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Innovative Medicines & Omics Progress in antivenom therapy

species and limited access to modern healthcare services. production technologies, improve pharmacovigilance,
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Within these areas, the most vulnerable populations are and implement regulatory frameworks that ensure both
impoverished agricultural laborers, herders, hunters, and product efficacy and equitable distribution.
children, who are frequently exposed to snake habitats In light of these realities, this review aims to provide a
during their daily activities. Rural isolation, deficient comprehensive examination of the historical development
transportation infrastructure, and economic constraints of antivenom therapy, analyze the present therapeutic
often delay or prevent victims from receiving timely limitations, and explore emerging innovations that
medical treatment. Consequently, snakebite envenomation promise to revolutionize the management of snakebite
is both a biomedical emergency and a disease of inequity, envenomation. In doing so, it highlights the interplay
mirroring broader systemic failures in healthcare delivery between scientific progress and global health policy and
and resource allocation.
underscores the necessity for translational research that
The clinical course of snakebite envenomation bridges laboratory breakthroughs with real-world impact.
varies significantly based on the offending species
and the composition of its venom, which may contain 2. Historical background
neurotoxins, hemotoxins, myotoxins, cardiotoxins, or The genesis of antivenom therapy can be traced to the late
cytotoxins, often in complex mixtures. Envenomation 19 century, an era marked by burgeoning discoveries in
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can lead to rapid-onset systemic manifestations, such as immunology and the emerging germ theory of disease.
hypotension, coagulopathy, renal failure, neuromuscular Central to the early development of antivenom was the
paralysis, and extensive local tissue necrosis. Without pioneering work of French physician and bacteriologist
prompt administration of effective antivenom, the risk of Albert Calmette. In 1891, Calmette was sent by the Institut
irreversible organ damage or death increases dramatically. Pasteur to establish a research facility in Saigon, then
Compounding this challenge, diagnostic capabilities to part of French Indochina, where he was confronted with
identify the envenoming species are frequently absent in high mortality rates due to cobra bites. Recognizing the
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rural clinics, further complicating clinical decision-making. urgent need for a therapeutic countermeasure, Calmette
Treatment status worldwide remains suboptimal. The embarked on experimental immunization of horses
mainstay of therapy is the administration of antivenom with sublethal doses of Naja naja (Indian cobra) venom.
derived from the immunized plasma of horses or Through repeated injections, he induced the production
sheep, which contains polyclonal antibodies capable of of circulating neutralizing antibodies in the horses, which
neutralizing venom components. However, the efficacy he subsequently extracted and purified from their serum.
of such preparations is often geographically limited to the In 1894, he reported the successful production of the
venom profiles of specific snake populations used during first anti-cobra antivenom, which could confer passive
the immunization process. In Africa and Asia, polyclonal immunity in envenomated subjects. Calmette’s work
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antivenoms often lack adequate species coverage or marked a transformative moment in toxinology, heralding
exhibit poor cross-reactivity. Adverse reactions, such the birth of serotherapy—using serum-derived antibodies
as early anaphylaxis or late-onset serum sickness, are to neutralize exogenous toxins—as a viable and scientific
relatively common due to the xenogeneic nature of approach to treating snake envenomation (Table 1).
these biologics. Furthermore, many antivenoms are
prohibitively expensive and require cold-chain storage, Table 1. Historical timeline of antivenom therapy
rendering them inaccessible or impractical in remote
regions. The unregulated proliferation of substandard Year Milestone Key contributor/
institution
or counterfeit products further erodes the trust of both
clinicians and patients, jeopardizing treatment outcomes 1891 First experimental immunization Albert Calmette, Institut
with cobra venom
Pasteur
and contributing to therapeutic hesitancy.
1894 First anti-cobra antivenom Albert Calmette
Recognizing these challenges, the WHO launched its developed
global strategy for the prevention and control of snakebite 1901 Development of polyvalent Vital Brazil, Instituto
envenoming in 2019, with the goal of halving the number antivenoms Butantan
of deaths and disabilities by 2030. This plan emphasizes 1916 Establishment of the Australia
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four pillars: Community empowerment, accessibility of Commonwealth Serum Laboratories
safe and effective antivenoms, strengthened health systems, 2019 Launch of the WHO global strategy WHO
and increased research and innovation. As part of this for snakebite envenoming
initiative, there is an urgent call to modernize antivenom Abbreviation: WHO: World Health Organization.

Volume 2 Issue 3 (2025) 14 doi: 10.36922/IMO025240026