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抗蛇毒血清治疗蛇咬伤中毒疗效的临床前评估:现状与未来挑战

Preclinical Evaluation of the Efficacy of Antivenoms for Snakebite Envenoming: State-of-the-Art and Challenges Ahead.

作者信息

Gutiérrez José María, Solano Gabriela, Pla Davinia, Herrera María, Segura Álvaro, Vargas Mariángela, Villalta Mauren, Sánchez Andrés, Sanz Libia, Lomonte Bruno, León Guillermo, Calvete Juan J

机构信息

Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José 11501-2060, Costa Rica.

Instituto de Biomedicina de Valencia, CSIC, Valencia 46010, Spain.

出版信息

Toxins (Basel). 2017 May 13;9(5):163. doi: 10.3390/toxins9050163.

Abstract

Animal-derived antivenoms constitute the mainstay in the therapy of snakebite envenoming. The efficacy of antivenoms to neutralize toxicity of medically-relevant snake venoms has to be demonstrated through meticulous preclinical testing before their introduction into the clinical setting. The gold standard in the preclinical assessment and quality control of antivenoms is the neutralization of venom-induced lethality. In addition, depending on the pathophysiological profile of snake venoms, the neutralization of other toxic activities has to be evaluated, such as hemorrhagic, myotoxic, edema-forming, dermonecrotic, in vitro coagulant, and defibrinogenating effects. There is a need to develop laboratory assays to evaluate neutralization of other relevant venom activities. The concept of the 3Rs (Replacement, Reduction, and Refinement) in Toxinology is of utmost importance, and some advances have been performed in their implementation. A significant leap forward in the study of the immunological reactivity of antivenoms against venoms has been the development of "antivenomics", which brings the analytical power of mass spectrometry to the evaluation of antivenoms. International partnerships are required to assess the preclinical efficacy of antivenoms against snake venoms in different regions of the world in order to have a detailed knowledge on the neutralizing profile of these immunotherapeutics.

摘要

动物源抗蛇毒血清是治疗蛇咬伤中毒的主要手段。在将抗蛇毒血清引入临床之前,必须通过细致的临床前测试来证明其中和具有医学相关性的蛇毒毒性的功效。抗蛇毒血清临床前评估和质量控制的金标准是中和毒液诱导的致死性。此外,根据蛇毒的病理生理特征,还必须评估其他毒性活性的中和情况,如出血、肌毒性、形成水肿、皮肤坏死、体外凝血和去纤维蛋白作用。需要开发实验室检测方法来评估其他相关毒液活性的中和情况。毒素学中的3R(替代、减少和优化)概念至关重要,并且在其实施方面已经取得了一些进展。抗蛇毒血清与蛇毒免疫反应性研究的一个重大飞跃是“抗蛇毒血清组学”的发展,它将质谱分析能力引入抗蛇毒血清的评估。需要建立国际合作关系,以评估抗蛇毒血清在世界不同地区针对蛇毒的临床前疗效,以便详细了解这些免疫疗法的中和特性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c960/5450711/f9f7fea55347/toxins-09-00163-g001.jpg

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