Hepatotoxicity of hornet's venom sac extract, after repeated in vivo and in vitro envenomation

Wasp envenomation-induced acute renal failure: a report of three cases

Acute renal failure is an unusual complication of wasp stings. We report three cases who developed acute renal failure after multiple wasp stings (Vespa magnifica). Two patients had evidence of intravascular haemolysis and rhabdomyolysis whereas one patient investigation showed no evidence of intravascular haemolysis or rhabdomyolysis. All three cases had impaired liver functions. Oligo-anuria was seen in all three of the patients and all of them required dialytic support. One patient died of massive gastrointestinal bleeding while the remaining two recovered completely. Although acute renal failure after wasp stings is typically caused by acute tubular necrosis in the setting of haemolysis or rhabdomyolysis, in some patients, renal failure may result from a direct nephrotoxic effect or acute interstitial nephritis from a hypersensitivity reaction to the wasp venom.

Acute interstitial nephritis and pigmented tubulopathy in a patient after wasp stings

Acute renal failure (ARF) is an unusual complication of wasp stings and mostly results from toxic-ischemic acute tubular necrosis. This patient, who was stung by a swarm of wasps, experienced an allergic reaction, rhabdomyolysis, intravascular hemolysis, and subsequent ARF. The originality of this case report is related to the finding of combined lesions of acute tubulointerstitial nephritis and acute tubular nephropathy. From our extensive literature review, it is the first case of a patient developing this type of injury after wasp stings, and the complications have been documented previously only in one form or another. Renal biopsy should be encouraged, especially for a patient with delayed recovery of renal function after wasp stings, to facilitate early steroid treatment for the patient with the histological change of acute interstitial nephritis. Early use of steroid therapy may hasten renal recovery by preventing the development of interstitial fibrosis.

Acute renal failure after massive honeybee stings

Two clinical cases of patients who survived after numerous attacks of Africanized bees (600 and 1500 bee stings, respectively) are reported. Clinical manifestation was characterized by diffuse and widespread edema, a burning sensation in the skin, headache, weakness, dizziness, generalized paresthesia, somnolence and hypotension. Acute renal failure developed and was attributed to hypotension, intravascular hemolysis, myoglobinuria due to rhabdomyolysis and probably to direct toxic effect of the massive quantity of injected venom. They were treated with antihistaminic, corticosteroids and fluid infusion. One of them had severe acute renal failure and dialysis was required. No clinical complication was observed during hospital stay and complete renal function recovery was observed in both patients. In conclusion, acute renal failure after bee stings is probably due to pigment nephropathy associated with hypovolemia. Early recognition of this syndrome is crucial to the successful management of these patients.

Multiple hornet (Vespa orientalis) stings with fatal outcome in a child

A case of multiple hornet stings is described with a rapidly fatal course due to the combination of massive haemolysis, coagulopathy, rhabdomyolysis, hyperkalaemia, acute renal failure, encephalopathy, hepatotoxicity and hyperglycaemia. These features of systemic envenomation can all be attributed to the toxic properties of Oriental hornet venom described in in vitro and in vivo experimental studies. Greater awareness of these features, aggressive treatment of hyperkalaemia and early institution of treatments such as peritoneal dialysis and plasma exchange may prevent fatalities in such cases.

Hepatotoxic effects of repeated administration of oriental hornet (Vespa orientalis) venom

Venom sac extract (VSE) of the Oriental hornet (Vespa orientalis) has been shown to exert a toxic effect on hepatic cells. The present work set out to examine its effect on liver cells using serum levels of a lysosomal hydrolase as a marker of injury in rats. Serum activities of beta-N-acetyl hexosaminidase (BNAH; EC 3.2.1.30) were found to be positively correlated with the number of treatments received by the rats. The maximal elevation occurred from the third to the sixth day and comprised a 2-3-fold increase over the control mean level. This enhancement effect was reversible. The rat envenomend for 2 wk showed 3.5 times as much BNAH activity as in control rats. Biochemical analysis revealed increased specific activity of the lysosomal enzyme in rats treated repeatedly with VSE.

Liver damage induced by Oriental hornet venom sac extract at the level of subcellular fractions

The hepatotoxic effect of venom sac extract (VSE) of the Oriental hornet has already been demonstrated using the well-known models of experimental toxicology: in vivo, isolated in situ and in vitro. The present work deals with a series of 48 rats treated daily with 5 mg VSE/kg body weight for 1-14 days. Serum activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) were measured. Liver tissue fractionation was performed. Detailed information on the topographical and functional aspects of some enzyme changes was obtained in respect to the number of envenomations. The biochemical alterations are partially reversible. The biochemically proven liver damage induced by VSE correlated well with previous electron microscopic observations of damage to mitochondria and cell membranes.

Gamma-glutamyltranspeptidase in murine lymphomas

Five murine lymphoma cell lines were assayed for the content and activity of gamma-glutamyltranspeptidase (GTT). All lines [S49; L-12; 230-23-8 (C57 Black); 2M3 and RA3-2C2] contained detectable amounts of GGT. The specific activities of GGT were low and ranged between 1.2 and 2.3 mU/mg protein in cells growth in vitro. A highly malignant variant of the S49 line was also grown in vivo in BALB/c mice. This subline invariably produces both solid and ascitic tumors with infiltrations into the pancreas, liver and spleen. GGT levels in the tumor cells were low and independent of tumor type (solid, ascitic), location, passage number or inoculum size. Infiltrations of S49 tumor cells in liver and spleen were invariably GGT--negative as judged by histochemical examination. GGT activities in suspension cultures prepared from solid, as well ascitic tumors were low. Occasional high GGT activity of solid tumors was due to the presence of pancreas cells in them. The only host tissue significantly responding to the presence of tumors by elevated GGT levels was the liver. Compilation of data from this study and those of others clearly indicates that low GGT level is a typical property of tumors originating in the immune system.

Histopathological changes in rat liver following repeated vespine envenomation

The histopathological picture of rat liver was studied after repeated envenomation with hornet (Vespa orientalis) venom sac extract (VSE). Light microscopical and histochemical investigation showed foci of necrosis of the hepatocytes, a decrease in glycogen content and in succinic dehydrogenase activity, some fat infiltration and an increase in alkaline phosphatase activity. Electron microscopy showed a decrease in the number of mitochondria per cell as well as a decrease in their cristae, enlargement of bile canaliculi, and destruction of the endothelium of the sinusoids bringing the cytoplasm of the necrotic hepatocytes in contact with the lumen of the sinusoid. The rat liver is proposed as a model for the study of pathological effects of animal toxins.

Multiple hornet stings with features of Reye's syndrome

Hornet's venom is known to possess a variety of toxic effects. A 19-mo-old girl who developed a Reye-like syndrome following multiple stings by the Oriental hornet (Vespa orientalis) is described. She presented with encephalopathy associated with hepatomegaly, elevated transaminase levels, low prothrombin time, and hyperammonemia. Liver biopsy demonstrated microvesicular fatty infiltration and diffuse mitochondrial changes. Additional features were acute renal tubular necrosis and massive hemolysis.

Hepatotoxicity of hornet's venom sac extract in isolated perfused rat liver

The changes in the activity of some enzymes in parenchymal liver cells were measured in the perfusate of rat isolated liver after a single envenomation with two different doses of Hornet's (Vespa orientalis) venom sac extract (VSE). The maximal observed enzymatic changes were significant: twenty four fold rise of alkaline phosphatase E.C.3.1.3.1(ALP), six fold rise of alanine aminotransferase E.C.2.6.1.2. (ALT) and nine fold rise of aspartate aminotransferase E.C.2.6.1.1. (AST) activity. There were moderate changes (four fold) in lactic dehydrogenase activity E.C.1.1.1.2.7. (LDH) and a non-significant change in gamma-glutamyl-transferase E.C.2.3.2.1. (GGT) activity. These changes varied with the venom's dose. Also a decrease in the rate of effluent draining out via the hepatic vein was noted as an additional sign of liver damage. In light of the biochemical evidence presented here, as well as in previous work, it seems that no further biochemical proof is needed to establish the hepatotoxicity of VSE in rats, cats and probably humans too. It seems that VSE is a predictable hepatotoxin causing a pattern of enzyme changes of the cholangiocellular type.