Immuchemistry Laboratory, Butantan Institute, São Paulo 05503-900, Brazil.
Biopharmaceuticals Laboratory, Butantan Institute, São Paulo 05503-900, Brazil.
Toxins (Basel). 2022 Sep 1;14(9):606. doi: 10.3390/toxins14090606.
Snakebite envenomation is considered a neglected tropical disease, affecting tens of thousands of people each year. The recommended treatment is the use of antivenom, which is composed of immunoglobulins or immunoglobulin fragments obtained from the plasma of animals hyperimmunized with one (monospecific) or several (polyspecific) venoms. In this review, the efforts made in the improvement of the already available antivenoms and the development of new antivenoms, focusing on snakes of medical importance from sub-Saharan Africa and Latin America, are described. Some antivenoms currently used are composed of whole IgGs, whereas others use F(ab')2 fragments. The classic methods of attaining snake antivenoms are presented, in addition to new strategies to improve their effectiveness. Punctual changes in immunization protocols, in addition to the use of cross-reactivity between venoms from different snakes for the manufacture of more potent and widely used antivenoms, are presented. It is known that venoms are a complex mixture of components; however, advances in the field of antivenoms have shown that there are key toxins that, if effectively blocked, are capable of reversing the condition of in vivo envenomation. These studies provide an opportunity for the use of monoclonal antibodies in the development of new-generation antivenoms. Thus, monoclonal antibodies and their fragments are described as a possible alternative for the production of antivenoms, regardless of the venom. This review also highlights the challenges associated with their development.
蛇伤中毒被认为是一种被忽视的热带病，每年影响数万人。推荐的治疗方法是使用抗蛇毒血清，它由免疫球蛋白或免疫球蛋白片段组成，这些免疫球蛋白或免疫球蛋白片段是从用一种（单特异性）或几种（多特异性）毒液高度免疫的动物的血浆中获得的。在这篇综述中，描述了在改进现有的抗蛇毒血清和开发新的抗蛇毒血清方面所做的努力，重点是来自撒哈拉以南非洲和拉丁美洲的具有医学重要性的蛇类。目前使用的一些抗蛇毒血清由完整的 IgG 组成，而另一些则使用 F(ab')2 片段。除了新的策略来提高它们的有效性外，还介绍了获得蛇抗蛇毒血清的经典方法。除了使用来自不同蛇的毒液之间的交叉反应性来制造更有效和更广泛使用的抗蛇毒血清外，还提出了免疫接种方案的即时变化。众所周知，毒液是一种复杂的成分混合物；然而，抗蛇毒血清领域的进展表明，存在一些关键毒素，如果有效地阻断这些毒素，就能够逆转体内蛇伤中毒的状况。这些研究为使用单克隆抗体开发新一代抗蛇毒血清提供了机会。因此，单克隆抗体及其片段被描述为生产抗蛇毒血清的一种可能替代方法，而与毒液无关。这篇综述还强调了与它们的发展相关的挑战。
