Review Article

Developing Small Molecule Therapeutics for the Initial and Adjunctive Treatment of Snakebite

Table 1

Desirable preclinical characteristics of an SMT for snakebite.

Safe(i) Minimize off-target toxicity [66]
(ii) Without adverse interactions with antivenom
(iii) Broad therapeutic index

Efficacy (in vitro)(i) Nano- or subsnanomolar in vitro potency (IC50) for scalability [66, 77, 80]
(ii) Determination of affinity, minimum active concentrations, physical characteristics, stability, mechanisms of action, dose-response, and drug effects [8, 31, 32, 54, 69, 77, 8087]

Efficacy (in vivo)(i) Tested with both:
   (a) Minimum acceptable: Pre-mixing of venom and antidote prior to injection (ED50 determination) [32]
   (b) Ideal: Venom administration prior to administration of antidote [8, 31, 88]
(ii) Compatible with standard assessments of coagulation [89]

Broad Spectrum(i) Wide target selection (ubiquity and medical importance of inhibitory target amon snake species) [34, 35]

Heat Stable(i) Real-time stability studies up to 37°C (±2°C) and relative humidity of 75% (±5%) (WHO “Climatic Zone IVb”) [90]

Ease of Administration(i) Oral solution, rectal or nasal formulations
(ii) Auto-Injectable [54]

Bioavailability(i) For oral formulations, adequate bioavailability in fed state

Half-life(i) For field antidotes, half-life of at least 5 to 7 hours [78, 91, 92]
(ii) Potential for re-dosing