Tissue damaging toxins in snake venoms: mechanisms of action, pathophysiology and treatment strategies.

Snakebite envenoming is an important public health issue responsible for mortality and severe morbidity. Where mortality is mainly caused by venom toxins that induce cardiovascular disturbances, neurotoxicity, and acute kidney injury, morbidity is caused by toxins that directly or indirectly destroy cells and degrade the extracellular matrix. These are referred to as 'tissue-damaging toxins' and have previously been classified in various ways, most of which are based on the tissues being affected (e.g., cardiotoxins, myotoxins). This categorisation, however, is primarily phenomenological and not mechanistic. In this review, we propose an alternative way of classifying cytotoxins based on their mechanistic effects rather than using a description that is organ- or tissue-based. The mechanisms of toxin-induced tissue damage and their clinical implications are discussed. This review contributes to our understanding of fundamental biological processes associated with snakebite envenoming, which may pave the way for a knowledge-based search for novel therapeutic options.

Multiplex lateral flow assay development for snake venom detection in biological matrices.

Bothrops and Lachesis are two of Brazil's medically most relevant snake genera, causing tens of thousands of bites annually. Fortunately, Brazil has good accessibility to high-quality antivenoms at the genus and inter-genus level, enabling the treatment of many of these envenomings. However, the optimal use of these treatments requires that the snake species responsible for the bite is determined. Currently, physicians use a syndromic approach to diagnose snakebite, which can be difficult for medical personnel with limited training in clinical snakebite management. In this work, we have developed a novel monoclonal antibody-based multiplex lateral flow assay for differentiating Bothrops and Lachesis venoms within 15 min. The test can be read by the naked eye or (semi)-quantitatively by a smartphone supported by a 3D-printed attachment for controlling lighting conditions. The LFA can detect Bothrops and Lachesis venoms in spiked plasma and urine matrices at concentrations spanning six orders of magnitude. The LFA has detection limits of 10-50 ng/mL in spiked plasma and urine, and 50-500 ng/mL in spiked sera, for B. atrox and L. muta venoms. This test could potentially support medical personnel in correctly diagnosing snakebite envenomings at the point-of-care in Brazil, which may help improve patient outcomes and save lives.

Repurposed drugs and their combinations prevent morbidity-inducing dermonecrosis caused by diverse cytotoxic snake venoms.

Morbidity from snakebite envenoming affects approximately 400,000 people annually. Tissue damage at the bite-site often leaves victims with catastrophic life-long injuries and is largely untreatable by current antivenoms. Repurposed small molecule drugs that inhibit specific snake venom toxins show considerable promise for tackling this neglected tropical disease. Using human skin cell assays as an initial model for snakebite-induced dermonecrosis, we show that the drugs 2,3-dimercapto-1-propanesulfonic acid (DMPS), marimastat, and varespladib, alone or in combination, inhibit the cytotoxicity of a broad range of medically important snake venoms. Thereafter, using preclinical mouse models of dermonecrosis, we demonstrate that the dual therapeutic combinations of DMPS or marimastat with varespladib significantly inhibit the dermonecrotic activity of geographically distinct and medically important snake venoms, even when the drug combinations are delivered one hour after envenoming. These findings strongly support the future translation of repurposed drug combinations as broad-spectrum therapeutics for preventing morbidity caused by snakebite.

Clinical Risk Factors Associated with Poor Outcomes in Snake Envenoming: A Narrative Review.

Snakebite-related fatalities disproportionately affect populations in impoverished socio-economic regions, marked by limited access to adequate healthcare and constrained antivenom availability. Early medical intervention is pivotal in mitigating mortality and morbidity associated with snakebite envenoming (SBE). While clinical assessment remains fundamental in treating SBE, this review aims to spotlight objective parameters that could also affect outcomes. Selected studies that identify factors associated with poor outcomes are predominantly region-specific, single-site, and observational, yet collectively reveal similar findings. They consistently report factors such as treatment delays, susceptibility in vulnerable groups such as children and pregnant women, as well as various biochemical and haematological abnormalities. Acute kidney injury (AKI), low platelets, leucocytosis, abnormal coagulation, and elevated creatine kinase (CK) all show an association with poor outcomes. Furthermore, recognising rare and unusual SBE presentations such as adrenal insufficiency, severe hypertension, intracranial haemorrhage, acute angle closure glaucoma, and bowel ischaemia also has a bearing on outcomes. Despite the integration of these parameters into clinical decision tools and guidelines, the validation of this evidence is limited. This review underscores the imperative for high-quality, multi-centre studies aligned with consensus-driven Core Outcome Sets (COS) and Patient-Reported Outcome Measures (PROMS) to validate and strengthen the current evidence.

Snake venom disintegrins update: insights about new findings

Snake venom disintegrins are low molecular weight, non-enzymatic proteins rich in cysteine, present in the venom of snakes from the families Viperidae, Crotalidae, Atractaspididae, Elapidae, and Colubridae. This family of proteins originated in venom through the proteolytic processing of metalloproteinases (SVMPs), which, in turn, evolved from a gene encoding an A Disintegrin And Metalloprotease (ADAM) molecule. Disintegrins have a recognition motif for integrins in their structure, allowing interaction with these transmembrane adhesion receptors and preventing their binding to proteins in the extracellular matrix and other cells. This interaction gives disintegrins their wide range of biological functions, including inhibition of platelet aggregation and antitumor activity. As a result, many studies have been conducted in an attempt to use these natural compounds as a basis for developing therapies for the treatment of various diseases. Furthermore, the FDA has approved Tirofiban and Eptifibatide as antiplatelet compounds, and they are synthesized from the structure of echistatin and barbourin, respectively. In this review, we discuss some of the main functional and structural characteristics of this class of proteins and their potential for therapeutic use.(AU)

Venenos animais como possíveis ferramentas terapéuticas contra o estresse oxidativo em diversas doengas: Revisao da Literatura / Animal venoms as possible therapeutic tools against oxidative stress in several diseases: Literature Review

Resumo Venenos sao uma substancia tóxica (composta por uma ou mais toxinas) que podem causando lesao fisiológica dependente da dose. As toxinas sao moléculas bioativas formadas principalmente por compostos enzimáticos e nao enzimático que porque provocam consequéncias indesejáveis nas presas, além disso, exibem atividades biológicas únicas, diversas e específicas que perturbam os processos fisiológicos normais. Entretanto, muitas toxinas, de diferentes animais, tém sido isoladas e muitas delas sao consideradas ótimas ferramentas para pesquisa básica e alvos terapéuticos. Foi relatado que o estresse oxidativo desempenha um papel fundamental na patogénese de várias doengas, como distúrbios neurodegenerativos, distúrbios cardiovasculares e cáncer. O mecanismo pelo qual as toxinas animais atuam nos parametros de estresse oxidativo em várias doengas, ainda nao está estabelecido. O foco principal desta revisao é destacar os principais estudos com toxinas animais como ferramenta terapéutica em diversas doengas, atuando no balango redox do organismo.

Abstract Venoms are a toxic substance (comprised of one or more toxins) that can cause dose-dependent physiological injury. Toxins are bioactive molecules formed primarily by enzymatic and non-enzymatic compounds that cause undesirable conse-quences in prey, in addition, exhibit unique, diverse and specific biological activities that disrupt normal physiological processes. However, many toxins, from different animals, have been isolated and many of them are considered great tools for basic research and therapeutic targets. Oxidative stress has been reported to play a key role in the pathogenesis of various diseases such as neurodegenerative disorders, cardiovascular disorders and cancer. How animal toxins act on oxidative stress parameters in several diseases is not yet established. The main focus of this review is to highlight the main studies with animal toxins as a therapeutic tool in several diseases, acting on the organism's redox balance.

Resumen Los venenos son sustancias tóxicas (compuestas por una o más toxinas) que pueden causar daño fisiológico dependiente de la dosis. Las toxinas son moléculas bioactivas formadas principalmente por compuestos enzimáticos y no enzimáticos que debido a que causan consecuencias indeseables en las presas, además, exhiben actividades biológicas únicas, diversas y específicas que alteran los procesos fisiológicos normales. Sin embargo, se han aislado muchas toxinas de diferentes animales, y muchos de ellos se consideran grandes herramientas para la investigación básica y dianas terapéuticas. Se ha informado que el estrés oxidativo juega un papel clave en la patogenia de diversas enfermedades, como los trastornos neurodegenerativos, enfermedades cardiovasculares y cáncer. El mecanismo por el cual las toxinas animales actúan sobre los parámetros de estrés oxidativo en vários enfermedades, aún no está establecido. El enfoque principal de esta revisión es resaltar los principales estudios con toxinas animales como herramienta terapéutica en diversas enfermedades, actuando en el equilibrio redox del organismo.

Caracterización bioquímica y biológica del veneno de la serpiente Neotropical Macagua (Bothrops Colombiensis) de la región de Barlovento, estado Miranda, Venezuela / Biological and biochemical characterization of the Neotropical Macagua (Bothrops colombiensis) snake venom from Barlovento region, Miranda state, Venezuela

Introducción: el veneno de B. colombiensis no es solamente un elemento tóxico; en su composición existen múltiples componentes, que tienen un gran potencial terapéutico, principalmente en el tratamiento de patologías de la trombosis y la coagulación. Objetivos: estudiar una mezcla de venenos de Bothrops colombiensis de una ubicacion geográfica de Venezuela, a fin de hacer un barrido de sus actividades hemostáticas, que permitirá posteriormente purificar y caracterizar moléculas con actividad antitrombótica y anticoagulantes, entre otras, con potencial terapéutico. Métodos: el veneno a estudiar, es una mezcla de ellos obtenidos de serpientes provenientes de la Región de Barlovento, estado Miranda, Venezuela. Se caracterizó bioquímicamente por cromatografias de exclusión molecular, cromatografía de fase reversa C18 y por electroforesis a través de SDS­PAGE; y biológicamente por medio de actividades relacionadas con la hemostasia. Se analizaron los perfiles en relación a las actividades fibrinolítica, proteolítica sobre polvo azul y cadena ß de insulina, procoagulante, hemorrágica y letal. Resultados: la actividad hemorrágica, definida como la Dosis Hemorrágica Mínima fue de 8,7 mg/kg. La letalidad, definida como la Dosis Letal cincuenta fue 8,7 mg/kg. El veneno presentó actividad procoagulante y fibrinolítica. Las fracciones mostraron actividad fibrinolítica y proteolítica sobre polvo azul de ocultamiento y sobre la cadena ß de insulina. Conclusiones: las características biológicas de los componentes de este veneno le confieren un enorme potencial terapéutico, ya que contiene una alta actividad fibrinolítica y anticoagulante. Estos compuestos una vez purificados y caracterizados podrían explorarse como coadyuvantes en procesos trombolíticos, dado que disuelven coágulos de fibrina y degradan fibrinógeno, evitando episodios de retrombosis(AU)

Introduction: This paper is a screening of multiple toxic activities, of which some will be potentially useful for the management of coagulation pathologies. Objetives: A pool of Bothrops colombiensis venoms from a specific geographical location was studied, in order to carry out a hemostatic activities screening, allowing then to purify and characterise molecules with antithrombotic and anticoagulant activity, among others, which could have therapeutic potential. Methods: The venom was chromatographically by molecular exclusion and reverse phase C18 and SDS -PAGE characterized; its hemostatic activity was also established. Snakes were from the region of Barlovento, Miranda state, Venezuela. Profiles of fibrinolytic, proteolytic, procoagulant, hemorrhagic and lethal activities were analyzed. Hemorrhagic activity was 8.7 mg/kg. The LD50 was 8.7 mg/kg. The venom showed strongly procoagulant activity. Both, crude venom as fractions showed high fibrinolytic activity. The majority of the eluted fractions showed significant proteolytic activity in azure blue powder and on ß chain of insulin. Conclusions: The biological characteristics of the components of this venom confer enormous therapeutic potential because they contain a high fibrinolytic and anticoagulant activity. Most of these proteinases, once purified and characterized, could be explored as thrombolytic agents given that dissolves fibrin clots or prevent their formation(AU)

Análise histológica e da aplicabilidade do adesivo cirúrgico derivado do veneno de cobra em feridas de animais diabéticos / Histological analysis and applicability of the surgical adhesive derived from snake venom in wounds of diabetic animals

Considerando que os dados epidemiológicos apontam uma elevação alarmante na incidência de diabetes na população mundial, muitos estudos vêm sendo realizados buscando estabelecer propostas preventivas e terapêuticas para esta patologia e suas complicações, principalmente em relação a cicatrização de feridas. A maneira convencional de unir os tecidos e as margens de feridas, utilizando suturas pode causar problemas como fístula e formação de granulomas, devido a uma incompatibilidade do tecido com os materiais de sutura, deiscência quando os materiais de sutura absorvível mostram desintegração precoce e isquemia tecidual com conseqüente necrose de borda da ferida quando uma sutura é muito apertada. Dentre os novos meios de adesão tecidual que têm sido idealizados, um deles é o adesivo biológico, tendo como objetivo selar tecidos e feridas sem produzir qualquer tipo de trauma O adesivo cirúrgico derivado do veneno de serpente é um produto biológico e biodegradável que não produz reações adversas, não contém produtos derivados do sangue humano, portanto não favorece transmissão de doenças infecciosas, tem uma capacidade de bom adesivo, e pode ser usado como coadjuvante nos procedimentos de sutura convencional. Este trabalho analisou, portanto, em feridas cirúrgicas feitas no dorso de ratos Wistar machos de três meses de idade diabéticos e não diabéticos três materiais utilizados como coadjuvantes na cicatrização de feridas cirúrgicas: sutura de nylon 5.0, a cola de fibrina comercial Tissucol® e o adesivo cirúrgico do veneno de serpente. Os animais foram eutanasiados nos períodos de três e sete dias do pós-operatório e as áreas das feridas foram analisadas microscopicamente através das colorações de Hematoxilina & Eosina e Tricrômio de Mallory. No experimento realizado constatamos que a reepitelização no grupo controle foi favorecida pelo material Tissucol®. A presença de infiltrado inflamatório mononuclear foi significativamente proeminente pelo uso do adesivo...

Whereas epidemiological data point to an alarming increase in the incidence of diabetes in the world population, many studies have been conducted to establish preventive and therapeutic proposals for this disease and its complications, especially in relation to wound healing. The conventional way of joining tissue and wound edges, using sutures may cause problems such as fistulas and granulomas due to incompatibility with the materials of the fabric of suture dehiscence when the absorbable suture materials show premature disintegration and tissue ischemia with subsequent necrosis of the wound edge when a suture is too tight. Among the new means of tissue adhesion that have been devised, one of them is the biological adhesive, aiming to "paste" and injured tissues without producing any kind of trauma. The surgical adhesive derived from snake venom is a biological product that is not biodegradable and produce adverse reactions, it does not contain human blood therefore does not favor the transmission of infectious diseases, have a good adhesive ability , and can be used as an adjunct to conventional suturing procedures. This study therefore considered in surgical wounds made in the back of male Wistar rats three months old diabetic and non-diabetic three materials used as adjuvants in the healing of surgical wounds: 5.0 nylon suture, the commercial fibrin seletante Tissucol® and surgical adhesive snake venom. The animals were sacrificed at three and seven days after surgery and wound areas were analyzed microscopically by staining with hematoxylin & eosin and Mallory trichrome . In the experiment we found that re-epithelialization in the control group was favored by the material Tissucol®. The presence of mononuclear cell infiltration was prominent significantly by the use of surgical adhesive derived from snake venom. Additionally, vascular proliferation was significantly enhanced by the use of surgical adhesive derived from snake venom...

Use of fibrin glue derived from snake venom in the repair of deep corneal ulcers: experimental study in dogs (Canis familiaris, Linnaeus, 1758)

Fibrin glue has been researched as an alternative method for tissue synthesis and is known for its capability to promote hemostasis at the application site, good approximation of wound edges and fast healing. The current study consisted in the application of fibrin glue derived from snake venom as treatment for experimental corneal ulcers. Twenty-one dogs had their corneas experimentally prepared through lamellar keratectomy (of standardized diameter and depth). Animals were divided into seven groups of three animals each. Six experimental groups were periodically evaluated and collection was carried out on the 1st, 3rd, 7th, 15th, 30th and 60th post-operative days, whereas one control group was evaluated throughout the experiment. Analyses consisted in the clinical evolution and in the histopathological study of all operated on eyes. Results indicated that fibrin glue was efficient in repairing keratectomy wounds in dogs and contributed to an earlier healing phenomenon, avoiding edema formation and keeping corneal clearness. The use of fibrin glue derived from snake venom showed to be easy to apply, feasible with animal models and of low cost, avoiding the lesion progress and allowing fast and appropriate corneal healing.

Alteraciones cardiovasculares inducidas por el veneno de Lachesis muta (Serpientes: Viperidae) y por su enzima fibrinogenolítica / Cardiovascular alterations induced by the venom of Lachesis muta (Serpentes: Viperidae) and for its fibrinogenolytic enzime

Se estudió la actividad fibrinolítica del veneno Lachesis muta stenophyrs y de su enzima fibrinogenolítica. Ratas Wistar cateterizadas e la arteria carótida y vena yugular fueron inoculadas con el veneno crudo o la enzima. Se monitoreó los cambios en la presión arterial, frecuencia cardíaca y electrocardiograma. La enzima indujo una mayor reducción del fibrinógeno en el veneno crudo sin causar alteraciones cardiovasculares o histológicas. In vitro el veneno crudo coaguló la sangre mientras que la enzima redujo el fibrinógeno en un 23 por ciento. Los resultados sugieren el uso potencial de la enzima fibrinogenolítica como agente antitrombótico

Antitumor effect of snake venoms

The search for biological antitumor agents has been pursued for over half a century. Snake venom has been shown to possess a wide spectrum of biological activities. The objectives of the present review are to evaluate the existing controversies on this subject published in a number of papers and to propose probable explanations for the phenomena observed. We reported our results obtained in a study, in which we evaluated the action of the venoms of Crotalus durissus terrificus and Bothrops jararaca on Ehrlich ascites tumor cells. We noticed an important antitumor effect, mainly with Bothrops jararaca venom, as well as an increase in the functional activity of macrophages. We also observed an increase in the number of mononuclear and polymorphonuclear cells with Bothrops jararaca venom. Considering these findings, we postulate that both Bothrops jararaca and Crotalus durissus terrificus venoms can act directly on tumor cells. In addition, we propose an indirect mechanism, based on the stimulation of the inflammatory response, to inhibit tumor growth and to promote its rejection.

Descripción de un programa para la determinación de capacidad de los antivenenos para neutralizar la actividad hemolítica de los venenos / Description of a program to determinate neutralizing antihemolitic capacity of antivenems

Se describe un programa en lenguaje Pascal para calcular la capacidad de los anntivenenos para neutralizar la actividad hemolítica indirecta de los venenos de serpientes, cuando se emplea la técnica de hemólisis radial descrita por Gutiérrez et al. el operador debe suministrar el número de niveles, asi como los niveles mayor y menor, el diámetro de los halos, de hemólisis y el diámetro del orificio que se hace en el gel para aplicar las muestras. El resultado se expresa como dosis efectiva 50%(DE50), definida como la razón Ul de antiveneno/mg de veneno en la que se neutraliza en un 50%la actividad hemolítica del veneno.