ArticlePLoS neglected tropical diseases2019
Beyond the 'big four': Venom profiling of the medically important yet neglected Indian snakes reveals disturbing antivenom deficiencies.
Article in PLoS neglected tropical diseases, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 91 papers, 2 of them syntheses that pooled it.
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Who cites it
91 citing papers in PubMed, 2 syntheses or guidelines pooled it, 183 citations in OpenAlex.
- Pooled it
- Antivenom preclinical efficacy testing against Asian snakes and their availability in Asia: A systematic review.PloS one · 2023Pooled it
- Immunological Cross-Reactivity and Neutralizing Efficacy of Antivenom Against Five Medically Important Iranian Viper Venoms.Veterinary medicine and science · 2026Article
- Animal models in venom and antivenom research: The need to align academic discovery with manufacturing and regulatory expectations.PLoS neglected tropical diseases · 2026Review
- Development of a deep learning based framework for classification of Indian venomous snakes integrated with explainable artificial intelligence for primary and emergency care providers.PLoS neglected tropical diseases · 2026Article
- Venom variation and the future of antivenom design: Integrating population venomics, evolutionary toxinology, and precision therapeutics.Toxicon: X · 2026Review
- The cobras (genus Naja) of Myanmar: An updated species list with information on identification, distributions, and medical importance.PLoS neglected tropical diseases · 2026Article
- Preliminary Insights into Geographic Variation in Venom Profiles and Functional Activities of Nigerian Snakes,Toxins · 2026Article
- Snake Venom Protease Detection and Inhibition in Serum.ChemMedChem · 2026Article
- Bispecific single-domain antibody (VHH) fused with human IgG1 Fc with dual specificity effectively neutralize Naja Kaouthia venom.PLoS neglected tropical diseases · 2026Article
- Article
- The unmet need for the mitigation of snakebite envenoming in India: a one health perspective.Tropical medicine and health · 2026Review
- Article
- Hiss and tell: What influences venom yields of India's big four snakes?PLoS neglected tropical diseases · 2025Article
- Snakebite envenoming in India: it is time we look beyond the concept of the Big Four species.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2025Review
- Future of snakebite risk in India: Consequence of climate change and the shifting habitats of the big four species in next five decades.PLoS neglected tropical diseases · 2025Article
- ExplainingToxins · 2025Article
- Clinical challenges, controversies, and regional strategies in snakebite care in India.The Lancet regional health. Southeast Asia · 2025Review
- Diagnosis of Indian Big Four and monocled Cobra snakebites in envenomed plasma using smartphone-based digital imaging colourimetry method.PLoS neglected tropical diseases · 2025Article
- Epitope-based antibody development against metalloproteinases and phospholipases AThe journal of venomous animals and toxins including tropical diseases · 2025Article
31 more citing papers are in PubMed but not listed here.
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSnakebite in India causes the highest annual rates of death (46,000) and disability (140,000) than any other country. Antivenom is the mainstay treatment of snakebite, whose manufacturing protocols, in essence, have remained unchanged for over a century. In India, a polyvalent antivenom is produced for the treatment of envenomations from the so called 'big four' snakes: the spectacled cobra (Naja naja), common krait (Bungarus caeruleus), Russell's viper (Daboia russelii), and saw-scaled viper (Echis carinatus). In addition to the 'big four', India is abode to many other species of venomous snakes that have the potential to inflict severe clinical or, even, lethal envenomations in their human bite victims. Unfortunately, specific antivenoms are not produced against these species and, instead, the 'big four' antivenom is routinely used for the treatment.
methodsWe characterized the venom compositions, biochemical and pharmacological activities and toxicity profiles (mouse model) of the major neglected yet medically important Indian snakes (E. c. sochureki, B. sindanus, B. fasciatus, and two populations of N. kaouthia) and their closest 'big four' congeners. By performing WHO recommended in vitro and in vivo preclinical assays, we evaluated the efficiencies of the commercially marketed Indian antivenoms in recognizing venoms and neutralizing envenomations by these neglected species.
findingsAs a consequence of dissimilar ecologies and diet, the medically important snakes investigated exhibited dramatic inter- and intraspecific differences in their venom profiles. Currently marketed antivenoms were found to exhibit poor dose efficacy and venom recognition potential against the 'neglected many'. Premium Serums antivenom failed to neutralise bites from many of the neglected species and one of the 'big four' snakes (North Indian population of B. caeruleus).
conclusionsThis study unravels disturbing deficiencies in dose efficacy and neutralisation capabilities of the currently marketed Indian antivenoms, and emphasises the pressing need to develop region-specific snakebite therapy for the 'neglected many'.
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