A therapeutic combination of two small molecule toxin inhibitors provides broad preclinical efficacy against viper snakebite

Nat Commun. 2020 Dec 15;11(1):6094. doi: 10.1038/s41467-020-19981-6.

Abstract

Snakebite is a medical emergency causing high mortality and morbidity in rural tropical communities that typically experience delayed access to unaffordable therapeutics. Viperid snakes are responsible for the majority of envenomings, but extensive interspecific variation in venom composition dictates that different antivenom treatments are used in different parts of the world, resulting in clinical and financial snakebite management challenges. Here, we show that a number of repurposed Phase 2-approved small molecules are capable of broadly neutralizing distinct viper venom bioactivities in vitro by inhibiting different enzymatic toxin families. Furthermore, using murine in vivo models of envenoming, we demonstrate that a single dose of a rationally-selected dual inhibitor combination consisting of marimastat and varespladib prevents murine lethality caused by venom from the most medically-important vipers of Africa, South Asia and Central America. Our findings support the translation of combinations of repurposed small molecule-based toxin inhibitors as broad-spectrum therapeutics for snakebite.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antivenins / administration & dosage*
  • Antivenins / therapeutic use*
  • Asia
  • Benzamidines
  • Central America
  • Dimercaprol / pharmacology
  • Dimercaprol / therapeutic use
  • Disease Models, Animal
  • Drug Combinations
  • Drug Evaluation, Preclinical
  • Guanidines
  • Kaplan-Meier Estimate
  • Male
  • Mice
  • Neutralization Tests
  • Serine Proteases / drug effects
  • Snake Bites / drug therapy*
  • Toxins, Biological
  • Viper Venoms

Substances

  • Antivenins
  • Benzamidines
  • Drug Combinations
  • Guanidines
  • Toxins, Biological
  • Viper Venoms
  • Dimercaprol
  • Serine Proteases
  • nafamostat