[HN Gopher] The lottery of the snakebite antivenom industry
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The lottery of the snakebite antivenom industry
Author : n1b0m
Score : 68 points
Date : 2025-02-13 15:04 UTC (4 days ago)
(HTM) web link (www.theguardian.com)
(TXT) w3m dump (www.theguardian.com)
| molf wrote:
| > The first snakebite antivenom was made in the mid-1890s and the
| method has changed little since: snakes are "milked" for their
| venom, which is injected into horses or sheep and the antibodies
| that their immune systems then produce are extracted via the
| animals' blood.
|
| This is expensive, and many people develop allergies to the
| antibodies.
|
| A cool practical application of DeepMind's AlphaFold is that it
| allows one to "design" proteins because it is now possible to
| predict how they will fold. [0]
|
| This means it is possible to create synthetic protein antibodies
| that neutralise snake venom, specifically designed for humans
| [1].
|
| There is a recent Veritasium video [2] that contains a great
| explanation. The whole video is worth a watch!
|
| [0]:
| https://ui.adsabs.harvard.edu/abs/2023Natur.620.1089W/abstra...
|
| [1]: https://www.nature.com/articles/s41586-024-08393-x
|
| [2]: https://www.youtube.com/watch?v=P_fHJIYENdI&t=20m36s
| mschuster91 wrote:
| > This is expensive
|
| ... and the antivenoms have an expiration date, plus you'll
| need to keep the antivenoms distributed around the country at
| least enough to be able to fly it via a chopper anywhere it
| might be needed fast enough to be actually useful. The process
| for spider toxins is pretty similar with similar challenges.
|
| And on top of that, at least for snakes, even in a specific
| region the composition of what is in the snake venom might
| differ between local snake populations based on what the snakes
| eat.
| perching_aix wrote:
| I did see Veritasium's video on this, and have been generally
| familiar with AlphaFold, but it remains unclear to me how the
| safety and efficacy of the antivenoms' designed with its help
| would be ensured short of a regular clinical trial gauntlet,
| which I understand continues to be extremely costly and long on
| its own.
|
| This isn't comparing it to the animal antibody harvesting
| approach, but on its own. Like I'm sure it's great and all, but
| I can definitely see it both mispredicting (mistakenly missing
| suitable proteins as well as mistakenly considering proteins
| suitable) and not having the predictive power to know how a
| given protein will interact with the countless atoms and
| molecules in the countless, somewhat arbitrary, random human
| bodies.
| mschuster91 wrote:
| > I did see Veritasium's video on this, and have been
| generally familiar with AlphaFold, but it remains unclear to
| me how the safety and efficacy of the antivenoms' designed
| with its help would be ensured short of a regular clinical
| trial gauntlet, which I understand continues to be extremely
| costly and long on its own.
|
| Well that one will have to be done for _any_ medicine, the
| problem is snake and spider bites are rare in the Global
| North countries [1], but pretty prevalent in Global South
| countries. That means that there isn 't much money in getting
| antivenins through certifications, there are dozens of
| majorly relevant species and hundreds of lesser importance
| which means a ton of expenses even if the antivenins share
| superstructures, and we'd run into the same issue as with the
| Covid vaccines - the accusation of local populations that
| they will be used as testbeds.
|
| [1] https://en.wikipedia.org/wiki/Epidemiology_of_snakebites
| gus_massa wrote:
| > _and not having the predictive power to know how a given
| protein will interact with the countless atoms and molecules
| in the countless, somewhat arbitrary, random human bodies._
|
| You test it first in mice. If the new drug has not nasty side
| effects, you try it in other animals, then in monkeys, then
| voluntairs and then in pilot trial with humans.
| gosub100 wrote:
| In rare situations, they can test on non-consenting patients.
| A few years back, there was a trial of "synthetic blood"
| intended to save trauma patients who were bleeding to death.
| They got a special permit to administer it to said patients
| without consent, because there is effectively no other way to
| test it. I don't recall the brand name or whatever came out
| of it. But something similar might be possible for this
| antivenom.
| j16sdiz wrote:
| AlphaFold helps the _design_ problem. ... but, How good are we
| at synthesizing the actual protein?
|
| Unless there are some breakthrough recently, Looks like we
| can't really do it at scale. Doing a few in lab setting is
| possible, but you can't really use them in drug.
| shiandow wrote:
| In theory at least you could produce the mRNA and duplicate
| it and use it to produce the proteins.
|
| Though I'm probably missing a few steps here. A large part of
| this seems to be possible though, given the success of mRNA
| vaccines. Though using humans rather than animals to produce
| the actual protein is less than ideal.
| afthonos wrote:
| In theory, the difference between theory and practice is
| zero.
| aaronmdjones wrote:
| I've heard this phrased as "In theory, there's no
| difference between theory and practice. In practice,
| there is."
| maxerickson wrote:
| The methods for producing antibodies are well understood.
| There were several different monoclonal antibodies produced
| for use in treating Covid infections.
|
| I imagine the harder part is finding the most effective
| ones to manufacture, as it is still quite costly.
| Harvesting serum from a live animal has the benefit of
| harvesting whatever antibodies have been produced, rather
| than a single specific one, so an effective antivenom might
| need to be composed of a number of monoclonal antibodies.
| flobosg wrote:
| > How good are we at synthesizing the actual protein?
|
| Quite good actually. Recombinant insulin is one example.
| cogman10 wrote:
| TIL. I didn't realize insulin was being produced like this.
|
| Is this a common form of insulin and how does the price
| compare to the old pig insulin?
|
| For something like an antivenom that hardly matters. But
| just curious on what it means for a daily protein dose.
| maxerickson wrote:
| In richer countries, essentially all insulin on the
| market uses recombinant insulin.
|
| The $25 vials at Walmart are a human insulin. More recent
| formulations modify the insulin to act faster or last
| longer, but they are based on human insulin.
| zosima wrote:
| There has been well-known processes for many years, to produce
| the relevant antibodies from industrial fermentation processes.
|
| If that is not being done, then it's surely because there is
| too little demand and the hurdles to get FDA to accept a new,
| obviously better serum, are too expensive to overcome.
| pyrale wrote:
| Technology won't fix the issues described in the article, which
| include scam, african countries not receiving antivenom
| designed for local snakes, shortages, delay to get to treatment
| centers, and expensive products.
| noah_buddy wrote:
| Maybe, maybe not. Cheapening costs can improve access,
| especially if it's possible to perform a new cheap technique
| more widely.
| marcosdumay wrote:
| It most likely will.
|
| A big reason why the antivenon for those snakes is rare is
| because one needs to keep a population of the snakes to
| produce them. If you don't need the snakes anymore, just the
| minimum amount countries have on hand for dealing with exotic
| fauna is enough to justify manufacturing them, and once you
| are manufacturing them, there's no reason not to do a larger
| batch and export some.
| krisoft wrote:
| I don't understand what you are saying. Part of the problem
| is that the african country is buying snake venom specific
| to snakes in india. This is a problem which is not going to
| be solved by someone manufacturing a larger batch of snake
| venom and exporting some. In fact it is caused by that
| practice at least in part.
| marcosdumay wrote:
| Nobody is going to make antivenom for their snakes is
| large amounts because doing that would risk introducing
| their snakes on the local fauna.
|
| But if you optimize it for full in-vitro manufacturing,
| then anybody will be able to make it. And there's plenty
| of demand for _somebody_ to do it, because lots of
| countries want small amounts of it.
| squigz wrote:
| Why wouldn't it?
|
| > scam
|
| Probably not completely, but making the venom more accessible
| and affordable means less people are likely to fall for it
| and thus less people are likely to run a scam for it
|
| > african countries not receiving antivenom designed for
| local snakes
|
| A more abundant antivenom would mean more can be shipped to
| wherever it's needed most.
|
| > shortages, delay to get to treatment centers, and expensive
| products.
|
| Again, more abundance = easier to get, cheaper to make, etc.
| flobosg wrote:
| > This means it is possible to create synthetic protein
| antibodies that neutralise snake venom, specifically designed
| for humans [1].
|
| The designed protein does not necessarily have to be an
| antibody or nanobody, where only part of the protein is
| involved in antigen binding. The example you cite shows how
| smaller, single-domain proteins can also block and neutralize
| the venom.
| hoseja wrote:
| Paragraph sixteen, second sentence.
| rybosome wrote:
| > The father of five children under 10, who made his living
| from fixing, building and digging, can no longer work and so
| his children no longer go to school.
|
| Was this the sentence you were referring to?
|
| What a sad situation, I can't imagine the stress of being
| disabled and unable to provide for my young children.
| AStonesThrow wrote:
| "Covered wagon Medicine Show!
|
| Take you to the place where the Healing flow, oh ho
|
| Weak in Spirit? We got The Juice!
|
| Won't save your Soul; It'll Shine Your Shoes."
| wavemode wrote:
| Evaluating the quality of snakebite antivenom feels like a
| classic example of: https://xkcd.com/937/
| RecycledEle wrote:
| If there is insufficient supply of antivenom, is it wise to
| reduce the supply further with regulation?
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