{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:06:50Z","timestamp":1760058410584,"version":"build-2065373602"},"reference-count":74,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:00:00Z","timestamp":1743984000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000923","name":"Australian Research Council","doi-asserted-by":"publisher","award":["DP190100304"],"award-info":[{"award-number":["DP190100304"]}],"id":[{"id":"10.13039\/501100000923","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Accelerated Science and Technology Human Resource Development Program of the Department of Science and Technology\u2013Science Education Institute","award":["DP190100304"],"award-info":[{"award-number":["DP190100304"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>The Philippines has a high diversity of venomous snake species, but there is minimal information on their envenomation effects. This is evidenced by the small number of case reports, the poor reporting of envenomation cases, and the absence of specific antivenoms apart from one against the Philippine cobra (Naja philippinensis). This study sought to profile the action of selected Philippine pit viper venoms on blood coagulation and to investigate whether commercially available non-specific antivenoms can provide adequate protection against these venoms. Venom from the pit vipers Trimeresurus flavomaculatus and Trimeresurus mcgregori were subjected to coagulation assays, antivenom cross-neutralization tests, and thromboelastography. Venoms from both species were able to clot human plasma and isolated human fibrinogen. Consistent with pseudo-procoagulant\/thrombin-like activity, the resulting fibrin clots were weak and transient, thereby contributing to net anticoagulation through the depletion of fibrinogen levels. Clotting factors fIXa and fXa were also inhibited by the venoms, further contributing to the net anticoagulant activity. Monovalent and polyvalent antivenoms from the Thai Red Cross Society were effective against both venoms, indicating cross-neutralization of venom toxins; the polyvalent antivenom was able to rescue fibrinogen clotting to a greater degree than the monovalent antivenom. Our findings highlight the coagulopathic effects of these pit viper venoms and suggest the utility of procuring the non-specific antivenoms for areas in the Philippines with a high risk for pit viper envenomation.<\/jats:p>","DOI":"10.3390\/toxins17040185","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T05:30:59Z","timestamp":1744003859000},"page":"185","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bite First, Bleed Later: How Philippine Trimeresurus Pit Viper Venoms Hijack Blood Clotting"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6226-1655","authenticated-orcid":false,"given":"Daniel Albert E.","family":"Castillo","sequence":"first","affiliation":[{"name":"The Graduate School, University of Santo Tomas, Espa\u00f1a Boulevard, Manila 1008, Philippines"},{"name":"Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia 4072, Australia"},{"name":"Department of Biological Sciences, College of Science, University of Santo Tomas, Espa\u00f1a Boulevard, Manila 1008, Philippines"},{"name":"Avilon Wildlife Conservation Foundation and School of Practical Veterinary Management, Inc., 9003 GP Sitio Gulod, Barangay San Isidro, Rodriguez 1860, Rizal, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Seneci","sequence":"additional","affiliation":[{"name":"Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia 4072, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhinandan","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia 4072, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marilyn G.","family":"Rimando","sequence":"additional","affiliation":[{"name":"The Graduate School, University of Santo Tomas, Espa\u00f1a Boulevard, Manila 1008, Philippines"},{"name":"Department of Biological Sciences, College of Science, University of Santo Tomas, Espa\u00f1a Boulevard, Manila 1008, Philippines"},{"name":"Research Center for the Natural and Applied Sciences, University of Santo Tomas, Espa\u00f1a Boulevard, Manila 1008, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6661-1283","authenticated-orcid":false,"given":"Bryan G.","family":"Fry","sequence":"additional","affiliation":[{"name":"Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia 4072, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"doi-asserted-by":"crossref","unstructured":"Jackson, T.N.W., and Fry, B.G. (2016). A tricky trait: Applying the fruits of the \u201cfunction debate\u201d in the philosophy of biology to the \u201cvenom debate\u201d in the science of toxinology. Toxins, 8.","key":"ref_1","DOI":"10.3390\/toxins8090263"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3488","DOI":"10.3390\/toxins6123488","article-title":"Quo Vadis Venomics? A Roadmap to Neglected Venomous Invertebrates","volume":"6","author":"Campbell","year":"2014","journal-title":"Toxins"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1042\/BCJ20160577","article-title":"Venomics: Integrative venom proteomics and beyond","volume":"474","author":"Calvete","year":"2017","journal-title":"Biochem. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.toxicon.2014.02.023","article-title":"Recent advances in the understanding of brown spider venoms: From the biology of spiders to the molecular mechanisms of toxins","volume":"83","author":"Gremski","year":"2014","journal-title":"Toxicon"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.toxicon.2016.04.035","article-title":"A fatal bite from the burrowing asp Atractaspis corpulenta (Hallowell 1854)","volume":"118","author":"Tilbury","year":"2016","journal-title":"Toxicon"},{"doi-asserted-by":"crossref","unstructured":"Senthilkumaran, S., Sampath, S., Almeida, J.R., Williams, J., Williams, H.F., Patel, K., Thirumalaikolundusubramanian, P., and Vaiyapuri, S. (2024). Pulmonary Thromboembolism following Russell\u2019s Viper Bites. Toxins, 16.","key":"ref_6","DOI":"10.3390\/toxins16050222"},{"key":"ref_7","first-page":"7","article-title":"Electrostatic resistance to alpha-neurotoxins conferred by charge reversal mutations in nicotinic acetylcholine receptors","volume":"288","author":"Harris","year":"2021","journal-title":"Proc. R. Soc. B Biol. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"giac048","DOI":"10.1093\/gigascience\/giac048","article-title":"Modern venomics\u2014Current insights, novel methods, and future perspectives in biological and applied animal venom research","volume":"11","author":"Anderluh","year":"2022","journal-title":"GigaScience"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.toxicon.2021.09.021","article-title":"Potential para-specific and geographical utility of Thai Green Pit Viper (Trimeresurus albolabris) Monovalent Antivenom: Neutralization of procoagulant and hemorrhagic activities of diverse Trimeresurus pit viper venoms","volume":"203","author":"Yong","year":"2021","journal-title":"Toxicon"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e296","DOI":"10.1016\/S2214-109X(22)00479-X","article-title":"A global core outcome measurement set for snakebite clinical trials","volume":"11","author":"Abouyannis","year":"2023","journal-title":"Lancet Glob. Health"},{"unstructured":"World Health Organization (2017). Recommendation for the Adoption of an Additional Disease as a Neglected Tropical Disease: The Case for Snakebite Envenoming, World Health Organization.","key":"ref_11"},{"doi-asserted-by":"crossref","unstructured":"Williams, D.J., Faiz, M.A., Abela-Ridder, B., Ainsworth, S., Bulfone, T.C., Nickerson, A.D., Habib, A.G., Junghanss, T., Fan, H.W., and Turner, M. (2019). Strategy for a globally coordinated response to a priority neglected tropical disease: Snakebite envenoming. PLoS Negl. Trop. Dis., 13.","key":"ref_12","DOI":"10.1371\/journal.pntd.0007059"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"6160","DOI":"10.1038\/s41467-022-33627-9","article-title":"Global mortality of snakebite envenoming between 1990 and 2019","volume":"13","author":"Roberts","year":"2022","journal-title":"Nat. Commun."},{"doi-asserted-by":"crossref","unstructured":"Habib, A.G., Kuznik, A., Hamza, M., Abdullahi, M.I., Chedi, B.A., Chippaux, J.-P., and Warrell, D.A. (2015). Snakebite is Under Appreciated: Appraisal of Burden from West Africa. PLoS Negl. Trop. Dis., 9.","key":"ref_14","DOI":"10.1371\/journal.pntd.0004088"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s40409-017-0127-6","article-title":"Snakebite envenomation turns again into a neglected tropical disease!","volume":"23","author":"Chippaux","year":"2017","journal-title":"J. Venom. Anim. Toxins Trop. Dis."},{"unstructured":"Williams, G.C., and Gosliner, T.M. (2014). The Dangerously Venomous Snakes of the Philippine Archipelago with Identification Keys and Species Accounts. The Coral Triangle: The 2011 Hearst Philippine Biodiversity Expedition, California Academy of Sciences.","key":"ref_16"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1080\/10225706.2011.623415","article-title":"Medical geography views on snakebites in Southeast Asia: A case study from Vietnam","volume":"28","author":"Eriksson","year":"2011","journal-title":"Asian Geogr."},{"doi-asserted-by":"crossref","unstructured":"Patikorn, C., Blessmann, J., Nwe, M.T., Tiglao, P.J.G., Vasaruchapong, T., Maharani, T., Doan, U.V., Zainal Abidin, S.A., Ismail, A.K., and Othman, I. (2022). Estimating economic and disease burden of snakebite in ASEAN countries using a decision analytic model. PLoS Negl. Trop. Dis., 16.","key":"ref_18","DOI":"10.1371\/journal.pntd.0010775"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"107751","DOI":"10.1016\/j.toxicon.2024.107751","article-title":"A fatal snakebite envenomation due to King Cobra (Ophiophagus hannah) in the Eastern Visayas, Philippines","volume":"244","author":"Arrieta","year":"2024","journal-title":"Toxicon"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/S0041-0101(96)00194-8","article-title":"Intraarticular envenomation by Trimeresurus flavomaculatus mcgregori resulting in joint destruction","volume":"35","author":"Clark","year":"1997","journal-title":"Toxicon"},{"key":"ref_21","first-page":"477","article-title":"Cobra Anti-Venom Serum Production at the Alabang Serum and Vaccine Laboratories","volume":"85","author":"Salafranca","year":"1956","journal-title":"Philipp. J. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"447","DOI":"10.15171\/ijhpm.2015.75","article-title":"Needs and availability of snake antivenoms: Relevance and application of international guidelines","volume":"4","author":"Scheske","year":"2015","journal-title":"Int. J. Health Policy Manag."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e007639","DOI":"10.1136\/bmjgh-2021-007639","article-title":"Situation of snakebite, antivenom market and access to antivenoms in ASEAN countries","volume":"7","author":"Patikorn","year":"2022","journal-title":"BMJ Glob. Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1080\/15659801.2016.1176614","article-title":"Novel predator recognition by Allenby\u2019s gerbil (Gerbillus andersoni allenbyi): Do gerbils learn to respond to a snake that can \u201csee\u201d in the dark?","volume":"62","author":"Bleicher","year":"2016","journal-title":"Isr. J. Ecol. Evol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"107798","DOI":"10.1016\/j.toxicon.2024.107798","article-title":"Platelet and red cell responses to three North American pit vipers","volume":"247","author":"Francis","year":"2024","journal-title":"Toxicon"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.toxicon.2018.06.079","article-title":"Thromboelastometry analysis of severe North American pit viper-induced coagulopathy: A case report","volume":"151","author":"Cao","year":"2018","journal-title":"Toxicon"},{"doi-asserted-by":"crossref","unstructured":"Qamruddin, R.M., Safferi, R.S., Mohamed@Ismail, Z., Salleh, M.S., Abd Hamid, M.N.H., Ng, V.E.R.F., Goh, W.C., and Ismail, A.K. (2023). Frequency, geographical distribution and outcomes of pit viper bites in Malaysia consulted to Remote Envenomation Consultancy Services (RECS) from 2017 to 2020. PLoS Negl. Trop. Dis., 17.","key":"ref_27","DOI":"10.1371\/journal.pntd.0011569"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1097\/01.NURSE.0000651632.09894.b4","article-title":"Caring for patients with venomous Crotalinae snakebites","volume":"50","author":"Miller","year":"2020","journal-title":"Nursing"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"100053","DOI":"10.1016\/j.toxcx.2020.100053","article-title":"A brief review on the natural history, venomics and the medical importance of bushmaster (Lachesis) pit viper snakes","volume":"7","author":"Moraes","year":"2020","journal-title":"Toxicon X"},{"key":"ref_30","first-page":"1","article-title":"Illustrated Key to the Snakes of the Philippines","volume":"66","author":"Weinell","year":"2019","journal-title":"Proc. Calif. Acad. Sci."},{"unstructured":"World Health Organization, and WHO Expert Committee on Biological Standardization (2017). WHO Guidelines for the Production, Control and Regulation of Snake Antivenom Immunoglobulins, WHO Press.","key":"ref_31"},{"doi-asserted-by":"crossref","unstructured":"Le Roux, G., Grenet, G., Schmitt, C., French Poison Control Centers Research Group, Larr\u00e9ch\u00e9, S., and Descatha, A. (2022). Bites by Non-Native Reptiles in France: Species, Circumstances and Outcome. Toxins, 14.","key":"ref_32","DOI":"10.3390\/toxins14080570"},{"doi-asserted-by":"crossref","unstructured":"Ilagan, V.A.D., Alejandro, G.J.D., Paraguison, D.J.B., Perolina, S.M.W., Mendoza, G.R., Bolina, A.B., Raterta, R., Vales, M.B., Suarez, G.J.D., and Blasco, F.A. (2022). Ethnopharmacological documentation and molecular authentication of medicinal plants used by the Manobo and Mamanwa tribes of Surigao del Sur, Philippines. Biodiversitas J. Biol. Divers., 23.","key":"ref_33","DOI":"10.13057\/biodiv\/d230646"},{"unstructured":"Litschka-Koen, T., Pons, J., Tiglao, P.J., Comandante, J.D., Santamaria, E., Sarmiento, M.J., Whitaker, R., Jesudasan, A., Kartik, A., and Ch, G. (2025, January 28). Case Reports of Tropical Snakebite Victims Illustrate the Vital Humanitarian Role and Challenges of Community Action Groups: RSTMH Special Report on Snakebite 2019. Available online: https:\/\/www.rstmh.org\/sites\/rstmh\/files\/content\/attachments\/2021-04-01\/RSTMH%20%E2%80%93%20Snakebite%20Report%202019%20v2.1.pdf.","key":"ref_34"},{"doi-asserted-by":"crossref","unstructured":"Panagides, N., Jackson, T.N.W., Ikonomopoulou, M.P., Arbuckle, K., Pretzler, R., Yang, D.C., Ali, S.A., Koludarov, I., Dobson, J., and Sanker, B. (2017). How the cobra got its flesh-eating venom: Cytotoxicity as a defensive innovation and its co-evolution with hooding, aposematic marking, and spitting. Toxins, 9.","key":"ref_35","DOI":"10.3390\/toxins9030103"},{"doi-asserted-by":"crossref","unstructured":"Patikorn, C., Ismail, A.K., Zainal Abidin, S.A., Othman, I., Chaiyakunapruk, N., and Taychakhoonavudh, S. (2022). Potential economic and clinical implications of improving access to snake antivenom in five ASEAN countries: A cost-effectiveness analysis. PLoS Negl. Trop. Dis., 16.","key":"ref_36","DOI":"10.1371\/journal.pntd.0010915"},{"doi-asserted-by":"crossref","unstructured":"Sanchez, E.F., Flores-Ortiz, R.J., Alvarenga, V.G., and Eble, J.A. (2017). Direct fibrinolytic snake venom metalloproteinases affecting hemostasis: Structural, biochemical features and therapeutic potential. Toxins, 9.","key":"ref_37","DOI":"10.3390\/toxins9120392"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/s10495-017-1350-x","article-title":"Apoptosis induced by a snake venom metalloproteinase from Bothrops alternatus venom in C2C12 muscle cells","volume":"22","author":"Bustillo","year":"2017","journal-title":"Apoptosis"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.wem.2016.09.007","article-title":"Clinically Significant Envenomation from Postmortem Copperhead (Agkistrodon contortrix)","volume":"28","author":"Emswiler","year":"2017","journal-title":"Wilderness Environ. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1111\/bjh.14591","article-title":"Haemotoxic snake venoms: Their functional activity, impact on snakebite victims and pharmaceutical promise","volume":"177","author":"Slagboom","year":"2017","journal-title":"Br. J. Haematol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.toxicon.2022.05.042","article-title":"Coagulopathy induced by viperid snake venoms in a murine model: Comparison of standard coagulation tests and rotational thromboelastometry","volume":"214","author":"Rucavado","year":"2022","journal-title":"Toxicon"},{"doi-asserted-by":"crossref","unstructured":"Kim, Y., Bae, H., and Yu, D. (2024). The in vitro effects of acidemia and acidemia reversal on coagulation in dogs. Front. Vet. Sci., 11.","key":"ref_42","DOI":"10.3389\/fvets.2024.1427237"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1097\/TA.0000000000003834","article-title":"Admission maximum amplitude\u2013reaction time ratio: Association between thromboelastography values predicts poor outcome in injured children","volume":"94","author":"Gaines","year":"2023","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1097\/MBC.0000000000001130","article-title":"The role of thrombin in haemostasis","volume":"33","year":"2022","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.toxlet.2020.03.009","article-title":"Trimeresurus albolabris snakebite treatment implications arising from ontogenetic venom comparisons of anticoagulant function, and antivenom efficacy","volume":"327","author":"Bourke","year":"2020","journal-title":"Toxicol. Lett."},{"doi-asserted-by":"crossref","unstructured":"Youngman, N.J., Peng, Y.H., Harris, R.J., Jones, L., Llinas, J., Haworth, M., Gillett, A., and Fry, B.G. (2022). Differential coagulotoxic and neurotoxic venom activity from species of the arboreal viperid snake genus Bothriechis (palm-pitvipers). Comp. Biochem. Physiol.-Part C Toxicol. Pharmacol., 256.","key":"ref_46","DOI":"10.1016\/j.cbpc.2022.109326"},{"doi-asserted-by":"crossref","unstructured":"Youngman, N.J., Lewin, M.R., Carter, R., Naude, A., and Fry, B.G. (2022). Efficacy and Limitations of Chemically Diverse Small-Molecule Enzyme-Inhibitors against the Synergistic Coagulotoxic Activities of Bitis Viper Venoms. Molecules, 27.","key":"ref_47","DOI":"10.3390\/molecules27051733"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"190.e1","DOI":"10.1016\/j.ajem.2024.07.044","article-title":"Successful use of anti-venom cross-neutralization effects in the clinical management of Shore Pit Viper envenomation","volume":"84","author":"Kant","year":"2024","journal-title":"Am. J. Emerg. Med."},{"doi-asserted-by":"crossref","unstructured":"Yong, M.Y., Tan, K.Y., and Tan, C.H. (2025). A genus-wide study on venom proteome variation and phospholipase A2 inhibition in Asian lance-headed pit vipers (genus: Trimeresurus). Comp. Biochem. Physiol. Part C Toxicol. Pharmacol., 288.","key":"ref_49","DOI":"10.1016\/j.cbpc.2024.110077"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.toxlet.2019.09.003","article-title":"Clinical implications of differential antivenom efficacy in neutralising coagulotoxicity produced by venoms from species within the arboreal viperid snake genus Trimeresurus","volume":"316","author":"Debono","year":"2019","journal-title":"Toxicol. Lett."},{"unstructured":"(2016). World Health Organization Guidelines for the Management of Snakebites, World Health Organization Regional Office for South-East Asia.","key":"ref_51"},{"unstructured":"WHO Expert Committee on Biological Standardization (2018). WHO Guidelines for the Production, Control and Regulation of Snake Antivenom Immunoglobulins. WHO Technical Report Series, No. 1004, WHO Press. (Print)r2105-0678 (Linking).","key":"ref_52"},{"doi-asserted-by":"crossref","unstructured":"Leong, P.K., Sim, S.M., Fung, S.Y., Sumana, K., Sitprija, V., and Tan, N.H. (2012). Cross neutralization of Afro-Asian cobra and Asian Krait Venoms by a Thai polyvalent snake antivenom (Neuro Polyvalent Snake Antivenom). PLoS Negl. Trop. Dis., 6.","key":"ref_53","DOI":"10.1371\/journal.pntd.0001672"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.actatropica.2013.12.015","article-title":"Cross neutralization of common Southeast Asian viperid venoms by a Thai polyvalent snake antivenom (Hemato Polyvalent Snake Antivenom)","volume":"132","author":"Leong","year":"2014","journal-title":"Acta Trop."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.jprot.2015.05.035","article-title":"Venomics of the beaked sea snake, Hydrophis schistosus: A minimalist toxin arsenal and its cross-neutralization by heterologous antivenoms","volume":"126","author":"Tan","year":"2015","journal-title":"J. Proteomics"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s12640-017-9771-4","article-title":"The Bold and the Beautiful: A Neurotoxicity Comparison of New World Coral Snakes in the Micruroides and Micrurus Genera and Relative Neutralization by Antivenom","volume":"32","author":"Yang","year":"2017","journal-title":"Neurotox. Res."},{"doi-asserted-by":"crossref","unstructured":"Ainsworth, S., Slagboom, J., Alomran, N., Pla, D., Alhamdi, Y., King, S.I., Bolton, F.M.S., Guti\u00e9rrez, J.M., Vonk, F.J., and Toh, C.-H. (2018). The paraspecific neutralisation of snake venom induced coagulopathy by antivenoms. Commun. Biol., 1.","key":"ref_57","DOI":"10.1038\/s42003-018-0039-1"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1016\/j.jprot.2011.05.027","article-title":"Ending the drought: New strategies for improving the flow of affordable, effective antivenoms in Asia and Africa","volume":"74","author":"Williams","year":"2011","journal-title":"J. Proteomics"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1093\/trstmh\/traa087","article-title":"Immunoreactivity and neutralization capacity of Philippine cobra antivenom against Naja philippinensis and Naja samarensis venoms","volume":"115","author":"Tan","year":"2021","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"doi-asserted-by":"crossref","unstructured":"Palasuberniam, P., Chan, Y.W., Tan, K.Y., and Tan, C.H. (2021). Snake Venom Proteomics of Samar Cobra (Naja samarensis) from the Southern Philippines: Short Alpha-Neurotoxins as the Dominant Lethal Component Weakly Cross-Neutralized by the Philippine Cobra Antivenom. Front. Pharmacol., 12.","key":"ref_60","DOI":"10.3389\/fphar.2021.727756"},{"unstructured":"Department of Health (2012). Philippine Health Advisories, Department of Health.","key":"ref_61"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"106942","DOI":"10.1016\/j.toxicon.2022.106942","article-title":"Preclinical assessment of VPEAV, a new trivalent antivenom for elapid snakebite envenoming in the Philippines: Proteomics, immunoreactivity and toxicity neutralization","volume":"220","author":"Chan","year":"2022","journal-title":"Toxicon"},{"doi-asserted-by":"crossref","unstructured":"Chaisakul, J., Rusmili, M.R.A., Alsolaiss, J., Albulescu, L.-O., Harrison, R.A., Othman, I., and Casewell, N.R. (2020). In Vitro Immunological Cross-Reactivity of Thai Polyvalent and Monovalent Antivenoms with Asian Viper Venoms. Toxins, 12.","key":"ref_63","DOI":"10.3390\/toxins12120766"},{"doi-asserted-by":"crossref","unstructured":"Chuang, P.-C., Chen, J.-W., Chan, Y.-Y., Tse, T.-C., Chiang, Y.-W., and Tsai, T.-S. (2024). In vitro immunoreactivity and in vivo neutralization of Trimeresurus gracilis venom with antivenoms targeting four pit viper species. PLoS Negl. Trop. Dis., 18.","key":"ref_64","DOI":"10.1371\/journal.pntd.0012070"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"107689","DOI":"10.1016\/j.toxicon.2024.107689","article-title":"Indian green pit vipers: A lesser-known snake group of north-east India","volume":"242","author":"Thakur","year":"2024","journal-title":"Toxicon"},{"doi-asserted-by":"crossref","unstructured":"Mao, Y.-C., Liu, P.-Y., Lai, K.-L., Luo, Y., Chen, K.-T., and Lai, C.-S. (2025). Clinical Characteristics of Snakebite Envenomings in Taiwan. Toxins, 17.","key":"ref_66","DOI":"10.3390\/toxins17010014"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1093\/trstmh\/trae058","article-title":"Haemotoxicity of snakes: A review of pathogenesis, clinical manifestations, novel diagnostics and challenges in management","volume":"119","author":"Alvitigala","year":"2025","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"doi-asserted-by":"crossref","unstructured":"Bittenbinder, M.A., Zdenek, C.N., op den Brouw, B., Youngman, N.J., Dobson, J.S., Naude, A., Vonk, F.J., and Fry, B.G. (2019). Coagulotoxic Cobras: Clinical Implications of Strong Anticoagulant Actions of African Spitting Naja Venoms That Are Not Neutralised by Antivenom but Are by LY315920 (Varespladib). Toxins, 10.","key":"ref_68","DOI":"10.3390\/toxins10120516"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.toxlet.2020.12.019","article-title":"Clinical implications of differential procoagulant toxicity of the palearctic viperid genus Macrovipera, and the relative neutralization efficacy of antivenoms and enzyme inhibitors","volume":"340","author":"Chowdhury","year":"2021","journal-title":"Toxicol. Lett."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.toxlet.2020.05.014","article-title":"Anticoagulant activity of black snake (Elapidae: Pseudechis) venoms: Mechanisms, potency, and antivenom efficacy","volume":"330","author":"Zdenek","year":"2020","journal-title":"Toxicol. Lett."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"107756","DOI":"10.1016\/j.toxicon.2024.107756","article-title":"Fangs and foliage: Unearthing the haemotoxic secrets of cannabis-dwelling rattlesnakes","volume":"244","author":"Bourke","year":"2024","journal-title":"Toxicon"},{"doi-asserted-by":"crossref","unstructured":"Youngman, N.J., Debono, J., Dobson, J.S., Zdenek, C.N., Harris, R.J., op den Brouw, B., Coimbra, F.C.P., Naude, A., Coster, K., and Sundman, E. (2019). Venomous Landmines: Clinical Implications of Extreme Coagulotoxic Diversification and Differential Neutralization by Antivenom of Venoms within the Viperid Snake Genus Bitis. Toxins, 11.","key":"ref_72","DOI":"10.3390\/toxins11070422"},{"doi-asserted-by":"crossref","unstructured":"Grashof, D., Zdenek, C.N., Dobson, J.S., Youngman, N.J., Coimbra, F., Benard-Valle, M., Alagon, A., and Fry, B.G. (2020). A web of coagulotoxicity: Failure of antivenom to neutralize the destructive (non-clotting) fibrinogenolytic activity of Loxosceles and Sicarius spider venoms. Toxins, 12.","key":"ref_73","DOI":"10.3390\/toxins12020091"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.toxlet.2022.06.009","article-title":"The relative efficacy of chemically diverse small-molecule enzyme-inhibitors against anticoagulant activities of Black Snake (Pseudechis spp.) venoms","volume":"366","author":"Chowdhury","year":"2022","journal-title":"Toxicol. Lett."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/17\/4\/185\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:11:21Z","timestamp":1760029881000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/17\/4\/185"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,7]]},"references-count":74,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["toxins17040185"],"URL":"https:\/\/doi.org\/10.3390\/toxins17040185","relation":{},"ISSN":["2072-6651"],"issn-type":[{"type":"electronic","value":"2072-6651"}],"subject":[],"published":{"date-parts":[[2025,4,7]]}}}