A randomized blinded clinical trial of two antivenoms, prepared by caprylic acid or ammonium sulphate fractionation of IgG, in Bothrops and Porthidium snake bites in Colombia: correlation between safety and biochemical characteristics of antivenoms

Otero, Rafael; Gutiérrez, José Marı́a; Rojas, Gustavo; Núñez, Vitelbina; Dı́az, Abel; Miranda, Edward Roshan; Uribe, Aída; Silva, J.F; Ospina, Jorge; Medina, Yenisley; Toro, María Eugenia; Garcı́a, Mildred; León, Guillermo; Lizano, Sergio; Torre, Javier de la; Márquez, Judith; Mena, Y; González, Nery Sablón; Arenas, L.C; Puzón, A; Blánco, N.; Sierra, Arturo; Espinal, Mariana; Arboleda, Margarita; Jiménez, JoséManuel; Ramírez, Patricia; Diaz, Mario; Guzmán, Miguel; Barros, Josie Gomes de Almeida; Henao, S; Ramí­rez, A.; Macea, U; Lozano, Rocío Castilla

doi:10.1016/s0041-0101(98)00220-7

Cited by 117 publications

(76 citation statements)

References 17 publications

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“…However, a number of clinical trials have yielded controversial results about the efficacy of snake antivenoms constituted by F(ab') 2 and Fab (2,7,9,31). Additionally, clinical studies with whole IgG antibodies produced by caprylic acid purification revealed a relatively low incidence of early adverse reactions (9,64). These conflicting results can be explained by the presence of variable aggregate levels in the product.…”

Section: Csa By the Fragment Fc Of Heterologous Antibodymentioning

confidence: 99%

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Snake antivenoms: adverse reactions and production technology

Morais¹,

Massaldi²

2009

J. Venom. Anim. Toxins incl. Trop. Dis

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Antivenoms have been widely used for more than a century for treating snakebites and other accidents with poisonous animals. Despite their efficacy, the use of heterologous antivenoms involves the possibility of adverse reactions due to activation of the immune system. In this paper, alternatives for antivenom production already in use were evaluated in light of their ability to minimize the occurrence of adverse reactions. These effects were classified according to their molecular mechanism as: anaphylactic reactions mediated by IgE, anaphylactoid reactions caused by complement system activation, and pyrogenic reactions produced mainly by the presence of endotoxins in the final product. In the future, antivenoms may be replaced by humanized antibodies, specific neutralizing compounds or vaccination. Meanwhile, improvements in antivenom quality will be focused on the obtainment of a more purified and specific product in compliance with good manufacturing practices and at an affordable cost.

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Section: Csa By the Fragment Fc Of Heterologous Antibodymentioning

confidence: 99%

“…The second precipitation and resuspension steps that take place in the classic ammonium sulfate fractionation protocol for an IgG or F(ab´) 2 product (10), seem to increase the aggregates level when compared to caprylic acid purification, in which the immunoglobulins remain in a soluble form continuously (12,22,24,64).…”

Section: Csa By Protein Aggregatesmentioning

confidence: 99%

Snake antivenoms: adverse reactions and production technology

Morais¹,

Massaldi²

2009

J. Venom. Anim. Toxins incl. Trop. Dis

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“…Otero et al (1999) evaluated the neutralization of the lethal effects of B. asper venom using 74 ethanol extracts of anti-ophidian plants, showing that 7 species completely inhibited this activity. Similarly, Mahanta and Mukherjee (2001) showed that aqueous extracts of the dried roots of Mimosa pudica L. inhibited the lethal effect of Naja kaouthia Lesson venom.…”

Section: Resultsmentioning

confidence: 99%

Anti-snake venom activities of extracts and fractions from callus cultures ofSapindus saponaria

Silva

Marcussi

Fernandes

et al. 2011

Pharmaceutical Biology

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“…In several experimental and clinical trials it has been demonstrated that antivenoms are of limited value to stop edema progression within the first 12-24 h of treatment, while they are highly efficient in restoring blood coagulation status within the same time interval (7,22,23).…”

Section: Discussionmentioning

confidence: 99%

Neutralization of the edema-forming, defibrinating and coagulant effects of Bothrops asper venom by extracts of plants used by healers in Colombia

Núñez

Otero

Barona

et al. 2004

Braz J Med Biol Res

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We determined the neutralizing activity of 12 ethanolic extracts of plants against the edema-forming, defibrinating and coagulant effects of Bothrops asper venom in Swiss Webster mice. The material used consisted of the leaves and branches of Bixa orellana (Bixaceae), Ficus nymphaeifolia (Moraceae), Struthanthus orbicularis (Loranthaceae) and Gonzalagunia panamensis (Rubiaceae); the stem barks of Brownea rosademonte (Caesalpiniaceae) and Tabebuia rosea (Bignoniaceae); the whole plant of Pleopeltis percussa (Polypodiaceae) and Trichomanes elegans (Hymenophyllaceae); rhizomes of Renealmia alpinia (Zingiberaceae), Heliconia curtispatha (Heliconiaceae) and Dracontium croatii (Araceae), and the ripe fruit of Citrus limon (Rutaceae). After preincubation of varying amounts of each extract with either 1.0 µg venom for the edema-forming effect or 2.0 µg venom for the defibrinating effect, the mixture was injected subcutaneously (sc) into the right foot pad or intravenously into the tail, respectively, to groups of four mice (18-20 g). All extracts (6.2-200 µg/mouse) partially neutralized the edema-forming activity of venom in a dose-dependent manner (58-76% inhibition), with B. orellana, S. orbicularis, G. panamensis, B. rosademonte, and D. croatii showing the highest effect. Ten extracts (3.9-2000 µg/mouse) also showed 100% neutralizing ability against the defibrinating effect of venom, and nine prolonged the coagulation time induced by the venom. When the extracts were administered either before or after venom injection, the neutralization of the edema-forming effect was lower than 40% for all extracts, and none of them neutralized the defibrinating effect of venom. When they were administered in situ (sc at the same site 5 min after venom injection), the neutralization of edema increased for six extracts, reaching levels up to 64% for C. limon.

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A randomized blinded clinical trial of two antivenoms, prepared by caprylic acid or ammonium sulphate fractionation of IgG, in Bothrops and Porthidium snake bites in Colombia: correlation between safety and biochemical characteristics of antivenoms

Cited by 117 publications

References 17 publications

Snake antivenoms: adverse reactions and production technology

Snake antivenoms: adverse reactions and production technology

Anti-snake venom activities of extracts and fractions from callus cultures ofSapindus saponaria

Neutralization of the edema-forming, defibrinating and coagulant effects of Bothrops asper venom by extracts of plants used by healers in Colombia

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