1
|
Murphy K, Tasoulis T, Dunstan N, Isbister GK. Anticoagulant activity in Australasian elapid snake venoms and neutralisation with antivenom and varespladib. Toxicon 2024; 247:107836. [PMID: 38945217 DOI: 10.1016/j.toxicon.2024.107836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/04/2024] [Accepted: 06/25/2024] [Indexed: 07/02/2024]
Abstract
The venoms of Australasian elapid snakes are known to possess coagulant activity, including some with strong procoagulant activity and others with anticoagulant activity, although the latter are less well known. This study investigates the anticoagulant activity of Australasian elapid snake venoms, and whether this activity is neutralised by commercial snake antivenom and varespladib (PLA2 inhibiting agent). Clotting assays were completed for 34 species of Australasian elapids. Antivenom neutralisation assays with tiger snake antivenom (TSAV) were performed on five species to determine if there was cross-neutralisation. Varespladib neutralisation assays were also completed for the same five species. All Pseudechis species venoms had anticoagulant activity, except P. porphyriacus, which was procoagulant. Pseudechis species venoms had similar anticoagulant potency ranging from the most potent P. colletti venom to the least potent P. butleri venom. The three Austrelaps (copperhead) species venoms were the next most potent anticoagulants. Six further snakes, Elapognathus coronatus, Acanthophis pyrrhus, A. antarcticus, Suta suta, Denisonia devisi and D. maculata, had weaker anticoagulant activity, except for D. maculata which had similar anticoagulant activity to Pseudechis species. Tiger Snake Antivenom (1200mU/mL) neutralised the anticoagulant effect of P. australis for concentrations up to 1 mg/mL. TSAV (1200mU/mL) also neutralised P. colletti, D. maculata, A. superbus and A. pyrrhus venoms at their EC50, demonstrating cross neutralisation. Varespladib neutralised the anticoagulant effect of P. australis venom at 5 μM and for venoms of P. colletti, D. maculata, A. superbus and A. pyrrhus. We found anticoagulant activity to be present in six genera of Australasian snakes at low concentrations, which can be completely neutralised by both antivenom and varespladib. Anticoagulant activity in Australian elapid venoms was associated with species possessing high PLA2 activity without procoagulant snake venom serine proteases.
Collapse
Affiliation(s)
- Kate Murphy
- Clinical Toxicology Research Group, University of Newcastle, New South Wales, Australia
| | - Theo Tasoulis
- Clinical Toxicology Research Group, University of Newcastle, New South Wales, Australia
| | | | - Geoffrey K Isbister
- Clinical Toxicology Research Group, University of Newcastle, New South Wales, Australia; Department of Clinical Toxicology, Calvary Mater Newcastle, New South Wales, Australia.
| |
Collapse
|
2
|
Chowdhury A, Youngman NJ, Liu J, Lewin MR, Carter RW, Fry BG. The relative efficacy of chemically diverse small-molecule enzyme-inhibitors against anticoagulant activities of Black Snake (Pseudechis spp.) venoms. Toxicol Lett 2022; 366:26-32. [PMID: 35788045 DOI: 10.1016/j.toxlet.2022.06.009] [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: 01/12/2022] [Revised: 05/31/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
Snakebite remains a worldwide public health burden and a severely neglected tropical disease. Recent research has begun to focus on the potential use of repurposed small-molecule enzyme-inhibitors as early treatments to neutralise the effects of snake venoms. Black snakes (Pseudechis spp.) are a widespread and dangerously venomous group found throughout Australia and New Guinea. Utilising validated coagulation assays, our study assessed the efficacy of two chemically different small molecule inhibitors, a phospholipase A2 inhibitor (varespladib) and a metalloproteinase inhibitor (prinomastat), in vitro neutralisation of the anticoagulant prothrombinase-inhibiting activity of venom from seven species within the Pseudechis genus (P. australis, P. butleri, P. coletti, P. guttatus, P. papuanus, P.rossignolii, P. sp (NT).). Varespladib was shown to be highly effective at neutralising this anticoagulant activity for all seven species, but with P. coletti notably less so than the others. In contrast, prinomastat showed strong neutralisation for five out of the seven species, but was ineffective at neutralising the activity of P. coletti or P. rossignolii venoms. This suggests that varespladib binds to a highly conserved site but that prinomastat binds to a more variable site. These results build upon recent literature indicating that metalloproteinase inhibitors have cross-neutralising potential towards snake venom phospholipase A2 toxins, but with higher degrees of variability that PLA2-specific inhibitors. An important caveat is that these are in vitro tests and while suggestive of potential clinical utility, in vivo animal testing and clinical trials are required as future work.
Collapse
Affiliation(s)
- Abhinandan Chowdhury
- Venom Evolution Lab, School of Biological Science, University of Queensland, St. Lucia QLD, 4072 Australia; Department of Biochemistry & Microbiology, North South University, Dhaka 1229, Bangladesh.
| | - Nicholas J Youngman
- Venom Evolution Lab, School of Biological Science, University of Queensland, St. Lucia QLD, 4072 Australia
| | - Jiaojiao Liu
- Venom Evolution Lab, School of Biological Science, University of Queensland, St. Lucia QLD, 4072 Australia
| | - Matthew R Lewin
- California Academy of Sciences, San Francisco, CA, 94118, USA; Ophirex, Inc., Corte Madera, CA, 94925, USA
| | | | - Bryan G Fry
- Venom Evolution Lab, School of Biological Science, University of Queensland, St. Lucia QLD, 4072 Australia.
| |
Collapse
|
3
|
Abstract
BACKGROUND Myotoxicity is a recognised but poorly characterised effect of snake envenoming worldwide. We aimed to describe the clinical effects, complications and effectiveness of antivenom in myotoxicity from Australian snake envenoming. METHODS Patients were recruited to the Australian Snakebite Project (ASP), a prospective, observational study of patients with suspected or proven snakebite countrywide. After informed consent data is collected and stored in a dedicated database and blood samples are taken and stored. We included patients with envenoming and biochemical evidence of myotoxicity (peak creatine kinase [CK] > 1000 U/L). Snake species was determined by expert identification or venom specific enzyme immunoassay. Analysis included patient demographics, clinical findings, pathology results, treatment and outcomes (length of hospital stay, complications). RESULTS 1638 patients were recruited January 2003-December 2016, 935 (57%) were envenomed, 148 developed myotoxicity (16%). Snake species most commonly associated with myotoxicity were Notechis spp. (30%), Pseudechis porphyriacus (20%) and Pseudechis australis (13%). Bite site effects occurred in 19 patients. Non-specific systemic symptoms occurred in 135 patients (91%), specific signs and symptoms in 83. In 120 patients with early serial CK results, the median peak CK was 3323 U/L (IQR;1050-785100U/L), the median time to first CK >500 U/L was 11.1 h and median time to peak CK of 34.3 h. White cell count was elevated in 136 patients (93%; median time to elevation, 4.9 h). 37 patients had elevated creatinine, six were dialysed. Two patients died from complications of severe myotoxicity. Antivenom given before the first abnormal CK (>500 U/L) was associated with less severe myotoxicity (2976 versus 7590 U/L). Non-envenomed patients with elevated CK had rapid rise to abnormal CK (median 3.5 h) and less had elevated WCC (32%). CONCLUSION Myotoxicity from Australian snakes is relatively common and has systemic effects, with significant associated morbidity and mortality. CK is not a good early biomarker of mytoxicity. Early antivenom may play a role in reducing severity.
Collapse
|
4
|
Braga JRM, Jorge ARC, Marinho AD, Silveira JADM, Nogueira-Junior FA, Valle MB, Alagón A, de Menezes RRPPB, Martins AMC, Feijão LX, Monteiro HSA, Jorge RJB. Renal effects of venoms of Mexican coral snakes Micrurus browni and Micrurus laticollaris. Toxicon 2020; 181:45-52. [DOI: 10.1016/j.toxicon.2020.04.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 12/23/2022]
|
5
|
Wang CR, Bubner ER, Jovcevski B, Mittal P, Pukala TL. Interrogating the higher order structures of snake venom proteins using an integrated mass spectrometric approach. J Proteomics 2020; 216:103680. [PMID: 32028038 DOI: 10.1016/j.jprot.2020.103680] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/20/2020] [Accepted: 02/02/2020] [Indexed: 12/20/2022]
Abstract
Snake venoms contain complex mixtures of proteins vital for the survival of venomous snakes. Aligned with their diverse pharmacological activities, the protein compositions of snake venoms are highly variable, and efforts to characterise the primary structures of such proteins are ongoing. Additionally, a significant knowledge gap exists in terms of the higher-order protein structures which modulate venom potency, posing a challenge for successful therapeutic applications. Here we use a multifaceted mass spectrometry approach to characterise proteins from venoms of Collett's snake Pseudechis colletti and the puff adder Bitis arietans. Following chromatographic fractionation and bottom-up proteomics analysis, native mass spectrometry identified, among other components, a non-covalent l-amino acid oxidase dimer in the P. colletti venom and a C-type lectin tetramer in the B. arietans venom. Furthermore, a covalently-linked phospholipase A2 (PLA2) dimer was identified in P. colletti venom, from which the PLA2 species were shown to adopt compact geometries using ion mobility measurements. Interestingly, we show that the dimeric PLA2 possesses greater bioactivity than the monomeric PLA2s. This work contributes to ongoing efforts cataloguing components of snake venoms, and notably, emphasises the importance of understanding higher-order venom protein interactions and the utility of a combined mass spectrometric approach for this task. SIGNIFICANCE: The protein constituents of snake venoms represent a sophisticated cocktail of biologically active molecules ideally suited for further exploration in drug design and development. Despite ongoing efforts to characterise the diverse protein components of such venoms there is still much work required in this area, particularly in moving from simply describing the protein primary sequence to providing an understanding of quaternary structure. The combined proteomic and native mass spectrometry workflow utilised here gives new insights into higher order protein structures in selected snake venoms, and can underpin further investigation into the protein interactions which govern snake venom specificity and potency.
Collapse
Affiliation(s)
- C Ruth Wang
- Department of Chemistry, School of Physical Sciences, University of Adelaide, Adelaide 5005, Australia
| | - Emily R Bubner
- Department of Chemistry, School of Physical Sciences, University of Adelaide, Adelaide 5005, Australia
| | - Blagojce Jovcevski
- Department of Chemistry, School of Physical Sciences, University of Adelaide, Adelaide 5005, Australia
| | - Parul Mittal
- Adelaide Proteomics Centre, University of Adelaide, Adelaide 5005, Australia
| | - Tara L Pukala
- Department of Chemistry, School of Physical Sciences, University of Adelaide, Adelaide 5005, Australia.
| |
Collapse
|
6
|
Abstract
Long-term effects of envenoming compromise the quality of life of the survivors of snakebite. We searched MEDLINE (from 1946) and EMBASE (from 1947) until October 2018 for clinical literature on the long-term effects of snake envenoming using different combinations of search terms. We classified conditions that last or appear more than six weeks following envenoming as long term or delayed effects of envenoming. Of 257 records identified, 51 articles describe the long-term effects of snake envenoming and were reviewed. Disability due to amputations, deformities, contracture formation, and chronic ulceration, rarely with malignant change, have resulted from local necrosis due to bites mainly from African and Asian cobras, and Central and South American Pit-vipers. Progression of acute kidney injury into chronic renal failure in Russell's viper bites has been reported in several studies from India and Sri Lanka. Neuromuscular toxicity does not appear to result in long-term effects. Endocrine anomalies such as delayed manifestation of hypopituitarism following Russell's viper bites have been reported. Delayed psychological effects such as depressive symptoms, post-traumatic stress disorder and somatisation have been reported. Blindness due to primary and secondary effects of venom is a serious, debilitating effect. In general, the available studies have linked a clinical effect to a snakebite in retrospect, hence lacked accurate snake authentication, details of acute management and baseline data and are unable to provide a detailed picture of clinical epidemiology of the long-term effects of envenoming. In the future, it will be important to follow cohorts of snakebite patients for a longer period of time to understand the true prevalence, severity, clinical progression and risk factors of long-term effects of snake envenoming.
Collapse
|
7
|
Pla D, Bande BW, Welton RE, Paiva OK, Sanz L, Segura Á, Wright CE, Calvete JJ, Gutiérrez JM, Williams DJ. Proteomics and antivenomics of Papuan black snake (Pseudechis papuanus) venom with analysis of its toxicological profile and the preclinical efficacy of Australian antivenoms. J Proteomics 2016; 150:201-215. [PMID: 27650695 DOI: 10.1016/j.jprot.2016.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 11/28/2022]
Abstract
The Papuan black snake (Pseudechis papuanus Serpentes: Elapidae) is endemic to Papua New Guinea, Indonesian Papua and Australia's Torres Strait Islands. We have investigated the biological activity and proteomic composition of its venom. The P. papuanus venom proteome is dominated by a variety (n≥18) of PLA2s, which together account for ~90% of the venom proteins, and a set of low relative abundance proteins, including a short-neurotoxic 3FTx (3.1%), 3-4 PIII-SVMPs (2.8%), 3 cysteine-rich secretory proteins (CRISP; 2.3%) 1-3 l-amino acid oxidase (LAAO) molecules (1.6%). Probing of a P. papuanus cDNA library with specific primers resulted in the elucidation of the full-length nucleotide sequences of six new toxins, including vespryn and NGF not found in the venom proteome, and a calglandulin protein involved in toxin expression with the venom glands. Intravenous injection of P. papuanus venom in mice induced lethality, intravascular haemolysis, pulmonary congestion and oedema, and anticoagulation after intravenous injection, and these effects are mainly due to the action of PLA2s. This study also evaluated the in vivo preclinical efficacy of Australian black snake and polyvalent Seqirus antivenoms. These antivenoms were effective in neutralising the lethal, PLA2 and anticoagulant activities of P. papuanus venom in mice. On the other hand, all of the Seqirus antivenoms tested using an antivenomic approach exhibited strong immunorecognition of all the venom components. These preclinical results suggest that Australian Seqirus1 antivenoms may provide paraspecific protection against P. papuanus venom in humans. SIGNIFICANCE PARAGRAPH The toxicological profile and proteomic composition of the venom of the Papuan black snake, Pseudechis papuanus, a large diurnal snake endemic to the southern coast of New Guinea and a handful of close offshore islands, were investigated. Intravenous injection of P. papuanus venom in mice induced intravascular hemolysis, pulmonary congestion and edema, anticoagulation, and death. These activities could be assigned to the set of PLA2 molecules, which dominate the P. papuanus venom proteome. This study also showed that Australian Seqirus black snake or polyvalent antivenoms were effective in neutralising the lethal, PLA2 and anticoagulant activities of the venom. These preclinical results support the continued recommendation of these Seqirus antivenoms in the clinical management of P. papuanus envenoming in Australia, Papua New Guinea or Indonesian Papua Province.
Collapse
Affiliation(s)
- Davinia Pla
- Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas (CSIC), Valencia, Spain
| | - Benjamin W Bande
- Charles Campbell Toxinology Centre, School of Medicine & Health Sciences, University of Papua New Guinea, Boroko, NCD, Papua New Guinea
| | - Ronelle E Welton
- Australian Venom Research Unit, Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Owen K Paiva
- Charles Campbell Toxinology Centre, School of Medicine & Health Sciences, University of Papua New Guinea, Boroko, NCD, Papua New Guinea
| | - Libia Sanz
- Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas (CSIC), Valencia, Spain
| | - Álvaro Segura
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Christine E Wright
- Australian Venom Research Unit, Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Victoria 3010, Australia; Cardiovascular Therapeutics Unit, Department of Pharmacology and Therapeutics, University of Melbourne, Victoria 3010, Australia
| | - Juan J Calvete
- Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas (CSIC), Valencia, Spain.
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica.
| | - David J Williams
- Charles Campbell Toxinology Centre, School of Medicine & Health Sciences, University of Papua New Guinea, Boroko, NCD, Papua New Guinea; Australian Venom Research Unit, Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Victoria 3010, Australia.
| |
Collapse
|
8
|
Persistent anosmia and olfactory bulb atrophy after mulga (Pseudechis australis) snakebite. J Clin Neurosci 2016; 29:199-201. [PMID: 26896910 DOI: 10.1016/j.jocn.2015.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/17/2015] [Indexed: 11/20/2022]
Abstract
Loss of sense of smell is an intriguing yet under-recognised complication of snakebite. We report olfactory function testing and neuroimaging of the olfactory bulbs in a 30-year-old man with anosmia persisting for more than 1year after mulga (Pseudechis australis) snakebite. This problem was first noted by the patient 1week after being definitely bitten in Queensland, Australia. He had then presented to a regional hospital where his envenomation was considered mild enough to not warrant antivenom administration. A week later the patient noted a reduction of sense of smell, which progressed to complete inability to smell over the ensuing weeks. On clinical review the patient's neurologic and rhinologic examination did not reveal any structural cause for anosmia. Formal olfactory testing was performed using ''sniffin' sticks" and the patient scored 17 on this test, indicating severe hyposmia (functional anosmia <16.5, normal score >30.3 for men aged 16-35years). MRI of the brain showed no abnormalities. The olfactory bulb volumes were then measured on a volumetric T2-weighted MRI that demonstrated significantly reduced volume of both bulbs, with the right 34.86mm(3) and left 36.25mm(3) (normal volume ⩾58mm(3), 10th centile). The current patient represents a rare instance of a definite, untreated, elapid (mulga snake) envenomation with an intriguing disjunction between the mildness of the systemic features and the severity of the olfactory lesion. It is also unclear if early antivenom use attenuates this condition, and due to the delayed manifestation of the symptoms, awareness of this phenomenon may be lacking amongst physicians.
Collapse
|
9
|
Ong HM, Witham A, Kelers K, Boller M. Presumed secondary immune-mediated haemolytic anaemia following elapid snake envenomation and its treatment in four dogs. Aust Vet J 2015; 93:319-26. [DOI: 10.1111/avj.12359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/05/2015] [Accepted: 02/09/2015] [Indexed: 01/10/2023]
Affiliation(s)
- HM Ong
- UVet Werribee Animal Hospital, University of Melbourne; 250 Princes Highway Werribee VIC 3030 Australia
| | - A Witham
- UVet Werribee Animal Hospital, University of Melbourne; 250 Princes Highway Werribee VIC 3030 Australia
| | - K Kelers
- UVet Werribee Animal Hospital, University of Melbourne; 250 Princes Highway Werribee VIC 3030 Australia
| | - M Boller
- UVet Werribee Animal Hospital, University of Melbourne; 250 Princes Highway Werribee VIC 3030 Australia
| |
Collapse
|
10
|
Abstract
Rhabdomyolysis is characterized by severe acute muscle injury resulting in muscle pain, weakness, and/or swelling with release of myofiber contents into the bloodstream. Symptoms develop over hours to days after an inciting factor and may be associated with dark pigmentation of the urine. Serum creatine kinase and urine myoglobin levels are markedly elevated. Clinical examination, history, laboratory studies, muscle biopsy, and genetic testing are useful tools for diagnosis of rhabdomyolysis, and they can help differentiate acquired from inherited causes of rhabdomyolysis. Acquired causes include substance abuse, medication or toxic exposures, electrolyte abnormalities, endocrine disturbances, and autoimmune myopathies. Inherited predisposition to rhabdomyolysis can occur with disorders of glycogen metabolism, fatty acid β-oxidation, and mitochondrial oxidative phosphorylation. Less common inherited causes of rhabdomyolysis include structural myopathies, channelopathies, and sickle-cell disease. This review focuses on the differentiation of acquired and inherited causes of rhabdomyolysis and proposes a practical diagnostic algorithm. Muscle Nerve 51: 793-810, 2015.
Collapse
Affiliation(s)
- Jessica R Nance
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew L Mammen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 50, Room 1146, Bethesda, Maryland, 20892, USA
| |
Collapse
|
11
|
Hart AJ, Hodgson WC, O'Leary M, Isbister GK. Pharmacokinetics and pharmacodynamics of the myotoxic venom of Pseudechis australis (mulga snake) in the anesthetised rat. Clin Toxicol (Phila) 2014; 52:604-10. [PMID: 24940643 DOI: 10.3109/15563650.2014.914526] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Myotoxicity is a common clinical effect of snake envenoming and results from either local or systemic myotoxins in snake venoms. Although numerous myotoxins have been isolated from snake venoms, there has been limited study on the relationship between the time course of venom concentrations (pharmacokinetics) and the time course of muscle injury measured as a rise in creatine kinase (CK) (pharmacodynamics). OBJECTIVE The aim of this study was to develop an in vivo model of myotoxicity to investigate the time course of myotoxicity and the effect of antivenom. MATERIALS AND METHODS Anesthetised rats were administered Pseudechis australis (mulga snake) venom either through i.v., i.m. or s.d. route, including a range of doses (5-100 μg/kg). Serial blood samples were collected for measurement of venom using enzyme immunoassay and measurement of CK and creatinine. Antivenom was administered before, 1 and 6 h after venom administration to investigate its effect on muscle injury. Plots of venom and CK versus time were made and the area under the curve (AUC) was calculated. RESULTS There was a significant dose-dependent increase in CK concentration after administration of P. australis venom, which was greatest for i.v. administration. Timed measurement of venom concentrations showed a rapid absorption through s.d. and i.m. routes and a delayed rise in CK concentrations following any route. Antivenom prevented myotoxicity shown by a decrease in the CK AUC, which was most effective if given earliest. There was a rise in creatinine following i.v. venom administration. CONCLUSION The study shows the delayed relationship between venom absorption and the rise in CK, consistent with the delayed onset of myotoxicity in human envenoming. Antivenom prevented myotoxicity more effectively if given earlier.
Collapse
Affiliation(s)
- A J Hart
- Department of Pharmacology, Monash Venom Group, Monash University , Victoria , Australia
| | | | | | | |
Collapse
|
12
|
Hart AJ, Isbister GK, O’Donnell P, Williamson NA, Hodgson WC. Species differences in the neuromuscular activity of post-synaptic neurotoxins from two Australian black snakes (Pseudechis porphyriacus and Pseudechis colletti). Toxicol Lett 2013; 219:262-8. [DOI: 10.1016/j.toxlet.2013.03.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/20/2013] [Accepted: 03/21/2013] [Indexed: 11/27/2022]
|
13
|
Johnston CI, Brown SGA, O'Leary MA, Currie BJ, Greenberg R, Taylor M, Barnes C, White J, Isbister GK. Mulga snake (Pseudechis australis) envenoming: a spectrum of myotoxicity, anticoagulant coagulopathy, haemolysis and the role of early antivenom therapy - Australian Snakebite Project (ASP-19). Clin Toxicol (Phila) 2013; 51:417-24. [PMID: 23586640 DOI: 10.3109/15563650.2013.787535] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Mulga snakes (Pseudechis australis) are venomous snakes with a wide distribution in Australia. Objective. The objective of this study was to describe mulga snake envenoming and the response of envenoming to antivenom therapy. MATERIALS AND METHODS Definite mulga bites, based on expert identification or venom-specific enzyme immunoassay, were recruited from the Australian Snakebite Project. Demographics, information about the bite, clinical effects, laboratory investigations and antivenom treatment are recorded for all patients. Blood samples are collected to measure the serum venom concentrations pre- and post-antivenom therapy using enzyme immunoassay. RESULTS There were 17 patients with definite mulga snake bites. The median age was 37 years (6-70 years); 16 were male and six were snake handlers. Thirteen patients had systemic envenoming with non-specific systemic symptoms (11), anticoagulant coagulopathy (10), myotoxicity (7) and haemolysis (6). Antivenom was given to ten patients; the median dose was one vial (range, one-three vials). Three patients had systemic hypersensitivity reactions post-antivenom. Antivenom reversed the coagulopathy in all cases. Antivenom appeared to prevent myotoxicity in three patients with high venom concentrations, given antivenom within 2 h of the bite. Median peak venom concentration in 12 envenomed patients with samples was 29 ng/mL (range, 0.6-624 ng/mL). There was a good correlation between venom concentrations and the area under the curve of the creatine kinase for patients receiving antivenom after 2 h. Higher venom concentrations were also associated with coagulopathy and haemolysis. Venom was not detected after antivenom administration except in one patient who had a venom concentration of 8.3 ng/ml after one vial of antivenom, but immediate reversal of the coagulopathy. DISCUSSION Mulga snake envenoming is characterised by myotoxicity, anticoagulant coagulopathy and haemolysis, and has a spectrum of toxicity that is venom dose dependant. This study supports a dose of one vial of antivenom, given as soon as a systemic envenoming is identified, rather than waiting for the development of myotoxicity.
Collapse
Affiliation(s)
- C I Johnston
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Pycroft K, Fry BG, Isbister GK, Kuruppu S, Lawrence J, Ian Smith A, Hodgson WC. Toxinology of Venoms from Five Australian Lesser Known Elapid Snakes. Basic Clin Pharmacol Toxicol 2012; 111:268-74. [DOI: 10.1111/j.1742-7843.2012.00907.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 05/22/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Kyle Pycroft
- Monash Venom Group, Department of Pharmacology; Monash University; Clayton Vic. Australia
| | - Bryan G. Fry
- Venom Evolution Laboratory; School of Biological Sciences, University of Queensland; Brisbane Qld Australia
| | - Geoffrey K. Isbister
- Monash Venom Group, Department of Pharmacology; Monash University; Clayton Vic. Australia
- Discipline of Clinical Pharmacology; University of Newcastle; Newcastle NSW Australia
| | - Sanjaya Kuruppu
- Department of Biochemistry and Molecular Biology; Monash University; Clayton Vic. Australia
| | - Josie Lawrence
- Department of Biochemistry and Molecular Biology; Monash University; Clayton Vic. Australia
| | - A. Ian Smith
- Department of Biochemistry and Molecular Biology; Monash University; Clayton Vic. Australia
| | - Wayne C. Hodgson
- Monash Venom Group, Department of Pharmacology; Monash University; Clayton Vic. Australia
| |
Collapse
|
15
|
Barber CM, Isbister GK, Hodgson WC. Solving the 'Brown snake paradox': in vitro characterisation of Australasian snake presynaptic neurotoxin activity. Toxicol Lett 2012; 210:318-23. [PMID: 22343038 DOI: 10.1016/j.toxlet.2012.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 02/01/2012] [Accepted: 02/01/2012] [Indexed: 11/19/2022]
Abstract
Pseudonaja textilis (Eastern Brown snake) and Oxyuranus scutellatus scutellatus (Coastal taipan) are clinically important Australian elapid snakes, whose potent venoms contain the presynaptic (β) neurotoxins, textilotoxin and taipoxin, respectively, and a number of postsynaptic neurotoxins. However, while taipan envenoming frequently results in neurotoxicity, Brown snake envenoming causes an isolated coagulopathy and neurotoxicity is rare. This phenomenon is called the 'Brown snake paradox'. This study compared the pharmacology of both venoms and their respective presynaptic neurotoxins to investigate this phenomenon. From size-exclusion high performance liquid chromatography (HPLC) analysis textilotoxin represents a significantly smaller proportion (5.7%) of P. textilis venom compared to taipoxin in O. s. scutellatus venom (20.4%). In the chick biventer cervicis nerve-muscle (CBCNM) preparation both venoms caused concentration-dependent neurotoxicity, with P. textilis venom being significantly more potent than O. s. scutellatus venom. Conversely, taipoxin was significantly more potent than textilotoxin when compared at the same concentration. Textilotoxin only partially contributed to the overall neurotoxicity of P. textilis venom, while taipoxin accounted for the majority of the neurotoxicity of O. s. scutellatus venom in the CBCNM preparation. Compared with taipoxin, textilotoxin is less potent and constitutes a smaller proportion of the venom. This is likely to be the reason for the absence of neurotoxicity in envenomed humans thus explaining the 'Brown snake paradox'.
Collapse
Affiliation(s)
- Carmel M Barber
- Monash Venom Group, Department of Pharmacology, Monash University, Victoria, Australia
| | | | | |
Collapse
|
16
|
de Roodt AR, Lago NR, Stock RP. Myotoxicity and nephrotoxicity by Micrurus venoms in experimental envenomation. Toxicon 2012; 59:356-64. [DOI: 10.1016/j.toxicon.2011.11.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 11/09/2011] [Accepted: 11/10/2011] [Indexed: 11/30/2022]
|
17
|
Lane J, O’Leary M, Isbister G. Coagulant effects of black snake (Pseudechis spp.) venoms and in vitro efficacy of commercial antivenom. Toxicon 2011; 58:239-46. [DOI: 10.1016/j.toxicon.2011.05.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 05/29/2011] [Accepted: 05/31/2011] [Indexed: 11/30/2022]
|
18
|
Hart AJ, Hodgson WC, Scott-Davey T, Harris JB. Neuromuscular toxicology of the venom of Collett's snake (Pseudechis colletti
): A histopathological study. Muscle Nerve 2011; 43:552-9. [DOI: 10.1002/mus.21916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2010] [Indexed: 11/07/2022]
|
19
|
Churchman A, O'Leary MA, Buckley NA, Page CB, Tankel A, Gavaghan C, Holdgate A, Brown SGA, Isbister GK. Clinical effects of red‐bellied black snake (
Pseudechis porphyriacus
) envenoming and correlation with venom concentrations: Australian Snakebite Project (ASP‐11). Med J Aust 2010; 193:696-700. [DOI: 10.5694/j.1326-5377.2010.tb04108.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Accepted: 10/18/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew Churchman
- Emergency Department, Princess Alexandra Hospital, Brisbane, QLD
| | - Margaret A O'Leary
- Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, NSW
| | - Nicholas A Buckley
- Medical Professorial Unit, Prince of Wales Hospital Medical School, University of New South Wales, Sydney, NSW
| | - Colin B Page
- Emergency Department, Princess Alexandra Hospital, Brisbane, QLD
- Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, NSW
| | - Alan Tankel
- Emergency Department, Coffs Harbour Base Hospital, Coffs Harbour, NSW
| | - Chris Gavaghan
- Emergency Department, Lismore Base Hospital, Lismore, NSW
| | - Anna Holdgate
- Emergency Department, Liverpool Hospital, Sydney, NSW
- Department of Anaesthetics, Emergency Medicine and Intensive Care, University of New South Wales, Sydney, NSW
| | - Simon G A Brown
- Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research, Perth, WA
- Emergency Medicine, Royal Perth Hospital, University of Western Australia, Perth, WA
| | - Geoffrey K Isbister
- Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, NSW
- Discipline of Clinical Pharmacology, University of Newcastle, Newcastle, NSW
| |
Collapse
|
20
|
|
21
|
Keyler DE. Envenomation by the lowland viper (Proatheris superciliaris): Severe case profile documentation. Toxicon 2008; 52:836-41. [DOI: 10.1016/j.toxicon.2008.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 10/08/2008] [Accepted: 10/10/2008] [Indexed: 10/21/2022]
|
22
|
Hart A, Scott-Davey T, Harris J. Venom of Collett's snake (Pseudechis colletti) blocks the binding of α-bungarotoxin to acetylcholine receptors at chick but not human neuromuscular junctions: A histochemical study. Toxicon 2008; 52:647-50. [DOI: 10.1016/j.toxicon.2008.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 07/17/2008] [Accepted: 07/22/2008] [Indexed: 10/21/2022]
|
23
|
Vohra R, Clark R, Shah N. A pilot study of occupational envenomations in North American zoos and aquaria. Clin Toxicol (Phila) 2008; 46:790-3. [PMID: 18803120 DOI: 10.1080/15563650802210095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To characterize occupational envenomations from exotic and native creatures, we surveyed North American zoos and aquaria. METHODS Survey questionnaires were mailed to curators at 216 zoos/aquaria which are accredited by the Association of Zoos and Aquariums (AZA) and listed on the AZA website. Reptile curators were asked to complete the zoo surveys. The questions addressed the number and types of bites, availability of antivenom (AV) on the premises, and sources of general information about envenoming. Responses were kept anonymous. RESULTS A total of 216 surveys were mailed. The response rate was 58% for this pilot research project. Twenty-six (21%) of responding institutions replied that they had at least one incident of bite from a venomous species in the last 10 years. Species of animals included a variety of native and exotic terrestrial and marine species. There were no deaths or serious outcomes reported as complications of these incidents. Less than one-third of responding institutions reported having AVs on-site for medical use in case of envenomations. A variety of information sources, including internally developed protocols and poison center resources, were reported as sources of envenoming information for respondents. CONCLUSIONS Clinicians and toxicologists should be prepared to care for cases of envenomations from exotic zoo or aquarium species such as the ones identified in this survey in their practice regions.
Collapse
Affiliation(s)
- Rais Vohra
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Olive View Medical Center, Sylmar, CA, USA.
| | | | | |
Collapse
|
24
|
Isbister GK, Williams V, Brown SGA, White J, Currie BJ. Clinically applicable laboratory end-points for treating snakebite coagulopathy. Pathology 2007; 38:568-72. [PMID: 17393987 DOI: 10.1080/00313020601024045] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS To determine which coagulation tests best reflect the return of clotting function after snakebite venom induced consumptive coagulopathy (VICC). METHODS Cases of snake envenoming were prospectively recruited to the Australian Snakebite Project (ASP). This study examined cases with VICC treated with antivenom and monitored with serial measures of clottable fibrinogen, prothrombin time (PT) and activated partial thromboplastin time (aPTT). The main outcome measures were times from antivenom treatment until a moderate recovery in the PT (<24 seconds), a measurable aPTT and detectable fibrinogen. RESULTS Forty-six cases were examined, including 27 brown snakes with proven complete venom neutralisation by antivenom in 25, 16 tiger snake group and three taipans. The times from initial antivenom dose to recovery were: PT<24 seconds, median 9.2 hours (IQR 6.2-11.3 hours); measurable aPTT, median 5.2 hours (IQR 3.4-8.8 hours); and detectable fibrinogen, median 8.8 hours (IQR 5.4-11.7 hours). In 10 cases where fibrinogen was detectable earlier than recovery of the PT, the mean fibrinogen was 0.25 g/L (SD 0.10) compared with 0.6 g/L (SD 0.28) in the remaining 36 cases (p<0.0001), reflecting differing sensitivities between laboratories. In only three patients (7%) was fibrinogen measurable before the other two outcomes, using highly sensitive fibrinogen assays. CONCLUSION The combination of the PT and aPTT is an effective, clinically available and cost-effective end-point for treating VICC, and may take longer to return to normal after venom neutralisation than previously believed. The fibrinogen assays that are generally in use do not provide any additional useful information.
Collapse
Affiliation(s)
- Geoffrey K Isbister
- Tropical Toxinology Unit, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | | | | | | | | |
Collapse
|
25
|
Jansen M, McLeod M, White J, Isbister GK. Spotted black snake (Pseudechis guttatus) envenoming. Med J Aust 2007; 186:41-2. [PMID: 17229034 DOI: 10.5694/j.1326-5377.2007.tb00788.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 10/09/2006] [Indexed: 11/17/2022]
Abstract
We report two cases of spotted black snake (Pseudechis guttatus) envenoming. One patient experienced localised burning pain around the bite and developed nausea, vomiting, diarrhoea, upper abdominal cramping and diaphoresis. He was treated with intravenous fluids and antiemetics, but no antivenom, and was discharged 23 hours after the bite. The second patient developed a severe headache, blurred vision and mild nausea, associated with severe pain and swelling of the bitten limb that took 4 days to resolve. No antivenom was given and the patient had no sequelae. Neither patient developed significant coagulopathy, myolysis or neuromuscular paralysis. Bites by this species appear to cause effects similar to those of the more common red-bellied black snake (P. porphyriacus).
Collapse
Affiliation(s)
- Melanie Jansen
- School of Medical Practice and Population Health, University of Newcastle, Newcastle, NSW, Australia.
| | | | | | | |
Collapse
|