engleski

Comparison of preclinical properties of several available antivenoms in the search for effective treatment of Vipera ammodytes and Vipera berus envenoming

Aim Snakebites in Europe are mostly caused by Vipera ammodytes, Vipera berus and Vipera aspis. Among eight available antivenoms, only Zagreb antivenom, Viperfav and ViperaTAb have been used almost exclusively for decades. Zagreb antivenom and Viperfav are considered clinically efficient against envenoming caused by all three medically relevant species, while ViperaTAb is indicated for the treatment of V. berus bites solely. When the production of Zagreb antivenom was discontinued and a shortage of Viperfav occurred, other potentially suitable antivenoms were implemented into clinical practice, but without comparative assessment of their eligibility. Due to a lack of the product indicated for the treatment of V. ammodytes bites, other antivenoms were implemented into clinical practice without comparative assessment of their eligibility. The aim of our work was to identify at preclinical level the most promising candidate that might ensure the successful treatment of V. ammodytes and V. berus bites. Methods A thorough preclinical analysis of the safety- related properties and efficacy of a panel of anti-Vipera spp. antivenoms that are currently available, or in development for the European market, was performed in a comparative manner. Purity and aggregate content were evaluated by size-exclusion chromatography. Neutralisation potencies were determined by lethal toxicity neutralisation assay in mice. Results Since Zagreb antivenom is no longer available on the European market, Viperfav emerged as the highest-quality product and the only one whose neutralisation potency against V. ammodytes and V. berus venoms was above regulatory requirements. Main conclusion Although monitoring of effectiveness is of outmost importance in the decision-making process, the presented findings may serve as a starting point for guidance to clinicians when choosing the most appropriate antivenom for the treatment of envenoming in Southeastern Europe.

Zagreb antivenom ; Viperfav ; ViperaTAb ; Vipera ammodytes ; Vipera berus ; preclinical efficacy

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