Gutiérrez J M, León G, Rojas G, Lomonte B, Rucavado A, Chaves F
Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José.
Toxicon. 1998 Nov;36(11):1529-38. doi: 10.1016/s0041-0101(98)00145-7.
Local tissue damage represents a serious consequence of Bothrops asper envenomations. It encompasses a complex series of alterations, including myonecrosis, dermonecrosis, hemorrhage and edema. Due to its rapid development it is difficult to neutralize by antivenoms, especially if there is a delay in serotherapy. Experimental studies with this venom and the polyvalent (Crotalinae) antivenom produced in Costa Rica indicate that antivenom is effective in neutralizing these toxic activities when incubated with the venom prior to injection. However, if venom and antivenom are injected independently in mice, neutralization of these effects is only partial. Moreover, neutralization is not complete even if homologous or heterologous antibodies are present in the circulation before venom is injected. Despite differences in their pharmacokinetic profiles, equine whole IgG and F(ab')2 antivenoms show similar efficacy in the neutralization of edema, hemorrhage and myonecrosis induced by B. asper venom, suggesting that the use of antivenoms made of antibody fragments may not improve neutralization of these effects. This is due, at least in part, to the fact that microvessel disruption by venom components favors a similar antibody concentration in the affected tissues. Recent advances in the development of neutralizing substances of rapid diffusion, that could be injected locally in the field, may contribute to the neutralization of metalloproteinases and phospholipases A2. In addition, the rapid administration of antivenoms with high antibody titers against locally-acting toxins is very important in the treatment of these effects.
本地组织损伤是矛头蝮蛇咬伤的严重后果。它包括一系列复杂的改变，包括肌坏死、皮肤坏死、出血和水肿。由于其发展迅速，抗蛇毒血清很难中和，特别是如果血清疗法延迟的话。对这种毒液和在哥斯达黎加生产的多价（响尾蛇科）抗蛇毒血清进行的实验研究表明，在注射前将抗蛇毒血清与毒液一起孵育时，抗蛇毒血清能有效中和这些毒性活性。然而，如果毒液和抗蛇毒血清分别注射到小鼠体内，这些作用的中和只是部分的。此外，即使在注射毒液之前循环中存在同源或异源抗体，中和也不完全。尽管马全IgG和F(ab')2抗蛇毒血清的药代动力学特征不同，但它们在中和矛头蝮蛇毒液引起的水肿、出血和肌坏死方面显示出相似的效果，这表明使用由抗体片段制成的抗蛇毒血清可能不会改善对这些作用的中和。这至少部分是由于毒液成分对微血管的破坏有利于在受影响组织中形成相似的抗体浓度。开发能够在现场局部注射的快速扩散中和物质方面的最新进展，可能有助于中和金属蛋白酶和磷脂酶A2。此外，快速给予针对局部作用毒素的高抗体效价抗蛇毒血清在治疗这些作用方面非常重要。
