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Rapid test to save lives of snakebite victims: New diagnostic test awarded 1st prize at the Göttingen Innovation Competition
04 December 2012
Senckenberg Research Institute and Natural History Museum
A new test to detect snake venom won the first place on the winner’s podium at this year’s Göttingen Innovation Competition. The rapid test, developed by scientists from the biotechnology company miprolab GmbH and the Biodiversity and Climate Research Centre (BiK-F) in collaboration with researchers from Myanmar, indicates in 20 minutes if a patient has been envenomed by a certain species of snake. The use of such tests could save hundreds of thousands of lives each year, especially in developing countries.
According to the World Health Organisation (WHO) 5 million people are bitten by snakes each year. Over 100,000 of those affected die, while more than 300,000 suffer permanent disabilities like amputation. New studies, however, suggest that the real extent of the problem is dramatically underestimated. For example, in India alone 46,000 people die from snake bites every year. Children are particularly severely affected because of their lower body weight. “Snake bite envenoming is most neglected among the so-called ‘neglected tropical diseases’ because it mostly affects the poor rural population in developing countries who has no lobby,” says Dr. Ulrich Kuch, head of the ‘Emerging and Neglected Tropical Diseases’ research group of the Biodiversity and Climate Research Centre (BiK-F) in Frankfurt, Germany. His work on venomous snakes and snake bite in South and Southeast Asia he provided the impulse for the development of the test.
Rapid diagnosis impossible until now
In principle, snake bite envenoming can be treated highly effectively; a single infusion is often enough – if you have the correct antidote. If patients arrive at a clinic, in many countries after a long ride on a motorbike ambulance or carried on a stretcher across rough terrain, doctors must first keep them under observation for 24 hours, looking for any symptoms of envenoming. Many people are bitten by non-venomous snakes; moreover, even venomous ones can bite in defence without injecting venom. Only when the species of snake can be inferred based on the symptoms of envenoming, the corresponding antivenom is given – because these antidotes are too scarce and expensive to waste. By this time, however, the venoms have often caused irreversible damage: the toxins they contain can, for example, destroy skin, muscles, blood vessels or nerves, and affect blood coagulation. Normally, these effects help the snakes kill and digest their prey, which is swallowed whole.
Rapid test saves diagnostic time
The rapid test, developed by the BiK-F scientists and the Göttingen company miprolab GmbH in collaboration with researchers from Myanmar, indicates the presence of injected venom in 20 minutes: two red lines in the display show that the venom of the snake in question is in the patient’s blood. Doctors do not need any complicated laboratory infrastructure for the diagnosis and can administer the life-saving antivenom immediately, without losing valuable time. “The sooner treatment can begin, the higher the survival chances of the patients,” says Kuch. “Moreover, early treatment reduces the risk that the venom will destroy muscles or kidneys, for example, to such an extent that arms or legs need to be amputated or that the patient will require dialysis.” Such permanent damage is even more serious for people in developing countries where many families plunge into poverty as a result of the disability or death of their bread-earners following snake bites. Finally, rapid diagnosis also relieves pressure from overcrowded hospitals because snake bite patients who are not envenomed can be released sooner and those who are envenomed can be cured more quickly.
Efficient public-private partnership
Until now, no comparable rapid diagnostic test for snake venom is on the market. Existing laboratory procedures to detect snake venom are either complex, expensive, or provide results only after multiple working steps. None have been designed for large-scale use in developing countries. The miprolab rapid test was first developed for one of the most widely distributed and dangerous snakes in Southeast Asia, Russell’s Viper (Daboia siamensis). Tests for other relevant species from the region are now underway. The development of the test is an example of successful public-private partnership: while Ulrich Kuch and his group at the Biodiversity and Climate Research Centre (BiK-F) contributed their knowledge of the species, toxins and public health situation in the target region, the miprolab team shared their experience with the development of rapid tests for infectious agents and their economic competence. “Such an idea can only become a marketable innovation if both organisations work hand in hand,” says Dr. Frank Gessler, CEO of miprolab GmbH.
Biodiversity as a starting point
Ulrich Kuch is a biologist. However, his research does not stop at studying snakes, their diversity, distribution and ecology. Instead, he also spends a lot of time in the hospitals and with health officials of developing countries like Myanmar. As a consequence, his research is focused on problems at the interface of biodiversity and health, and his knowledge of species, venoms and their potential hazards forms the scientific basis of this approach. Fascinated by snakes since childhood, Kuch’s personal experience of being envenomed likely contributed to his motivation. Indeed, paying attention to this neglected public health problem is overdue, and new challenges emerge: “Climate change is shifting the habitats and activity patterns of snakes and the increasingly frequent floodings, for example, drive them out of their shelters directly into human settlements,” says Kuch. Even without extreme events like floods, humans increasingly invade previously untouched areas with their fields and plantations where they encounter venomous snakes and other health risks – with fatal consequences. “Unfortunately, the most dangerous species such as cobras, kraits and certain vipers have a tendency to adapt best to those changed environments where agriculture provides them with a surplus of food in the form of mice and rats.” Winning the Göttingen Innovation Prize now enhances the team’s motivation to develop and produce the life-saving test for additional species as soon as possible.
In Myanmar alone, Russell’s Viper (Daboia siamensis) causes more than 1000 deaths per year. Envenoming by its bite is one of the commonest causes of death among rice farmers in Myanmar. Copyright: David A. Warrell
Envenoming following a bite by Russell’s Viper (Daboia siamensis) in Myanmar. The venom leads to non-clotting blood and causes internal and external bleeding. In addition, it destroys muscles and the kidneys. Copyright: Aniruddha Ghose
Children are at particular risk and especially severely affected by snake bite envenoming. In Myanmar, the mortality of children after a snake bite is twice as high as the average snake bite mortality of the entire population. Copyright: Ulrich Kuch
miprolab rapid diagnostic test with test cassette: top, negative test (displaying control line only, demonstrating proper function of the test); below, positive test (control line and test line showing detection of the snake venom).