Snakebites a globally neglected killer get a transformational injection of research funds

first_img In 1970, when David Warrell was a young hospital clinician in northern Nigeria, he faced three horrifying snakebite cases in quick succession that would change the course of his career. One man had stepped on a puff adder while getting out of bed. He arrived with a gangrenous leg and died of sepsis before Warrell could amputate. Another man was bitten by a saw-scaled viper while farming sorghum. He arrived bleeding from his mouth and urinary tract, and he soon died from massive internal bleeding. A third victim, a boy, was struck by a snake charmer’s Egyptian cobra. He was dead on arrival, after the snake’s venom progressively paralyzed his body, starting with his eyelids and ending with his breathing muscles. In no cases did Warrell have antivenom to administer as he helplessly observed deaths that he soon realized were common.“I got a missionarylike attitude toward snakebite as a neglected public health problem,” says Warrell, an emeritus professor of tropical medicine at the University of Oxford in the United Kingdom and director of the Global Snakebite Initiative in Brisbane, Australia.Snakebites kill as many as 138,000 people a year, mostly among the rural poor in sub-Saharan Africa and South Asia. Another 400,000 victims suffer major disabilities such as amputation. The health burden is greater than that of any of the 20 neglected tropical diseases tracked by the World Health Organization (WHO) and equal to that of prostate or cervical cancer. Yet funders, more interested in infectious diseases that can be prevented and eradicated, have largely stayed away. Snakebites, a globally neglected killer, get a ‘transformational’ injection of research funds Click to view the privacy policy. Required fields are indicated by an asterisk (*) That is now changing. Today, the Wellcome Trust charity in London announced an £80 million, 7-year research program to improve antivenoms and search for new treatments—a major influx of money in a small field. The announcement comes ahead of the first-ever WHO snakebite strategy, set to be unveiled on 23 May, that seeks to halve death and disability from snakebites by 2030. “The tide really does seem to have turned,” Warrell says.The Wellcome money could invigorate a small research field that, by Wellcome’s estimate, has received only £30 million over the past decade. “It’s transformational,” says David Lalloo, director of the Liverpool School of Tropical Medicine in the United Kingdom. “It will make an enormous difference,” Lalloo says the money could help refine the scale of the problem by shoring up spotty data on incidents around the world. “It builds the economic argument for manufacturers to invest in antivenom,” he says.Each of the world’s 250 species of venomous snakes produces a unique cocktail of toxins that must be counteracted by a specific antivenom. But the antivenoms are plagued by problems. Even when such antidotes are available—and they often aren’t in the rural areas where most snakebites occur—they can be expensive, beyond the reach of poor people. Clinical data on their effectiveness are lacking. And they are often unsafe, triggering allergic reactions. That is because of the way that antivenoms are produced: Venoms, milked from snakes, are injected at low doses into animals, typically horses, to trigger an immune response. Antibodies from the animals’ blood are harvested, purified, and then used as antivenoms. But people’s immune systems can react to the animal product.Phil Price, Wellcome’s science lead for its snakebite priority area, says a first goal for the new program will be to improve existing antivenoms. Wellcome funding could help manufacturers follow protocols and avoid bad practices, such as using a single animal to produce a mix of antivenoms. The process could also be simplified. For example, some manufacturers use enzymes to split harvested antibodies into pieces and eliminate the stalk of the Y-shaped molecules, which is believed to trigger allergic reactions. “We don’t necessarily know that’s true,” Price says. Instead, he says, it may be that other bits of animal proteins cause most side effects, and splitting the antibodies is unnecessary. By helping establish a clinical trial network, he says, scientists can begin to evaluate the safety and effectiveness of antivenoms in a more rigorous way.A second prong of the Wellcome program will look for new treatments. One approach would look for traditional small-molecule drugs—developed for other medical uses—that could neutralize the toxic effects of snakebites. Warrell says the drug varespladib, for instance, used to combat inflammation, appears to stop bleeding caused by snakebites.Another approach would identify the proteins in a snake’s venom that are the most toxic, Lalloo says. Then, scientists could genetically engineer cells to produce human antibodies for those toxins. Price points out that treatment research should also include efforts to improve the long-term care of victims, who suffer from trauma and other persistent disabilities.The forthcoming WHO strategy could also nudge snakebite up the global health agenda. “The real significance is that this is the first time WHO has ever done this,” Lalloo says. Bernadette Abela-Ridder, head of WHO’s neglected zoonotic diseases department in Geneva, Switzerland, says the strategy will include outreach, focusing on prevention by encouraging people who work among snakes to wear shoes and gloves.For Warrell, the Wellcome money and the support of WHO are signs that 50 years after his first encounters with snakebites, the field is changing. “Neither of these developments would have been thinkable to me a few years ago,” he says. Sign up for our daily newsletter Get more great content like this delivered right to you! Country Email reptiles4all/Shutterstock By Eric HandMay. 15, 2019 , 7:01 PM Country * Afghanistan Aland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d’Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People’s Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Vietnam Virgin Islands, British Wallis and Futuna Western Sahara Yemen Zambia Zimbabwelast_img read more