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Brasileiro-Martins LM, Cavalcante SA, Nascimento TP, Silva-Neto AV, Mariano Santos MD, Camillo-Andrade AC, da Gama Fischer JDS, Ferreira CC, Oliveira LB, Sartim MA, Costa AG, Pucca MB, Wen FH, Moura-da-Silva AM, Sachett J, Carvalho PC, de Aquino PF, Monteiro WM. Urinary proteomics reveals biological processes related to acute kidney injury in Bothrops atrox envenomings. PLoS Negl Trop Dis 2024; 18:e0012072. [PMID: 38536893 PMCID: PMC11020875 DOI: 10.1371/journal.pntd.0012072] [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: 11/17/2023] [Revised: 04/16/2024] [Accepted: 03/14/2024] [Indexed: 04/18/2024] Open
Abstract
Acute kidney injury (AKI) is a critical systemic complication caused by Bothrops envenoming, a neglected health problem in the Brazilian Amazon. Understanding the underlying mechanisms leading to AKI is crucial for effectively mitigating the burden of this complication. This study aimed to characterize the urinary protein profile of Bothrops atrox snakebite victims who developed AKI. We analyzed three groups of samples collected on admission: healthy subjects (controls, n = 10), snakebite victims who developed AKI (AKI, n = 10), and those who did not evolve to AKI (No-AKI, n = 10). Using liquid-chromatography tandem mass spectrometry, we identified and quantified (label-free) 1190 proteins. A panel of 65 proteins was identified exclusively in the urine of snakebite victims, with 32 exclusives to the AKI condition. Proteins more abundant or exclusive in AKI's urine were associated with acute phase response, endopeptidase inhibition, complement cascade, and inflammation. Notable proteins include serotransferrin, SERPINA-1, alpha-1B-glycoprotein, and NHL repeat-containing protein 3. Furthermore, evaluating previously reported biomarkers candidates for AKI and renal injury, we found retinol-binding protein, beta-2-microglobulin, cystatin-C, and hepcidin to be significant in cases of AKI induced by Bothrops envenoming. This work sheds light on physiological disturbances caused by Bothrops envenoming, highlighting potential biological processes contributing to AKI. Such insights may aid in better understanding and managing this life-threatening complication.
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Affiliation(s)
- Lisele Maria Brasileiro-Martins
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- School of Health Sciences, Amazonas State University, Manaus, Brazil
| | | | - Thaís Pinto Nascimento
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- School of Health Sciences, Amazonas State University, Manaus, Brazil
- Leonidas and Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Brazil
| | - Alexandre Vilhena Silva-Neto
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Marlon Dias Mariano Santos
- Structural and Computational Proteomics Laboratory, Carlos Chagas Institute, Oswaldo Cruz Foundation, Curitiba, Brazil
| | - Amanda C. Camillo-Andrade
- Structural and Computational Proteomics Laboratory, Carlos Chagas Institute, Oswaldo Cruz Foundation, Curitiba, Brazil
| | | | | | | | - Marco Aurelio Sartim
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Research, Nilton Lins University, Manaus, Brazil
| | - Allyson Guimarães Costa
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- School of Health Sciences, Amazonas State University, Manaus, Brazil
- Nursing School, Amazonas Federal University, Manaus, Brazil
| | - Manuela B. Pucca
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University, Araraquara, Brazil
| | - Fan Hui Wen
- Immunopathology Laboratory, Butantan Institute, São Paulo, Brazil
| | | | - Jacqueline Sachett
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- Immunopathology Laboratory, Butantan Institute, São Paulo, Brazil
| | - Paulo Costa Carvalho
- Structural and Computational Proteomics Laboratory, Carlos Chagas Institute, Oswaldo Cruz Foundation, Curitiba, Brazil
| | | | - Wuelton M. Monteiro
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- School of Health Sciences, Amazonas State University, Manaus, Brazil
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2
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Abd El-Azim MM, Mousa MK, Abdelmaaboud RM, Rezq NN, Mohammed SS. Evaluation of the role of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) time series as predictors of diagnosis and prognosis of hemotoxic snakebite. Biomarkers 2023; 28:652-662. [PMID: 37902066 DOI: 10.1080/1354750x.2023.2277668] [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: 06/21/2023] [Accepted: 10/22/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND This study aimed to assess the predictive value of NLR, PLR, and MPV time series for diagnosis and prognosis of hemotoxic snakebite envenomation. METHODS This is a prospective study among snakebite patients admitted to the Poison Control Center of Ain Shams University Hospitals and Assiut University Hospitals from the beginning of July 2019 to the end of October 2021. Patients were classified according to their clinical severity into three groups: mild, moderate, and severe. RESULTS The maximum incidence of snakebite was found in males (95%) from rural areas (80%); at lower limbs (70%); at night (51%); and during the autumn season (43.3%). The admission NLR and PLR can predict hemotoxic snakebite envenomation with an AUC of 0.940 and 0.569. The combination of NLR with PLR can develop a more predominant prediction of snakebite envenomation with an area under the curve (AUC) of 0.979. Furthermore, higher admission NLR and PLR levels are associated with prolonged hospital stays. CONCLUSION While NLR and PLR levels may be helpful in the diagnosis of snakebite, MPV plays no part in the prognosis of snakebite patients. Serial NLR, PLR initially, at 24 hours, and predischarge can be used to evaluate the early treatment response.
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Affiliation(s)
- Mariam M Abd El-Azim
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mona K Mousa
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ragaa M Abdelmaaboud
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nabil N Rezq
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sarah S Mohammed
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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3
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Lopes-de-Souza L, Costal-Oliveira F, Rodrigues CR, Stransky S, de Assis TCS, Liberato C, Vivas-Ruiz D, Chocas AY, Guerra-Duarte C, Braga VMM, Chávez-Olortegui C. Bothrops atrox venom: Biochemical properties and cellular phenotypes of three highly toxic classes of toxins. BIOCHIMICA ET BIOPHYSICA ACTA. PROTEINS AND PROTEOMICS 2023; 1871:140930. [PMID: 37442518 DOI: 10.1016/j.bbapap.2023.140930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 07/15/2023]
Abstract
Snake venoms have a complex mixture of compounds that are conserved across species and act synergistically, triggering severe local and systemic effects. Identification of the toxin classes that are most damaging to cell homeostasis would be a powerful approach to focus on the main activities that underpin envenomation. Here, we focus on the venom of Bothrops atrox, snake responsible for most of the accidents in Amazon region of South America. We identified the key cytotoxic toxin fractions from B. atrox venom and mapped their biochemical properties, protein composition and cell damage. Five fractions were obtained by mass exclusion chromatography and contained either a single class of enzymatic activity (i.e., L-amino acid oxidases or Hyaluronidases) or different activities co-distributed in two or more protein fractions (e.g., Metalloproteinases, Serine Proteases, or Phospholipases A2). Only three protein fractions reduced cell viability of primary human cells. Strikingly, such activity is accompanied by disruption of cell attachment to substratum and to neighbouring cells. Such strong perturbation of morphological cell features indicates likely defects in tissue integrity in vivo. Mass spectrometry identified the main classes of toxins that contribute to these phenotypes. We provide here a strategy for the selection of key cytotoxic proteins for targeted investigation of their mechanism of action and potential synergism during snakebite envenomation. Our data highlights putative toxins (or combinations of) that may be the focus of future therapeutic interference.
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Affiliation(s)
- Leticia Lopes-de-Souza
- Departamento de Bioquímica e Imunologia, Instituto Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda Costal-Oliveira
- Departamento de Bioquímica e Imunologia, Instituto Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carolina Rego Rodrigues
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Stephanie Stransky
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Thamyres C S de Assis
- Departamento de Bioquímica e Imunologia, Instituto Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Camila Liberato
- Departamento de Bioquímica e Imunologia, Instituto Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Dan Vivas-Ruiz
- Laboratorio de Biología Molecular - Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos (UNMSM), Peru
| | - Armando Yarleque Chocas
- Laboratorio de Biología Molecular - Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos (UNMSM), Peru
| | - Clara Guerra-Duarte
- Diretoria de Pesquisa e Desenvolvimento, Fundação Ezequiel Dias, Belo Horizonte, Minas Gerais, Brazil
| | - Vania M M Braga
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, Sir Alexander Fleming Building, London SW7 2AZ, UK.
| | - Carlos Chávez-Olortegui
- Departamento de Bioquímica e Imunologia, Instituto Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Larréché S, Chevillard L, Jourdi G, Mathé S, Servonnet A, Joly BS, Siguret V, Chippaux JP, Mégarbane B. Bothrops venom-induced hemostasis disorders in the rat: Between Scylla and Charybdis. PLoS Negl Trop Dis 2023; 17:e0011786. [PMID: 38011218 PMCID: PMC10703418 DOI: 10.1371/journal.pntd.0011786] [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: 09/14/2023] [Revised: 12/07/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023] Open
Abstract
Hemostasis impairment represents the most threatening consequence of Viperidae envenoming, notably with Bothrops genus. In the French departments of America, B. atrox envenomation in French Guiana may lead to bleeding while B. lanceolatus envenomation in Martinique to thrombosis. Bleeding related to B. atrox envenomation is attributed to vascular damage mediated by venom metalloproteinases and blood uncoagulable state resulting from thrombocytopenia and consumptive coagulopathy. Thrombosis related to B. lanceolatus envenomation are poorly understood. We aimed to compare the effects of B. atrox and B. lanceolatus venoms in the rat to identify the determinants of the hemorrhagic versus thrombotic complications. Viscoelastometry (ROTEM), platelet count, plasma fibrinogen, thrombin generation assay, fibrinography, endothelial (von Willebrand factor, ADAMTS13 activity, ICAM-1, and soluble E-selectin), and inflammatory biomarkers (IL-1β, IL-6, TNF-α, MCP-1, and PAI-1) were determined in blood samples obtained at H3, H6, and H24 after the subcutaneous venom versus saline injection. In comparison to the control, initial fibrinogen consumption was observed with the two venoms while thrombocytopenia and reduction in the clot amplitude only with B. atrox venom. Moreover, we showed an increase in thrombin generation at H3 with the two venoms, an increase in fibrin generation accompanied with hyperfibrinogenemia at H24 and an increase in inflammatory biomarkers with B. lanceolatus venom. No endothelial damage was found with the two venoms. To conclude, our data support two-sided hemostasis complications in Bothrops envenoming with an initial risk of hemorrhage related to platelet consumption and hypocoagulability followed by an increased risk of thrombosis promoted by the activated inflammatory response and rapid-onset fibrinogen restoration.
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Affiliation(s)
- Sébastien Larréché
- Université Paris Cité, Inserm UMRS-1144, Paris, France
- Department of Medical Biology, Bégin Military Teaching Hospital, Saint-Mandé, France
| | | | - Georges Jourdi
- Université Paris Cité, Inserm UMRS-1140, Innovative Therapies in Hemostasis, Paris, France
- Department of Biological Hematology, Lariboisière Hospital, APHP, Paris, France
| | - Simon Mathé
- Université Paris Cité, Inserm UMRS-1144, Paris, France
| | - Aurélie Servonnet
- Unité analyses biologiques, Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
| | - Bérangère S. Joly
- Université Paris Cité, Inserm UMRS-1140, Innovative Therapies in Hemostasis, Paris, France
- Université Paris Cité, EA3518, Institut de Recherche Saint-Louis, Paris, France
| | - Virginie Siguret
- Université Paris Cité, Inserm UMRS-1140, Innovative Therapies in Hemostasis, Paris, France
- Department of Biological Hematology, Lariboisière Hospital, APHP, Paris, France
| | - Jean-Philippe Chippaux
- Université Paris Cité, Research Institute for Development, Mother, and Child in Tropical Environment: Pathogens, Health system and Epidemiological transition, Paris, France
| | - Bruno Mégarbane
- Université Paris Cité, Inserm UMRS-1144, Paris, France
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Federation of Toxicology, APHP, Paris, France
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da Silva WRGB, de Siqueira Santos L, Lira D, de Oliveira Luna KP, Fook SML, Alves RRN. Who are the most affected by Bothrops snakebite envenoming in Brazil? A Clinical-epidemiological profile study among the regions of the country. PLoS Negl Trop Dis 2023; 17:e0011708. [PMID: 37856557 PMCID: PMC10617728 DOI: 10.1371/journal.pntd.0011708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/31/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
Snakebite envenoming represents an important Neglected Tropical Disease (NTD) that mainly affects tropical and subtropical developing countries according to the World Health Organization (WHO). As a priority issue in the tropics, it is estimated that accidental encounter between snakes and humans is the leading cause of morbidity and mortality among all NTDs in the world. In Brazil, an extremely diverse country with continental dimensions, snakebite envenoming is the second leading cause of reported human envenoming. Treating the disease has been an unprecedented challenge for Brazilian Health Systems for decades. Despite access to Antivenom therapy and distributing it free of charge across the country, Brazil faces numerous issues regarding the notification process and accurate treatment targeting for at-risk populations. Thus, this study aimed to identify the temporal epidemiological dynamics of accidents caused by Bothrops snakes in Brazil, the country's major group of venomous snakes, based on secondary information from the online database provided by The Brazilian Notifiable Diseases Information System (SINAN). For this purpose, reported Bothrops snakebites between 2012 and 2021 were counted, then the data were analyzed. We looked at the frequency, occurrence, mortality rates, case fatality rate (CFR), age and gender distribution, and the time lapse between the incident and the initiation of Antivenom therapy. The data were also organized considering regional variations of the country. Throughout the studied period, a total of 202,604 cases of envenoming caused by Bothrops spp. were notified, resulting in 766 fatalities. These accidents were found to occur in variable proportions across different regions in Brazil, with notable concentrations observed in the North, Northeast, and Southeast regions. The epidemiological profile of patients varied greatly between the regions, revealing that snake envenoming is much more a social, economic, and ecological problem than a medical one. In conclusion, our study provides an overview of the clinical and epidemiological profile of envenoming by Bothrops snakes in Brazil. Notably, this is the first study to present such information in a country as vast and diverse as Brazil, encompassing a comparative analysis of its regions using SINAN data, that proves to be a very useful national tool to improve the control and management of envenoming.
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Affiliation(s)
- Weslley Ruan Guimarães Borges da Silva
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Bioinformatics, Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Lucas de Siqueira Santos
- Graduate Program in Geodetic Sciences and Geoinformation Technologies, Department of Cartographic Engineering, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Derick Lira
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ecology and Conservation, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
| | - Karla Patrícia de Oliveira Luna
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Science Teaching and Mathematics Education, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Cellular and Molecular Biology, Department of Molecular Biology, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
| | - Sayonara Maria Lia Fook
- Graduate Program in Public Health, Department of Pharmacy, State University of Paraíba, Campina Grande, Paraíba, Brazil
| | - Rômulo Romeu Nóbrega Alves
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ecology and Conservation, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ethnobiology and Nature Conservation, Federal Rural University of Pernambuco, Recife, Pernambuco, Brazil
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Cavalcante JS, de Almeida DEG, Santos-Filho NA, Sartim MA, de Almeida Baldo A, Brasileiro L, Albuquerque PL, Oliveira SS, Sachett JAG, Monteiro WM, Ferreira RS. Crosstalk of Inflammation and Coagulation in Bothrops Snakebite Envenoming: Endogenous Signaling Pathways and Pathophysiology. Int J Mol Sci 2023; 24:11508. [PMID: 37511277 PMCID: PMC10380640 DOI: 10.3390/ijms241411508] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 07/30/2023] Open
Abstract
Snakebite envenoming represents a major health problem in tropical and subtropical countries. Considering the elevated number of accidents and high morbidity and mortality rates, the World Health Organization reclassified this disease to category A of neglected diseases. In Latin America, Bothrops genus snakes are mainly responsible for snakebites in humans, whose pathophysiology is characterized by local and systemic inflammatory and degradative processes, triggering prothrombotic and hemorrhagic events, which lead to various complications, organ damage, tissue loss, amputations, and death. The activation of the multicellular blood system, hemostatic alterations, and activation of the inflammatory response are all well-documented in Bothrops envenomings. However, the interface between inflammation and coagulation is still a neglected issue in the toxinology field. Thromboinflammatory pathways can play a significant role in some of the major complications of snakebite envenoming, such as stroke, venous thromboembolism, and acute kidney injury. In addition to exacerbating inflammation and cell interactions that trigger vaso-occlusion, ischemia-reperfusion processes, and, eventually, organic damage and necrosis. In this review, we discuss the role of inflammatory pathways in modulating coagulation and inducing platelet and leukocyte activation, as well as the inflammatory production mediators and induction of innate immune responses, among other mechanisms that are altered by Bothrops venoms.
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Affiliation(s)
- Joeliton S Cavalcante
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu 18618-687, São Paulo, Brazil
| | - Denis Emanuel Garcia de Almeida
- Department of Bioprocess and Biotechnology, School of Agriculture, Agronomic Sciences School, São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu 18618-687, São Paulo, Brazil
| | - Norival A Santos-Filho
- Institute of Chemistry, São Paulo State University (UNESP-Univ Estadual Paulista), Araraquara 14800-900, São Paulo, Brazil
| | - Marco Aurélio Sartim
- Laboratory of Bioprospection, University Nilton Lins, Manaus 69058-030, Amazonas, Brazil
- Research & Development Department, Nilton Lins Foundation, Manaus 69058-030, Amazonas, Brazil
- Graduate Program in Tropical Medicine, Department of Research at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Amazonas State University, Manaus 69850-000, Amazonas, Brazil
| | - Amanda de Almeida Baldo
- Institute of Biosciences, São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu 18618-687, São Paulo, Brazil
| | - Lisele Brasileiro
- Graduate Program in Tropical Medicine, Department of Research at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Amazonas State University, Manaus 69850-000, Amazonas, Brazil
| | - Polianna L Albuquerque
- Toxicological Information and Assistance Center, Instituto Doutor Jose Frota Hospital, Fortaleza 60025-061, Ceará, Brazil
- Faculty of Medicine, University of Fortaleza, Fortaleza 60430-140, Ceará, Brazil
| | - Sâmella S Oliveira
- Research Management, Hospital Foundation of Hematology and Hemotherapy of Amazonas, Manaus 69050-001, Amazonas, Brazil
| | - Jacqueline Almeida Gonçalves Sachett
- Research & Development Department, Nilton Lins Foundation, Manaus 69058-030, Amazonas, Brazil
- Graduate Program in Tropical Medicine, Department of Research at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Amazonas State University, Manaus 69850-000, Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- Research & Development Department, Nilton Lins Foundation, Manaus 69058-030, Amazonas, Brazil
- Graduate Program in Tropical Medicine, Department of Research at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Amazonas State University, Manaus 69850-000, Amazonas, Brazil
| | - Rui Seabra Ferreira
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu 18618-687, São Paulo, Brazil
- Center for Translational Science and Development of Biopharmaceuticals FAPESP/CEVAP-UNESP, Botucatu 18610-307, São Paulo, Brazil
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu 18610-307, São Paulo, Brazil
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7
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Pierre-Louis O, Resiere D, Alphonsine C, Dantin F, Banydeen R, Dubois MD, Mehdaoui H, Neviere R. Increased Binding of von Willebrand Factor to Sub-Endothelial Collagen May Facilitate Thrombotic Events Complicating Bothrops lanceolatus Envenomation in Humans. Toxins (Basel) 2023; 15:441. [PMID: 37505710 PMCID: PMC10467054 DOI: 10.3390/toxins15070441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 07/29/2023] Open
Abstract
Consumption coagulopathy and hemorrhagic syndrome exacerbated by blood anticoagulability remain the most important causes of lethality associated with Bothrops snake envenomation. Bothrops venom also engages platelet aggregation on the injured endothelium via von Willebrand factor (vWF) interactions. Besides platelet aggregation, some Bothrops venom toxins may induce qualitative thrombopathy, which has been in part related to the inhibition of vWF activation. We tested whether B. lanceolatus venom impaired vWF to collagen(s) binding (vWF:CB) activity. Experiments were performed with B. lanceolatus crude venom, in the presence or absence of Bothrofav, a monospecific B. lanceolatus antivenom. Venom of B. lanceolatus fully inhibited vWF to collagen type I and III binding, suggesting venom interactions with the vWF A3 domain. In contrast, B. lanceolatus venom increased vWF to collagen type VI binding, suggesting the enhancement of vWF binding to collagen at the vWF A1 domain. Hence, B. lanceolatus venom exhibited contrasting in vitro effects in terms of the adhesive properties of vWF to collagen. On the other hand, the antivenom Bothrofav reversed the inhibitory effects of B. lanceolatus venom on vWF collagen binding activity. In light of the respective distribution of collagen type III and collagen type VI in perivascular connective tissue and the sub-endothelium, a putative association between an increase in vWF:CB activity for collagen type VI and the onset of thrombotic events in human B. lanceolatus envenomation might be considered.
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Affiliation(s)
- Olivier Pierre-Louis
- Cardiovascular Research Team EA7525, University of the French West Indies (Université des Antilles), 97233 Fort de France, France; (O.P.-L.); (D.R.); (C.A.); (F.D.); (R.B.); (M.-D.D.); (H.M.)
| | - Dabor Resiere
- Cardiovascular Research Team EA7525, University of the French West Indies (Université des Antilles), 97233 Fort de France, France; (O.P.-L.); (D.R.); (C.A.); (F.D.); (R.B.); (M.-D.D.); (H.M.)
- Department of Critical Care Medicine and Toxicology, University Hospital of Martinique (CHU Martinique), 97200 Fort-de-France, France
| | - Celia Alphonsine
- Cardiovascular Research Team EA7525, University of the French West Indies (Université des Antilles), 97233 Fort de France, France; (O.P.-L.); (D.R.); (C.A.); (F.D.); (R.B.); (M.-D.D.); (H.M.)
| | - Fabienne Dantin
- Cardiovascular Research Team EA7525, University of the French West Indies (Université des Antilles), 97233 Fort de France, France; (O.P.-L.); (D.R.); (C.A.); (F.D.); (R.B.); (M.-D.D.); (H.M.)
| | - Rishika Banydeen
- Cardiovascular Research Team EA7525, University of the French West Indies (Université des Antilles), 97233 Fort de France, France; (O.P.-L.); (D.R.); (C.A.); (F.D.); (R.B.); (M.-D.D.); (H.M.)
| | - Marie-Daniela Dubois
- Cardiovascular Research Team EA7525, University of the French West Indies (Université des Antilles), 97233 Fort de France, France; (O.P.-L.); (D.R.); (C.A.); (F.D.); (R.B.); (M.-D.D.); (H.M.)
| | - Hossein Mehdaoui
- Cardiovascular Research Team EA7525, University of the French West Indies (Université des Antilles), 97233 Fort de France, France; (O.P.-L.); (D.R.); (C.A.); (F.D.); (R.B.); (M.-D.D.); (H.M.)
- Department of Critical Care Medicine and Toxicology, University Hospital of Martinique (CHU Martinique), 97200 Fort-de-France, France
| | - Remi Neviere
- Cardiovascular Research Team EA7525, University of the French West Indies (Université des Antilles), 97233 Fort de France, France; (O.P.-L.); (D.R.); (C.A.); (F.D.); (R.B.); (M.-D.D.); (H.M.)
- Department of Cardiology, University Hospital of Martinique (CHU Martinique), 97200 Fort-de-France, France
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8
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Galan LEB, Silva VS, Silva VS, Monte RC, Jati SR, Oliveira IS, Cerni FA, Monteiro WM, Sachett J, Dantas DSM, Carbonell RCC, Pucca MB. Acute mesenteric ischemia following lancehead snakebite: an unusual case report in the Northernmost Brazilian Amazon. Front Med (Lausanne) 2023; 10:1197446. [PMID: 37425310 PMCID: PMC10323676 DOI: 10.3389/fmed.2023.1197446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Snakebites have a great impact in the Brazilian Amazon, being the lancehead Bothrops atrox the species responsible for most accidents, disabilities, and deaths. This study shows a case report of an indigenous patient from the Yanomami ethnicity, male, 33 years-old, envenomed by a B. atrox snake. Envenoming caused by B. atrox are characterized by local manifestations (e.g., pain and edema) and systemic manifestations, mainly coagulation disorders. The indigenous victim was admitted in the main hospital of Roraima and evolved with an unusual complication, an ischemia and necrosis of the proximal ileum, requiring segmental enterectomy with posterior side-to-side anastomosis. The victim was discharge after 27 days of hospitalization with no complaints. Snakebite envenomations may evolve with life-threatening complications, which can be treated by the antivenom following access to a healthcare unit, often late in indigenous population. This clinical case shows the need of strategies that aim improvement in the access to the healthcare by indigenous people, as well as demonstrates an unusual complication that may result from lancehead snakebites. The article also discusses the decentralization of snakebites clinical management to indigenous community healthcare centers to mitigate complications.
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Affiliation(s)
- Luis E. B. Galan
- Medical School, Federal University of Roraima, Boa Vista, Roraima, Brazil
| | | | | | - Rommel C. Monte
- Medical School, Federal University of Roraima, Boa Vista, Roraima, Brazil
| | - Sewbert R. Jati
- Post Graduate Program in Tropical Medicine (PPGMT) of the State University of Amazonas, Manaus, Amazonas, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Isadora S. Oliveira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Felipe A. Cerni
- Post Graduate Program in Tropical Medicine (PPGMT) of the State University of Amazonas, Manaus, Amazonas, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Wuelton M. Monteiro
- Post Graduate Program in Tropical Medicine (PPGMT) of the State University of Amazonas, Manaus, Amazonas, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Jacqueline Sachett
- Post Graduate Program in Tropical Medicine (PPGMT) of the State University of Amazonas, Manaus, Amazonas, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Domingos S. M. Dantas
- Programa Doutoral de Bioética da Faculdade de Medicina do Porto, Cidade do Porto, Portugal
| | | | - Manuela B. Pucca
- Post Graduate Program in Tropical Medicine (PPGMT) of the State University of Amazonas, Manaus, Amazonas, Brazil
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University, Araraquara, São Paulo, Brazil
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9
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Resiere D, Kallel H, Florentin J, Houcke S, Mehdaoui H, Gutiérrez JM, Neviere R. Bothrops (Fer-de-lance) snakebites in the French departments of the Americas (Martinique and Guyana): Clinical and experimental studies and treatment by immunotherapy. PLoS Negl Trop Dis 2023; 17:e0011083. [PMID: 36854042 PMCID: PMC9974124 DOI: 10.1371/journal.pntd.0011083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Snakebite envenomation is a relevant medical hazard in French Guiana and Martinique, two French territories in the Americas. All snakebite envenomations in Martinique are inflicted by the endemic viperid species Bothrops lanceolatus, whereas Bothrops atrox is responsible for the majority of snakebites in French Guiana, although other venomous snake species also occur in this South American territory. This review summarizes some of the key aspects of the natural history of these species, as well as of their venom composition, the main clinical manifestations of envenomations, and their treatment by antivenoms. B. atrox venom induces the typical set of clinical manifestations characteristic of Bothrops sp. venoms, i.e., local tissue damage and systemic alterations associated with coagulopathies, hemorrhage, hemodynamic alterations, and acute kidney injury. In the case of B. lanceolatus venom, in addition to some typical features of bothropic envenomation, a unique and severe thrombotic effect occurs in some patients. The pathogenesis of this effect remains unknown but may be related to the action of venom components and inflammatory mediators on endothelial cells in the vasculature. A monospecific antivenom has been successfully used in Martinique to treat envenomations by B. lanceolatus. In the case of French Guiana, a polyvalent antivenom has been used for some years, but it is necessary to assess the preclinical and clinical efficacy against viperid venoms in this country of other antivenoms manufactured in the Americas.
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Affiliation(s)
- Dabor Resiere
- Cardiovascular Research Team EA7525, Université des Antilles, Fort de France, France
- Department of Critical Care Medicine, Toxicology and Emergency, CHU Martinique (University Hospital of Martinique), Fort-de-France, France
| | - Hatem Kallel
- Intensive Care Unit, Cayenne General Hospital, Cayenne, French Guiana, France
| | - Jonathan Florentin
- Cardiovascular Research Team EA7525, Université des Antilles, Fort de France, France
- Department of Critical Care Medicine, Toxicology and Emergency, CHU Martinique (University Hospital of Martinique), Fort-de-France, France
| | - Stephanie Houcke
- Intensive Care Unit, Cayenne General Hospital, Cayenne, French Guiana, France
| | - Hossein Mehdaoui
- Cardiovascular Research Team EA7525, Université des Antilles, Fort de France, France
- Department of Critical Care Medicine, Toxicology and Emergency, CHU Martinique (University Hospital of Martinique), Fort-de-France, France
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Remi Neviere
- Cardiovascular Research Team EA7525, Université des Antilles, Fort de France, France
- * E-mail:
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10
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Alsolaiss J, Alomran N, Hawkins L, Casewell NR. Commercial Antivenoms Exert Broad Paraspecific Immunological Binding and In Vitro Inhibition of Medically Important Bothrops Pit Viper Venoms. Toxins (Basel) 2022; 15:1. [PMID: 36668821 PMCID: PMC9862972 DOI: 10.3390/toxins15010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/13/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Snakebite envenoming is a life threatening neglected tropical disease that represents a considerable public health concern in the tropics. Viperid snakes of the genus Bothrops are among those of greatest medical importance in Latin America, and they frequently cause severe systemic haemotoxicity and local tissue destructive effects in human victims. Although snakebite antivenoms can be effective therapeutics, their efficacy is undermined by venom toxin variation among snake species. In this study we investigated the extent of paraspecific venom cross-reactivity exhibited by three distinct anti-Bothrops antivenoms (Soro antibotrópico-crotálico, BothroFav and PoliVal-ICP) against seven different Bothrops pit viper venoms from across Latin America. We applied a range of in vitro assays to assess the immunological binding and recognition of venom toxins by the antivenoms and their inhibitory activities against specific venom functionalities. Our findings demonstrated that, despite some variations, the monovalent antivenom BothroFav and the polyvalent antivenoms Soro antibotrópico-crotálico and PoliVap-ICP exhibited extensive immunological recognition of the distinct toxins found in the different Bothrops venoms, with Soro antibotrópico-crotálico generally outperformed by the other two products. In vitro functional assays revealed outcomes largely consistent with the immunological binding data, with PoliVap-ICP and BothroFav exhibiting the greatest inhibitory potencies against procoagulant and fibrinogen-depleting venom activities, though Soro antibotrópico-crotálico exhibited potent inhibition of venom metalloproteinase activities. Overall, our findings demonstrate broad levels of antivenom paraspecificity, with in vitro immunological binding and functional inhibition often highly comparable between venoms used to manufacture the antivenoms and those from related species, even in the case of the monovalent antivenom BothroFav. Our findings suggest that the current clinical utility of these antivenoms could possibly be expanded to other parts of Latin America that currently suffer from a lack of specific snakebite therapies.
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Affiliation(s)
- Jaffer Alsolaiss
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
- Tropical Disease Biology Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Nessrin Alomran
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
- Tropical Disease Biology Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Laura Hawkins
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
- Tropical Disease Biology Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Nicholas R. Casewell
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
- Tropical Disease Biology Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
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11
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Nascimento TP, Vilhena Silva-Neto A, Baia-da-Silva DC, da Silva Balieiro PC, Baleiro AADS, Sachett J, Brasileiro L, Sartim MA, Martinez-Espinosa FE, Wen FH, Pucca MB, Gerardo CJ, Sampaio VS, Ferreira de Aquino P, Monteiro WM. Pregnancy outcomes after snakebite envenomations: A retrospective cohort in the Brazilian Amazonia. PLoS Negl Trop Dis 2022; 16:e0010963. [PMID: 36469516 PMCID: PMC9754599 DOI: 10.1371/journal.pntd.0010963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/15/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Snakebite envenomations (SBEs) in pregnant women can result in adverse maternal or neonatal effects, such as abortion, placental abruption, preterm labor, fetal malformations, and maternal, fetal or neonatal deaths. Despite the high incidence of SBEs in the Brazilian Amazon, there is no literature on the impact of SBEs on pregnancy outcomes. The objective of this study was to describe clinical epidemiology and outcomes associated with SBEs in women of childbearing age and pregnant women in the state of Amazonas, Western Brazilian Amazon, from 2007 to 2021. Information on the population was obtained from the Reporting Information System (SINAN), Mortality Information System (SIM) and Live Birth Information System (SINASC) for the period from 2007 to 2021. A total of 36,786 SBEs were reported, of which 3,297 (9%) involved women of childbearing age, and 274 (8.3%) involved pregnant women. Severity (7.9% in pregnant versus 8.7% in non-pregnant women) (P = 0.87) and case-fatality (0.4% in pregnant versus 0.3% in non-pregnant women) rates were similar between groups (P = 0.76). Pregnant women who suffered snakebites were at higher risk for fetal death (OR: 2.17, 95%CI: 1.74-2.67) and neonatal death (OR = 2.79, 95%CI: 2.26-3.40). This study had major limitations related to the completeness of the information on the pregnancy outcomes. Although SBE incidence in pregnant women is low in the Brazilian Amazon, SBEs increased the risk of fetal and neonatal deaths.
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Affiliation(s)
- Thaís P. Nascimento
- Leônidas & Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Amazonas, Brazil
| | - Alexandre Vilhena Silva-Neto
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Djane Clarys Baia-da-Silva
- Leônidas & Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Amazonas, Brazil
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
- Amazonas Federal University, Manaus, Amazonas, Brazil
| | | | | | - Jacqueline Sachett
- Amazonas State University, Manaus, Amazonas, Brazil
- Butantan Institute, São Paulo, Brazil
| | - Lisele Brasileiro
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Marco A. Sartim
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Flor Ernestina Martinez-Espinosa
- Leônidas & Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | | | | | - Charles J. Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Vanderson S. Sampaio
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | | | - Wuelton M. Monteiro
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
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12
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Comparative Venom Proteomics of Iranian, Macrovipera lebetina cernovi, and Cypriot, Macrovipera lebetina lebetina, Giant Vipers. Toxins (Basel) 2022; 14:toxins14100716. [PMID: 36287984 PMCID: PMC9609362 DOI: 10.3390/toxins14100716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022] Open
Abstract
Envenoming by Macrovipera lebetina subspecies causes severe life-threatening difficulties for people living in North Africa and the Middle East. To better understand the pathophysiology of envenoming and improve patient management, knowledge about the venom components of the subspecies is essential. Here, the venom proteomes of Macrovipera lebetina lebetina from Cyprus and Macrovipera lebetina cernovi from Iran were characterized using RP-HPLC separation of the crude venom proteins, SDS-PAGE of fractionated proteins, and LC-MS/MS of peptides obtained from in-gel tryptic digestion of protein bands. Moreover, we also used high-resolution shot-gun proteomics to gain more reliable identification, where the whole venom proteomes were subjected directly to in-solution digestion before LC-HR-MS/MS. The data revealed that both venoms consisted of at least 18 protein families, of which snake venom Zn2+-dependent metalloprotease (SVMP), serine protease, disintegrin, phospholipase A2, C-type lectin-like, and L-amino acid oxidase, together accounted for more than 80% of the venoms’ protein contents. Although the two viper venoms shared mostly similar protein classes, the relative occurrences of these toxins were different in each snake subspecies. For instance, P-I class of SVMP toxins were found to be more abundant than P-III class in the venoms of M. l. cernovi compared to M. l. lebetina, which gives hints at a more potent myonecrotic effect and minor systemic hemorrhage following envenoming by M. l. cernovi than M. l. lebetina. Moreover, single-shot proteomics also revealed many proteins with low abundance (<1%) within the venoms, such as aminopeptidase, hyaluronidase, glutaminyl-peptide cyclotransferase, cystatin, phospholipase B, and vascular endothelial growth factor. Our study extends the in-depth understanding of the venom complexity of M. lebetina subspecies, particularly regarding toxin families associated with envenoming pathogenesis and those hard-detected protein classes expressed in trace amounts.
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13
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Brasileiro-Martins LM, Nascimento TP, Silva-Neto AV, Martins F, Cavalcante SA, Martins RB, Marques H, Colombini M, Martins M, Sartim MA, Wen FH, Carlos de Lima Ferreira L, de Almeida Gonçalves Sachett J, Moura-da-Silva AM, Ferreira de Aquino P, Monteiro WM. The severity of acute kidney injury correlates with plasma venom levels in Bothrops atrox envenomings. Toxicon 2022; 219:106924. [PMID: 36126694 DOI: 10.1016/j.toxicon.2022.09.010] [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: 06/08/2022] [Revised: 08/17/2022] [Accepted: 09/11/2022] [Indexed: 11/20/2022]
Abstract
The Brazilian Amazon has high rates of snakebite envenomings (SBEs), with ∼90% caused by Bothrops atrox. Envenomings by this species can trigger local and systemic effects, such as acute kidney injury (AKI). Our aim was to identify predictors of AKI in Bothrops SBEs in patients from Manaus, Western Brazilian Amazon. A total of 127 patients were enrolled, with a predominance of men between 16 and 45 years old from rural areas. Of the 127 patients, 38.6% developed AKI, with 61.2% presenting stage I, 34.7% presenting stage II and 4.1% presenting stage III severity. The age groups 0-10 years and ≥60 years presented a significantly higher frequency of AKI compared to the 11-40 years group. Moderate/severe edema in the affeccted limb was significantly associated with lower risk of AKI [p = 0.01; OR = 0.11 (95%CI 0.02-0.53)]. Nausea [p = 0.01; OR = 54.44 (95%CI = 3.26-909.27)] and high blood urea levels [p = 0.01; OR = 5.38 (95%CI = 2.12-13.66)] were risk factors for AKI. There was a significant positive correlation between circulating venom levels and the highest creatinine serum values during the hospital stay (p = 0.03) and with the difference between the maximum creatinine levels and the creatinine levels on admission (p = 0.02). A positive correlation between serum venom concentrations and creatinine levels suggests a direct or indirect dose-dependent participation of the venom toxins in the pathogenesis of AKI.
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Affiliation(s)
- Lisele Maria Brasileiro-Martins
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | - Alexandre Vilhena Silva-Neto
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | - Felipe Martins
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | | | - Hedylamar Marques
- Hemostasis Laboratory, Amazonas State Hematology and Hemotherapy Hospital Foundation, Manaus, 69050-001, Brazil
| | - Monica Colombini
- Immunopathology Laboratory, Butantan Institute, São Paulo, 05503-900, Brazil
| | - Marilaine Martins
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | - Fan Hui Wen
- Immunopathology Laboratory, Butantan Institute, São Paulo, 05503-900, Brazil
| | | | - Jacqueline de Almeida Gonçalves Sachett
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | | | - Wuelton Marcelo Monteiro
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil.
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14
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Oliveira IS, Ananias CB, Medeiros JM, Franco MVS, Ferreira IG, Cerni FA, Sandri EA, Monteiro WM, Pucca MB. Medical Management after Lancehead Snakebite in North Amazon: A Case Report of Long-Term Disability. Toxins (Basel) 2022; 14:toxins14070494. [PMID: 35878232 PMCID: PMC9319475 DOI: 10.3390/toxins14070494] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 01/27/2023] Open
Abstract
Snakebites are a major public health problem in indigenous communities in Brazil, leading to acute local and systemic damage with resulting deficiencies. Long-term musculoskeletal disabilities related to snakebites have been a neglected area of research. Bothrops (lancehead) snakes are responsible for most of the permanent sequelae related to snakebites in Latin America. Here, we present a case report of a 32-year-old male indigenous patient who was envenomed by a Bothrops species. The patient was clinically followed for a period of approximately 2 years and 6 months, during which time he experienced a loss of musculoskeletal tissue and required several medical procedures such as debridement, tissue reconstruction, and physical therapy, which resulted in a recovery of mobility, though with a permanent sequelae in gait. This case report shows how snakebites have a significant impact on health systems, as victims require physiotherapy, plastic surgery, and orthopedics services, as well as social support for reintegration into their local communities.
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Affiliation(s)
- Isadora S. Oliveira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-903, Brazil; (I.S.O.); (I.G.F.)
| | - Carla B. Ananias
- Medical School, Federal University of Roraima, Boa Vista 69310-000, Brazil; (C.B.A.); (J.M.M.); (M.V.S.F.)
| | - Jilvando M. Medeiros
- Medical School, Federal University of Roraima, Boa Vista 69310-000, Brazil; (C.B.A.); (J.M.M.); (M.V.S.F.)
| | - Michelle V. S. Franco
- Medical School, Federal University of Roraima, Boa Vista 69310-000, Brazil; (C.B.A.); (J.M.M.); (M.V.S.F.)
| | - Isabela G. Ferreira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-903, Brazil; (I.S.O.); (I.G.F.)
| | - Felipe A. Cerni
- Health Sciences Posgraduate Program, Federal University of Roraima, Boa Vista 69310-000, Brazil;
| | - Eliseu A. Sandri
- Insikiram Institute of Indigenous Higher Studies, Federal University of Roraima, Boa Vista 69310-000, Brazil;
| | - Wuelton M. Monteiro
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Brazil;
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus 69050-010, Brazil
| | - Manuela B. Pucca
- Medical School, Federal University of Roraima, Boa Vista 69310-000, Brazil; (C.B.A.); (J.M.M.); (M.V.S.F.)
- Health Sciences Posgraduate Program, Federal University of Roraima, Boa Vista 69310-000, Brazil;
- Correspondence: ; Tel.: +55-953-621-3146
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15
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Adrião AAX, dos Santos AO, de Lima EJSP, Maciel JB, Paz WHP, da Silva FMA, Pucca MB, Moura-da-Silva AM, Monteiro WM, Sartim MA, Koolen HHF. Plant-Derived Toxin Inhibitors as Potential Candidates to Complement Antivenom Treatment in Snakebite Envenomations. Front Immunol 2022; 13:842576. [PMID: 35615352 PMCID: PMC9126284 DOI: 10.3389/fimmu.2022.842576] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Snakebite envenomations (SBEs) are a neglected medical condition of global importance that mainly affect the tropical and subtropical regions. Clinical manifestations include pain, edema, hemorrhage, tissue necrosis, and neurotoxic signs, and may evolve to functional loss of the affected limb, acute renal and/or respiratory failure, and even death. The standard treatment for snake envenomations is antivenom, which is produced from the hyperimmunization of animals with snake toxins. The inhibition of the effects of SBEs using natural or synthetic compounds has been suggested as a complementary treatment particularly before admission to hospital for antivenom treatment, since these alternative molecules are also able to inhibit toxins. Biodiversity-derived molecules, namely those extracted from medicinal plants, are promising sources of toxin inhibitors that can minimize the deleterious consequences of SBEs. In this review, we systematically synthesize the literature on plant metabolites that can be used as toxin-inhibiting agents, as well as present the potential mechanisms of action of molecules derived from natural sources. These findings aim to further our understanding of the potential of natural products and provide new lead compounds as auxiliary therapies for SBEs.
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Affiliation(s)
- Asenate A. X. Adrião
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Aline O. dos Santos
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Emilly J. S. P. de Lima
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Jéssica B. Maciel
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Weider H. P. Paz
- Post Graduate Program in Chemistry, Department of Chemistry, Federal University of Amazonas, Manaus, Brazil
| | - Felipe M. A. da Silva
- Post Graduate Program in Chemistry, Department of Chemistry, Federal University of Amazonas, Manaus, Brazil
- Multidisciplinary Support Center, Federal University of Amazonas, Manaus, Brazil
| | - Manuela B. Pucca
- Medical School, Federal University of Roraima, Boa Vista, Brazil
| | - Ana M. Moura-da-Silva
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- Laboratory of Immunopathology, Institute Butantan, São Paulo, Brazil
| | - Wuelton M. Monteiro
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Marco A. Sartim
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- University Nilton Lins, Manaus, Brazil
| | - Hector H. F. Koolen
- Post Graduate Program in Biodiversity and Biotechnology BIONORTE, Superior School of Health Sciences, Amazonas State University, Manaus, Brazil
- Post Graduate Program in Tropical Medicine, Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- Post Graduate Program in Chemistry, Department of Chemistry, Federal University of Amazonas, Manaus, Brazil
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16
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Lower levels of CXCL-8 and IL-2 on admission as predictors of early adverse reactions to Bothrops antivenom in the Brazilian Amazon. Cytokine 2022; 152:155825. [DOI: 10.1016/j.cyto.2022.155825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 12/13/2022]
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Gimenes SNC, Sachett JAG, Colombini M, Freitas-de-Sousa LA, Ibiapina HNS, Costa AG, Santana MF, Park JJ, Sherman NE, Ferreira LCL, Wen FH, Monteiro WM, Moura-da-Silva AM, Fox JW. Observation of Bothrops atrox Snake Envenoming Blister Formation from Five Patients: Pathophysiological Insights. Toxins (Basel) 2021; 13:toxins13110800. [PMID: 34822585 PMCID: PMC8618272 DOI: 10.3390/toxins13110800] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
In the Brazilian Amazon, Bothrops atrox snakebites are frequent, and patients develop tissue damage with blisters sometimes observed in the proximity of the wound. Antivenoms do not seem to impact blister formation, raising questions regarding the mechanisms underlying blister formation. Here, we launched a clinical and laboratory-based study including five patients who followed and were treated by the standard clinical protocols. Blister fluids were collected for proteomic analyses and molecular assessment of the presence of venom and antivenom. Although this was a small patient sample, there appeared to be a correlation between the time of blister appearance (shorter) and the amount of venom present in the serum (higher). Of particular interest was the biochemical identification of both venom and antivenom in all blister fluids. From the proteomic analysis of the blister fluids, all were observed to be a rich source of damage-associated molecular patterns (DAMPs), immunomodulators, and matrix metalloproteinase-9 (MMP-9), suggesting that the mechanisms by which blisters are formed includes the toxins very early in envenomation and continue even after antivenom treatment, due to the pro-inflammatory molecules generated by the toxins in the first moments after envenomings, indicating the need for local treatments with anti-inflammatory drugs plus toxin inhibitors to prevent the severity of the wounds.
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Affiliation(s)
- Sarah N. C. Gimenes
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo 05503-900, SP, Brazil; (S.N.C.G.); (M.C.); (L.A.F.-d.-S.)
| | - Jacqueline A. G. Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69050-030, AM, Brazil; (J.A.G.S.); (H.N.S.I.); (A.G.C.); (M.F.S.); (W.M.M.)
- Departamento de Ensino e Pesquisa, Fundação de Dermatologia Alfredo da Matta, Manaus 69065-130, AM, Brazil
| | - Mônica Colombini
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo 05503-900, SP, Brazil; (S.N.C.G.); (M.C.); (L.A.F.-d.-S.)
| | - Luciana A. Freitas-de-Sousa
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo 05503-900, SP, Brazil; (S.N.C.G.); (M.C.); (L.A.F.-d.-S.)
| | - Hiochelson N. S. Ibiapina
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69050-030, AM, Brazil; (J.A.G.S.); (H.N.S.I.); (A.G.C.); (M.F.S.); (W.M.M.)
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil;
| | - Allyson G. Costa
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69050-030, AM, Brazil; (J.A.G.S.); (H.N.S.I.); (A.G.C.); (M.F.S.); (W.M.M.)
- Departamento de Ensino e Pesquisa, Fundação de Hematologia e Hemoterapia do Amazonas, Manaus 69040-010, AM, Brazil
| | - Monique F. Santana
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69050-030, AM, Brazil; (J.A.G.S.); (H.N.S.I.); (A.G.C.); (M.F.S.); (W.M.M.)
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil;
- Departamento de Ensino e Pesquisa, Fundação de Hematologia e Hemoterapia do Amazonas, Manaus 69040-010, AM, Brazil
| | - Jeong-Jin Park
- School of Medicine, University of Virginia, Charlottesville, VA 22903, USA; (J.-J.P.); (N.E.S.)
| | - Nicholas E. Sherman
- School of Medicine, University of Virginia, Charlottesville, VA 22903, USA; (J.-J.P.); (N.E.S.)
| | - Luiz C. L. Ferreira
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil;
| | - Fan H. Wen
- Núcleo de Produção de Soros, Instituto Butantan, São Paulo 05503-900, SP, Brazil;
| | - Wuelton M. Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69050-030, AM, Brazil; (J.A.G.S.); (H.N.S.I.); (A.G.C.); (M.F.S.); (W.M.M.)
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil;
| | - Ana M. Moura-da-Silva
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo 05503-900, SP, Brazil; (S.N.C.G.); (M.C.); (L.A.F.-d.-S.)
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil;
- Correspondence: (A.M.M.-d.-S.); (J.W.F.)
| | - Jay W. Fox
- School of Medicine, University of Virginia, Charlottesville, VA 22903, USA; (J.-J.P.); (N.E.S.)
- Correspondence: (A.M.M.-d.-S.); (J.W.F.)
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Valenta J, Stach Z, Vagenknechtová E, Hoskovec D. Splenic Rupture and Massive Hemoperitoneum Due to Coagulopathy after Atheris Viper Snakebite. Prague Med Rep 2021; 122:216-221. [PMID: 34606434 DOI: 10.14712/23362936.2021.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Coagulopathy with defibrination is one of symptoms accompanying snakebite envenoming, where life-threatening complications such as massive bleeding and organ hematomas formation can occur. Here, we report a case of hemocoagulation failure due to bite by African Great Lakes bush viper Atheris nitschei with impossibility of specific treatment for absence of antivenom and its life-threatening complication: very rare and unexpected atraumatic splenic rupture with massive hemoperitoneum and necessity of urgent splenectomy.
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Affiliation(s)
- Jiří Valenta
- Department of Anesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Zdeněk Stach
- Department of Anesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Eva Vagenknechtová
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - David Hoskovec
- 1st Department of Surgery - Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Larréché S, Chippaux JP, Chevillard L, Mathé S, Résière D, Siguret V, Mégarbane B. Bleeding and Thrombosis: Insights into Pathophysiology of Bothrops Venom-Related Hemostasis Disorders. Int J Mol Sci 2021; 22:ijms22179643. [PMID: 34502548 PMCID: PMC8431793 DOI: 10.3390/ijms22179643] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/29/2021] [Accepted: 09/03/2021] [Indexed: 12/13/2022] Open
Abstract
Toxins from Bothrops venoms targeting hemostasis are responsible for a broad range of clinical and biological syndromes including local and systemic bleeding, incoagulability, thrombotic microangiopathy and macrothrombosis. Beyond hemostais disorders, toxins are also involved in the pathogenesis of edema and in most complications such as hypovolemia, cardiovascular collapse, acute kidney injury, myonecrosis, compartmental syndrome and superinfection. These toxins can be classified as enzymatic proteins (snake venom metalloproteinases, snake venom serine proteases, phospholipases A2 and L-amino acid oxidases) and non-enzymatic proteins (desintegrins and C-type lectin proteins). Bleeding is due to a multifocal toxicity targeting vessels, platelets and coagulation factors. Vessel damage due to the degradation of basement membrane and the subsequent disruption of endothelial cell integrity under hydrostatic pressure and tangential shear stress is primarily responsible for bleeding. Hemorrhage is promoted by thrombocytopenia, platelet hypoaggregation, consumption coagulopathy and fibrin(ogen)olysis. Onset of thrombotic microangiopathy is probably due to the switch of endothelium to a prothrombotic phenotype with overexpression of tissue factor and other pro-aggregating biomarkers in association with activation of platelets and coagulation. Thrombosis involving large-caliber vessels in B. lanceolatus envenomation remains a unique entity, which exact pathophysiology remains poorly understood.
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Affiliation(s)
- Sébastien Larréché
- INSERM, UMRS-1144, Paris University, 75006 Paris, France; (S.L.); (L.C.); (S.M.)
- Department of Medical Biology, Bégin Military Teaching Hospital, 94160 Saint-Mandé, France
| | - Jean-Philippe Chippaux
- MERIT, IRD, Paris University, 75006 Paris, France;
- CRT, Pasteur Institute, 75015 Paris, France
| | - Lucie Chevillard
- INSERM, UMRS-1144, Paris University, 75006 Paris, France; (S.L.); (L.C.); (S.M.)
| | - Simon Mathé
- INSERM, UMRS-1144, Paris University, 75006 Paris, France; (S.L.); (L.C.); (S.M.)
| | - Dabor Résière
- Clinical Toxicology Unit, Critical Care Department, University Hospital of Martinique, Fort de France, 97200 Martinique, France;
| | - Virginie Siguret
- INSERM, UMRS-1140, Paris University, 75006 Paris, France;
- Laboratory of Hematology, Lariboisière Hospital, 75010 Paris, France
| | - Bruno Mégarbane
- INSERM, UMRS-1144, Paris University, 75006 Paris, France; (S.L.); (L.C.); (S.M.)
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, 75010 Paris, France
- Correspondence: ; Tel.: +33-(0)-143-985-299
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Pujo JM, Houcke S, Fremery A, Lontsi-Ngoula G, Burin A, Mutricy R, Hommel D, Resiere D, Kallel H. Les envenimations vipérines en Guyane française. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’OMS classe l’envenimation vipérine comme pathologie négligée. Elle représente un problème de santé publique associé à des taux de mortalité et de morbidité importants. Notre objectif est de faire une mise au point sur les données récentes de la littérature sur l’épidémiologie et la prise en charge de l’envenimation vipérine en Guyane française. La Guyane est un département français presque entièrement recouvert par une forêt tropicale. Elle abrite une herpétofaune très riche comportant notamment les espèces du genre Bothrops (famille des Viperidae) qui provoquent le plus grand nombre de morsures et d’envenimations. La gestion des envenimations vipérines représente un défi de santé publique. En effet, la plupart des envenimations se produisent dans des zones rurales éloignées où l’accès aux soins est le plus compliqué, avec la présence d’un personnel médical peu formé à la prise en charge et l’indisponibilité de l’antivenin, ce qui constitue une véritable perte de chance pour les patients. En conclusion, dans un contexte d’efforts mondiaux visant à réduire l’impact des envenimations vipérines, la coopération internationale et l’engagement des autorités locales de santé et de la société civile sont nécessaires. En Guyane, la mise en place d’une véritable filière de soins et la mise à disposition de l’antivenin dans les structures sanitaires les plus isolées constitueraient un réel progrès sanitaire.
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Gutiérrez JM, Albulescu LO, Clare RH, Casewell NR, Abd El-Aziz TM, Escalante T, Rucavado A. The Search for Natural and Synthetic Inhibitors That Would Complement Antivenoms as Therapeutics for Snakebite Envenoming. Toxins (Basel) 2021; 13:451. [PMID: 34209691 PMCID: PMC8309910 DOI: 10.3390/toxins13070451] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 12/28/2022] Open
Abstract
A global strategy, under the coordination of the World Health Organization, is being unfolded to reduce the impact of snakebite envenoming. One of the pillars of this strategy is to ensure safe and effective treatments. The mainstay in the therapy of snakebite envenoming is the administration of animal-derived antivenoms. In addition, new therapeutic options are being explored, including recombinant antibodies and natural and synthetic toxin inhibitors. In this review, snake venom toxins are classified in terms of their abundance and toxicity, and priority actions are being proposed in the search for snake venom metalloproteinase (SVMP), phospholipase A2 (PLA2), three-finger toxin (3FTx), and serine proteinase (SVSP) inhibitors. Natural inhibitors include compounds isolated from plants, animal sera, and mast cells, whereas synthetic inhibitors comprise a wide range of molecules of a variable chemical nature. Some of the most promising inhibitors, especially SVMP and PLA2 inhibitors, have been developed for other diseases and are being repurposed for snakebite envenoming. In addition, the search for drugs aimed at controlling endogenous processes generated in the course of envenoming is being pursued. The present review summarizes some of the most promising developments in this field and discusses issues that need to be considered for the effective translation of this knowledge to improve therapies for tackling snakebite envenoming.
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Affiliation(s)
- José María Gutiérrez
- Facultad de Microbiología, Instituto Clodomiro Picado, Universidad de Costa Rica, San José 11501, Costa Rica; (T.E.); (A.R.)
| | - Laura-Oana Albulescu
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (L.-O.A.); (R.H.C.); (N.R.C.)
| | - Rachel H. Clare
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (L.-O.A.); (R.H.C.); (N.R.C.)
| | - Nicholas R. Casewell
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (L.-O.A.); (R.H.C.); (N.R.C.)
| | - Tarek Mohamed Abd El-Aziz
- Zoology Department, Faculty of Science, Minia University, El-Minia 61519, Egypt;
- Department of Cellular and Integrative Physiology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA
| | - Teresa Escalante
- Facultad de Microbiología, Instituto Clodomiro Picado, Universidad de Costa Rica, San José 11501, Costa Rica; (T.E.); (A.R.)
| | - Alexandra Rucavado
- Facultad de Microbiología, Instituto Clodomiro Picado, Universidad de Costa Rica, San José 11501, Costa Rica; (T.E.); (A.R.)
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de Souza Barbosa Ê, Santos Ibiapina HN, Rocha da Silva S, Costa AG, Val FF, Mendonça-da-Silva I, Carlos de Lima Ferreira L, Sartim MA, Monteiro WM, Cardoso de Melo G, de Almeida Gonçalves Sachett J. Association of cfDNA levels and bothrops envenomation. Toxicon 2021; 192:66-73. [PMID: 33497746 DOI: 10.1016/j.toxicon.2021.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/21/2020] [Accepted: 01/20/2021] [Indexed: 01/05/2023]
Abstract
In the Amazon, around 90% of snakebites are caused by the Bothrops genus. Complications arising from Bothrops envenomations result from the inflammatory and coagulotoxic activities of the venom. The aim of this study was to investigate the potential of cell-free DNA (cfDNA) as a biomarker of severity in Bothrops snakebites. Patients were treated at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, in the Brazilian Amazon. cfDNA plasma levels were measured by amplifying the human telomerase reverse transcriptase (hTERT) sequence using quantitative RT-PCR. Median levels of cfDNA were compared between envenomed and healthy volunteers and among patients presenting different complications, such as renal failure, bleeding and infection. Of the 76 patients included, 82.9% were male, with a mean age of 32.8 years, and envenomations were mainly classified as severe (39.5%). ROC curve analysis showed a good accuracy of cfDNA levels (AUROC of 0.745) in envenomation diagnosis. A correlation analysis using laboratory variables showed positive correlation with lactate dehydrogenase (p = 0.033) and platelet count (p = 0.003). When cfDNA levels were compared with clinical complications, significant statistical differences were only found among individuals with mild and severe pain (p < 0.05). In summary, our results demonstrated that cfDNA levels are sufficiently accurate for discriminating between envenomed and non-envenomed patients, but are not able to distinguish different complications and the level of severity among envenomed patients. Thus, the role of cfDNA in the pathogenesis of the snakebite envenomations needs to be further investigated.
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Affiliation(s)
- Êndila de Souza Barbosa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Hiochelson Najibe Santos Ibiapina
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | | | - Allyson Guimarães Costa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil; Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, Brazil
| | - Fernando Fonseca Val
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Iran Mendonça-da-Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Luiz Carlos de Lima Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil; Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, Brazil
| | - Marco Aurélio Sartim
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil; Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Gisely Cardoso de Melo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Jacqueline de Almeida Gonçalves Sachett
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil.
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Fatal brain hemorrhage after Bothrops asper bite in the Catatumbo region of Colombia. ACTA ACUST UNITED AC 2020; 40:609-615. [PMID: 33275340 PMCID: PMC7808782 DOI: 10.7705/biomedica.5181] [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: 08/26/2019] [Indexed: 11/24/2022]
Abstract
Las mordeduras de serpientes son un problema de salud pública en regiones tropicales y subtropicales del mundo. Ocurren, especialmente, en trabajadores rurales, y son una importante fuente de discapacidad y mortalidad. Se presenta el caso de un hombre de 59 años, agricultor de la región del Catatumbo (Colombia), quien sufrió la mordedura de una serpiente Bothrops asper, la cual le produjo una hemorragia cerebral fatal. Se llama la atención sobre el grave trastorno hemorrágico en contraste con los leves cambios en el sitio de la mordedura, así como sobre la necesidad del tratamiento temprano de la intoxicación con el suero antiofídico, incluso, en ausencia de manifestaciones cutáneas significativas.
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Resiere D, Houcke S, Pujo JM, Mayence C, Mathien C, NkontCho F, Blaise N, Demar MP, Hommel D, Kallel H. Clinical Features and Management of Snakebite Envenoming in French Guiana. Toxins (Basel) 2020; 12:E662. [PMID: 33086750 PMCID: PMC7589911 DOI: 10.3390/toxins12100662] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/11/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
The management of snakebite (SB) envenoming in French Guiana (FG) is based on symptomatic measures and antivenom (AV) administration (Antivipmyn Tri®; Instituto Bioclon-Mexico). Our study aimed to assess clinical manifestations, the efficacy, and safety of Antivipmyn Tri® in the management of SB. Our study is a prospective observational work. It was conducted in the Intensive Care Unit (ICU) of Cayenne General Hospital between 1 January 2016 and 31 December 2019. We included all patients hospitalized for SB envenoming. Our study contained three groups (without AV, three vials, and six vials Antivipmyn Tri®). During the study period, 133 patients were included. The main clinical symptoms were edema (98.5%), pain (97.7%), systemic hemorrhage (18%), blister (14.3%), and local hemorrhage (14.3%). AV was prescribed for 83 patients (62.3%), and 17 of them (20%) developed early adverse reactions. Biological parameters at admission showed defibrinogenation in 124 cases (93.2%), International Normalized Ratio (INR) > 2 in 104 cases (78.2%), and partial thromboplastin time (PTT) > 1.5 in 74 cases (55.6%). The time from SB to AV was 9:00 (5:22-20:40). The median time from SB to achieve a normal dosage of fibrinogen was 47:00 vs. 25:30, that of Factor II was 24:55 vs. 15:10, that of Factor V was 31:42 vs. 19:42, and that of Factor VIII was 21:30 vs. 10:20 in patients without and with AV, respectively, (p < 0.001 for all factors). Patients receiving Antivipmyn Tri® showed a reduction in the time to return to normal clotting tests, as compared to those who did not. We suggest assessing other antivenoms available in the region to compare their efficacy and safety with Antivipmyn Tri® in FG.
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Affiliation(s)
- Dabor Resiere
- Intensive Care Unit, Cayenne General Hospital, 97300 Cayenne, French Guiana, France; (D.R.); (S.H.); (C.M.); (C.M.); (D.H.)
- Intensive Care Unit, Martinique University Hospital, 97261 Martinique, France
| | - Stéphanie Houcke
- Intensive Care Unit, Cayenne General Hospital, 97300 Cayenne, French Guiana, France; (D.R.); (S.H.); (C.M.); (C.M.); (D.H.)
| | - Jean Marc Pujo
- Emergency Department, Cayenne General Hospital, 97300 Cayenne, French Guiana, France;
| | - Claire Mayence
- Intensive Care Unit, Cayenne General Hospital, 97300 Cayenne, French Guiana, France; (D.R.); (S.H.); (C.M.); (C.M.); (D.H.)
| | - Cyrille Mathien
- Intensive Care Unit, Cayenne General Hospital, 97300 Cayenne, French Guiana, France; (D.R.); (S.H.); (C.M.); (C.M.); (D.H.)
| | - Flaubert NkontCho
- Pharmacy Department, Cayenne General Hospital, 97300 Cayenne, French Guiana, France; (F.N.); (N.B.)
| | - Nicaise Blaise
- Pharmacy Department, Cayenne General Hospital, 97300 Cayenne, French Guiana, France; (F.N.); (N.B.)
| | - Magalie Pierre Demar
- Laboratory department, Cayenne General Hospital, 97300 Cayenne, French Guiana, France;
| | - Didier Hommel
- Intensive Care Unit, Cayenne General Hospital, 97300 Cayenne, French Guiana, France; (D.R.); (S.H.); (C.M.); (C.M.); (D.H.)
| | - Hatem Kallel
- Intensive Care Unit, Cayenne General Hospital, 97300 Cayenne, French Guiana, France; (D.R.); (S.H.); (C.M.); (C.M.); (D.H.)
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Bleeding Disorders in Bothrops atrox Envenomations in the Brazilian Amazon: Participation of Hemostatic Factors and the Impact of Tissue Factor. Toxins (Basel) 2020; 12:toxins12090554. [PMID: 32872404 PMCID: PMC7551922 DOI: 10.3390/toxins12090554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 02/06/2023] Open
Abstract
Bleeding is a common hemostatic disorder that occurs in Bothrops envenomations. We evaluated the changes in coagulation, fibrinolysis components, and platelets in Bothrops atrox envenomations with bleeding. This is an observational study with B. atrox snakebite patients (n = 100) treated in Manaus, Brazilian Amazon. Bleeding was recorded on admission and during hospitalization. We found that the platelet count in our patients presented a weak correlation to tissue factor, factor II, and plasminogen. Tissue factor presented weak correlation to factor V, II, D-dimer, plasminogen, alpha 2-antiplasmin, and moderate correlation to fibrinogen and fibrin/fibrinogen degradation product (FDP). Patients with systemic bleeding (n = 20) presented low levels of factor V, II, fibrinogen, plasminogen, and alpha 2-antiplasmin, and high levels of tissue factor and FDP compared to those without bleeding. Patients with only local bleeding (n = 41) and without bleeding showed similar levels of hemostatic factors. Thrombocytopenia was observed mainly in patients with systemic bleeding and increased levels of serum venom. No association was found between venom levels and systemic bleeding, or between venom levels and clinical severity of envenomation. This is the first report that shows the participation of the extrinsic coagulation pathway in the consumption coagulopathy of B. atrox envenomations with systemic bleeding due to tissue factor release.
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Cerebrovascular Accidents Related to Snakebites in the Amazon-Two Case Reports. Wilderness Environ Med 2020; 31:337-343. [PMID: 32830028 DOI: 10.1016/j.wem.2020.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/20/2022]
Abstract
The objective of this case series was to describe 2 patients presenting with subarachnoid hemorrhage with hydrocephalus and hemoventricle after a snakebite caused by presumed Bothrops ssp. Both cases occurred in the municipality of Guajará (Amazonas state), Western Brazilian Amazon. Both cases featured delay in administration of serum therapy, which may have contributed to the emergence of complications such as stroke. Patient 1 was admitted to hospital 16 h after the snakebite occurred. Before receiving antivenom, testing showed the patient as having unclottable blood. She developed hemorrhagic stroke (a subarachnoid hemorrhage with hydrocephalus and hemoventricle). On the seventh day, she was discharged from hospital. Patient 2 arrived at the hospital 3 d after the snakebite occurred and presented with unclottable blood. He had a stroke (right frontoparietal hemorrhage, intraparenchymal hemorrhage already open to the ventricle) and died on the eighth day after the snakebite. Delay in seeking health care after snake envenomation can result in worse outcome.
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Nascimento da Costa T, Mota-da-Silva A, Colombini M, Moura-da-Silva AM, Medeiros de Souza R, Monteiro WM, Bernarde PS. Relationship between snake size and clinical, epidemiological and laboratory aspects of Bothrops atrox snakebites in the Western Brazilian Amazon. Toxicon 2020; 186:160-167. [PMID: 32822734 DOI: 10.1016/j.toxicon.2020.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 01/19/2023]
Abstract
In the Brazilian Amazon, snakebites are a significant problem, especially for populations in rural areas, particularly in forests, where victims are a considerable distance from hospital care. Several factors are associated with the severity of the accident, such as the size and age of the snake. This study aims to compare the clinical, epidemiological and laboratory aspects of envenomation to the size of Bothrops atrox snakes. Clinical, epidemiological and laboratory variables were collected from patients bitten by B. atrox and who were admitted to a hospital in the city of Cruzeiro do Sul (western Brazilian Amazon). When the two punctures of the teeth were present in the bite sign, the distance between these was measured. When taken to the hospital, the snake was measured; otherwise, its size was estimated via interviews with patients. In 92 cases, the size of the snake was estimated, and most of these were caused by small snakes. Bites of small snakes occur mainly on the feet, while larger specimens reach the legs or higher regions. Small snakes were associated primarily with mild and moderate snakebites, with more presence of hemorrhagic manifestations, while larger snakes were responsible for severe cases and characterized by local effects (necrosis, edema, flictena, compartment syndrome, and infection) and patients were treated with a higher amount of antivenom and for a longer period of hospitalization. The distance of the punctures was related to the size of the snake and the severity of the local envenomation. The observation of the distance between puncture marks when present, which is correlated with the length of the specimen, as well as the estimation of the snake size by the patient, may provide more support for the health professional on the prognosis of envenomation. The use of boots in activities in rural areas and forests could contribute to a lower rate of cases of snakebites, and health education on preventive measures and first aid for populations is fundamental.
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Affiliation(s)
- Tamires Nascimento da Costa
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, AC, Brazil; Universidade Federal do Acre, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde na Amazônia Ocidental, Rio Branco, AC, Brazil
| | - Ageane Mota-da-Silva
- Instituto Federal do Acre, Campus de Cruzeiro do Sul, Cruzeiro do Sul. 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; Universidade Federal do Acre, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde na Amazônia Ocidental, Rio Branco, AC, Brazil.
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Monteiro WM, Contreras-Bernal JC, Bisneto PF, Sachett J, Mendonça da Silva I, Lacerda M, Guimarães da Costa A, Val F, Brasileiro L, Sartim MA, Silva-de-Oliveira S, Bernarde PS, Kaefer IL, Grazziotin FG, Wen FH, Moura-da-Silva AM. Bothrops atrox, the most important snake involved in human envenomings in the amazon: How venomics contributes to the knowledge of snake biology and clinical toxinology. Toxicon X 2020; 6:100037. [PMID: 32550592 PMCID: PMC7285970 DOI: 10.1016/j.toxcx.2020.100037] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 01/22/2023] Open
Abstract
Bothrops atrox snakes are mostly endemic of the Amazon rainforest and is certainly the South American pit viper responsible for most of the snakebites in the region. The composition of B. atrox venom is significantly known and has been used to trace the relevance of the venom phenotype for snake biology and for the impacts in the clinics of human patients involved in accidents by B. atrox. However, in spite of the wide distribution and the great medical relevance of B. atrox snakes, B. atrox taxonomy is not fully resolved and the impacts of the lack of taxonomic resolution on the studies focused on venom or envenoming are currently unknown. B. atrox venom presents different degrees of compositional variability and is generally coagulotoxic, inducing systemic hematological disturbances and local tissue damage in snakebite patients. Antivenoms are the effective therapy for attenuating the clinical signs. This review brings a comprehensive discussion of the literature concerning B. atrox snakes encompassing from snake taxonomy, diet and venom composition, towards clinical aspects of snakebite patients and efficacy of the antivenoms. This discussion is highly supported by the contributions that venomics and antivenomics added for the advancement of knowledge of B. atrox snakes, their venoms and the treatment of accidents they evoke.
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Affiliation(s)
- Wuelton Marcelo Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Jorge Carlos Contreras-Bernal
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Pedro Ferreira Bisneto
- Programa de Pós-Graduação em Zoologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Brazil
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil
| | - Iran Mendonça da Silva
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Marcus Lacerda
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas & Maria Deane, Manaus, Brazil
| | - Allyson Guimarães da Costa
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação em Zoologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Hematologia e Hemoterapia do Amazonas, Manaus, Brazil
| | - Fernando Val
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Lisele Brasileiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Marco Aurélio Sartim
- Programa de Pós-Graduação em Zoologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Brazil
| | - Sâmella Silva-de-Oliveira
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Paulo Sérgio Bernarde
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, AC, Brazil
| | - Igor L. Kaefer
- Programa de Pós-Graduação em Zoologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Brazil
| | | | | | - Ana Maria Moura-da-Silva
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Butantan, São Paulo, Brazil
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29
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Sachett JDAG, Val FF, Alcântara JA, Cubas-Vega N, Montenegro CS, da Silva IM, de Souza TG, Santana MF, Ferreira LCL, Monteiro WM. Bothrops atrox Snakebite: How a Bad Decision May Lead to a Chronic Disability: A Case Report. Wilderness Environ Med 2020; 31:317-323. [PMID: 32456876 DOI: 10.1016/j.wem.2020.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
Snakebites are a neglected and underestimated global health hazard. In the Brazilian Amazon, Bothrops snakebites are the most prevalent and may lead to severe complications. Here we describe a severe case of Bothrops atrox snakebite that, owing to delayed medical assistance, presented with renal and respiratory failure, compartment syndrome, and tissue necrosis. After several fasciotomy surgeries, the patient survived; however, he showed significant functional disability. Prompt management of snake envenomation would aid in the early diagnosis of local and systemic complications and, consequently, would result in a better functional outcome with improved quality of life.
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Affiliation(s)
| | - Fernando F Val
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - João A Alcântara
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Nadia Cubas-Vega
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | - Iran M da Silva
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | - Monique F Santana
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Luiz C L Ferreira
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil; Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
| | - Wuelton M Monteiro
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
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30
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Souza JB, Cardoso R, Almeida-Souza HO, Carvalho CP, Correia LIV, Faria PCB, Araujo GR, Mendes MM, Rodrigues RS, Rodrigues VM, Dandekar AM, Goulart LR, Nascimento R. Generation and In-planta expression of a recombinant single chain antibody with broad neutralization activity on Bothrops pauloensis snake venom. Int J Biol Macromol 2020; 149:1241-1251. [PMID: 32035152 DOI: 10.1016/j.ijbiomac.2020.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/26/2022]
Abstract
The main systemic alterations present in bothropic envenomation are hemostasis disorders, for which the conventional treatment is based on animal-produced antiophidic sera. We have developed a neutralizing antibody against Bothrops pauloensis (B. pauloensis) venom, which is member of the genus most predominant in snakebite accidents in Brazil. Subsequently, we expressed this antibody in plants to evaluate its enzymatic and biological activities. The ability of single-chain variable fragment (scFv) molecules to inhibit fibrinogenolytic, azocaseinolytic, coagulant and hemorrhagic actions of snake venom metalloproteinases (SVMPs) contained in B. pauloensis venom was verified through proteolytic assays. The antibody neutralized the toxic effects of envenomation, particularly those related to systemic processes, by interacting with one of the predominant classes of metalloproteinases. This novel molecule is a potential tool with great antivenom potential and provides a biotechnological antidote to snake venom due to its broad neutralizing activity.
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Affiliation(s)
- Jessica B Souza
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil.
| | - Rone Cardoso
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Hebréia O Almeida-Souza
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Camila P Carvalho
- Department of Plant Pathology, University of Sao Paulo, Av. Padua Dias 11, 13418-310 Piracicaba, SP, Brazil
| | - Lucas Ian Veloso Correia
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Paula Cristina B Faria
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Galber R Araujo
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Mirian M Mendes
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Renata Santos Rodrigues
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Veridiana M Rodrigues
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
| | - Abhaya M Dandekar
- Plant Sciences Department, University of California, Davis, 1 Shields Ave, Davis, CA 95616, USA
| | - Luiz Ricardo Goulart
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil.
| | - Rafael Nascimento
- Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas, Bloco 2E, Campus Umuarama, 38400-902 Uberlandia, MG, Brazil
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31
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Resiere D, Monteiro W, Houcke S, Pujo JM, Mathien C, Mayence C, Neviere R, Hommel D, de Almeida Gonçalves Sachett J, Mehdaoui H, Gutiérrez JM, Kallel H. Bothrops Snakebite Envenomings in the Amazon Region. CURRENT TROPICAL MEDICINE REPORTS 2020. [DOI: 10.1007/s40475-020-00203-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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32
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Bernal JCC, Bisneto PF, Pereira JPT, Ibiapina HNDS, Sarraff LKS, Monteiro-Júnior C, da Silva Pereira H, Santos B, de Moura VM, de Oliveira SS, Lacerda M, Sampaio V, Kaefer IL, Gutiérrez JM, Bernarde PS, Fan HW, Sachett J, da Silva AMM, Monteiro WM. " Bad things come in small packages": predicting venom-induced coagulopathy in Bothrops atrox bites using snake ontogenetic parameters. Clin Toxicol (Phila) 2019; 58:388-396. [PMID: 31387401 DOI: 10.1080/15563650.2019.1648817] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Snake venom composition shows significant inter- and intra-species variation. In the case of the viperid species Bothrops atrox, responsible for the majority of snakebites in the Amazon region, geographical and ontogenetic variables affect venom composition, with ecological and medical implications. Previous studies had shown that venom from neonate and juvenile Bothrops specimens have a higher in vitro coagulant activity. The aim of this investigation was to assess the association of clinical outcomes, such as venom-induced coagulopathy and local complications, with B. atrox ontogenetic variables.Methods: This study explored the relationship between some clinical parameters in patients suffering envenomations by B. atrox in the Amazon and several morphometric parameters of the snake specimens causing the bites.Results: There were 248 specimens confirmed as agents of envenomation, mostly female snakes (70.5%) and classified as juveniles (62.7%). Patients bitten by neonates compared to adult snakes [OR = 2.70 (95%CI 1.15-6.37); p = .021] and by snakes with white tail tip [OR = 1.98 (95%CI 1.15-3.41); p = .013] were more likely to develop coagulopathy. Time from patient admission to the unclottable blood reversion was not affected by the snake gender (p = .214) or age (p = .254). Patients bitten by neonate (p = .024) or juvenile snakes (p < .0001) presented a lower frequency of moderate to severe edema, as compared to those bitten by adult snakes. In agreement with experimental observations, patients bitten by neonates and by snakes with a white tail tip were more likely to develop coagulopathy than those bitten by adult snakes. In contrast, envenomations by adult snakes were associated with a higher incidence of severe local edema.Conclusion: Despite these variations, no difference was observed in the time needed to recover blood clotting in these patients after Bothrops antivenom administration.
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Affiliation(s)
- Jorge Carlos Contreras Bernal
- Escola Superior de Ciências da Saúde, Universidade Do Estado Do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - João Pedro Tavares Pereira
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Hiochelson Najibe Dos Santos Ibiapina
- Escola Superior de Ciências da Saúde, Universidade Do Estado Do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Lybia Kássia Santos Sarraff
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Cláudio Monteiro-Júnior
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Handerson da Silva Pereira
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Bruno Santos
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Valeria Mourão de Moura
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Instituto de Saúde Coletiva, Universidade Federal Do Oeste Do Pará, Santarém, Brazil
| | - Sâmella Silva de Oliveira
- Escola Superior de Ciências da Saúde, Universidade Do Estado Do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Marcus Lacerda
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Instituto Leônidas & Maria Deane, Manaus, Brazil
| | - Vanderson Sampaio
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Sala de Situação em Saúde, Fundação de Vigilância em Saúde Do Amazonas, Manaus, Brazil
| | - Igor Luis Kaefer
- Programa de Pós-Graduação em Zoologia, Universidade Federal Do Amazonas, Manaus, Brazil
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Paulo Sérgio Bernarde
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal Do Acre, Cruzeiro Do Sul, AC, Brazil.,Instituto Federal Do Acre, Campus de Cruzeiro Do Sul, Cruzeiro Do Sul, Acre, Brazil
| | - Hui Wen Fan
- Núcleo Estratégico de Venenos e Antivenenos, Instituto Butantan, São Paulo, Brazil
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade Do Estado Do Amazonas, Manaus, Brazil.,Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil
| | | | - Wuelton Marcelo Monteiro
- Escola Superior de Ciências da Saúde, Universidade Do Estado Do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
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33
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Silva de Oliveira S, Campos Alves E, Dos Santos Santos A, Freitas Nascimento E, Tavares Pereira JP, Mendonça da Silva I, Sachett J, Dos Santos Ibiapina HN, Santos Sarraf LK, Contreras Bernal JC, Freitas de Sousa LA, Colombini M, Oliveira Marques H, Guimarães de Lacerda MV, Moura-da-Silva AM, Wen Fan H, de Lima Ferreira LC, Sigueko Sano Martins I, Monteiro WM. Bothrops snakebites in the Amazon: recovery from hemostatic disorders after Brazilian antivenom therapy. Clin Toxicol (Phila) 2019; 58:266-274. [PMID: 31264481 DOI: 10.1080/15563650.2019.1634273] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Bothrops atrox snakebites are a major public health problem in the Amazon region and also cause hemostatic disorders. In this study, we assessed the recovery from hemostatic disorders in Bothrops snakebite patients after being given antivenom therapy.Methods: This is a prospective study of Bothrops snakebite patients (n = 100) treated at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazilian Amazon, between January 2016 and December 2017. Blood samples were taken for the measurement of venom concentrations, platelets, clotting time and factors of patients on admission, 12, 24 and 48 h after antivenom therapy, and taken again on discharge. The presence of systemic bleeding was recorded during the follow-up.Results: On admission, systemic bleeding was observed in 14% of the patients. Thrombocytopenia was noted in 10% of the patients. A total of 54% of the patients presented unclottable blood with low levels of fibrinogen and alpha 2-antiplasmin, and high levels of fibrin/fibrinogen degradation product (FDP) and D-dimers. Unclottable blood and systemic bleeding were overcome in most patients 12 h after the antivenom therapy. Three patients developed systemic bleeding 48 h after antivenom therapy. Levels of fibrinogen and alpha 2-antiplasmin, FDP and D-dimer returned to normal around 48 h after the treatment or on discharge. The frequency of thrombocytopenia with high mean platelet volume increased in the first 24 h after antivenom therapy, and decreased on discharge. Bothrops venom levels in patients decreased 12 h after antivenom therapy and were not correlated with coagulation and fibrinolytic parameters. There were no deaths.Conclusion: Laboratorial parameters of coagulopathy returned to normal values within 48 h after the antivenom therapy until discharge. A few patients still presented bleeding signs within 48 h after beginning antivenom therapy. However, the Brazilian antivenom was able to overcome the hemostatic disorders in these cases of envenomation.
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Affiliation(s)
- Sâmella Silva de Oliveira
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.,College of Health Sciences, University of the State of Amazonas, Manaus, Brazil
| | - Eliane Campos Alves
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.,College of Health Sciences, University of the State of Amazonas, Manaus, Brazil
| | - Alessandra Dos Santos Santos
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil
| | - Elizandra Freitas Nascimento
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil
| | - João Pedro Tavares Pereira
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil
| | - Iran Mendonça da Silva
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.,College of Health Sciences, University of the State of Amazonas, Manaus, Brazil
| | - Jacqueline Sachett
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.,College of Health Sciences, University of the State of Amazonas, Manaus, Brazil
| | - Hiochelson Najibe Dos Santos Ibiapina
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.,College of Health Sciences, University of the State of Amazonas, Manaus, Brazil
| | - Lybia Kássia Santos Sarraf
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil
| | - Jorge Carlos Contreras Bernal
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.,College of Health Sciences, University of the State of Amazonas, Manaus, Brazil
| | | | - Mônica Colombini
- Immunopathology Laboratory, Butantan Institute, São Paulo, Brazil
| | | | | | | | - Hui Wen Fan
- Bioindustrial Division, Butantan Institute, São Paulo, Brazil
| | - Luiz Carlos de Lima Ferreira
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil
| | | | - Wuelton Marcelo Monteiro
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.,College of Health Sciences, University of the State of Amazonas, Manaus, Brazil
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