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Roman-Ramos H, Prieto-da-Silva ÁRB, Dellê H, Floriano RS, Dias L, Hyslop S, Schezaro-Ramos R, Servent D, Mourier G, de Oliveira JL, Lemes DE, Costa-Lotufo LV, Oliveira JS, Menezes MC, Markus RP, Ho PL. The Cloning and Characterization of a Three-Finger Toxin Homolog (NXH8) from the Coralsnake Micrurus corallinus That Interacts with Skeletal Muscle Nicotinic Acetylcholine Receptors. Toxins (Basel) 2024; 16:164. [PMID: 38668589 PMCID: PMC11054780 DOI: 10.3390/toxins16040164] [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: 02/01/2024] [Revised: 03/04/2024] [Accepted: 03/20/2024] [Indexed: 04/29/2024] Open
Abstract
Coralsnakes (Micrurus spp.) are the only elapids found throughout the Americas. They are recognized for their highly neurotoxic venom, which is comprised of a wide variety of toxins, including the stable, low-mass toxins known as three-finger toxins (3FTx). Due to difficulties in venom extraction and availability, research on coralsnake venoms is still very limited when compared to that of other Elapidae snakes like cobras, kraits, and mambas. In this study, two previously described 3FTx from the venom of M. corallinus, NXH1 (3SOC1_MICCO), and NXH8 (3NO48_MICCO) were characterized. Using in silico, in vitro, and ex vivo experiments, the biological activities of these toxins were predicted and evaluated. The results showed that only NXH8 was capable of binding to skeletal muscle cells and modulating the activity of nAChRs in nerve-diaphragm preparations. These effects were antagonized by anti-rNXH8 or antielapidic sera. Sequence analysis revealed that the NXH1 toxin possesses eight cysteine residues and four disulfide bonds, while the NXH8 toxin has a primary structure similar to that of non-conventional 3FTx, with an additional disulfide bond on the first loop. These findings add more information related to the structural diversity present within the 3FTx class, while expanding our understanding of the mechanisms of the toxicity of this coralsnake venom and opening new perspectives for developing more effective therapeutic interventions.
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Affiliation(s)
- Henrique Roman-Ramos
- Laboratório de Biotecnologia, Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo 01504-001, SP, Brazil; (H.D.); (J.L.d.O.); (D.E.L.)
| | | | - Humberto Dellê
- Laboratório de Biotecnologia, Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo 01504-001, SP, Brazil; (H.D.); (J.L.d.O.); (D.E.L.)
| | - Rafael S. Floriano
- Laboratório de Toxinologia e Estudos Cardiovasculares, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente 19067-175, SP, Brazil;
| | - Lourdes Dias
- Departamento de Farmacologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil; (L.D.); (S.H.); (R.S.-R.)
| | - Stephen Hyslop
- Departamento de Farmacologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil; (L.D.); (S.H.); (R.S.-R.)
| | - Raphael Schezaro-Ramos
- Departamento de Farmacologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil; (L.D.); (S.H.); (R.S.-R.)
| | - Denis Servent
- Service d’Ingénierie Moléculaire pour la Santé (SIMoS), Département Médicaments et Technologies pour la Santé, Université Paris Saclay, Commissariat à l’énergie Atomique et aux Énergies Alternatives (CEA), F-91191 Gif sur Yvette, France; (D.S.); (G.M.)
| | - Gilles Mourier
- Service d’Ingénierie Moléculaire pour la Santé (SIMoS), Département Médicaments et Technologies pour la Santé, Université Paris Saclay, Commissariat à l’énergie Atomique et aux Énergies Alternatives (CEA), F-91191 Gif sur Yvette, France; (D.S.); (G.M.)
| | - Jéssica Lopes de Oliveira
- Laboratório de Biotecnologia, Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo 01504-001, SP, Brazil; (H.D.); (J.L.d.O.); (D.E.L.)
| | - Douglas Edgard Lemes
- Laboratório de Biotecnologia, Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo 01504-001, SP, Brazil; (H.D.); (J.L.d.O.); (D.E.L.)
| | - Letícia V. Costa-Lotufo
- Departamento de Farmacologia, Instituto de Ciências Biomédicas, Universidade de São Paulo (USP), São Paulo 05508-000, SP, Brazil;
| | - Jane S. Oliveira
- Centro de Biotecnologia, Instituto Butantan, São Paulo 05503-900, SP, Brazil;
| | | | - Regina P. Markus
- Laboratório de Cronofarmacologia, Instituto de Biociências, Universidade de São Paulo (USP), São Paulo 05508-090, SP, Brazil;
| | - Paulo Lee Ho
- Centro Bioindustrial, Instituto Butantan, São Paulo 05503-900, SP, Brazil;
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Duque BR, Bruno SF, Ferreira V, Guedes TB, Machado C, Hamdan B. Venomous snakes of medical importance in the Brazilian state of Rio de Janeiro: habitat and taxonomy against ophidism. BRAZ J BIOL 2023; 83:e272811. [PMID: 37909585 DOI: 10.1590/1519-6984.272811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/19/2023] [Indexed: 11/03/2023] Open
Abstract
Snakebite envenoming is a major global health problem that kills or disables half a million people in the world's poorest countries. Identifying the biting snake and its habitat use is key to understanding snakebite eco-epidemiology and optimizing its clinical management. To prevent and combat the neglected snakebite disease, we characterize the morphology, geographic distribution, habitat use, and snakebites of medically important venomous snakes in the state of Rio de Janeiro (Brazil). Despite Philodryas spp. not being considered of medical importance by the Brazilian Ministry of Health, we also explore their data once the bites may require medical intervention, may cause death, and their consequences are underestimated. Methods: We assessed taxonomy and geographic data from specimens housed in scientific collections, the literature, and the Notifiable Diseases Information System. Our data revealed fragility in the morphological characters recommended to distinguish Bothrops jararaca from B. jararacussu, identify the subspecies of Crotalus durissus and distinguish the species of Philodryas. To help identify these species, we present an identification key to the venomous snake species from Rio de Janeiro based on the morphological data collected. We record the genera Bothrops and Micrurus in all mesoregions of the state. Here, we provide the first record of C. durissus in the Serrana region, supporting the hypothesis of geographic expansion of the species in the state. The crotalic antivenom must not be missing in Médio Paraíba, Centro-Sul Fluminense, and Serrana, where the rattlesnake C. durissus occurs. Bothrops bilineatus and Lachesis muta have historical records presented for the first time herein. However, these species are likely endangered or extinct in the state. There were 7,483 snakebites reported between 2001 and 2019, with an annual average of 393.8 cases. The Bothrops genus is responsible for the majority of accidents. The highest number of cases occurred in the Serrana region, the largest pole of family agriculture in Rio de Janeiro. We improve the identification of venomous snake species, better delimit their distribution, and update the number of cases of snakebites, thus providing greater precision in the attention to this problem in Rio de Janeiro. We emphasize the importance of clinical studies to test using bothropic-crotalic antivenom and heparin in all mesoregions to treat B. jararacussu envenomation; and mechanical ventilation, atropine, and anticholinesterases in the emergency health centers in the Metropolitana and Norte Fluminense regions due to the occurrence of the coral M. lemniscatus in these areas.
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Affiliation(s)
- B R Duque
- Instituto Vital Brazil - IVB, Laboratório de Coleções Biológicas e Biodiversidade, Diretoria Científica, Niterói, RJ, Brasil
- Universidade Federal do Estado do Rio de Janeiro - UNIRIO, Programa de Pós-graduação em Ecoturismo e Conservação, Rio de Janeiro, RJ, Brasil
| | - S F Bruno
- Universidade Federal Fluminense - UFF, Faculdade de Veterinária, Niterói, RJ, Brasil
| | - V Ferreira
- Instituto Vital Brazil - IVB, Laboratório de Coleções Biológicas e Biodiversidade, Diretoria Científica, Niterói, RJ, Brasil
| | - T B Guedes
- Universidade Estadual de Campinas - UNICAMP, Instituto de Biologia, Departamento de Biologia Animal, Campinas, SP, Brasil
- University of Gothenburg, Gothenburg Global Biodiversity Center - GGBC, Department of Biological and Environmental Sciences, Göteborg, Sweden
| | - C Machado
- Instituto Vital Brazil - IVB, Laboratório de Coleções Biológicas e Biodiversidade, Diretoria Científica, Niterói, RJ, Brasil
| | - B Hamdan
- Instituto Vital Brazil - IVB, Laboratório de Coleções Biológicas e Biodiversidade, Diretoria Científica, Niterói, RJ, Brasil
- Universidade Federal do Rio de Janeiro - UFRJ, Instituto de Bioquímica Médica Leopoldo de Meis, Laboratório de Hemostase e Venenos, Rio de Janeiro, RJ, Brasil
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Silva-Carvalho R, Gaspar MZ, Quadros LHB, Lobo LGG, Giuffrida R, Santarém CL, Silva EO, Gerez JR, Silva NJ, Hyslop S, Lomonte B, Floriano RS. Partial efficacy of a Brazilian coralsnake antivenom and varespladib in neutralizing distinct toxic effects induced by sublethal Micrurus dumerilii carinicauda envenoming in rats. Toxicon 2022; 213:99-104. [PMID: 35489427 DOI: 10.1016/j.toxicon.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/31/2022] [Accepted: 04/20/2022] [Indexed: 11/26/2022]
Abstract
In this work, we report the efficacy of a combination of Brazilian therapeutic coralsnake antivenom (CAV) and varespladib (phospholipase A2 inhibitor - VPL) in partially neutralizing selected toxic effects of Micrurus dumerilii carinicauda coralsnake venom in rats. Venom caused local myonecrosis and systemic neurotoxicity, nephrotoxicity, and hepatotoxicity within 2 h of injection. CAV and VPL administered separately failed to prevent most of these alterations. However, a combination of CAV plus VPL offered variable protection against venom-induced coagulation disturbances, leukocytosis, and renal and hepatic morphological alterations.
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Affiliation(s)
- Rosimeire Silva-Carvalho
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo, Rodovia Raposo Tavares Km 572, B2-205, 19067-175, Presidente Prudente, SP, Brazil
| | - Matheus Z Gaspar
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo, Rodovia Raposo Tavares Km 572, B2-205, 19067-175, Presidente Prudente, SP, Brazil
| | - Luiz H B Quadros
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo, Rodovia Raposo Tavares Km 572, B2-205, 19067-175, Presidente Prudente, SP, Brazil
| | - Luís G G Lobo
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo, Rodovia Raposo Tavares Km 572, B2-205, 19067-175, Presidente Prudente, SP, Brazil
| | - Rogério Giuffrida
- Graduate Program in Animal Sciences, University of Western São Paulo, Rodovia Raposo Tavares Km 572, 19067-175, Presidente Prudente, SP, Brazil
| | - Cecília L Santarém
- Graduate Program in Animal Sciences, University of Western São Paulo, Rodovia Raposo Tavares Km 572, 19067-175, Presidente Prudente, SP, Brazil
| | - Elisangela O Silva
- Graduate Program in Animal Sciences, University of Western São Paulo, Rodovia Raposo Tavares Km 572, 19067-175, Presidente Prudente, SP, Brazil
| | - Juliana R Gerez
- Department of Histology, State University of Londrina (UEL), Rodovia Celso Garcia Cid Km 380, 86057-970, Londrina, PR, Brazil
| | - Nelson J Silva
- Graduate Program in Environmental Sciences and Health, School of Medical, Pharmaceutical and Biomedical Sciences, Pontifical Catholic University of Goiás (PUC-Goiás), 74605-140, Goiânia, GO, Brazil
| | - Stephen Hyslop
- Section of Pharmacology, Department of Translational Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, 13083-887, Campinas, SP, Brazil
| | - Bruno Lomonte
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, 11501, San José, Costa Rica.
| | - Rafael S Floriano
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo, Rodovia Raposo Tavares Km 572, B2-205, 19067-175, Presidente Prudente, SP, Brazil.
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In vivo treatment with varespladib, a phospholipase A 2 inhibitor, prevents the peripheral neurotoxicity and systemic disorders induced by Micrurus corallinus (coral snake) venom in rats. Toxicol Lett 2021; 356:54-63. [PMID: 34774704 DOI: 10.1016/j.toxlet.2021.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/14/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022]
Abstract
In this study, we investigated the action of varespladib (VPL) alone or in combination with a coral snake antivenom (CAV) on the local and systemic effects induced by Micrurus corallinus venom in rats. Adult male Wistar rats were exposed to venom (1.5 mg/kg - i.m.) and immediately treated with CAV (antivenom:venom ratio 1:1.5 'v/w' - i.p.), VPL (0.5 mg/kg - i.p.), or both of these treatments. The animals were monitored for 120 min and then anesthetized to collect blood samples used for haematological and serum biochemical analysis; after euthanasia, skeletal muscle, renal and hepatic tissue samples were collected for histopathological analysis. M. corallinus venom caused local oedema without subcutaneous haemorrhage or apparent necrosis formation, although there was accentuated muscle morphological damage; none of the treatments prevented oedema formation but the combination of CAV and VPL reduced venom-induced myonecrosis. Venom caused neuromuscular paralysis and respiratory impairment in approximately 60 min following envenomation; CAV alone did not prevent the neurotoxic action, whereas VPL alone prevented neurotoxic symptoms developing as did the combination of CAV and VPL. Venom induced significant increase of serum CK and AST release, mostly due to local and systemic myotoxicity, which was partially prevented by the combination of CAV and VPL. The release of hepatotoxic serum biomarkers (LDH and ALP) induced by M. corallinus venom was not prevented by CAV and VPL when individually administered; their combination effectively prevented ALP release. The venom-induced nephrotoxicity (increase in serum creatinine concentration) was prevented by all the treatments. VPL alone or in combination with CAV significantly prevented the venom-induced lymphocytosis. In conclusion, VPL shows to be effective at preventing the neurotoxic, nephrotoxic, and inflammatory activities of M. corallinus venom. In addition, VPL acts synergistically with antivenom to prevent a number of systemic effects caused by M. corallinus venom.
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Mack N, Reyes AJ, Ramcharan K, Giddings SL. Acute myasthenic syndrome following coral snake envenomation in the Caribbean: a harbinger for admission to the intensive care unit. BMJ Case Rep 2021; 14:e241991. [PMID: 33766976 PMCID: PMC8006831 DOI: 10.1136/bcr-2021-241991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Narine Mack
- Medicine, San Fernando General Hospital, San Fernando, Trinidad and Tobago
| | - Antonio Jose Reyes
- Medicine, Neurology Unit, San Fernando Teaching Hospital, San Fernando, Trinidad and Tobago
| | | | - Stanley Lawrence Giddings
- Medicine, University of the West Indies at Saint Augustine, Saint Augustine, Tunapuna-Piarco, Trinidad and Tobago
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Reis LDPG, Botelho AFM, Novais CR, Fiúza ATL, Barreto MSO, Ferreira MG, Bonilla C, Chavez-Olórtegui C, Melo MM. Cardiotoxic Effects of Micrurus surinamensis (Cuvier, 1817) Snake Venom. Cardiovasc Toxicol 2021; 21:462-471. [PMID: 33559838 DOI: 10.1007/s12012-021-09640-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/28/2021] [Indexed: 11/25/2022]
Abstract
Micrurus surinamensis is a coral snake from the Elapidae family of wide distribution in Amazonia Forest. Its venom contains neurotoxins that induce muscular and respiratory paralysis; however, its cardiovascular action is not yet characterized. The aim of this study was to investigate the cardiotoxic effects caused by M. surinamensis poisoning in rodents. Twelve guinea pigs (Cavia porcellus) were distributed in two groups (n = 6) named as control and envenomed. The control group received 0.2 ml of PBS/BSA via intramuscular injection (IM), while envenomed animals received 0.75 µg of venom per g of body weight, also via IM. Electrocardiographic examination (ECG) and biochemical serum tests were conducted before and 2 h after inoculation. ECG of the envenomed animals revealed severe progressive arrhythmias including atrioventricular block, supraventricular, and ventricular extrasystoles. Serum biochemistry showed significant increase in CK, CK-MB, and LDH enzymes corroborating the skeletal and cardiac muscle damage. Myonecrosis and degeneration were observed in both skeletal and heart muscle; nevertheless, transmission electron microscopy revealed cardiac muscle fibers fragmentation. In conclusion, M. surinamensis venom has a potent cardiotoxic activity eliciting arrhythmogenic effects and heart damage after only 2 h of envenomation.
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Affiliation(s)
- Lilian de Paula Gonçalves Reis
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ana Flávia Machado Botelho
- Departamento de Medicina Veterinária, Escola de Veterinária e Zootecnia, Universidade Federal de Goiás, Rodovia Goiânia- Nova Veneza, km 8, Campus Samambaia, Goiânia, GO, 74690-900, Brazil.
| | - Clara Rojo Novais
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Aparecida Tatiane Lino Fiúza
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maira Souza Oliveira Barreto
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marina Guimarães Ferreira
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Carlos Chavez-Olórtegui
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marília Martins Melo
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Pucca MB, Knudsen C, S. Oliveira I, Rimbault C, A. Cerni F, Wen FH, Sachett J, Sartim MA, Laustsen AH, Monteiro WM. Current Knowledge on Snake Dry Bites. Toxins (Basel) 2020; 12:E668. [PMID: 33105644 PMCID: PMC7690386 DOI: 10.3390/toxins12110668] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022] Open
Abstract
Snake 'dry bites' are characterized by the absence of venom being injected into the victim during a snakebite incident. The dry bite mechanism and diagnosis are quite complex, and the lack of envenoming symptoms in these cases may be misinterpreted as a miraculous treatment or as proof that the bite from the perpetrating snake species is rather harmless. The circumstances of dry bites and their clinical diagnosis are not well-explored in the literature, which may lead to ambiguity amongst treating personnel about whether antivenom is indicated or not. Here, the epidemiology and recorded history of dry bites are reviewed, and the clinical knowledge on the dry bite phenomenon is presented and discussed. Finally, this review proposes a diagnostic and therapeutic protocol to assist medical care after snake dry bites, aiming to improve patient outcomes.
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Affiliation(s)
- Manuela B. Pucca
- Medical School, Federal University of Roraima, Boa Vista 69310-000, Roraima, Brazil;
| | - Cecilie Knudsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark; (C.K.); (C.R.); (A.H.L.)
- Bioporto Diagnostics A/S, DK-2900 Hellerup, Denmark
| | - Isadora S. Oliveira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo 14049-900, Brazil; (I.S.O.); (F.A.C.)
| | - Charlotte Rimbault
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark; (C.K.); (C.R.); (A.H.L.)
| | - Felipe A. Cerni
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo 14049-900, Brazil; (I.S.O.); (F.A.C.)
| | - Fan Hui Wen
- Butantan Institute, São Paulo 05503-900, Brazil;
| | - Jacqueline Sachett
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus 69065-001, Amazonas, Brazil;
- Department of Teaching and Research, Alfredo da Matta Foundation, Manaus 69065-130, Amazonas, Brazil
| | - Marco A. Sartim
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil;
- Institute of Biological Sciences, Amazonas Federal University, Manaus 69067-005, Amazonas, Brazil
| | - Andreas H. Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark; (C.K.); (C.R.); (A.H.L.)
| | - Wuelton M. Monteiro
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus 69065-001, Amazonas, Brazil;
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil;
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Bisneto PF, Araújo BDS, Pereira HDS, Mendonça da Silva I, Sachett JDAG, Bernarde PS, Monteiro WM, Kaefer IL. Envenomations by coral snakes in an Amazonian metropolis: Ecological, epidemiological and clinical aspects. Toxicon 2020; 185:193-202. [PMID: 32710896 DOI: 10.1016/j.toxicon.2020.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022]
Abstract
Envenomation by coral snakes represents a little known burden in Brazilian Amazonia. So far, details on clinical and epidemiological aspects remain obscure in the region. We gathered data from medical charts and from the scientific collection of snakes from Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, finding 26 cases of envenomation by five species of Micrurus in Manaus region, between 1987 and 2018. They represent 0.7% of the snakebites treated in the hospital since the records began, in 1979. Micrurus lemniscatus was responsible for most of the bites (10), followed by M. hemprichii (five), M. spixii (three), M. surinamensis (three) and M. averyi (one). There was no difference between the sexes of the snakes that caused bites. Patients were mostly males, and most of the cases were reported in urban areas. Bites predominated in dry season, and there was a clear geographical segregation among species. We describe seven cases of envenomation, three mild and four severe, all of which evolved to cure. Paresthesia (six), pain (five) and edema (four) were the most common local symptoms. Systemic features such as dyspnea/shallow breath (four), palpebral ptosis (four), blurred vision (three), dysarthria (three) and difficulty to walk (three) were also detected. Two patients bitten by Micrurus sp. and M. hemprichii, showed slight increased serum levels of creatine kinase (reference level <190 U/L), 1184 U/L and 1229 U/L, respectively, indicative of mild systemic myotoxicity. This is the first report of myotoxic manifestation in the envenomation by M. hemprichii. No patient developed respiratory failure, though one bitten by an adult M. spixii required intubation and mechanical ventilation due to decreased level of consciousness during evolution, probably related to induced sedation caused by concurrent alcohol intoxication. All patients were treated with Brazilian Micrurus antivenom (soro antielapídico, median = 10 vials). Six patients were pretreated intravenously with H1 and H2 antagonists and steroids, with two patients developing early adverse reactions. The median length of hospital stay was four days. Envenomations by coral snakes in Manaus region are clinically severe, but rare and sparsely distributed over time, making the detection of epidemiological and clinical patterns a challenge for public health.
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Affiliation(s)
- Pedro Ferreira Bisneto
- Universidade Federal do Amazonas - UFAM, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Zoologia, Av. General Rodrigo Octavio, 1200, Coroado I, 69067-005, Manaus, Amazonas, Brazil.
| | - Bruno Dos Santos Araújo
- Faculdade Estácio do Amazonas, Av. Constantino Nery, 3693, Chapada, 69050-001, Manaus, Amazonas, Brazil
| | | | - Iran Mendonça da Silva
- Universidade do Estado do Amazonas - UEA, Escola Superior de Ciências da Saúde, Programa de Pós-Graduação em Medicina Tropical, Av. Carvalho Leal, 1777, Cachoeirinha, 69065-001, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado - FMT-HVD, Diretoria de Ensino e Pesquisa, Av. Pedro Teixeira, 25, Dom Pedro, 69040-000, Manaus, Amazonas, Brazil
| | - Jacqueline de Almeida Gonçalves Sachett
- Universidade do Estado do Amazonas - UEA, Escola Superior de Ciências da Saúde, Programa de Pós-Graduação em Medicina Tropical, Av. Carvalho Leal, 1777, Cachoeirinha, 69065-001, Manaus, Amazonas, Brazil; Fundação Alfredo da Matta - FUAM, Diretoria de Ensino e Pesquisa, Av. Codajás, 24, Cachoeirinha, 69065-130, Manaus, Amazonas, Brazil
| | - Paulo Sérgio Bernarde
- Universidade Federal do Acre - UFAC, Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Estrada do Canela Fina, Km 12, 69980-000, Cruzeiro do Sul, Acre, Brazil
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas - UEA, Escola Superior de Ciências da Saúde, Programa de Pós-Graduação em Medicina Tropical, Av. Carvalho Leal, 1777, Cachoeirinha, 69065-001, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado - FMT-HVD, Diretoria de Ensino e Pesquisa, Av. Pedro Teixeira, 25, Dom Pedro, 69040-000, Manaus, Amazonas, Brazil
| | - Igor Luis Kaefer
- Universidade Federal do Amazonas - UFAM, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Zoologia, Av. General Rodrigo Octavio, 1200, Coroado I, 69067-005, Manaus, Amazonas, Brazil
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Bolon I, Durso AM, Botero Mesa S, Ray N, Alcoba G, Chappuis F, Ruiz de Castañeda R. Identifying the snake: First scoping review on practices of communities and healthcare providers confronted with snakebite across the world. PLoS One 2020; 15:e0229989. [PMID: 32134964 PMCID: PMC7058330 DOI: 10.1371/journal.pone.0229989] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 02/18/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Snakebite envenoming is a major global health problem that kills or disables half a million people in the world's poorest countries. Biting snake identification is key to understanding snakebite eco-epidemiology and optimizing its clinical management. The role of snakebite victims and healthcare providers in biting snake identification has not been studied globally. OBJECTIVE This scoping review aims to identify and characterize the practices in biting snake identification across the globe. METHODS Epidemiological studies of snakebite in humans that provide information on biting snake identification were systematically searched in Web of Science and Pubmed from inception to 2nd February 2019. This search was further extended by snowball search, hand searching literature reviews, and using Google Scholar. Two independent reviewers screened publications and charted the data. RESULTS We analysed 150 publications reporting 33,827 snakebite cases across 35 countries. On average 70% of victims/bystanders spotted the snake responsible for the bite and 38% captured/killed it and brought it to the healthcare facility. This practice occurred in 30 countries with both fast-moving, active-foraging as well as more secretive snake species. Methods for identifying biting snakes included snake body examination, victim/bystander biting snake description, interpretation of clinical features, and laboratory tests. In nine publications, a picture of the biting snake was taken and examined by snake experts. Snakes were identified at the species/genus level in only 18,065/33,827 (53%) snakebite cases. 106 misidentifications led to inadequate victim management. The 8,885 biting snakes captured and identified were from 149 species including 71 (48%) non-venomous species. CONCLUSION Snakebite victims and healthcare providers can play a central role in biting snake identification and novel approaches (e.g. photographing the snake, crowdsourcing) could help increase biting snake taxonomy collection to better understand snake ecology and snakebite epidemiology and ultimately improve snakebite management.
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Affiliation(s)
- Isabelle Bolon
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Andrew M. Durso
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sara Botero Mesa
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Ray
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Gabriel Alcoba
- Médecins Sans Frontières, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland
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11
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Bisneto PF, Alcântara JA, Mendonça da Silva I, de Almeida Gonçalves Sachett J, Bernarde PS, Monteiro WM, Kaefer IL. Coral snake bites in Brazilian Amazonia: Perpetrating species, epidemiology and clinical aspects. Toxicon 2020; 175:7-18. [DOI: 10.1016/j.toxicon.2019.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/16/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022]
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de Castro KLP, Lopes-de-Souza L, de Oliveira D, Machado-de-Ávila RA, Paiva ALB, de Freitas CF, Ho PL, Chávez-Olórtegui C, Guerra-Duarte C. A Combined Strategy to Improve the Development of a Coral Antivenom Against Micrurus spp. Front Immunol 2019; 10:2422. [PMID: 31695693 PMCID: PMC6816313 DOI: 10.3389/fimmu.2019.02422] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/27/2019] [Indexed: 01/08/2023] Open
Abstract
Accidents involving Micrurus snakes are not the most common ones but are noteworthy due to their severity. Victims envenomed by Micrurus snakes are at high risk of death and therefore must be treated with coral antivenom. In Brazil, the immunization mixture used to fabricate coral antivenom contains Micrurus frontalis and Micrurus corallinus venoms, which are difficult to be obtained in adequate amounts. Different approaches to solve the venom limitation problem have been attempted, including the use of synthetic and recombinant antigens as substitutes. The present work proposes a combined immunization protocol, using priming doses of M. frontalis venom and booster doses of synthetic B-cell epitopes derived from M. corallinus toxins (four three-finger toxins-3FTX; and one phospholipase A2-PLA2) to obtain coral antivenom in a rabbit model. Immunized animals elicited a humoral response against both M. frontalis and M. corallinus venoms, as detected by sera reactivity in ELISA and Western Blot. Relevant cross-reactivity of the obtained sera with other Micrurus species (Micrurus altirostris, Micrurus lemniscatus, Micrurus spixii, Micrurus surinamensis) venoms was also observed. The elicited antibodies were able to neutralize PLA2 activity of both M. frontalis and M. corallinus venoms. In vivo, immunized rabbit sera completely protected mice from a challenge with 1.5 median lethal dose (LD50) of M. corallinus venom and 50% of mice challenged with 1.5 LD50 of M. frontalis venom. These results show that this combined protocol may be a suitable alternative to reduce the amount of venom used in coral antivenom production in Brazil.
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Affiliation(s)
| | - Letícia Lopes-de-Souza
- Departamento de Bioquímica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | | - Carlos Chávez-Olórtegui
- Departamento de Bioquímica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Lomonte B, Camacho E, Fernández J, Salas M, Zavaleta A. Three-finger toxins from the venom of Micrurus tschudii tschudii (desert coral snake): Isolation and characterization of tschuditoxin-I. Toxicon 2019; 167:144-151. [DOI: 10.1016/j.toxicon.2019.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/08/2019] [Accepted: 06/14/2019] [Indexed: 11/29/2022]
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15
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Neurotoxicity of Micrurus lemniscatus lemniscatus (South American coralsnake) venom in vertebrate neuromuscular preparations in vitro and neutralization by antivenom. Arch Toxicol 2019; 93:2065-2086. [PMID: 31123802 DOI: 10.1007/s00204-019-02476-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
We investigated the effect of South American coralsnake (Micrurus lemniscatus lemniscatus) venom on neurotransmission in vertebrate nerve-muscle preparations in vitro. The venom (0.1-30 µg/ml) showed calcium-dependent PLA2 activity and caused irreversible neuromuscular blockade in chick biventer cervicis (BC) and mouse phrenic nerve-diaphragm (PND) preparations. In BC preparations, contractures to exogenous acetylcholine and carbachol (CCh), but not KCl, were abolished by venom concentrations ≥ 0.3 µg/ml; in PND preparations, the amplitude of the tetanic response was progressively attenuated, but with little tetanic fade. In low Ca2+ physiological solution, venom (10 µg/ml) caused neuromuscular blockade in PND preparations within ~ 10 min that was reversible by washing; the addition of Ca2+ immediately after the blockade temporarily restored the twitch responses, but did not prevent the progression to irreversible blockade. Venom (10 µg/ml) did not depolarize diaphragm muscle, prevent depolarization by CCh, or cause muscle contracture or histological damage. Venom (3 µg/ml) had a biphasic effect on the frequency of miniature end-plate potentials, but did not affect their amplitude; there was a progressive decrease in the amplitude of evoked end-plate potentials. The amplitude of compound action potentials in mouse sciatic nerve was unaffected by venom (10 µg/ml). Pre-incubation of venom with coralsnake antivenom (Instituto Butantan) at the recommended antivenom:venom ratio did not neutralize the neuromuscular blockade in PND preparations, but total neutralization was achieved with a tenfold greater volume of antivenom. The addition of antivenom after 50% and 80% blockade restored the twitch responses. These results show that M. lemniscatus lemniscatus venom causes potent, irreversible neuromuscular blockade, without myonecrosis. This blockade is apparently mediated by pre- and postsynaptic neurotoxins and can be reversed by coralsnake antivenom.
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New insights into the phylogeographic distribution of the 3FTx/PLA2 venom dichotomy across genus Micrurus in South America. J Proteomics 2019; 200:90-101. [DOI: 10.1016/j.jprot.2019.03.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 01/01/2023]
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Lippa E, Török F, Gómez A, Corrales G, Chacón D, Sasa M, Gutiérrez JM, Lomonte B, Fernández J. First look into the venom of Roatan Island's critically endangered coral snake Micrurus ruatanus: Proteomic characterization, toxicity, immunorecognition and neutralization by an antivenom. J Proteomics 2019; 198:177-185. [DOI: 10.1016/j.jprot.2019.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 12/11/2022]
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Medeiros CRD, Souza SND, Lara AN, Grego KF. Use of infrared thermography in a case of systemic envenomation by the coral snake Micrurus frontalis (Duméril et al., 1854) in Sao Paulo, Brazil. Toxicon 2019; 163:70-73. [PMID: 30905699 DOI: 10.1016/j.toxicon.2019.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/11/2019] [Accepted: 03/17/2019] [Indexed: 11/27/2022]
Abstract
Infrared thermography is a technique that quantifies the thermal (infrared) radiation emitted by an object and produces a high-resolution, digital thermal image of it. Medically, this technique is used to visualize the body's surface temperature distribution in a non-invasive, safe, and convenient fashion. However, to the best of our knowledge, the use of infrared thermography for assessing the systemic effects of envenomation by coral snakes has not been reported. In this case report, we describe the use of this technique in the management of a case of snakebite in Sao Paulo, Brazil. A 51-year-old woman was bitten on the back of the right hand by Micrurus frontalis, a species of coral snake, 10 min prior to her arrival at the hospital. Infrared imaging performed at admission revealed elevated temperatures at the bite site and in the elbow, as well as the preservation of a normal distal thermal gradient in both hands. A few minutes later, the patient developed muscle weakness in the upper limbs and in the eyelids, and infrared imaging showed an alteration of the thermal gradient in both hands, reflecting the systemic action of the venom. Following these observations, the patient was treated with the specific antivenom and was discharged 48 h post admission. At the two-week follow-up, the thermal image obtained showed no anomalies, indicating the recovery of the patient. Hence, infrared thermography can be very useful in the early identification of systemic neurotoxicity in cases of Micrurus snake bites, facilitating the decision to prescribe the antivenom.
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Affiliation(s)
| | - Solange Nogueira de Souza
- Hospital Vital Brazil, Instituto Butantan, Av. Dr. Vital Brasil 1500, 05503-900, São Paulo, SP, Brazil.
| | - Amanda Nazareth Lara
- Hospital Vital Brazil, Instituto Butantan, Av. Dr. Vital Brasil 1500, 05503-900, São Paulo, SP, Brazil.
| | - Kathleen Fernandes Grego
- Laboratório de Herpetologia, Instituto Butantan, Av. Dr. Vital Brasil 1500, 05503-900, São Paulo, SP, Brazil.
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Mendes GF, Stuginski DR, Loibel SMC, de Morais-Zani K, da Rocha MMT, Fernandes W, Sant’Anna SS, Grego KF. Factors that can influence the survival rates of coral snakes (Micrurus corallinus) for antivenom production. J Anim Sci 2019; 97:972-980. [PMID: 30541079 PMCID: PMC6358253 DOI: 10.1093/jas/sky467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/07/2018] [Indexed: 01/16/2023] Open
Abstract
Envenoming and deaths resulting from snakebites are a particularly important public health problem in rural tropical areas of Africa, Asia, Latin America, and New Guinea. In 2015, The Lancet highlighted snake-bite envenoming as a neglected tropical disease and urged the world to increase antivenom production. In Brazil, around 20,000 snakebites occur per year affecting mostly agricultural workers and children, of which 1% is caused by coral snakes (Micrurus sp.). Although human envenoming by coral snakes is relatively rare due to their semifossorial habits and nonaggressive behavior, they are always considered severe due to the neurotoxic, myotoxic, hemorrhagic, and cardiovascular actions of their venom, which is highly toxic when compared to the venom of other Brazilian venomous snakes as Bothrops sp. (pit vipers), Crotalus sp. (rattlesnakes), and Lachesis sp. (bushmasters). The production of antivenom serum is an important public health issue worldwide and the maintenance of venomous snakes in captivity essential to obtain high-quality venom. Though more than 30 species of Brazilian coral snakes exist, the specific antivenom serum produced with the venom of two species, Micrurus corallinus and M. frontalis, is able to neutralize the accidents caused by the genus in general. M. corallinus is considered a difficult species to maintain in captivity and concerned about this difficulty the Laboratory of Herpetology (LH) at Instituto Butantan, over the last 10 yr, has given special attention to its maintenance in captivity. In more than 20 yr of maintenance, LH has made some changes to improve Micrurus captive husbandry and welfare. The objective of this study was to verify the factors influencing the survival rates of coral snakes in captivity through data generated from 289 M. corallinus from the LH snake facility in the last 10 yr. We observed that survival rates increased significantly with the improvement of nutritional adequacy that included freezing food items before offering them to coral snakes, as well as the development of a new pasty diet to force-feed anorexic animals. Another important factor responsible for increasing life expectancy was the shift of the cage's substrate from Sphagnum to bark in 2010, aiding in the eradication of Blister Disease, which used to be responsible for the death of several coral snakes in previous years.
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Affiliation(s)
- Guilherme F Mendes
- Laboratório de Herpetologia do Instituto Butantan, CEP, São Paulo, Brazil
| | - Daniel R Stuginski
- Laboratório de Herpetologia do Instituto Butantan, CEP, São Paulo, Brazil
| | - Selene M C Loibel
- UNESP – Universidade Estadual Paulista, DEMAC/IGCE, Campus Rio Claro, CEP, Caixa Postal, Rio Claro/SP, Brazil
| | | | | | - Wilson Fernandes
- Laboratório de Herpetologia do Instituto Butantan, CEP, São Paulo, Brazil
| | - Sávio S Sant’Anna
- Laboratório de Herpetologia do Instituto Butantan, CEP, São Paulo, Brazil
| | - Kathleen F Grego
- Laboratório de Herpetologia do Instituto Butantan, CEP, São Paulo, Brazil
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Casais-e-Silva LL, Teixeira C. Neurogenic mediators contribute to local edema induced by Micrurus lemniscatus venom. PLoS Negl Trop Dis 2017; 11:e0005874. [PMID: 29161255 PMCID: PMC5716551 DOI: 10.1371/journal.pntd.0005874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 12/05/2017] [Accepted: 08/15/2017] [Indexed: 01/10/2023] Open
Abstract
Background/Aims Micrurus is one of the four snake genera of medical importance in Brazil. Coral snakes have a broad geographic distribution from the southern United States to Argentina. Micrurine envenomation is characterized by neurotoxic symptoms leading to dyspnea and death. Moreover, various local manifestations, including edema formation, have been described in patients bitten by different species of Micrurus. Thus, we investigated the ability of Micrurus lemniscatus venom (MLV) to induce local edema. We also explored mechanisms underlying this effect, focusing on participation of neuropeptides and mast cells. Methodology/Principal findings Intraplantar injection of MLV (1–10 μg/paw) in rats caused dose- and time-dependent edema with a peak between 15 min and 1 h after injection. MLV also induced degranulation of peritoneal mast cells (MCs). MC depletion by compound 48/80 markedly reduced MLV-induced edema. Pre-treatment (30 min) of rats with either promethazine a histamine H1 receptor antagonist or methysergide, a nonselective 5-HT receptor antagonist, reduced MLV-induced edema. However, neither thioperamide, a histamine H3/H4 receptor antagonist, nor co-injection of MLV with HOE-140, a BK2 receptor antagonist, altered the response. Depletion of neuropeptides by capsaicin or treatment of animals with NK1- and NK2-receptor antagonists (SR 140333 and SR 48968, respectively) markedly reduced MLV-induced edema. Conclusions/Significance In conclusion, MLV induces paw edema in rats by mechanisms involving activation of mast cells and substance P-releasing sensory C-fibers. Tachykinins NKA and NKB, histamine, and serotonin are major mediators of the MLV-induced edematogenic response. Targeting mast cell- and sensory C-fiber-derived mediators should be considered as potential therapeutic approaches to interrupt development of local edema induced by Micrurus venoms. Micrurus venoms have neurotoxic activity that is responsible for the serious sequelae in human envenomation. However, various local manifestations of envenoming have been described in patients bitten by different Micrurus species and edematogenic activity has been experimentally demonstrated. Despite the low frequency of edema in Micrurus envenomation, this effect can worsen the clinical manifestations. However, there are few studies on local inflammatory effects induced by Micrurus snake venom. We investigated the edematogenic effect of Micrurus lemniscatus venom (MLV) and participation of neuropeptides and mast cells in inflammation. Results demonstrate that MLV induces prominent edema with rapid onset. Using specific pharmacological interferences, we found that MLV-induced edema is dependent on activation of mast cells and substance P-releasing sensory C-fibers. NKA and NKB tachykinins, histamine via H1 receptor and serotonin are major mediators of the MLV-induced edematogenic response. These findings suggest that mast cell- and C-fiber-derived mediators are promising therapeutic targets to efficiently counteract the local edema induced by Micrururs venoms.
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Affiliation(s)
- Luciana Lyra Casais-e-Silva
- Laboratory of Neuroimmunoendocrinology and Toxinology, Department of Bioregulation, Institute of Health Sciences (ICS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Catarina Teixeira
- Laboratory of Pharmacology, Butantan Institute, Sao Paulo, SP, Brazil
- * E-mail:
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Oliveira FDR, Noronha MDDN, Lozano JLL. Biological and molecular properties of yellow venom of the Amazonian coral snake Micrurus surinamensis. Rev Soc Bras Med Trop 2017; 50:365-373. [DOI: 10.1590/0037-8682-0408-2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 04/11/2017] [Indexed: 11/22/2022] Open
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Lomonte B, Rey-Suárez P, Fernández J, Sasa M, Pla D, Vargas N, Bénard-Valle M, Sanz L, Corrêa-Netto C, Núñez V, Alape-Girón A, Alagón A, Gutiérrez JM, Calvete JJ. Venoms of Micrurus coral snakes: Evolutionary trends in compositional patterns emerging from proteomic analyses. Toxicon 2016; 122:7-25. [DOI: 10.1016/j.toxicon.2016.09.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/04/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
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Ramos HR, Vassão RC, de Roodt AR, Santos e Silva EC, Mirtschin P, Ho PL, Spencer PJ. Cross neutralization of coral snake venoms by commercial Australian snake antivenoms. Clin Toxicol (Phila) 2016; 55:33-39. [DOI: 10.1080/15563650.2016.1222615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Henrique Roman Ramos
- Centro de Biotecnologia, Instituto Butantan, São Paulo, Brazil
- Departamento de Ciências da Saúde, Universidade Nove de Julho, São Paulo, Brazil
| | | | - Adolfo Rafael de Roodt
- Primera Cátedra de Toxicología y Laboratorio de Toxinopatología, Facultad de Medicina de la Universidad de Buenos Aires, Buenos Aires, Argentina
- Dirección Nacional de Determinantes de la Salud e Investigación, INPB-ANLIS “Dr. Carlos G. Malbrán”, Ministerio de Salud, Buenos Aires, Argentina
| | | | | | - Paulo Lee Ho
- Centro de Biotecnologia, Instituto Butantan, São Paulo, Brazil
- Divisão de Desenvolvimento Tecnológico e Produção, Instituto Butantan, São Paulo, Brazil
- Departamento de Bioquímica, Instituto de Química da Universidade de São Paulo, São Paulo, Brazil
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Lewin M, Samuel S, Merkel J, Bickler P. Varespladib (LY315920) Appears to Be a Potent, Broad-Spectrum, Inhibitor of Snake Venom Phospholipase A2 and a Possible Pre-Referral Treatment for Envenomation. Toxins (Basel) 2016; 8:toxins8090248. [PMID: 27571102 PMCID: PMC5037474 DOI: 10.3390/toxins8090248] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/11/2016] [Accepted: 08/15/2016] [Indexed: 01/07/2023] Open
Abstract
Snakebite remains a neglected medical problem of the developing world with up to 125,000 deaths each year despite more than a century of calls to improve snakebite prevention and care. An estimated 75% of fatalities from snakebite occur outside the hospital setting. Because phospholipase A2 (PLA2) activity is an important component of venom toxicity, we sought candidate PLA2 inhibitors by directly testing drugs. Surprisingly, varespladib and its orally bioavailable prodrug, methyl-varespladib showed high-level secretory PLA2 (sPLA2) inhibition at nanomolar and picomolar concentrations against 28 medically important snake venoms from six continents. In vivo proof-of-concept studies with varespladib had striking survival benefit against lethal doses of Micrurus fulvius and Vipera berus venom, and suppressed venom-induced sPLA2 activity in rats challenged with 100% lethal doses of M. fulvius venom. Rapid development and deployment of a broad-spectrum PLA2 inhibitor alone or in combination with other small molecule inhibitors of snake toxins (e.g., metalloproteases) could fill the critical therapeutic gap spanning pre-referral and hospital setting. Lower barriers for clinical testing of safety tested, repurposed small molecule therapeutics are a potentially economical and effective path forward to fill the pre-referral gap in the setting of snakebite.
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Affiliation(s)
- Matthew Lewin
- Research and Development, Ophirex, Inc., Corte Madera, CA 94925, USA.
- Center for Exploration and Travel Health, California Academy of Sciences, San Francisco, CA 94118, USA.
| | - Stephen Samuel
- General Medicine, Queen Elizabeth Hospital, King's Lynn, Norfolk PE30 4ET, UK.
| | - Janie Merkel
- Yale Center for Molecular Discovery, Yale University, West Haven, CT 06516, USA.
| | - Philip Bickler
- Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA.
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Ramos HR, Junqueira-de-Azevedo IDLM, Novo JB, Castro K, Duarte CG, Machado-de-Ávila RA, Chavez-Olortegui C, Ho PL. A Heterologous Multiepitope DNA Prime/Recombinant Protein Boost Immunisation Strategy for the Development of an Antiserum against Micrurus corallinus (Coral Snake) Venom. PLoS Negl Trop Dis 2016; 10:e0004484. [PMID: 26938217 PMCID: PMC4777291 DOI: 10.1371/journal.pntd.0004484] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 02/02/2016] [Indexed: 01/08/2023] Open
Abstract
Background Envenoming by coral snakes (Elapidae: Micrurus), although not abundant, represent a serious health threat in the Americas, especially because antivenoms are scarce. The development of adequate amounts of antielapidic serum for the treatment of accidents caused by snakes like Micrurus corallinus is a challenging task due to characteristics such as low venom yield, fossorial habit, relatively small sizes and ophiophagous diet. These features make it difficult to capture and keep these snakes in captivity for venom collection. Furthermore, there are reports of antivenom scarcity in USA, leading to an increase in morbidity and mortality, with patients needing to be intubated and ventilated while the toxin wears off. The development of an alternative method for the production of an antielapidic serum, with no need for snake collection and maintenance in captivity, would be a plausible solution for the antielapidic serum shortage. Methods and Findings In this work we describe the mapping, by the SPOT-synthesis technique, of potential B-cell epitopes from five putative toxins from M. corallinus, which were used to design two multiepitope DNA strings for the genetic immunisation of female BALB/c mice. Results demonstrate that sera obtained from animals that were genetically immunised with these multiepitope constructs, followed by booster doses of recombinant proteins lead to a 60% survival in a lethal dose neutralisation assay. Conclusion Here we describe that the genetic immunisation with a synthetic multiepitope gene followed by booster doses with recombinant protein is a promising approach to develop an alternative antielapidic serum against M. corallinus venom without the need of collection and the very challenging maintenance of these snakes in captivity. Coral snakes are a group of deadly venomous snakes that exhibit a characteristic red, yellow/white, and black coloured banding pattern. Accidents involving these snakes tend to be very severe or even lethal, causing peripheral nervous system depression with muscle paralysis and vasomotor instability. The only acceptable medical treatment for snakebite accidents is the administration of an antivenom, generally produced by immunising horses with the snake venom. Nonetheless, for what concerns the antielapidic serum production in Brazil, the total amount of venom available for horse immunisations is insufficient. This is mainly due to the small size of coral snake glands, their underground life style, combined with its very low survival rates in captivity. Moreover, cases of patients being intubated and ventilated as a consequence of antivenom shortage in USA have also been registered. In this work, we present an alternative method for the development of antielapidic serum, which does not rely upon snake capture. This serum was produced by a heterologous DNA prime—with a multiepitope DNA string coding for the most reactive epitopes from the most abundant toxins of M. corallinus, a coral snake which occupy highly populated areas in Brazil—followed by recombinant multiepitope protein boost immunisation of mice.
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MESH Headings
- Animals
- Antivenins/immunology
- Antivenins/pharmacology
- Disease Models, Animal
- Elapidae/genetics
- Elapidae/immunology
- Epitopes, B-Lymphocyte/genetics
- Epitopes, B-Lymphocyte/immunology
- Female
- Mice, Inbred BALB C
- Neutralization Tests
- Snake Bites/therapy
- Snake Venoms/genetics
- Snake Venoms/immunology
- Technology, Pharmaceutical/methods
- Vaccination/methods
- Vaccines, DNA/administration & dosage
- Vaccines, DNA/immunology
- Vaccines, Subunit/administration & dosage
- Vaccines, Subunit/immunology
- Vaccines, Synthetic/administration & dosage
- Vaccines, Synthetic/immunology
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Affiliation(s)
| | | | | | - Karen Castro
- Departamento de Bioquímica, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Clara Guerra Duarte
- Departamento de Bioquímica, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | | | - Carlos Chavez-Olortegui
- Departamento de Bioquímica, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Paulo Lee Ho
- Centro de Biotecnologia, Instituto Butantan, São Paulo, São Paulo, Brazil
- * E-mail:
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Integrative characterization of the venom of the coral snake Micrurus dumerilii (Elapidae) from Colombia: Proteome, toxicity, and cross-neutralization by antivenom. J Proteomics 2016; 136:262-73. [PMID: 26883873 DOI: 10.1016/j.jprot.2016.02.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 12/19/2022]
Abstract
UNLABELLED In Colombia, nearly 2.8% of the 4200 snakebite accidents recorded annually are inflicted by coral snakes (genus Micrurus). Micrurus dumerilii has a broad distribution in this country, especially in densely populated areas. The proteomic profile of its venom was here studied by a bottom-up approach combining RP-HPLC, SDS-PAGE and MALDI-TOF/TOF. Venom proteins were assigned to eleven families, the most abundant being phospholipases A2 (PLA2; 52.0%) and three-finger toxins (3FTx; 28.1%). This compositional profile shows that M. dumerilii venom belongs to the 'PLA2-rich' phenotype, in the recently proposed dichotomy for Micrurus venoms. Enzymatic and toxic venom activities correlated with protein family abundances. Whole venom induced a conspicuous myotoxic, cytotoxic and anticoagulant effect, and was mildly edematogenic and proteolytic, whereas it lacked hemorrhagic activity. Some 3FTxs and PLA2s reproduced the lethal effect of venom. A coral snake antivenom to Micrurus nigrocinctus demonstrated significant cross-recognition of M. dumerilii venom proteins, and accordingly, ability to neutralize its lethal effect. The combined compositional, functional, and immunological data here reported for M. dumerilii venom may contribute to a better understanding of these envenomings, and support the possible use of anti-M. nigrocinctus coral snake antivenom in their treatment. BIOLOGICAL SIGNIFICANCE Coral snakes represent a highly diversified group of elapids in the New World, with nearly 70 species within the genus Micrurus. Owing to their scarce yields, the biochemical composition and toxic activities of coral snake venoms have been less well characterized than those of viperid species. In this work, an integrative view of the venom of M. dumerilii, a medically relevant coral snake from Colombia, was obtained by a combined proteomic, functional, and immunological approach. The venom contains proteins from at least eleven families, with a predominance of phospholipases A2 (PLA2), followed by three-finger toxins (3FTx). According to its compositional profile, M. dumerilii venom can be grouped with those of several Micrurus species from North and Central America that present a PLA2-predominant phenotype, to date it is the most southerly coral snake species to do so. Other coral snake species that a 'PLA2-rich' venom, M. dumerilii venom contains both components that form MitTx, a pain-inducing heterodimeric complex recently characterized from the venom of Micrurus tener, also present in Micrurus mosquitensis and M. nigrocinctus venoms. In addition to a lethal three-finger toxin, PLA2s participate in the toxicity of M. dumerilii venom, some of them displaying ability to induce cytolysis, muscle necrosis, and lethality to mice. An antivenom to M. nigrocinctus demonstrated significant cross-recognition of M. dumerilii venom proteins, and accordingly, ability to neutralize its lethal effect, being of potential therapeutic usefulness in these envenomings.
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Bucaretchi F, De Capitani EM, Vieira RJ, Rodrigues CK, Zannin M, Da Silva NJ, Casais-e-Silva LL, Hyslop S. Coral snake bites (Micrurus spp.) in Brazil: a review of literature reports. Clin Toxicol (Phila) 2016; 54:222-34. [DOI: 10.3109/15563650.2015.1135337] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Fábio Bucaretchi
- Campinas Poison Control Center, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Department of Pediatrics, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Eduardo Mello De Capitani
- Campinas Poison Control Center, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Department of Clinical Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Ronan José Vieira
- Campinas Poison Control Center, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Department of Clinical Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Cinthia K. Rodrigues
- Santa Catarina Poison Control Center, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Marlene Zannin
- Santa Catarina Poison Control Center, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
- Department of Pathology, Health Science Center, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Nelson J. Da Silva
- Department of Biology, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | | | - Stephen Hyslop
- Campinas Poison Control Center, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Fernández J, Vargas-Vargas N, Pla D, Sasa M, Rey-Suárez P, Sanz L, Gutiérrez JM, Calvete JJ, Lomonte B. Snake venomics of Micrurus alleni and Micrurus mosquitensis from the Caribbean region of Costa Rica reveals two divergent compositional patterns in New World elapids. Toxicon 2015; 107:217-33. [PMID: 26325292 DOI: 10.1016/j.toxicon.2015.08.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/25/2015] [Indexed: 01/16/2023]
Abstract
Protein composition, toxicity, and neutralization of the venoms of Micrurus alleni and Micrurus mosquitensis, two sympatric monadal coral snakes found in humid environments of the Caribbean region of Costa Rica, were studied. Proteomic profiling revealed that these venoms display highly divergent compositions: the former dominated by three-finger toxins (3FTx) and the latter by phospholipases A2 (PLA2). Protein family abundances correlated with enzymatic and toxic characteristics of the venoms. Selective inhibition experiments showed that PLA2s play only a marginal role in the lethal effect of M. alleni venom, but have a major role in M. mosquitensis venom. Proteomic data gathered from other Micrurus species evidenced that the two divergent venom phenotypes are recurrent, and may constitute a general trend across New World elapids. Further, M. mosquitensis, but not M. alleni, venom contains PLA2-like/Kunitz-type inhibitor complex(es) that resemble the ASIC1a/2-activating MitTx heterodimeric toxin isolated from Micrurus tener venom. The evolutionary origin and adaptive relevance of the puzzling phenotypic variability of Micrurus venoms remain to be understood. An antivenom against the PLA2-predominant Micrurus nigrocinctus venom strongly cross-recognized and neutralized M. mosquitensis venom, but only weakly M. alleni venom.
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Affiliation(s)
- Julián Fernández
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Nancy Vargas-Vargas
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Davinia Pla
- Instituto de Biomedicina de Valencia, CSIC, Jaume Roig 11, 46010 Valencia, Spain
| | - Mahmood Sasa
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Paola Rey-Suárez
- Programa de Ofidismo y Escorpionismo, Universidad de Antioquia, Medellín, Colombia
| | - Libia Sanz
- Instituto de Biomedicina de Valencia, CSIC, Jaume Roig 11, 46010 Valencia, Spain
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Juan J Calvete
- Instituto de Biomedicina de Valencia, CSIC, Jaume Roig 11, 46010 Valencia, Spain
| | - Bruno Lomonte
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica.
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Abstract
This review is on the pulmonary complications of snakebites, which can have fatal consequences. We identified three common themes as reported in the literature regarding envenomation: generalized neuromuscular paralysis affecting airway and respiratory muscles, pulmonary edema, and pulmonary hemorrhages or thrombosis due to coagulopathy. Respiratory paralysis and pulmonary edema can be due to either elapid or viper bites, whereas pulmonary complications of coagulopathy are exclusively reported with viper bites. The evidence for each complication, timeline of appearance, response to treatment, and details of pathophysiology are discussed.
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Affiliation(s)
- Ariaranee Gnanathasan
- From the The Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Chaturaka Rodrigo
- From the The Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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30
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Geier MV, Quarcoo D, Spallek MF, Joachim R, Groneberg DA. Giftschlangenbisse — eine globale Herausforderung. ZENTRALBLATT FUR ARBEITSMEDIZIN ARBEITSSCHUTZ UND ERGONOMIE 2014. [DOI: 10.1007/bf03344195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Roodt ARD, de Titto E, Dolab JA, Chippaux JP. Envenoming by coral snakes (Micrurus) in Argentina, during the period between 1979-2003. Rev Inst Med Trop Sao Paulo 2013; 55:13-8. [DOI: 10.1590/s0036-46652013000100003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 08/06/2012] [Indexed: 11/21/2022] Open
Abstract
Envenomation by coral snakes (Micrurus sp.) is one of the most dangerous injuries in America and it is considered as a serious medical emergency, however bites by these snakes appear to be rare. We analyzed epidemiological data, clinical signs and antivenom use in Argentina during the period between 1979-2003. During this period of study 46 non-fatal Micrurus bites were reported. The majority of cases were men from 31 to 40 years old. Bites occurred primarily in spring and summer. Most cases were reported from the northeast and northwest provinces of the country. The bites were mostly located on hands or feet and occurred mostly during agricultural activities and so mainly involved farmers. Only four cases occurred as a result of handling snakes. The median time it took for antivenom to be administrated was 60 minutes after the bite, and the median number of vials applied was 2. Local pain was mentioned and edema was reported in 41% of patients. All patients recovered without sequelae. This study showed a low incidence of Micrurus bites and low severity of envenomation. However, although no deaths have been reported during the last 30 years, given the toxicity of the venom of Micrurus snakes, the risk of severe envenomation should be considered.
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Affiliation(s)
| | - Ernesto de Titto
- Dirección Nacional de Determinantes de Salud e Investigación, República Argentina
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32
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Del Brutto OH. Neurological effects of venomous bites and stings: snakes, spiders, and scorpions. HANDBOOK OF CLINICAL NEUROLOGY 2013; 114:349-68. [PMID: 23829924 DOI: 10.1016/b978-0-444-53490-3.00028-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Snake and spider bites, as well as scorpion sting envenoming, are neglected diseases affecting millions of people all over the world. Neurological complications vary according to the offending animal, and are often directly related to toxic effects of the venom, affecting the central nervous system, the neuromuscular transmission, the cardiovascular system, or the coagulation cascade. Snake bite envenoming may result in stroke or muscle paralysis. Metalloproteinases and other substances (common in vipers and colubrids) have anticoagulant or procoagulant activity, and may induce ischemic or hemorrhagic strokes. The venom of elapids is rich in neurotoxins affecting the neuromuscular transmission at either presynaptic or postsynaptic levels. The clinical picture of scorpion sting envenoming is dominated by muscle weakness associated with arterial hypertension, cardiac arrythmias, myocarditis, or pulmonary edema. These manifestations occur as the result of release of catecholamines into the bloodstream or due to direct cardiac toxicity of the venom. Cerebrovascular complications have been reported after the sting of the Indian red scorpion. Intracranial hemorrhages occur in the setting of acute increases in arterial blood pressure related to sympathetic overstimulation, and cerebral infarctions are related to either cerebral hypoperfusion, consumption coagulopathy, vasculitis, or cardiogenic brain embolism. Three main syndromes result from spider bite envenoming: latrodectism, loxoscelism, and funnel-web spider envenoming. Latrodectism is related to neurotoxins present in the venom of widow spiders. Most cases present with headache, lethargy, irritability, myalgia, tremor, fasciculation, or ataxia. Loxoscelism is caused by envenoming by spiders of the family Sicariidae. It may present with a stroke due to a severe coagulopathy. The venom of funnel-web spiders also has neurotoxins that stimulate neurotransmitter release, resulting in sensory disturbances and muscle paralysis. Proper management of the envenomed patient, including prompt transport to the hospital, correction of the hemostatic disorder, ventilatory support, and administration of antivenom, significantly reduce the risk of neurological complications which, in turn, reduce the mortality and improve the functional outcome of survivors.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espiritu Santo, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital Clinica Kennedy, Guayaquil, Ecuador.
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Chacón D, Rodríguez S, Arias J, Solano G, Bonilla F, Gómez A. Maintaining Coral Snakes (Micrurus nigrocinctus, Serpentes: Elapidae) for venom production on an alternative fish-based diet. Toxicon 2012; 60:249-53. [PMID: 22538193 DOI: 10.1016/j.toxicon.2012.04.332] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/29/2012] [Accepted: 04/03/2012] [Indexed: 10/28/2022]
Abstract
American Elapid snakes (Coral Snakes) comprise the genera Leptomicrurus, Micruroides and Micrurus, which form a vast taxonomic assembly of 330 species distributed from the South of United States to the southern region of South America. In order to obtain venom for animal immunizations aimed at antivenom production, Coral Snakes must be kept in captivity and submitted periodically to venom extraction procedures. Thus, to maintain a snake colony in good health for this purpose, a complete alternative diet utilizing an easily obtained prey animal is desirable. The development of a diet based on fish is compared to the wild diet based on colubrid snakes, and assessed in terms of gain in body weight rate (g/week), longevity (weeks), venom yield (mg/individual), venom median lethal dose (LD₅₀) and venom chromatographic profiles. The animals fed with the fish-based diet gained more weight, lived longer, and produced similar amount of venom whose biological and biochemical characteristics were similar to those of venom collected from specimens fed with the wild diet. This fish-based diet appears to be suitable (and preferable to the wild diet) to supply the nutritional requirements of a Micrurus nigrocinctus snake collection for the production of antivenom.
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Affiliation(s)
- Danilo Chacón
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
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Corrêa-Netto C, Junqueira-de-Azevedo IDLM, Silva DA, Ho PL, Leitão-de-Araújo M, Alves MLM, Sanz L, Foguel D, Zingali RB, Calvete JJ. Snake venomics and venom gland transcriptomic analysis of Brazilian coral snakes, Micrurus altirostris and M. corallinus. J Proteomics 2011; 74:1795-809. [PMID: 21515432 DOI: 10.1016/j.jprot.2011.04.003] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Revised: 04/01/2011] [Accepted: 04/04/2011] [Indexed: 11/26/2022]
Abstract
The venom proteomes of Micrurus altirostris and M. corallinus were analyzed by combining snake venomics and venom gland transcriptomic surveys. In both coral snake species, 3FTx and PLA(2) were the most abundant and diversified toxin families. 33 different 3FTxs and 13 PLA(2) proteins, accounting respectively for 79.5% and 13.7% of the total proteins, were identified in the venom of M. altirostris. The venom of M. corallinus comprised 10 3FTx (81.7% of the venom proteome) and 4 (11.9%) PLA(2) molecules. Transcriptomic data provided the full-length amino acid sequences of 18 (M. altirostris) and 10 (M. corallinus) 3FTxs, and 3 (M. altirostris) and 1 (M. corallinus) novel PLA(2) sequences. In addition, venom from each species contained single members of minor toxin families: 3 common (PIII-SVMP, C-type lectin-like, L-amino acid oxidase) and 4 species-specific (CRISP, Kunitz-type inhibitor, lysosomal acid lipase in M. altirostris; serine proteinase in M. corallinus) toxin classes. The finding of a lipase (LIPA) in the venom proteome and in the venom gland transcriptome of M. altirostris supports the view of a recruitment event predating the divergence of Elapidae and Viperidae more than 60 Mya. The toxin profile of both M. altirostris and M. corallinus venoms points to 3FTxs and PLA(2) molecules as the major players of the envenoming process. In M. altirostris venom, all major, and most minor, 3FTxs display highest similarity to type I α-neurotoxins, suggesting that these postsynaptically acting toxins may play the predominant role in the neurotoxic effect leading to peripheral paralysis, respiratory arrest, and death. M. corallinus venom posesses both, type I α-neurotoxins and a high-abundance (26% of the venom proteome) protein of subfamily XIX of 3FTxs, exhibiting similarity to bucandin from Malayan krait, Bungarus candidus, venom, which enhances acetylcholine release presynaptically. This finding may explain the presynaptic neurotoxicity of M. corallinus venom and the lack of this effect in M. altirostris venom. The anti-Micrurus (corallinus and frontalis) antivenom produced by Instituto Butantan quantitatively immunodepleted the minor toxins from M. altirostris and M. corallinus venoms but showed impaired crossreactivity towards their major 3FTx and PLA(2) molecules. The structural diversity of 3FTxs among Micrurus sp. may underlay the impaired cross-immunoreactivity of the Butantan antivenom towards M. altirostris and M. corallinus toxins, hampering the possibility to raise an antivenom against a simple venom mixture exhibiting paraspecific neutralization of other Micrurus venoms.
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Affiliation(s)
- Carlos Corrêa-Netto
- Instituto de Bioquímica Médica, Programa de Biologia Estrutural and Instituto Nacional de Biologia Estrutural e Bioimagem, Universidade Federal do Rio de Janeiro, Brazil
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Pardal PPDO, Pardal JSDO, Gadelha MADC, Rodrigues LDS, Feitosa DT, Prudente ALDC, Fan HW. Envenomation by Micrurus coral snakes in the Brazilian Amazon region: report of two cases. Rev Inst Med Trop Sao Paulo 2010; 52:333-7. [DOI: 10.1590/s0036-46652010000600009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 10/08/2010] [Indexed: 11/22/2022] Open
Abstract
Two cases of proven coral snake bites were reported in Belém, Pará State, Brazil. The first case was a severe one caused by Micrurus surinamensis. The patient required mechanical ventilation due to acute respiratory failure. The second case showed just mild signs of envenomation caused by Micrurus filiformis. Both patients received specific Micrurus antivenom and were discharged without further complications. Coral snake bites are scarcely reported in the Amazon region and there is a broad spectrum of clinical manifestations, varying from extremely mild to those which may rapidly lead to death if the patient is not treated as soon as possible.
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de Abreu VA, Leite GB, Oliveira CB, Hyslop S, Furtado MDFD, Simioni LR. Neurotoxicity ofMicrurus altirostris(Uruguayan coral snake) venom and its neutralization by commercial coral snake antivenom and specific antiserum raised in rabbits. Clin Toxicol (Phila) 2009; 46:519-27. [DOI: 10.1080/15563650701647405] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Manock SR, Suarez G, Graham D, Avila-Aguero ML, Warrell DA. Neurotoxic envenoming by South American coral snake (Micrurus lemniscatus helleri): case report from eastern Ecuador and review. Trans R Soc Trop Med Hyg 2008; 102:1127-32. [DOI: 10.1016/j.trstmh.2008.03.026] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Revised: 03/27/2008] [Accepted: 03/28/2008] [Indexed: 11/30/2022] Open
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Larréché S, Mion G, Clapson P, Debien B, Wybrecht D, Goyffon M. Neurotoxines ophidiennes. ACTA ACUST UNITED AC 2008; 27:310-6. [DOI: 10.1016/j.annfar.2008.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 02/05/2008] [Indexed: 10/22/2022]
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