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Passos JGR, Gomes JAS, Xavier-Santos JB, Yamashita FO, Cavalcanti-Cruz JV, Siqueira EMS, Garcia VB, Zucolotto SM, de Araujo-Junior RF, Ferreira LS, Silva-Junior AA, Félix-Silva J, Fernandes-Pedrosa MF. Anti-inflammatory, healing and antiophidic potential of Jatropha mollissima (Pohl) Baill. (Euphorbiaceae): From popular use to pharmaceutical formulation in gel. Biomed Pharmacother 2024; 173:116290. [PMID: 38458010 DOI: 10.1016/j.biopha.2024.116290] [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: 11/30/2023] [Revised: 02/05/2024] [Accepted: 02/17/2024] [Indexed: 03/10/2024] Open
Abstract
Jatropha mollissima (Pohl) Baill. (Euphorbiaceae) is widely used in traditional medicine to treat inflammatory disorders. So, a topical gel containing the hydroethanolic extract of its leaves was developed and evaluated for its anti-inflammatory, wound healing, and antiophidic properties in mice. First, the chemical profile of different parts of the plant was characterized by liquid chromatography coupled to mass spectrometry (LC-MS) using molecular networking. In the leaf extract, 11 compounds were characterized, with a particular emphasis on the identification of flavonoids. The gel efficiently inhibited carrageenan-induced paw edema, as well as acute and chronic croton oil-induced ear edema models, thereby reducing inflammatory and oxidative parameters in inflamed tissues. Besides anti-inflammatory activity, the herbal gel showed significant wound healing activity. The edematogenic, hemorrhagic and dermonecrotic activities induced by Bothrops jararaca snake venom were effectively inhibited by the treatment with J. mollissima gel. The association with the herbal gel improved in up to 90% the efficacy of commercial snake antivenom in reduce venom-induced edema. Additionally, while antivenom was not able to inhibit venom-induced dermonecrosis, treatment with herbal gel reduced in 55% the dermonocrotic halo produced. These results demonstrate the pharmacological potential of the herbal gel containing J. mollissima extract, which could be a strong candidate for the development of herbal products that can be used to complement the current antivenom therapy against snake venom local toxicity.
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Affiliation(s)
- Júlia G R Passos
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Jacyra A S Gomes
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Jacinthia B Xavier-Santos
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Fabiana O Yamashita
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Joelly V Cavalcanti-Cruz
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Emerson M S Siqueira
- Laboratory of Pharmacognosy (PNBio), Department of Pharmacy, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Vinícius Barreto Garcia
- Cancer and Inflammatory Research Laboratory, Department of Morphology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal 59078-970, Brazil.
| | - Silvana M Zucolotto
- Laboratory of Pharmacognosy (PNBio), Department of Pharmacy, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Raimundo Fernandes de Araujo-Junior
- Cancer and Inflammatory Research Laboratory, Department of Morphology, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal 59078-970, Brazil.
| | - Leandro S Ferreira
- Laboratory of Quality Control, Department of Pharmacy, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Arnóbio A Silva-Junior
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Juliana Félix-Silva
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil; Laboratory of Clinical Haematology, Faculty of Pharmacy, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Brazil.
| | - Matheus F Fernandes-Pedrosa
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), Faculty of Pharmacy, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
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Rodrigues PSDM, Cirqueira Martins H, Falcão MS, Trevisan M, Portaro FCV, da Silva LG, Sano-Martins IS, Gonçalves LRDC, Seibert CS. Effects of Mauritia flexuosa L. f. buriti oil on symptoms induced by Bothrops moojeni snake envenomation. JOURNAL OF ETHNOPHARMACOLOGY 2023; 313:116612. [PMID: 37156448 DOI: 10.1016/j.jep.2023.116612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In Brazil, there are species of snakes that become involved in accidents and cause serious health problems to the inhabitants, highlighting the genus Bothrops for being responsible for approximately 90% of accidents reported annually. In the northern region of the country, this genus is responsible for the largest number of accidents, especially among rural dwellers. These populations invest in alternative treatments for with the purpose of improving the symptoms caused by snakebites. The species Mauritia flexuosa L. f., known as buriti, is traditionally used for the treatment of envenomation by snakes. AIM OF THE STUDY This study aimed to evaluate the antiophidic potential of the oil of Mauritia flexuosa L. f. for Bothrops moojeni H. venom, confronting cultural and scientific knowledge. MATERIALS AND METHODS The physicochemical properties were determined, and the components present in the oil, extracted from fruit pulp, were analyzed by Gas Chromatography Coupled with Mass Spectrometry. The in vitro inhibitory capacity of the oil for phospholipase, metalloprotease and serine protease activities was investigated. In the in vivo studies, male Swiss mice were used to evaluate the effect of oil on lethality and toxicity, and hemorrhagic, myotoxic and edematogenic activities were assessed. RESULTS GC‒MS analysis identification of 90.95% of the constituents of the oil, with the main components being 9-eicosenoic acid, (Z)- (34.54%), n-hexadecanoic acid (25.55%) and (E)-9-octadecenoic acid ethyl ester (12.43%). For the substrates, the outcomes indicate that the oil inhibited the activity of the main classes of toxins present in Bothrops moojeni H. venom (VBm) at the highest dose tested (0.5 μL), with inhibition of 84% for the hydrolysis of the selective substrate for serine protease and inhibition of 60% for the hydrolysis of substrates for PLA2 and metalloproteases. The antiophidic activity in vivo was evaluated with two concentrations of the oil: 1.5 mg, the dosage the population, diluted in mineral oil to a volume of 1 tablespoon and 15 mg, administered by gavage 30 min before poisoning and at time zero (concomitant to poisoning), and both concentrations administered by gavage in combination with topical use at time zero. The bleeding time in the group treated with oil at a concentration of 15 mg administered at time zero was significantly lower than that in the control group (p < 0.05). However, a greater inhibition of bleeding time was observed when local application was combined with the gavage treatment at both concentrations tested at time zero (p < 0.05). In the myotoxicity test, oil was efficient in reducing the myotoxic effects induced by the venom at the two concentrations tested, with gavage administration at time zero and gavage plus topical administration at time zero (p < 0.05). CONCLUSIONS The data obtained show that the oil is safe to use at the concentrations studied and contains fatty acids that may collaborate for cellular-level repair of the injuries caused by Bm poisoning. The in vitro and in vivo experiments showed that oil inhibits the main proteolytic enzymes present in the venom and that it has important activities to control the local effects caused by bothropic venom.
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Affiliation(s)
| | - Hemilly Cirqueira Martins
- Postgraduate Program in Environmental Sciences, PPGCiamb, Federal University of Tocantins, Palmas, TO, Brazil.
| | - Milena Santos Falcão
- Postgraduate Program in Environmental Sciences, PPGCiamb, Federal University of Tocantins, Palmas, TO, Brazil.
| | - Márcio Trevisan
- Postgraduate Program in Environmental Sciences, PPGCiamb, Federal University of Tocantins, Palmas, TO, Brazil.
| | | | - Lais Gomes da Silva
- Laboratory of Immunochemistry, Butantan Institute, Av. Vital Brazil, 1500, São Paulo, SP, Brazil.
| | - Ida Sigueko Sano-Martins
- Laboratory of Pathophysiology, Butantan Institute, Av. Vital Brazil, 1500, São Paulo, SP, Brazil.
| | | | - Carla Simone Seibert
- Postgraduate Program in Environmental Sciences, PPGCiamb, Federal University of Tocantins, Palmas, TO, Brazil.
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Tsai TS, Tsai IH. Full sequencing and comparison of five venom metalloproteases of Trimeresurus gracilis: The PI-enzyme is most similar to okinalysin but the PIII-enzyme is most similar to Crotalus venom enzymes. Toxicon 2023; 225:107053. [PMID: 36758773 DOI: 10.1016/j.toxicon.2023.107053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
The cDNAs encoding the Zn+2-metalloproteases (SVMPs) of Trimeresurus gracilis (abbreviated as Tgc), a pitviper endemic to Taiwan, were cloned from venom glands and sequenced. The amino-acid sequences of five novel SVMPs, including one P-III, three P-II and one P-I class enzymes, were thus deduced and subjected to BLAST-analyses. The P-III enzyme (designated as Tgc-PIII) is structurally most similar to the PIII-SVMPs of New World pitvipers but not similar to the PIII-SVMP of Ovophis okinavensis. Sequence-similarity analysis of 22 homologous PIII-SVMPs reveal three major structural subtypes of the pitviper PIII-SVMPs, which possibly have different substrate specificities. In addition, Tgc-PIII and the PI-class SVMP (named Tgc-MP) were isolated from the venom and verified by mass spectrometry. All the three deduced sequences of PII-SVMPs (Tgc-PIIs) contain an abnormal Zn+2-binding-site in their catalytic-domain, and an identical "long-disintegrin" domain. The predicted 85-residues disintegrin, gracilisin, bears high similarities to some long-disintegrins of the New-World pitvipers and salmosin3. By BLAST search and comparison, Tgc-MP is 96% similar to okinalysin, the hemorrhagic PI-SVMP of O. okinavensis, rather than any other PI-SVMPs in the databanks. Our results confirm the fast evolution of Tgc-SVMPs as well as their structural similarities to different SVMP-classes of the New-World pitvipers and of O. okinavensis, respectively. The implications of our findings are discussed along with our previous sequence comparisons of venom phospholipases A2 and ten venom serine proteases of Tgc.
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Affiliation(s)
- Tein-Shun Tsai
- Department of Biological Science and Technology, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Inn-Ho Tsai
- Institute of Biological Chemistry, Academia Sinica, Taipei, Taiwan; Institute of Biochemical Sciences, National Taiwan University, Taipei, Taiwan.
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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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The secretory phenotypes of envenomed cells: Insights into venom cytotoxicity. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2023; 133:193-230. [PMID: 36707202 DOI: 10.1016/bs.apcsb.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Snake envenomation is listed as Category A Neglected Tropical Diseases (NTD) by World Health Organization, indicates a severe public health problem. The global figures for envenomation cases are estimated to be more than 1.8 million annually. Even if the affected victims survive the envenomation, they might suffer from permanent morbidity due to local envenomation. One of the most prominent local envenomation is dermonecrosis. Dermonecrosis is a pathophysiological outcome of envenomation that often causes disability in the victims due to surgical amputations, deformities, contracture, and chronic ulceration. The key venom toxins associated with this local symptom are mainly attributed to substantial levels of enzymatic and non-enzymatic toxins as well as their possible synergistic actions. Despite so, the severity of the local tissue damage is based on macroscopic observation of the bite areas. Furthermore, limited knowledge is known about the key biomarkers involved in the pathogenesis of dermonecrosis. The current immunotherapy with antivenom is also ineffective against dermonecrosis. These local effects eventually end up as sequelae. There is also a global shortage of toxins-targeted therapeutics attributed to inadequate knowledge of the actual molecular mechanisms of cytotoxicity. This chapter discusses the characterization of secretory phenotypes of dermonecrosis as an advanced tool to indicate its severity and pathogenesis in envenomation. Altogether, the secretory phenotypes of envenomed cells and tissues represent the precise characteristics of dermonecrosis caused by venom toxins.
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Zane L, Kraschowetz S, Trentini MM, Alves VDS, Araujo SC, Goulart C, Leite LCDC, Gonçalves VM. Peptide linker increased the stability of pneumococcal fusion protein vaccine candidate. Front Bioeng Biotechnol 2023; 11:1108300. [PMID: 36777254 PMCID: PMC9909212 DOI: 10.3389/fbioe.2023.1108300] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
Streptococcus pneumoniae is a bacterial pathogen exclusive to humans, responsible for respiratory and systemic diseases. Pneumococcal protein vaccines have been proposed as serotype-independent alternatives to currently used conjugated polysaccharide vaccines, which have presented limitations regarding their coverage. Previously in our group, pneumococcal surface protein A (PspA) and detoxified pneumolysin (PdT) were genetically fused and the hybrid protein protected mice against pneumococcal challenge, offered higher cross-protection against different strains and showed greater opsonophagocytosis rate than co-administered proteins. As juxtaposed fusion was unstable to upscale production of the protein, flexible (PspA-FL-PdT) and rigid (PspA-RL-PdT) molecular linkers were inserted between the antigens to increase stability. This work aimed to produce recombinant fusion proteins, evaluate their stability after linker insertion, both in silico and experimentally, and enable the production of two antigens in a single process. The two constructs with linkers were cloned into Escherichia coli and hybrid proteins were purified using chromatography; purity was evaluated by SDS-PAGE and stability by Western blot and high performance size exclusion chromatography. PspA-FL-PdT showed higher stability at -20°C and 4°C, without additional preservatives. In silico analyses also showed differences regarding stability of the fusion proteins, with molecule without linker presenting disallowed amino acid positions in Ramachandran plot and PspA-FL-PdT showing the best scores, in agreement with experimental results. Mice were immunized with three doses and different amounts of each protein. Both fusion proteins protected all groups of mice against intranasal lethal challenge. The results show the importance of hybrid protein structure on the stability of the products, which is essential for a successful bioprocess development.
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Affiliation(s)
- Luciano Zane
- Laboratory of Vaccine Development, Butantan Institute, Sao Paulo, Brazil,Interunits Graduate Program in Biotechnology, University of Sao Paulo, Sao Paulo, Brazil
| | - Stefanie Kraschowetz
- Laboratory of Vaccine Development, Butantan Institute, Sao Paulo, Brazil,Interunits Graduate Program in Biotechnology, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Vitor dos Santos Alves
- Laboratory of Vaccine Development, Butantan Institute, Sao Paulo, Brazil,Interunits Graduate Program in Biotechnology, University of Sao Paulo, Sao Paulo, Brazil
| | - Sergio Carneiro Araujo
- Laboratory of Vaccine Development, Butantan Institute, Sao Paulo, Brazil,Interunits Graduate Program in Biotechnology, University of Sao Paulo, Sao Paulo, Brazil
| | - Cibelly Goulart
- Laboratory of Vaccine Development, Butantan Institute, Sao Paulo, Brazil,Interunits Graduate Program in Biotechnology, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Viviane Maimoni Gonçalves
- Laboratory of Vaccine Development, Butantan Institute, Sao Paulo, Brazil,*Correspondence: Viviane Maimoni Gonçalves,
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Chiang LC, Chien KY, Su HY, Chen YC, Mao YC, Wu WG. Comparison of Protein Variation in Protobothrops mucrosquamatus Venom between Northern and Southeast Taiwan and Association with Human Envenoming Effects. Toxins (Basel) 2022; 14:toxins14090643. [PMID: 36136582 PMCID: PMC9501293 DOI: 10.3390/toxins14090643] [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: 07/12/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 12/03/2022] Open
Abstract
Reports of bite from Protobothrops mucrosquamatus (Pmu) are frequent in Taiwan, and its wide-spread distribution and diverse habitats drove us to investigate its envenoming effects and relevant venom variations. We used reversed-phase high-performance liquid chromatography and mass spectrometry to analyze 163 Pmu venom samples collected from northern and southeastern Taiwan. Twenty-two major protein fractions were separated and analyzed, and their contents were determined semi-quantitatively. The results showed that despite the trivial differences in the protein family, there is an existing variation in acidic phospholipases A2s, serine proteinases, metalloproteinases, C-type lectin-like proteins, and other less abundant components in the Pmu venoms. Moreover, clinical manifestations of 209 Pmu envenomed patients hospitalized in northern or southeastern Taiwan revealed significant differences in local symptoms, such as ecchymosis and blistering. The mechanism of these local effects and possibly relevant venom components were examined. Further analysis showed that certain venom components with inter-population variation might work alone or synergistically with others to aggravate the local effects. Therefore, our findings of the venom variation may help one to improve antivenom production and better understand and manage Pmu bites.
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Affiliation(s)
- Liao-Chun Chiang
- College of Life Sciences, National Tsing Hua University, Hsinchu City 300, Taiwan
| | - Kun-Yi Chien
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan County 333, Taiwan
- Clinical Proteomics Core Laboratory, Chang Gung Memorial Hospital, Taoyuan County 333, Taiwan
- Department of Biochemistry and Molecular Biology, College of Medicine, Chang Gung University, Taoyuan County 333, Taiwan
| | - Hung-Yuan Su
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung County 824, Taiwan
- The School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung County 840, Taiwan
- Department of Safety, Health and Environmental Engineering, National Kaohsiung University of Science and Technology, Kaohsiung County 811, Taiwan
| | - Yen-Chia Chen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei City 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City 112, Taiwan
- Department of Emergency Medicine, National Defense Medical Center, Taipei City 114, Taiwan
| | - Yan-Chiao Mao
- Department of Emergency Medicine, National Defense Medical Center, Taipei City 114, Taiwan
- Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung City 407, Taiwan
- College of Medicine, National Chung Hsing University, Taichung City 402, Taiwan
- Correspondence: (Y.-C.M.); (W.-G.W.)
| | - Wen-Guey Wu
- College of Life Sciences, National Tsing Hua University, Hsinchu City 300, Taiwan
- Correspondence: (Y.-C.M.); (W.-G.W.)
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Khelfi A, Oussedik-Oumehdi H, Laraba-Djebari F. Therapeutic Outcome of Anti-inflammatory and Antioxidative Medicines on the Dermonecrotic Activity of Cerastes cerastes Venom. Inflammation 2022; 45:1700-1719. [DOI: 10.1007/s10753-022-01654-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/01/2022]
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Bernarde PS, Pucca MB, Mota-da-Silva A, da Fonseca WL, de Almeida MRN, de Oliveira IS, Cerni FA, Gobbi Grazziotin F, Sartim MA, Sachett J, Wen FH, Moura-da-Silva AM, Monteiro WM. Bothrops bilineatus: An Arboreal Pitviper in the Amazon and Atlantic Forest. Front Immunol 2021; 12:778302. [PMID: 34975866 PMCID: PMC8714932 DOI: 10.3389/fimmu.2021.778302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
The two-striped forest-pitviper (Bothrops bilineatus) is an arboreal snake that is currently represented by two subspecies (B. b. bilineatus and B. b. smaragdinus) that comprise a species complex, and its distribution is in the Amazon and the Atlantic Forest. The rarity of encounters with this snake is reflected in the low occurrence of cases of snakebites throughout its geographic distribution and the resulting low number of published clinical reports. However, in some areas, B. bilineatus proves to be more frequent and causes envenomations in a greater proportion. Herein, we review the main aspects of the species complex B. bilineatus, including its biology, ecology, taxonomy, morphology, genetic and molecular studies, geographic distribution, conservation status, venom, pathophysiology and clinical aspects, and epidemiology. In addition, the different antivenoms available for the treatment of envenomations caused by B. bilineatus are presented along with suggestions for future studies that are needed for a better understanding of the snakebites caused by this snake.
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Affiliation(s)
- Paulo Sérgio Bernarde
- Laboratório de Herpetologia, Universidade Federal do Acre, Cruzeiro do Sul, Brazil
- *Correspondence: Paulo Sérgio Bernarde, ; Wuelton M. Monteiro,
| | - Manuela Berto Pucca
- Curso de Medicina, Universidade Federal de Roraima, Boa Vista, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Roraima, Boa Vista, Brazil
| | | | | | | | - Isadora Sousa de Oliveira
- Departamento de Ciências Biomoleculares, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Felipe Augusto Cerni
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Roraima, Boa Vista, Brazil
| | | | - Marco A. Sartim
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Brazil
- Departamento de Pós-Graduação, Universidade Nilton Lins, Manaus, Brazil
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Departamento de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil
| | - Fan Hui Wen
- Núcleo Estratégico de Venenos e Antivenenos, Instituto Butantan, São Paulo, Brazil
| | - Ana Maria Moura-da-Silva
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo, Brazil
| | - Wuelton M. Monteiro
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- *Correspondence: Paulo Sérgio Bernarde, ; Wuelton M. Monteiro,
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Individual Variability in Bothropsatrox Snakes Collected from Different Habitats in the Brazilian Amazon: New Findings on Venom Composition and Functionality. Toxins (Basel) 2021; 13:toxins13110814. [PMID: 34822598 PMCID: PMC8618853 DOI: 10.3390/toxins13110814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023] Open
Abstract
Differences in snake venom composition occur across all taxonomic levels and it has been argued that this variation represents an adaptation that has evolved to facilitate the capture and digestion of prey and evasion of predators. Bothrops atrox is a terrestrial pitviper that is distributed across the Amazon region, where it occupies different habitats. Using statistical analyses and functional assays that incorporate individual variation, we analyzed the individual venom variability in B. atrox snakes from four different habitats (forest, pasture, degraded area, and floodplain) in and around the Amazon River in Brazil. We observed venom differentiation between spatially distinct B. atrox individuals from the different habitats, with venom variation due to both common (high abundance) and rare (low abundance) proteins. Moreover, differences in the composition of the venoms resulted in individual variability in functionality and heterogeneity in the lethality to mammals and birds, particularly among the floodplain snakes. Taken together, the data obtained from individual venoms of B. atrox snakes, captured in different habitats from the Brazilian Amazon, support the hypothesis that the differential distribution of protein isoforms results in functional distinctiveness and the ability of snakes with different venoms to have variable toxic effects on different prey.
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Yong MY, Tan KY, Tan CH. Potential para-specific and geographical utility of Thai Green Pit Viper (Trimeresurus albolabris) Monovalent Antivenom: Neutralization of procoagulant and hemorrhagic activities of diverse Trimeresurus pit viper venoms. Toxicon 2021; 203:85-92. [PMID: 34600909 DOI: 10.1016/j.toxicon.2021.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/01/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
The Trimeresurus complex consists of diverse medically important venomous pit vipers that cause snakebite envenomation. Antivenoms, however, are in limited supply, and are specific to only two out of the many species across Asia. This study thus investigated the immunoreactivities of regional pit viper antivenoms toward selected Trimeresurus pit viper venoms, and examined the neutralization of their hemotoxic activities. Trimeresurus albolabris Monovalent Antivenom (TaMAV, Thailand) exhibited a higher immunoreactivity than Hemato Bivalent Antivenom (HBAV, raised against Trimeresurus stejnegeri and Protobothrops mucrosquamatus, Taiwan) and Gloydius brevicaudus Monovalent Antivenom (GbMAV, China), attributed to its monovalent nature and conserved antigens in the Trimeresurus pit viper venoms. The venoms showed moderate-to-strong in vitro procoagulant and in vivo hemorrhagic effects consistent with hemotoxic envenomation, except for the Sri Lankan Trimeresurus trigonocephalus venom which lacked hemorrhagic activity. TaMAV was able to differentially neutralize both in vitro and in vivo hemotoxic effects of the venoms, with the lowest efficacy shown against the procoagulant effect of T. trigonocephalus venom. The findings suggest that TaMAV is a potentially useful treatment for envenomation caused by hetero-specific Trimeresurus pit vipers, in particular those in Southeast Asia and East Asia. Clinical study is warranted to establish its spectrum of para-specific effectiveness, and dosages need be tailored to the different species in respective regions.
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Affiliation(s)
- Mun Yee Yong
- Venom Research and Toxicology Laboratory, Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kae Yi Tan
- Protein and Interactomics Laboratory, Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Choo Hock Tan
- Venom Research and Toxicology Laboratory, Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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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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Bhat SK, Joshi MB, Vasishta S, Jagadale RN, Biligiri SG, Coronado MA, Arni RK, Satyamoorthy K. P-I metalloproteinases and L-amino acid oxidases from Bothrops species inhibit angiogenesis. J Venom Anim Toxins Incl Trop Dis 2021; 27:e20200180. [PMID: 34471403 PMCID: PMC8381740 DOI: 10.1590/1678-9199-jvatitd-2020-0180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/08/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Snake venoms are composed of pharmacologically active proteins that are evolutionarily diverse, stable and specific to targets. Hence, venoms have been explored as a source of bioactive molecules in treating numerous diseases. Recent evidences suggest that snake venom proteins may affect the formation of new blood vessels. Excessive angiogenesis has been implicated in several pathologies including tumours, diabetic retinopathy, arthritis, inter alia. In the present study, we have examined the effects of P-I metalloproteinases isolated from Bothrops moojeni (BmMP-1) and Bothrops atrox (BaMP-1) and L-amino acid oxidases (LAAO) isolated from B. moojeni (BmLAAO) and B. atrox (BaLAAO) on biochemical and functional aspects of angiogenesis. METHODS P-I metalloproteinases and LAAO were purified from venom by molecular size exclusion and ion-exchange chromatography and subsequently confirmed using mass spectrometry. The P-I metalloproteinases were characterized by azocaseinolytic, fibrinogenolytic and gelatinase activity and LAAO activity was assessed by enzyme activity on L-amino acids. Influence of these proteins on apoptosis and cell cycle in endothelial cells was analysed by flow cytometry. The angiogenic activity was determined by in vitro 3D spheroid assay, Matrigel tube forming assay, and in vivo agarose plug transformation in mice. RESULTS P-I metalloproteinases exhibited azocaseinolytic activity, cleaved α and partially β chain of fibrinogen, and displayed catalytic activity on gelatin. LAAO showed differential activity on L-amino acids. Flow cytometry analysis indicated that both P-I metalloproteinases and LAAO arrested the cells in G0/G1 phase and further induced both necrosis and apoptosis in endothelial cells. In vitro, P-I metalloproteinases and LAAO exhibited significant anti-angiogenic properties in 3D spheroid and Matrigel models by reducing sprout outgrowth and tube formation. Using agarose plug transplants in mice harbouring P-I metalloproteinases and LAAO we demonstrated a marked disruption of vasculature at the periphery. CONCLUSION Our research suggests that P-I metalloproteinases and LAAO exhibit anti-angiogenic properties in vitro and in vivo.
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Affiliation(s)
- Shreesha K. Bhat
- Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Manjunath B. Joshi
- Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Sampara Vasishta
- Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, India
| | | | | | - Monika A. Coronado
- Multiuser Center for Biomolecular Innovation, Department of Physics, São Paulo State University (UNESP), São José do Rio Preto, SP, Brazil
| | - Raghuvir K. Arni
- Multiuser Center for Biomolecular Innovation, Department of Physics, São Paulo State University (UNESP), São José do Rio Preto, SP, Brazil
| | - Kapaettu Satyamoorthy
- Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, India
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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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Castro AC, Escalante T, Rucavado A, Gutiérrez JM. Basement membrane degradation and inflammation play a role in the pulmonary hemorrhage induced by a P-III snake venom metalloproteinase. Toxicon 2021; 197:12-23. [PMID: 33872676 DOI: 10.1016/j.toxicon.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
Snakebite envenoming is a neglected tropical disease affecting millions of people every year, especially in vulnerable rural populations in the developing world. Viperid snakes cause envenomings characterized by a complex pathophysiology which includes local and systemic hemorrhage due to the action of snake venom metalloproteinases (SVMPs). The pathogenesis of SVMP-induced systemic hemorrhage has not been investigated in detail. This study explored the pulmonary hemorrhage induced in a murine model by a P-III SVMP from the venom of Crotalus simus. Histological analysis revealed extravasation in the lungs as early as 15 min after intravenous injection of the toxin, and hemorrhage increased at 360 min. Western blot analysis demonstrated the cleavage of basement membrane (BM) proteins in lung homogenates and in bronchoalveolar lavage fluid, implying an enzymatic disruption of this extracellular matrix structure at the capillary-alveolar barrier. Likewise, alveolar edema was observed, with an increment in protein concentration in the bronchoalveolar lavage fluid, and a neutrophil-rich inflammatory infiltrate was present in the parenchyma of the lungs as part of the inflammatory reaction. Pretreatment of mice with indomethacin, pentoxifylline and an anti-neutrophil antibody resulted in a significant decrease in pulmonary hemorrhage at 360 min. These findings suggest that this P-III SVMP induces acute lung injury through the direct action of this enzyme in the capillary-alveolar barrier integrity, as revealed by BM degradation, and as a consequence of the inflammatory reaction that develops in lung tissue. Our findings provide novel clues to understand the mechanism of action of hemorrhagic SVMPs in the lungs.
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Affiliation(s)
- Ana Cristina Castro
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, 11501, Costa Rica
| | - Teresa Escalante
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, 11501, Costa Rica
| | - Alexandra Rucavado
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, 11501, Costa Rica
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, 11501, Costa Rica.
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Patiño RSP, Salazar-Valenzuela D, Medina-Villamizar E, Mendes B, Proaño-Bolaños C, da Silva SL, Almeida JR. Bothrops atrox from Ecuadorian Amazon: Initial analyses of venoms from individuals. Toxicon 2021; 193:63-72. [PMID: 33503404 DOI: 10.1016/j.toxicon.2021.01.007] [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: 10/26/2020] [Revised: 12/26/2020] [Accepted: 01/20/2021] [Indexed: 12/18/2022]
Abstract
Bothrops atrox is the most clinically relevant snake species within the Amazon region, which includes Ecuadorian territories. It comprises a large distribution, which could contribute to the genetic and venomic variation identified in the species. The high variability and protein isoform diversity of its venom are of medical interest, since it can influence the clinical manifestations caused by envenomation and its treatment. However, in Ecuador there is insufficient information on the diversity of venomic phenotypes, even of relevant species such as B. atrox. Here, we characterized the biochemical and toxicological profiles of the venom of six B. atrox individuals from the Ecuadorian Amazon. Differences in catalytic activities of toxins, elution profiles in liquid chromatography, electrophoretic patterns, and toxic effects among the analyzed samples were identified. Nonetheless, in the preclinical testing of antivenom, two samples from Mera (Pastaza) required a higher dose to achieve total neutralization of lethality and hemorrhage. Taken together, these data highlight the importance of analyzing individual venoms in studies focused on the outcomes of envenoming.
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Affiliation(s)
- Ricardo S P Patiño
- Biomolecules Discovery Group, Universidad Regional Amazónica Ikiam, Km 7 Via Muyuna, Tena, Napo, Ecuador; Escuela Superior Politécnica del Litoral (ESPOL), Centro Nacional de Acuicultura e Investigaciones Marinas (CENAIM), Guayaquil, Ecuador
| | - David Salazar-Valenzuela
- Centro de Investigación de la Biodiversidad y Cambio Climático (BioCamb) e Ingeniería en Biodiversidad y Recursos Genéticos, Facultad de Ciencias de Medio Ambiente, Universidad Tecnológica Indoamérica, Quito, Ecuador
| | - Evencio Medina-Villamizar
- Biomolecules Discovery Group, Universidad Regional Amazónica Ikiam, Km 7 Via Muyuna, Tena, Napo, Ecuador
| | - Bruno Mendes
- Departamento de Biologia Animal, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carolina Proaño-Bolaños
- Biomolecules Discovery Group, Universidad Regional Amazónica Ikiam, Km 7 Via Muyuna, Tena, Napo, Ecuador
| | - Saulo L da Silva
- Escuela de Bioquímica y Farmacia, Facultad de Ciencias Químicas, Universidad de Cuenca, Cuenca, Azuay, Ecuador; Centro de Innovación de la Salud - EUS/EP, Cuenca, Azuay, Ecuador; Chemistry and Biochemistry Department, Faculty of Sciences, University of Porto, Porto, Portugal; LAQV - REQUIMTE, University of Porto, Porto, Portugal
| | - José R Almeida
- Biomolecules Discovery Group, Universidad Regional Amazónica Ikiam, Km 7 Via Muyuna, Tena, Napo, Ecuador.
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Clinical Features and Management of Snakebite Envenoming in French Guiana. Toxins (Basel) 2020; 12:toxins12100662. [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] [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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Evaluation of the anti-snakebite, antimicrobial and antioxidant potential of Philodendron megalophyllum Schott (Araceae), traditionally used in accidents caused by snakes in the western region of Pará, Brazil. Toxicon 2020; 184:99-108. [DOI: 10.1016/j.toxicon.2020.05.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/16/2020] [Accepted: 05/27/2020] [Indexed: 11/24/2022]
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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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Mamede CCN, de Sousa Simamoto BB, da Cunha Pereira DF, de Oliveira Costa J, Ribeiro MSM, de Oliveira F. Edema, hyperalgesia and myonecrosis induced by Brazilian bothropic venoms: overview of the last decade. Toxicon 2020; 187:10-18. [PMID: 32846146 DOI: 10.1016/j.toxicon.2020.08.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/15/2020] [Accepted: 08/19/2020] [Indexed: 01/19/2023]
Abstract
Snakebite accidents are considered serious public health problems. They are often neglected, and individuals who have received insufficient treatment are subjected to various disabling alterations. Snake venoms are secretions composed of biologically active molecules capable of triggering local and systemic effects in envenomation victims. Bothropic snakes are responsible for most of the ophidian accidents in Brazil; their venoms are mainly related to local manifestations, due to a composition that is especially rich in proteases and phospholipases A2. The most common local damages are inflammation, with consequent cellular activation and release of inflammatory mediators, hemorrhage, edema, pain and (myo)necrosis, which may lead to amputation of the affected areas. Antivenom therapy is the main treatment for snakebites. However, the efficiency is mainly due to the neutralization of the toxins responsible for the systemic alterations. Thus, the local damages can evolve to markedly compromise the tissue. The complexity of these local effects associated with the toxicity of the snake venom components of the genus Bothrops, arouse interest in the study of the biochemical and pathophysiological mechanisms involved with the actions caused by toxins of the venom. Therefore, this review aims to analyze the edematogenic, hyperalgesic and myotoxic effects caused by Brazilian bothropic venoms in order to contribute to the study and elucidation of the mechanisms of action of its components and, consequently, enable discoveries of more effective combined therapies in the treatment of local damages resulting from envenoming.
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Affiliation(s)
| | | | | | - Júnia de Oliveira Costa
- Instituto Federal de Educação, Ciência e Tecnologia do Triângulo Mineiro (IFTM), Ituiutaba, MG, Brazil
| | | | - Fabio de Oliveira
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia (UFU), Uberlândia, MG, Brazil
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Sousa LF, Bernardoni JL, Zdenek CN, Dobson J, Coimbra F, Gillett A, Lopes-Ferreira M, Moura-da-Silva AM, Fry BG. Differential coagulotoxicity of metalloprotease isoforms from Bothrops neuwiedi snake venom and consequent variations in antivenom efficacy. Toxicol Lett 2020; 333:211-221. [PMID: 32841740 DOI: 10.1016/j.toxlet.2020.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/14/2022]
Abstract
Bothrops (lance-head pit vipers) venoms are rich in weaponised metalloprotease enzymes (SVMP). These toxic enzymes are structurally diverse and functionally versatile. Potent coagulotoxicity is particularly important for prey capture (via stroke-induction) and relevant to human clinical cases (due to consumption of clotting factors including the critical depletion of fibrinogen). In this study, three distinct isoforms of P-III class SVMPs (IC, IIB and IIC), isolated from Bothrops neuwiedi venom, were evaluated for their differential capacities to affect hemostasis of prey and human plasma. Furthermore, we tested the relative antivenom neutralisation of effects upon human plasma. The toxic enzymes displayed differential procoagulant potency between plasma types, and clinically relevant antivenom efficacy variations were observed. Of particular importance was the confirmation the antivenom performed better against prothrombin activating toxins than Factor X activating toxins, which is likely due to the greater prevalence of the former in the immunising venoms used for antivenom production. This is clinically relevant as the enzymes displayed differential potency in this regard, with one (IC) in particular being extremely potent in activating Factor X and thus was correspondingly poorly neutralised. This study broadens the current understanding about the adaptive role of the SVMPs, as well as highlights how the functional diversity of SVMP isoforms can influence clinical outcomes. Key Contribution: Our findings shed light upon the hemorrhagic and coagulotoxic effects of three SVMPs of the P-III class, as well as the coagulotoxic effects of SVMPs on human, avian and amphibian plasmas. Antivenom neutralised prothrombin-activating isoforms better than Factor X activating isoforms.
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Affiliation(s)
- Leijiane F Sousa
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo, SP, Brazil; Toxin Evolution Lab, School of Biological Sciences, University of Queensland, Santa Lucia, QLD 4072, Australia
| | | | - Christina N Zdenek
- Toxin Evolution Lab, School of Biological Sciences, University of Queensland, Santa Lucia, QLD 4072, Australia
| | - James Dobson
- Toxin Evolution Lab, School of Biological Sciences, University of Queensland, Santa Lucia, QLD 4072, Australia
| | - Francisco Coimbra
- Toxin Evolution Lab, School of Biological Sciences, University of Queensland, Santa Lucia, QLD 4072, Australia
| | - Amber Gillett
- Fauna Vet Wildlife Veterinary Consultancy, Beerwah, QLD, Australia
| | - Mônica Lopes-Ferreira
- Immunoregulation Unit of the Special Laboratory of Applied Toxinology (Center of Toxins Immune-Response and Cell Signaling), Butantan Institute, São Paulo, SP, Brazil
| | - A M Moura-da-Silva
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo, SP, Brazil.
| | - Bryan G Fry
- Toxin Evolution Lab, School of Biological Sciences, University of Queensland, Santa Lucia, QLD 4072, Australia.
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The relationship between clinics and the venom of the causative Amazon pit viper (Bothrops atrox). PLoS Negl Trop Dis 2020; 14:e0008299. [PMID: 32511239 PMCID: PMC7302866 DOI: 10.1371/journal.pntd.0008299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/18/2020] [Accepted: 04/16/2020] [Indexed: 11/26/2022] Open
Abstract
Snake venoms are complex mixtures of proteins with toxic activities, with many distinct isoforms, affecting different physiological targets, comprised in a few protein families. It is currently accepted that this diversity in venom composition is an adaptive advantage for venom efficacy on a wide range of prey. However, on the other side, variability on isoforms expression has implications in the clinics of human victims of snakebites and in the efficacy of antivenoms. B. atrox snakes are responsible for most of the human accidents in Brazilian Amazon and the type and abundance of protein families on their venoms present individual variability. Thus, in this study we attempted to correlate the individual venom proteome of the snake brought to the hospital by the patient seeking for medical assistance with the clinical signs observed in the same patient. Individual variability was confirmed in venoms of the 14 snakes selected for the study. The abundance of each protein family was quite similar among the venom samples, while the isoforms composition was highly variable. Considering the protein families, the SVMP group presented the best correlation with bleeding disorders and edema. Considering individual isoforms, some isoforms of venom metalloproteinase (SVMP), C-type lectin-like toxins (CTL) and snake venom serine proteinases (SVSP) presented expression levels that with statistically significant positive correlation to signs and symptoms presented by the patients as bleeding disorders, edema, ecchymosis and blister formation. However, some unexpected data were also observed as the correlation between a CTL, CRISP or LAAO isoforms with blister formation, still to be confirmed with a larger number of samples. Although this is still a small number of patient samples, we were able to indicate that venom composition modulates clinical manifestations of snakebites, to confirm at the bedside the prominent role of SVMPs and to include new possible toxin candidates for the development of toxin inhibitors or to improve antivenom selectiveness, important actions for the next generation treatments of snakebites. Bothrops atrox is a snake of major medical importance in the Amazon. Its venom is specialized to kill preys in the nature, especially because of coagulotoxic and proteolytic activities. B. atrox envenomings cause local inflammation and, in a significant proportion, systemic manifestations, namely bleeding disorders. These signs and symptoms are caused by the various toxins present in the venom of this snake, which act in the organism by different mechanisms. It is not known to what extent the composition of the venom that was inoculated by the snake that caused the envenoming can influence the patient’s clinical condition. To study this subject, this work correlated the constituents of the venom with the clinical manifestations of hospitalized patients, taking advantage of the fact that many patients bring the snake responsible for the bite. The abundance of each toxin family was similar among the venom samples, but the variants composition of each toxin was highly variable. Considering the protein families, a group named metalloproteases (SVMP) presented the best correlation with bleeding disorders and edema. Some variants of venom SVMPs, and other toxin families, such as C-type lectin-like toxins (CTL) and snake venom serine proteinases (SVSP) presented correlation to signs and symptoms presented by the patients as bleeding disorders, edema, ecchymosis and blister formation. Our results show that venom composition modulates clinical manifestations of snakebites.
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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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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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25
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Inflammatory Reaction Induced by Two Metalloproteinases Isolated from Bothrops atrox Venom and by Fragments Generated from the Hydrolysis of Basement Membrane Components. Toxins (Basel) 2020; 12:toxins12020096. [PMID: 32024243 PMCID: PMC7076977 DOI: 10.3390/toxins12020096] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/21/2020] [Accepted: 01/30/2020] [Indexed: 12/23/2022] Open
Abstract
Snake venom metalloproteinases (SVMPs) play an important role in local tissue damage of snakebite patients, mostly by hydrolysis of basement membrane (BM) components. We evaluated the proinflammatory activity of SVMPs Atroxlysin-Ia (ATXL) and Batroxrhagin (BATXH) from Bothrops atrox venom and their hydrolysis products of Matrigel. BALB/c mice were injected with SVMPs (2 μg), for assessment of paw edema and peritoneal leukocyte accumulation. Both SVMPs induced edema, representing an increase of ~70% of the paw size. Leukocyte infiltrates reached levels of 6 × 106 with ATXL and 5 × 106 with BATXH. TNF-α was identified in the supernatant of BATXH—or venom-stimulated MPAC cells. Incubation of Matrigel with the SVMPs generated fragments, including peptides from Laminin, identified by LC–MS/MS. The Matrigel hydrolysis peptides caused edema that increased 30% the paw size and promoted leukocyte accumulation (4–5 × 106) to the peritoneal cavity, significantly higher than Matrigel control peptides 1 and 4 h after injection. Our findings suggest that ATXL and BATXH are involved in the inflammatory reaction observed in B. atrox envenomings by direct action on inflammatory cells or by releasing proinflammatory peptides from BM proteins that may amplify the direct action of SVMPs through activation of endogenous signaling pathways.
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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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27
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Convergent recruitment of adamalysin-like metalloproteases in the venom of the red bark centipede (Scolopocryptops sexspinosus). Toxicon 2019; 168:1-15. [PMID: 31229627 DOI: 10.1016/j.toxicon.2019.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/10/2019] [Accepted: 06/14/2019] [Indexed: 12/17/2022]
Abstract
Many venom proteins have presumably been convergently recruited by taxa from diverse venomous lineages. These toxic proteins have characteristics that allow them to remain stable in solution and have a high propensity for toxic effects on prey and/or potential predators. Despite this well-established convergent toxin recruitment, some toxins seem to be lineage specific. To further investigate the toxic proteins found throughout venomous lineages, venom proteomics and venom-gland transcriptomics were performed on two individual red bark centipedes (Scolopocryptops sexspinosus). Combining the protein phenotype with the transcript genotype resulted in the first in-depth venom characterization of S. sexspinosus, including 72 venom components that were identified in both the transcriptome and proteome and 1468 nontoxin transcripts identified in the transcriptome. Ten different toxin families were represented in the venom and venom gland with the majority of the toxins belonging to metalloproteases, CAPS (cysteine-rich secretory protein, antigen 5, and pathogenesis-related 1 proteins), and β-pore-forming toxins. Nine of these toxin families shared a similar proteomic structure to venom proteins previously identified from other centipedes. However, the most highly expressed toxin family, the adamalysin-like metalloproteases, has until now only been observed in the venom of snakes. We confirmed adamalysin-like metalloprotease activity by means of in vivo functional assays. The recruitment of an adamalysin-like metalloprotease into centipede venom represents a striking case of convergent evolution.
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Functional variability of Bothrops atrox venoms from three distinct areas across the Brazilian Amazon and consequences for human envenomings. Toxicon 2019; 164:61-70. [DOI: 10.1016/j.toxicon.2019.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/21/2019] [Accepted: 04/12/2019] [Indexed: 11/23/2022]
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29
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Gomes M, Alvarez MA, Quellis LR, Becher ML, Castro JMDA, Gameiro J, Caporrino MC, Moura-da-Silva AM, de Oliveira Santos M. Expression of an scFv antibody fragment in Nicotiana benthamiana and in vitro assessment of its neutralizing potential against the snake venom metalloproteinase BaP1 from Bothrops asper. Toxicon 2019; 160:38-46. [PMID: 30802471 DOI: 10.1016/j.toxicon.2019.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/24/2019] [Accepted: 02/13/2019] [Indexed: 11/29/2022]
Abstract
Human accidents with venomous snakes represent an overwhelming public health problem, mainly in rural populations of underdeveloped countries. Their high incidence and the severity of the accidents result in 81,000 to 138,000 deaths per year. The treatment is based on the administration of purified antibodies, produced by hyper immunization of animals to generate immunoglobulins (Igs), and then obtained by fractionating hyper immune plasma. The use of recombinant antibodies is an alternative to conventional treatment of snakebite envenoming, particularly the Fv fragment, named the single-chain variable fragment (scFv). We have produced recombinant single chain variable fragment scFv against the venom of the pit viper Bothrops asper at high levels expressed transiently and stably in transgenic plants and in vitro cultures that is reactive to BaP1 (a metalloproteinase from B. asper venom). The yield from stably transformed plants was significantly (p > 0.05) higher than the results in from transient expression. In addition, scFvBaP1 yields from systems derived from stable transformation were: transgenic callus 62 μg/g (±2); biomass from cell suspension cultures 83 μg/g (±0.2); culture medium from suspensions 71.75 mg/L (±6.18). The activity of scFvBaP1 was confirmed by binding and neutralization of the fibrin degradation induced by BnP1 toxins from B. neuwiedi and by Atroxlysin Ia from B. atrox venoms. In the present work, we demonstrated the potential use of plant cells to produce scFvBaP1 to be used in the future as a biotechnological alternative to horse immunization protocols to produce anti-venoms to be used in human therapy against snakebites.
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Affiliation(s)
- Marinna Gomes
- Laboratorio de Genética, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Rua José Lourenço Kelmer, S/n - Martelos, Juiz de Fora, MG, 36036-330, Brazil
| | | | - Leonardo Ramos Quellis
- Laboratorio de Genética, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Rua José Lourenço Kelmer, S/n - Martelos, Juiz de Fora, MG, 36036-330, Brazil
| | - Melina Laguia Becher
- CONICET-Universidade Maimónides (CEBBAD), Hidalgo 775, Lab 603, Buenos Aires, Argentina
| | - Juciane Maria de Andrade Castro
- Laboratorio de Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Rua José Lourenço Kelmer, S/n - Martelos, Juiz de Fora, MG, 36036-330, Brazil
| | - Jacy Gameiro
- Laboratorio de Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Rua José Lourenço Kelmer, S/n - Martelos, Juiz de Fora, MG, 36036-330, Brazil
| | - Maria Cristina Caporrino
- Laboratorio de Imunopatologia, Instituto Butantan, Av. Vital Brazil, 1500, Butantã, CEP 05503-900 São Paulo, SP, Brazil
| | - Ana Maria Moura-da-Silva
- Laboratorio de Imunopatologia, Instituto Butantan, Av. Vital Brazil, 1500, Butantã, CEP 05503-900 São Paulo, SP, Brazil
| | - Marcelo de Oliveira Santos
- Laboratorio de Genética, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Rua José Lourenço Kelmer, S/n - Martelos, Juiz de Fora, MG, 36036-330, Brazil.
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Identification of a linear B-cell epitope in the catalytic domain of bothropasin, a metalloproteinase from Bothrops jararaca snake venom. Mol Immunol 2018; 104:20-26. [DOI: 10.1016/j.molimm.2018.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/16/2018] [Accepted: 10/23/2018] [Indexed: 11/22/2022]
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31
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Herrera C, Escalante T, Rucavado A, Fox JW, Gutiérrez JM. Metalloproteinases in disease: identification of biomarkers of tissue damage through proteomics. Expert Rev Proteomics 2018; 15:967-982. [DOI: 10.1080/14789450.2018.1538800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Cristina Herrera
- Facultad de Farmacia, Universidad de Costa Rica, San José, Costa Rica
| | - Teresa Escalante
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Alexandra Rucavado
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Jay W. Fox
- School of Medicine, University of Virginia, Charlottesville, VA22959, USA
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
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Estevão-Costa MI, Sanz-Soler R, Johanningmeier B, Eble JA. Snake venom components in medicine: From the symbolic rod of Asclepius to tangible medical research and application. Int J Biochem Cell Biol 2018; 104:94-113. [PMID: 30261311 DOI: 10.1016/j.biocel.2018.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/03/2018] [Accepted: 09/19/2018] [Indexed: 12/21/2022]
Abstract
Both mythologically and logically, snakes have always fascinated man. Snakes have attracted both awe and fear not only because of the elegant movement of their limbless bodies, but also because of the potency of their deadly venoms. Practically, in 2017, the world health organization (WHO) listed snake envenomation as a high priority neglected disease, as snakes inflict up to 2.7 million poisonous bites, around 100.000 casualties, and about three times as many invalidities on man. The venoms of poisonous snakes are a cocktail of potent compounds which specifically and avidly target numerous essential molecules with high efficacy. The individual effects of all venom toxins integrate into lethal dysfunctions of almost any organ system. It is this efficacy and specificity of each venom component, which after analysis of its structure and activity may serve as a potential lead structure for chemical imitation. Such toxin mimetics may help in influencing a specific body function pharmaceutically for the sake of man's health. In this review article, we will give some examples of snake venom components which have spurred the development of novel pharmaceutical compounds. Moreover, we will provide examples where such snake toxin-derived mimetics are in clinical use, trials, or consideration for further pharmaceutical exploitation, especially in the fields of hemostasis, thrombosis, coagulation, and metastasis. Thus, it becomes clear why a snake captured its symbolic place at the Asclepius rod with good reason still nowadays.
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Affiliation(s)
- Maria-Inacia Estevão-Costa
- Institute of Physiological Chemistry and Pathobiochemistry, University of Münster, Waldeyerstr. 15, 48149, Münster, Germany
| | - Raquel Sanz-Soler
- Institute of Physiological Chemistry and Pathobiochemistry, University of Münster, Waldeyerstr. 15, 48149, Münster, Germany
| | - Benjamin Johanningmeier
- Institute of Physiological Chemistry and Pathobiochemistry, University of Münster, Waldeyerstr. 15, 48149, Münster, Germany
| | - Johannes A Eble
- Institute of Physiological Chemistry and Pathobiochemistry, University of Münster, Waldeyerstr. 15, 48149, Münster, Germany.
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Amazonas DR, Portes-Junior JA, Nishiyama-Jr MY, Nicolau CA, Chalkidis HM, Mourão RH, Grazziotin FG, Rokyta DR, Gibbs HL, Valente RH, Junqueira-de-Azevedo IL, Moura-da-Silva AM. Molecular mechanisms underlying intraspecific variation in snake venom. J Proteomics 2018; 181:60-72. [DOI: 10.1016/j.jprot.2018.03.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/08/2018] [Accepted: 03/31/2018] [Indexed: 10/17/2022]
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Unresolved issues in the understanding of the pathogenesis of local tissue damage induced by snake venoms. Toxicon 2018; 148:123-131. [PMID: 29698755 DOI: 10.1016/j.toxicon.2018.04.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/04/2018] [Accepted: 04/22/2018] [Indexed: 12/20/2022]
Abstract
Snakebite envenoming by viperid species, and by some elapids, is characterized by a complex pattern of tissue damage at the anatomical site of venom injection. In severe cases, tissue destruction may be so extensive as to lead to permanent sequelae, with serious pathophysiological, social and psychological consequences. Significant advances have been performed in the study of venom-induced tissue damage, including identification and characterization of the toxins involved, insights into the mechanisms of action of venoms and toxins, and study of tissue responses to venom-induced injury. Nevertheless, much remains to be known and understood on the pathogenesis of these alterations. This review focuses on some of the pending issues in the topic of snake venom-induced local tissue damage. The traditional 'reductionist' approach, which has predominated in the study of snake venoms and their actions, needs to be complemented by more integrative and holistic perspectives aimed at capturing the complexity of these pathological alterations. Future advances in the study of these topics will certainly pave the way for innovative therapeutic interventions, with the goal of reducing the impact of this aspect of snakebite envenoming.
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Soares KSR, Gláucia-Silva F, Daniele-Silva A, Torres-Rêgo M, Araújo NKD, Menezes YASD, Damasceno IZ, Tambourgi DV, da Silva-Júnior AA, Fernandes-Pedrosa MDF. Antivenom Production against Bothrops jararaca and Bothrops erythromelas Snake Venoms Using Cross-Linked Chitosan Nanoparticles as an Immunoadjuvant. Toxins (Basel) 2018; 10:toxins10040158. [PMID: 29659491 PMCID: PMC5923324 DOI: 10.3390/toxins10040158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 12/17/2022] Open
Abstract
In Brazil, envenomation by snakes of the genus Bothrops is clinically relevant, particularly for the species Bothrops jararaca and B. erythromelas. The most effective treatment for envenomation by snakes is the administration of antivenoms associated with adjuvants. Novel adjuvants are required to reduce side effects and maximize the efficiency of conventional serum and vaccine formulations. The polymer chitosan has been shown to have immunoadjuvant properties, and it has been used as a platform for delivery systems. In this context, we evaluated the potential immunoadjuvant properties of chitosan nanoparticles (CNPs) loaded with B. jararaca and B. erythromelas venoms in the production of sera against these venoms. Stable CNPs were obtained by ionic gelation, and mice were immunized subcutaneously for 6 weeks with 100 µL of each snake venom at concentrations of 5.0 or 10.0% (w/w), encapsulated in CNPs or associated with aluminium hydroxide (AH). The evaluation of protein interactions with the CNPs revealed their ability to induce antibody levels equivalent to those of AH, even with smaller doses of antigen. In addition, the CNPs were less inflammatory due to their modified release of proteins. CNPs provide a promising approach for peptide/protein delivery from snake venom and will be useful for new vaccines.
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Affiliation(s)
- Karla Samara Rocha Soares
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil.
| | - Fiamma Gláucia-Silva
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil.
| | - Alessandra Daniele-Silva
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil.
| | - Manoela Torres-Rêgo
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil.
| | - Nathália Kelly de Araújo
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil.
| | - Yamara Arruda Silva de Menezes
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil.
| | - Igor Zumba Damasceno
- Department of Materials Engineering, Technology Center, University Campus, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil.
| | | | - Arnóbio Antônio da Silva-Júnior
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil.
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de Brito Sousa JD, Sachett JAG, de Oliveira SS, Mendonça-da-Silva I, Marques HO, de Lacerda MVG, Fan HW, Monteiro WM. Accuracy of the Lee-White Clotting Time Performed in the Hospital Routine to Detect Coagulopathy in Bothrops atrox Envenomation. Am J Trop Med Hyg 2018; 98:1547-1551. [PMID: 29611503 DOI: 10.4269/ajtmh.17-0992] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Snake envenomation is a major public health problem in Brazil. Systemic complications that may arise from snakebites are mainly related to coagulopathy. The Lee-White clotting time (LWCT) is a simple and inexpensive test and available even in remote health facilities. However, the diagnostic value of such test needs to be evaluated to accurately diagnose coagulopathy in the clinical practice. This study aimed to assess the reliability of the LWCT performed in hospital routine to diagnose venom-induced coagulopathy. We studied 186 patients admitted at the Tropical Medicine Foundation Dr. Heitor Vieira Dourado in Manaus, Amazonas, Brazil, with Bothrops envenomation diagnosis. At admission, blood samples were collected for performing LWCT and the concentration of fibrinogen. Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, diagnostic odds ratio, and accuracy were calculated with 95% confidence intervals. From the total, 85.5% had hypofibrinogenemia. The sensitivity of the LWCT to the diagnosis of hypofibrinogenemia was 78.0% and the specificity 40.7%. The accuracy of the test was 72.6%, and patients with a prolonged LWCT had 2.4 higher odds of developing hypofibrinogenemia. In addition, the LWCT was also compared with venom antigen levels and systemic hemorrhage. The LWCT showed moderate sensitivity to detect consumption coagulopathy and constitutes a valuable tool for the diagnosis of Bothrops snake envenomation and indication of antivenom therapy.
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Affiliation(s)
- Jose Diego de Brito Sousa
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Jacqueline Almeida Gonçalves Sachett
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Sâmella Silva de Oliveira
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Iran Mendonça-da-Silva
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Marcus Vinicius Guimarães de Lacerda
- Instituto de Pesquisas Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Wuelton Marcelo Monteiro
- Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
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Silva de Oliveira S, Freitas-de-Sousa LA, Alves EC, de Lima Ferreira LC, da Silva IM, de Lacerda MVG, Fan HW, Moura-da-Silva AM, Monteiro WM. Fatal stroke after Bothrops snakebite in the Amazonas state, Brazil: A case report. Toxicon 2017; 138:102-106. [DOI: 10.1016/j.toxicon.2017.08.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
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