title: Experimental Assays to Assess the Efficacy of Vinegar and Other Topical First-Aid Approaches on Cubozoan (Alatina alata) Tentacle Firing and Venom Toxicity.
abstract: Despite the medical urgency presented by cubozoan envenomations, ineffective and contradictory first-aid management recommendations persist. A critical barrier to progress has been the lack of readily available and reproducible envenomation assays that (1) recapitulate live-tentacle stings; (2) allow quantitation and imaging of cnidae discharge; (3) allow primary quantitation of venom toxicity; and (4) employ rigorous controls. We report the implementation of an integrated array of three experimental approaches designed to meet the above-stated criteria. Mechanistically overlapping, yet distinct, the three approaches comprised (1) direct application of test solutions on live tentacles (termed tentacle solution assay, or TSA) with single image- and video-microscopy; (2) spontaneous stinging assay using freshly excised tentacles overlaid on substrate of live human red blood cells suspended in agarose (tentacle blood agarose assays, or TBAA); and (3) a "skin" covered adaptation of TBAA (tentacle skin blood agarose assay, or TSBAA). We report the use and results of these assays to evaluate the efficacy of topical first-aid approaches to inhibit tentacle firing and venom activity. TSA results included the potent stimulation of massive cnidae discharge by alcohols but only moderate induction by urine, freshwater, and "cola" (carbonated soft drink). Although vinegar, the 40-year field standard of first aid for the removal of adherent tentacles, completely inhibited cnidae firing in TSA and TSBAA ex vivo models, the most striking inhibition of both tentacle firing and subsequent venom-induced hemolysis was observed using newly-developed proprietary formulations (Sting No More™) containing copper gluconate, magnesium sulfate, and urea.
authors.affiliation: Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96822, USA. ayanagih@hawaii.edu.|Békésy Laboratory of Neurobiology, Pacific Biosciences Research Center, School of Ocean and Earth Science and Technology, University of Hawaii at Manoa, Honolulu HI 96822, USA. ayanagih@hawaii.edu.
authors.forename: Angel A
authors.initials: AA
authors.lastname: Yanagihara
authors.affiliation: Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96822, USA. wilcoxcl@hawaii.edu.
authors.forename: Christie
authors.initials: C
authors.lastname: Wilcox
authors.affiliation: Békésy Laboratory of Neurobiology, Pacific Biosciences Research Center, School of Ocean and Earth Science and Technology, University of Hawaii at Manoa, Honolulu HI 96822, USA. rak62123@hawaii.edu.
authors.forename: Rebecca
authors.initials: R
authors.lastname: King
authors.affiliation: Békésy Laboratory of Neurobiology, Pacific Biosciences Research Center, School of Ocean and Earth Science and Technology, University of Hawaii at Manoa, Honolulu HI 96822, USA. kikiana@go.byuh.edu.|Department of Natural Sciences, Brigham Young University-Hawaii, Honolulu, HI 96717, USA. kikiana@go.byuh.edu.
authors.forename: Kikiana
authors.initials: K
authors.lastname: Hurwitz
authors.affiliation: Békésy Laboratory of Neurobiology, Pacific Biosciences Research Center, School of Ocean and Earth Science and Technology, University of Hawaii at Manoa, Honolulu HI 96822, USA. castelf@pbrc.hawaii.edu.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Castelfranco
mesh_terms: D019342:Acetic Acid / Q000494:pharmacology / Q000627:therapeutic use*; D000287:Administration, Topical; D000818:Animals; D001681:Biological Assay; D001733:Bites and Stings / Q000188:drug therapy*; D003064:Cnidarian Venoms / Q000633:toxicity*; D037462:Cubozoa; D004912:Erythrocytes / Q000187:drug effects; D005392:First Aid; D006461:Hemolysis / Q000187:drug effects; D006801:Humans; D058894:Nematocyst / Q000187:drug effects
chemical_list: D003064:Cnidarian Venoms; D019342:Acetic Acid
keywords: Alatina alata; Sting No More™; copper gluconate; cubozoan; first aid; hemolysis; jellyfish; sting; venom; vinegar