Experimental Lachesis muta rhombeata envenomation and effects of soursop (Annona muricata) as natural antivenom

Abstract\ud \ud Background\ud In the Atlantic forest of the North and Northeast regions of Brazil, local population often uses the fruit juice and the aqueous extract of leaves of soursop (Annona muricata L.) to treat Lachesis muta rhombeata envenomation. Envenomation is a relevant health issue in these areas, especially due to its severity and because the production and distribution of antivenom is limited in these regions. The aim of the present study was to evaluate the relevance of the use of soursop leaf extract and its juice against envenomation by Lachesis muta rhombeata.\ud \ud \ud Methods\ud We evaluated the biochemical, hematological and hemostatic parameters, the blood pressure, the inflammation process and the lethality induced by Lachesis muta rhombeata snake venom. We also assessed the action of the aqueous extract of leaves (AmL) and juice (AmJ) from A. muricata on the animal organism injected with L. m. rhombeata venom (LmrV) in the laboratory environment.\ud \ud \ud Results\ud LmrV induced a decrease of total protein, albumin and glucose; and increase of creatine kinase, aspartate aminotransferase, and urea concentrations. It provoked hemoconcentration followed by reduction of hematocrit, an increase in prothrombin time and partial thromboplastin time and a decrease of the blood pressure. LmrV induced the release of interleukin-6, an increase in neutrophils and changes in the serum protein profile, characteristic of the acute inflammatory process. LD50 values were similar for the groups injected with LmrV and treated or untreated with AmJ and AmL. Both treatments play a role on the maintenance of blood glucose, urea and coagulation parameters and exert a protective action against the myotoxicity. However, they seem to worsen the hypotension caused by LmrV.\ud \ud \ud Conclusion\ud The treatments with AmJ and AmL present some beneficial actions, but they might intensify some effects of the venom. Therefore, additional studies on A. muricata are necessary to enable its use as natural antivenom for bushmaster snakebite.The authors are grateful to Dr. Marcelo Dias Baruffi, Luisa Helena Dias Costa,\ud Luciana Prado Turin, and Laboratory of Clinical Analysis of School of\ud Pharmaceutical Sciences of Ribeirão Preto for assistance in clinical analysis. This\ud study was supported by the following grants: the São Paulo Research\ud Foundation (FAPESP, grant no. 2005/54855–0 and doctoral scholarship to FAC\ud 2012/13590–8), the National Council for Scientific and Technological\ud Development (CNPq, masters scholarship to CMC 143472/2011–9) and\ud Research Support Center in Animal Toxins (NAP-TOXAN-USP, grant no. 12-\ud 125432.1.3). Thanks are also due to the Center for the Study of Venoms and\ud Venomous Animals (CEVAP) of UNESP for enabling the publication of this paper\ud (CAPES, grant no\ud . 23038.006285/2011–21, AUXPE – Toxinologia – 1219/2011)

Study of the antiophidic action of the leaves extract and the juice of soursop (Annona muricata) on Lachesis muta rhombeata envenomation

O envenenamento humano por Lachesis, embora pouco freqüente, é bastante severo, caracterizado por pronunciado dano tecidual local e efeitos sistêmicos, como hipotensão e bradicardia, tonturas, náuseas, cólicas abdominais e diarréia. A soroterapia é única terapia específica disponível. Entretanto, para muitas plantas é atribuída ação antiofídica. No Norte e Nordeste brasileiro, o suco da fruta (SAm) e o extrato aquoso de folhas (EFAm) de graviola (Annona muricata) são freqüentemente usados pela população local para tratar o envenenamento por Lachesis muta rhombeata. O objetivo deste estudo foi avaliar a letalidade, as alterações de parâmetros hematológicos, bioquímicos, de pressão arterial e processo inflamatório induzidos pela peçonha de L. m. rhombeata (PLmr), bem como a relevância do tratamento com EFAm e SAm no envenenamento. O perfil hematológico mostra uma hemoconcentração inicial seguida de extensa hemólise, evidenciada pela redução do hematócrito, hemoglobina total e contagem global de eritrócitos, não alterado pelos tratamentos. A contagem diferencial de leucócitos revela neutrofilia nas primeiras horas de envenenamento e aumento de linfócitos 24h após a injeção da peçonha, características de processo inflamatório agudo, não influenciado pelos tratamentos. Houve diminuição de albumina e proteínas totais e aumento de uréia, decorrentes do envenenamento. Os valores de AST foram ainda maiores nos animais tratados, mas os aumentos de CK foram reduzidos pelos tratamentos com EFAm e SAm. Houve aumento de TP e TTPA na primeira hora, e diminuição da pressão arterial tempo dependente no envenenamento. O suco intensificou a queda da pressão. Foi observado aumento de IL-6 nas primeiras horas de envenenamento e alterações das proteínas plasmáticas características de processo inflamatório agudo, como esperado em casos de envenenamento. O ensaio de letalidade revela DL50 de 51,0 ± 6,3 mg/kg, para o grupo injetados com a peçonha e sem tratamento; de 56,3 ± 8,5 mg/kg, para o grupo injetado com a peçonha e tratado com SAm e de 62,2 ± 6,8 mg/kg, para o grupo injetado com a peçonha e tratado com EFAm. Concluindo, o quadro clínico do envenenamento laquético foi bem analisado, que era o objetivo principal do trabalho. Avaliou-se também a eficiência do uso popular da graviola (A. muricata) nos acidentes ofídicos com a serpente L. m. rhombeata. De forma geral, os tratamentos com EFAm e com SAm não alteram de forma relevante o quadro clínico do envenenamento, como observado pelos valores semelhantes de DL50. Entretanto, o tratamento com suco parece agravar a hipotensão causada pelo envenenamento e provocar um aumento significativo das transaminases hepáticas. Por outro lado, é possível notar nos animais tratados menores alterações da hemostasia, bem como uma possível proteção contra a miotoxicidade da peçonha.The human envenomation by Lachesis, although rare, is quite severe, characterized by pronounced local tissue damage and systemic effects, such as hypotension and bradycardia, dizziness, nausea, abdominal cramps and diarrhea. The only specific therapy available is the serum therapy. However, for many plants is attributed antiophidic action. In North and Northeast Brazil, the fruit juice and the aqueous extract of leaves of soursop (Annona muricata) are often used by local population to treat Lachesis muta rhombeata envenomation. The aim of this study was evaluate the lethality, hematological, biochemical, blood pressure, and inflammation parameters induced by L. m. rhombeata snake venom, as well as the relevance of treatment with fruit juice and the aqueous extract of leaves of soursop. The hematological parameters shows an initial hemoconcentration followed by extensive hemolysis, as evidenced by decreased hematocrit, total hemoglobin and total red blood cells count, which were not altered by the treatments. The leukocytes differential count revealed neutrophilia in the early hours after the envenomation and increased lymphocytes 24h after the injection of L. m. rhombeata venom, characteristics of acute inflammatory process, which were not influenced by treatments. There was a decrease of albumin and total proteins and urea increased as a result of the envenomation. The AST concentration were still higher in treated animals, although the increases in CK values were reduced by treatments with leaves extract and soursop juice. There was an increase of prothrombin time and activated partial thromboplastin time during the first hour, and there were time dependent decrease of the blood pressure after the envenomation. The juice intensified the pressure decrease. An increase of IL-6 was observed in the early hours after the envenomation, as well as changes in the profile of plasmatic proteins, characteristic of acute inflammatory process, as expected in cases of snake bite. The lethality assay reveals LD50 of 51,0 ± 6,3 mg / kg for the group injected with venom without treatment; 48,3 ± 8,6 mg /kg for the group injected with venom and treated with juice of A. muricata; and 62,2 ± 6,8 mg/kg for the group injected with venom and treated with leaves extract of A. muricata. In conclusion, the clinical profile of L. m. rhmobeata envenomation was well analyzed, the main goal of this work. The efficiency of the popular use of soursop on envenomation by L. m. rhombeata snakes was also evaluated. In general, treatments with extracts of leaves and soursop juice do not significantly modify the clinical profile of the envenomation, as observed by similar LD50 values. However, treatment with juice seems to worsen the hypotension caused by envenomation and induce a significant increase in AST levels. On the other hand, there are lower changes in hemostasis on treated animals, as well as a possible protection against the myotoxicity of the venom

Study of the antiophidic action of the leaves extract and the juice of soursop (Annona muricata) on Lachesis muta rhombeata envenomation

O envenenamento humano por Lachesis, embora pouco freqüente, é bastante severo, caracterizado por pronunciado dano tecidual local e efeitos sistêmicos, como hipotensão e bradicardia, tonturas, náuseas, cólicas abdominais e diarréia. A soroterapia é única terapia específica disponível. Entretanto, para muitas plantas é atribuída ação antiofídica. No Norte e Nordeste brasileiro, o suco da fruta (SAm) e o extrato aquoso de folhas (EFAm) de graviola (Annona muricata) são freqüentemente usados pela população local para tratar o envenenamento por Lachesis muta rhombeata. O objetivo deste estudo foi avaliar a letalidade, as alterações de parâmetros hematológicos, bioquímicos, de pressão arterial e processo inflamatório induzidos pela peçonha de L. m. rhombeata (PLmr), bem como a relevância do tratamento com EFAm e SAm no envenenamento. O perfil hematológico mostra uma hemoconcentração inicial seguida de extensa hemólise, evidenciada pela redução do hematócrito, hemoglobina total e contagem global de eritrócitos, não alterado pelos tratamentos. A contagem diferencial de leucócitos revela neutrofilia nas primeiras horas de envenenamento e aumento de linfócitos 24h após a injeção da peçonha, características de processo inflamatório agudo, não influenciado pelos tratamentos. Houve diminuição de albumina e proteínas totais e aumento de uréia, decorrentes do envenenamento. Os valores de AST foram ainda maiores nos animais tratados, mas os aumentos de CK foram reduzidos pelos tratamentos com EFAm e SAm. Houve aumento de TP e TTPA na primeira hora, e diminuição da pressão arterial tempo dependente no envenenamento. O suco intensificou a queda da pressão. Foi observado aumento de IL-6 nas primeiras horas de envenenamento e alterações das proteínas plasmáticas características de processo inflamatório agudo, como esperado em casos de envenenamento. O ensaio de letalidade revela DL50 de 51,0 ± 6,3 mg/kg, para o grupo injetados com a peçonha e sem tratamento; de 56,3 ± 8,5 mg/kg, para o grupo injetado com a peçonha e tratado com SAm e de 62,2 ± 6,8 mg/kg, para o grupo injetado com a peçonha e tratado com EFAm. Concluindo, o quadro clínico do envenenamento laquético foi bem analisado, que era o objetivo principal do trabalho. Avaliou-se também a eficiência do uso popular da graviola (A. muricata) nos acidentes ofídicos com a serpente L. m. rhombeata. De forma geral, os tratamentos com EFAm e com SAm não alteram de forma relevante o quadro clínico do envenenamento, como observado pelos valores semelhantes de DL50. Entretanto, o tratamento com suco parece agravar a hipotensão causada pelo envenenamento e provocar um aumento significativo das transaminases hepáticas. Por outro lado, é possível notar nos animais tratados menores alterações da hemostasia, bem como uma possível proteção contra a miotoxicidade da peçonha.The human envenomation by Lachesis, although rare, is quite severe, characterized by pronounced local tissue damage and systemic effects, such as hypotension and bradycardia, dizziness, nausea, abdominal cramps and diarrhea. The only specific therapy available is the serum therapy. However, for many plants is attributed antiophidic action. In North and Northeast Brazil, the fruit juice and the aqueous extract of leaves of soursop (Annona muricata) are often used by local population to treat Lachesis muta rhombeata envenomation. The aim of this study was evaluate the lethality, hematological, biochemical, blood pressure, and inflammation parameters induced by L. m. rhombeata snake venom, as well as the relevance of treatment with fruit juice and the aqueous extract of leaves of soursop. The hematological parameters shows an initial hemoconcentration followed by extensive hemolysis, as evidenced by decreased hematocrit, total hemoglobin and total red blood cells count, which were not altered by the treatments. The leukocytes differential count revealed neutrophilia in the early hours after the envenomation and increased lymphocytes 24h after the injection of L. m. rhombeata venom, characteristics of acute inflammatory process, which were not influenced by treatments. There was a decrease of albumin and total proteins and urea increased as a result of the envenomation. The AST concentration were still higher in treated animals, although the increases in CK values were reduced by treatments with leaves extract and soursop juice. There was an increase of prothrombin time and activated partial thromboplastin time during the first hour, and there were time dependent decrease of the blood pressure after the envenomation. The juice intensified the pressure decrease. An increase of IL-6 was observed in the early hours after the envenomation, as well as changes in the profile of plasmatic proteins, characteristic of acute inflammatory process, as expected in cases of snake bite. The lethality assay reveals LD50 of 51,0 ± 6,3 mg / kg for the group injected with venom without treatment; 48,3 ± 8,6 mg /kg for the group injected with venom and treated with juice of A. muricata; and 62,2 ± 6,8 mg/kg for the group injected with venom and treated with leaves extract of A. muricata. In conclusion, the clinical profile of L. m. rhmobeata envenomation was well analyzed, the main goal of this work. The efficiency of the popular use of soursop on envenomation by L. m. rhombeata snakes was also evaluated. In general, treatments with extracts of leaves and soursop juice do not significantly modify the clinical profile of the envenomation, as observed by similar LD50 values. However, treatment with juice seems to worsen the hypotension caused by envenomation and induce a significant increase in AST levels. On the other hand, there are lower changes in hemostasis on treated animals, as well as a possible protection against the myotoxicity of the venom

Isolation and structural and functional characterization of neurotoxins present on fractions XIIA and XIIB from Tityus serrulatus venom

O escorpião amarelo Tityus serrulatus (Ts) é considerado a espécie mais perigosa do Brasil, e muitas das toxinas de sua peçonha já foram isoladas e caracterizadas. No entanto, as frações XIIA e XIIB, obtidas da cromatografia de troca iônica da peçonha de Ts, possuem várias toxinas de baixa massa molecular ainda não caracterizadas. Através da combinação de técnicas de RP-FPLC em colunas C8 e C18, espectrometria de massas e/ou sequenciamento amino-terminal, foi possível isolar e identificar os componentes destas frações, bem como realizar as caracterizações estrutural, por RMN, e eletrofisiológica, por Two Microelectrode Voltage Clamp, de algumas neurotoxinas isoladas. Foram escolhidas três toxinas de interesse: Ts11, Ts9 e Ts1-G. Nossos resultados mostram que a Ts11 foi capaz de bloquear canais para potássio dependentes de voltagem (Kv): Kv1.2, Kv1.3, Kv4.2, Kv10.1, hERG, e Shaker IR, bloqueando em 25%, 27%, 25%, 15%, 12%, e 10% as correntes de potássio, respectivamente. A Ts11 possui uma estrutura única (estrutura obtida por RMN): ICK scaffold sem os elementos de estrutura secundária (alfa-hélice ou fita-beta). Esta estrutura diferenciada, somada à atividade biológica caracterizada neste estudo, evidencia uma nova subfamília de KTxs, a qual foi denominada como ?-KTx, sendo a Ts11 o primeiro membro desta subfamília: ?-KTx1.1. A caracterização funcional da Ts9 mostra que a mesma não apresenta atividade bloqueadora sobre os canais Kv testados (Kv1.1; Kv1.2; Kv1.3; Kv1.4; Kv1.5; Kv1.6; Kv2.1; Kv3.1; Kv4.2; Kv7.2; Kv10.1 hERG e Shaker IR), na concentração de 100 nM. Apesar da Ts9 não ter bloqueado os canais testados, ela apresenta estrutura e resíduoschave que sugerem sua ação em Kvs e estudo anteriormente publicado mostra que ela é um potente ligante de canais para potássio ativados por cálcio de baixa condutância (SK). Também foi conduzido um estudo comparativo entre a Ts1e sua isoforma precursora Ts1-G nos canais para sódio dependentes de voltagem Nav1.1 - 1.8 e DmNav1, a fim de analisar a importância da amidação C-terminal. A Ts1 madura possui região C-terminal amidada, enquanto que sua isoforma Ts1-G não é amidada, pois apresenta uma Gly na região Cterminal (última etapa de transformação pós-traducional, anterior a ação da enzima ?- amidante). A Ts1-G não apresentou ação nos canais (Nav) na concentração testada (100 nM), enquanto que a Ts1 (100 nM) age como ?- toxina, reduzindo o limiar de excitação dos canais Nav e/ou reduzindo as correntes de sódio, evidenciando que a amidação C-terminal é importante para a atividade biológica da toxina madura. Adicionalmente, nas análises por MALDI/TOF das frações XIIA e XIIB, foram encontrados 45 componentes cujas massas moleculares não correspondem a de toxinas já isoladas, abrindo perspectivas para a identificação de moléculas com potencial uso biotecnológico, visto que toxinas com ação em canais iônicos podem ser ferramentas valiosas para a elucidação das características farmacológicas, fisiológicas e estruturais dos seus alvos.The yellow scorpion Tityus serrulatus (Ts) is considered the most dangerous species of Brazil, and several toxins present in its venom have been already isolated and characterized. However, fractions XIIA and XIIB obtained from ion exchange chromatography of Ts crude venom, presented many low molecular weight toxins which have not been characterized yet. Through a combination of RP-FPLC technique using C8 and C18 columns, mass spectrometry and / or amino terminal sequencing, it was possible to isolate and identify the components of these fractions, as well as perform structural characterization thru NMR and electrophysiological characterization using Two Microelectrode Voltage Clamp, of some of the neurotoxins isolated. It was choosen three toxins of interest: Ts11, Ts9 and Ts1-G. Our results show that Ts11 was able to block voltage gated potassium channels (Kv): Kv1.2, Kv1.3, Kv4.2, Kv10.1, hERG, and Shaker IR, blocking 25%, 27%, 25% 15%, 12% and 10% of the potassium currents, respectively. Ts11 has an unique structure (structure obtained thru NRM technique): ICK scaffold without the elements of secondary structure (alpha helix or beta-sheet). Additionaly, the differentiated structure and functional characterization, Ts11 shows us an evidence of a new subfamily of toxins, which was named as ?-KTX, and therefore, Ts11 is the first member of this subfamily: ?-KTx1.1. The functional characterization of Ts9 shows that it has no blocking activity on the tested Kv channels (Kv1.1, Kv1.2, Kv1.3, Kv1.4, Kv1.5, Kv1.6, Kv2.1, Kv3.1 , Kv4.2, Kv7.2, Kv10.1, hERG and Shaker IR) at a concentration of 100 nM. Despite the Ts9 have not blocked the tested channels, it presents structure and key-amino acid residues that suggest its action on Kvs and previously published study shows that it is a potent ligant for slow conductance calciumactivated potassium channels (SK). It was also conducted a comparative electrophysiological study between the Ts1and its precursor isoform Ts1-G on voltage gated sodium channels, in order to evaluate the importance of the C-terminal amidation. The mature Ts1 has amidated C-terminal region, whereas Ts1-G isoform is not amidated, and therefore has a Gly at the Cterminal region (last step of post-translational modification, before the action of the enzyme ?-amidante). The Ts1-G showed no action on Nav channels at the concentration tested (100 nM), whereas Ts1 (100 nM) acts as ?-toxin, lowering the excitation threshold of Nav channels and/or reducing sodium currents, evidencing that the C-terminal amidation is important for the biological activity of the mature toxin. Additionally, the analyses by MALDI/TOF of the fractions XIIA and XIIB showed several molecules whose molar masses do not match the toxins already identified, opening prospects for the identification of new molecules with potential biotechnological use, considering that toxins that act on ion channels can be valuable tools for the elucidation of pharmacological, physiological and structural characteristics of their targets