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Alsolaiss J, Leeming G, Da Silva R, Alomran N, Casewell NR, Habib AG, Harrison RA, Modahl CM. Investigating Snake-Venom-Induced Dermonecrosis and Inflammation Using an Ex Vivo Human Skin Model. Toxins (Basel) 2024; 16:276. [PMID: 38922170 PMCID: PMC11209077 DOI: 10.3390/toxins16060276] [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: 03/31/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024] Open
Abstract
Snakebite envenoming is a neglected tropical disease that causes >100,000 deaths and >400,000 cases of morbidity annually. Despite the use of mouse models, severe local envenoming, defined by morbidity-causing local tissue necrosis, remains poorly understood, and human-tissue responses are ill-defined. Here, for the first time, an ex vivo, non-perfused human skin model was used to investigate temporal histopathological and immunological changes following subcutaneous injections of venoms from medically important African vipers (Echis ocellatus and Bitis arietans) and cobras (Naja nigricollis and N. haje). Histological analysis of venom-injected ex vivo human skin biopsies revealed morphological changes in the epidermis (ballooning degeneration, erosion, and ulceration) comparable to clinical signs of local envenoming. Immunostaining of these biopsies confirmed cell apoptosis consistent with the onset of necrosis. RNA sequencing, multiplex bead arrays, and ELISAs demonstrated that venom-injected human skin biopsies exhibited higher rates of transcription and expression of chemokines (CXCL5, MIP1-ALPHA, RANTES, MCP-1, and MIG), cytokines (IL-1β, IL-1RA, G-CSF/CSF-3, and GM-CSF), and growth factors (VEGF-A, FGF, and HGF) in comparison to non-injected biopsies. To investigate the efficacy of antivenom, SAIMR Echis monovalent or SAIMR polyvalent antivenom was injected one hour following E. ocellatus or N. nigricollis venom treatment, respectively, and although antivenom did not prevent venom-induced dermal tissue damage, it did reduce all pro-inflammatory chemokines, cytokines, and growth factors to normal levels after 48 h. This ex vivo skin model could be useful for studies evaluating the progression of local envenoming and the efficacy of snakebite treatments.
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Affiliation(s)
- Jaffer Alsolaiss
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (R.D.S.); (N.A.); (N.R.C.); (R.A.H.); (C.M.M.)
- Abqaiq General Hospital, Rural Health Network, Eastern Health Cluster, Ministry of Health, Abqaiq 33241, Saudi Arabia
| | - Gail Leeming
- Department of Veterinary Anatomy, Physiology and Pathology, School of Veterinary Science, University of Liverpool, Liverpool L69 7ZX, UK;
| | - Rachael Da Silva
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (R.D.S.); (N.A.); (N.R.C.); (R.A.H.); (C.M.M.)
| | - Nessrin Alomran
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (R.D.S.); (N.A.); (N.R.C.); (R.A.H.); (C.M.M.)
- Qatif Medical Fitness Center, Clinical Laboratory Department, Qatif Health Network, Eastern Health Cluster, Ministry of Health, Qatif 31911, Saudi Arabia
| | - Nicholas R. Casewell
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (R.D.S.); (N.A.); (N.R.C.); (R.A.H.); (C.M.M.)
| | - Abdulrazaq G. Habib
- African Snakebite Research Group (ASRG) Project, Bayero University, Kano 700251, Nigeria;
| | - Robert A. Harrison
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (R.D.S.); (N.A.); (N.R.C.); (R.A.H.); (C.M.M.)
| | - Cassandra M. Modahl
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (R.D.S.); (N.A.); (N.R.C.); (R.A.H.); (C.M.M.)
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2
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Dashevsky D, Harris RJ, Zdenek CN, Benard-Valle M, Alagón A, Portes-Junior JA, Tanaka-Azevedo AM, Grego KF, Sant'Anna SS, Frank N, Fry BG. Red-on-Yellow Queen: Bio-Layer Interferometry Reveals Functional Diversity Within Micrurus Venoms and Toxin Resistance in Prey Species. J Mol Evol 2024; 92:317-328. [PMID: 38814340 PMCID: PMC11168994 DOI: 10.1007/s00239-024-10176-x] [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: 12/20/2023] [Accepted: 05/03/2024] [Indexed: 05/31/2024]
Abstract
Snakes in the family Elapidae largely produce venoms rich in three-finger toxins (3FTx) that bind to the α 1 subunit of nicotinic acetylcholine receptors (nAChRs), impeding ion channel activity. These neurotoxins immobilize the prey by disrupting muscle contraction. Coral snakes of the genus Micrurus are specialist predators who produce many 3FTx, making them an interesting system for examining the coevolution of these toxins and their targets in prey animals. We used a bio-layer interferometry technique to measure the binding interaction between 15 Micrurus venoms and 12 taxon-specific mimotopes designed to resemble the orthosteric binding region of the muscular nAChR subunit. We found that Micrurus venoms vary greatly in their potency on this assay and that this variation follows phylogenetic patterns rather than previously reported patterns of venom composition. The long-tailed Micrurus tend to have greater binding to nAChR orthosteric sites than their short-tailed relatives and we conclude this is the likely ancestral state. The repeated loss of this activity may be due to the evolution of 3FTx that bind to other regions of the nAChR. We also observed variations in the potency of the venoms depending on the taxon of the target mimotope. Rather than a pattern of prey-specificity, we found that mimotopes modeled after snake nAChRs are less susceptible to Micrurus venoms and that this resistance is partly due to a characteristic tryptophan → serine mutation within the orthosteric site in all snake mimotopes. This resistance may be part of a Red Queen arms race between coral snakes and their prey.
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Affiliation(s)
- Daniel Dashevsky
- Australian National Insect Collection, Commonwealth Scientific and Industrial Research Organisation, Canberra, ACT, 2601, Australia.
| | - Richard J Harris
- Venom Evolution Lab, School of the Environment, The University of Queensland, Saint Lucia, QLD, 4072, Australia
- Australian Institute of Marine Science, Cape Cleveland, QLD, 4810, Australia
| | - Christina N Zdenek
- Celine Frere Group, School of the Environment, The University of Queensland, Saint Lucia, QLD, 4072, Australia
| | - Melisa Benard-Valle
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens Lyngby, Region Hovedstaden, Denmark
| | - Alejandro Alagón
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, 62210, Cuernavaca, Morelos, Mexico
| | - José A Portes-Junior
- Laboratório de Coleções Zoológicas, Instituto Butantan, São Paulo, São Paulo, 05503-900, Brazil
| | - Anita M Tanaka-Azevedo
- Laboratório de Herpetologia, Instituto Butantan, São Paulo, São Paulo, 05503-900, Brazil
| | - Kathleen F Grego
- Laboratório de Herpetologia, Instituto Butantan, São Paulo, São Paulo, 05503-900, Brazil
| | - Sávio S Sant'Anna
- Laboratório de Herpetologia, Instituto Butantan, São Paulo, São Paulo, 05503-900, Brazil
| | - Nathaniel Frank
- MToxins Venom Lab, 717 Oregon Street, Oshkosh, WI, 54902, USA
| | - Bryan G Fry
- Venom Evolution Lab, School of the Environment, The University of Queensland, Saint Lucia, QLD, 4072, Australia
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3
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Benard-Valle M, Wouters Y, Ljungars A, Nguyen GTT, Ahmadi S, Ebersole TW, Dahl CH, Guadarrama-Martínez A, Jeppesen F, Eriksen H, Rodríguez-Barrera G, Boddum K, Jenkins TP, Bjørn SP, Schoffelen S, Voldborg BG, Alagón A, Laustsen AH. In vivo neutralization of coral snake venoms with an oligoclonal nanobody mixture in a murine challenge model. Nat Commun 2024; 15:4310. [PMID: 38773068 PMCID: PMC11109316 DOI: 10.1038/s41467-024-48539-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/02/2024] [Indexed: 05/23/2024] Open
Abstract
Oligoclonal mixtures of broadly-neutralizing antibodies can neutralize complex compositions of similar and dissimilar antigens, making them versatile tools for the treatment of e.g., infectious diseases and animal envenomations. However, these biotherapeutics are complicated to develop due to their complex nature. In this work, we describe the application of various strategies for the discovery of cross-neutralizing nanobodies against key toxins in coral snake venoms using phage display technology. We prepare two oligoclonal mixtures of nanobodies and demonstrate their ability to neutralize the lethality induced by two North American coral snake venoms in mice, while individual nanobodies fail to do so. We thus show that an oligoclonal mixture of nanobodies can neutralize the lethality of venoms where the clinical syndrome is caused by more than one toxin family in a murine challenge model. The approaches described may find utility for the development of advanced biotherapeutics against snakebite envenomation and other pathologies where multi-epitope targeting is beneficial.
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Affiliation(s)
- Melisa Benard-Valle
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens, Lyngby, Denmark
| | - Yessica Wouters
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens, Lyngby, Denmark
| | - Anne Ljungars
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens, Lyngby, Denmark
| | - Giang Thi Tuyet Nguyen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens, Lyngby, Denmark
| | - Shirin Ahmadi
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens, Lyngby, Denmark
| | - Tasja Wainani Ebersole
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens, Lyngby, Denmark
| | - Camilla Holst Dahl
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens, Lyngby, Denmark
| | - Alid Guadarrama-Martínez
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Avenida Universidad 2001, Cuernavaca, Mor, 62210, México
| | - Frederikke Jeppesen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens, Lyngby, Denmark
| | - Helena Eriksen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens, Lyngby, Denmark
| | - Gibran Rodríguez-Barrera
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Avenida Universidad 2001, Cuernavaca, Mor, 62210, México
| | - Kim Boddum
- Sophion Bioscience, DK-2750, Ballerup, Denmark
| | - Timothy Patrick Jenkins
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens, Lyngby, Denmark
| | - Sara Petersen Bjørn
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens, Lyngby, Denmark
| | - Sanne Schoffelen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens, Lyngby, Denmark
| | - Bjørn Gunnar Voldborg
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens, Lyngby, Denmark
| | - Alejandro Alagón
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Avenida Universidad 2001, Cuernavaca, Mor, 62210, México
| | - Andreas Hougaard Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens, Lyngby, Denmark.
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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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Neri-Castro E, Zarzosa V, Benard-Valle M, Rodríguez-Solís AM, Hernández-Orihuela L, Ortiz-Medina JA, Alagón A. Quantifying venom production: A study on Micrurus snakes in Mexico. Toxicon 2024; 240:107658. [PMID: 38395261 DOI: 10.1016/j.toxicon.2024.107658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/12/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
Our study quantifies venom production in nine Mexican coral snake species (Micrurus), encompassing 76 specimens and 253 extractions. Noteworthy variations were observed, with M. diastema and M. laticollaris displaying diverse yields, ranging from 0.3 mg to 59 mg. For animals for which we have length data, there is a relationship between size and venom quantity. Twenty-eight percent of the observed variability in venom production can be explained by snake size, suggesting that other factors influence the amount of obtained venom. These findings are pivotal for predicting venom effects and guiding antivenom interventions. Our data offer insights into Micrurus venom yields, laying the groundwork for future research and aiding in medical response strategies. This study advances understanding coral snake venom production, facilitating informed medical responses to coral snake bites.
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Affiliation(s)
- Edgar Neri-Castro
- Investigador por México, Facultad de Ciencias Biológicas, Universidad Juárez del Estado de Durango, Av. Universidad s/n. Fracc. Filadelfia, C.P. 35010, Gómez Palacio, Dgo., Mexico; Instituto de Biotecnología, Universidad Nacional Autónoma de México, Avenida Universidad 2001, Chamilpa, C.P. 62210, Cuernavaca, Mor., Mexico.
| | - Vanessa Zarzosa
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Avenida Universidad 2001, Chamilpa, C.P. 62210, Cuernavaca, Mor., Mexico
| | - Melisa Benard-Valle
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Søltofts Plads, 2800, Kongens Lyngby, Denmark
| | - Audrey Michelle Rodríguez-Solís
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Avenida Universidad 2001, Chamilpa, C.P. 62210, Cuernavaca, Mor., Mexico
| | - Lorena Hernández-Orihuela
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Avenida Universidad 2001, Chamilpa, C.P. 62210, Cuernavaca, Mor., Mexico
| | - Javier A Ortiz-Medina
- Departamento de Sistemática y Ecología Acuática, El Colegio de la Frontera Sur, Unidad Chetumal, Avenida Centenario km 5.5, 77014, Chetumal Quintana Roo, Mexico; Unidad de Manejo para la conservación de la vida silvestre Tsáab Kaan, Baca, Yucatán, Mexico; HERP.MX A.C., Villa de Álvarez, Colima, Mexico
| | - Alejandro Alagón
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Avenida Universidad 2001, Chamilpa, C.P. 62210, Cuernavaca, Mor., Mexico
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Piedrahita JD, Cardona-Ruda A, Pereañez JA, Rey-Suárez P. In-depth immunorecognition and neutralization analyses of Micrurus mipartitus and M. dumerilii venoms and toxins by a commercial antivenom. Biochimie 2024; 216:120-125. [PMID: 37844754 DOI: 10.1016/j.biochi.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/13/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
In Colombia, the Micrurus genus comprises 30 species, including M. mipartitus and M. dumerilii, which are of major clinical relevance due to their wide geographical distribution and the number of snakebites inflicted by them. These neurotoxic envenomations are characterized by neuromuscular paralysis attributed to venom components such as three-finger toxins (3FTx) and phospholipases (PLA2). Additionally, there is limited information available on the neutralizing coverage of commercially available antivenoms, underscoring the need to perform studies to assess the cross-neutralizing ability of these life-saving products. Therefore, we present an in-depth immunorecognition analysis by the anticoral-INS antivenom from Colombia on the M. mipartitus and M. dumerilii venoms. The antivenom cross-recognized the whole venoms and their components with different intensities. For instance, the antivenom showed better recognition on PLA2s than on 3FTxs in both venoms. Moreover, at doses tested, the antivenom totally neutralized the lethal effect of M. dumerilii venom; however, it did not neutralize this effect induced by M. mipartitus venom and its main toxic components from the southwestern region of the department of Antioquia. Furthermore, the anticoral-INS antivenom displayed better cross-immunorecognition of PLA2-predominant Micrurus venoms than of 3FTx-predominant Micrurus venoms. This highlights the need to include venoms from both types of venom patterns in the immunization mixture to produce antivenoms against coral snakes. Finally, our results suggest the need for further research to optimize the composition of immunizing mixtures for antivenom production and improve their efficacy against coral snake envenomation in Colombia and the Americas.
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Affiliation(s)
- Juan Diego Piedrahita
- Departamento de Toxicología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Ana Cardona-Ruda
- Grupo de Investigación en Toxinología, Alternativas Terapéuticas y Alimentarias, Facultad de Ciencias Farmacéuticas y Alimentarias, Universidad de Antioquia, Medellín, Colombia
| | - Jaime Andrés Pereañez
- Grupo de Investigación en Toxinología, Alternativas Terapéuticas y Alimentarias, Facultad de Ciencias Farmacéuticas y Alimentarias, Universidad de Antioquia, Medellín, Colombia
| | - Paola Rey-Suárez
- Grupo de Investigación en Toxinología, Alternativas Terapéuticas y Alimentarias, Facultad de Ciencias Farmacéuticas y Alimentarias, Universidad de Antioquia, Medellín, Colombia; Centro de Investigación en Recursos Naturales y Sustentabilidad, Universidad Bernardo O'Higgins, Santiago, Chile.
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7
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D’Este G, Fabris F, Stazi M, Baggio C, Simonato M, Megighian A, Rigoni M, Negro S, Montecucco C. Agonists of melatonin receptors strongly promote the functional recovery from the neuroparalysis induced by neurotoxic snakes. PLoS Negl Trop Dis 2024; 18:e0011825. [PMID: 38190386 PMCID: PMC10798625 DOI: 10.1371/journal.pntd.0011825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/19/2024] [Accepted: 12/22/2023] [Indexed: 01/10/2024] Open
Abstract
Snake envenoming is a major, but neglected, tropical disease. Among venomous snakes, those inducing neurotoxicity such as kraits (Bungarus genus) cause a potentially lethal peripheral neuroparalysis with respiratory deficit in a large number of people each year. In order to prevent the development of a deadly respiratory paralysis, hospitalization with pulmonary ventilation and use of antivenoms are the primary therapies currently employed. However, hospitals are frequently out of reach for envenomated patients and there is a general consensus that additional, non-expensive treatments, deliverable even long after the snake bite, are needed. Traumatic or toxic degenerations of peripheral motor neurons cause a neuroparalysis that activates a pro-regenerative intercellular signaling program taking place at the neuromuscular junction (NMJ). We recently reported that the intercellular signaling axis melatonin-melatonin receptor 1 (MT1) plays a major role in the recovery of function of the NMJs after degeneration of motor axon terminals caused by massive Ca2+ influx. Here we show that the small chemical MT1 agonists: Ramelteon and Agomelatine, already licensed for the treatment of insomnia and depression, respectively, are strong promoters of the neuroregeneration after paralysis induced by krait venoms in mice, which is also Ca2+ mediated. The venom from a Bungarus species representative of the large class of neurotoxic snakes (including taipans, coral snakes, some Alpine vipers in addition to other kraits) was chosen. The functional recovery of the NMJ was demonstrated using electrophysiological, imaging and lung ventilation detection methods. According to the present results, we propose that Ramelteon and Agomelatine should be tested in human patients bitten by neurotoxic snakes acting presynaptically to promote their recovery of health. Noticeably, these drugs are commercially available, safe, non-expensive, have a long bench life and can be administered long after a snakebite even in places far away from health facilities.
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Affiliation(s)
- Giorgia D’Este
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Federico Fabris
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Marco Stazi
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Chiara Baggio
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | | | - Aram Megighian
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- Padua Neuroscience Center, University of Padova, Padova, Italy
| | - Michela Rigoni
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- Myology Center (CIR-Myo), University of Padova, Padova, Italy
| | - Samuele Negro
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- U.O.C. Clinica Neurologica, Azienda Ospedale-Università Padova, Padova, Italy
| | - Cesare Montecucco
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- CNR Institute of Neuroscience, Padova, Italy
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Rodríguez-Vargas A, Franco-Vásquez AM, Bolívar-Barbosa JA, Vega N, Reyes-Montaño E, Arreguín-Espinosa R, Carbajal-Saucedo A, Angarita-Sierra T, Ruiz-Gómez F. Unveiling the Venom Composition of the Colombian Coral Snakes Micrurus helleri, M. medemi, and M. sangilensis. Toxins (Basel) 2023; 15:622. [PMID: 37999485 PMCID: PMC10674450 DOI: 10.3390/toxins15110622] [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: 06/23/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 11/25/2023] Open
Abstract
Little is known of the biochemical composition and functional features of the venoms of poorly known Colombian coral snakes. Here, we provide a preliminary characterization of the venom of two Colombian endemic coral snake species, Micrurus medemi and M. sangilensis, as well as Colombian populations of M. helleri. Electrophoresis and RP-HPLC techniques were used to identify venom components, and assays were conducted to detect enzyme activities, including phospholipase A2, hyaluronidase, and protease activities. The median lethal dose was determined using murine models. Cytotoxic activities in primary cultures from hippocampal neurons and cancer cell lines were evaluated. The venom profiles revealed similarities in electrophoretic separation among proteins under 20 kDa. The differences in chromatographic profiles were significant, mainly between the fractions containing medium-/large-sized and hydrophobic proteins; this was corroborated by a proteomic analysis which showed the expected composition of neurotoxins from the PLA2 (~38%) and 3FTx (~17%) families; however, a considerable quantity of metalloproteinases (~12%) was detected. PLA2 activity and protease activity were higher in M. helleri venom according to qualitative and quantitative assays. M. medemi venom had the highest lethality. All venoms decreased cell viability when tested on tumoral cell cultures, and M. helleri venom had the highest activity in neuronal primary culture. These preliminary studies shed light on the venoms of understudied coral snakes and broaden the range of sources that could be used for subsequent investigations of components with applications to specific diseases. Our findings also have implications for the clinical manifestations of snake envenoming and improvements in its medical management.
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Affiliation(s)
- Ariadna Rodríguez-Vargas
- Grupo de Investigación en Proteínas, Departamento de Química, Faculty of Sciences, Universidad Nacional de Colombia, Bogotá 11001, Colombia (N.V.); (E.R.-M.)
- Grupo de Investigación en Animales Ponzoñosos y sus Venenos, Dirección de Producción, Instituto Nacional de Salud, Bogotá 111321, Colombia; (T.A.-S.); (F.R.-G.)
| | - Adrián Marcelo Franco-Vásquez
- Departamento de Química de Biomacromoléculas, Instituto de Química, Universidad Nacional Autónoma de México, Coyoacán, Ciudad de México 04510, Mexico (R.A.-E.)
| | - Janeth Alejandra Bolívar-Barbosa
- Grupo de Investigación en Proteínas, Departamento de Química, Faculty of Sciences, Universidad Nacional de Colombia, Bogotá 11001, Colombia (N.V.); (E.R.-M.)
| | - Nohora Vega
- Grupo de Investigación en Proteínas, Departamento de Química, Faculty of Sciences, Universidad Nacional de Colombia, Bogotá 11001, Colombia (N.V.); (E.R.-M.)
| | - Edgar Reyes-Montaño
- Grupo de Investigación en Proteínas, Departamento de Química, Faculty of Sciences, Universidad Nacional de Colombia, Bogotá 11001, Colombia (N.V.); (E.R.-M.)
| | - Roberto Arreguín-Espinosa
- Departamento de Química de Biomacromoléculas, Instituto de Química, Universidad Nacional Autónoma de México, Coyoacán, Ciudad de México 04510, Mexico (R.A.-E.)
| | - Alejandro Carbajal-Saucedo
- Laboratorio de Herpetología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza 66450, Mexico;
| | - Teddy Angarita-Sierra
- Grupo de Investigación en Animales Ponzoñosos y sus Venenos, Dirección de Producción, Instituto Nacional de Salud, Bogotá 111321, Colombia; (T.A.-S.); (F.R.-G.)
- Grupo de investigación Biodiversidad para la Sociedad, Escuela de pregrados, Dirección Académica, Universidad Nacional de Colombia sede de La Paz, Cesar 22010, Colombia
| | - Francisco Ruiz-Gómez
- Grupo de Investigación en Animales Ponzoñosos y sus Venenos, Dirección de Producción, Instituto Nacional de Salud, Bogotá 111321, Colombia; (T.A.-S.); (F.R.-G.)
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9
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Baudou FG, Gutiérrez JM, Rodríguez JP. Immune response to neurotoxic South American snake venoms. Toxicon 2023; 234:107300. [PMID: 37757959 DOI: 10.1016/j.toxicon.2023.107300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
South American rattlesnakes (Crotalus durissus spp) and coral snakes (Micrurus sp) venoms are characterized by inducing a limited inflammatory innate immune response, in contrast to Bothrops sp snake venoms which exert a prominent inflammatory activity. Some Crotalus durissus spp venoms, in addition, exert immunosuppressive activities that hamper the development of neutralizing antibodies in animals immunized for antivenom production. Micrurus sp venoms are rich in low molecular mass neurotoxins that elicit a limited immune response. These characteristics make it difficult to generate antivenoms of high neutralizing activity. Therefore, the study of the mechanisms operating behind this limited immune response to venoms is relevant from both fundamental and practical perspectives. This review summarizes key aspects of the immune response to these venoms and discusses some pending challenges to further understand these phenomena and to improve antivenom production.
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Affiliation(s)
- Federico G Baudou
- Universidad Nacional de Luján (UNLu), Depto. de Ciencias Básicas, Luján, Buenos Aires, Argentina; Grupo de Investigaciones Básicas y Aplicadas en Inmunología y Bioactivos (GIBAIB), Instituto de Ecología y Desarrollo Sustentable (INEDES), UNLu-CONICET, Luján, Buenos Aires, Argentina.
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Juan Pablo Rodríguez
- Laboratorio de Investigaciones Bioquímicas de la Facultad de Medicina (LIBIM), Instituto de Química Básica y Aplicada del Nordeste Argentino (IQUIBA-NEA), Universidad Nacional del Nordeste, Consejo Nacional de Investigaciones Científicas y Técnicas (UNNE-CONICET), Corrientes, Argentina
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10
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Couceiro FYGM, Demico PJ, Dias SR, Oliveira IN, Pacagnelli FL, Silva EO, Sant'Anna SS, Grego KF, Morais-Zani K, Torres-Bonilla KA, Hyslop S, Floriano RS. Involvement of phospholipase A 2 in the neuromuscular blockade caused by coralsnake (Micrurus spp.) venoms in mouse phrenic nerve-diaphragm preparations in vitro. Toxicon 2023; 234:107263. [PMID: 37659667 DOI: 10.1016/j.toxicon.2023.107263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 09/04/2023]
Abstract
In this work, we examined the neuromuscular blockade caused by venoms from four South-American coralsnakes (Micrurus altirostris - MA, M. corallinus - MC, M. spixii - MS, and M. dumerilii carinicauda - MDC) and the ability of varespladib (VPL), a phospholipase A2 (PLA2) inhibitor, to attenuate this blockade. PLA2 activity was determined using a colorimetric assay and a fixed amount of venom (10 μg). Neurotoxicity was assayed using a single concentration of venom (10 μg/ml) in mouse phrenic nerve-diaphragm (PND) preparations mounted for myographic recordings and then subjected to histological analysis. All venoms showed PLA2 activity, with MS and MA venoms having the highest (15.53 ± 1.9 A425 nm/min) and lowest (0.23 ± 0.14 A425 nm/min) activities, respectively. VPL (292 and 438 μM) inhibited the PLA2 activity of all venoms, although that of MA venom was least affected. All venoms caused neuromuscular blockade, with MS and MDC venoms causing the fastest and slowest 100% blockade [in 40 ± 3 min and 120 ± 6 min (n = 4), respectively]; MA and MC produced complete blockade within 90-100 min. Preincubation of venoms with 292 μM VPL attenuated the blockade to varying degrees: the greatest inhibition was seen with MDC venom and blockade by MS venom was unaffected by this inhibitor. These results indicate that PLA2 has a variable contribution to coralsnake venom-induced neuromuscular blockade in vitro, with the insensitivity of MS venom to VPL suggesting that blockade by this venom is mediated predominantly by post-synaptically-active α-neurotoxins.
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Affiliation(s)
- Fernanda Y G M Couceiro
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente, SP, Brazil
| | - Poliana J Demico
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente, SP, Brazil
| | - Samuel R Dias
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente, SP, Brazil
| | - Isabele N Oliveira
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente, SP, Brazil
| | - Francis L Pacagnelli
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente, SP, Brazil
| | - Elisangela O Silva
- Laboratory of Pathological Anatomy, Veterinary Hospital, University of Western São Paulo (UNOESTE), Presidente Prudente, SP, Brazil
| | - Sávio S Sant'Anna
- Laboratory of Herpetology, Butantan Institute (IB), São Paulo, SP, Brazil
| | - Kathleen F Grego
- Laboratory of Herpetology, Butantan Institute (IB), São Paulo, SP, Brazil
| | - Karen Morais-Zani
- Laboratory of Herpetology, Butantan Institute (IB), São Paulo, SP, Brazil
| | - Kristian A Torres-Bonilla
- Section of Pharmacology, Department of Translational Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Stephen Hyslop
- Section of Pharmacology, Department of Translational Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Rafael S Floriano
- Laboratory of Toxinology and Cardiovascular Research, Graduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente, SP, Brazil.
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11
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Deikumah JP, Biney RP, Awoonor-Williams JK, Gyakobo MK. Compendium of medically important snakes, venom activity and clinical presentations in Ghana. PLoS Negl Trop Dis 2023; 17:e0011050. [PMID: 37506181 PMCID: PMC10411737 DOI: 10.1371/journal.pntd.0011050] [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: 12/23/2022] [Revised: 08/09/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Snake bite envenoming (SBE) is one neglected tropical disease that has not received the needed attention. The sequelae of burdensome disability and mortality impact the socioeconomic life of communities adversely with little documentation of SBE in health facility records in Ghana. This study details SBE and snake distribution, habits/habitats, type of venom expressed and clinical manifestations. METHODOLOGY We conducted a structured thematic desk review of peer reviewed papers, books and reports from repositories including PubMed, World Health Organization (WHO) and Women's & Children's Hospital (WCH) Clinical Toxinology Resources using bibliographic software EndNote and search engine Google Scholar with the following key words; snakes, medical importance, snake bites, venom and venom type, envenomation, symptoms and signs, vaccines, venom expenditure, strike behaviour and venom-metering + Ghana, West Africa, Africa, World. We also reviewed data from the District Health Information Management System (DHIMS) of the Ghana Health Service (GHS). Outcome variables were organized as follows: common name (s), species, habitat/habit, species-specific toxin, clinical manifestation, antivenom availability, WHO category. FINDINGS Snake bites and SBE were grouped by the activity of the expressed venom into neurotoxic, cardiotoxic, haemorrhagic, cytotoxic, myotoxic, nephrotoxic and procoagulants. Neurotoxic snake bites were largely due to elapids. Expressed venoms with cardiotoxic, haemorrhagic, nephrotoxic and procoagulant activities principally belonged to the family Viperidae. Snakes with venoms showing myotoxic activity were largely alien to Ghana and the West African sub-region. Venoms showing cytotoxic activity are expressed by a wide range of snakes though more prevalent among the Viperidae family. Snakes with neurotoxic and haemorrhagic venom activities are prevalent across all the agro-ecological zones in Ghana. CONCLUSION/SIGNIFICANCE Understanding the characteristics of snakes and their venoms is useful in the management of SBE. The distribution of snakes by their expressed venoms across the agro-ecological zones is also instructive to species identification and diagnosis of SBE.
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Affiliation(s)
- Justus Precious Deikumah
- Department of Conservation Biology and Entomology, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Robert Peter Biney
- Department of Pharmacotherapeutics and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | - Mawuli Kotope Gyakobo
- Department of Internal Medicine and Therapeutics, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
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12
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Morris CAD, Donaldson RE. Mechanical ventilation in snake envenomation of dogs and cats. Front Vet Sci 2023; 10:1071257. [PMID: 37065246 PMCID: PMC10090310 DOI: 10.3389/fvets.2023.1071257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Envenomation by snakes in Elapidae and Viperidae families have been associated with respiratory failure in dogs and cats. Mechanical ventilation may be required for hypoventilation due to neuromuscular paralysis or hypoxemia due to pulmonary hemorrhage or aspiration pneumonia. Median incidence of dogs and cats with snake envenomation that require mechanical ventilation is 13% (0.06-40%). Standard treatment of snake envenomation in dogs and cats includes prompt administration of appropriate antivenom and management of envenomation complications such as coagulopathy, rhabdomyolysis and acute kidney injury. When mechanical ventilation is required, overall prognosis is good with appropriate treatment. Standard anesthetic protocols and mechanical ventilator settings are generally appropriate, with lung protective ventilation strategies typically reserved for patients with pulmonary disease. Median survival to discharge for cats and dogs with elapid envenomation is 72% (76-84%) with 33 h (19.5-58 h) median duration of mechanical ventilation and 140 h (84-196 h) median hospitalization. This article reviews indications for mechanical ventilation in cats and dogs with snake envenomation, and discusses ventilator settings, anesthetic and nursing considerations, complications and outcomes specific to this disease.
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Affiliation(s)
- Cameron A. D. Morris
- Critical Care Department, Queensland Veterinary Specialists, Brisbane, QLD, Australia
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13
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Oliveira DD, Guerra-Duarte C, Stransky S, Scussel R, Pereira de Castro KL, Costal-Oliveira F, Aragão M, Oliveira-Souza GD, Saavedra-Langer R, Trevisan G, Bonilla-Ferreyra C, Chávez-Olórtegui C, Machado-de-Ávila RA. Toxic and antigenic characterization of Peruvian Micrurus surinamensis coral snake venom. Toxicon 2023; 225:107056. [PMID: 36804442 DOI: 10.1016/j.toxicon.2023.107056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023]
Abstract
Micrurus surinamensis is a semi-aquatic coral snake found in primary forest region and can cause relevant human accidents. In this work we investigated the toxic and antigenic activities of the Peruvian Micrurus surinamensis venom (MsV). We found that MsV show hyaluronidase activity but lack LAAO and PLA2 enzymatic activities. Interestingly, MsV induce edematogenic responses but cannot cause nociceptive effects. Furthermore, MsV can reduce in vitro cell viability in MGSO-3 cell line derived from human breast cancer tissue. To evaluate its antigenic potential, rabbits were immunized with MsV, which proved to be immunogenic. ELISA, immunobloting and in vivo neutralization assays demonstrated that the specific rabbit anti-MsV antivenom is more efficient than the therapeutic Brazilian antivenom in recognizing and neutralizing the lethal activity of MsV. MsV differs in protein profile and biological activities from M. frontalis venom (MfV), used as control, which impairs its recognition and neutralization by Brazilian therapeutic anti-elapidic antivenom. We performed a SPOT immunoassay for the identification of B-cell linear epitopes in the main toxins described for MsV targeted by the elicited neutralizing antibodies previously produced. A membrane containing 15-mer peptides representing the sequences of five 3TFxs and five PLA2s was produced and probed with anti- MsV antibodies. Results revealed important regions in 3FTx toxins for venom neutralization. Identifying the main MsV components and its biological activities can be helpful in guiding the production of antivenoms and in the optimization of treatment for coral snake envenomation in Brazil.
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Affiliation(s)
- Daysiane de Oliveira
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Brazil
| | - Clara Guerra-Duarte
- Centro de Pesquisa e Desenvolvimento, Fundação Ezequiel Dias, Belo Horizonte, Brazil
| | - Stephanie Stransky
- Department of Biochemistry, Albert Einstein College of Medicine, New York, United States
| | - Rahisa Scussel
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Brazil
| | | | - Fernanda Costal-Oliveira
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Matheus Aragão
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gladstony de Oliveira-Souza
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rafael Saavedra-Langer
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gabriela Trevisan
- Programa de Pós-Graduação em Farmacologia, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | | | - Carlos Chávez-Olórtegui
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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14
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Bisneto PF, Silva Pereira H, de Almeida Gonçalves Sachett J, Kaefer IL, Monteiro WM. Envenomation by Micrurus hemprichii in Brazilian Amazonia: A report of three cases. Toxicon 2023; 224:107048. [PMID: 36709049 DOI: 10.1016/j.toxicon.2023.107048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/27/2023]
Abstract
Herein, we report three new separate cases of human envenomations by Micrurus hemprichii for the Amazon, which is a biome where envenomations by Micrurus are seldom reported. Two women were bitten after stepping on the snakes and one man was bitten while handling the animal. All cases occurred in the peridomicile, in rural areas. The first case evolved mainly to local symptoms, but the patient was discharged before the identification of the snake and had to be called back for observation before being eventually discharged. In the second case, the patient presented transitory dyspnea and she was discharged after four days in hospital. In the third case, the patient showed only local symptoms, but he was about to receive unnecessary antivenom against coral snakes. Cases like these show the importance of educational problems regarding local venomous snakes in order to avoid bites and to provide the correct hospital treatment. For this, trained professionals in cases involving venomous animals are needed.
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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.
| | - Handerson Silva Pereira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado - FMT-HVD, Diretoria de Ensino e Pesquisa, Av. Pedro Teixeira, w/n, Dom Pedro, 69040-000, Manaus, Amazonas, Brazil.
| | - Jacqueline de Almeida Gonçalves Sachett
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado - FMT-HVD, Diretoria de Ensino e Pesquisa, Av. Pedro Teixeira, w/n, Dom Pedro, 69040-000, Manaus, Amazonas, Brazil; 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.
| | - 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.
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado - FMT-HVD, Diretoria de Ensino e Pesquisa, Av. Pedro Teixeira, w/n, Dom Pedro, 69040-000, Manaus, Amazonas, Brazil; 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.
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15
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Cardiac Effects of Micrurus corallinus and Micrurus dumerilii carinicauda (Elapidae) Venoms and Neutralization by Brazilian Coralsnake Antivenom and Varespladib. Cardiovasc Toxicol 2023; 23:132-146. [PMID: 36813862 DOI: 10.1007/s12012-023-09786-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
In this work, we examined the action of two South American coralsnake (Micrurus corallinus and Micrurus dumerilii carinicauda) venoms on rat heart function in the absence and presence of treatment with Brazilian coralsnake antivenom (CAV) and varespladib (VPL), a potent phospholipase A2 inhibitor. Anesthetized male Wistar rats were injected with saline (control) or a single dose of venom (1.5 mg/kg, i.m.) and monitored for alterations in echocardiographic parameters, serum CK-MB levels and cardiac histomorphology, the latter using a combination of fractal dimension and histopathological methods. Neither of the venoms caused cardiac functional alterations 2 h after venom injection; however, M. corallinus venom caused tachycardia 2 h after venom injection, with CAV (given i.p. at an antivenom:venom ratio of 1:1.5, v/w), VPL (0.5 mg/kg, i.p.) and CAV + VPL preventing this increase. Both venoms increased the cardiac lesional score and serum CK-MB levels compared to saline-treated rats, but only the combination of CAV + VPL prevented these alterations, although VPL alone was able to attenuate the increase in CK-MB caused by M. corallinus venom. Micrurus corallinus venom increased the heart fractal dimension measurement, but none of the treatments prevented this alteration. In conclusion, M. corallinus and M. d. carinicauda venoms caused no major cardiac functional alterations at the dose tested, although M. corallinus venom caused transient tachycardia. Both venoms caused some cardiac morphological damage, as indicated by histomorphological analyses and the increase in circulating CK-MB levels. These alterations were consistently attenuated by a combination of CAV and VPL.
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16
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Oliveira IS, Pucca MB, Cerni FA, Vieira S, Sachett J, Seabra de Farias A, Lacerda M, Murta F, Baia-da-Silva D, Rocha TAH, Silva LL, Bassat Q, Vissoci JRN, Gerardo CJ, Sampaio VS, Wen FH, Bernarde PS, Monteiro WM. Snakebite envenoming in Brazilian children: clinical aspects, management and outcomes. J Trop Pediatr 2023; 69:fmad010. [PMID: 36795080 DOI: 10.1093/tropej/fmad010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Snakebite envenoming is currently considered a neglected tropical disease, which affects over 5 million people worldwide, and causes almost 150 000 deaths every year, as well as severe injuries, amputations and other sequelae. Snakebite envenoming in children, although proportionally less frequent, is generally more severe, and represents an important challenge for pediatric medicine, since they often result in worse outcomes. In Brazil, given its ecological, geographic and socioeconomic characteristics, snakebites are considered an important health problem, presenting approximately 30 000 victims per year, approximately 15% of them in children. Even with low snakebite incidence, children tend to have higher snakebite severity and complications due to the small body mass and same venom volume inoculated in comparison to adults, even though, due to the lack of epidemiological information about pediatric snakebites and induced injuries, it is difficult to measure the treatment effectiveness, outcomes and quality of emergency medical services for snakebites in children. In this review, we report how Brazilian children are affected by snakebites, describing the characteristics of this affected population, clinical aspects, management, outcomes and main challenges.
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Affiliation(s)
- Isadora S Oliveira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo 14040-903, Brazil
| | - Manuela B Pucca
- Medical School, Federal University of Roraima, Boa Vista, Roraima 69310-000, Brazil
- Health Sciences Postgraduate Program, Federal University of Roraima, Boa Vista, Roraima 69310-000, Brazil
| | - Felipe A Cerni
- Health Sciences Postgraduate Program, Federal University of Roraima, Boa Vista, Roraima 69310-000, Brazil
| | - Samuel Vieira
- Medical School, Federal University of Roraima, Boa Vista, Roraima 69310-000, Brazil
| | - Jacqueline Sachett
- School of Health Sciences, Amazonas State University, Manaus, Amazonas 69065-001, Brazil
- Department of Teaching and Research, Alfredo da Matta Foundation, Manaus, Amazonas 69065-130, Brazil
| | | | - Marcus Lacerda
- Instituto Leônidas & Maria Deane, Fiocruz Amazônia, Manaus, Amazonas 69040-000, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas 69040-000, Brazil
| | - Felipe Murta
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas 69040-000, Brazil
| | - Djane Baia-da-Silva
- School of Health Sciences, Amazonas State University, Manaus, Amazonas 69065-001, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas 69040-000, Brazil
| | | | - Lincoln Luís Silva
- Graduate Program in Biosciences and Physiopathology, State University of Maringá, Paraná, Brazil
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Barcelona 08010, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Graduate Program in Biosciences and Physiopathology, State University of Maringá, Paraná, Brazil
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Charles J Gerardo
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Graduate Program in Biosciences and Physiopathology, State University of Maringá, Paraná, Brazil
| | - Vanderson Souza Sampaio
- School of Health Sciences, Amazonas State University, Manaus, Amazonas 69065-001, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas 69040-000, Brazil
- Instituto Todos pela Saúde, São Paulo, Brazil
| | | | - Paulo S Bernarde
- Laboratório de Herpetologia, Campus Floresta, Federal University of Acre, Cruzeiro do Sul CEP, Acre, Brazil
| | - Wuelton M Monteiro
- School of Health Sciences, Amazonas State University, Manaus, Amazonas 69065-001, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas 69040-000, Brazil
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Corrêa-Netto C, Strauch MA, Monteiro-Machado M, Teixeira-Araújo R, Fonseca JG, Leitão-Araújo M, Machado-Alves ML, Sanz L, Calvete JJ, Melo PA, Zingali RB. Monoclonal-Based Antivenomics Reveals Conserved Neutralizing Epitopes in Type I PLA 2 Molecules from Coral Snakes. Toxins (Basel) 2022; 15:toxins15010015. [PMID: 36668835 PMCID: PMC9863321 DOI: 10.3390/toxins15010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/18/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
For over a century, polyclonal antibodies have been used to treat snakebite envenoming and are still considered by the WHO as the only scientifically validated treatment for snakebites. Nevertheless, moderate innovations have been introduced to this immunotherapy. New strategies and approaches to understanding how antibodies recognize and neutralize snake toxins represent a challenge for next-generation antivenoms. The neurotoxic activity of Micrurus venom is mainly due to two distinct protein families, three-finger toxins (3FTx) and phospholipases A2 (PLA2). Structural conservation among protein family members may represent an opportunity to generate neutralizing monoclonal antibodies (mAbs) against family-conserved epitopes. In this work, we sought to produce a set of monoclonal antibodies against the most toxic components of M. altirostris venom. To this end, the crude venom was fractionated, and its major toxic proteins were identified and used to generate a panel of five mAbs. The specificity of these mAbs was characterized by ELISA and antivenomics approaches. Two of the generated mAbs recognized PLA2 epitopes. They inhibited PLA2 catalytic activity and showed paraspecific neutralization against the myotoxicity from the lethal effect of Micrurus and Naja venoms' PLA2s. Epitope conservation among venom PLA2 molecules suggests the possibility of generating pan-PLA2 neutralizing antibodies.
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Affiliation(s)
- Carlos Corrêa-Netto
- Instituto Vital Brazil, Rio de Janeiro 24230-410, RJ, Brazil
- Instituto de Bioquímica Médica Leopoldo de Meis, Instituto Nacional de Biologia Estrutural e Bioimagem, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
- Correspondence: (C.C.-N.); (R.B.Z.); Tel.: +55-213-938-6782 (R.B.Z.)
| | - Marcelo A. Strauch
- Instituto Vital Brazil, Rio de Janeiro 24230-410, RJ, Brazil
- Programa de Farmacologia e Química Medicinal-UFRJ, Instituto de Ciências Biomédicas, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, 373, Rio de Janeiro 21941-902, RJ, Brazil
| | - Marcos Monteiro-Machado
- Programa de Farmacologia e Química Medicinal-UFRJ, Instituto de Ciências Biomédicas, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, 373, Rio de Janeiro 21941-902, RJ, Brazil
| | - Ricardo Teixeira-Araújo
- Instituto Vital Brazil, Rio de Janeiro 24230-410, RJ, Brazil
- Instituto de Bioquímica Médica Leopoldo de Meis, Instituto Nacional de Biologia Estrutural e Bioimagem, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
| | | | - Moema Leitão-Araújo
- Fundação Zoobotânica do Rio Grande do Sul, Museu de Ciências Naturais, Núcleo Regional de Ofiologia de Porto Alegre, Porto Alegre 90690-000, RS, Brazil
| | - Maria Lúcia Machado-Alves
- Fundação Zoobotânica do Rio Grande do Sul, Museu de Ciências Naturais, Núcleo Regional de Ofiologia de Porto Alegre, Porto Alegre 90690-000, RS, Brazil
| | - Libia Sanz
- Laboratorio de Venómica Estructural y Funcional, Instituto de Biomedicina de Valencia, 46010 Valencia, Spain
| | - Juan J. Calvete
- Laboratorio de Venómica Estructural y Funcional, Instituto de Biomedicina de Valencia, 46010 Valencia, Spain
| | - Paulo A. Melo
- Programa de Farmacologia e Química Medicinal-UFRJ, Instituto de Ciências Biomédicas, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, 373, Rio de Janeiro 21941-902, RJ, Brazil
| | - Russolina Benedeta Zingali
- Instituto de Bioquímica Médica Leopoldo de Meis, Instituto Nacional de Biologia Estrutural e Bioimagem, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
- Correspondence: (C.C.-N.); (R.B.Z.); Tel.: +55-213-938-6782 (R.B.Z.)
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18
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Casais-E-Silva LL, da Cruz-Hofling MA, Teixeira CFP. The edematogenic effect of Micrurus lemniscatus venom is dependent on venom phospholipase A 2 activity and modulated by non-neurogenic factors. Toxicol Lett 2022; 369:12-21. [PMID: 35970279 DOI: 10.1016/j.toxlet.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
Coral snakes mainly cause neurotoxic symptoms in human envenomation, but experimental studies have already demonstrated several pharmacological activities in addition to these effects. This investigation was carried out with the aim of evaluating (1) non-neurogenic mechanisms involved in the inflammatory response induced by Micrurus lemniscatus venom (MLV) in rat hind paws, (2) participation of PLA2 in this response, and (3) neutralizing efficiency of commercial anti-elapid antivenom on edema. MLV promoted a rapid, significant increase in vascular permeability, influx of leukocytes, and disorganization of collagen bundles, as demonstrated by histological analysis. Several pretreatments were applied to establish the involvement of inflammatory mediators in MLV-induced edema (5 µg/paw). Treatment of animals with chlorpromazine reduced MLV-induced edema, indicating participation of TNF-α. However, the inefficiency of other pharmacological treatments suggests that eicosanoids, leukotrienes, and nitric oxide have no role in this type of edema formation. In contrast, PAF negatively modulates this venom-induced effect. MLV was recognized by anti-elapid serum, but this antivenom did not neutralize edema formation. Chemical modification of MLV with p-bromophenacyl bromide abrogated the phospholipase activity and markedly reduced edema, demonstrating PLA2 participation in MLV-induced edema. In conclusion, the non-neurogenic inflammatory profile of MLV is characterized by TNF-α-mediated edema, participation of PLA2 activity, and down-regulation by PAF. MLV induces an influx of leukocytes and destruction of collagen fibers at the site of its injection.
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Affiliation(s)
- Luciana L Casais-E-Silva
- Laboratory of Neuroimmunoendocrinology and Toxinology, Department of Bioregulation, Institute of Health Sciences (ICS), Federal University of Bahia (UFBA), Salvador, BA, Brazil.
| | - Maria Alice da Cruz-Hofling
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas (UNICAMP), Campinas, SP, Brazil
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Recovery from the Neuroparalysis Caused by the Micrurus nigrocinctus Venom Is Accelerated by an Agonist of the CXCR4 Receptor. Toxins (Basel) 2022; 14:toxins14080531. [PMID: 36006193 PMCID: PMC9412299 DOI: 10.3390/toxins14080531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/22/2022] [Accepted: 07/30/2022] [Indexed: 12/10/2022] Open
Abstract
Snake envenoming is a major but neglected human disease in tropical and subtropical regions. Among venomous snakes in the Americas, coral snakes of the genus Micrurus are particularly dangerous because they cause a peripheral neuroparalysis that can persist for many days or, in severe cases, progress to death. Ventilatory support and the use of snake species-specific antivenoms may prevent death from respiratory paralysis in most cases. However, there is a general consensus that additional and non-expensive treatments that can be delivered even long after the snake bite are needed. Neurotoxic degeneration of peripheral motor neurons activates pro-regenerative intercellular signaling programs, the greatest of which consist of the chemokine CXCL12α, produced by perisynaptic Schwann cells, which act on the CXCR4 receptor expressed on damaged neuronal axons. We recently found that the CXCR4 agonist NUCC-390 promotes axonal growth. Here, we show that the venom of the highly neurotoxic snake Micrurus nigrocinctus causes a complete degeneration of motor axon terminals of the soleus muscle, followed by functional regeneration whose time course is greatly accelerated by NUCC-390. These results suggest that NUCC-390 is a potential candidate for treating human patients envenomed by Micrurus nigrocinctus as well as other neurotoxic Micrurus spp. in order to improve the recovery of normal neuromuscular physiology, thus reducing the mortality and hospital costs of envenoming.
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20
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Pharmacological Screening of Venoms from Five Brazilian Micrurus Species on Different Ion Channels. Int J Mol Sci 2022; 23:ijms23147714. [PMID: 35887062 PMCID: PMC9318628 DOI: 10.3390/ijms23147714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 12/05/2022] Open
Abstract
Coral snake venoms from the Micrurus genus are a natural library of components with multiple targets, yet are poorly explored. In Brazil, 34 Micrurus species are currently described, and just a few have been investigated for their venom activities. Micrurus venoms are composed mainly of phospholipases A2 and three-finger toxins, which are responsible for neuromuscular blockade—the main envenomation outcome in humans. Beyond these two major toxin families, minor components are also important for the global venom activity, including Kunitz-peptides, serine proteases, 5′ nucleotidases, among others. In the present study, we used the two-microelectrode voltage clamp technique to explore the crude venom activities of five different Micrurus species from the south and southeast of Brazil: M. altirostris, M. corallinus, M. frontalis, M. carvalhoi and M. decoratus. All five venoms induced full inhibition of the muscle-type α1β1δε nAChR with different levels of reversibility. We found M. altirostris and M. frontalis venoms acting as partial inhibitors of the neuronal-type α7 nAChR with an interesting subsequent potentiation after one washout. We discovered that M. altirostris and M. corallinus venoms modulate the α1β2 GABAAR. Interestingly, the screening on KV1.3 showed that all five Micrurus venoms act as inhibitors, being totally reversible after the washout. Since this activity seems to be conserved among different species, we hypothesized that the Micrurus venoms may rely on potassium channel inhibitory activity as an important feature of their envenomation strategy. Finally, tests on NaV1.2 and NaV1.4 showed that these channels do not seem to be targeted by Micrurus venoms. In summary, the venoms tested are multifunctional, each of them acting on at least two different types of targets.
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21
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Ben Abderrazek R, Ksouri A, Idoudi F, Dhaouadi S, Hamdi E, Vincke C, Farah A, Benlasfar Z, Majdoub H, El Ayeb M, Muyldermans S, Bouhaouala-Zahar B. Neutralizing Dromedary-Derived Nanobodies Against BotI-Like Toxin From the Most Hazardous Scorpion Venom in the Middle East and North Africa Region. Front Immunol 2022; 13:863012. [PMID: 35514999 PMCID: PMC9063451 DOI: 10.3389/fimmu.2022.863012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/16/2022] [Indexed: 01/18/2023] Open
Abstract
Scorpion envenoming is a severe health problem in many regions causing significant clinical toxic effects and fatalities. In the Middle East/North Africa (MENA) region, Buthidae scorpion stings are responsible for devastating toxic outcomes in human. The only available specific immunotherapeutic treatment is based on IgG fragments of animal origin. To overcome the limitations of classical immunotherapy, we have demonstrated the in vivo efficacy of NbF12-10 bispecific nanobody at preclinical level. Nanobodies were developed against BotI analogues belonging to a distinct structural and antigenic group of scorpion toxins, occurring in the MENA region. From Buthus occitanus tunetanus venom, BotI-like toxin was purified. The 41 N-terminal amino acid residues were sequenced, and the LD50 was estimated at 40 ng/mouse. The BotI-like toxin was used for dromedary immunization. An immune VHH library was constructed, and after screening, two nanobodies were selected with nanomolar and sub-nanomolar affinity and recognizing an overlapping epitope. NbBotI-01 was able to neutralize 50% of the lethal effect of 13 LD50 BotI-like toxins in mice when injected by i.c.v route, whereas NbBotI-17 neutralized 50% of the lethal effect of 7 LD50. Interestingly, NbBotI-01 completely reduced the lethal effect of the 2 LD50 of BotG50 when injected at 1:4 molar ratio excess. More interestingly, an equimolar mixture of NbBotI-01 with NbF12-10 neutralized completely the lethal effect of 7 and 5 LD50 of BotG50 or AahG50, at 1:4 and 1:2 molar ratio, respectively. Hence, NbBotI-01 and NbF12-10 display synergic effects, leading to a novel therapeutic candidate for treating Buthus occitanus scorpion stings in the MENA region.
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Affiliation(s)
- Rahma Ben Abderrazek
- Laboratoire des Biomolécules, Venins et Applications Théranostiques, Institut Pasteur Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ayoub Ksouri
- Laboratoire des Biomolécules, Venins et Applications Théranostiques, Institut Pasteur Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Faten Idoudi
- Laboratoire des Biomolécules, Venins et Applications Théranostiques, Institut Pasteur Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Sayda Dhaouadi
- Laboratoire des Biomolécules, Venins et Applications Théranostiques, Institut Pasteur Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Emna Hamdi
- Laboratoire des Biomolécules, Venins et Applications Théranostiques, Institut Pasteur Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Cécile Vincke
- Laboratory of Cellular and Molecular Immunology, Vrije Universiteit Brussel, Brussels, Belgium.,Myeloid Cell Immunology Lab, Vlaams Interuniversitair Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Brussels, Belgium
| | - Azer Farah
- Laboratory of Cellular and Molecular Immunology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Zakaria Benlasfar
- Laboratoire des Biomolécules, Venins et Applications Théranostiques, Institut Pasteur Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Hafedh Majdoub
- Unité des Services Communs de Recherche (USCR) Séquenceur de Protéines, Faculté des Sciences de Sfax, Sfax, Tunisia
| | - Mohamed El Ayeb
- Laboratoire des Biomolécules, Venins et Applications Théranostiques, Institut Pasteur Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Serge Muyldermans
- Laboratory of Cellular and Molecular Immunology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Balkiss Bouhaouala-Zahar
- Laboratoire des Biomolécules, Venins et Applications Théranostiques, Institut Pasteur Tunis, University Tunis El Manar, Tunis, Tunisia.,Unité des Services Communs de Recherche (USCR) Séquenceur de Protéines, Faculté des Sciences de Sfax, Sfax, Tunisia.,Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis, Tunisia
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22
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Anti-Neurotoxins from Micrurus mipartitus in the Development of Coral Snake Antivenoms. Toxins (Basel) 2022; 14:toxins14040265. [PMID: 35448874 PMCID: PMC9027008 DOI: 10.3390/toxins14040265] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 02/05/2023] Open
Abstract
In Colombia, the genus Micrurus includes 30 species, of which M. mipartitus and M. dumerilii are the most widely distributed. Micrurus causes less than 3% of the approximately 5000 cases of snakebite per year. The elapid envenomation caused by the snakes from the Micrurus genus, are characterized by the severity of their clinical manifestations, due to the venom neurotoxic components such as three-finger toxins (3FTx) and phospholipases (PLA2). The treatment for snakebites is the administration of specific antivenoms, however, some of them have limitations in their neutralizing ability. A strategy proposed to improve antivenoms is to produce antibodies against the main components of the venom. The aim of this work was to produce an antivenom, using an immunization protocol including the main 3FTx and PLA2 responsible for M. mipartitus lethality. The antibody titers were determined by ELISA in rabbits’ serum. The immunized animals elicited a response against toxins and whole venom. The Immunoglobulin G (IgGs) obtained were able to neutralize the lethal effect of their homologous toxins. A combination of antivenom from M. mipartitus with antitoxins improved their neutralizing ability. In the same way, a mixture of anti 3FTx and PLA2 protected the mice from a 1.5 median lethal dose (LD50) of M. mipartitus venom. The results showed that this might be a way to improve antibody titers specificity against the relevant toxins in M. mipartitus venom and indicated that there is a possibility to develop and use recombinant 3FTx and PLA2 toxins as immunogens to produce antivenoms. Additionally, this represents an alternative to reduce the amount of venom used in anti-coral antivenom production.
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23
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Mena G, Chaves-Araya S, Chacón J, Török E, Török F, Bonilla F, Sasa M, Gutiérrez JM, Lomonte B, Fernández J. Proteomic and toxicological analysis of the venom of Micrurus yatesi and its neutralization by an antivenom. Toxicon X 2022; 13:100097. [PMID: 35243330 PMCID: PMC8864321 DOI: 10.1016/j.toxcx.2022.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/22/2022] Open
Abstract
Coralsnakes belong to the family Elapidae and possess venoms which are lethal to humans and can be grouped based on the predominance of either three finger toxins (3FTxs) or phospholipases A2 (PLA2s). A proteomic and toxicological analysis of the venom of the coralsnake Micrurus yatesi was performed. This species, distributed in southeastern Costa Rica, was formerly considered a subspecies of M. alleni. Results showed that this venom is PLA2-rich, in contrast with the previously studied venom of Micrurus alleni. Toxicological evaluation of the venom, in accordance with proteomic data, revealed that it has a markedly higher in vitro PLA2 activity upon a synthetic substrate than M. alleni. The evaluation of in vivo myotoxicity in CD-1 mice using histological evaluation and plasma creatine kinase release also showed that M. yatesi venom caused muscle damage. A commercial equine antivenom prepared using the venom of Micrurus nigrocinctus displayed a similar recognition of the venoms of M. yatesi and M. nigrocinctus by enzyme immunoassay. This antivenom also immunorecognized the main fractions of the venom of M. yatesi and was able to neutralize its lethal effect in a murine model. The venom proteome of Micrurus yatesi was determined. The venom of Micrurus yatesi is a Phospholipase A2-rich venom. When injected in mice, the venom of Micrurus yatesi caused muscle damage. An antivenom immunorecognized the main fractions of Micrurus yatesi venom. The antivenom was able to neutralize the lethal activity of the venom of Micrurus yatesi.
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24
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In Vivo Cardiotoxic Potential of Micrurus frontalis Venom. Cardiovasc Toxicol 2022; 22:181-190. [DOI: 10.1007/s12012-021-09713-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
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Affiliation(s)
- Ravikar Ralph
- Department of Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | - Sanjib Kumar Sharma
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, 76500, Nepal
| | - Isabela Ribeiro
- Dynamic Portfolio, Drugs for Neglected Diseases initiative (DNDi), 15 Chemin Louis-Dunant, 1202, Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, Geneva, CH 1211, Switzerland
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26
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Baudou FG, Rodriguez JP, Fusco L, de Roodt AR, De Marzi MC, Leiva L. South American snake venoms with abundant neurotoxic components. Composition and toxicological properties. A literature review. Acta Trop 2021; 224:106119. [PMID: 34481791 DOI: 10.1016/j.actatropica.2021.106119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 01/18/2023]
Abstract
In South America there are three snake genera with predominantly neurotoxic venoms: Crotalus, Micrurus and Hydrophis, which include nine species/subspecies, 97 species and a single marine species, respectively. Although accidents with neurotoxic venoms are less frequent than those with anticoagulant, cytotoxic or necrotic venoms (e.g. from Bothrops), they are of major public health importance. Venoms from genus Crotalus have been extensively studied, while data on the venoms from the other two genera are very limited, especially for Hydrophis. The venoms of North and South American Crotalus species show biochemical and physiopathological differences. The former species cause bothrops-like envenomation symptoms, while the latter mainly have neurotoxic and myotoxic effects, leading to respiratory paralysis and, occasionally, renal failure by myoglobinuria and death, often with no local lesions. Micrurus and Hydrophis also cause neurotoxic envenomations. Many studies have isolated, identified and characterized new enzymes and toxins, thus expanding the knowledge of snake venom composition. The present review summarizes the currently available information on neurotoxic venoms from South American snakes, with a focus on protein composition and toxicological properties. It also includes some comments concerning potential medical applications of elapid and crotalic toxins.
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Affiliation(s)
- Federico G Baudou
- Universidad Nacional de Luján (UNLu), Depto. de Ciencias Básicas, Luján, Buenos Aires, Argentina; Laboratorio de Inmunología, Instituto de Ecología y Desarrollo Sustentable (INEDES), UNLu-CONICET, Luján, Buenos Aires, Argentina.
| | - Juan P Rodriguez
- Laboratorio de Investigaciones Bioquímicas de la Facultad de Medicina (LIBIM), Instituto de Química Básica y Aplicada del Nordeste Argentino (IQUIBA-NEA), Universidad Nacional del Nordeste, Consejo Nacional de Investigaciones Científicas y Técnicas (UNNE-CONICET), Corrientes, Argentina
| | - Luciano Fusco
- Laboratorio de Investigación en Proteínas (LabInPro), IQUIBA-NEA (UNNE, CONICET), FaCENA, (UNNE), Corrientes, Argentina
| | - Adolfo R de Roodt
- Área Investigación y Desarrollo-Venenos, Instituto Nacional de Producción de Biológicos, Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán", Ministerio de Salud de la Nación, Argentina; Primera Cátedra de Toxicología, Facultad de Medicina, Universidad de Buenos Aires, Argentina; Laboratorio de Toxinopatología, Centro de Patología Experimental y Aplicada, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Mauricio C De Marzi
- Universidad Nacional de Luján (UNLu), Depto. de Ciencias Básicas, Luján, Buenos Aires, Argentina; Laboratorio de Inmunología, Instituto de Ecología y Desarrollo Sustentable (INEDES), UNLu-CONICET, Luján, Buenos Aires, Argentina
| | - Laura Leiva
- Laboratorio de Investigación en Proteínas (LabInPro), IQUIBA-NEA (UNNE, CONICET), FaCENA, (UNNE), Corrientes, Argentina
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27
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Ceron K, Vieira C, Carvalho PS, Carrillo JFC, Alonso J, Santana DJ. Epidemiology of snake envenomation from Mato Grosso do Sul, Brazil. PLoS Negl Trop Dis 2021; 15:e0009737. [PMID: 34495969 PMCID: PMC8452014 DOI: 10.1371/journal.pntd.0009737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 09/20/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
Snake envenomation is considered a public health problem in tropical countries, where they occur in a high incidence. The present study reports the snake envenomation that occurred in Mato Grosso do Sul state (Brazil) between 2007 and 2017. Epidemiological data were obtained from the online platform of the Notification Disease Information System and were analyzed according to biome. A total of 5568 cases of snake envenomations were recorded during the study period, where the highest frequency was registered between October and April. The majority of envenomations occurred in working-age males (20 to 39 years), caused mainly by Bothrops snakes, and the duration of care after the envenomation in most cases took three hours. The municipalities that showed the highest snake envenomations case per 100,000 inhabitants presents low population density, and have their economy based on agricultural activity, which is a risk factor to snake envenomations. To the Mato Grosso do Sul state, the total number of snake envenomations had a positive relationship with the size of the municipality. Since this, larger areas usually have a mosaic of environments, which may harbor higher richness and abundance of snakes, and can cause more snake encounters with the population, resulting in more snake envenomations. Brazil is the country in South America with the most reported snake envenomations, however, the incidence of snake envenomations is not equal throughout the country. In most cases, the occurrence of snake envenomations is related to environmental factors (e.g., climate) and the increase of human activity in fieldwork. Besides those factors, problems in urban infrastructure, municipality size, or population size are also variables that can influence the number of snake envenomations in a region. The authors found that in the Mato Grosso do Sul state, Brazil, the number of snake envenomations is low when compared with Mato Grosso and Goiás states, and the national average. Despite this, snake envenomations in Mato Grosso do Sul confirmed trends observed in other Brazilian regions, happening mainly in October and April. Most of the envenomations occurred in males by Bothrops snakes and with an attendance time of 3 hours. Also, the authors found that there is a relationship between municipality areas with the number of snake envenomations. Seen this, municipalities with larger areas usually have a mosaic of environments, which may harbor higher richness and abundance of snakes, and can cause more snake encounters with the population, resulting in more snake envenomations.
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Affiliation(s)
- Karoline Ceron
- Mapinguari-Laboratório de Sistemática e Biogeografia de Anfíbios e Répteis, Instituto de Biociências, Universidade Federal de Mato Grosso do Sul, Cidade Universitária, Campo Grande, Brazil
| | - Cássia Vieira
- Mapinguari-Laboratório de Sistemática e Biogeografia de Anfíbios e Répteis, Instituto de Biociências, Universidade Federal de Mato Grosso do Sul, Cidade Universitária, Campo Grande, Brazil
| | - Priscila Santos Carvalho
- Mapinguari-Laboratório de Sistemática e Biogeografia de Anfíbios e Répteis, Instituto de Biociências, Universidade Federal de Mato Grosso do Sul, Cidade Universitária, Campo Grande, Brazil.,Instituto de Biociências, Letras e Ciências Exatas, Universidade Estadual Paulista (UNESP), São José do Rio Preto, Brazil
| | - Juan Fernando Cuestas Carrillo
- Mapinguari-Laboratório de Sistemática e Biogeografia de Anfíbios e Répteis, Instituto de Biociências, Universidade Federal de Mato Grosso do Sul, Cidade Universitária, Campo Grande, Brazil
| | - Jaqueline Alonso
- Mapinguari-Laboratório de Sistemática e Biogeografia de Anfíbios e Répteis, Instituto de Biociências, Universidade Federal de Mato Grosso do Sul, Cidade Universitária, Campo Grande, Brazil
| | - Diego José Santana
- Mapinguari-Laboratório de Sistemática e Biogeografia de Anfíbios e Répteis, Instituto de Biociências, Universidade Federal de Mato Grosso do Sul, Cidade Universitária, Campo Grande, Brazil
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Rafael de Roodt A, Lanari LC, Ramírez JE, Gómez C, Barragán J, Litwin S, Henriët van Grootheest J, Desio M, Dokmetjian JC, Dolab JA, Damin CF, Alagón A. Cross-reactivity of some Micrurus venoms against experimental and therapeutic anti-Micrurus antivenoms. Toxicon 2021; 200:153-164. [PMID: 34303716 DOI: 10.1016/j.toxicon.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/25/2021] [Accepted: 07/15/2021] [Indexed: 01/22/2023]
Abstract
We developed experimental equine polyvalent and monovalent antivenoms against the venoms of Micrurus (M.) fulvius, M. nigrocinctus and M. surinamensis and studied their immunochemical reactivity on the venoms used as immunogens and on M. pyrrhocryptus, M altirostris and M. balyocoriphus venoms. Assessment of the neutralizing capacity of the polyvalent experimental antivenom was based on inhibition of lethality (preincubation and rescue assay experiments in mice) and indirect hemolytic and phospholipase activities. The immunochemical reactivity and neutralizing capacity were compared with those of two therapeutic antivenoms used for the treatment of coral snake envenomation in North America and in Argentina. In general, the experimental antivenom conferred a comparable level of neutralization against the venoms used as immunogens when compared to the therapeutic antivenoms and a certain level of cross-neutralization against the other venoms. The results suggest the need for additional venoms in the immunogenic mixture used, in order to obtain a broad spectrum anti-Micrurus antivenom with a good neutralizing potency. Paraspecific neutralization of South American coral snake venoms, although present at a higher level than the neutralization conferred by available nonspecific Micrurus therapeutic antivenoms, was rather low in relation to the specific neutralizing capacity.
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Affiliation(s)
- Adolfo Rafael de Roodt
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Ministerio de Salud, Buenos Aires, Argentina; Primera Cátedra de Toxicología, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
| | - Laura Cecilia Lanari
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Ministerio de Salud, Buenos Aires, Argentina
| | | | - Carlos Gómez
- Cátedra de Inmunología, Facultad de Ciencias Veterinarias de la Universidad Nacional de La Plata, Argentina
| | - Javier Barragán
- Cátedra de Inmunología, Facultad de Ciencias Veterinarias de la Universidad Nacional de La Plata, Argentina
| | - Silvana Litwin
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Ministerio de Salud, Buenos Aires, Argentina
| | - Jantine Henriët van Grootheest
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Ministerio de Salud, Buenos Aires, Argentina
| | - Marcela Desio
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Ministerio de Salud, Buenos Aires, Argentina
| | - José Christian Dokmetjian
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Ministerio de Salud, Buenos Aires, Argentina
| | - Jorge Adrián Dolab
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Ministerio de Salud, Buenos Aires, Argentina
| | - Carlos Fabián Damin
- Primera Cátedra de Toxicología, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Alejandro Alagón
- Instituto de Biotecnología de la Universidad Nacional Autónoma de México, Cuernavaca, Morelos, Mexico
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Snakebite biomedical and epidemiological aspects in the department of Cauca, Colombia, 2009-2018. ACTA ACUST UNITED AC 2021; 41:314-337. [PMID: 34214272 PMCID: PMC8388738 DOI: 10.7705/biomedica.5853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Indexed: 11/21/2022]
Abstract
Introduction: Snakebite is a relevant public health problem in Colombia, which is evident in epidemiological data at the Latin American level, where it ranks third place in the number of snakebites, after México and Brazil.
Objective: To perform a retrospective analysis of snakebite accidents in the department of Cauca between 2009 and 2018 based on the data from the Public Health Surveillance System of Colombia reported to the Health Institute of Cauca.
Materials and methods: We compiled and interpreted the information from the compulsory snakebite notification forms for the study’s 10 years period. We determined snakebite incidence and frequency according to the geographical distribution and the causal agents, and we analyzed related socioeconomic variables as well.
Results: The records accounted for 1,653 cases and low mortality. Bothrops and Bothriechis species (77.43%) caused most of the accidents followed by Micrurus (2.9%). Most of the notifications came from the south of the department, and males and farmers were the most affected with bites mainly in the upper extremities. During poisoning, hemorrhagic manifestations predominated over necrosis and infections; serotherapy criteria were not always adequately applied, however, iatrogenic complications were not frequent.
Conclusions: El Tambo and Piamonte municipalities, being male, and rural areas were the variables most affected by ophidism, mainly bothropic ophidism. The highest incidences occurred in the southern part of Cauca, in the Patía and Caquetá river basins.
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Matos RR, Ignotti E. [Incidence of venomous snakebite accidents by snake species in Brazilian biomes]. CIENCIA & SAUDE COLETIVA 2021; 25:2837-2846. [PMID: 32667565 DOI: 10.1590/1413-81232020257.31462018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/23/2018] [Indexed: 11/21/2022] Open
Abstract
The supply of antidotes for the treatment of venomous snakebite accidents, as well as the training of the care team, should be structured according to the frequency and risks by geographical areas. The scope of this article is to analyze the trend of the incidence of snakebite accidents in Brazilian biomes between 2003 and 2012. It involved the ecological study by means of Prais-Winsten regression of the incidence of snakebites by the Bothrops, Crotalus, Lachesis and Micrurus species for the Brazilian biomes in the period from 2003 to 2012. The research revealed that the number of accidents increased from 26,082 in 2003 to 27,870 in 2012 with an increased demand for antidotes. The trend analysis of the incidence showed a stationary trend, except for the Crotalus species with an upward trend in the Brazilian aggregate. An upward trend was found in the Cerrado for the Crotalus, Lachesis and Micrurus species: in the Pampa for Crotalus; in the Caatinga for Lachesis and in the Atlantic Forest for Micrurus. The conclusion drawn is that the stationary trend observed for snakebite accidents in Brazil is due to the fact that the majority of these (87%) are caused by snakes of the Bothrops species. However, it should be stressed that there is an increased risk of accidents with snakes of the Crotalus, Lachesis and Micrurus species.
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Affiliation(s)
- Rafael Rodrigues Matos
- Universidade do Estado de Mato Grosso. Av. Tancredo Neves 1095, Cavalhada III. 78217-900 Cárceres MT Brasil.
| | - Eliane Ignotti
- Universidade do Estado de Mato Grosso. Av. Tancredo Neves 1095, Cavalhada III. 78217-900 Cárceres MT Brasil.
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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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32
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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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Dashevsky D, Rokyta D, Frank N, Nouwens A, Fry BG. Electric Blue: Molecular Evolution of Three-Finger Toxins in the Long-Glanded Coral Snake Species Calliophis bivirgatus. Toxins (Basel) 2021; 13:124. [PMID: 33567660 PMCID: PMC7915963 DOI: 10.3390/toxins13020124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 01/17/2023] Open
Abstract
The genus Calliophis is the most basal branch of the family Elapidae and several species in it have developed highly elongated venom glands. Recent research has shown that C. bivirgatus has evolved a seemingly unique toxin (calliotoxin) that produces spastic paralysis in their prey by acting on the voltage-gated sodium (NaV) channels. We assembled a transcriptome from C. bivirgatus to investigate the molecular characteristics of these toxins and the venom as a whole. We find strong confirmation that this genus produces the classic elapid eight-cysteine three-finger toxins, that δδ-elapitoxins (toxins that resemble calliotoxin) are responsible for a substantial portion of the venom composition, and that these toxins form a distinct clade within a larger, more diverse clade of C. bivirgatus three-finger toxins. This broader clade of C. bivirgatus toxins also contains the previously named maticotoxins and is somewhat closely related to cytotoxins from other elapids. However, the toxins from this clade that have been characterized are not themselves cytotoxic. No other toxins show clear relationships to toxins of known function from other species.
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Affiliation(s)
- Daniel Dashevsky
- Venom Evolution Lab, School of Biological Sciences, University of Queensland, St Lucia, QLD 4072, Australia;
- Australian National Insect Collection, Commonwealth Science and Industry Research Organization, Canberra, ACT 2601, Australia
| | - Darin Rokyta
- Department of Biological Sciences, Florida State University, Tallahassee, FL 24105, USA;
| | - Nathaniel Frank
- MToxins Venom Lab, 717 Oregon Street, Oshkosh, WI 54902, USA;
| | - Amanda Nouwens
- School of Chemistry and Molecular Biosciences, University of Queensland, St Lucia, QLD 4072, Australia;
| | - Bryan G. Fry
- Venom Evolution Lab, School of Biological Sciences, University of Queensland, St Lucia, QLD 4072, Australia;
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34
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Bénard-Valle M, Neri-Castro E, Elizalde-Morales N, Olvera-Rodríguez A, Strickland J, Acosta G, Alagón A. Protein composition and biochemical characterization of venom from Sonoran Coral Snakes (Micruroides euryxanthus). Biochimie 2021; 182:206-216. [PMID: 33485932 DOI: 10.1016/j.biochi.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 11/16/2022]
Abstract
The elapid genus, Micruroides, is considered the sister clade of all New World coral snakes (Genus Micrurus), is monotypic, and is represented by Sonoran Coral Snakes, Micruroides euryxanthus. Coral snakes of the genus Micrurus have been reported to have venoms that are predominantly composed of phospholipases A2 (PLA2) or three finger toxins (3FTx), but the venoms of the genus Micruroides are almost completely unstudied. Here, we present the first description of the venom of M. euryxanthus including identification of some proteins as well as transcriptomic, and biological activity assays. The most abundant components within M. euryxanthus venom are 3FTxs (62.3%) and there was relatively low proportion of PLA2s (14.2%). The venom phenotype supports the hypothesis that the common ancestor of Micrurus and Micruroides had a 3FTx-dominated venom. Within the venom, there were two nearly identical α-neurotoxins (α-Ntx), one of which was designated Eurytoxin, that account for approximately 60% of the venom's lethality to mice. Eurytoxin was cloned, expressed in a soluble and active form, and used to produce rabbit hyperimmune serum. This allowed the analysis of its immunochemical properties, showing them to be different from the recombinant αNTx D.H., present in the venoms of some species of Micrurus. Finally, we observed that the commercial antivenom produced in Mexico for coral snake envenomation is unable to neutralize the lethality from M. euryxanthus venom. This work allowed the classification of Micruroides venom into the 3FTx-predominant group and identified the main components responsible for toxicity to mice.
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Affiliation(s)
- Melisa Bénard-Valle
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Av. Universidad # 2001, Colonia Chamilpa, CP: 62210, Cuernavaca, Morelos, Mexico
| | - Edgar Neri-Castro
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Av. Universidad # 2001, Colonia Chamilpa, CP: 62210, Cuernavaca, Morelos, Mexico
| | - Nicolás Elizalde-Morales
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Av. Universidad # 2001, Colonia Chamilpa, CP: 62210, Cuernavaca, Morelos, Mexico
| | - Alejandro Olvera-Rodríguez
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Av. Universidad # 2001, Colonia Chamilpa, CP: 62210, Cuernavaca, Morelos, Mexico
| | - Jason Strickland
- Department of Biological Sciences, Clemson University, Clemson, SC, 29632, USA; Department of Biology, University of South Alabama, Mobile, AL, 36688, USA
| | - Gerardo Acosta
- MIVIA. Museo Itinerante de Vida Animal, Hermosillo, Sonora, Mexico
| | - Alejandro Alagón
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Av. Universidad # 2001, Colonia Chamilpa, CP: 62210, Cuernavaca, Morelos, Mexico.
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35
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Titelbaum NV, Hughes MJ, Wilson JL. Myalgia as a Symptom of Envenomation by the Eastern Coral Snake, Micrurus Fulvius: A Case Report. Wilderness Environ Med 2020; 32:63-69. [PMID: 33309199 DOI: 10.1016/j.wem.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/09/2020] [Accepted: 08/21/2020] [Indexed: 11/19/2022]
Abstract
We present the case of a patient who developed myalgia as the primary symptom of envenomation by the eastern coral snake, Micrurus fulvius. The patient was evaluated and treated in the emergency department. Physical examination did not demonstrate any neuromuscular abnormalities. On consultation with the poison control center, the patient's myalgia was determined to be an effect of envenomation, and 5 vials of North American coral snake antivenin were administered. The patient was admitted to the intensive care unit where his symptoms resolved. He was discharged the following day after remaining asymptomatic for 24 h.
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Affiliation(s)
- Nicholas V Titelbaum
- University of Central Florida, Orlando, FL; Ocala Regional Emergency Department, Ocala Regional Medical Center, Ocala, FL.
| | - Michael J Hughes
- University of Central Florida, Orlando, FL; Ocala Regional Emergency Department, Ocala Regional Medical Center, Ocala, FL
| | - James L Wilson
- Ocala Regional Emergency Department, Ocala Regional Medical Center, Ocala, FL
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36
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Simões LO, Alves QL, Camargo SB, Araújo FA, Hora VRS, Jesus RLC, Barreto BC, Macambira SG, Soares MBP, Meira CS, Aguiar MC, Couto RD, Lomonte B, Menezes-Filho JE, Cruz JS, Vannier-Santos MA, Casais-E-Silva LL, Silva DF. Cardiac effect induced by Crotalus durissus cascavella venom: Morphofunctional evidence and mechanism of action. Toxicol Lett 2020; 337:121-133. [PMID: 33238178 DOI: 10.1016/j.toxlet.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/28/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
Envenoming, resulting from snake bites, is a global public health problem. The present study was undertaken to investigate the influence of Crotalus durissus cascavella (Cdcas) venom on cardiac activity and the mechanisms of action underlying its effect. To investigate the inotropic and chronotropic effects induced by Cdcas, studies were performed on the left and right atria. A series of tests were conducted to investigate whether the negative inotropic effect, induced by Cdcas, was related to cardiac damage. Cdcas venom (0.1-30 μg/mL) elicited a significant negative inotropic effect. The addition of Cdcas crude venom (7.5, 15 and 30 μg/mL) did not induce significant alterations in cell proliferation, nor in the enzymatic activity of total-CK and CKMB. Ultrastructural evaluation demonstrated that cardiac cells from isoproterenol and Cdcas groups revealed discreet swelling and displaced intermyofibrillar mitochondria with disorganization of the cristae. No change was observed in cardiac electrical activity in perfused isolated rat hearts with Cdcas. In addition, Cdcas reduced contractility in isolated cardiomyocytes from the rat left ventricle. The negative inotropic effect of Cdcas was reduced by l-NAME (100 μM), PTIO (100 μM), ODQ (10 μM) and KT5823 (1 μM), suggesting the participation of NO/cGMP/PKG pathway due to Cdcas. In non-anesthetized rats, Cdcas induced hypotension followed by bradycardia, the latter was also observed by ECG (anesthetized animals). Our results suggest that the negative inotropic effect induced by Cdcas venom is unrelated to cardiac toxicity, at least, at the concentrations tested; and occurs through of NO/cGMP/PKG pathway, likely leading to hypotension and bradycardia when administered in vivo.
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Affiliation(s)
- Letícia O Simões
- Department of Bioregulation, Federal University of Bahia, Salvador, BA, 40110-902, Brazil
| | - Quiara L Alves
- Department of Bioregulation, Federal University of Bahia, Salvador, BA, 40110-902, Brazil
| | - Samuel B Camargo
- Department of Bioregulation, Federal University of Bahia, Salvador, BA, 40110-902, Brazil
| | - Fênix A Araújo
- Department of Bioregulation, Federal University of Bahia, Salvador, BA, 40110-902, Brazil
| | - Viviane R S Hora
- Department of Bioregulation, Federal University of Bahia, Salvador, BA, 40110-902, Brazil
| | - Rafael L C Jesus
- Department of Bioregulation, Federal University of Bahia, Salvador, BA, 40110-902, Brazil
| | | | - Simone G Macambira
- Gonçalo Moniz Institute, FIOCRUZ, Salvador, BA, Brazil; Department of Biochemistry and Biophysics, Federal University of Bahia, Salvador, BA, 40110-902, Brazil
| | | | | | - Márcio C Aguiar
- Department of Biomorphology, Institute of Health Sciences, Federal University of Bahia, Salvador, BA, 40110-902, Brazil
| | - Ricardo D Couto
- Department of Clinical and Toxicological Analysis, Federal University of Bahia, Salvador, BA, 41170290, Brazil
| | - Bruno Lomonte
- Clodomiro Picado Institute, Faculty of Microbiology, University of Costa Rica, San José, 11501, Costa Rica
| | - José Evaldo Menezes-Filho
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, MG, 30161970, Brazil
| | - Jader S Cruz
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, MG, 30161970, Brazil
| | | | | | - Darizy F Silva
- Department of Bioregulation, Federal University of Bahia, Salvador, BA, 40110-902, Brazil
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37
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Dashevsky D, Bénard-Valle M, Neri-Castro E, Youngman NJ, Zdenek CN, Alagón A, Portes-Junior JA, Frank N, Fry BG. Anticoagulant Micrurus venoms: Targets and neutralization. Toxicol Lett 2020; 337:91-97. [PMID: 33197555 DOI: 10.1016/j.toxlet.2020.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 11/26/2022]
Abstract
Snakebite is a neglected tropical disease with a massive global burden of injury and death. The best current treatments, antivenoms, are plagued by a number of logistical issues that limit supply and access in remote or poor regions. We explore the anticoagulant properties of venoms from the genus Micrurus (coral snakes), which have been largely unstudied, as well as the effectiveness of antivenom and a small-molecule phospholipase inhibitor-varespladib-at counteracting these effects. Our in vitro results suggest that these venoms likely interfere with the formation or function of the prothrombinase complex. We find that the anticoagulant potency varies widely across the genus and is especially pronounced in M. laticollaris. This variation does not appear to correspond to previously described patterns regarding the relative expression of the three-finger toxin and phospholipase A2 (PLA2) toxin families within the venoms of this genus. The coral snake antivenom Coralmyn, is largely unable to ameliorate these effects except for M. ibiboboca. Varespladib on the other hand completely abolished the anticoagulant activity of every venom. This is consistent with the growing body of results showing that varespladib may be an effective treatment for a wide range of toxicity caused by PLA2 toxins from many different snake species. Varespladib is a particularly attractive candidate to help alleviate the burden of snakebite because it is an approved drug that possesses several logistical advantages over antivenom including temperature stability and oral availability.
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Affiliation(s)
- Daniel Dashevsky
- Toxin Evolution Lab, School of Biological Sciences, University of Queensland, St Lucia, QLD 4072 Australia; Australian National Insect Collection, Commonwealth Science and Industry Research Organization, Canberra, ACT 2601 Australia
| | - Melisa Bénard-Valle
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnologa, Universidad Nacional Autónoma de México, Av. Universidad 2001, Cuernavaca, Morelos, 62210, Mexico
| | - Edgar Neri-Castro
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnologa, Universidad Nacional Autónoma de México, Av. Universidad 2001, Cuernavaca, Morelos, 62210, Mexico
| | - Nicholas J Youngman
- Toxin Evolution Lab, School of Biological Sciences, University of Queensland, St Lucia, QLD 4072 Australia
| | - Christina N Zdenek
- Toxin Evolution Lab, School of Biological Sciences, University of Queensland, St Lucia, QLD 4072 Australia
| | - Alejandro Alagón
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnologa, Universidad Nacional Autónoma de México, Av. Universidad 2001, Cuernavaca, Morelos, 62210, Mexico
| | - José A Portes-Junior
- Laboratório de Coleções Zoológicas, Instituto Butantan, São Paulo 05503-900, Brazil
| | | | - Bryan G Fry
- Toxin Evolution Lab, School of Biological Sciences, University of Queensland, St Lucia, QLD 4072 Australia.
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ALfaifi MS, ALOtaibi AE, AlQahtani SA, ALShahrani OA, ALSharani KM, ALbshabshi AO, ALZahrani HM, ALAli HE. Cobra snakebite mimicking brain death treated with a novel combination of polyvalent snake antivenom and anticholinesterase. Am J Emerg Med 2020; 38:2490.e5-2490.e7. [PMID: 32712238 DOI: 10.1016/j.ajem.2020.05.111] [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: 01/29/2020] [Revised: 03/31/2020] [Accepted: 05/30/2020] [Indexed: 11/29/2022] Open
Abstract
In toxicology literature, snake bites were the second toxicology-relevant cause mimicking brain death. A 57-year-old woman with history of cobra snake bite. On examination, the brain stem reflexes were absent with Glasgow coma score of 3. The patient accomplished full neurological recovery after using a novel combination of Polyvalent Snake Antivenom (PSA) and anticholinesterases. This case highlights a unique presentation of cobra bite induced brain death mimicking. Thus, intensivist should exclude neuroparalytic effect of snakebite before considering withdrawal of ventilatory support or organ donation. Also, the life-threatening presentation of cobra envenomation mandates the use of higher doses of PSA to reverse the neuroparalytic toxicity. We should consider the rule of anticholinesterase as an adjunctive therapy to PSA in severe cobra envenomation.
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Affiliation(s)
- Musa S ALfaifi
- Department of Emergency Medicine, Aseer Central Hospital, Abha, Saudi Arabia.
| | - Atheer E ALOtaibi
- Department of Emergency Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Saeed A AlQahtani
- Emergency Medicine Department and Clinical Toxicology Division, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ohood A ALShahrani
- Department of Emergency Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Khalid M ALSharani
- Department of Emergency Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Ali O ALbshabshi
- Department of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Hadi E ALAli
- Department of Emergency Medicine, Armed forces hospital southern region, Khamis Mushait, Saudi Arabia
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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:toxins12110668. [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;
- Correspondence: ; Tel.: +55-92-99165-2486
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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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Cardiovascular activity of Micrurus lemniscatus lemniscatus (South American coralsnake) venom. Toxicon 2020; 186:58-66. [DOI: 10.1016/j.toxicon.2020.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/30/2020] [Accepted: 07/18/2020] [Indexed: 11/20/2022]
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Bénard-Valle M, Neri-Castro E, Yañez-Mendoza MF, Lomonte B, Olvera A, Zamudio F, Restano-Cassulini R, Possani LD, Jiménez-Ferrer E, Alagón A. Functional, proteomic and transcriptomic characterization of the venom from Micrurus browni browni: Identification of the first lethal multimeric neurotoxin in coral snake venom. J Proteomics 2020; 225:103863. [DOI: 10.1016/j.jprot.2020.103863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/18/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
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Calvete JJ, Bonilla F, Granados-Martínez S, Sanz L, Lomonte B, Sasa M. Venomics of the Duvernoy's gland secretion of the false coral snake Rhinobothryum bovallii (Andersson, 1916) and assessment of venom lethality towards synapsid and diapsid animal models. J Proteomics 2020; 225:103882. [DOI: 10.1016/j.jprot.2020.103882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
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Azevedo E, Figueiredo RG, Pinto RV, Ramos TDCF, Sampaio GP, Bulhosa Santos RP, Guerreiro MLDS, Biondi I, Trindade SC. Evaluation of systemic inflammatory response and lung injury induced by Crotalus durissus cascavella venom. PLoS One 2020; 15:e0224584. [PMID: 32084665 PMCID: PMC7035002 DOI: 10.1371/journal.pone.0224584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/28/2020] [Indexed: 12/12/2022] Open
Abstract
This study investigated the systemic inflammatory response and mechanism of pulmonary lesions induced by Crotalus durissus cascavella venom in murine in the state of Bahia. In order to investigate T helper Th1, Th2 and Th17 lymphocyte profiles, we measured interleukin (IL) -2, IL-4, IL-6, IL-10, IL-17, tumor necrosis factor (TNF) and interferon gamma (IFN-γ) levels in the peritoneal fluid and macerated lungs of mice and histopathological alterations at the specific time windows of 1h, 3h, 6h, 12h, 24h and 48h after inoculation with Crotalus durissus cascavella venom. The data demonstrated an increase of acute-phase cytokines (IL-6 and TNF) in the first hours after inoculation, with a subsequent increase in IL-10 and IL-4, suggesting immune response modulation for the Th2 profile. The histopathological analysis showed significant morphological alterations, compatible with acute pulmonary lesions, with polymorphonuclear leukocyte (PMN) infiltration, intra-alveolar edema, congestion, hemorrhage and atelectasis. These findings advance our understanding of the dynamics of envenomation and contribute to improve clinical management and antiophidic therapy for individuals exposed to venom.
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Affiliation(s)
- Elen Azevedo
- Laboratory of Venomous Animals and Herpetology, Biology Department, State University of Feira de Santana, Feira de Santana, Brazil
- Postgraduate Program in Biotechnology, State University of Feira de Santana, Feira de Santana, Brazil
| | - Ricardo Gassmann Figueiredo
- Pulmonology Division, Department of Health, State University of Feira de Santana–UEFS, Feira de Santana, Brazil
| | - Roberto Vieira Pinto
- Pathological Anatomy Laboratory–LABSEAP, Cardiopulmonary Clinic, Novo Mundo, Brazil
| | | | | | | | - Marcos Lázaro da Silva Guerreiro
- Laboratory of Venomous Animals and Herpetology, Biology Department, State University of Feira de Santana, Feira de Santana, Brazil
| | - Ilka Biondi
- Laboratory of Venomous Animals and Herpetology, Biology Department, State University of Feira de Santana, Feira de Santana, Brazil
- * E-mail: (SCT); (IB)
| | - Soraya Castro Trindade
- Postgraduate Program in Biotechnology, State University of Feira de Santana, Feira de Santana, Brazil
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
- * E-mail: (SCT); (IB)
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Dos Santos RTF, Silva MFP, Porto RM, Lebrun I, Gonçalves LRDC, Batista IDFC, Sandoval MRL, Abdalla FMF. Effects of Mlx-8, a phospholipase A 2 from Brazilian coralsnake Micrurus lemniscatus venom, on muscarinic acetylcholine receptors in rat hippocampus. J Venom Anim Toxins Incl Trop Dis 2020; 26:e20190041. [PMID: 32063920 PMCID: PMC6986814 DOI: 10.1590/1678-9199-jvatitd-2019-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 12/04/2019] [Indexed: 11/22/2022] Open
Abstract
Background: Here, we described the presence of a neurotoxin with phospholipase
A2 activity isolated from Micrurus
lemniscatus venom (Mlx-8) with affinity for muscarinic
acetylcholine receptors (mAChRs). Methods: The purification, molecular mass determination, partial amino acid
sequencing, phospholipase A2 activity determination, inhibition
of the binding of the selective muscarinic ligand [3H]QNB and
inhibition of the total [3H]inositol phosphate accumulation in
rat hippocampus of the Mlx-8 were determined. Results: Thirty-one fractions were collected from HPLC chromatography, and the Mlx-8
toxin was used in this work. The molecular mass of Mlx-8 is 13.628 Da. Edman
degradation yielded the following sequence:
NLYQFKNMIQCTNTRSWL-DFADYG-CYCGRGGSGT. The Mlx-8 had phospholipase
A2 enzymatic activity. The pKi values were
determined for Mlx-8 toxin and the M1 selective muscarinic
antagonist pirenzepine in hippocampus membranes via [3H]QNB
competition binding assays. The pKi values obtained from the
analysis of Mlx-8 and pirenzepine displacement curves were 7.32 ± 0.15, n =
4 and 5.84 ± 0.18, n = 4, respectively. These results indicate that Mlx-8
has affinity for mAChRs. There was no effect on the inhibition ability of
the [3H]QNB binding in hippocampus membranes when 1 µM Mlx-8 was
incubated with 200 µM DEDA, an inhibitor of phospholipase A2.
This suggests that the inhibition of the phospholipase A2
activity of the venom did not alter its ability to bind to displace
[3H]QNB binding. In addition, the Mlx-8 toxin caused a
blockade of 43.31 ± 8.86%, n = 3 and 97.42 ± 2.02%, n = 3 for 0.1 and 1 µM
Mlx-8, respectively, on the total [3H]inositol phosphate content
induced by 10 µM carbachol. This suggests that Mlx-8 inhibits the
intracellular signaling pathway linked to activation of mAChRs in
hippocampus. Conclusion: The results of the present work show, for the first time, that muscarinic
receptors are also affected by the Mlx-8 toxin, a muscarinic ligand with
phospholipase A2 characteristics, obtained from the venom of the
Elapidae snake Micrurus lemniscatus, since this toxin was
able to compete with muscarinic ligand [3H]QNB in hippocampus of
rats. In addition, Mlx-8 also blocked the accumulation of total
[3H]inositol phosphate induced by muscarinic agonist
carbachol. Thus, Mlx-8 may be a new pharmacological tool for examining
muscarinic cholinergic function.
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Affiliation(s)
| | | | - Rafael Marques Porto
- Laboratory of Biochemistry and Biophysics, Butantan Institute, São Paulo, SP, Brazil
| | - Ivo Lebrun
- Laboratory of Biochemistry and Biophysics, Butantan Institute, São Paulo, SP, Brazil
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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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Tsai TH, Lin CC, Mao YC, Hung CL, Yang YC, Yang CC, Jeng MJ. Naja atra venom-spit ophthalmia in Taiwan: An epidemiological survey from 1990 to 2016. J Chin Med Assoc 2020; 83:77-83. [PMID: 31714443 DOI: 10.1097/jcma.0000000000000223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Venomous snakebites are common during hot seasons in Taiwan. However, rarely is venom spat directly into the subject's eyes, causing eye injury. Despite being uncommon, analytical data regarding venom-spit ophthalmia in Taiwan have been lacking. This study thus aimed to conduct an epidemiological survey on Naja atra venom-spit ophthalmia in Taiwan during the past decades to improve future care of such patients. METHODS Registered records of cases with snake venom injuries at the Taiwan National Poison Control Center from 1990 to 2016 were retrospectively reviewed, enrolling those with records of cobra venom-spit eye injuries and excluding exotic species. Demographic data, clinical symptoms, snake species, ocular conditions, management, and outcomes were recorded and analyzed. RESULTS A total of 39 cases suffering from Naja atra venom-spit ophthalmia were enrolled. The overall incidence rate was 1.6 cases per million people from 1990 to 2016. Among the included cases, most were unilaterally injured (82%), male (95%), aged 18 to 59 years (90%), injured during catching (51%), and injured in spring and summer (92%). Ocular symptoms occurred in 90% of the cases, majority of which included ocular pain (90%) and redness (85%). Conjunctivitis (67%) and corneal injury (59%) of involved eyes were common. Immediate water irrigations were done in all cases, most of whom received further topical eye drops, including antibiotics, corticosteroids, and vasoconstrictors. Although topical or intravenous antivenoms were administered in 11 cases, no obviously superior outcome was observed. Most cases (77%) were symptom free after the acute stage. CONCLUSION Although Naja atra venom-spit ophthalmia in Taiwan is uncommon, the risk for transient ocular symptoms and corneal/conjunctival injury does exists. Prompt ocular irrigation and professional ophthalmic care after envenomation help prevent serious ocular sequelae. Moreover, superior outcomes were not achieved with the use of antivenom. Nonetheless, further studies are required to clarify the role antivenoms play in venom-spit ophthalmia.
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Affiliation(s)
- Tsung-Han Tsai
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Emergency, Taichung Armed Forces General Hospital, Taichung, Taiwan, ROC
- Department of Emergency, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chun-Chi Lin
- Division of Occupational Medicine, Department of Family Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan, ROC
- Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yan-Chiao Mao
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chia-Lien Hung
- Department of Medical Education and Research, Taichung Armed Forces General Hospital, Taichung, Taiwan, ROC
| | - Yi-Chiang Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chen-Chang Yang
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Mei-Jy Jeng
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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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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da Silva AM, Colombini M, Moura-da-Silva AM, de Souza RM, Monteiro WM, Bernarde PS. Ethno-knowledge and attitudes regarding snakebites in the Alto Juruá region, Western Brazilian Amazonia. Toxicon 2019; 171:66-77. [PMID: 31628968 DOI: 10.1016/j.toxicon.2019.10.238] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/31/2019] [Accepted: 10/12/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Alto Juruá region, located in the extreme western part of the Brazilian Amazonia, possesses an indigenous and riverine population which is involved in agricultural and forest extraction activities, and is a region that stands out for its high incidence of snakebites. OBJECTIVES To assess the attitudes of the victims, the characteristics of the snakes and the circumstances of the snakebites which occurred in a region where human populations are highly exposed to snakes. METHODS The study was conducted at the Regional Hospital of Juruá in the Municipality of Cruzeiro do Sul (Acre), which regularly attends victims of snakebites in the Alto Juruá region. The snakes that caused the envenomations were identified from clinical and epidemiological diagnosis of the symptoms and signs that patients presented during hospital, and by enzyme immunoassay for venom detection using serum samples of the patients, or by identification of the snake responsible for the envenomation when it was taken to the hospital or photographed. People who suffered or witnessed the snakebite were interviewed to assess the circumstances of the bite, the attitude adopted after the accident and whether they recognized the species of snake that caused the envenomation. RESULTS There were 133 cases of snakebite (76.24/100.000 inhabitants), mainly involving male individuals living in the rural area and who had a low level of education. The most affected groups were farmers (48%) and children and teenagers (39%). It was observed that 8.3% of them presented a history of recurrence for bites. The lower limbs were the most affected anatomical region (84%). The Bothrops atrox snake, mainly small specimens (mostly juveniles), was the main species involved in the envenomations (83.4%). Snakebites occurred mainly in forest areas, backyards of houses in rural areas and near to aquatic environments, during activities (walking, farming, extractivism, hunting). Most of the time, the snake was on the ground and the bite occurred because of the approximation of the individual, either by trampling or by approximation of a hand. Half of the victims performed some kind of inadequate first aid (not drinking water, use of tourniquet, incision at the site of the bite, use of black stone, drinking a compound "Específico Pessoa"). CONCLUSIONS Snakebite is an important cause of morbidity in the Alto Juruá region. Bothrops bites are mostly caused by small-sized specimens, probably due to the greater abundance of B. atrox juveniles, and also because small snakes are more difficult for people to see. People are more often bitten on the lower limbs probably due to the size of B. atrox (small and medium) and because the snakes are usually on the ground in most situations. Many victims resort to ineffective actions that can cause complications and also delay serotherapy. A low level of education is a factor that may contribute to worse outcomes in snakebites since it is associated with a lack of knowledge of preventive and first aid measures.
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Affiliation(s)
- Ageane Mota da Silva
- Instituto Federal do Acre, Campus de Cruzeiro do Sul, Cruzeiro do Sul, Acre, Brazil; Programa de Pós-Graduação Bionorte, Universidade Federal do Acre, Campus Universitário, BR 364, Rio Branco, Acre, Brazil
| | - Mônica Colombini
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo, Brazil
| | | | - Rodrigo Medeiros de Souza
- Laboratório de Microbiologia, Imunologia e Parasitologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, AC, Brazil
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas, Manaus, AM, Brazil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Paulo Sérgio Bernarde
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, AC, Brazil.
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