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Coimbra FCP, Sanchez EE, Lomonte B, Gutiérrez JM, Calvete JJ, Fry BG. Blood Lines: Intraspecific and Interspecific Variations in Anticoagulant Actions of Agkistrodon Viperid Venoms. Toxins (Basel) 2024; 16:291. [PMID: 39057931 PMCID: PMC11281148 DOI: 10.3390/toxins16070291] [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: 05/28/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
This study investigated the intraspecific and interspecific variability in the venom effects of Agkistrodon viperid snake species and subspecies (eleven venoms total) on plasma clotting times, fibrinogen levels, and fibrin clot strength. Significant delays in plasma clotting time were observed for A. conanti, A. contortrix mokasen, A. contortrix phaeogaster, A. howardgloydi, A. piscivorus leucostoma, and A. piscivorus piscivorus. Notably, the phylogenetically disjunct lineages A. conanti, A. contortrix mokasen, and A. howardgloydi exhibited the most potent anticoagulant effects, indicating the independent amplification of a basal trait. Inhibition assays with the activated clotting enzymes Factors XIa, IXa, Xa, and IIa (thrombin) revealed that FXa inhibition is another basal trait amplified independently on multiple occasions within the genus, but with A. howardgloydi, notably more potent than all others. Phospholipid degradation and zymogen destruction were identified as mechanisms underlying the variability in venom effects observed experimentally and in previous clinical reports. Thromboelastography demonstrated that the venoms did not clot fibrinogen directly but affected fibrin clot strength by damaging fibrinogen and that thrombin was subsequently only able to cleave into weak, unstable clots. The ability to activate Protein C, an endogenous anticoagulant enzyme, varied across species, with some venoms exceeding that of A. contortrix contortrix, which previously yielded the protein diagnostic agent Protac®. Phylogenetic analysis suggested that both fibrinogen degradation and Protein C activation were each amplified multiple times within the genus, albeit with negative correlation between these two modes of action. This study highlights the evolutionary, clinical, and biodiscovery implications of venom variability in the Agkistrodon species, underscoring their dynamic evolution, emphasising the need for tailored clinical approaches, and highlighting the potential for novel diagnostic and therapeutic developments inspired by the unique properties of snake venoms.
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Affiliation(s)
- Francisco C. P. Coimbra
- Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia, QLD 4072, Australia;
| | - Elda E. Sanchez
- National Natural Toxins Research Center, Department of Chemistry, Texas A&M University-Kingsville, MSC 224, 975 West Avenue B, Kingsville, TX 78363, USA;
| | - Bruno Lomonte
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José 11501, Costa Rica; (B.L.); (J.M.G.)
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José 11501, Costa Rica; (B.L.); (J.M.G.)
| | - Juan J. Calvete
- Laboratorio de Venómica Evolutiva y Traslacional, Instituto de Biomedicina de Valencia, CSIC, 46010 Valencia, Spain;
| | - Bryan G. Fry
- Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia, QLD 4072, Australia;
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Basse J, Ruha AM, Baumgartner K, Mullins ME, Greene S, Wax PM, Brent J, Campleman S, Schwarz ES. Clinical Presentations, Treatments, and Outcomes of Non-native Snake Envenomations in the United States Reported in the North American Snakebite Registry. J Med Toxicol 2023; 19:16-25. [PMID: 36175787 DOI: 10.1007/s13181-022-00912-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Non-native snake envenomations in the United States are uncommon with much unknown about a patient's presenting signs and symptoms. Antivenoms for non-native snake envenomations are not typically available in hospital pharmacies which may limit their administration. What are the clinical presentations, treatments, and outcomes of non-native snake envenomation cases reported to the North American Snakebite Registry (NASBR) of the Toxicology Investigators Consortium (ToxIC)? METHODS This is a descriptive review of all non-native envenomations reported to the NASBR from 2013 to March 2022. Data abstracted included snake species, patient history, clinical signs, diagnostics, treatment (including antivenom usage), follow-up, and final outcome. RESULTS We identified 19 non-native snake envenomations resulting from encounters with eleven different species, eight of which belonged to the Viperidae family. The most common presenting symptoms were edema (18 patients), ecchymosis (seven patients), and necrosis (six patients). Systemic effects and hematologic abnormalities were less common. The most common treatments were extremity elevation and analgesia, with two patients receiving mechanical ventilation. Ten patients received antivenom. No patients died. Three patients had loss of mobility in a digit at the last follow-up visit. One patient had permanent tissue loss of a small area on a finger. CONCLUSIONS The results of this study suggest that non-native snake envenomations in the United States frequently cause local soft tissue effects and less frequently cause systemic or hematologic effects. Most patients received antivenom, although several patients envenomated by snakes for which a specific antivenom exists did not receive any. Sequelae at the last follow-up of such encounters consisted of local mobility deficits.
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Affiliation(s)
- Jack Basse
- Washington University School of Medicine, 660 S. Euclid Ave, Campus, Box 8072, St. Louis, MO, 63110, USA
| | - Anne-Michelle Ruha
- Banner University Medical Center Phoenix, 1012 E Willetta ST, Phoenix, AZ, Fl285006, USA
| | - Kevin Baumgartner
- Washington University School of Medicine, 660 S. Euclid Ave, Campus, Box 8072, St. Louis, MO, 63110, USA
| | - Michael E Mullins
- Washington University School of Medicine, 660 S. Euclid Ave, Campus, Box 8072, St. Louis, MO, 63110, USA
| | - Spencer Greene
- University of Houston College of Medicine, Kingwood, TX, 22999 US Hwy 59N773394, USA
| | - Paul M Wax
- American College of Medical Toxicology, 10645 N. Tatum Blvd, Suite 200-111, Phoenix, AZ, 85028, USA
| | - Jeffrey Brent
- School of Medicine, University of Colorado, 12401 East 17th Avenue, 7th floor, Aurora, CO, 80045, USA
| | - Sharan Campleman
- American College of Medical Toxicology, 10645 N. Tatum Blvd, Suite 200-111, Phoenix, AZ, 85028, USA
| | - Evan S Schwarz
- Washington University School of Medicine, 660 S. Euclid Ave, Campus, Box 8072, St. Louis, MO, 63110, USA.
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Wilson BZ, Larsen J, Smelski G, Dudley S, Shirazi FM. Use of Crotalidae equine immune F(ab') 2 antivenom for treatment of an Agkistrodon envenomation. Clin Toxicol (Phila) 2021; 59:1023-1026. [PMID: 33703984 DOI: 10.1080/15563650.2021.1892718] [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: 10/22/2022]
Abstract
INTRODUCTION Anavip (F(ab')2AV) is a lyophilized F(ab')2 immunoglobulin fragment derived from horses immunized with venom from Bothrops asper and Crotalus durissus. It was approved by the FDA in 2015 for treatment of North American rattlesnake envenomation but not for Agkistrodon envenomation. Published data regarding the efficacy and safety of Anavip in treating Agkistrodon envenomations is limited. We present a case of a patient treated with Anavip after confirmed Agkistrodon laticinctus envenomation. CASE DETAILS A 77 year-old man was bitten on his fifth finger by a captive A. laticinctus. He was taken to a local emergency department where he received a 10 vial initial dose of F(ab')2AV for pain and swelling and was transferred. At the receiving facility, his pain had improved and his swelling had not progressed. Over the next 30 h, his platelets declined to 132,000/mm3 and he received an additional 4 vials of F(ab')2AV. The remainder of his course was unremarkable with complete recovery by 3 months. DISCUSSION This case provides an additional published datapoint on the use of this F(ab')2AV in the treatment of envenomation by Agkistrodon.
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Affiliation(s)
- B Z Wilson
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Arizona Poison and Drug Information Center, University of Arizona, Tucson, AZ, USA
| | - J Larsen
- Arizona Poison and Drug Information Center, University of Arizona, Tucson, AZ, USA
| | - G Smelski
- Arizona Poison and Drug Information Center, University of Arizona, Tucson, AZ, USA
| | - S Dudley
- Arizona Poison and Drug Information Center, University of Arizona, Tucson, AZ, USA
| | - F M Shirazi
- Arizona Poison and Drug Information Center, University of Arizona, Tucson, AZ, USA
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Greene SC, Folt J, Wyatt K, Brandehoff NP. Epidemiology of fatal snakebites in the United States 1989-2018. Am J Emerg Med 2020; 45:309-316. [PMID: 33046301 DOI: 10.1016/j.ajem.2020.08.083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND There are 5000-10,000 snake envenomations annually in the United States. Fortunately, few are fatal. In this study we review the epidemiology of fatal snakebites. METHODS Native snakebite cases from the American Association of Poison Control Centers (AAPCC) National Poison Data System from 1989 to 2018 were reviewed. Additional cases that were not reported to the AAPCC were identified by reviewing Wikipedia and by searching PubMed and online news outlets using various combinations of relevant keywords. RESULTS We identified 101 fatal bites from native snakes. Rattlesnakes accounted for 74 (90.2%) of the 82 deaths for which the species was known or which occurred where rattlesnakes are the only native crotalids. There were five fatalities attributed to copperheads, two due to cottonmouths, and one caused by an eastern coral snake. Males were disproportionately affected. The median age for victims was 40 years old. In cases for which data were available, many of the snake interactions were intentional, e.g. religious services, animal husbandry, and attempting to kill the snake. CONCLUSIONS Death following envenomation from a native U.S. snake is unlikely, particularly if medical attention is sought promptly. Rattlesnake envenomations are more likely to be fatal than bites from other species. Intentionally engaging with a venomous snake raises the risk of incurring a fatal bite, as does concurrent alcohol or drug use. Age less than 12 years old does not appear to be a risk factor for a fatal outcome, while elderly patients may have a slightly increased risk of death.
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Affiliation(s)
- Spencer C Greene
- Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, 3525 Southern Blvd, Dayton, OH 45429, United States of America; Bayou City Medical Toxicology & Emergency Medicine Consultants, 6711 Stella Link Rd. #313, Houston, TX 77005, United States of America.
| | - Jason Folt
- Department of Emergency Medicine, Henry Ford Health System, 2799 West Grand Boulevard, CFP-258, Detroit, MI 48202, United States of America
| | - Kimberly Wyatt
- Department of Biological Sciences, University of Cincinnati, 614 Rieveschl Hall, Cincinnati, OH 45221-0006, United States of America
| | - Nicklaus P Brandehoff
- Rocky Mountain Poison and Drug Center, 1391 Speer Blvd #600, Denver, CO 80204, United States of America; Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, Aurora, CO 80045, United States of America
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Huancahuire-Vega S, Hollanda LM, Gomes-Heleno M, Newball-Noriega EE, Marangoni S. ACP-TX-I and ACP-TX-II, Two Novel Phospholipases A 2 Isolated from Trans-Pecos Copperhead Agkistrodon contortrix pictigaster Venom: Biochemical and Functional Characterization. Toxins (Basel) 2019; 11:toxins11110661. [PMID: 31739403 PMCID: PMC6891687 DOI: 10.3390/toxins11110661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/30/2019] [Accepted: 11/06/2019] [Indexed: 01/18/2023] Open
Abstract
This work reports the purification and biochemical and functional characterization of ACP-TX-I and ACP-TX-II, two phospholipases A2 (PLA2) from Agkistrodon contortrix pictigaster venom. Both PLA2s were highly purified by a single chromatographic step on a C18 reverse phase HPLC column. Various peptide sequences from these two toxins showed similarity to those of other PLA2 toxins from viperid snake venoms. ACP-TX-I belongs to the catalytically inactive K49 PLA2 class, while ACP-TX-II is a D49 PLA2, and is enzymatically active. ACP-TX-I PLA2 is monomeric, which results in markedly diminished myotoxic and inflammatory activities when compared with dimeric K49 PLA2s, confirming the hypothesis that dimeric structure contributes heavily to the profound myotoxicity of the most active viperid K49 PLA2s. ACP-TX-II exhibits the main pharmacological actions reported for this protein family, including in vivo local myotoxicity, edema-forming activity, and in vitro cytotoxicity. ACP-TX-I PLA2 is cytotoxic to A549 lung carcinoma cells, indicating that cytotoxicity to these tumor cells does not require enzymatic activity.
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Affiliation(s)
- Salomón Huancahuire-Vega
- Departamento de Ciencias Básicas, Facultad de Ciencias de la Salud, Escuela de Medicina Humana, Universidad Peruana Unión (UPeU), Lima 15, Peru;
- Correspondence: ; Tel.: +51-9-9757-4011
| | - Luciana M. Hollanda
- Instituto de Tecnologia e Pesquisa, Universidade Tiradentes (UNIT), Aracaju 49032-490, SE, Brazil;
| | - Mauricio Gomes-Heleno
- Departamento de Bioquímica, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, SP, Brazil; (M.G.-H.); (S.M.)
| | - Edda E. Newball-Noriega
- Departamento de Ciencias Básicas, Facultad de Ciencias de la Salud, Escuela de Medicina Humana, Universidad Peruana Unión (UPeU), Lima 15, Peru;
| | - Sergio Marangoni
- Departamento de Bioquímica, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, SP, Brazil; (M.G.-H.); (S.M.)
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