CMC aims to make antivenom locally

A research team, for the first time in Bangladesh, is studying native snake species aim-ing at mass-scale production of effective antivenom for local patients.

As part of the initiative, they are rearing and hatching poisonous snakes in a laboratory of the Venom Research Centre, being operated by the medicine department at Chitta-gong Medical College (CMC).

The researchers would collect venoms from the snakes, analyse their properties, and develop techniques to produce the antidote. If the sample antivenom meet the WHO standards, the government would go for mass production.

A total of 15 researchers from CMC, Chittagong University (CU), Goethe University of Germany, and Toxicology Society of Bangladesh are involved with the five-year project, which was launched in March 2018.

The centre is also breeding rats and lizards to feed the snakes with, and often adds one-day-old chickens to the reptiles’ diet. The researchers have collected 60 snakes of three species (viper, cobra and krait) from different parts of the country.

Mizanur Rahman, an assistant researcher and zoology graduate of CU, said, “Apart from collecting snakes, we have hatched 34 snakes in our lab so far.”

According to a 2018 report of the World Health Organization (WHO), seven lakh people fall victim to snakebites in Bangladesh annually and more than 6,000 of them die. This is the second biggest cause of deaths during floods when snakes slither out of their habitats and take shelter in human homes.

Dr Aniruddha Ghosh, the principal investigator and associate professor of medicine at CMC, said hospitals treat patients with anti-venoms, but in many cases they do not work and result in deaths. The goal of this research is to develop effective anti-venoms for treating snakebite patients in the country, he added.

The problem was explained by Dr Robed Amin, an associate professor of Dhaka Medical College. He said, “Imported anti-venoms hardly match with the venoms from the snakes in the country. There is a chance of adverse reactions when the patients are administered those. That’s why doctors in most cases refuse to use them.”

Bangladesh usually imports anti-venoms from India.

Dr MA Faiz, president of Toxicology Society of Bangladesh, said, “WHO recommends that anti-venoms be made from the snakes of the country where it will be used because the poison properties of snakes vary with geographical locations.”

It was found that the same snakes even within the same country have different compo-sition of venoms if locations change. There are also variations in venom properties of the same snake species, he added.

“So, in 2017, WHO adopted a resolution that snakebite patients would have to be treated with anti-venoms produced in the native country,” said Dr Aniruddha. “That’s why the government took this initiative.”

There are at least 80 species of snakes in Bangladesh, but only 10 of them are poison-ous (two species of cobras, five of kraits and three of vipers) for humans, according to Dr Aniruddha. Among the three species, bites by kraits and cobras are the principal cause of snakebite mortality, he added.

Asked, why CMC was chosen for the project, Aniruddha said some of the teachers here did academic research on snake venoms, and their proposal also convinced the commis-sioning authority, Directorate General of Health Services (DGHS).

Abdullah Abu Sayeed, a co-investigator and assistant professor of medicine at CMC, said the laboratory collects venoms using two techniques.

One of them involves a beaker where the snake is made to release the venom. The oth-er uses an artificial environment where snakes are deceived into biting the extraction containers as enemies, he said.

“Now we are analysing the properties of the venoms. It’s the first stage,” said Dr Ab-dullah. “In the second stage, we will see whether the anti-venoms available in the mar-ket can fully neutralise the effects of the venoms.”

The next stage will be standardisation (documentation of categories and properties) of the venoms. “Then we will inject a very low dose of venom into the body of a horse or a strong animal,” said Abdul Wahed Chowdhury, another co-investigator and assistant professor of zoology at CU.

“When injected, the animal body would produce an antibody against the antigen of the venom. We will collect the antibody [a sort of protein] from the animal, do further pro-cessing, and come up with a sample anti-venom in the final stage.”

The entire procedure would follow WHO guidelines.

Dr Aniruddha said they would like to have the first anti-venom by 2023. “Then we will submit it to WHO for approval, which would pave the way for the country to go for mass production of anti-venoms.”

The project is set to cost Tk 8 crore over a period of five years.

Anti-venoms are available at all state-run tertiary-level and district hospitals and dis-tributed free to patients in the country, said Dr Abdullah.

The upazila health complexes do not keep them, and give primary treatment because administering anti-venoms needs special skills and proper care for patients, he said. One dose costs the government about Tk 15,000-20,000, he added.