Nephrotoxic effects of Cnidaria toxins
Abstract
There are many species of animals in the marine environment which are potentially dangerous to humans. Cnidarians that are responsible for burns are mainly found in tropical waters, but there are several species with cosmopolitan distribution. In some cases, contact with toxins from Cnidarians can cause symptoms of acute kidney damage. Because of an enormous diversity of the toxins produced by individual species of cnidaria, the mechanisms of renal damage are different in different cases. Currently, there is only one antitoxin available to treat burns by Cnidarians, this antitoxin can neutralize the toxin produced by Chironex fleckeri. However, recent studies on animal models give hope for the introduction of a universal biological agent that would be capable of inhibiting the activity of toxins produced by a variety of Cniadaria species.
Keywords: Cnidariabox jellyfishacute kidney injurytreatment
References
- D'Ambra I, Lauritano C. A Review of Toxins from Cnidaria. Mar Drugs. 2020; 18(10).
- Boulware DR. A randomized, controlled field trial for the prevention of jellyfish stings with a topical sting inhibitor. J Travel Med. 2006; 13(3): 166–171.
- Jouiaei M, Yanagihara AA, Madio B, et al. Ancient Venom Systems: A Review on Cnidaria Toxins. Toxins (Basel). 2015; 7(6): 2251–2271.
- Jankowski T, Anokhin B. Phylum Cnidaria. Thorp and Covich's Freshwater Invertebrates. 2019: 93–111.
- David CN, Ozbek S, Adamczyk P, et al. Evolution of complex structures: minicollagens shape the cnidarian nematocyst. Trends Genet. 2008; 24(9): 431–438.
- Podobnik M, Anderluh G. Pore-forming toxins in Cnidaria. Semin Cell Dev Biol. 2017; 72: 133–141.
- Youngman NJ, Walker A, Naude A, et al. Varespladib (LY315920) neutralises phospholipase A mediated prothrombinase-inhibition induced by Bitis snake venoms. Comp Biochem Physiol C Toxicol Pharmacol. 2020; 236: 108818.
- Burnett JW, Calton GJ, Burnett JW, et al. Jellyfish envenomation syndromes. J Am Acad Dermatol. 1986; 14(1): 100–106.
- Burnett JW, Gable WD. A fatal jellyfish envenomation by the Portuguese man-o'war. Toxicon. 1989; 27(7): 823–824.
- Cegolon L, Heymann WC, Lange JH, et al. Jellyfish stings and their management: a review. Mar Drugs. 2013; 11(2): 523–550.
- Currie B. Clinical implications of research on the box-jellyfish Chironex fleckeri. Toxicon. 1994; 32(11): 1305–1313.
- Mizuno M. Envenomation by cnidarians and renal injuries Nephrotoxic Effects of Venoms from Sea Anemones from Japan. Toxinology. 2017: 1–13.
- Lippmann JM, Fenner PJ, Winkel K, et al. Fatal and severe box jellyfish stings, including Irukandji stings, in Malaysia, 2000-2010. J Travel Med. 2011; 18(4): 275–281.
- Olson CE, Pockl EE, Calton GJ, et al. Immunochromatographic purification of a nematocyst toxin from the cnidarian Chironex fleckeri (sea wasp). Toxicon. 1984; 22(5): 733–742.
- Brinkman DL, Burnell JN. Biochemical and molecular characterisation of cubozoan protein toxins. Toxicon. 2009; 54(8): 1162–1173.
- Elkafafi M, Hamed H, Ali Y, et al. Compartment syndrome following a jellyfish sting: a case report. J Med Case Rep. 2023; 17(1): 4.
- DeLoughery EP. There's something in the water: an overview of jellyfish, their stings, and treatment. Int Marit Health. 2022; 73(4): 199–202.
- Tintinalli JE. Emergency medicine. JAMA: The Journal of the American Medical Association. 1996; 275(23): 1804–1805.
- Courtney R, Sachlikidis N, Jones R, et al. Prey Capture Ecology of the Cubozoan Carukia barnesi. PLoS One. 2015; 10(5): e0124256.
- Carrette TJ, Underwood AH, Seymour JE. Irukandji syndrome: a widely misunderstood and poorly researched tropical marine envenoming. Diving Hyperb Med. 2012; 42(4): 214–223.
- Kong EL, Nappe TM. Irukandji Syndrome. 2023 Aug 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Indexed in Pubmed. ; 32965935.
- Pereira P, Barry J, Corkeron M, et al. Intracerebral hemorrhage and death after envenoming by the jellyfish Carukia barnesi. Clin Toxicol (Phila). 2010; 48(4): 390–392.
- Maharani T, Widiastuti W. First envenomation report of the Cnidarian Physalia physalis in Indonesia. Int Marit Health. 2021; 72(2): 110–114.
- Suput D. In vivo effects of cnidarian toxins and venoms. Toxicon. 2009; 54(8): 1190–1200.
- Burnett J. Medical aspects of jellyfish envenomation: pathogenesis, case reporting and therapy. Jellyfish Blooms: Ecological and Societal Importance. 2001: 1–9.
- Haddad V, Virga R, Bechara A, et al. An outbreak of Portuguese man-of-war (Physalia physalis - Linnaeus, 1758) envenoming in Southeastern Brazil. Rev Soc Bras Med Trop. 2013; 46(5): 641–644.
- Spielman FJ, Bowe EA, Watson CB, et al. Acute renal failure as a result of Physalia physalis sting. South Med J. 1982; 75(11): 1425–1426.
- Sitprija V, Sitprija S. Marine toxins and nephrotoxicity:Mechanism of injury. Toxicon. 2019; 161: 44–49.
- Mizuno M, Ito Y, Morgan BP. Exploiting the nephrotoxic effects of venom from the sea anemone, Phyllodiscus semoni, to create a hemolytic uremic syndrome model in the rat. Mar Drugs. 2012; 10(7): 1582–1604.
- Sitprija V. Animal toxins and the kidney. Nat Clin Pract Nephrol. 2008; 4(11): 616–627.
- Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012; 120(4): c179–c184.
- Bakrac B, Kladnik A, Macek P, et al. A toxin-based probe reveals cytoplasmic exposure of Golgi sphingomyelin. J Biol Chem. 2010; 285(29): 22186–22195.
- Nevalainen TJ, Peuravuori HJ, Quinn RJ, et al. Phospholipase A2 in cnidaria. Comp Biochem Physiol B Biochem Mol Biol. 2004; 139(4): 731–735.
- Guess HA, Saviteer PL, Morris CR. Hemolysis and acute renal failure following a Portuguese man-of-war sting. Pediatrics. 1982; 70(6): 979–981.
- Deuel JW, Schaer CA, Boretti FS, et al. Hemoglobinuria-related acute kidney injury is driven by intrarenal oxidative reactions triggering a heme toxicity response. Cell Death Dis. 2016; 7(1): e2064.
- Qian Qi, Nath KA, Wu Y, et al. Hemolysis and acute kidney failure. Am J Kidney Dis. 2010; 56(4): 780–784.
- Prema J, Kurien AA. Hemoglobin Casts in Kidney Biopsies: Etiological Spectrum. Indian J Nephrol. 2023; 33(1): 46–49.
- Patel PS, Singh PP, Archana A, et al. A Series of Eight Cases of Pigment Nephropathy: An Obscured Aspect of Acute Kidney Injury. Cureus. 2024; 16(7): e64214.
- Huerta-Alardín A, Varon J, Marik P. Bench-to-bedside review: rhabdomyolysis—an overview for clinicians. Critical Care. 2005; 9(2): 158–169.
- Maldonado E, Maillaud C, Barguil Y, et al. Rhabdomyolysis during envenomation by Physalia sp envenomation in New Caldonia. Med Sante Trop. 2017; 27(1): 105–108.
- Vanholder R, Sever MS, Erek E, et al. Rhabdomyolysis. J Am Soc Nephrol. 2000; 11(8): 1553–1561.
- Boutaud O, Roberts LJ. Mechanism-based therapeutic approaches to rhabdomyolysis-induced renal failure. Free Radic Biol Med. 2011; 51(5): 1062–1067.
- Chavez LO, Leon M, Einav S, et al. Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. Crit Care. 2016; 20(1): 135.
- Baeza-Trinidad R. Rhabdomyolysis: A syndrome to be considered. Med Clin (Barc). 2022; 158(6): 277–283.
- Mizuno M, Nozaki M, Morine N, et al. A protein toxin from the sea anemone Phyllodiscus semoni targets the kidney and causes a severe renal injury with predominant glomerular endothelial damage. Am J Pathol. 2007; 171(2): 402–414.
- McGee RG, Webster AC, Lewis SR, et al. Interventions for the symptoms and signs resulting from jellyfish stings. Cochrane Database Syst Rev. 2023; 6(6): CD009688.
- Cunha SA, Dinis-Oliveira RJ. Raising Awareness on the Clinical and Forensic Aspects of Jellyfish Stings: A Worldwide Increasing Threat. Int J Environ Res Public Health. 2022; 19(14).
- Konstantakopoulos N, Isbister GK, Seymour JE, et al. A cell-based assay for screening of antidotes to, and antivenom against Chironex fleckeri (box jellyfish) venom. J Pharmacol Toxicol Methods. 2009; 59(3): 166–170.
- Winter KL, Isbister GK, Jacoby T, et al. An in vivo comparison of the efficacy of CSL box jellyfish antivenom with antibodies raised against nematocyst-derived Chironex fleckeri venom. Toxicol Lett. 2009; 187(2): 94–98.
- Australian Resuscitation Council. Guideline 9.4.5 Envenomation – Jellyfish Stings. 2010. http://www.resus.org.au/policy/guidelines/section_9/jellyfish_stings.htm (May 2014).
- Little M. First aid for jellyfish stings: do we really know what we are doing? Emerg Med Australas. 2008; 20(1): 78–80.
- Loten C, Stokes B, Worsley D, et al. A randomised controlled trial of hot water (45 degrees C) immersion versus ice packs for pain relief in bluebottle stings. Med J Aust. 2006; 184(7): 329–333.
- Tibballs J. Australian venomous jellyfish, envenomation syndromes, toxins and therapy. Toxicon. 2006; 48(7): 830–859.
- Wang R, Gao D, Yu F, et al. Phospholipase A inhibitor varespladib prevents wasp sting-induced nephrotoxicity in rats. Toxicon. 2022; 215: 69–76.