From Venome to Syndrome: Using Mass Spectrometry to Understand the Correspondence of Rattlesnake Venom Composition and Clinical Symptoms of Snakebite

摘要

Rattlesnake venom composition characterized by relative peak areas of 11 RP-HPLC elution regions differed significantly among taxa. Envenomation symptoms characterized by snakebite severity subscores differed significantly among rattlesnake taxa. Overall snakebite severity (the sum of all subscores, SSS), in contrast, does not differ among the southern California rattlesnake taxa after controlling for the highly influential variables of snake size (positive correlation) and mass of snakebitten patient (negative correlation). Peaks and elution regions representing exceptional proportions of total protein (area under the curves) were associated with distinct clinical syndromes. Antivenom treatment is generally administered based largely on local wound features (swelling) and hematological abnormalities. However, because some venoms (e.g., C. scutulatus) produce minimal swelling, other important symptoms should also be monitored to properly discern snakebite severity. Physicians should be aware of this to avoid undertreatment with antivenom. Venom from C. scutulatus and from the Mt. San Jacinto population of C. o. helleri possess Mojave toxin, a potent neurotoxin.5 However, venoms having high levels of basic myotoxins (C. o. helleri) produced the highest neurological subscores due to inclusion of muscle fasciculations in the scoring for neurologial symptoms. The currently available antivenom may have low reactivity to these myotoxins, and therefore further study is needed. Future investigations should aim to quantify identified proteins within specific RP-HPLC peaks. These findings can inform the design of more effective treatment algorithms and antivenoms for snakebite.