ANTI-COBRATOXIN SERUMS

 

Nguyen Thi Nguyet Thu P, Dang Hong Phong V, Nguyen Thi Ke V, Nguyen Le Trang P.

P Pasteur Institute in HoChiMinh City, 167 Pasteur St. - Dist. 3, HCM City,

V National Institute for Manufacturing vaccines and biological products, 9 Pasteur – Nha Trang. Viet Nam.

ABSTRACT

Serums against bacterial toxins (Diphtheria and Tetanus) were recently investigated in Europe when Albert Calmette founded the new Pasteur Institute in Saigon. Facing victimes bitten by snakes, the vision of toxin in the venom did not escape to him. In October 1891, he received life monocellate cobras and animal toxins were prepared. For attenuating the toxicity, the cobra venom was chemically treated and used to prepare antivenom serums in large animals. In 1895, “an Anamite cruelly bitten by a Naja” was treated successfully with a horse serum. This anti-cobra serum protected against lethality for patients bitten by Asian Cobra but was inefficient on victims bitten by Crotalus and Bothrops in South America. The venoms from these species were used by Dr. Vital Brazil for preparing similarly antivenom serums which were efficient for treating patients in Saőo Paulo. Antivenom therapy is specific but actually serums are not always available, of high cost and not ease of use (for example inducing of anaphylactic reactions associated with complement activation).

In a report (1907), Calmette had mentioned that serotherapy allowed to reduce mortality due to snake bites. Neutralizing lethality effect of the venom while preventing complications are objectives in manufacturing antiserums.

The higest incidence with the highest mortality in Viet Nam is due to cobra bites. The cobra venom is characterized by a lethal toxine occupying 20 – 30% of the total protein. An other component not lethal but extensively studied is the Cobra Venom Factor (CVF) which is similar to the complement C3 present in human blood. Antibodies to the CVF participate in generating complications. So, we used an purified cobraroxin as immunogen for serum production. A new immunization method efficiently induced response in all immunized animals, without inducing tolerance, taking into account affinity maturation for raising the anti-cobratoxin serums.

Every serums obtained individually from immunized horses exhibited protection against the entire venom lethal toxicity. The average neutralization potency of crude serums was
117 LD50/mL (/i.v./20g mouse). For determination of antibidies specific to the cobratoxin, an immuno-enzymatic method was adjusted, consisting of purified toxin attached on solid phase for capturing the antibodies and biotinylated toxin as detecting reagent with comercial streptavidin-peroxidase. The neutralization potency data obtained by in vivo method correlated well with the titers of specific antibodies determined by in vitro measurements, demonstrating the role of antibodies specific to cobratoxin in the neutralization against the lethal effect of the entire venom.

The annual production capacity from six horses used in the present experiment was estimated to 25.106 LD50. After processing, 12,000 doses of 1000 LD50 should be available annually for the needs, able for facing an incidence of 5 – 6/100,000 population in a total population of 70 millions.

ALPHA-FETOPROTEIN (AFP)

AFP is a major fetal blood protein, carrier of estrogen, unsaturated fatty acids, billirubin, etc... It is involved in carcinogenic and immuno-regulatory processes which are under investigation. AFP is a serum marker for the diagnosis of hepatocellular carcinoma and fetal malformations.

From fetal sera, we have isolated AFP in mg amounts. Rabbit antiserum and AFP-Sepharose were then prepared for obtaining immuno-affinity purified Fab and F(ab’). Fab was attached covalently to polystyrene microplates and used for capturing AFP. Fab’-s-biotin was prepared by site directed labeling and used as detecting antibodies (with streptavidin-peroxidase conjugated). The enzyme-immuno-assay (EIA) system obtained can be used with serum samples directly without dilution. The sensitivity observed was 0.2ng/mL.

AFP concentrations of 380 serum samples from normal individuals and 240 maternal serum samples were determined at present, for establishing reference values before further epidemiological studies.

SNAKE VENOM

A project, conducted since 1992, has been completed with the production of an antivenenum for treatment of Naja naja kaouthia and Naja naja atra venom poisoning.

Using the horse antisera produced, an enzyme-immuno-assay has been carried out as following: Naja naja kaouthia and Naja naja atra venom were immobilized on CNBr-activated Sepharose 4B. IgG fraction was submitted for specific antibody isolation. Fab and Fab’-s-biotin were then obtained from the immuno-affinity purified antibodies.

Polystyrene microplates were coated covalently by a titrated concentration of Fab. Fab’-s-biotin was used as detecting antibody in association with an streptavidin-peroxidase conjugated.

Calibration curve obtained by using separately Naja naja kaouthia and Naja naja atra venoms manifested a same slope from 1ng/mL to 1mg/mL of venom concentrations. Probably the high proportions of neurotoxins and cardiotoxins and their homology in both of these venom could explain the results observed. The sensitivity of the system was 0.1ng/mL, suggesting a high affinity for the antibodies used. This EIA system should satisfy the need of poisoning evaluation for adequate treatment. Up to now, 36 victims of cobra snake bites were rescued at Cho Ray Hospital with the antivenenum produced.

CYTOKINES IN LEPROSY

TNF-a plays a pivotal function in the regulation of immune responses. Clinical data concerning cytokines may give information on the state of immuno-regulation and pathogenesis.

Sera from 73 new non treated patients were adequately (2) collected and submitted for TNF-a determination, using an enzyme-immuno-assay system in which other cytokines and soluble TNF receptors did not interfere (3).

Data obtained showed that 100% of TT patients (11 individuals) presented normal TNF-a concentrations (1,1 to 3.99pg/mL). The proportion of patients presenting normal plasma TNF-a concentrations (<4pg/mL) decreased in the progression toward the LL pole: BT patients, 12/14 (85.7%); BB patients, 15/18 (83.3%); BL patients, 10/18 (55%); LL patients 6/12 (50%). However, the highest values were observed in the unstable leprosy groups: BT patients (9, 8 pg/mL); BB patients (4.4, 14.5, >32pg/mL); BL patients (4.2, 4.7, 4.8, 10, 12, 16, 23, >32pg/mL) compared to the LL group (4.0, 4.6, 5.3, 7, 7.6, 28). High values of TNF-a probably reflect the activities of cellular mediated immune responses. The data may reflect the immuno-stimularory activities of TNF-a in human. Relatively low values found in TT and LL patients may be due to an immuno-suppressive property of Mycobacterium leprae.