of premedication for the prevention of adverse reactions. J Venom Anim Toxins Incl Trop Dis 2018; 24:7. [PMID: 29507580 PMCID: PMC5831611 DOI: 10.1186/s40409-018-0144-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/07/2018] [Indexed: 11/29/2022] Open
Abstract
Antivenoms or antitoxins have been effectively used for more than a century. During this time, these products have always proven to be highly effective in the treatment of infections and envenomations. However, antivenoms did not exhibit good safety results in their initial applications. After many improvements, antivenoms have substantially better safety profiles but still have some side effects. Due to the occurrence of adverse reactions, the practice of using premedication with the intent to decrease side effects has become accepted or mandatory in many countries. The drugs used for premedication belong to the histamine H1 antagonist, glucocorticoid and catecholamine groups. Currently, this practice is being questioned due to low or controversial efficacies in clinical assays. In this article, we discuss the causes of adverse reactions, the mechanisms of drugs that block the undesired effects and the results obtained in clinical trials. Although these three families of drugs could have positive effects on reducing adverse reactions, only adrenaline has demonstrated positive results in clinical assays.
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Affiliation(s)
- Victor Morais
- Department of Biotechnology, Institute of Hygiene, Faculty of Medicine, University of the Republic, Uruguay, Av. Alfredo Navarro, 3051 Montevideo, Uruguay
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10
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Morais V. An Old Solution for a New Problem: Antiserum against Emerging Infectious Diseases. Front Public Health 2016; 4:178. [PMID: 27617259 PMCID: PMC5000394 DOI: 10.3389/fpubh.2016.00178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/11/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Victor Morais
- Department of Biotechnology, Faculty of Medicine, Institute of Hygiene, University of the Republic, Montevideo, Uruguay
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de Silva HA, Ryan NM, de Silva HJ. Adverse reactions to snake antivenom, and their prevention and treatment. Br J Clin Pharmacol 2016; 81:446-52. [PMID: 26256124 PMCID: PMC4767202 DOI: 10.1111/bcp.12739] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 01/04/2023] Open
Abstract
Antivenom is the mainstay of treatment of snakebite envenoming. However, adverse reactions to snake antivenom that is available are common in many parts of the world where snakebite is prevalent. Both acute (anaphylactic or pyrogenic) and delayed (serum sickness type) reactions occur. Acute reactions are usually mild but severe systemic anaphylaxis may develop, often within an hour or so of exposure to antivenom. Serum sickness after antivenom has a delayed onset between 5 and 14 days after its administration. Ultimately, the prevention reactions will depend mainly on improving the quality of antivenom. Until these overdue improvements take place, doctors will have to depend on pharmacological prophylaxis, where the search for the best prophylactic agent is still on-going, as well as careful observation of patients receiving antivenom in preparation for prompt management of acute as well as delayed reactions when they occur.
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Affiliation(s)
- H. Asita de Silva
- Clinical Trials Unit, Faculty of MedicineUniversity of KelaniyaRagamaSri Lanka
| | - Nicole M. Ryan
- Clinical Toxicology Research Group, School of Medicine and Public HealthThe University of NewcastleNewcastleNSWAustralia
| | - H. Janaka de Silva
- Clinical Trials Unit, Faculty of MedicineUniversity of KelaniyaRagamaSri Lanka
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12
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Clinical features of serum sickness after Australian snake antivenom. Toxicon 2015; 108:181-3. [DOI: 10.1016/j.toxicon.2015.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/17/2015] [Accepted: 10/20/2015] [Indexed: 11/24/2022]
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Hung DZ, Lin JH, Mo JF, Huang CF, Liau MY. Rapid diagnosis of Naja atra snakebites. Clin Toxicol (Phila) 2014; 52:187-91. [PMID: 24580058 DOI: 10.3109/15563650.2014.887725] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The clinical diagnosis of snakebites is critical and necessary in many parts of the world, especially in Southeastern Asia, where venomous snakebites are a burden on public health. It is difficult to define or recognize the species of venomous snake because of the overlapping clinical manifestations of envenomations. A quick and reliable method for identifying the snake species is necessary. We designed and tested a strip of lateral flow system for the diagnosis of cobra snake bites in Taiwan. METHODS We developed a kit based on an immunochromatographic method for rapid detection of cobra (Naja atra) venom in human serum. The test and control lines composed of 1 mg/ml polyclonal duck antivenom and 0.5 mg/ml goat anti-rabbit immunoglobulin antibody solutions, respectively, were coated on nitrocellulose strips. Colloidal gold was conjugated with rabbit polyclonal anti-cobra venom antibodies. From July 2007 to December 2012, we used the kit to test serum from snakebite patients and to examine the agreement between our rapid test and the currently used sandwich enzyme-linked immunosorbent assay (ELISA). RESULTS Our kit was able to detect cobra venom in serum samples in 20 minutes with a detection limit of 5 ng/ml. An absence of cross-reactivity with other non-cobra venoms from Taiwan was noted in vitro. A total of 88 snakebite patients (34 cobra and 54 other non-cobra) were tested. The sensitivity of the strips based on the ELISA results was 83.3% and the specificity was 100%. There was a strong agreement between the results of the ELISA and immunochromatographic strips (κ = 0.868). DISCUSSION AND CONCLUSIONS This data indicates that an immunochromatographic strip might be suitable for cobra venom detection and could be used as a quick diagnostic tool in cases of N. atra snakebite.
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Affiliation(s)
- D Z Hung
- Division of Toxicology, China Medical University Hospital , Taichung , Taiwan
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Nadur-Andrade N, Zamuner SR, Toniolo EF, de Lima CJ, Cogo JC, Dale CS. Analgesic Effect of Light-Emitting Diode (LED) Therapy at Wavelengths of 635 and 945 nm on Bothrops moojeni Venom-Induced Hyperalgesia. Photochem Photobiol 2013; 90:207-13. [PMID: 24131406 DOI: 10.1111/php.12189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 10/11/2013] [Indexed: 12/18/2022]
Abstract
Envenoming induced by Bothrops snakes is characterized by drastic local tissue damage involving hemorrhage, myonecrosis and proeminent inflammatory and hyperalgesic response. The most effective treatment is antivenom therapy, which is ineffective in neutralizing the local response. Herein, it was evaluated the effectiveness of light-emitting diode (LED) at wavelengths of 635 and 945 nm in reducing inflammatory hyperalgesia induced by Bothrops moojeni venom (BmV) in mice, produced by an subplantar injection of BmV (1 μg). Mechanical hyperalgesia and allodynia were assessed by von Frey filaments at 1, 3, 6 and 24 h after venom injection. The site of BmV injection (1.2 cm(2) ) was irradiated by LEDs at 30 min and 3 h after venom inoculation. Both 635 nm (110 mW, fluence of 3.76 J/cm(2) and 41 s of irradiation time) and 945 nm (120 mW, fluence of 3.8 J/cm(2) and 38 s of irradiation time) LED inhibited mechanical allodynia and hyperalgesia of mice alone or in combination with antivenom treatment, even when the symptoms were already present. The effect of phototherapy in reducing local pain induced by BmV should be considered as a novel therapeutic tool for the treatment of local symptoms induced after bothropic snake bites.
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Affiliation(s)
| | | | | | - Carlos J de Lima
- Laboratory of Biomedical Instrumentation, Camilo Castelo Branco University, São José dos Campos, Brazil
| | - José C Cogo
- Laboratory of Inflammation, Institute of Research and Development, University of Vale do Paraiba, São José dos Campos, SP, Brazil
| | - Camila S Dale
- Sírio-Libanês Hospital, São Paulo, SP, Brazil.,Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
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León G, Herrera M, Segura Á, Villalta M, Vargas M, Gutiérrez JM. Pathogenic mechanisms underlying adverse reactions induced by intravenous administration of snake antivenoms. Toxicon 2013; 76:63-76. [PMID: 24055551 DOI: 10.1016/j.toxicon.2013.09.010] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/01/2013] [Accepted: 09/11/2013] [Indexed: 11/28/2022]
Abstract
Snake antivenoms are formulations of immunoglobulins, or immunoglobulin fragments, purified from the plasma of animals immunized with snake venoms. Their therapeutic success lies in their ability to mitigate the progress of toxic effects induced by snake venom components, when administered intravenously. However, due to diverse factors, such as deficient manufacturing practices, physicochemical characteristics of formulations, or inherent properties of heterologous immunoglobulins, antivenoms can induce undesirable adverse reactions. Based on the time lapse between antivenom administration and the onset of clinical manifestations, the World Health Organization has classified these adverse reactions as: 1 - Early reactions, if they occur within the first hours after antivenom infusion, or 2 - late reactions, when occurring between 5 and 20 days after treatment. While all late reactions are mediated by IgM or IgG antibodies raised in the patient against antivenom proteins, and the consequent formation of immune complexes, several mechanisms may be responsible for the early reactions, such as pyrogenic reactions, IgE-mediated reactions, or non IgE-mediated reactions. This work reviews the hypotheses that have been proposed to explain the mechanisms involved in these adverse reactions to antivenoms. The understanding of these pathogenic mechanisms is necessary for the development of safer products and for the improvement of snakebite envenomation treatment.
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Affiliation(s)
- Guillermo León
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica.
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Morais V, Negrín A, Tortorella MN, Massaldi H. Evolution of venom antigenaemia and antivenom concentration in patients bitten by snakes in Uruguay. Toxicon 2012; 60:990-4. [PMID: 22819686 DOI: 10.1016/j.toxicon.2012.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 06/23/2012] [Accepted: 07/05/2012] [Indexed: 11/27/2022]
Abstract
In this work we describe the first study carried out in Uruguay of venom antigenaemia and antivenom concentration in patients bitten by snakes. Between 50 and 70 snake bite accidents per year are caused in Uruguay by 2 species: Rhinocerophis alternatus and Bothropoides pubescens. The patients are treated with a specific polyvalent antivenom. Gaining insight on the evolution of venom antigenaemia and antivenom concentration in patients is important to improve treatment protocols. Blood samples of 29 patients were analysed to determine venom and antivenom concentrations at different times. Venom was detected in 18 of 19 samples before antivenom administration, with a mean concentration of 57 ng/mL. Most of the patients received 4 or 8 vials to neutralize the venom effects. Only one patient needed a total of 16 vials. He showed a severe envenomation and needed supplementary amounts of antivenom after the fifth day of the snake bite accident to reach normal clotting parameters. Antivenom concentrations were determined at 12 h, 24 h and 15 days after antivenom administration. It was found a faster antivenom decrease between 12 and 24 h than to 24 h to 15 days. This was explained by a different clearance mechanism in each period. In the first phase, the cause would be the neutralization of venom present in the blood whereas in the second phase it would be due to unbound antivenom elimination.
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Affiliation(s)
- Victor Morais
- Department of Biotechnology, Institute of Hygiene, Faculty of Medicine, University of the Republic, Av. Alfredo Navarro 3051, Montevideo, CP 11600, Uruguay.
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