Snake Venom: A Deadly Toxin

Snake venoms are complex mixtures of enzymatic and non-enzymatic protein components that work synergistically to immobilize prey and defend against predators. Snake venoms contain toxins that attack a variety of systems in the body like the cardiovascular, nervous and skin systems. Some of the commonly encountered toxins in snake venom are phospholipases, hyaluronidases, proteases, neurotoxins and cytotoxins. The bites from snakes like cobras, kraits, saw-scaled vipers and Russell's viper are responsible for the majority of venomous snakebites in India. Envenomation by these snakes can cause symptoms ranging from local tissue damage to life-threatening conditions like neuroparalysis and coagulopathy if left untreated.

Development of Anti-Venom

To combat the effects of snake venom, the use of Anti-Venom or antivenin emerged as an effective treatment. Anti-venom is made by hyper-immunizing horses or sheep with small, repeated, non-lethal doses of snake venom. This causes the animals to produce antibodies against the venom in their blood. The immunoglobulins or antibodies present in the blood are then purified and processed to form anti-venom immunoglobulin complexes that can neutralize venom when administered to an envenomed victim. The first anti-venom manufactured in India was a bivalent anti-venom raised against the venoms of cobra and krait released in the year 1967. Since then different polyvalent anti-venoms have been developed against the common venomous snakes found in India.

Mechanism of Action and Treatment Protocol

Anti-venom works by binding to venom molecules in the bloodstream and at the site of the bite, preventing them from attaching to their target receptors in the body. This neutralizes the activity of the toxins and halts further spread. Anti-venom is given as soon as possible after the bite, usually within 4-6 hours as the toxins would have spread beyond the bite site by this time. The usual dosage is 10-20 vials depending on the severity of envenomation and clinical status of the patient. Anti-venom administration is usually accompanied by supportive care measures like intravenous fluids, ventilation, inotropes and wound management. Timely treatment with anti-venom along with symptom-directed care can significantly reduce mortality fromsnake bites.

Drawbacks and Improvements

Like all biologics, anti-venoms also have some limitations. They work only against the venoms that were used for immunizing the animals, so may not cover other clinically-relevant venoms. There are also issues related to availability, shelf life, cost, risk of adverse reactions and need for repeated dosing. Research is ongoing to develop alternative anti-venoms using newer production methods. Venom-mimicking peptides that can bind venoms, monoclonal antibodies and polyclonal fragments are being studied. Anti-venoms based on animal platforms replaced by plants or through recombinant techniques may help address some of the shortcomings in future. Tissue culture methods and venom-normalized anti-venoms are other avenues being explored to enhance efficacy, safety and accessibility of snake bite treatment globally.

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