1. Doxycycline-Mediated Inhibition of Snake Venom Phospholipase and Metalloproteinase.
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Arens, Daniel K, Rose, Meaghan A, Salazar, Emelyn M, Harvey, Merideth A, Huh, Eun Y, Ford, April A, Thompson, Daniel W, Sanchez, Elda E, and Hwang, Yoon Y
- Subjects
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SNAKE venom , *COBRAS , *INTRAMUSCULAR injections , *CREATINE kinase , *VENOM , *SPIDER venom - Abstract
Introduction Warfighters are exposed to life-threatening injuries daily and according to the Joint Trauma System Military Clinical Practice Guideline—Global Snake Envenomation Management snakebites are a concerning threat in all theaters of operation. Snake venom is a complex mixture of toxins including phospholipases A2 (PLA2) and snake venom metalloproteinases (SVMP) that produce myotoxic, hemotoxic, and cytotoxic injuries. Antibody-based antivenom is the standard of care but new approaches including small-molecule inhibitors have gained attention in recent years. Doxycycline is an effective inhibitor of human metalloproteinases and PLA2. The enzymatic activities of 3 phylogenetically distinct snakes: Agkistrodon piscivorus, Naja kaouthia , and Daboia russelii were tested under inhibitory conditions using doxycycline. Materials and Methods Enzymatic activity of PLA2 and SVMP was measured in N. kaouthia, D. russelii , and A. piscivorus venom alone and with doxycycline using EnzChek Phospholipase A2 and Gelatinase Assay Kits. A 1-way ANOVA with Tukey's post-hoc test was used to conduct comparative analysis. The median lethal dose of the venoms, the effective dose of doxycycline, and creatine kinase (CK) inhibition levels were measured in a murine model with adult Bagg Albino (BALB/c) mice using intramuscular injections. Median lethal and effective doses were determined using Spearman-Karber's method and a 1-way ANOVA with Tukey's post-hoc test was used to compare CK inhibition levels. Results Phospholipases A2 activity was reduced to 1.5% to 44.0% in all 3 venoms in a dose-dependent manner using 0.32, 0.16, and 0.08 mg/mL doxycycline when compared to venom-only controls (P < .0001) (Fig. 1A). Snake venom metalloproteinases activity was reduced to 4% to 62% in all 3 venoms in a dose-dependent manner using 0.32, 0.16, and 0.08 mg/mL doxycycline (P < .0001) (Fig. 1B). The lethal dose (LD50) values of the venoms in the murine model were calculated as follows: A. piscivorus = 20.29 mg/kg (Fig. 2A), N. kaouthia = 0.38 mg/kg (Fig. 2B), and D. russelii = 7.92 mg/kg (Fig. 2C). The effective dose (ED50) of doxycycline in A. piscivorus was calculated to be 20.82 mg/kg and 72.07 mg/kg when treating D. russelii venom. No ED50 could be calculated when treating N. kaouthia venom (Fig. 3). Creatine kinase activity was significantly decreased in all 3 venoms treated with doxycycline (P < .0001) (Fig. 4). FIGURE 1. In vitro doxycycline inhibition of PLA, and SVMP activity in whole venom. The AUC was calculated for PLA and SVMP activities for 20-min and 4-h time courses, respectively using EnzChek Phospholipase A2, assay kits, and EnzChek Gelatinase (SVMP) assay kits. (A) Inhibition of PLA2, with doxycycline (Dox) was tested at concentrations of 0.32 mg/mL, 0.16 mg/mL, and 0.08 mg/mL against A. piscivorus (4 μg/mL), N. kaouthia (4 μg/mL), and D. russelii (8 μg/mL) venom. A venom-only control was included. (B) Inhibition of SVMP with doxycycline was tested at concentrations of 0.32 mg/mL, 0.16 mg/mL, and 0.08 mg/mL against A. piscivorus (120 μg/ml.), N. kaouthia (125 μg/ml.), and D. russelii (250 μg/ml.). A venom-only control was included. An ordinary 1-way ANOVA with Tukey's post-hoc test was performed for inhibition assays to compare treatments to their respective venom controls. All error bars show mean ± SD, n = 3, (****, P < .0001). Open in new tab Download slide FIGURE 2. Percent survival of mice receiving various dosages for each venom studied and LDs, calculation. Adult BALB/c mice received intramuscular injections of various venom dosages for each venom, (A) A. piscivorus , (B) N. kaouthia , and (C) D. russelii. The resulting percent survival was measured across 48 h and the lethal dose 50 (LD50) was calculated using the Spearman-Karber method. In each graph, each treatment group (venom dosage) has n = 5. Open in new tab Download slide FIGURE 3. Percent survival of mice receiving various doxycycline dosages for each venom studied and ED calculation. Adult BALB/c mice received intramuscular injections of various doxycycline dosages combined with 3 times the LD50 of cach venom [ A. piscivorus (AP) (60.87 mg/kg), N. kaouthia (NK) (1.14 mg/kg). D. russelii (DR) (23.76 mg/kg)] and the resulting percent survival was measured across 48 hours and the effective dose 50 (ED50) was calculated using the Spearman–Karber method. Each treatment group has n = 5. Open in new tab Download slide FIGURE 4. Venom-induced CK activity with doxycycline-mediated inhibition. The amount of CK produced by mice exposed to one-fourth of the LD50, strength of A. piscivorus (AP) (5.07 mg/kg), N. kaouthia (NK) (0.095 mg/kg), or D. russelli (DR) (1.98 mg/kg) venom either with or without doxycycline (64 mg/kg). All error bars show mean, ± SD, n = 5 (NaCl—Dox, AP NaCl), n-4 (NK Dox), and n-3 (AP Dox. NK NaCl, DR Dox, DR + NaCl). Statistical differences were determined using an ordinary 1-way ANOVA with Tukey's post-hoc test comparing each venom group within itself and to the doxycycline only control (**** P < .0001). (*** P < .001), (** P < .01). (* P < .05). Open in new tab Download slide Conclusion Doxycycline reduced PLA2- and SVMP-related lethality, particularly in A. piscivorus envenomings and in a limited capacity with D. russelii revealing its promise as a treatment for snakebites. In addition, CK activity, a common indicator of muscle damage was inhibited in mice that received doxycycline-treated venom. The doxycycline concentrations identified in the ED50 studies correspond to 1,456 to 5,061 mg dosages for a 70 kg human. Factors including venom yield and snake species would affect the actual dosage needed. Studies into high-dose doxycycline safety and its effectiveness against several snake species is needed to fully translate its use into humans. Based on this work, doxycycline could be used as a treatment en route to higher echelons of care, providing protection from muscle damage and reducing lethality in different snake species. [ABSTRACT FROM AUTHOR]
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- 2024
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