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Senji Laxme RR, Khochare S, Bhatia S, Martin G, Sunagar K. From birth to bite: the evolutionary ecology of India's medically most important snake venoms. BMC Biol 2024; 22:161. [PMID: 39075553 PMCID: PMC11287890 DOI: 10.1186/s12915-024-01960-8] [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: 01/30/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Snake venoms can exhibit remarkable inter- and intraspecific variation. While diverse ecological and environmental factors are theorised to explain this variation, only a handful of studies have attempted to unravel their precise roles. This knowledge gap not only impedes our understanding of venom evolution but may also have dire consequences on snakebite treatment. To address this shortcoming, we investigated the evolutionary ecology of venoms of Russell's viper (Daboia russelii) and spectacled cobra (Naja naja), India's two clinically most important snakes responsible for an alarming number of human deaths and disabilities. METHODOLOGY Several individuals (n = 226) of D. russelii and N. naja belonging to multiple clutches (n = 9) and their mothers were maintained in captivity to source ontogenetic stage-specific venoms. Using various in vitro and in vivo assays, we assessed the significance of prey, ontogeny and sex in driving venom composition, function, and potency. RESULTS Considerable ontogenetic shifts in venom profiles were observed in D. russelii, with the venoms of newborns being many times as potent as juveniles and adults against mammalian (2.3-2.5 ×) and reptilian (2-10 ×) prey. This is the first documentation of the ontogenetic shift in viperine snakes. In stark contrast, N. naja, which shares a biogeographic distribution similar to D. russelii, deployed identical biochemical cocktails across development. Furthermore, the binding kinetics of cobra venom toxins against synthetic target receptors from various prey and predators shed light on the evolutionary arms race. CONCLUSIONS Our findings, therefore, provide fascinating insights into the roles of ecology and life history traits in shaping snake venoms.
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Affiliation(s)
- R R Senji Laxme
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore, 560012, Karnataka, India
| | - Suyog Khochare
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore, 560012, Karnataka, India
| | - Siddharth Bhatia
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore, 560012, Karnataka, India
| | - Gerard Martin
- The Liana Trust. Survey, #1418/1419 Rathnapuri, Hunsur, 571189, Karnataka, India
| | - Kartik Sunagar
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore, 560012, Karnataka, India.
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Bittenbinder MA, Bergkamp ND, Slagboom J, Bebelman JPM, Casewell NR, Siderius MH, Smit MJ, Kool J, Vonk FJ. Monitoring Snake Venom-Induced Extracellular Matrix Degradation and Identifying Proteolytically Active Venom Toxins Using Fluorescently Labeled Substrates. BIOLOGY 2023; 12:765. [PMID: 37372050 DOI: 10.3390/biology12060765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 06/29/2023]
Abstract
Snakebite envenoming is an important public health issue with devastating consequences and annual mortality rates that range between 81,000 and 138,000. Snake venoms may cause a range of pathophysiological effects affecting the nervous system and the cardiovascular system. Moreover, snake venom may have tissue-damaging activities that result in lifelong morbidities such as amputations, muscle degeneration, and organ malfunctioning. The tissue-damaging components in snake venoms comprise multiple toxin classes with various molecular targets including cellular membranes and the extracellular matrix (ECM). In this study, we present multiple assay formats that enable investigation of snake venom-induced ECM degradation using a variety of (dye-quenched) fluorescently labeled ECM components. Using a combinatorial approach, we were able to characterise different proteolytic profiles for different medically relevant snake venoms, followed by identification of the responsible components within the snake venoms. This workflow could provide valuable insights into the key mechanisms by which proteolytic venom components exert their effects and could therefore prove useful for the development of effective snakebite treatments against this severe pathology.
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Affiliation(s)
- Mátyás A Bittenbinder
- Naturalis Biodiversity Center, 2333 CR Leiden, The Netherlands
- Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Amsterdam Institute of Molecular and Life Sciences (AIMMS), Faculty of Sciences, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Centre for Analytical Sciences Amsterdam (CASA), 1081 HZ Amsterdam, The Netherlands
| | - Nick D Bergkamp
- Division of Medicinal Chemistry, Amsterdam Institute of Molecular and Life Sciences (AIMMS), Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Julien Slagboom
- Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Amsterdam Institute of Molecular and Life Sciences (AIMMS), Faculty of Sciences, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Centre for Analytical Sciences Amsterdam (CASA), 1081 HZ Amsterdam, The Netherlands
| | - Jan Paul M Bebelman
- Division of Medicinal Chemistry, Amsterdam Institute of Molecular and Life Sciences (AIMMS), Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Nicholas R Casewell
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Marco H Siderius
- Division of Medicinal Chemistry, Amsterdam Institute of Molecular and Life Sciences (AIMMS), Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Martine J Smit
- Division of Medicinal Chemistry, Amsterdam Institute of Molecular and Life Sciences (AIMMS), Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Jeroen Kool
- Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Amsterdam Institute of Molecular and Life Sciences (AIMMS), Faculty of Sciences, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Centre for Analytical Sciences Amsterdam (CASA), 1081 HZ Amsterdam, The Netherlands
| | - Freek J Vonk
- Naturalis Biodiversity Center, 2333 CR Leiden, The Netherlands
- Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Amsterdam Institute of Molecular and Life Sciences (AIMMS), Faculty of Sciences, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Centre for Analytical Sciences Amsterdam (CASA), 1081 HZ Amsterdam, The Netherlands
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A novel broad spectrum venom metalloproteinase autoinhibitor in the rattlesnake Crotalus atrox evolved via a shift in paralog function. Proc Natl Acad Sci U S A 2022; 119:e2214880119. [PMID: 36508672 PMCID: PMC9907073 DOI: 10.1073/pnas.2214880119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The complexity of snake venom composition reflects adaptation to the diversity of prey and may be driven at times by a coevolutionary arms race between snakes and venom-resistant prey. However, many snakes are also resistant to their own venom due to serum-borne inhibitors of venom toxins, which raises the question of how snake autoinhibitors maintain their efficacy as venom proteins evolve. To investigate this potential three-way arms race among venom, prey, and autoinhibitors, we have identified and traced the evolutionary origin of serum inhibitors of snake venom metalloproteinases (SVMPs) in the Western Diamondback rattlesnake Crotalus atrox which possesses the largest known battery of SVMP genes among crotalids examined. We found that C. atrox expresses five members of a Fetuin A-related metalloproteinase inhibitor family but that one family member, FETUA-3, is the major SVMP inhibitor that binds to approximately 20 different C. atrox SVMPs and inhibits activities of all three SVMP classes. We show that the fetua-3 gene arose deep within crotalid evolution before the origin of New World species but, surprisingly, fetua-3 belongs to a different paralog group than previously identified SVMP inhibitors in Asian and South American crotalids. Conversely, the C. atrox FETUA-2 ortholog of previously characterized crotalid SVMP inhibitors shows limited activity against C. atrox SVMPs. These results reveal that there has been a functional evolutionary shift in the major SVMP inhibitor in the C. atrox lineage as the SVMP family expanded and diversified in the Crotalus lineage. This broad-spectrum inhibitor may be of potential therapeutic interest.
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Senji Laxme RR, Khochare S, Attarde S, Kaur N, Jaikumar P, Shaikh NY, Aharoni R, Primor N, Hawlena D, Moran Y, Sunagar K. The Middle Eastern Cousin: Comparative Venomics of Daboia palaestinae and Daboia russelii. Toxins (Basel) 2022; 14:toxins14110725. [PMID: 36355975 PMCID: PMC9696752 DOI: 10.3390/toxins14110725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Among the medically most important snakes in the world, the species belonging to the genus Daboia have been attributed to the highest number of human envenomings, deaths and disabilities. Given their significant clinical relevance, the venoms of Russell's vipers (D. russelii and D. siamensis) have been the primary focus of research. In contrast, the composition, activity, ecology and evolution of venom of its congener, the Palestine viper (D. palaestinae), have remained largely understudied. Therefore, to unravel the factors responsible for the enhanced medical relevance of D. russelii in comparison to D. palaestinae, we comparatively evaluated their venom proteomes, biochemical activities, and mortality and morbidity inflicting potentials. Furthermore, the synthesis and regulation of venom in snakes have also remained underinvestigated, and the relative contribution of each venom gland remains unclear. We address this knowledge gap by sequencing the tissue transcriptomes of both venom glands of D. palaestinae, and comparatively evaluating their contribution to the secreted venom concoction. Our findings highlight the disparity in the venom composition, function and toxicities of the two Daboia species. We also show that toxin production is not partitioned between the two venom glands of D. palaestinae.
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Affiliation(s)
- R. R. Senji Laxme
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore 560012, India
| | - Suyog Khochare
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore 560012, India
| | - Saurabh Attarde
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore 560012, India
| | - Navneet Kaur
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore 560012, India
| | - Priyanka Jaikumar
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore 560012, India
| | - Naeem Yusuf Shaikh
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore 560012, India
| | - Reuven Aharoni
- Department of Ecology, Evolution and Behavior, Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Naftali Primor
- Shulov Institute of Science, 10 Oppenheimer Street, Science Park, Rehovot 7670110, Israel
| | - Dror Hawlena
- Department of Ecology, Evolution and Behavior, Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Yehu Moran
- Department of Ecology, Evolution and Behavior, Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel
- Correspondence: (Y.M.); (K.S.)
| | - Kartik Sunagar
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore 560012, India
- Correspondence: (Y.M.); (K.S.)
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Hayashi MAF, Campeiro JD, Yonamine CM. Revisiting the potential of South American rattlesnake Crotalus durissus terrificus toxins as therapeutic, theranostic and/or biotechnological agents. Toxicon 2021; 206:1-13. [PMID: 34896407 DOI: 10.1016/j.toxicon.2021.12.005] [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: 09/09/2021] [Revised: 11/10/2021] [Accepted: 12/08/2021] [Indexed: 02/07/2023]
Abstract
The potential biotechnological and biomedical applications of the animal venom components are widely recognized. Indeed, many components have been used either as drugs or as templates/prototypes for the development of innovative pharmaceutical drugs, among which many are still used for the treatment of human diseases. A specific South American rattlesnake, named Crotalus durissus terrificus, shows a venom composition relatively simpler compared to any viper or other snake species belonging to the Crotalus genus, although presenting a set of toxins with high potential for the treatment of several still unmet human therapeutic needs, as reviewed in this work. In addition to the main toxin named crotoxin, which is under clinical trials studies for antitumoral therapy and which has also anti-inflammatory and immunosuppressive activities, other toxins from the C. d. terrificus venom are also being studied, aiming for a wide variety of therapeutic applications, including as antinociceptive, anti-inflammatory, antimicrobial, antifungal, antitumoral or antiparasitic agent, or as modulator of animal metabolism, fibrin sealant (fibrin glue), gene carrier or theranostic agent. Among these rattlesnake toxins, the most relevant, considering the potential clinical applications, are crotamine, crotalphine and gyroxin. In this narrative revision, we propose to organize and present briefly the updates in the accumulated knowledge on potential therapeutic applications of toxins collectively found exclusively in the venom of this specific South American rattlesnake, with the objective of contributing to increase the chances of success in the discovery of drugs based on toxins.
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Affiliation(s)
- Mirian A F Hayashi
- Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), SP, Brazil.
| | - Joana D Campeiro
- Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), SP, Brazil
| | - Camila M Yonamine
- Department of Microbiology, Immunology and Parasitology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), SP, Brazil.
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LIMITED PROTEOLYSIS OF FIBRINOGEN BY PROTEASE OF Gloydius halys halys SNAKE VENOM. BIOTECHNOLOGIA ACTA 2021. [DOI: 10.15407/biotech14.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim. One of the approaches for studying structure and functions of proteins is their limited proteolysis. Proteolytic fragments of macromolecules can preserve the biological activity and can be used for the study of their structural and functional peculiarities. Thus, the characterization of new proteolytic enzymes and determination of the specificity of their action can be of interest for exploration. In the present work, we focused on the action of protease from the venom of Gloydius halys halys on fibrinogen, the crucial protein of blood coagulation system. Methods. Products of fibrinogen hydrolysis by protease from the venom of G. halys halys were studied by SDS-PAGE electrophoresis and western-blot analysis using monoclonal antibodies ІІ-5 Сand 1-5A targeted to 20‒78 and 549‒610 fragments of fibrinogen Aα-chain. Molecular weights of hydrolytic products were determined using MALDI-TOF analysis on Voyager DE PRO (USA). Sequence of hydrolytic products were predicted by «Peptide Mass Calculator» soft ware. Results. SDS-PAGE showed that protease from the venom of Gloydius halys halys initially cleaved Аα-chain of fibrinogen molecule. Western-blot analysis confirmed that this protease specifically cleaves off fragment of C-terminal parts of Аα-chain with apparent molecular weight of 22 kDa. Cleaved fragment was identified by MALDI-TOF analysis as the 21.1 kDa polypeptide. «Peptide Mass Calculator» predicted that such a fragment corresponded to Аα414-610 residue of fibrinogen molecule. Thus, we showed that studied protease cleaved peptide bond AαK413-L414 with the formation of stable partly hydrolyzed fibrinogen desAα414-610. Conclusions. The use of protease from the venom of Gloydius halys halys would allow obtaining the unique partly hydrolyzed fibrinogen des Aα 414‒610 that is suitable for the study of structure and functions of fibrinogen αС-regions.
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Lin Y, Zhang M, Lin T, Wang L, Wang G, Chen T, Su S. Royal jelly from different floral sources possesses distinct wound-healing mechanisms and ingredient profiles. Food Funct 2021; 12:12059-12076. [PMID: 34783324 DOI: 10.1039/d1fo00586c] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In recent years, population aging together with the increased prevalence of diabetes and obesity has fuelled a surge in the instances of cutaneous non-healing wounds. Royal jelly (RJ) is a traditional remedy for wound repair; however, the subjacent mechanisms and ingredient profiles are still largely unknown. Our previous study found that Castanea mollissima Bl. RJ (CmRJ-Zj) possessed superior wound healing-promoting effects on both the in vivo and in vitro models than Brassica napus L. RJ (BnRJ-Zj). This study conducted an in-depth investigation on the wound-repairing mechanisms of CmRJ-Zj and BnRJ-Zj to explain the previously observed phenomenon and also comprehensively characterized their constituents. It was found that chestnut RJ could enhance cutaneous wound healing by boosting the growth and mobility of keratinocytes, modulating the expression of aquaporin 3 (AQP3), regulating MAPK and calcium pathways, and mediating inflammatory responses. By employing LC-MS/MS-based proteomic and metabolomic techniques, the comprehensive molecules present in CmRJ-Zj and BnRJ-Zj were elucidated, resulting in a clear discrimination from each other. A total of 15 and 631 differential proteins and compounds were identified, and 217 proteins were newly found in RJ proteome. With bioinformatic functional analysis, we speculated that some differential components were responsible for the wound-healing properties of CmRJ-Zj. Therefore, this study provides an insight into the wound-healing mechanisms of RJ and is the first to explore the compositions of RJ from different nectar plants. It will facilitate the development of therapeutic agents from RJ to treat difficult-to-heal wounds and the distinction of different RJ categories.
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Affiliation(s)
- Yan Lin
- College of Animal Sciences (College of Bee Science), Fujian Agriculture and Forestry University, Fuzhou 350002, China.
| | - Meng Zhang
- College of Animal Sciences (College of Bee Science), Fujian Agriculture and Forestry University, Fuzhou 350002, China. .,Apicultural Research Institute of Jiangxi Province, Nanchang 330052, China
| | - Tianxing Lin
- College of Animal Sciences (College of Bee Science), Fujian Agriculture and Forestry University, Fuzhou 350002, China.
| | - Luying Wang
- College of Animal Sciences (College of Bee Science), Fujian Agriculture and Forestry University, Fuzhou 350002, China.
| | - Guanggao Wang
- College of Animal Sciences (College of Bee Science), Fujian Agriculture and Forestry University, Fuzhou 350002, China. .,Apicultural Research Institute of Jiangxi Province, Nanchang 330052, China
| | - Tianbao Chen
- Natural Drug Discovery Group, School of Pharmacy, Queen's University, Belfast BT9 7BL, Northern Ireland, UK
| | - Songkun Su
- College of Animal Sciences (College of Bee Science), Fujian Agriculture and Forestry University, Fuzhou 350002, China.
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Pucca MB, Bernarde PS, Rocha AM, Viana PF, Farias RES, Cerni FA, Oliveira IS, Ferreira IG, Sandri EA, Sachett J, Wen FH, Sampaio V, Laustsen AH, Sartim MA, Monteiro WM. Crotalus Durissus Ruruima: Current Knowledge on Natural History, Medical Importance, and Clinical Toxinology. Front Immunol 2021; 12:659515. [PMID: 34168642 PMCID: PMC8219050 DOI: 10.3389/fimmu.2021.659515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Crotalus durissus ruruima is a rattlesnake subspecies mainly found in Roraima, the northernmost state of Brazil. Envenomings caused by this subspecies lead to severe clinical manifestations (e.g. respiratory muscle paralysis, rhabdomyolysis, and acute renal failure) that can lead to the victim’s death. In this review, we comprehensively describe C. d. ruruima biology and the challenges this subspecies poses for human health, including morphology, distribution, epidemiology, venom cocktail, clinical envenoming, and the current and future specific treatment of envenomings by this snake. Moreover, this review presents maps of the distribution of the snake subspecies and evidence that this species is responsible for some of the most severe envenomings in the country and causes the highest lethality rates. Finally, we also discuss the efficacy of the Brazilian horse-derived antivenoms to treat C. d. ruruima envenomings in Roraima state.
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Affiliation(s)
- Manuela B Pucca
- Medical School, Federal University of Roraima, Boa Vista, Brazil
| | - Paulo Sérgio Bernarde
- Laboratório de Herpetologia, Centro Multidisciplinar, Universidade Federal do Acre, Cruzeiro do Sul, Brazil
| | | | - Patrik F Viana
- National Institute of Amazonian Research, Biodiversity Coordination, Laboratory of Animal Genetics, Manaus, Brazil
| | - Raimundo Erasmo Souza Farias
- National Institute of Amazonian Research, Biodiversity Coordination, Laboratory of Animal Genetics, Manaus, Brazil
| | - Felipe A Cerni
- Medical School, Federal University of Roraima, Boa Vista, Brazil.,Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Isadora S Oliveira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Isabela G Ferreira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Eliseu A Sandri
- Insikiram Institute of Indigenous Higher Studies, Federal University of Roraima, Boa Vista, Brazil
| | - Jacqueline Sachett
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil.,Department of Teaching and Research, Alfredo da Matta Foundation, Manaus, Brazil
| | - Fan Hui Wen
- Antivenom Production Section, Butantan Institute, São Paulo, Brazil
| | - Vanderson Sampaio
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Andreas H Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Marco A Sartim
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil.,Institute of Biological Sciences, Amazonas Federal University, Manaus, Brazil
| | - Wuelton M Monteiro
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil.,Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
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