Gutiérrez José María, León Guillermo, Lomonte Bruno, Angulo Yamileth
Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica.
Inflamm Allergy Drug Targets. 2011 Oct;10(5):369-80. doi: 10.2174/187152811797200669.
Animal-derived antivenoms constitute the mainstay in the therapy of snakebite envenoming. Antivenoms are manufactured by immunizing animals, usually horses, with venoms from a single or several medically-relevant snake species. Antivenoms are constituted by either whole IgG molecules or the immunoglobulin fragments F(ab')₂ and Fab, obtained by digestion with pepsin and papain, respectively. Differences in the pharmacokinetics of these active substances have pharmacodynamic implications. Novel technological possibilities may improve the quality of antivenoms in the future, as well as their microbial safety. Antivenom administration might induce early and late adverse reactions, whose possible mechanisms are discussed. Owing to the large variety in the composition of snake venoms and to the need to demonstrate neutralization of relevant snake venoms in different countries, a meticulous preclinical and clinical assessment of antivenom efficacy and safety is required before an antivenom is introduced into clinical application. The accessibility of antivenoms in low-income tropical countries is of concern and efforts should be directed at guaranteeing the access of safe and effective antivenoms at affordable prices and their correct clinical use in these countries.
动物源性抗蛇毒血清是治疗蛇咬伤中毒的主要手段。抗蛇毒血清是通过用一种或几种具有医学相关性的蛇类毒液免疫动物（通常是马）来生产的。抗蛇毒血清由完整的IgG分子或分别用胃蛋白酶和木瓜蛋白酶消化获得的免疫球蛋白片段F(ab')₂和Fab组成。这些活性物质药代动力学的差异具有药效学意义。新的技术可能性未来可能会提高抗蛇毒血清的质量及其微生物安全性。抗蛇毒血清的给药可能会引发早期和晚期不良反应，并对其可能的机制进行了讨论。由于蛇毒成分差异很大，且需要在不同国家证明对相关蛇毒的中和作用，因此在抗蛇毒血清投入临床应用之前，需要对其疗效和安全性进行细致的临床前和临床评估。低收入热带国家抗蛇毒血清的可及性令人担忧，应努力确保以可承受的价格提供安全有效的抗蛇毒血清，并确保其在这些国家得到正确的临床使用。
