A polyspecific antivenom for Sri Lanka: first to include hypnale
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| Autores: | , , , , , , , , |
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| Fecha de Publicación: | 2017 |
| Descripción: | Introduction: Snakebite envenoming is a significant medical problem in Sri Lanka, with an estimated 40,000 hospital admissions annually. Despite the magnitude of this problem, there is no antivenom that has been developed derived from the venom of Sri Lankan snakes. Moreover, there is no antivenom specific for Hypnale spp. (H. hypnale, H. nepa, H. zara), viperid species reported to account for 22-77% of snakebite patients in the country. Hypnale species, commonly called Merrem’s hump-nosed pit viper, or kunakatuwa (Sinhala), are ubiquitous in distribution, being prevalent in tea, rubber, coconut plantations, and home gardens. Envenomation is rarely fatal, but significant morbidity is frequent. Hematological, nephrotoxic, and cerebral infarction have been reported. Venom analyses reported for all three Hypnale species have shown varying degrees of procoagulant activity, potent cytotoxic effects, and myotoxic, neurotoxic, and phospholipase A2 activities. Recent in vivo research in Sri Lanka has provided preliminary data suggesting potential Hypnale species-specific venom differences that influence the severity of clinical manifestations in envenomated patients. Para-specific protection against Hypnale venom-induced coagulopathic effects and lethality in animals by Malayan pit viper (Calloselasma rhodostoma) antivenom suggests the presence of similar venom antigens in the different genera; however, clinical efficacy in envenomated patients is unproven. Methods: A partnership to develop a Sri Lanka antivenom has involved academic groups (University of Peradeniya and Instituto Clodomiro Picado, University of Costa Rica), a non-profit public charity from the USA (Animal Venom Research International-AVRI), and a public antivenom manufacturer (Instituto Clodomiro Picado (ICP), University of Costa Rica). A basic toxicological characterization of Sri Lanka snake venoms has been performed using conventional laboratory assays at ICP. In parallel, horses have been immunized with the venoms of Daboia russelli, Echis carinatus, Hypnale hypnale and Naja naja, and a pilot batch of antivenom has been produced, which has been evaluated for its preclinical efficacy against these venoms. Results: This antivenom compares favorably with the currently used Indian antivenom; however, there is no comparison that can be made for Hypnale. A research clinical trial is to be conducted in 2016 in Sri Lanka which will involve a non-placebo treatment arm for Hypnale to evaluate antivenom safety and efficacy. |
| País: | Kérwá |
| Institución: | Universidad de Costa Rica |
| Repositorio: | Kérwá |
| Lenguaje: | Inglés |
| OAI Identifier: | oai:kerwa.ucr.ac.cr:10669/104966 |
| Acceso en línea: | https://hdl.handle.net/10669/104966 https://doi.org/10.1016/j.toxicon.2016.04.004 |
| Palabra clave: | Antivenom Hypnale Sri Lanka |