Trialing Australian snake anti-venom

Normal, Weekender

The National, Friday 11th November 2011

UNIVERSITY of Melbourne researchers have been awarded more than A$1.4 million by the Australian National Health & Medical Research Council (ANHMRC) to conduct the first-ever randomised clinical trial of an Australian snake antivenom.
The study, to be conducted in partnership with collaborators from the University of Papua New Guinea in Port Moresby, will compare the current CSL taipan antivenom with a new antivenom made in Costa Rica and will take place in Port Moresby General Hospital.
While similar numbers of snakebites occur in both Australia and PNG, death following snakebite in Australia is rare, whereas in PNG up to 200 people die from snakebites every year, partly because their health system has not been able to afford to supply enough of the antivenom produced in Australia.
Scientists from the Australia Venom Research Unit (AVRU) at the University of Melbourne teamed up with colleagues from the School of Medicine & Health Sciences at the UPNG in 2005 to investigate snakebite problems in PNG, and this collaboration led them to team up with a not-for-profit, university-based antivenom producer in Costa Rica to produce a new, more-affordable antivenom, that could eventually be manufactured in PNG by UPNG scientists themselves.
The taipan is a common and potentially deadly snake in some parts of Australia and in PNG.
Taipans have the most-toxic venoms of all land snakes, along with very long fangs and a very accurate bite, making them some of the most-dangerous snakes in the world.
Bites can destroy nerve and muscle tissue, cause severe paralysis, bleeding problems, kidney injury and heart rhythm problems.
Dr Ken Winkel, director of the AVRU, is excited about this grant and what it will mean for the Australian and PNG communities.
“Funding from the grant will see the establishment of a snakebite clinic within the emergency department of Port Moresby General Hospital, and a clinical research laboratory at the neighbouring UPNG Medical School,” he said.
 “The trial has been rigorously designed, and will be carried out by a team of 13 PNG doctors, nurses and scientists led by two AVRU researchers based in Port Moresby.
 “The ANHMRC funding enables us to conduct the trial under the best possible conditions for patient safety and medical care, and will significantly enhance the capacity to treat snakebites at the local hospital, not just throughout the trial, but well into the future.”
The UPNG’s dean of research, Prof Teatulohi Matainaho, is equally enthusiastic about the benefits of the research.
“This research has accomplished a great deal in a very short period of time, and will not only provide an opportunity to improve the training of our medical staff and laboratory scientists, but also moves us one step closer to potentially being able to manufacture our own antivenoms to provide a sustainable solution to a very serious public health problem that kills many Papua New Guineans,” he said.
“Snakebites are an acute medical emergency.
“Without antivenom many patients will die within 24 hours, but for a long time now, the cost of Australian antivenom has been rising because of factors such as international exchange rate fluctuations, and PNG has been able to afford less and less of this lifesaving medicine.
 “If the new antivenom from Costa Rica is shown to be as safe and as effective as the Australian antivenom, the cost of treating snakebites could drop enormously, and we hope that a future technology transfer will enable us to make the new antivenom here, providing a truly local solution, as well as local jobs for our young scientists, and a unique training environment for future biomedical research students.”
Snakebite places a significant burden on the resources of PMGH, with up to 300 cases being seen every year, and the recruitment of a team of local doctors and nurses working in a new snakebite clinic is expected to take some pressure off the hospital’s emergency and intensive care departments.
“We expect that after the trial, the snakebite clinic will continue to operate and deliver improved care to snakebite patients in PNG, and we will work towards identifying sustainable funding to achieve this outcome,” Winkel said.
“At the same time, this grant also enables us to continue to build research capacity, and contribute to the training of young scientists at the UPNG Medical School.”
Prof Matainaho agrees, and said that the establishment of laboratory facilities for undertaking the analysis of the data obtained from the patients in the antivenom trial would also eventually benefit the school more broadly.
“The Snakebite Project has already helped UPNG to develop new infrastructure, research programs and projects for students,” he said, “and the new facilities that will be set up for the antivenom trial will be a significant new resource that we expect will continue to operate after the trial concludes.
“In light of recent discussions between Prime Ministers of Australia and PNG regarding better relations and support in higher education, science and research, this project is a fine example of how Australian and PNG universities can partner with each other successfully, and also provides an excellent model for other institutions to follow”.
One of the UPNG researchers who will benefit directly from the grant will be Owen Paiva, who has worked with the AVRU-UPNG Snakebite Project for several years, and carried research on the venom of another of PNG’s venomous snakes, the small-eyed snake, for his master’s thesis.
“This is an amazing opportunity for Papua New Guinean researchers to be involved in a major medical breakthrough that will directly help the people of our country,” he said.
“Right from the beginning it has been clear that this project wasn’t just about doing research for the sake of research, but that the objective was to save people’s lives and find a long-term solution to an important problem.
“Snakebite and antivenom research is truly multidisciplinary so this project doesn’t just benefit one group of researchers, because it involves clinical medicine, biochemistry and molecular biology, pharmacology, immunology, microbiology and public health disciplines like epidemiology and biostatistics.
“And if we eventually start to make the antivenom here in PNG, we’ll also be creating jobs for scientists like myself in our own country, as well as helping our people.”
Winkel also sees potential benefits beyond PNG’s borders.
“There is an urgent need to develop effective, high-potency antivenoms to affordably replace a number of low efficacy products in Africa and Asia, and the success of this new, high-potency, affordable Papuan taipan antivenom, tested in a robust clinical trial, would offer proof-of-principle and a path forward towards achieving this objective.
“ He says the trial in Port Moresby is also very important to Australia,” he said.
“Not only are we helping our closest neighbours to develop their own capacity to become truly independent by developing local biotechnology and research capacity, research skills and improved health for its population, but we are increasing our knowledge of the effects of taipan snakebites, and how to manage them successfully.
“We are confident the results of the trial will inform and improve snakebite management for the benefit of both countries.”

For more information: Dr Ken Winkel ([email protected]): Ph: +61 3 8344 7753 or Prof Teatulohi Matainaho ([email protected]): +675 7102 5768.