1
|
Nyarko E, Ameho EK, Iddi S, Asiedu L. Challenges associated with the availability, accessibility, and use of antivenoms for treating snakebite envenoming in Ghana: A MaxDiff experiment design. Toxicon 2024; 238:107594. [PMID: 38191031 DOI: 10.1016/j.toxicon.2023.107594] [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: 11/08/2023] [Revised: 12/20/2023] [Accepted: 12/30/2023] [Indexed: 01/10/2024]
Abstract
Successful snakebite envenoming (SBE) treatment requires safe, effective, and quality-assured antivenom products specifically tailored to combat endemic venomous snake species. This study aims to identify the challenges associated with the availability, accessibility, and use of antivenoms for treating SBE. The data for this study were obtained from a cross-sectional study involving healthcare workers from two districts (namely Afram Plains North and Afram Plains South) in the Eastern Region of Ghana. Through the MaxDiff design methodology, we quantify the challenges associated with the availability, accessibility, and use of antivenoms. Responses from a simple random sample of 203 healthcare workers were included in this study. Participants identified the high cost of antivenoms as the most challenging factor that limits the availability, accessibility, and use of antivenoms for treating SBE. Other important challenges were the lack of access to effective antivenoms in remote areas when needed and the increased use of unorthodox and harmful practices, followed by resort to unorthodox and harmful practices and the lack of effective antivenoms to address envenoming from local species in some instances. However, poor outcomes from using substandard antivenoms, stock-outs, inadequate number of manufacturers, and the resort to substandard, cheap, and harmful antivenoms were traded off. Also, poor utilization of antivenoms, suboptimal utilization of antivenoms (low quality, under-dose), use of ineffective, substandard antivenoms, and flooding of the market with products that have not been evaluated thoroughly were underscored. Our findings provide essential data to guide discussions on barriers to the availability, accessibility, and use of antivenoms for treating SBE to improve the supply of antivenoms, enhance the effectiveness of snakebite treatment, and improve patient care quality in Ghana. Multi-component strategies are needed to address the challenges identified, such as intensified advocacy, ongoing education and community engagement, healthcare worker training, and leveraging institutional and governance structures.
Collapse
Affiliation(s)
- Eric Nyarko
- Department of Statistics and Actuarial Science, School of Physical and Mathematical Sciences, University of Ghana, Box LG 115, Legon, Accra, Ghana.
| | - Ebenezer Kwesi Ameho
- Department of Statistics and Actuarial Science, School of Physical and Mathematical Sciences, University of Ghana, Box LG 115, Legon, Accra, Ghana
| | - Samuel Iddi
- Department of Statistics and Actuarial Science, School of Physical and Mathematical Sciences, University of Ghana, Box LG 115, Legon, Accra, Ghana
| | - Louis Asiedu
- Department of Statistics and Actuarial Science, School of Physical and Mathematical Sciences, University of Ghana, Box LG 115, Legon, Accra, Ghana
| |
Collapse
|
2
|
Findlay-Wilson S, Easterbrook L, Smith S, Pope N, Aldridge M, Humphries G, Schuhmann H, Ngabo D, Rayner E, Otter A, Coleman T, Hicks B, Halkerston R, Apostolakis K, Taylor S, Fotheringham S, Horton A, CanoCejas I, Wand M, Tree JA, Sutton M, Graham V, Hewson R, Dowall S. Refinement of an ovine-based immunoglobulin therapy against SARS-CoV-2, with comparison of whole IgG versus F(ab') 2 fragments. Sci Rep 2023; 13:13912. [PMID: 37626085 PMCID: PMC10457378 DOI: 10.1038/s41598-023-40277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
The development of new therapies against SARS-CoV-2 is required to extend the toolkit of intervention strategies to combat the global pandemic. In this study, hyperimmune plasma from sheep immunised with whole spike SARS-CoV-2 recombinant protein has been used to generate candidate products. In addition to purified IgG, we have refined candidate therapies by removing non-specific IgG via affinity binding along with fragmentation to eliminate the Fc region to create F(ab')2 fragments. These preparations were evaluated for in vitro activity and demonstrated to be strongly neutralising against a range of SARS-CoV-2 strains, including Omicron B2.2. In addition, their protection against disease manifestations and viral loads were assessed using a hamster SARS-CoV-2 infection model. Results demonstrated protective effects of both IgG and F(ab')2, with the latter requiring sequential dosing to maintain in vivo activity due to rapid clearance from the circulation.
Collapse
Affiliation(s)
| | - Linda Easterbrook
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Sandra Smith
- International Therapeutic Proteins Ltd, Longford, TAS, 7301, Australia
| | - Neville Pope
- International Therapeutic Proteins Ltd, Goleigh Farm, Selborne, GU34 3SE, Hampshire, UK
| | | | - Gareth Humphries
- Native Antigen Company, Langford Locks, Kidlington, Oxford, OX5 1LH, UK
| | - Holger Schuhmann
- Native Antigen Company, Langford Locks, Kidlington, Oxford, OX5 1LH, UK
| | - Didier Ngabo
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Emma Rayner
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Ashley Otter
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Thomas Coleman
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Bethany Hicks
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Rachel Halkerston
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Kostis Apostolakis
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Stephen Taylor
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Susan Fotheringham
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Amanda Horton
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Irene CanoCejas
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Matthew Wand
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Julia A Tree
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Mark Sutton
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Victoria Graham
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Roger Hewson
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Stuart Dowall
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK.
| |
Collapse
|
3
|
Romo E, Torres M, Martin-Solano S. Current situation of snakebites envenomation in the Neotropics: Biotechnology, a versatile tool in the production of antivenoms. BIONATURA 2022. [DOI: 10.21931/rb/2022.07.04.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Snakebite envenomation is a neglected tropical disease that affects millions of people around the world with a great impact on health and the economy. Unfortunately, public health programs do not include this kind of disease as a priority in their social programs. Cases of snakebite envenomations in the Neotropics are inaccurate due to inadequate disease management from medical records to the choice of treatments. Victims of snakebite envenomation are primarily found in impoverished agricultural areas where remote conditions limit the availability of antivenom. Antivenom serum is the only Food and Drug Administration-approved treatment used up to date. However, it has several disadvantages in terms of safety and effectiveness. This review provides a comprehensive insight dealing with the current epidemiological status of snakebites in the Neotropics and technologies employed in antivenom production. Also, modern biotechnological tools such as transcriptomic, proteomic, immunogenic, high-density peptide microarray and epitope mapping are highlighted for producing new-generation antivenom sera. These results allow us to propose strategic solutions in the Public Health Sector for managing this disease.
Keywords: antivenom, biotechnology, neglected tropical disease, omics, recombinant antibody.
Collapse
Affiliation(s)
- Elizabeth Romo
- Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Sangolquí, Ecuador
| | - Marbel Torres
- Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Sangolquí, Ecuador, Grupo de Investigación en Sanidad Animal y Humana (GISAH), Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Immunology and Virology Laboratory, Nanoscience and Nanotechnology Center, Universidad de las Fuerzas Armadas, ESPE, Sangolquí, Ecuador
| | - Sarah Martin-Solano
- Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Sangolquí, Ecuador, Grupo de Investigación en Sanidad Animal y Humana (GISAH), Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Grupo de Investigación en Biodiversidad, Zoonosis y Salud Pública, Universidad Central del Ecuador
| |
Collapse
|