Observation of Bothrops atrox Snake Envenoming Blister Formation from Five Patients: Pathophysiological Insights

Author(s):Show less -

Gimenes, Sarah N. C. ^[1] ; Sachett, Jacqueline A. G. ^{[2, 3]} ; Colombini, Monica ^[1] ; Freitas-de-Sousa, Luciana A. ^[1] ; Ibiapina, Hiochelson N. S. ^{[4, 2]} ; Costa, Allyson G. ^{[2, 5]} ; Santana, Monique F. ^{[4, 2, 5]} ; Park, Jeong-Jin ^[6] ; Sherman, Nicholas E. ^[6] ; Ferreira, Luiz C. L. ^[4] ; Wen, Fan H. ^[7] ; Monteiro, Wuelton M. ^{[4, 2]} ; Moura-da-Silva, Ana M. ^{[1, 4]} ; Fox, Jay W. ^[6]

Affiliation

^[1] Inst Butantan, Lab Imunopatol, BR-05503900 Sao Paulo, SP - Brazil

^[2] Univ Estado Amazonas, Escola Super Ciencias Saude, BR-69050030 Manaus, Amazonas - Brazil

^[3] Fundacao Dermatol Alfredo da Matta, Dept Ensino & Pesquisa, BR-69065130 Manaus, Amazonas - Brazil

^[4] Fundacao Med Trop Dr Heitor Vieira Dourado, Dept Ensino & Pesquisa, BR-69040000 Manaus, Amazonas - Brazil

^[5] Fundacao Hematol & Hemoterapia Amazonas, Dept Ensino & Pesquisa, BR-69040010 Manaus, Amazonas - Brazil

^[6] Univ Virginia, Sch Med, Charlottesville, VA 22903 - USA

^[7] Inst Butantan, Nucleo Prod Soros, BR-05503900 Sao Paulo, SP - Brazil

• Document type: Journal article
• Source: TOXINS; v. 13, n. 11 NOV 2021.
• Web of Science Citations: 0

Abstract

In the Brazilian Amazon, Bothrops atrox snakebites are frequent, and patients develop tissue damage with blisters sometimes observed in the proximity of the wound. Antivenoms do not seem to impact blister formation, raising questions regarding the mechanisms underlying blister formation. Here, we launched a clinical and laboratory-based study including five patients who followed and were treated by the standard clinical protocols. Blister fluids were collected for proteomic analyses and molecular assessment of the presence of venom and antivenom. Although this was a small patient sample, there appeared to be a correlation between the time of blister appearance (shorter) and the amount of venom present in the serum (higher). Of particular interest was the biochemical identification of both venom and antivenom in all blister fluids. From the proteomic analysis of the blister fluids, all were observed to be a rich source of damage-associated molecular patterns (DAMPs), immunomodulators, and matrix metalloproteinase-9 (MMP-9), suggesting that the mechanisms by which blisters are formed includes the toxins very early in envenomation and continue even after antivenom treatment, due to the pro-inflammatory molecules generated by the toxins in the first moments after envenomings, indicating the need for local treatments with anti-inflammatory drugs plus toxin inhibitors to prevent the severity of the wounds. (AU)

• FAPESP's process: 17/24546-3 - Scales of biodiversity: integrated studies of snake evolution and venom function
• Grantee: Luciana Aparecida Freitas de Sousa
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 18/13108-8 - Translational studies on the importance of metalloproteinases in envenoming by Bothrops atrox in patients from the North region of Brazil
• Grantee: Sarah Natalie Cirilo Gimenes
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 19/08208-6 - Importance of metalloproteinases in envenoming by Bothrops atrox, in the Brazilian Amazon: experimental and translational approaches
• Grantee: Sarah Natalie Cirilo Gimenes
• Support Opportunities: Scholarships abroad - Research Internship - Post-doctor
• FAPESP's process: 16/50127-5 - Dimensions US-BIOTA São Paulo: scales of biodiversity: integrated studies of snake venom evolution and function across multiple levels of diversity
• Grantee: Inácio de Loiola Meirelles Junqueira de Azevedo
• Support Opportunities: BIOTA-FAPESP Program - Thematic Grants