Ramos Henrique Roman, Vassão Ruth Camargo, de Roodt Adolfo Rafael, Santos E Silva Ed Carlos, Mirtschin Peter, Ho Paulo Lee, Spencer Patrick Jack
a Centro de Biotecnologia , Instituto Butantan , São Paulo , Brazil.
b Departamento de Ciências da Saúde , Universidade Nove de Julho , São Paulo , Brazil.
Clin Toxicol (Phila). 2017 Jan;55(1):33-39. doi: 10.1080/15563650.2016.1222615. Epub 2016 Sep 5.
Although rare, coral snake envenomation is a serious health threat in Brazil, because of the highly neurotoxic venom and the scarcely available antivenom. The major bottleneck for antivenom production is the low availability of venom. Furthermore, the available serum is not effective against all coral snake species found in Brazil. An alternative to circumvent the lack of venom for serum production and the restricted protection of the actually available antivenom would be of great value. We compared the Brazilian coral snake and mono and polyvalent Australian antivenoms in terms of reactivity and protection.
The immunoreactivity of venoms from 9 coral snakes species were assayed by ELISA and western blot using the Brazilian Micrurus and the Australian pentavalent as well as monovalent anti-Notechis, Oxyuranus and Pseudechis antivenoms. Neutralization assays were performed in mice, using 3 LD of the venoms, incubated for 30 minutes with 100 μL of antivenom/animal.
All the venoms reacted against the autologous and heterologous antivenoms. Nevertheless, the neutralization assays showed that the coral snake antivenom was only effective against M. corallinus, M. frontalis, M. fulvius, M. nigrocinctus and M. pyrrhocryptus venoms. On the other hand, the Australian pentavalent antivenom neutralized all venoms except the one from M. spixii. A combination of anti-Oxyuranus and Pseudechis monovalent sera, extended the protection to M. altirostris and, partially, to M. ibiboboca. By adding Notechis antivenom to this mixture, we obtained full protection against M. ibiboboca and partial neutralization against M. lemniscatus venoms.
Our findings confirm the limited effectiveness of the Brazilian coral snake antivenom and indicate that antivenoms made from Australian snakes venoms are an effective alternative for coral snake bites in South America and also in the United States were coral snake antivenom production has been discontinued.
尽管珊瑚蛇咬伤事件罕见，但在巴西，由于其毒液具有高度神经毒性且抗蛇毒血清供应稀缺，这对健康构成了严重威胁。抗蛇毒血清生产的主要瓶颈在于毒液供应不足。此外，现有的血清对巴西发现的所有珊瑚蛇种类并不都有效。找到一种方法来规避血清生产中毒液短缺以及现有抗蛇毒血清保护范围有限的问题将具有重要价值。我们比较了巴西珊瑚蛇抗蛇毒血清与澳大利亚单价和多价抗蛇毒血清的反应性和保护效果。
使用巴西珊瑚蛇属蛇毒以及澳大利亚五价和单价抗诺氏蛇属、太攀蛇属和伪盾蛇属蛇毒血清，通过酶联免疫吸附测定法（ELISA）和蛋白质印迹法检测9种珊瑚蛇毒液的免疫反应性。在小鼠身上进行中和试验，使用3倍半数致死量（LD）的毒液，与每只动物100μL抗蛇毒血清孵育30分钟。
所有毒液均与自身及异源抗蛇毒血清发生反应。然而，中和试验表明，珊瑚蛇抗蛇毒血清仅对珊瑚林蛇、眉珊瑚蛇、黄腹珊瑚蛇、黑带珊瑚蛇和红隐珊瑚蛇的毒液有效。另一方面，澳大利亚五价抗蛇毒血清能中和除斯氏珊瑚蛇毒液外的所有毒液。抗太攀蛇属和伪盾蛇属单价血清的组合将保护范围扩大至高地珊瑚蛇，对伊比波博卡珊瑚蛇也有部分保护作用。在该混合物中加入抗诺氏蛇属蛇毒血清后，我们获得了对伊比波博卡珊瑚蛇的完全保护以及对饰纹珊瑚蛇毒液的部分中和效果。
我们的研究结果证实了巴西珊瑚蛇抗蛇毒血清的有效性有限，并表明由澳大利亚蛇毒制成的抗蛇毒血清是南美洲以及美国珊瑚蛇咬伤的有效替代方案，在美国，珊瑚蛇抗蛇毒血清的生产已停止。
