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S A M Kularatne - One of the best experts on this subject based on the ideXlab platform.
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thrombotic microangiopathy hemolytic uremic syndrome and thrombotic thrombocytopenic purpura following hump nosed Pit Viper genus hypnale envenoming in sri lanka
Wilderness & Environmental Medicine, 2019Co-Authors: P Anusha Nishanthi E Ranathunga, Rathnayaka Mudiyanselage Namal M K Rathnayaka, S A M KularatneAbstract:Thrombotic microangiopathy (TMA), which includes the spectrum of hemolytic uremic syndrome and thrombotic thrombocytopenic purpura, is an uncommon complication of hump-nosed Pit Viper envenomation. We describe 4 cases of TMA following hump-nosed Pit Viper (Hypnale spp) bites in Sri Lanka. The first case is a typical TMA that spontaneously resolved with supportive treatments. The second and third cases are related to hemolytic uremic syndrome complicated with acute kidney injury that required hemodialysis. The fourth case is thrombotic thrombocytopenic purpura associated with acute kidney injury that required hemodialysis and therapeutic plasma exchange. For each patient we describe the circumstances of the bite, clinical features, laboratory findings, and management.
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cardiac arrest and atrial fibrillation in a patient after hump nosed Pit Viper hypnale hypnale bite
Toxicon, 2018Co-Authors: R Namal M M K Rathnayaka, P Nishanthi E A Ranathunga, Janaka Ranaweera, Krishantha Jayasekara, S A M KularatneAbstract:A 42-year-old previously healthy male patient died 16 days after a proven hump-nosed Pit Viper (Hypnale hypnale) envenoming due to multi-organ failure. On admission he had cardiac arrest that recovered from cardiopulmonary resuscitation then developed atrial fibrillation which was reverted to normal rhythm by application of synchronized electrical cardioversion. He also had persistent coagulopathy and thrombotic microangiopathy comprising the triad of microangiopathic haemolysis, acute kidney injury and thrombocytopenia. This is the second reported case with cardiac complications following hump-nosed Pit Viper bites in Sri Lanka.
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microangiopathic hemolytic anemia following three different species of hump nosed Pit Viper genus hypnale envenoming in sri lanka
Wilderness & Environmental Medicine, 2018Co-Authors: Rathnayaka Mudiyanselage Namal M K Rathnayaka, S A M Kularatne, Anusha Nishanthi Ranathunga, Jayantha Rajapakse, Shirani Ranasinghe, Radha JayathungaAbstract:There are 3 species of hump-nosed Pit Vipers in Sri Lanka: Hypnale hypnale , Hypnale zara , and Hypnale nepa. The latter 2 are endemic to the country. Microangiopathic hemolytic anemia (MAHA) is a known complication of hump-nosed Pit Viper bites. It was previously documented as a complication of general Viper bites and not species specific. We report a series of 3 patients who developed MAHA after being bitten by each species of hump-nosed Pit Viper. The first patient was bitten by H hypnale and developed a severe form of MAHA associated with acute kidney injury and thrombocytopenia falling into the category of thrombotic microangiopathy. The other 2 developed MAHA that resolved without any complications.
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epidemiology and clinical features of green Pit Viper trimeresurus trigonocephalus envenoming in sri lanka
Toxicon, 2017Co-Authors: R Namal M M K Rathnayaka, Pean Ranathunga, S A M KularatneAbstract:Abstract Green Pit Viper is a venomous endemic snake in Sri Lanka. But little is known regarding its envenoming in the country. This study was carried out in order to find out epidemiology and clinical profile of its bites. A series of 17 patients with Sri Lankan Green Pit Viper ( Trimeresurus trigonocephalus ) bites was prospectively studied over 4 years. The mean age was 36 ½ years (range 12–61 years) and comprised 14 (82%) males. Except one case, all bites occurred during day time (0600 h-1800 h) due to inadvertent provocation. In 13 cases (76%) bite took place in estates (tea or cinnamon) and 8 patients (47%) were estate workers. The bitten sites were upper limbs in 11 cases (65%) and lower limbs in 6 cases (35%). Ten patients (59%) brought the offending snake to the hosPital and one patient was asymptomatic. Sixteen (94%) developed local envenoming features- 16 (94%) local pain and swelling, 6 (35%) local bleeding and lymphadenopathy and blistering in 4 (24%) patients. Systemic envenoming developed in 4 (24%) patients including 3 (18%) with coagulopathy that was treated with fresh frozen plasma. One (6%) patient developed bradycardia. Sri Lankan Green Pit Viper bites commonly occurs in estates and causes local envenoming frequently and coagulopathy occasionally.
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prolonged coagulopathy ecchymoses and microangiopathic hemolytic anemia following hump nosed Pit Viper hypnale hypnale bite in sri lanka
Wilderness & Environmental Medicine, 2017Co-Authors: Rathnayaka Mudiyanselage Namal M K Rathnayaka, S A M Kularatne, Anusha Nishanthi Ranathunga, Mahinda Kumarasinghe, Jayantha Rajapakse, Shirani RanasingheAbstract:A 74-year-old previously healthy woman was bitten by a hump-nosed Pit Viper (Hypnale hypnale) at dusk causing incoagulable blood lasting for 6 days. Further, she developed ecchymoses over her forearms, upper arms, hands, and lower back on day 4 after the snakebite, and microangiopathic hemolytic anemia (MAHA). Features of this nature are rare after hump-nosed Pit Viper bite.
R Namal M M K Rathnayaka - One of the best experts on this subject based on the ideXlab platform.
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cardiac arrest and atrial fibrillation in a patient after hump nosed Pit Viper hypnale hypnale bite
Toxicon, 2018Co-Authors: R Namal M M K Rathnayaka, P Nishanthi E A Ranathunga, Janaka Ranaweera, Krishantha Jayasekara, S A M KularatneAbstract:A 42-year-old previously healthy male patient died 16 days after a proven hump-nosed Pit Viper (Hypnale hypnale) envenoming due to multi-organ failure. On admission he had cardiac arrest that recovered from cardiopulmonary resuscitation then developed atrial fibrillation which was reverted to normal rhythm by application of synchronized electrical cardioversion. He also had persistent coagulopathy and thrombotic microangiopathy comprising the triad of microangiopathic haemolysis, acute kidney injury and thrombocytopenia. This is the second reported case with cardiac complications following hump-nosed Pit Viper bites in Sri Lanka.
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epidemiology and clinical features of green Pit Viper trimeresurus trigonocephalus envenoming in sri lanka
Toxicon, 2017Co-Authors: R Namal M M K Rathnayaka, Pean Ranathunga, S A M KularatneAbstract:Abstract Green Pit Viper is a venomous endemic snake in Sri Lanka. But little is known regarding its envenoming in the country. This study was carried out in order to find out epidemiology and clinical profile of its bites. A series of 17 patients with Sri Lankan Green Pit Viper ( Trimeresurus trigonocephalus ) bites was prospectively studied over 4 years. The mean age was 36 ½ years (range 12–61 years) and comprised 14 (82%) males. Except one case, all bites occurred during day time (0600 h-1800 h) due to inadvertent provocation. In 13 cases (76%) bite took place in estates (tea or cinnamon) and 8 patients (47%) were estate workers. The bitten sites were upper limbs in 11 cases (65%) and lower limbs in 6 cases (35%). Ten patients (59%) brought the offending snake to the hosPital and one patient was asymptomatic. Sixteen (94%) developed local envenoming features- 16 (94%) local pain and swelling, 6 (35%) local bleeding and lymphadenopathy and blistering in 4 (24%) patients. Systemic envenoming developed in 4 (24%) patients including 3 (18%) with coagulopathy that was treated with fresh frozen plasma. One (6%) patient developed bradycardia. Sri Lankan Green Pit Viper bites commonly occurs in estates and causes local envenoming frequently and coagulopathy occasionally.
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coagulopathy and extensive local swelling following green Pit Viper trimeresurus trigonocephalus envenoming in sri lanka
Toxicon, 2017Co-Authors: R Namal M M K Rathnayaka, S A M Kularatne, Pean RanathungaAbstract:Trimeresurus trigonocephalus (Sri Lankan Green Pit Viper) is a moderately venomous arboreal snake endemic to Sri Lanka. Even though, its bites are not uncommon, published reports of such cases are limited to three in literature. We report three cases of coagulopathy following Green Pit Viper bites and treatment with fresh frozen plasma.
Shin Yee Fung - One of the best experts on this subject based on the ideXlab platform.
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venomics of calloselasma rhodostoma the malayan Pit Viper a complex toxin arsenal unraveled
Journal of Proteomics, 2016Co-Authors: Esther Lai Har Tang, Shin Yee FungAbstract:Abstract The venom of Malayan Pit Viper (Calloselasma rhodostoma) is highly toxic but also valuable in drug discovery. However, a comprehensive proteome of the venom that details its toxin composition and abundance is lacking. This study aimed to unravel the venom complexity through a multi-step venomic approach. At least 96 distinct proteins (29 basic, 67 acidic) in 11 families were identified from the venom. The venom consists of mainly snake venom metalloproteinases (SVMP, 41.17% of total venom proteins), within which the P-I (kistomin, 20.4%) and P-II (rhodostoxin, 19.8%) classes predominate. This is followed by C-type lectins (snaclec, 26.3%), snake venom serine protease (SVSP, 14.9%), L-amino acid oxidase (7.0%), phospholipase A2 (4.4%), cysteine-rich secretory protein (2.5%), and five minor toxins (nerve growth factor, neurotrophin, phospholipase B, 5′ nucleotidase and phosphodiesterase, totaling 2.6%) not reported in the proteome hitherto. Importantly, all principal hemotoxins unveiled correlate with the syndrome: SVSP ancrod causes venom-induced consumptive coagulopathy, aggravated by thrombocytopenia caused by snaclec rhodocytin, a platelet aggregation inducer, while P-II rhodostoxin mediates hemorrhage, exacerbated by P-I kistomin and snaclec rhodocetin that inhibit platelet plug formation. These toxins exist in multiple isoforms and/or complex subunits, deserving further characterization for the development of an effective, polyspecific regional antivenom. Biological significance Advents in proteomics and bioinformatics have vigorously propelled the scientific discoveries of toxins from various lineages of venomous snakes. The Malayan Pit Viper, Calloselasma rhodostoma, is a medically important species in Southeast Asia as its bite can cause envenomation, while the venom is also a source of bioactive compounds for drug discovery. Detailed profiling of the venom, however, is inadequate possibly due to the complex nature of the venom and technical limitation in separating the constituents into details. Integrating a multi-step fractionation method, this study successfully revealed a comprehensive and quantitative profile of the composition of the venom of this medically important venomous snake. The relative abundance of the various venom proteins is determined in a global profile, providing useful information for understanding the pathogenic roles of the different toxins in C. rhodostoma envenomation. Notably, the principal hemotoxins were identified in great details, including the variety of toxin subunits and isoforms. The findings indicate that these toxins are the principal targets for effective antivenom neutralization, and should be addressed in the production of a pan-regional polyspecific antivenom. In addition, minor toxin components not reported previously in the venom were also detected in this study, enriching the current toxin database for the venomous snakes.
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proteomic investigation of sri lankan hump nosed Pit Viper hypnale hypnale venom
Toxicon, 2015Co-Authors: Shin Yee Fung, Christeine Ariaranee GnanathasanAbstract:Abstract The hump-nosed Pit Viper, Hypanle hypnale , contributes to snakebite mortality and morbidity in Sri Lanka. Studies showed that the venom is hemotoxic and nephrotoxic, with some biochemical and antigenic properties similar to the venom of Calloselasma rhodostoma (Malayan Pit Viper). To further characterize the complexity composition of the venom, we investigated the proteome of a pooled venom sample from >10 Sri Lankan H. hypnale with reverse-phase high performance liquid chromatography (rp-HPLC), sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and peptide sequencing (tandem mass-spectrometry and/or N-terminal sequencing). The findings ascertained that two phospholipase A 2 subtypes (E6-PLA 2 , W6-PLA 2 ) dominate the toxin composition by 40.1%, followed by snake venom metalloproteases (36.9%), l -amino acid oxidase (11.9%), C-type lectins (5.5%), serine proteases (3.3%) and others (2.3%). The presence of the major toxins correlates with the venom's major pathogenic effects, indicating these to be the principal target toxins for antivenom neutralization. This study supports the previous finding of PLA 2 dominance in the venom but diverges from the view that H. hypnale venom has low expression of large enzymatic toxins. The knowledge of the composition and abundance of toxins is essential to elucidate the pathophysiology of H. hypnale envenomation and to optimize antivenom formulation in the future.
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pharmacokinetics of cryptelytrops purpureomaculatus mangrove Pit Viper venom following intravenous and intramuscular injections in rabbits
International Immunopharmacology, 2013Co-Authors: Kamelia Saremi, Shin Yee FungAbstract:Abstract The pharmacokinetic profiles of Cryptelytrops purpureomaculatus (mangrove Pit Viper) venom following intravenous and intramuscular injections were investigated in rabbits. The serum levels of the venom were estimated using double-sandwich enzyme-linked immunosorbent assay (ELISA). After intravenous injection (0.2 mg/kg), the serum venom concentration–time course declined in a biexponential manner, consistent with a two-compartment model, with an α-phase half-life of 0.25 h and a β-phase half-life of 27.7 h. The volume of distribution by area was 2.19 L/kg and systemic clearance was 54.7 mL/h/kg. When the venom was injected intramuscularly (0.5 mg/kg), the serum level increased rapidly to reach a peak (500 ng/mL) at about 1 h, which then declined rapidly to a plateau (104–142 ng/mL) at 3–10 h before further gradual decline until the end of the 72-hour study. The terminal half-life (27.0 h), clearance (54.7 mL/h/kg) and volume of distribution (2.13 L/kg) of the venom for intramuscular route were not significantly different from the corresponding values for intravenous route, and the intramuscular bioavailability of the venom was estimated to be 41.6%.
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enzymatic and toxinological activities of hypnale hypnale hump nosed Pit Viper venom and its fractionation by ion exchange high performance liquid chromatography
Journal of Venomous Animals and Toxins Including Tropical Diseases, 2011Co-Authors: C A Gnanathasan, Shin Yee Fung, Gnanajothy Ponnudurai, Jayalakshmi PailoorAbstract:Hypnale hypnale (hump-nosed Pit Viper) has been recently identified as one of the medically important venomous snakes in Sri Lanka and on the southwestern coast of India. The characterization of its venom is essential for understanding the pathophysiology of envenomation and for optimizing its management. In the present study, the biological properties of Hypnale hypnale venom and venom fractions obtained using Resource Q ion exchange chromatography were determined. The venom exhibited toxic activities typical of Pit Viper venom, comparable to that of its sister taxon, the Malayan Pit Viper (Calloselasma rhodostoma). Particularly noteworthy were its high activities of thrombin-like enzyme, proteases, phospholipase A2, L-amino acid oxidase and hyaluronidase. The thrombin-like enzyme was mainly acidic and distributed over several chromatography fractions, indicating its existence in multiple isoforms. The hemorrhagic and necrotic activities of the venom were likely associated with the proteolytic enzyme found mainly in the basic fraction. Phospholipase A2 and phosphomonoesterase exist in both acidic and basic isoforms, while L-amino acid oxidase and hyaluronidase are highly acidic. The venom clotting activity on fibrinogens showed distinct species specificity in the following increasing order for clotting time: bovine < rabbit < goat < human < horse < < dog, and was comparable to that of C. rhodostoma venom. Its clot formation on human fibrinogen is gradual and prolonged, a phenomenon suggestive of consumptive coagulopathy as a complication observed clinically. At an intramuscular sublethal dose, the venom did not cause acute kidney injury in a rodent model, contrary to the positive control group treated with Daboia russelii venom. Nephrotoxicity may result from higher venom doses in the context of coagulopathy, as a complication provoked by venom hematoxicity.
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cross neutralization of hypnale hypnale hump nosed Pit Viper venom by polyvalent and monovalent malayan Pit Viper antivenoms in vitro and in a rodent model
Acta Tropica, 2011Co-Authors: Poh Kuan Leong, Shin Yee Fung, Gnanajothy Ponnudurai, Christeine Ariaratnam, Sumana Khomvilai, Visith SitprijaAbstract:Hypnale hypnale (hump-nosed Pit Viper) is a medically important venomous snake in Sri Lanka and Southwestern India. Bite of this snake may result in hemostatic dysfunction, acute kidney injury and death. Clinical studies indicated that the locally available polyvalent antivenoms produced in India are not effective against hump-nosed Pit Viper envenoming. Hence, there is an urgent need to search for effective antivenom. In this paper, we examined the ability of Calloselasma rhodostoma (Malayan Pit Viper) monovalent antivenom and the Hemato polyvalent antivenom (both produced by Thai Red Cross Society, TRCS) to neutralize the lethality and toxic effects of H. hypnale venom, as C. rhodostoma is considered a sister taxon of H. hypnale. In vitro neutralization studies showed that the Hemato polyvalent antivenom effectively neutralized the lethality of H. hypnale venom (1.52 mg venom/mL antivenom) as well as the hemorrhagic, procoagulant and necrotic activities of the venom. The monovalent C. rhodostoma antivenom could also neutralize the lethality and toxic activities of the venom, but the potency was lower. The Hemato polyvalent antivenom also effectively protected mice from the lethal and local effects of H. hypnale venom in an in vivo rodent model of envenoming. Furthermore, the polyvalent antivenom could also effectively neutralize the venom of Daboia russelii (2.50 mg venom/mL antivenom), another common cause of snake bites in Sri Lanka and South India. These findings suggested that the Hemato polyvalent antivenom may be beneficial in the antivenom treatment of H. hypnale envenoming.
Ponlapat Rojnuckarin - One of the best experts on this subject based on the ideXlab platform.
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the structure function relationship of thrombin like enzymes from the green Pit Viper trimeresurus albolabris
Toxicon, 2015Co-Authors: Paweena Pradniwat, Ponlapat RojnuckarinAbstract:Pit Viper venoms can decrease fibrinogen levels in snakebite patients. Studies have shown that the hypofibrinogenemia is a consequence of snake venom thrombin-like enzymes (TLEs), the serine proteases that have the potential to be both diagnostic and therapeutic agents. Exosites of thrombin are the molecular regions that determine the substrate specificities, but its presence and significance in TLEs are unclear. Therefore, the putative exosites of recombinant TLEs derived from Green Pit Viper (Trimeresurus albolabris), GPV-TL1 and GPV-TL2, were mutated in a Pichia pastoris system. In a previous report, GPV-TL1 showed a strong fibrinogenolytic activity on the Aα and Bβ chains of fibrinogen, as well as a plasma clotting activity. Compared with GPV-TL1, the GPV-TL1m mutated in the putative exosite (TRN to RRR at residues 60–62) showed a weaker fibrinogenolytic activity with a similar clotting activity of 207.1 thrombin units/mg. GPV-TL2 contained two-residue differences from GPV-TL1 in the putative exosite (N73M and V74Y). GPV-TL2 selectively cleaved only the Aα chain of fibrinogen without detectable clotting activity. The mutated GPV-TL2 (GPV-TL2m) showed a weaker fibrinogenolytic activity compared with that of the wild type. These results support the important roles of the putative exosite in snake venom TLE activities. This information is helpful for future protein engineering.
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systemic antivenom and skin necrosis after green Pit Viper bites
Clinical Toxicology, 2008Co-Authors: Runyawan Chotenimitkhun, Ponlapat RojnuckarinAbstract:Introduction. As systemic effects of Viper venoms can be neutralized by antivenom, local tissue damage, particularly necrosis of the skin, has become a more significant problem. The goal of this study is to evaluate the effectiveness of antivenom in preventing dermatonecrosis in envenomated patients with severe coagulopathy. Methods. Retrospective review of medical records of patients who were envenomated by green Pit Vipers (Trimeresurus albolabris or T. macrops) following bites on fingers or toes and who came to Chulalongkorn hosPital from 1996 to 2006. Results. 1,886 records of suspected green Pit Viper bite patients were reviewed: 243 cases fit the inclusion criteria; 1,643 cases were excluded: uncertain diagnosis (931), bites at other sites (508), inadequate follow-up (196), and necrosis on presentation (8 patients). One-third of the 243 study cases (80 patients) received green Pit Viper F (ab')2 antivenom an average of 21 hours after envenomation for the treatment of severe coagulopathy. The other 1...
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green Pit Viper trimeresurus albolabris and t macrops venom antigenaemia and kinetics in humans
Tropical Doctor, 2007Co-Authors: Ponlapat Rojnuckarin, Sukit Banjongkit, Walee Chantawibun, Benjaporn Akkawat, Jumlong Juntiang, Jureeporn Noiphrom, Narumol Pakmanee, Tanin IntragumtornchaiAbstract:Green Pit Viper bite is a common public health problem in Southeast Asia. Although most patients experience only local swelling, some may suffer from severe systemic bleeding that can be delayed. V...
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the effects of green Pit Viper trimeresurus albolabris and trimeresurus macrops venom on the fibrinolytic system in human
Toxicon, 1999Co-Authors: Ponlapat Rojnuckarin, Orawan Khow, Narumol Pakmanee, Tanin Intragumtornchai, Rung Sattapiboon, Chuanchom Muanpasitporn, Daratana SwasdikulAbstract:Abstract Green Pit Viper ( Trimeresurus albolabris and Trimeresurus macrops ) venom was found to have a thrombin-like effect in vitro but cause a defibrination syndrome in vivo. The effects of venom on fibrinolytic system have not been well characterized. This knowledge can help to define the roles of antifibrinolytic therapy, give insights in fibrinolytic system regulation and potentially lead to identification of a new profibrinolytic agent from this venom. Forty-six cases of green Pit Viper bites were studied for various coagulation and fibrinolytic parameters and correlated with serum venom levels measured by ELISA. Fibrinolytic system activation is very common as indicated by low plasminogen (50%), low antiplasmin (56.5%) and elevated fibrin–fibrinogen degradation products (FDPs, 97.4%) levels. FDP test is very sensitive and a normal level is useful for exclusion of systemic envenomation. In contrast to some other models of defibrination syndrome, such as Russell Viper ( Daboia russelli siamensis ), elevation of plasminogen activator activity (PA) was found indicating a hyperfibrinolytic state. Definite increase in tissue-type plasminogen activator (t-PA) antigen ( p =0.00075) with a modest elevation of its inhibitor plasminogen activator inhibitor-1 (PAI-1) ( p =0.27) probably contributes to this effect. This supports the idea that the balance between plasminogen activators and inhibitors can determine fibrinolytic responses in pathologic states. Fibrinopeptide A levels were markedly elevated (68.43±51.57 ng/ml in cases and 2.83±3.80 ng/ml in control, p
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prognostic factors of green Pit Viper bites
American Journal of Tropical Medicine and Hygiene, 1998Co-Authors: Ponlapat Rojnuckarin, S Mahasandana, Tanin Intragumthornchai, Pranee Sutcharitchan, Daratana SwasdikulAbstract:Clinical features of green Pit Viper bites vary from asymptomatic to fatal bleeding. Antivenin promptly reverses the coagulopathy but has considerable adverse side effects. In this study, potential clinical predictors of severe outcomes (wound necrosis, wound infection, and systemic bleeding) and antivenin allergy were determined in 271 moderate to severe cases of green Pit Viper bites by multivariate analysis. The incidences of systemic bleeding, wound necrosis, secondary infection, and antivenin allergy were 17.3%, 6.6%, 5.5%, and 20.8% respectively. The predictors of systemic bleeding were the combination of thrombocytopenia and prolonged venous clotting time and bite sites away from digits. A bite on the fingers or toes was a risk factor for skin necrosis (P = 0.03). Systemic absorption of the venom from digits may be poor, resulting in severe local but mild systemic effects. The presence of blisters often led to necrosis and secondary infections (P = 0.0037 and P = 0.0006, respectively). Although negative skin test results do not exclude the possibility of antivenin allergy, positive results indicate a high risk (P = 0.016) requiring special precautions.
Visith Sitprija - One of the best experts on this subject based on the ideXlab platform.
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venomics of trimeresurus popeia nebularis the cameron highlands Pit Viper from malaysia insights into venom proteome toxicity and neutralization of antivenom
Toxins, 2019Co-Authors: Tzu Shan Ng, Sumana Khomvilai, Ahmad Khaldun Ismail, Evan S H Quah, Visith SitprijaAbstract:: Trimeresurus nebularis is a montane Pit Viper that causes bites and envenomation to various communities in the central highland region of Malaysia, in particular Cameron's Highlands. To unravel the venom composition of this species, the venom proteins were digested by trypsin and subjected to nano-liquid chromatography-tandem mass spectrometry (LC-MS/MS) for proteomic profiling. Snake venom metalloproteinases (SVMP) dominated the venom proteome by 48.42% of total venom proteins, with a characteristic distribution of P-III: P-II classes in a ratio of 2:1, while P-I class was undetected. Snaclecs constituted the second most venomous protein family (19.43%), followed by snake venom serine proteases (SVSP, 14.27%), phospholipases A₂ (5.40%), disintegrins (5.26%) and minor proteins including cysteine-rich secretory proteins, L-amino acid oxidases, phosphodiesterases, 5'-nucleotidases. The venomic profile correlates with local (painful progressive edema) and systemic (hemorrhage, coagulopathy, thrombocytopenia) manifestation of T. nebularis envenoming. As specific antivenom is unavailable for T. nebularis, the hetero-specific Thai Green Pit Viper Monovalent Antivenom (GPVAV) was examined for immunological cross-reactivity. GPVAV exhibited good immunoreactivity to T. nebularis venom and the antivenom effectively cross-neutralized the hemotoxic and lethal effects of T. nebularis (lethality neutralizing potency = 1.6 mg venom per mL antivenom). The findings supported GPVAV use in treating T. nebularis envenoming.
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cross reactivity and lethality neutralization of venoms of indonesian trimeresurus complex species by thai green Pit Viper antivenom
Toxicon, 2017Co-Authors: Jia Lee Liew, Sumana Khomvilai, Ahmad Khaldun Ismail, Tri Maharani, Visith SitprijaAbstract:Abstract Arboreal Pit Vipers of the Trimeresurus complex group are medically important species in Indonesia (west of Wallace's line), but there is no specific antivenom produced in the country for treating related envenomation. Instead, the exiting trivalent Indonesian antivenom, Biosave ® Serum Anti Bisa Ular (SABU, indicated for envenoming by Malayan Pit Viper, Javan sPitting cobra and banded krait) is often misused to treat Trimeresus envenoming resulting in poor therapeutic outcome. Here, we investigated the cross-reactivity and neutralization capability of Thai Green Pit Viper Antivenom (GPVAV) against the venoms of four Indonesian Trimeresurus species. Consistently, the venoms of Trimeresurus ( Trimeresurus) insularis , Trimeresurus ( Trimeresurus) purpureomaculatus , Trimeresurus ( Parias) hageni and Trimeresurus ( Craspedocephalus) puniceus of Indonesia showed stronger immunoreactivity on ELISA to GPVAV than to Biosave ® . The findings correlated with in vivo neutralization results, whereby GPVAV was far more effective than Biosave ® in cross-neutralizing the lethality of the venoms by a potency of at least 13 to 80 times higher. The efficacy of GPVAV is partly attributable to its cross-neutralization of the procoagulant effect of the venoms, thereby mitigating the progression of venom-induced consumptive coagulopathy. The paraspecific effectiveness of GPVAV against Trimeresurus species envenoming in Indonesia await further clinical investigation.
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cross neutralization of hypnale hypnale hump nosed Pit Viper venom by polyvalent and monovalent malayan Pit Viper antivenoms in vitro and in a rodent model
Acta Tropica, 2011Co-Authors: Poh Kuan Leong, Shin Yee Fung, Gnanajothy Ponnudurai, Christeine Ariaratnam, Sumana Khomvilai, Visith SitprijaAbstract:Hypnale hypnale (hump-nosed Pit Viper) is a medically important venomous snake in Sri Lanka and Southwestern India. Bite of this snake may result in hemostatic dysfunction, acute kidney injury and death. Clinical studies indicated that the locally available polyvalent antivenoms produced in India are not effective against hump-nosed Pit Viper envenoming. Hence, there is an urgent need to search for effective antivenom. In this paper, we examined the ability of Calloselasma rhodostoma (Malayan Pit Viper) monovalent antivenom and the Hemato polyvalent antivenom (both produced by Thai Red Cross Society, TRCS) to neutralize the lethality and toxic effects of H. hypnale venom, as C. rhodostoma is considered a sister taxon of H. hypnale. In vitro neutralization studies showed that the Hemato polyvalent antivenom effectively neutralized the lethality of H. hypnale venom (1.52 mg venom/mL antivenom) as well as the hemorrhagic, procoagulant and necrotic activities of the venom. The monovalent C. rhodostoma antivenom could also neutralize the lethality and toxic activities of the venom, but the potency was lower. The Hemato polyvalent antivenom also effectively protected mice from the lethal and local effects of H. hypnale venom in an in vivo rodent model of envenoming. Furthermore, the polyvalent antivenom could also effectively neutralize the venom of Daboia russelii (2.50 mg venom/mL antivenom), another common cause of snake bites in Sri Lanka and South India. These findings suggested that the Hemato polyvalent antivenom may be beneficial in the antivenom treatment of H. hypnale envenoming.