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      New approaches & technologies of venomics to meet the challenge of human envenoming by snakebites in India

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          Abstract

          The direct estimate of 46,000 snakebite deaths in India in 2005 (1 for every 2 HIV/AIDS deaths), based on verbal autopsies, renders unrealistic the total of only 47,000 snakebite deaths in the whole world in 2010, obtained indirectly as part of the “Global Burden of Disease 2010” study. Persistent underestimation of its true morbidity and mortality has made snakebite the most neglected of all the WHO's “neglected tropical diseases”, downgrading its public health importance. Strategies to address this neglect should include the improvement of antivenom, the only specific antidote to envenoming. To accommodate increased understanding of geographical intraspecific variation in venom composition and the range of snake species that are medically important in India, the design of antivenoms (choice of venom sources and species coverage) should be reconsidered. Methods of preclinical and clinical testing should be improved. The relatively new science of venomics involves techniques and strategies for assessing the toxin composition of snake venoms directly through proteomics-centred approaches or indirectly via high-throughput venom gland transcriptomics and bioinformatic analysis. Antivenomics is translational venomics: a proteomics-based protocol to quantify the extent of cross-reactivity of antivenoms against homologous and heterologous venoms. These approaches could revolutionize the preclinical assessment of antivenom efficacy, leading to a new generation of antivenoms that are clinically more effective.

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          Most cited references139

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              Snake-bites: appraisal of the global situation.

              J Chippaux (1998)
              The true global incidence of envenomations and their severity remain largely misunderstood, except for a few countries where these accidents are rare or are correctly reported. Nevertheless, this information is essential for drawing up guidelines for dealing with snake-bites, to plan drug supplies, particularly antivenin, and to train medical staff on snake-bite treatments. Since the comprehensive review by Swaroop & Grab in 1954 no global survey has been carried out on snake-bite epidemiology. The present article is an attempt to draw the attention of health authorities to snake envenomations and urges them to prepare therapeutic protocols adapted to their needs.
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                Author and article information

                Journal
                Indian J Med Res
                Indian J. Med. Res
                IJMR
                The Indian Journal of Medical Research
                Medknow Publications & Media Pvt Ltd (India )
                0971-5916
                0975-9174
                July 2013
                : 138
                : 1
                : 38-59
                Affiliations
                [1 ] Global Snakebite Initiative, P.O. Box 193, Herston, Qld, 4029, Australia
                [2 ] Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
                [3 ] Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
                [4 ] Laboratorio de Venómica y Proteinómíca Estructural, Instituto de Biomedicina de Valencia, CSIC, Jaime Roig 11, 46010 Valencia, Spain
                [5 ] Australian Venom Research Unit, Department of Pharmacology, University of Melbourne, Parkville, Vic, 3010. Australia
                [6 ] School of Medicine & Health Sciences, University of Papua New Guinea, Boroko, NCD, Papua New Guinea
                Author notes
                Reprint requests: Prof. David A. Warrell, Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK e-mail: david.warrell@ 123456ndm.ox.ac.uk
                Article
                IJMR-138-38
                3767246
                24056555
                9c2ac9bf-2e59-470a-9eb1-d4c1dc4a4d53
                Copyright: © The Indian Journal of Medical Research

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 February 2013
                Categories
                Review Article

                Medicine
                antivenoms,cobra,envenoming,krait,preclinical efficacy,russell's viper,snakebite,venom,venomics
                Medicine
                antivenoms, cobra, envenoming, krait, preclinical efficacy, russell's viper, snakebite, venom, venomics

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