Mass spectrometric analysis to unravel the venom proteome composition of Indian snakes: opening new avenues in clinical research

Introduction The 'Big Four' venomous snakes -Daboia russelii, Naja naja, Bungarus caeruleus, andEchis carinatus- are primarily responsible for the majority of snake envenomation in India. Several other lesser-known venomous snake species also inflict severe envenomation in the country. Areas covered A comprehensive analysis of the venom proteome composition of the 'Big Four' and other medically important venomous snakes of India and the effect of regional variation in venom composition on immunorecognition and/or neutralization by commercial antivenom was undertaken by searching the literature (from 1985 to date) available in large public databases. Further, mass spectrometric identification of poorly immunogenic toxins of snake venom (against which commercial polyvalent antivenom contains a significantly lower proportion of antibodies) and its impact on antivenom therapy against snakebite are discussed. The application of mass spectrometry to identify protein (toxin) complexes as well as drug prototypes from Indian snake venoms and the clinical importance of such studies are also highlighted. Expert opinion Further detailed clinical and proteomic research is warranted to better understand the effects of regional snake venom composition on the clinical manifestation of envenomation and antivenom therapy and to improve the production of antibodies against poorly immunogenic venom components.