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Guadarrama-Martínez A, Neri-Castro E, Boyer L, Alagón A. Variability in antivenom neutralization of Mexican viperid snake venoms. PLoS Negl Trop Dis 2024; 18:e0012152. [PMID: 38717980 PMCID: PMC11078402 DOI: 10.1371/journal.pntd.0012152] [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] [Received: 11/17/2023] [Accepted: 04/16/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Each year, 3,800 cases of snakebite envenomation are reported in Mexico, resulting in 35 fatalities. The only scientifically validated treatment for snakebites in Mexico is the use of antivenoms. Currently, two antivenoms are available in the market, with one in the developmental phase. These antivenoms, produced in horses, consist of F(ab')2 fragments generated using venoms from various species as immunogens. While previous studies primarily focused on neutralizing the venom of the Crotalus species, our study aims to assess the neutralization capacity of different antivenom batches against pit vipers from various genera in Mexico. METHODOLOGY We conducted various biological and biochemical tests to characterize the venoms. Additionally, we performed neutralization tests using all three antivenoms to evaluate their effectiveness against lethal activity and their ability to neutralize proteolytic and fibrinogenolytic activities. RESULTS Our results reveal significant differences in protein content and neutralizing capacity among different antivenoms and even between different batches of the same product. Notably, the venom of Crotalus atrox is poorly neutralized by all evaluated batches despite being the primary cause of envenomation in the country's northern region. Furthermore, even at the highest tested concentrations, no antivenom could neutralize the lethality of Metlapilcoatlus nummifer and Porthidium yucatanicum venoms. These findings highlight crucial areas for improving existing antivenoms and developing new products. CONCLUSION Our research reveals variations in protein content and neutralizing potency among antivenoms, emphasizing the need for consistency in venom characteristics as immunogens. While Birmex neutralizes more LD50 per vial, Antivipmyn excels in specific neutralization. The inability of antivenoms to neutralize certain venoms, especially M. nummifer and P. yucatanicum, highlights crucial improvement opportunities, given the medical significance of these species.
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Affiliation(s)
- Alid Guadarrama-Martínez
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, México
| | - Edgar Neri-Castro
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, México
- Facultad de Ciencias Biológicas, Universidad Juárez del Estado de Durango, Gómez Palacio, Durango, México
| | - Leslie Boyer
- Department of Pathology, University of Arizona, Tucson, Arizona, United States of America
| | - Alejandro Alagón
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, México
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2
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Blanch NB, Cascone O, Fingermann M. Selective immunoglobulin aggregates removal in antivenoms by a simple chromatographic step based on a monolithic stationary phase. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1232:123978. [PMID: 38142501 DOI: 10.1016/j.jchromb.2023.123978] [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: 09/12/2023] [Revised: 11/29/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
Antivenom therapy is a critical intervention for treating the more than 5.000.000 envenomation accidents that occur each year around the world. These immunotherapeutic drugs are mostly produced following techniques developed more than fifty years ago with minor changes. Aggregate content has been described as one of the main causes of early adverse effects after intravenous administration of antivenoms. In this work we propose the introduction of a final polishing step to traditional antivenom manufacturing processes aimed at lowering the aggregate content in the final product. The refinement step proposed in this work is based on the selective capture of immunoglobulin aggregates by a cation exchange monolithic stationary phase. We show that this media can effectively remove aggregates in the final product under isotonic ion-strength and mildly acidic conditions following a negative chromatography strategy, thus making it a useful technique for producing higher quality products.
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Affiliation(s)
- Nicolás Berardo Blanch
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", CABA, Av. Vélez, Sarsfield 563, (1282), Argentina
| | - Osvaldo Cascone
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", CABA, Av. Vélez, Sarsfield 563, (1282), Argentina; Instituto de Nanobiotecnología (NANOBIOTEC), CONICET-UBA, CABA (1113) Junín 956, Argentina
| | - Matías Fingermann
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", CABA, Av. Vélez, Sarsfield 563, (1282), Argentina.
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3
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Findlay-Wilson S, Easterbrook L, Smith S, Pope N, Aldridge M, Humphries G, Schuhmann H, Ngabo D, Rayner E, Otter A, Coleman T, Hicks B, Halkerston R, Apostolakis K, Taylor S, Fotheringham S, Horton A, CanoCejas I, Wand M, Tree JA, Sutton M, Graham V, Hewson R, Dowall S. Refinement of an ovine-based immunoglobulin therapy against SARS-CoV-2, with comparison of whole IgG versus F(ab') 2 fragments. Sci Rep 2023; 13:13912. [PMID: 37626085 PMCID: PMC10457378 DOI: 10.1038/s41598-023-40277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
The development of new therapies against SARS-CoV-2 is required to extend the toolkit of intervention strategies to combat the global pandemic. In this study, hyperimmune plasma from sheep immunised with whole spike SARS-CoV-2 recombinant protein has been used to generate candidate products. In addition to purified IgG, we have refined candidate therapies by removing non-specific IgG via affinity binding along with fragmentation to eliminate the Fc region to create F(ab')2 fragments. These preparations were evaluated for in vitro activity and demonstrated to be strongly neutralising against a range of SARS-CoV-2 strains, including Omicron B2.2. In addition, their protection against disease manifestations and viral loads were assessed using a hamster SARS-CoV-2 infection model. Results demonstrated protective effects of both IgG and F(ab')2, with the latter requiring sequential dosing to maintain in vivo activity due to rapid clearance from the circulation.
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Affiliation(s)
| | - Linda Easterbrook
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Sandra Smith
- International Therapeutic Proteins Ltd, Longford, TAS, 7301, Australia
| | - Neville Pope
- International Therapeutic Proteins Ltd, Goleigh Farm, Selborne, GU34 3SE, Hampshire, UK
| | | | - Gareth Humphries
- Native Antigen Company, Langford Locks, Kidlington, Oxford, OX5 1LH, UK
| | - Holger Schuhmann
- Native Antigen Company, Langford Locks, Kidlington, Oxford, OX5 1LH, UK
| | - Didier Ngabo
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Emma Rayner
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Ashley Otter
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Thomas Coleman
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Bethany Hicks
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Rachel Halkerston
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Kostis Apostolakis
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Stephen Taylor
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Susan Fotheringham
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Amanda Horton
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Irene CanoCejas
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Matthew Wand
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Julia A Tree
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Mark Sutton
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Victoria Graham
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Roger Hewson
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Stuart Dowall
- UK Health Security Agency (UKHSA), Porton Down, Salisbury, Wiltshire, SP4 0JG, UK.
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4
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Ho PL, Wen FH, Akamatsu MA, Yamaguchi IK. Professor Isaías Raw (March 26th, 1927–December 14th, 2022). Toxicon 2023; 227:107089. [PMID: 36967018 DOI: 10.1016/j.toxicon.2023.107089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Paulo Lee Ho
- Instituto Butantan, 05503-900, São Paulo, SP, Brazil.
| | - Fan Hui Wen
- Instituto Butantan, 05503-900, São Paulo, SP, Brazil
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Dias da Silva W, De Andrade SA, Megale ÂAA, De Souza DA, Sant’Anna OA, Magnoli FC, Guidolin FR, Godoi KS, Saladini LY, Spencer PJ, Portaro FCV. Antibodies as Snakebite Antivenoms: Past and Future. Toxins (Basel) 2022; 14:606. [PMID: 36136544 PMCID: PMC9503307 DOI: 10.3390/toxins14090606] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/30/2022] Open
Abstract
Snakebite envenomation is considered a neglected tropical disease, affecting tens of thousands of people each year. The recommended treatment is the use of antivenom, which is composed of immunoglobulins or immunoglobulin fragments obtained from the plasma of animals hyperimmunized with one (monospecific) or several (polyspecific) venoms. In this review, the efforts made in the improvement of the already available antivenoms and the development of new antivenoms, focusing on snakes of medical importance from sub-Saharan Africa and Latin America, are described. Some antivenoms currently used are composed of whole IgGs, whereas others use F(ab')2 fragments. The classic methods of attaining snake antivenoms are presented, in addition to new strategies to improve their effectiveness. Punctual changes in immunization protocols, in addition to the use of cross-reactivity between venoms from different snakes for the manufacture of more potent and widely used antivenoms, are presented. It is known that venoms are a complex mixture of components; however, advances in the field of antivenoms have shown that there are key toxins that, if effectively blocked, are capable of reversing the condition of in vivo envenomation. These studies provide an opportunity for the use of monoclonal antibodies in the development of new-generation antivenoms. Thus, monoclonal antibodies and their fragments are described as a possible alternative for the production of antivenoms, regardless of the venom. This review also highlights the challenges associated with their development.
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Affiliation(s)
| | - Sonia A. De Andrade
- Biopharmaceuticals Laboratory, Butantan Institute, São Paulo 05503-900, Brazil
| | | | | | | | | | | | | | - Lucas Yuri Saladini
- Laboratory of Structure and Function of Biomolecules, Butantan Institute, São Paulo 05503-900, Brazil
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6
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In vitro laboratory analyses of commercial anti-scorpion (Mesobuthus tamulus) antivenoms reveal their quality and safety but the prevalence of a low proportion of venom-specific antibodies. Toxicon 2022; 215:37-48. [DOI: 10.1016/j.toxicon.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/15/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022]
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7
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Attarde S, Iyer A, Khochare S, Shaligram U, Vikharankar M, Sunagar K. The Preclinical Evaluation of a Second-Generation Antivenom for Treating Snake Envenoming in India. Toxins (Basel) 2022; 14:toxins14030168. [PMID: 35324665 PMCID: PMC8950585 DOI: 10.3390/toxins14030168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 11/23/2022] Open
Abstract
Snake envenoming afflicts the Indian subcontinent with the highest rates of mortality (47,000) and morbidity globally. The only effective treatment for snakebites is the administration of antivenom, which is produced by the hyperimmunisation of equines. Commercial Indian antivenoms, however, have been shown to exhibit a poor preclinical performance in neutralising venom, as a result of inter- and intrapopulation snake venom variation. Additionally, their poor dose effectiveness necessitates the administration of larger volumes of antivenom for treatment, leading to several harmful side effects in snakebite victims, including serum sickness and fatal anaphylaxis. In this study, we employed chromatographic purification to enhance the dose efficacy of commercial Indian antivenoms. The efficacy of this ‘second-generation’ antivenom was comparatively evaluated against six other marketed antivenoms using a number of in vitro and in vivo preclinical assays, which revealed its superior venom recognition capability. Enhanced purity also resulted in significant improvements in dose effectiveness, as the ‘second-generation’ antivenom exhibited a 3 to 4.5 times increased venom neutralisation potential. Furthermore, preclinical assays revealed the increased effectiveness of the ‘second-generation’ antivenom in countering morbid effects inflicted by the ‘big four’ Indian snakes. Thus, we demonstrate the role of simpler purification steps in significantly enhancing the effectiveness of snakebite therapy in regions that are most affected by snakebites.
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Affiliation(s)
- Saurabh Attarde
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore 560012, Karnataka, India; (S.A.); (A.I.); (S.K.)
| | - Ashwin Iyer
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore 560012, Karnataka, India; (S.A.); (A.I.); (S.K.)
| | - Suyog Khochare
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore 560012, Karnataka, India; (S.A.); (A.I.); (S.K.)
| | - Umesh Shaligram
- Serum Institute of India Pvt. Ltd., 212/2, Hadapsar, Off Soli Poonawalla Road, Pune 411028, Maharashtra, India; (U.S.); (M.V.)
| | - Mayur Vikharankar
- Serum Institute of India Pvt. Ltd., 212/2, Hadapsar, Off Soli Poonawalla Road, Pune 411028, Maharashtra, India; (U.S.); (M.V.)
| | - Kartik Sunagar
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore 560012, Karnataka, India; (S.A.); (A.I.); (S.K.)
- Correspondence:
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8
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Mender MM, Bolton F, Berry C, Young M. Antivenom: An immunotherapy for the treatment of snakebite envenoming in sub-Saharan Africa. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2021; 129:435-477. [PMID: 35305724 DOI: 10.1016/bs.apcsb.2021.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Snakebite envenoming (SBE) leads to significant morbidity and mortality, resulting in over 90,000 deaths and approximately 400,000 amputations annually. In sub-Saharan Africa (SSA) alone, SBE accounts for over 30,000 deaths per annum. Since 2017, SBE has been classified as a priority Neglected Tropical Disease (NTD) by the World Health Organisation (WHO). The major species responsible for mortality from SBE within SSA are from the Bitis, Dendroaspis, Echis and Naja genera. Pharmacologically active toxins such as metalloproteinases, serine proteinases, 3-finger toxins, kunitz-type toxins, and phospholipase A2s are the primary snake venom components. These toxins induce cytotoxicity, coagulopathy, hemorrhage, and neurotoxicity in envenomed victims. Antivenom is currently the only available venom-specific treatment for SBE and contains purified equine or ovine polyclonal antibodies, collected from donor animals repeatedly immunized with low doses of adjuvanted venom. The resulting plasma or serum contains a high titre of specific antibodies, which can then be collected and stored until required. The purified antibodies are either whole IgG, monovalent fragment antibody (Fab) or divalent fragment antibody F(ab')2. Despite pharmacokinetic and pharmacodynamic differences, all three are effective in the treatment of SBE. No antivenom is without adverse reactions but, the level of their impact and severity varies from benign early adverse reactions to the rarely occurring fatal anaphylactic shock. However, the major side effects are largely reversible with immediate administration of adrenaline and corticosteroids. There are 16 different antivenoms marketed within SSA, but the efficacy and safety profiles are only published for less than 50% of these products.
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Affiliation(s)
- Mender M Mender
- School of Bioscience, Cardiff University, Cardiff, United Kingdom; Department of Research and Development, MicroPharm Ltd, Newcastle Emlyn, United Kingdom.
| | - Fiona Bolton
- Department of Research and Development, MicroPharm Ltd, Newcastle Emlyn, United Kingdom
| | - Colin Berry
- School of Bioscience, Cardiff University, Cardiff, United Kingdom
| | - Mark Young
- School of Bioscience, Cardiff University, Cardiff, United Kingdom
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9
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Gutiérrez JM, Teixeira CFP, Fan HW. Instituto Butantan and Instituto Clodomiro Picado: A long-standing partnership in science, technology, and public health. Toxicon 2021; 202:75-81. [PMID: 34562498 DOI: 10.1016/j.toxicon.2021.09.007] [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: 08/30/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
Instituto Butantan (São Paulo, Brazil) and Instituto Clodomiro Picado (San José, Costa Rica) are public institutions devoted to scientific and technological research, production of antivenoms and other immunobiologicals, and a variety of public health interventions aimed at confronting the problem of snakebite envenoming in their countries and elsewhere. In the context of the 120th anniversary of Instituto Butantan, this work describes the historical developments in the relationship between these institutions, which has evolved into a solid cooperation platform in science, technology, and public health. The relationship between Instituto Butantan and Costa Rica started early in the 20th century, with the provision of Brazilian antivenoms to Costa Rica through the coordination of Instituto Butantan and the health system of Costa Rica, with the leadership of Clodomiro Picado Twight. After the decade of 1980, a prolific collaborative network has been established between Instituto Butantan and Instituto Clodomiro Picado (founded in 1970) in the areas of scientific and technological research in pharmacology, biochemistry, experimental pathology, immunology, and public health, as well as in antivenom development, production, preclinical evaluation, and quality control. In addition, both institutions have played a key role in the integration of regional efforts in Latin America to create a network of public institutions devoted to antivenom production and quality control, in close coordination with the Pan American Health Organization (PAHO). This long-standing partnership is an example of a highly productive south-south cooperation under a frame of solidarity and public well-being.
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Affiliation(s)
- José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, 11501, Costa Rica.
| | | | - Hui Wen Fan
- Núcleo de Produção de Soros, Instituto Butantan, São Paulo, Brazil
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10
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Patra A, Kalita B, Khadilkar MV, Salvi NC, Shelke PV, Mukherjee AK. Assessment of quality and pre-clinical efficacy of a newly developed polyvalent antivenom against the medically important snakes of Sri Lanka. Sci Rep 2021; 11:18238. [PMID: 34521877 PMCID: PMC8440654 DOI: 10.1038/s41598-021-97501-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 07/06/2021] [Indexed: 02/08/2023] Open
Abstract
Snake envenomation is a severe problem in Sri Lanka (SL) and Indian polyvalent antivenom (PAV) is mostly used for treating snakebite albeit due to geographical variation in venom composition, Indian PAV shows poor efficacy in neutralizing the lethality and toxicity of venom from the same species of snakes in SL. Therefore, the quality and in vivo venom neutralization potency of a country-specific PAV produced against the venom of the five most medically important snakes of SL (Daboia russelii, Echis carinatus, Hypnale hypnale, Naja naja, Bungarus caeruleus) was assessed. LC-MS/MS analysis of two batches of PAV showed the presence of 88.7-97.2% IgG and traces of other plasma proteins. The tested PAVs contained minor amounts of undigested IgG and F(ab')2 aggregates, showed complement activation, were devoid of IgE, endotoxin, and content of preservative was below the threshold level. Immunological cross-reactivity and in vitro neutralization of enzymatic activities, pharmacological properties demonstrated superior efficacy of SL PAV compared to Indian PAV against SL snake venoms. The in vivo neutralization study showed that the tested PAVs are potent to neutralize the lethality and venom-induced toxicity of SL snake venoms. Therefore, our study suggests that introduction of SL-specific PAV will improve snakebite management in SL.
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Affiliation(s)
- Aparup Patra
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, School of Science, Tezpur University, Tezpur, Assam, 784028, India
| | - Bhargab Kalita
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, School of Science, Tezpur University, Tezpur, Assam, 784028, India
| | - Milind V Khadilkar
- Premium Serums and Vaccines Pvt. Ltd, Narayangaon, Pune, Maharashtra, 410504, India
| | - Nitin C Salvi
- Premium Serums and Vaccines Pvt. Ltd, Narayangaon, Pune, Maharashtra, 410504, India
| | - Pravin V Shelke
- Premium Serums and Vaccines Pvt. Ltd, Narayangaon, Pune, Maharashtra, 410504, India
| | - Ashis K Mukherjee
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, School of Science, Tezpur University, Tezpur, Assam, 784028, India.
- Institute of Advanced Study in Science and Technology, Vigyan Path, Garchuk, Paschim Boragaon, Guwahati, Assam, 781035, India.
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11
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Patra A, Herrera M, Gutiérrez JM, Mukherjee AK. The application of laboratory-based analytical tools and techniques for the quality assessment and improvement of commercial antivenoms used in the treatment of snakebite envenomation. Drug Test Anal 2021; 13:1471-1489. [PMID: 34089574 DOI: 10.1002/dta.3108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/18/2022]
Abstract
Snakebite envenomation is a public health problem of high impact, particularly for the developing world. Antivenom, which contains whole or protease-digested immunoglobulin G, purified from the plasma of hyper-immunized animals (mainly horses), is the mainstay for the treatment of snakebite envenomation. The success of antivenom therapy depends upon its ability to abrogate or reduce the local and systemic toxicity of envenomation. In addition, antivenom administration must be safe for the patients. Therefore, antivenom manufacturers must ensure that these products are effective and safe in the treatment of envenomations. Antivenom efficacy and safety are determined by the physicochemical characteristics of formulations, purity of the immunoglobulin fragments and antibodies, presence of protein aggregates, endotoxin burden, preservative load, and batch to batch variation, as well as on the ability to neutralize the most important toxins of the venoms against which the antivenom is designed. In this context, recent studies have shown that laboratory-based simple analytical techniques, for example, size exclusion chromatography, sodium dodecyl sulphate polyacrylamide gel electrophoresis, mass spectrometry, immunological profiling including immuno-turbidimetry and enzyme-linked immunosorbent assays, Western blotting, immune-chromatographic technique coupled to mass spectrometry analysis, reverse-phase high performance liquid chromatography, spectrofluorometric analysis, in vitro neutralization of venom enzymatic activities, and other methodologies, can be applied for the assessment of antivenom quality, safety, stability, and efficacy. This article reviews the usefulness of different analytical techniques for the quality assessment of commercial antivenoms. It is suggested that these tests should be applied for screening the quality of commercial antivenoms before their preclinical and clinical assessment.
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Affiliation(s)
- Aparup Patra
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, India
| | - María Herrera
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Ashis K Mukherjee
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, India.,Life Science Division, Institute of Advanced Study in Science and Technology, Vigyan Path, Garchuk, Paschim Boragaon, Guwahati, 781035, India
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Patra A, Banerjee D, Dasgupta S, Mukherjee AK. The in vitro laboratory tests and mass spectrometry-assisted quality assessment of commercial polyvalent antivenom raised against the ‘Big Four’ venomous snakes of India. Toxicon 2021; 192:15-31. [DOI: 10.1016/j.toxicon.2020.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/06/2020] [Accepted: 12/27/2020] [Indexed: 12/22/2022]
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13
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Tan CH, Liew JL, Chong HP, Tan NH. Protein decomplexation and proteomics: A complementary assessment method of the physicochemical purity of antivenom. Biologicals 2021; 69:22-29. [PMID: 33431232 DOI: 10.1016/j.biologicals.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/28/2020] [Accepted: 12/22/2020] [Indexed: 01/21/2023] Open
Abstract
The quality of antivenom is governed by its safety and efficacy profiles. These quality characteristics are much influenced by the purity of antivenom content. Rigorous assessment and meticulous monitoring of antivenom purity at the preclinical setting is hence crucial. This study aimed to explore an integrative proteomic method to assess the physicochemical purity of four commercially available antivenoms in the region. The antivenoms were subjected to Superdex 200 HR 10/30 size-exclusion fast-protein liquid chromatography (SE-FPLC). The proteins in each fraction were trypsin-digested and analyzed by nano-ESI-liquid chromatography-tandem mass spectrometry (LC-MS/MS). SE-FPLC resolved the antivenom proteins into three major protein components of very high (>200 kDa), high (100-120 kDa) and medium (<60 kDa) molecular weights. The major components (80-95% of total proteins) in the antivenoms were proteins of 100-120 kDa consisting of mainly the light and partially digested heavy immunoglobulin chains, consistent with F(ab')2 as the active principle of the antivenoms. However, LC-MS/MS also detected substantial quantity of large proteins (e.g. alpha-2-macroglobulins), immunoglobulin aggregates and impurities e.g. albumins in some products. The method is practical and able to unveil the quantitative and qualitative aspects of antivenom protein compositions. It is therefore a potentially useful preclinical assessment tool of antivenom purity.
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Affiliation(s)
- Choo Hock Tan
- Venom Research and Toxicology Laboratory, Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Jia Lee Liew
- Venom Research and Toxicology Laboratory, Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ho Phin Chong
- Venom Research and Toxicology Laboratory, Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nget Hong Tan
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Zurbano BN, Tavarone E, Viacava BG, Dokmetjian JC, Cascone O, Fingermann M. Critical aspects on traditional antivenom production processes and their optimization by factorial analysis. Biologicals 2020; 68:65-73. [PMID: 32912811 DOI: 10.1016/j.biologicals.2020.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/02/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022] Open
Abstract
Most antivenoms are produced by techniques developed over 50 years ago, with minor modifications. Herein we revise the core of traditional antivenom production processes aiming to optimize key determinants for both consistent antivenom production and the best balance between F(ab')2 quality and recovery. Factorial design analysis revealed that pepsin digestion of 1:3 saline diluted equine plasma for 60 min under pH: 3.20, 37 °C temperature and a 1:15 pepsin to protein ratio conditions, allowed to achieve maximal IgG to F(ab')2 conversion with minimal protein aggregate formation. Further downstream processing by salting out with ammonium sulfate was also studied by factorial analysis. The influence of ammonium sulfate (AS) concentration, temperature (T) and the albumin to total plasma protein ratio plasma (Alb:P) were assayed, revealing that both AS, T and their interaction have a significant impact in F(ab')2 quality and recovery. Taking into account the existing compromise between F(ab')2 monomer recovery and quality two alternative conditions were selected: 14 g/dl AS at 56 °C and, alternatively 16 g/dl AS at 30 °C. Reasonable yields (42%) and product quality (2.5% of aggregates) without significant changes in production cost of traditional methodologies was achieved under the optimized conditions found.
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Affiliation(s)
- Beatriz N Zurbano
- Instituto Nacional de Producción de Biológicos (INPB), ANLIS "Dr. Carlos G. Malbrán", Vélez Sársfield 563, 1282, Buenos Aires, Argentina
| | - Eugenia Tavarone
- Instituto Nacional de Producción de Biológicos (INPB), ANLIS "Dr. Carlos G. Malbrán", Vélez Sársfield 563, 1282, Buenos Aires, Argentina
| | - Belén González Viacava
- Instituto Nacional de Producción de Biológicos (INPB), ANLIS "Dr. Carlos G. Malbrán", Vélez Sársfield 563, 1282, Buenos Aires, Argentina
| | - José C Dokmetjian
- Instituto Nacional de Producción de Biológicos (INPB), ANLIS "Dr. Carlos G. Malbrán", Vélez Sársfield 563, 1282, Buenos Aires, Argentina
| | - Osvaldo Cascone
- Instituto Nacional de Producción de Biológicos (INPB), ANLIS "Dr. Carlos G. Malbrán", Vélez Sársfield 563, 1282, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, 1425, Buenos Aires, Argentina; Instituto de Nanobiotecnología (NANOBIOTEC), CONICET-Universidad de Buenos Aires, Junín 956, 1113, Buenos Aires, Argentina; Cátedra de Biotecnología, Departamento de Microbiología, Inmunología, Biotecnología y Genética, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Junín 956, 1113, Buenos Aires, Argentina
| | - Matías Fingermann
- Instituto Nacional de Producción de Biológicos (INPB), ANLIS "Dr. Carlos G. Malbrán", Vélez Sársfield 563, 1282, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, 1425, Buenos Aires, Argentina.
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Rebbouh F, Martin-Eauclaire MF, Laraba-Djebari F. Chitosan nanoparticles as a delivery platform for neurotoxin II from Androctonus australis hector scorpion venom: Assessment of toxicity and immunogenicity. Acta Trop 2020; 205:105353. [PMID: 31982432 DOI: 10.1016/j.actatropica.2020.105353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
In recent years, biodegradable polymers based nanoparticles received high interest for the development of vaccine delivery vehicles. In this study, chitosan nanoparticles encapsulating Aah II toxin (AahII-CNPs) isolated from Androctonus australis hector venom, were investigated as vaccine delivery system. Particles obtained by ionotropic gelation were characterized for their size, surface charge, morphology and toxin release profile from Aah II-CNPs. Toxin-nanoparticles interactions were assessed by Fourier Transform Infrared Spectrometry and X-Ray Diffraction. An immunization protocol was designed in mice to investigate anti-toxin immunity and the protective status induced by different Aah II immune formulations. Unloaded chitosan nanoparticles presenting a spherical shape and smooth surface, were characterized by a size of 185 nm, a dispersion index (PDI) of 0.257 and a zeta potential of +34.6 mV. Aah II toxin was successfully entrapped into chitosan nanoparticles as revealed by FTIR and XRD data. Entrapment efficiency (EE) and Loading capacity (LC) were respectively of 96.66 and 33.5%. Aah II-CNPs had a diameter of 208 nm, a PDI of 0.23 and a zeta potential of +30 mV. Encapsulation of Aah II reduced its toxicity and protected mice until 10 LD50. Mice were immunized via a dual prime-boost scheme. Nanoentrapped Aah II immunogen elicited systemic innate and humoral immune responses as well as local spleen parenchyma hyperplasic alterations. Aah II-CNPs immunized mice withstood high lethal doses of native Aah II, one-month post-boost inoculation. This study provided encouraging and promising results for the development of preventive therapies against scorpion envenoming mainly for the populations at-risk.
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Sarmiento K, Rodríguez A, Quevedo-Buitrago W, Torres I, Ríos C, Ruíz L, Salazar J, Hidalgo-Martínez P, Diez H. Comparación de la eficacia, la seguridad y la farmacocinética de los antivenenos antiofídicos: revisión de literatura. UNIVERSITAS MÉDICA 2019. [DOI: 10.11144/javeriana.umed61-1.anti] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
En Colombia se presentan anualmente alrededor de 5000 casos de mordedura de serpiente y su tratamiento se basa en la neutralización con inmunoglobulinas completas purificadas, sin embargo, globalmente se utilizan antivenenos faboterápicos. Objetivo: Dar a conocer diferencias entre las generaciones de antivenenos, la importancia del veneno en la producción de anticuerpos, comparar aspectos farmacocinéticos y los efectos adversos en pacientes. Materiales Métodos: Se realizó una búsqueda de literatura en bases de datos utilizando combinaciones de los descriptores y términos Mesh, en inglés y español. Se cotejaron parámetros farmacocinéticos en estudios preclínicos y los efectos adversos en estudios clínicos. Resultados: Se encontraron diferencias debidas al tamaño de la fracción de la inmunoglobulina que la compone, así entre más pequeña es ésta, se observa mayor distribución a los tejidos y una vida media más corta, comparada con las moléculas más pesadas. Se encontraron estudios con disminución de efectos adversos con antivenenos faboterápicos
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Patra A, Kalita B, Mukherjee AK. Assessment of quality, safety, and pre-clinical toxicity of an equine polyvalent anti-snake venom (Pan Africa): Determination of immunological cross-reactivity of antivenom against venom samples of Elapidae and Viperidae snakes of Africa. Toxicon 2018; 153:120-127. [DOI: 10.1016/j.toxicon.2018.08.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/05/2018] [Accepted: 08/30/2018] [Indexed: 11/28/2022]
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Sifi A, Adi-Bessalem S, Laraba-Djebari F. Development of a new approach of immunotherapy against scorpion envenoming: Avian IgYs an alternative to equine IgGs. Int Immunopharmacol 2018; 61:256-265. [DOI: 10.1016/j.intimp.2018.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 12/20/2022]
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Squaiella-Baptistão CC, Magnoli FC, Marcelino JR, Sant'Anna OA, Tambourgi DV. Quality of horse F(ab') 2 antitoxins and anti-rabies immunoglobulins: protein content and anticomplementary activity. J Venom Anim Toxins Incl Trop Dis 2018; 24:16. [PMID: 29946337 PMCID: PMC6006770 DOI: 10.1186/s40409-018-0153-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/06/2018] [Indexed: 02/06/2023] Open
Abstract
Background Among other applications, immunotherapy is used for the post-exposure treatment and/or prophylaxis of important infectious diseases, such as botulism, diphtheria, tetanus and rabies. The effectiveness of serum therapy is widely proven, but improvements on the immunoglobulin purification process and on the quality control are necessary to reduce the amount of protein aggregates. These may trigger adverse reactions in patients by activating the complement system and inducing the generation of anaphylatoxins. Herein, we used immunochemical methods to predict the quality of horse F(ab’)2 anti-botulinum AB, anti-diphtheric, antitetanic and anti-rabies immunoglobulins, in terms of amount of proteins and protein aggregates. Methods Samples were submitted to protein quantification, SDS-PAGE, Western blot analysis and molecular exclusion chromatography. The anticomplementary activity was determined in vitro by detecting the production of C5a/C5a desArg, the most potent anaphylatoxin. Data were analyzed by one-way ANOVA followed by Tukey’s post-test, and differences were considered statistically significant when p < 0.05. Results Horse F(ab’)2 antitoxins and anti-rabies immunoglobulin preparations presented different amounts of protein. SDS-PAGE and Western blot analyses revealed the presence of protein aggregates, non-immunoglobulin contaminants and, unexpectedly, IgG whole molecules in the samples, indicating the non-complete digestion of immunoglobulins. The chromatographic profiles of antitoxins and anti-rabies immunoglobulins allowed to estimate the percentage of contaminants and aggregates in the samples. Although protein aggregates were present, the samples were not able to induce the generation of C5a/C5a desArg in vitro, indicating that they probably contain acceptable levels of aggregates. Conclusions Anti-botulinum AB (bivalent), anti-diphtheric, antitetanic and anti-rabies horse F(ab’)2 immunoglobulins probably contain acceptable levels of aggregates, although other improvements on the preparations must be carried out. Protein profile analysis and in vitro anticomplementary activity of F(ab’)2 immunoglobulin preparations should be included as quality control steps, to ensure acceptable levels of aggregates, contaminants and whole IgG molecules on final products, reducing the chances of adverse reactions in patients.
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Affiliation(s)
| | - Fábio Carlos Magnoli
- 1Laboratório de Imunoquímica, Instituto Butantan, Av. Vital Brazil, 1500, São Paulo, SP CEP 05503-900 Brazil
| | - José Roberto Marcelino
- 2Seção de Processamento de Plasmas Hiperimunes, Instituto Butantan, Av. Vital Brazil, 1500, São Paulo, SP CEP 05503-900 Brazil
| | - Osvaldo Augusto Sant'Anna
- 1Laboratório de Imunoquímica, Instituto Butantan, Av. Vital Brazil, 1500, São Paulo, SP CEP 05503-900 Brazil
| | - Denise V Tambourgi
- 1Laboratório de Imunoquímica, Instituto Butantan, Av. Vital Brazil, 1500, São Paulo, SP CEP 05503-900 Brazil
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Morais V. Antivenom therapy: efficacy of premedication for the prevention of adverse reactions. J Venom Anim Toxins Incl Trop Dis 2018; 24:7. [PMID: 29507580 PMCID: PMC5831611 DOI: 10.1186/s40409-018-0144-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/07/2018] [Indexed: 11/29/2022] Open
Abstract
Antivenoms or antitoxins have been effectively used for more than a century. During this time, these products have always proven to be highly effective in the treatment of infections and envenomations. However, antivenoms did not exhibit good safety results in their initial applications. After many improvements, antivenoms have substantially better safety profiles but still have some side effects. Due to the occurrence of adverse reactions, the practice of using premedication with the intent to decrease side effects has become accepted or mandatory in many countries. The drugs used for premedication belong to the histamine H1 antagonist, glucocorticoid and catecholamine groups. Currently, this practice is being questioned due to low or controversial efficacies in clinical assays. In this article, we discuss the causes of adverse reactions, the mechanisms of drugs that block the undesired effects and the results obtained in clinical trials. Although these three families of drugs could have positive effects on reducing adverse reactions, only adrenaline has demonstrated positive results in clinical assays.
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Affiliation(s)
- Victor Morais
- Department of Biotechnology, Institute of Hygiene, Faculty of Medicine, University of the Republic, Uruguay, Av. Alfredo Navarro, 3051 Montevideo, Uruguay
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da Rocha DG, Fernandez JH, de Almeida CMC, da Silva CL, Magnoli FC, da Silva OÉ, da Silva WD. Development of IgY antibodies against anti-snake toxins endowed with highly lethal neutralizing activity. Eur J Pharm Sci 2017; 106:404-412. [PMID: 28595875 DOI: 10.1016/j.ejps.2017.05.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 04/15/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
Snakebite envenoming is a major neglected disease related to poverty in developing countries. Treatment involves the administration of a specific antivenom serum and auxiliary therapies, if necessary. The improvement of antibodies is of great importance for the technological advancement of antivenom therapy and to reduce the morbidity and mortality associated with this medical burden. In the present study, adult hens were immunized nine times with 20μg of B. arietans or C. d. terrificus venoms at three-week intervals between immunizations. Developing antibodies presented increasing avidity and affinity to antigenic toxin epitopes along immunization, attaining a plateau after the seventh immunization. Pooled egg yolk-purified IgY antivenom antibodies, subjected to in vitro-in vivo lethality assay using Swiss adult mice, exhibited potent venom lethal neutralizing activity. Taken together, chickens under the described immunization schedule were considered alternative candidates for antivenom production. Lower maintenance costs, a simple antibody manufacturing process and immunization suffering restrictions are additional advantages.
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Affiliation(s)
- David Gitirana da Rocha
- Laboratório de Biologia do Reconhecer (LBR), Centro de Biociências e Biotecnologia (CBB), Universidade Estadual do Norte Fluminense Darcy Ribeiro (UENF), Avenida Alberto Lamego, 2000 - Campos dos Goytacazes, Rio de Janeiro 28013-602, Brazil
| | - Jorge Hernandez Fernandez
- Laboratório de Química e Função de Proteínas e Peptídeos (LQFPP), Centro de Biociências e Biotecnologia (CBB), Universidade Estadual do Norte Fluminense Darcy Ribeiro (UENF), Avenida Alberto Lamego, 2000 - Campos dos Goytacazes, Rio de Janeiro 28013-602, Brazil
| | - Cláudia Maria Costa de Almeida
- Laboratório de Sanidade Animal (LSA), Centro de Ciências e Tecnologias Agropecuárias (CCTA), Universidade Estadual do Norte Fluminense Darcy Ribeiro (UENF), Avenida Alberto Lamego, 2000 - Campos dos Goytacazes, Rio de Janeiro 28013-602, Brazil
| | - Cláudia Letícia da Silva
- Laboratório de Biologia do Reconhecer (LBR), Centro de Biociências e Biotecnologia (CBB), Universidade Estadual do Norte Fluminense Darcy Ribeiro (UENF), Avenida Alberto Lamego, 2000 - Campos dos Goytacazes, Rio de Janeiro 28013-602, Brazil
| | - Fábio Carlos Magnoli
- Laboratório de Imunoquímica, Instituto Butantan, Avenida Vital Brazil, 1500 - São Paulo, São Paulo 05503-900, Brazil.
| | - Osmair Élder da Silva
- Laboratório de Imunoquímica, Instituto Butantan, Avenida Vital Brazil, 1500 - São Paulo, São Paulo 05503-900, Brazil.
| | - Wilmar Dias da Silva
- Laboratório de Imunoquímica, Instituto Butantan, Avenida Vital Brazil, 1500 - São Paulo, São Paulo 05503-900, Brazil.
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de Roodt AR, Clement H, Dolab JA, Litwin S, Hajos SE, Boyer L, Alagón A. Protein content of antivenoms and relationship with their immunochemical reactivity and neutralization assays. Clin Toxicol (Phila) 2014; 52:594-603. [PMID: 24940642 DOI: 10.3109/15563650.2014.925561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Therapy for snakebites relies on the application of antivenoms, which may be produced with different immunogenic mixtures of venom and possess different pharmaceutical characteristics. For these reasons, immunological cross-reactivity and heterologous neutralization were analyzed relative to the protein content of three antivenoms used in the Americas. METHODS The antivenoms studied were composed of equine F(ab')2 fragments from animals immunized with Crotalinae venoms. The antivenoms were tested against venoms of seven pit viper species from Argentina, seven from Mexico, one from Costa Rica, and one from Colombia. RESULTS Immunoblotting showed high cross-reactivity of all major protein bands with all the antivenoms tested. ELISA results also showed high cross-reactivity among the different venoms and antivenoms, and a high heterologous neutralization was observed. The results can be interpreted in different ways depending on whether the reactivity is considered in terms of the volume of antivenom used or by the amount of protein contained in this volume of antivenom. The antivenoms with high immunochemical reactivity and neutralizing capacity were those with higher protein content per vial; but when doses were adjusted by protein content, antivenoms of apparently lower neutralizing capacity and immunochemical reactivity showed at least similar potency and reactivity although volumetrically at higher doses. CONCLUSION Protein content relative to neutralization potency of different products must be taken into account when antivenoms are compared, in addition to the volume required for therapeutic effect. These results show the importance of obtaining high-affinity and high-avidity antibodies to achieve good neutralization using low protein concentration and low-volume antivenoms.
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Affiliation(s)
- A R de Roodt
- Research and Development, INPB-ANLIS "Dr. Carlos G. Malbrán", Ministriy of Health, and LabToxPat, CPEyA, Faculty of Medicine University of Buenos Aires , Argentina
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