Evidence that Crotalus durissus terrificus (South American rattlesnake) envenomation in humans causes myolysis rather than hemolysis

The venom of the South American rattlesnake Crotalus durissus terrificus was originally reported to have a pathophysiological activity mainly involving hemolysis and neurotoxicity. The systemic myotoxic action of this venom was demonstrated in 1985. In the present paper we report clinical and laboratory data concerning three patients bitten by C. durissus terrificus and treated at the University Hospital of Ribeir?o Preto, University of S?o Paulo. The normal haptoglobin levels detected in the serum of these patients during the first 48 hr after the accident, as well as the absence of hemoglobin in darkened urine samples as evaluated by immunodiffusion against anti-hemoglobin serum, rule out the occurrence of intravascular hemolysis. These data permit us to conclude that the signs and symptoms observed in human envenomation with C. durissus terrificus are due to a myotoxic and neurotoxic action of the venom.     

Effects of convulxin,a toxin from rattlesnake venom,on platelets and leukocytes of anesthetized rabbits

Convulxin is a high molecular weight toxin isolated from rattlesnake (Crotalus durissus terrificus, Crotalus durissus collilineatus, Crotalus durissus cascavella) venom. When administered i.v. it reduces the number of circulating platelets and leukocytes of anesthetized rabbits in a dose dependent manner. Small doses induce reversible platelet aggregation, and larger doses cause lysis. The doses of convulxin that cause platelet lysis also evoke cardiovascular and respiratory disturbances in anesthetized animals. These effects were also observed when platelets which were preincubated with convulxin in vitro were administered to animals which had received antivenom serum. This indicates that convulxin may act by releasing substances contained in the platelets.     

A comparative study of biological activities of crotoxin and CB fraction of venoms from Crotalus durissus terrificus, Crotalus durissus cascavella and Crotalus durissus collilineatus.

In Brazil, the Crotalus durissus terrificus subspecie is the most studied, particularly concerning its crotoxin. Crotoxin is the major toxic component of the South American rattlesnake Crotalus durissus venom. It is composed of two different subunits, CA called crotapotin and CB weakly toxic phospholipase A2 with high enzymatic activity. In this paper, we decided to make a study of the main toxic characteristics of crotoxin (CTX) and CB fraction from the other subspecies, Crotalus durissus cascavella and of Crotalus durissus collilineatus, in comparison with those of C. d. terrificus. Ours results have shown that the venoms presented similar chromatographic profiles and the purified fractions were free of contaminants. Regarding the toxic activities, the DL50 of the crotoxins showed no significant differences between the subspecies. The smaller toxicity of CB indicated that the toxicity of the crotoxin complex depends on the interaction between CA and CB. CTX and fraction CB of the three species of Crotalus showed negligible proteolytic activity. C. d. terrificus CTX presented higher PLA2 activity when compared with the others two subspecies. The oedema induced by CB developed later than the CTX and reached its peak 3 h after the injection. The myotoxic activity was determined by assaying serum CK levels. Mice injected with CTX of C. d. terrificus presented greater myotoxic activity compared to the others. The myotoxic activity of CB from the three subspecies was lower than the activity of the crotoxin, reinforcing the idea that the fraction CA increases the toxicity of CB.     

Serum kinetics of crotoxin from Crotalus durissus terrificus venom in mice: evidence for a rapid clearance.

We report on an ELISA for the detection of crotoxin with a detection limit of 1-3 pg/ml of sample. Cross-reactivity with other animal venoms occurred only at concentrations above 1 microgram/ml. Serum kinetics of crotoxin were investigated in BALB/c mice after a single 10 micrograms s.c. dose of venom obtained from Crotalus durissus terrificus. Crotoxin levels were 254 +/- 141 ng/ml serum (X +/- S.E.) 15 min after venom injection, 3.9 +/- 0.5 ng/ml serum at 30 min and undetectable thereafter. The rapid clearance of crotoxin from the serum suggests that the test may be unsuitable for the clinical management of envenomation victims.     

Biochemical and pharmacological similarities between the venoms of newborn Crotalus durissus durissus and adult Crotalus durissus terrificus rattlesnakes.

A comparative study was performed with the venoms of newborn Crotalus durissus durissus, adult Crotalus durissus terrificus and adult Crotalus durissus durissus snakes. Venom of newborn specimens of C.d. durissus is very similar to that of adult specimens of C.d. terrificus, since they have strong lethal and myotoxic activities, and weak proteolytic, hemorrhagic and edema-forming effects, in contrast to venom of adult specimens of C.d. durissus. In addition, the two former venoms have high amounts of the neurotoxic complex crotoxin, whereas venom from adult C.d. durissus has a low concentration of crotoxin. Electrophoretic analysis corroborates the strong similarities between the former two venoms. It is concluded that venom of newborn C.d. durissus contains high concentrations of crotoxin and low amounts of hemorrhagic and proteolytic components, and that a drastic ontogenetic change takes place in the venom composition of this subspecies.     

delta-opioid receptors and nitric oxide mediate the analgesic effect of Crotalus durissus terrificus snake venom

The antinociceptive effect of Crotalus durissus terrificus venom was investigated in a model of inflammatory hyperalgesia induced by carrageenin. The rat paw pressure test was applied before and 3 h after the intraplantar (i.pl.) injection of carrageenin. The venom administered per os before and 1 or 2 h after carrageenin blocked hyperalgesia. When carrageenin was injected in both hind paws and naloxone into one hind paw, antinociception was abolished only in the paw injected with naloxone. D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr amide (CTOP) and nor-binaltorphimine, antagonists of micro- and kappa-opioid receptors, respectively, did not alter the effect of the venom. N,N-diallyl-Tyr-Aib-Aib-Phe-Leu (ICI 174,864), an antagonist of delta-opioid receptors, antagonised this effect. Prolonged administration of the venom did not induce tolerance to this antinociceptive effect. N(G)-methyl-L-arginine (L-NMMA) and methylene blue, inhibitors of nitric oxide synthase and soluble guanylate cyclase, respectively, injected i.pl., antagonised antinociception. These data indicate that both delta-opioid receptors and nitric oxide participate in the mediation of the peripheral antinociceptive effect of C. durissus terrificus venom.     

Several isoforms of crotoxin are present in individual venoms from the South American rattlesnake Crotalus durissus terrificus

Crotalus durissus terrificus venoms collected either from individual snakes or from a large number of animals (more than 30) have been fractionated by high performance liquid chromatography on gel-filtration and ion exchange columns. The chromatographic patterns obtained with individual venom samples indicated that each Crotalus durissus terrificus snake synthesizes five to ten different crotoxin isoforms in widely variable relative proportions. Furthermore, the heterogeneity of venom samples collected from a large number of snakes did not appear significantly larger than that observed with venoms obtained from individual snakes. The comparison of the chromatographic patterns that we obtained with the various (individual and pooled) venoms allowed us to identify about 15 crotoxin isoforms, which may result from the expression of isogenes, since two amino acid variants have been reported to occur at several positions in the sequence of crotoxin component B. These observations confirm the existence of numerous molecular isoforms of crotoxin and suggest that an individual Crotalus durissus terrificus snake possesses several genes coding for the various crotoxin isoforms. The heterogeneity of venom samples collected from a large number of animals is explained, in a large measure, by the complexity of the venom obtained from the individual snakes.     

Absence of myocardial involvement in children victims of Crotalus durissus terrificus envenoming.

The myotoxic activity of the venom of Crotalus durissus terrificus is demonstrable by increased serum levels of the enzymes creatine kinase (CK), lactate dehydrogenase (LD), and aspartate aminotransferase. Serial measurements of CK, LD and their isoenzymes in bite victims showed a pattern similar to that observed in acute myocardial infarction, although the clinical course and electro- and echocardiographic data did not suggest cardiac involvement. These data have raised the hypothesis that crotalid venom preferentially causes damage to type I and/or type IIa fibers, which contain quantities of CK-MB and LD1 similar to those found in cardiac fibers. In order to detect a possible concomitant silent cardiac involvement, seven children with severe crotalid envenoming were studied. Serum troponin I, determined more than once in each patient, were found to be normal. These data demonstrate the absence of cardiac involvement in these patients envenomed by C. durissus terrificus and confirmed the skeletal muscle origin of the elevated CK-MB.     

Effect of heparin on the coagulant action of snake venoms

The influence of heparin on the coagulant activity of Bothrops jararaca, B. atrox, Crotalus durissus terrificus, C. adamanteus, Lachesis muta and Vipera russelli venom was investigated. The in vitro results demonstrated that heparin in concentrations ranging from 0·1 to 200 units failed to delay clotting which was induced by the addition of 200 μg of thrombin-like venoms (per ml) to plasma or to fibrinogen. All these heparin concentrations, however, prolonged the clotting time of factor X activator fractions from V. russelli, B. atrox and B. jararaca venom. Heparin previously given to dogs intravenously in doses ranging from 15,000 to 200,000 units failed to prevent the defibrination induced by the thrombin-like activity of venoms. Consequently, the therapeutic use of heparin in human snake envenomation lacks physiopathological support.     

Cross-neutralization of the neurotoxicity of Crotalus durissus terrificus and Bothrops jararacussu venoms by antisera against crotoxin and phospholipase A2 from Crotalus durissus cascavella venom.

We have previously demonstrated that rabbit antisera raised against crotoxin from Crotalus durissus cascavella venom (cdc-crotoxin) and its PLA2 (cdc-PLA2) neutralized the neurotoxicity of this venom and its crotoxin. In this study, we examined the ability of these antisera to neutralize the neurotoxicity of Crotalus durissus terrificus and Bothrops jararacussu venoms and their major toxins, cdt-crotoxin and bothropstoxin-I (BthTX-I), respectively, in mouse isolated phrenic nerve-diaphragm preparations. Immunoblotting showed that antiserum to cdc-crotoxin recognized cdt-crotoxin and BthTX-I, while antiserum to cdc-PLA2 recognized cdt-PLA2 and BthTX-I. ELISA corroborated this cross-reactivity. Antiserum to cdc-crotoxin prevented the neuromuscular blockade caused by C. d. terrificus venom and its crotoxin at a venom/crotoxin:antiserum ratio of 1:3. Antiserum to cdc-PLA2 also neutralized the neuromuscular blockade caused by C. d. terrificus venom or its crotoxin at venom or toxin:antiserum ratios of 1:3 and 1:1, respectively. The neuromuscular blockade caused by B. jararacussu venom and BthTX-I was also neutralized by the antisera to cdc-crotoxin and cdc-PLA2 at a venom/toxin:antiserum ratio of 1:10 for both. Commercial equine antivenom raised against C. d. terrificus venom was effective in preventing the neuromuscular blockade typical of B. jararacussu venom (venom:antivenom ratio of 1:2), whereas for BthTX-I the ratio was 1:10. These results show that antiserum produced against PLA2, the major toxin in C. durissus cascavella venom, efficiently neutralized the neurotoxicity of C. d. terrificus and B. jararacussu venoms and their PLA2 toxins.     

Pulmonary mechanic and lung histology injury induced by Crotalus durissus terrificus snake venom.

In the present work we investigated the effects of Crotalus durissus terrificus venom (CdtV) on the pulmonary mechanic events [static and dynamic elastance, resistive (DeltaP1) and viscoelastic pressures (DeltaP2)] and histology after intramuscular injection of saline solution (control) or venom (0.6 microg/g). The static and dynamic elastance values were increased significantly after 3 h of venom inoculation, but were reduced at control values in the other periods studied. The DeltaP1 values that correspond to the resistive properties of lung tissue presented a significant increase after 6h of CdtV injection, reducing to basal levels 12h after the venom injection. In DeltaP2 analysis, correspondent to viscoelastic components, an increase occurred 12 h after the venom injection, returning to control values at 24 h. CdtV also caused an increase of leukocytes recruitment (3-24 h) to the airways wall as well as to the lung parenchyma. In conclusion, C. durissus terrificus rattlesnake venom leads to lung injury which is reverted, after 24 h of inoculation.     

Potentiation of the toxicity of basic peptides from rattlesnake venoms by sodium acetate

The potentiating effect of sodium acetate on the toxicity of crotamine from Crotalus durissus terrificus venom, E toxin from Crotalus horridus horridus venom, and myotoxin a from Crotalus viridus viridis venom was examined. Subcutaneous injection of 6.3 mg/kg body weight of either crotamine or E toxin in 0.6 ml of water or myotoxin a in 0.6 ml of 0.05 M Tris/0.1 M NaCl buffer, pH 9.0, failed to produce lethality in mice. Injection of either E toxin or crotamine at doses of 4.0 mg/kg in 0.6 ml of 20 mM phosphate, pH 7.2, containing 1 M sodium chloride also failed to produce lethality. However, when any of the toxins were injected in 0.4 ml of 1 M sodium acetate, pH 7.0, lethality was observed. LD50 values of 1.43 mg/kg for E toxin, 1.39 mg/kg for crotamine and 0.56 mg/kg for myotoxin a were determined under these conditions. Lethality was also observed when either sodium propionate or sodium butyrate was used as a carrier for E toxin. The effect of these two buffers on crotamine and myotoxin a was not examined. Injection of E toxin s.c. in water followed at various time intervals with i.p. injections of 1 M sodium acetate produced lethality, even when the acetate was injected up to 4 hr after the toxin challenge.     

Susceptibility of different strains of mice to South American rattlesnake (Crotalus durissus terrificus) venom: correlation between lethal effect and creatine kinase release

In the present work we report that susceptibility to Crotalus durissus terrificus venom: varies according to the strain of inbred mouse used. The s.c. LD50 for Balb/c and C57BI/6 mice were 193 micrograms/kg and 171 micrograms/kg, whereas for A/J and DBA/J they were 78 micrograms/kg and 74 micrograms/kg, respectively. In addition, a direct correlation between susceptibility to C. d. terrificus venom and creatine kinase serum levels (CK) was observed.     

An indirect haemolytic assay for assessing antivenoms

Dilutions of antivenom, venom, human erythrocytes and a phosphatidylcholine suspension, were incubated for 30 min at 37 degrees C. After centrifugation, the liberated haemoglobin was measured spectrophotometrically. The assay was used to assess an ovine antivenom against the venom from the South American rattlesnake, Crotalus durissus terrificus, and an equine Wyeth antivenin (Crotalidae, polyvalent). The ovine antivenom was more than five times as effective as the equine product. It also neutralized venoms from the Western diamondback rattlesnake, Crotalus atrox, and the fer-de-lance, Bothrops atrox. However, antivenoms raised against venoms from other Crotalus and Bothrops species provided little protection against the haemolytic activity of C. d. terrificus venom.     

Determination of the neutralizing potency of horse antibothropic and anticrotalic antivenoms in blood samples collected on filter paper.

The correlation coefficients between in vivo neutralization of lethal toxicity (ED(50)) and levels of antibodies measured by enzyme-linked immunosorbent assay (ELISA) in blood samples collected on filter paper were investigated to test the potency of horse antibothropic and anticrotalic antivenoms. Sixteen horses were hyperimmunized with Bothrops venom (50% from B. jararaca and 12.5% each from B. alternatus, B. jararacussu, B. neuwiedii and B. moojeni) and 12 horses with Crotalus durissus terrificus venom. Crude venom of C. d. terrificus and the lethal fraction of B. jararaca venom were used as antigens to set up an indirect ELISA. The correlation coefficient between ED(50) and ELISA antibodies titers against C. d. terrificus and the lethal fraction of B. jararaca venom was r = 0.8 (P<0.001) and r = 0.78 (P<0.001), respectively.     

Use of liposomes for protective immunisation against Crotalus durissus (tropical rattlesnake) venom

Crotalus durissus venom has been described as a weak antigen when injected in combination with Freund's complete adjuvant during the course of traditional methods of equine immunisation. Antibody production is slow and unpredictable, with a wide variation in individual responses. In this experimental study, C. durissus venom was incorporated into stabilised sphingomyelin-cholesterol liposomes both in the presence and absence of lipopolysaccharide immunostimulant and injected by both i.v. and s.c. routes into mice and rabbits. A rapid, sustained and protective immune response was obtained following a single injection of these preparations in mice. Antibody levels were estimated using enzyme-linked immunosorbent assay (ELISA), and the protective effect was evaluated by subsequent challenge with a subcutaneous minimum lethal dose of the venom. Results indicated that the immune response was significantly potentiated by the presence of immunostimulant in the venom liposomes. The use of C. durissus venom liposomes should be a useful tool for the immunisation of animals both in experimental and commercial procedures.     

Lipoxygenase-derived eicosanoids are involved in the inhibitory effect of Crotalus durissus terrificus venom or crotoxin on rat macrophage phagocytosis.

Crotalus durissus terrificus snake venom and its major toxin, crotoxin or type II PLA2 subunit of this toxin, induce an inhibitory effect on spreading and phagocytosis in 2h incubated macrophages. The involvement of arachidonate-derived mediators on the inhibitory action of the venom or toxins on rat peritoneal macrophage phagocytosis was presently investigated. Peritoneal cells harvested from naive rats and incubated with the venom or toxins or harvested from the peritoneal cavity of rats pre-treated with the toxins were used. Zileuton, a 5-lipoxygenase inhibitor but not indomethacin, a cyclooxygenase inhibitor, given in vivo and in vitro abolished the inhibitory effect of venom or toxins on phagocytosis. Resident peritoneal macrophages incubated with the venom or toxins showed increased levels of prostaglandin E2 and lipoxin A4, with no change in leukotriene B4. These results suggest that lipoxygenase-derived eicosanoids are involved in the inhibitory effect of C.d. terrificus venom, crotoxin or PLA2 on macrophage phagocytosis.     

Inflammatory oedema induced by phospholipases A2 isolated from Crotalus durissus sp. in the rat dorsal skin: a role for mast cells and sensory C-fibers.

The ability of the phospholipases A(2) (PLA(2)s) from Crotalus durissus cascavella, Crotalus durissus collilineatus and Crotalus durissus terrificus venoms and crotapotin to increase the vascular permeability in the rat skin as well as the contribution of both mast cells and sensory C-fibers have been investigated in this study. Vascular permeability was measured as the plasma extravascular accumulation at skin sites of intravenously injected 125I-human serum albumin. Intradermal injection of crotalic PLA(2)s (0.05-0.5 microg/site) in the rat skin resulted in dose-dependent increase in plasma extravascular whereas crotapotin (1 microg/site) failed to affect this response. Co-injection of crotapotin (1 microg/site) did not modify the increased vascular permeability induced by the PLA(2)s (0.05-0.5 microg/site). Previous treatment (30 min) of the animals with cyproheptadine (2 mg/kg, i.p.) markedly reduced PLA(2) (0.5 microg/site)-induced oedema. In rats treated neonatally with capsaicin to deplete neuropeptides, the plasma extravasation induced by all PLA(2)s (0.5 microg/site) was also significantly reduced. Similarly, the tachykinin NK(1) receptor antagonist SR140333 (1nmol/site) significantly reduced the PLA(2)-induced oedema. In addition, the combination of SR140333 with cyproheptadine further reduced the increased plasma extravasation by PLA(2) from C. d. cascavella venom, but not by PLA(2) from C. d. terrificus and C. d. collilineatus venoms. Our results suggest that increase in skin vascular permeability by crotalic PLA(2)s is mediated by activation of sensory C-fibers culminating in the release of substance P, as well as by activation of mast cells which in turn release amines such as histamine and serotonin.     

Enzyme-linked immunosorbant assay (ELISA) of size-selected crotalid venom antigens by Wyeth's polyvalent antivenom

The binding of Antivenom (Crotalidae) Polyvalent to fractions from crude venoms of eight crotalid and one viperid snake, obtained by high performance size-exclusion chromatography, was determined with an indirect enzyme-linked immunosorbent assay (ELISA). Most of the large (greater than 30,000 mol. wt) molecular mass crotalid venom fractions were associated with high (greater than 0.7 absorbance units) ELISA values. Similarly, the medium (13,000-30,000 mol. wt) and small (less than 14,000 mol. wt) molecular mass crotalid venom fractions were coincident with moderate (0.3-0.7 absorbance units) and low (less than 0.3 absorbance units) ELISA levels. Some variability in this pattern was seen with individual venom fractions. A distinctly different pattern of ELISA values were observed with two rattlesnake venoms: the South American (Crotalus durissus terrificus) and Mojave desert (Crotalus scutulatus scutulatus) rattlesnakes. The elution profile from these venoms showed a progression of low to moderate ELISA values within the large molecular mass fractions. This pattern was followed by a decline to low ELISA values throughout the remainder of the elution profile. When saw scaled viper (Echis carinatus leucogaster) venom fractions were tested, only background ELISA values were detected with antivenom. Similarly, background ELISA values were associated with the small molecular mass fractions of all venoms tested. In addition, the elution position for the basic peptides of southern Pacific (Crotalus viridis helleri) and timber (Crotalus h. horridus) rattlesnake venoms showed minimal ELISA values. These data support the view that except for the venom of C. durissus terrificus and C. s. scutulatus, most antivenom antibodies bind large (greater than 30,000 mol. wt) venom fractions. Thus, antivenom contains minimal levels of antibodies to the basic peptides in these venoms.     

Biochemical profile of dogs experimentally envenomed with Tityus serrulatus scorpion venom

The aim of this study was to evaluate the canine blood and urinary profiles after envenomation by Tityus serrulatus venom. Twelve dogs were randomly distributed into two equal groups. Control group animals received 0.5 mL phosphate buffered saline (PBS) injected subcutaneously into the internal portion of the left thigh, whilst dogs in the envenomed group were injected with scorpion venom (250 μg/kg in 0.5 mL PBS). No significant alterations were detected in the urine of envenomed dogs. Levels of plasma glucose and serum urea, creatinine, total protein, potassium, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH), and amylase were determined. Semi-quantitative analysis of serum cardiac troponin I (cTnI) was performed using an immunochromatographic test. The concentrations of cortisol and insulin were determined using commercial radioimmunoassay kits. Increases in serum cortisol levels in experimental group animals coincided with hyperglycaemia and was probably a response to pain. Increased insulin levels were observed during the hyperglycaemic peaks. Envenomed dogs presented discreet increases in ALT, AST and CK, but no alterations in LDH, amylase, cTnI, urea, creatinine and potassium levels were observed. It was concluded that the venom of T. serrulatus induces blood and urinary biochemical changes in dogs.