Immunization against Echis ocellatus (carpet viper) venom using liposomes incorporating immunostimulants: role of lipopolysaccharide in conferring protection in a mouse model

Innovative Immunization Strategies for Antivenom Development

Snakes, scorpions, and spiders are venomous animals that pose a threat to human health, and severe envenomings from the bites or stings of these animals must be treated with antivenom. Current antivenoms are based on plasma-derived immunoglobulins or immunoglobulin fragments from hyper-immunized animals. Although these medicines have been life-saving for more than 120 years, opportunities to improve envenoming therapy exist. In the later decades, new biotechnological tools have been applied with the aim of improving the efficacy, safety, and affordability of antivenoms. Within the avenues explored, novel immunization strategies using synthetic peptide epitopes, recombinant toxins (or toxoids), or DNA strings as immunogens have demonstrated potential for generating antivenoms with high therapeutic antibody titers and broad neutralizing capacity. Furthermore, these approaches circumvent the need for venom in the production process of antivenoms, thereby limiting some of the complications associated with animal captivity and venom collection. Finally, an important benefit of innovative immunization approaches is that they are often compatible with existing antivenom manufacturing setups. In this review, we compile all reported studies examining venom-independent innovative immunization strategies for antivenom development. In addition, a brief description of toxin families of medical relevance found in snake, scorpion, and spider venoms is presented, as well as how biochemical, bioinformatic, and omics tools could aid the development of next-generation antivenoms.

The impact of a low dose, low volume, multi-site immunization on the production of therapeutic antivenoms in Thailand

Therapeutic antivenom against snakes was first produced by Albert Calmette in 1894. Since then antivenoms have saved the life of countless snakebite victims. However, there are still many problems associated with antivenom production, for example variable percentage of responder horses, low neutralizing potency of antivenom, the large amount of snake venom needed for immunization and the difficulties encountered in producing potent polyvalent antivenoms. These problems have led to shortage and high cost of antivenom and, in some cases, failure of treatment. In 1997, a new immunization protocol for antivenom production was reported. It involves the injection of venom at low dose (approx. 2mg/horse) emulsified in Complete Freund's adjuvant in low volume (0.1-0.2 ml/site) in a total of 10 sites around the neck area of the horse. This immunization protocol has minimized the local reaction at the injection site thus allowing the use of the potent oil adjuvant. This, together with the increase in total surface area of the droplets, allow a more effective immune response to take place, e.g. enhancing the migration and activation of more antigen presenting cells and lymphocytes. The low dose, low volume multi-site immunization has resulted in dramatic improvements on the antivenom production in terms of amount of venom used for immunization, the time required to reach hyperimmune stage, the percent of responder horses and the potency of the antivenom. Furthermore, this protocol has made it possible to produce potent truly polyvalent antivenoms against several elapid and viperid snakes. This immunization protocol has alleviated various problems associated with antivenom production and has implications for immunization in general.

Tests for detection of snake venoms, toxins and venom antibodies: review on recent trends (1987-1997)

Various methods developed for the detection of snake venoms, toxins and venom antibodies, during the last decade is reviewed. Radioimmunoassay, agglutination assay, enzyme-linked immunosorbent assay (ELISA), fluorescence immunoassay etc. have been used for detection of venoms and toxins. Important contributions have been made to improve the specificity, sensitivity, rapidity and simplicity of the ELISA method. Monoclonal antibodies and affinity-purified venom-specific antibodies were used to achieve species specificity of ELISA and the latter seems to be the ideal for venom detection. Incorporation of avidin-biotin system as well as the fluorogenic substrate in the enzyme immunoassay sufficiently increased the sensitivity of the assay to detect venom concentrations to picogram levels. The ability to use undiluted blood and other whole biological fluids reduce the assay time considerably. Although there have been several reports were on venom detection, so far only a few field kits have been developed. This implies that the experiments and design were only at the laboratory levels and still more work has to be carried out before it could be used in the field. Concerning the venom antibody detection, ELISA has been used extensively and the humoral response of patients envenomed by snake has been investigated in detail. Non-specific reactivity along with cross-reactivity still limits the use of ELISA for species identification in epidemiological studies. Overall, ELISA remains the suitable method for the detection of snake venoms, toxins and venom antibodies in body fluids. The possible use of a biosensor approach to solve some of the problems associated with the ELISA method are also discussed.

Venoms, antivenoms and immunotherapy

A century after the discovery of antivenom and despite real progress undertaken in its manufacture, its use remains largely empirical. Recent studies of pharmacokinetics of envenoming permitted improved understanding of immunotherapy. Improved purification of the antivenom by using immunoglobulin fragments has lead to increased tolerance and efficiency of antivenom. The respective advantages and disadvantages of F(ab')2 and F(ab) are discussed in relation to neutralising efficacy and clearance from the circulation. Although the time during which the action of antivenom remains beneficial after the bite is unknown, the superiority of intravenous administration has now been proved. Although immunisation procedures and purification and use of IgG fragments can be improved using modern technology, the future of immunotherapy seems promising. It is vital that therapeutic protocols should be rigidly adhered to in order to optimise immunotherapy. The use of vaccination has yet to be explored.

Encapsulation of native crotoxin in liposomes: a safe approach for the production of antivenom and vaccination against Crotalus durissus terrificus venom

Crotoxin, the neurotoxic component of Crotalus durissus terrificus (Cdt) venom that displays phospholipase A2 activity, was successfully encapsulated into dehydration-rehydration vesicles (DRV/crotoxin) and reverse-phase evaporation vesicles (REV/crotoxin) made from sphingomyelin and cholesterol. The encapsulation efficiency of native crotoxin was higher in DRV/crotoxin than in REV/crotoxin. DRV/crotoxin was not toxic when i.v. inoculated in mice at a dose of crotoxin as high as 91 times its L.D50 or when s.c. inoculated at 42 times its LD50. On the other hand, crotoxin released from DRV/crotoxin retained its original toxicity. REV/crotoxin was found to be at least 1.9 times more toxic than DRV/crotoxin. The fact that DRV/crotoxin retained crotoxin more efficiently than REV/crotoxin may account for the difference in acute toxicity between the two preparations. DRV/crotoxin, when s.c. inoculated in mice, induced anti-crotoxin antibodies that protected animals against the lethal effect of Cdt venom. Following immunization with three doses of DRV/crotoxin (3 x 20 micrograms of crotoxin/mouse) and challenge with 8 x LD50 of Cdt venom, 75% of mice were protected. The DRV/crotoxin preparation was compared to crotoxin emulsified in Freund's adjuvant (FCA/crotoxin). DRV/crotoxin was found to be less toxic than FCA/crotoxin, and to induce lower levels of anti-crotoxin antibodies but similar levels of protection when inoculated at high doses (20 or 70 micrograms crotoxin/mouse). When DRV/crotoxin was adsorbed to alum at the time of immunization, it induced antibody and protection levels comparable to those produced by FCA/crotoxin.