title: Antivenoms for the treatment of snakebite envenomings: the road ahead.
abstract: The parenteral administration of antivenoms is the cornerstone of snakebite envenoming therapy. Efforts are made to ensure that antivenoms of adequate efficacy and safety are available world-wide. We address the main issues to be considered for the development and manufacture of improved antivenoms. Those include: (a) A knowledge-based composition design of venom mixtures used for immunization, based on biochemical, immunological, toxicological, taxonomic, clinical and epidemiological data; (b) a careful selection and adequate management of animals used for immunization; (c) well-designed immunization protocols; (d) sound innovations in plasma fractionation protocols to improve recovery, tolerability and stability of antivenoms; (e) the use of recombinant toxins as immunogens to generate antivenoms and the synthesis of engineered antibodies to substitute for animal-derived antivenoms; (f) scientific studies of the contribution of existing manufacturing steps to the inactivation or removal of viruses and other zoonotic pathogens; (g) the introduction of novel quality control tests; (h) the development of in vitro assays in substitution of in vivo tests to assess antivenom potency; and (i) scientifically-sound pre-clinical and clinical assessments of antivenoms. These tasks demand cooperative efforts at all main stages of antivenom development and production, and need concerted international partnerships between key stakeholders.
authors.affiliation: Instituto Clodomiro Picado, Universidad de Costa Rica, San José. jose.gutierrez@ucr.ac.cr
authors.forename: José María
authors.initials: JM
authors.lastname: Gutiérrez
authors.forename: Guillermo
authors.initials: G
authors.lastname: León
authors.forename: Thierry
authors.initials: T
authors.lastname: Burnouf
mesh_terms: D000818:Animals; D000997:Antivenins / Q000008:administration & dosage* / Q000302:isolation & purification; D019295:Computational Biology; D004340:Drug Contamination / Q000517:prevention & control; D055808:Drug Discovery; D006801:Humans; D007114:Immunization / Q000379:methods; D051188:Knowledge Bases; D011786:Quality Control; D012909:Snake Bites / Q000628:therapy*; D012910:Snake Venoms / Q000276:immunology; D012911:Snakes / Q000145:classification / Q000276:immunology
chemical_list: D000997:Antivenins; D012910:Snake Venoms