Patent Publication Number: US-11028159-B2

Title: Composition and methods for treating snake envenomation

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a national phase application from International Application No. PCT/US2018/029498, filed on Apr. 26, 2018, which claims priority of U.S. Provisional Application No. 62/500,372, filed May 2, 2017 Priority to the preceding patent applications is expressly claimed, and the disclosures of the preceding applications are hereby incorporated herein by reference in their entireties and for all purposes. 
    
    
     FIELD 
     The invention generally relates to compositions and methods for treating snake envenomation in humans and animals. In some aspects, the invention provides therapeutic compositions that contain one or more toxin binding molecules including, for example, anti-toxin antibodies and binding fragments. 
     BACKGROUND OF THE INVENTION 
     Envenomings due to snake bite are one of the largest and most neglected tropical diseases with a profound effect on people living in the topical or subtropical regions of Africa, Asia, Latin America, and Oceania (Gutierrez 2006; Harrison 2009; WHO 2007). Over 5 million estimated snake bite cases occur worldwide each year, greater than half of which cause envenomation, causing around 125,000 human deaths and (Chippaux 2006) and hundreds of thousands more cases of permanent disability. Snake venoms are complex mixtures of several proteins and peptides, several of which are toxins that cause damage due to snakebites. Among the major toxin components are metalloproteinases, phospholipase A2, serine proteases, neurotoxins, and many others that cause clinical manifestation of snakebite. 
     Envenomation by venomous snakes, depending on the species of snake is usually manifested by neurotoxicity, extensive local tissue necrosis (Viravan et al. 1986), cytotoxicity, and hemotoxicity. We have initially chosen five toxins in snake venoms to target and neutralize with camelid sdAb-V H H fragments: snake venom metalloproteinase (SVMP), snake venom phospholipase A2 (svPLA2), snake venom serine protease (SVSP), cobrotoxin and beta-bungarotoxin. 
     Snake venom metalloproteinases (SVMPs) (Moura-da-Silva et al. 2016) are one of the most abundant components on snake venoms, especially in most species of viperidae family (Sousa et al. 2013; Calvete et al. 2009). SVMPs can cause hemorrhage by breaking down capillaries and affecting coagulation through depletion of coagulation factors in plasma (Moura-da-Silva et al. 2007). 
     Snake venom PLA2 enzymes are some of the most toxic proteins in venom, and they affect a multitude of physiological processes (Kini 2003). Most presynaptic neurotoxins in snake venoms are PLA2 or enzymes with PLA2 activity (Kini 2003; Gubensĕk et al. 1997; Bon 1997). In addition, they have significant and wide ranging pharmacological effects like myotoxicity, hemolysis, cardiotoxicity and other organ and tissue damage. PLA2 family of enzymes hydrolyze substrate phospholipids and often act on a variety of pharmacological sites binding to target proteins. Penetrability of different svPLA2 enzymes also an important determinant in their ability to cause damage by hydrolysis. 
     β-bungarotoxins (β1 and β2) are PLA2-containing toxins that induce presynaptic toxicity by binding to nicotinic acetylcholine receptor and blocking the release of acetylcholine. (Cheng 2008). 
     Cobrotoxin is a short-chain non enzymatic basic protein in the three-finger toxin (3FT) family and is a major neurotoxin in the venom of  Naja atra  or Chinese Cobra (Yang 1999). 
     Snake venom serine proteases (SVSPs) (Serrano, 2013) are another important and ubiquitous class of venom proteins that are widely found in venoms of snakes from all families (except sea snakes where it is found more rarely) and geographies. Members of the SVSP toxin family show a great deal of substrate specificity and primarily affect the hemostatic system and affect various physiological functions like blood coagulation, fibrinolysis, blood pressure and platelet aggregation. 
     Antivenoms are currently the only recognized treatment for treating symptoms of snake bites. Conventional antivenoms are prepared by hyper-immunizing a large animal, generally a horse or a sheep, with snake venom to generate high affinity antibodies against immunogenic proteins in the snake venom. Horse serum is collected, and whole IgG molecules (150 kDa) are purified and used as whole IgG therapies, or are digested into F(ab′)2 antibody fragments (100 kDa) or Fab antibody fragments (50 kDa) by pepsin or papain digestion respectively (Lalloo and Theakston 2003). These whole IgG antibodies, or antibody fragments are then administered intravenously to an envenomed patient to neutralize the activity of the snake venom toxins. Systemic envenomation generally can be treated with antivenom; administration of antivenom rapidly neutralizes neurotoxicity caused by the action of post-synaptic neurotoxins (Warrell 1992 cited in Gutierrez et al. 2006). However, traditional antivenom therapies come with a number of significant limitations. Introduction of animal serum or antibody products can cause adverse immune reactions in host resulting in anaphylaxis and serum sickness. Full-sized and fragment-formatted antibodies (Fab or F(ab)2) also do not penetrate tissue efficiently (Beckman et al. 2007) and therefore are not very effective in neutralizing toxins at distal sites. They are ineffective in treating local effects on tissues near the snake bite because of the rapid activity of the toxins at the local tissue, and the inability of antivenom immunoglobulin fragments to reach and penetrate deep tissues (Gutierrez et al. 1998). Although many survive envenomation, a large number of victims are left with chronic physical disability and psychological sequelae as a result of the cytotoxic components of the snake venom (Viravan et al. 1992). 
     Camelids (camels, llamas) have unique heavy chain only immunoglobulins devoid of light chains and the CH1 domains (Hamers-Casterman et al. 1993). The antigen binding sites of these heavy chain antibodies are composed of a single variable domain (called V H H), and are the smallest natural antigen binding domain (15 kDa). V H H antibody fragments have several properties that potentially make them superior candidates for antivenom development over traditional antibody-based antivenoms. They are relatively non-immunogenic, exhibit greater solubility and stability, and highly tissue penetrable (Arbabi Ghahroudi et al. 1997; Cortez-Retamozo et al. 2002 and 2004; Muruganandam et al., 2002). Owing to their low molecular mass, V H H fragments permeate distal tissues more readily than conventional antibody fragments (Cortez-Retamozo et al., 2002 and 2004) and, therefore, may better protect victims from the tissue-damaging effects of venom toxins, both for acute effects on tissues and for venom effects that show up later due to tissue sequestration. Furthermore, because of their small size and high homology to the human VH3 gene family, V H Hs may produce fewer adverse reactions in patients than conventional antivenoms (Vu et al., 1997). Furthermore, V H H antibody fragments can be easily expressed and purified from  E. coli /yeast expression systems, solving the current short supply and high cost crisis of antivenoms (Arbabi Ghahroudi et al. 1997; Frenken et al. 2000). 
     SUMMARY OF THE INVENTION 
     The present invention provides camelid single heavy-chain antibody variable domains (V H H) and related antigen-binding polypeptides that bind to snake venom proteins or peptides, pharmaceutical formulations of those V H H, and associated methods for use, including for the treatment of envenomation. The invention also provides specific complementarity-determining regions (CDRs) and framework regions (FRs) from those V H H. 
     In one aspect, the invention provides a V H H or antigen-binding polypeptide that binds to one or more (e.g., two, three, four, five, six, or more) snake venom proteins. In some embodiments, the V H H or antigen-binding polypeptide binds to two or more (e.g., two, three, four, five, six, or more) snake venom proteins from the same snake species. In other embodiments, the V H H or antigen-binding polypeptide binds to at least one snake venom protein from two or more (e.g., two, three, four, five, six, or more) snake species. 
     In some embodiments, the V H H or antigen-binding polypeptide binds to venom proteins from the same snake species, wherein the venom proteins are at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 99%, or 100% identical in their primary amino sequence. Alternatively, the V H H or antigen-binding polypeptide binds to unrelated venom proteins from same snake species (i.e., proteins that are less than 70% identical). 
     In some embodiments, the V H H or antigen-binding polypeptide binds to venom proteins from different snake species, wherein the venom proteins are at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 99%, or 100% identical in their primary amino sequence. Alternatively, the V H H binds to unrelated venom proteins from different snake species (i.e., proteins that are less than 70% identical). 
     In some embodiments, the snake venom protein(s) to which the V H H or antigen-binding polypeptide binds include one or more of snake venom metalloproteinase (SVMP), snake venom phospholipase A2 (svPLA2), snake venom serine protease (SVSP), cobrotoxin, and beta-bungarotoxin. 
     In some embodiments, the venomous snake species is  Agkistrodon piscivorus, Bungarus candidus, Calloselasma rhodostoma, Crotalus adamanteus, Crotalus atrox, Crotalus oreganus helleri, Crotalus scutulatus  (A),  Crotalus scutulatus  (B),  Deinagkistrodon acutus, Naja  ( Naja )  siamensis, Naja  ( Naja )  sputatrix  and  Ophiophagus hannah , and any combination thereof. In some embodiments, the V H H or antigen-binding polypeptide binds to venom and/or venom proteins from snakes in the Viperidae and Elapidae families. 
     In some embodiments, the anti-svPLA2 V H H or antigen-binding polypeptide binds to the svPLA2 of North American crotalid species (e.g.,  A. piscivorous, C. atrox, C. adamanteus, C. oreganus helleri , and  C. scutulatus  (B)) and/or Asian crotalid species (e.g.,  C. rhodostoma, D. acutus, D. russelli , and  E. carinatus ) and/or Asian elapid species (e.g.,  C. hannah ). 
     In some embodiments, the anti-beta-bungarotoxin V H H or antigen-binding polypeptide binds to North American crotalid species (e.g.,  C. atrox ) and/or Asian crotalid species (e.g.,  C. rhodostoma, D. acutus , and  E. carinatus ) and/or Asian elapid species (e.g.,  B. caerulus, B. candidus, N. kaouthia , and  C. hannah ). 
     In some embodiments, the anti-SVMP V H H or antigen-binding polypeptide binds to North American crotalid species (e.g.,  C. atrox ) and/or Asian crotalid species (e.g.,  C. rhodostoma, D. acutus , and  E. carinatus ) and/or Asian elapid species (e.g.,  B. caerulus, B. candidus, N. kaouthia, N. siamensis, N. sputatrix , and  C. hannah ). 
     In some embodiments, the V H H or antigen-binding polypeptide comprises an amino acid sequence selected from the group consisting of SEQ ID NO 1, SEQ ID NO 2, SEQ ID NO 3, SEQ ID NO 4, SEQ ID NO 5, and substantially identical sequences thereof (i.e., having at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or at least 99% sequence identity). 
     In some embodiments, the camelid from which the V H H is derived is a camel or llama. 
     In some embodiments, the isolated V H H or antigen-binding polypeptide binds to a venom protein that has enzymatic activity, and wherein V H H or antigen-binding polypeptide binding reduces or completely inhibits the activity of the enzyme. In some embodiments, the activity of the enzyme is reduced at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, at least 99%, or 100%. 
     The invention also provides isolated CDRs and FRs derived from the V H Hs of SEQ ID NOs: 1-5. In particular, the invention provides isolated CDR-1 regions provided as SEQ ID NOs: 6-10, isolated CDR-2 regions provided as SEQ ID NOs: 11-15, isolated CDR-3 regions provided as SEQ ID NOs: 16-20, FR-1 regions provided as SEQ ID NOs: 21-26, FR-2 regions provided as SEQ ID NOs: 27-32, FR-3 regions provided as SEQ ID NOs: 33-38, and FR-4 regions provided as SEQ ID NOs: 39-41, and variants that are substantially identical thereto (i.e., having at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or at least 99% sequence identity). The isolated CDRs and FRs may be used alone for any purpose or used to construct other venom protein-binding V H Hs or antigen-binding polypeptides having the general formula: FR1-CDR1-FR2-CDR2-FR3-CDR3-FR4. 
     In another aspect, the invention provides a mixture of isolated V H H or antigen-binding polypeptides comprising two or more (e.g., three, four, five, six, seven, eight, or more) isolated V H H of the present invention. 
     In some embodiments, a single V H H, antigen-binding polypeptide, or a mixture thereof is provided in a pharmaceutical formulation suitable for administration to a mammal (e.g., a human). Pharmaceutical formulations may include one or more V H H, antigen-binding polypeptide, or pharmaceutically-acceptable salts thereof and a pharmaceutically-acceptable carrier. Pharmaceutical formulations may be formulated for oral, topical, or other parenteral administration including, for example, intravenous, intramuscular, and/or subcutaneous injection. 
     In another aspect, the invention also provides a method for treating envenomation of a mammal (e.g., a human) by administering a pharmaceutical formulation containing one or more (e.g., two, three, four, five, six, seven, eight, or more) V H H or antigen-binding polypeptides of the present invention. In some embodiments, the envenomation is caused by a snake species selected from the group consisting of  Agkistrodon piscivorus, Bungarus candidus, Calloselasma rhodostoma, Crotalus adamanteus, Crotalus atrox, Crotalus oreganus helleri, Crotalus scutulatus  (A),  Crotalus scutulatus  (B),  Deinagkistrodon acutus, Naja  ( Naja )  siamensis, Naja  ( Naja )  sputatrix  and  Ophiophagus Hannah . 
     
       
         
           
               
             
               
                 TABLE 1 
               
             
            
               
                   
               
               
                 Venom-binding V H H 
               
            
           
           
               
               
               
            
               
                   
                 Protein 
                   
               
               
                   
                 Binding 
                   
               
               
                 SEQ ID 
                 Specificity 
                   
               
               
                 NO: 
                 (Designation) 
                 Amino Acid Sequence 
               
               
                   
               
            
           
           
               
               
               
               
            
               
                 1 
                 Anti-SVMP 
                 MAQVQLQESG GGLVAPGGSL RLSCAASENI RVKAMGWYRQ TPGKQRELVA 
                  50 
               
               
                   
                 (B6) 
                 TISARPSGGI TNYVDPVKGR FTISRDNAKN VLYLQMNSLK PEDTGVYYCN 
                 100 
               
               
                   
                   
                 IVGTNIWGQG TQVTVSSTSG PGGQHHHHHH GAEQKLISEE DLS 
                 143 
               
               
                   
               
               
                 2 
                 Anti-SVMP 
                 MAQVQLQESG GGLVQAGGSL RLSCAASGRT FSSAAMGWFR RAPGEEREFV 
                  50 
               
               
                   
                 (D11) 
                 AAISWSGGTT HYTESVKGRF TISRDNAKNT VSLQMDSLKP EDTAIYYCAA 
                 100 
               
               
                   
                   
                 DMALSTVVEG TSRYWGQGTQ VTVSSTSGPG GQHHHHHHGA EQKLISEEDL 
                 150 
               
               
                   
                   
                 S 
                 151 
               
               
                   
               
               
                 3 
                 Anti- 
                 MAQVQLQESG GGLVQAGDSL RLSCAASGHT FRDRAMNWFR QAPGKEREFV 
                  50 
               
               
                   
                 bungarotoxin 
                 AAIHWSDGRT FYTDSVKGRF TISRDNAKNT GYLQMNSLKT EDTAVYYCAI 
                 100 
               
               
                   
                 (A4) 
                 VMAYPWTTPG GINDWGKGTL VTVSSTSGPG GQHHHHHHGA EQKLISEEDL 
                 150 
               
               
                   
                   
                 S 
                 151 
               
               
                   
               
               
                 4 
                 Anti- 
                 MAQVQLQESG GGLAQAGGSL RLSCSASRNI FRVYGWYRQA PGKQREWVAS 
                  50 
               
               
                   
                 cobrotoxin 
                 ITRDDSTAYA DSVKGRFTIS RDSAKNTMYL QMSSLRLEDT STYYCAAQSI 
                 100 
               
               
                   
                 (B9) 
                 SGTIQWGQGT QVTVSSTSGP GGQHHHHHHG AEQKLISEED LS 
                 142 
               
               
                   
               
               
                 5 
                 Anti-PLA2 
                 LAQVQLQQSG GGLVQAGDSL RLSCAASGRT FRDRAMNWFR QAPGKEREFV 
                  50 
               
               
                   
                 (H3) 
                 AAIHWSDGRT YYADSVKGRF TISRDNAKNT GSLQMDSLKT EDTGVYYCAI 
                 100 
               
               
                   
                   
                 VMAYPWTTPG GINDWGKGTL VTVSSTSGPG GQHHHHHHGA EQKLISEEDL 
                 150 
               
               
                   
                   
                 S 
                 151 
               
               
                   
               
            
           
         
       
     
     
       
         
           
               
             
               
                 TABLE 2 
               
             
            
               
                   
               
               
                 Exemplary CDR-1 Domains From Venom-binding 
               
               
                 V H H 
               
            
           
           
               
               
               
            
               
                 SEQ ID 
                   
                   
               
               
                 NO: 
                 V H H 
                 Amino Acid Sequence 
               
               
                   
               
               
                  6 
                 B6 
                 ENIRVKA 
               
               
                   
               
               
                  7 
                 D11 
                 GRTFSSAA 
               
               
                   
               
               
                  8 
                 A4 
                 GHTFRDRA 
               
               
                   
               
               
                  9 
                 B9 
                 RNIFRV 
               
               
                   
               
               
                 10 
                 H3 
                 GRTFRDRA 
               
               
                   
               
            
           
         
       
     
     
       
         
           
               
             
               
                 TABLE 3 
               
             
            
               
                   
               
               
                 Exemplary CDR-2 Domains From Venom-binding 
               
               
                 V H H 
               
            
           
           
               
               
               
               
            
               
                   
                 SEQ ID 
                   
                   
               
               
                   
                 NO: 
                 V H H 
                 Amino Acid Sequence 
               
               
                   
                   
               
               
                   
                 11 
                 B6 
                 ISARPSGGIT 
               
               
                   
                   
               
               
                   
                 12 
                 D11 
                 ISWSGGTT 
               
               
                   
                   
               
               
                   
                 13 
                 A4 
                 IHWSDGRT 
               
               
                   
                   
               
               
                   
                 14 
                 B9 
                 ITRDDST 
               
               
                   
                   
               
               
                   
                 15 
                 H3 
                 IHWSDGRT 
               
               
                   
                   
               
            
           
         
       
     
     
       
         
           
               
             
               
                 TABLE 4 
               
             
            
               
                   
               
               
                 Exemplary CDR-3 Domains From Venom-binding 
               
               
                 V H H 
               
            
           
           
               
               
               
               
            
               
                   
                 SEQ ID 
                   
                   
               
               
                   
                 NO: 
                 V H H 
                 Amino Acid Sequence 
               
               
                   
                   
               
               
                   
                 16 
                 B6 
                 NIVGTNI 
               
               
                   
                   
               
               
                   
                 17 
                 D11 
                 AADMALSTVVEGTSRY 
               
               
                   
                   
               
               
                   
                 18 
                 A4 
                 AIVMAYPWTTPGGIND 
               
               
                   
                   
               
               
                   
                 19 
                 B9 
                 AAQSISGTIQ 
               
               
                   
                   
               
               
                   
                 20 
                 H3 
                 AIVMAYPWTTPGGIND 
               
               
                   
                   
               
            
           
         
       
     
     
       
         
           
               
             
               
                 TABLE 5 
               
             
            
               
                   
               
               
                 Exemplary FR-1 Domains From Venom-binding 
               
               
                 V H H 
               
            
           
           
               
               
               
            
               
                 SEQ ID 
                   
                   
               
               
                 NO: 
                 V H H 
                 Amino Acid Sequence 
               
               
                   
               
               
                 21 
                 B6 
                 MAQVQLQESGGGLVAPGGSLRLSCAAS 
               
               
                   
               
               
                 22 
                 D11 
                 MAQVQLQESGGGLVQAGGSLRLSCAAS 
               
               
                   
               
               
                 23 
                 A4 
                 MAQVQLQESGGGLVQAGDSLRLSCAAS 
               
               
                   
               
               
                 24 
                 B9 
                 MAQVQLQESGGGLAQAGGSLRLSCSAS 
               
               
                   
               
               
                 25 
                 H3 
                 LAQVQLQQSGGGLVQAGDSLRLSCAAS 
               
               
                   
               
               
                 26 
                 Consensus 
                 (M/L)AQVQLQ(Q/E)SGGGL(V/A) 
               
               
                   
                   
                 (Q/A)G(G/D)SLRLSC(S/A)AS 
               
               
                   
               
            
           
         
       
     
     
       
         
           
               
             
               
                 TABLE 6 
               
             
            
               
                   
               
               
                 Exemplary FR-2 Domains From Venom-binding 
               
               
                 V H H 
               
            
           
           
               
               
               
            
               
                 SEQ ID 
                   
                   
               
               
                 NO: 
                 V H H 
                 Amino Acid Sequence 
               
               
                   
               
               
                 27 
                 B6 
                 MGWYRQTPGKQRELVAT 
               
               
                   
               
               
                 28 
                 D11 
                 MGWFRRAPGEEREFVAA 
               
               
                   
               
               
                 29 
                 A4 
                 MNWFRQAPGKEREFVAA 
               
               
                   
               
               
                 30 
                 B9 
                 YGWYRQAPGKQREWVAS 
               
               
                   
               
               
                 31 
                 H3 
                 MNWFRQAPGKEREFVAA 
               
               
                   
               
               
                 32 
                 Consensus 
                 (M/Y)(G/N)W(F/Y)R(R/Q)(A/T)PG 
               
               
                   
                   
                 (K/E)(Q/E)RE(F/L/W)VA(A/S/T) 
               
               
                   
               
            
           
         
       
     
     
       
         
           
               
             
               
                 TABLE 7 
               
             
            
               
                   
               
               
                 Exemplary FR-3 Domains From Venom-binding 
               
               
                 V H H 
               
            
           
           
               
               
               
            
               
                 SEQ 
                   
                   
               
               
                 ID 
                   
                   
               
               
                 NO: 
                 V H H 
                 Amino Acid Sequence 
               
               
                   
               
               
                 33 
                 B6 
                 NYVDPVKGRFTISRDNAKNVLYLQMNSLKPEDTGV 
               
               
                   
                   
                 YYC 
               
               
                   
               
               
                 34 
                 D11 
                 HYTESVKGRFTISRDNAKNTVSLQMDSLKPEDTAI 
               
               
                   
                   
                 YYC 
               
               
                   
               
               
                 35 
                 A4 
                 FYTDSVKGRFTISRDNAKNTGYLQMNSLKTEDTAV 
               
               
                   
                   
                 YYC 
               
               
                   
               
               
                 36 
                 B9 
                 AYADSVKGRFTISRDSAKNTMYLQMSSLRLEDTST 
               
               
                   
                   
                 YYC 
               
               
                   
               
               
                 37 
                 H3 
                 YYADSVKGRFTISRDNAKNTGSLQMDSLKTEDTGV 
               
               
                   
                   
                 YYC 
               
               
                   
               
               
                 38 
                 Consensus  
                 (A/F/H/N/Y)Y(A/T/V)(D/E)(S/P)VKGRFT 
               
               
                   
                 1 
                 ISRD(N/S)AKN(T/V)(G/L/M/V)(S/Y)LQM 
               
               
                   
                   
                 (D/N/S)SL(K/R)(L/P/T)EDT(A/G/S) 
               
               
                   
                   
                 (I/T/V)YYC 
               
               
                   
               
            
           
         
       
     
     
       
         
           
               
             
               
                 TABLE 8 
               
             
            
               
                   
               
               
                 Exemplary FR-4 Domains From Venom-binding 
               
               
                 V H H 
               
            
           
           
               
               
               
            
               
                 SEQ ID 
                   
                   
               
               
                 NO: 
                 V H H 
                 Amino Acid Sequence 
               
               
                   
               
               
                 39 
                 B6, D11, 
                 WGQGTQVTVSSTSGPGGQHHHHHHGAEQKL 
               
               
                   
                 B9 
                 ISEEDLS 
               
               
                   
               
               
                 40 
                 A4, H3 
                 WGKGTLVTVSSTSGPGGQHHHHHHGAEQKL 
               
               
                   
                   
                 ISEEDLS 
               
               
                   
               
               
                 41 
                 Consensus 
                 WG(K/Q)GT(L/Q)VTVSSTSGPGGQHHHH 
               
               
                   
                   
                 HHGAEQKLISEEDLS 
               
               
                   
               
            
           
         
       
     
     The present disclosure also includes variants of the isolated V H H that can bind to one or more of the same proteins or peptides present in venom recognized by the isolated V H H disclosed above. The term “variant” as used herein includes modifications or chemical equivalents of the amino acid sequences disclosed herein that perform substantially the same function as the isolated V H H disclosed herein in substantially the same way. For example, variants of amino acid sequences disclosed herein include, without limitation, conservative amino acid substitutions. A “conservative amino acid substitution” as used herein, is one in which one amino acid residue is replaced with another amino acid residue without abolishing the binding properties of the isolated V H Hs. Examples of conservative substitutions include the substitution of one non-polar (hydrophobic) residue such as alanine, isoleucine, valine, leucine or methionine for another, the substitution of one polar (hydrophilic) residue for another such as between arginine and lysine, between glutamine and asparagine, between glycine and serine, the substitution of one basic residue such as lysine, arginine or histidine for another, or the substitution of one acidic residue, such as aspartic acid or glutamic acid for another. 
     As used herein, the term “V H H” refers to a variable domain of a camelid heavy-chain antibody. 
     As used herein, the term “isolated V H H” refers to a V H H which has been separated from a component of its natural environment. vThe term “camelid” as used herein means a member of the family Camelidae including, without limitation, llamas, camels, dromedaries, alpacas, vicunas and guanacos. 
     The “binding affinity” of an antibody is the strength of binding of a monovalent ligand to a single antigen-binding site on the antibody, which may be measured methods known in the art such as ELISA, enzyme-linked immunospot (Elispot), immunofluorescence, and immunoelectrophoresis. 
     An isolated V H H is “stable” if it shows no significant increase of aggregation, precipitation and/or denaturation upon visual examination of color and/or clarity, or as measured by UV light scattering, gel electrophoresis of protein, size exclusion chromatography (SEC) and dynamic light scattering (DLS). 
     The term “envenomation” refers to injection of venom into a victim as a result of a bite or a sting by a reptile, amphibian, arthropod, mollusk, cnidarian, insect, coelenterate or other venomous vertebrate or invertebrate animal. 
     The terms “treat”, “treating”, and “treatment”, are used synonymously to refer to any action providing a benefit to a subject (i.e., a mammal, particularly a human) suffering from an envenomation, including improvement in the condition through lessening, inhibition, suppression or elimination of at least one symptom, delay in progression of or damage from the envenomation or related condition, prevention, delay in or inhibition of the likelihood of the onset of envenomation symptoms, etc. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1 : Representative ELISA data comparing llama serum titers of venom-binding antibodies (including single-domain antibodies) between pre-immunization bleed (tilted square tracer) with post-immunization bleed (post-immunization bleed 1; square tracer) at different serum dilutions. 
         FIG. 2 : ELISAs showing binding of post-immunized llama serum to purified α-cobratoxin, Cobrotoxin, β-Bungarotoxin, PLA2, and SVMP. 
         FIG. 3 : Enzymatic assay data showing in vitro neutralization of PLA2 activity on venoms of three different snake species by the anti-PLA2 purified V H H candidate. The y-axis shows percent PLA2 activity. On the x-axis three different snake species are shown:  Crotalus adamanteus, Crotalus atrox  and  Crotalus oreganus helleri . For each snake species, the four bars from left to right represent (1) no V H H, (2) anti-PLA2 V H H (2.4 μM), (3) anti-PLA2 (12 μM) and (4) Varespladib (65 μM). 
         FIG. 4 . Representative data showing stability of anti-PLA2 purified V H H candidate. 
         FIG. 5 : Binding of lead purified V H H candidates to venoms of different snake species determined by ELISA. 
     
    
    
     DETAILED DESCRIPTION 
     The invention provides compositions and associated reagents, and related methods for treating snake envenomation in humans and animals. Disclosed herein are novel V H H that bind to snake venom proteins and other toxins/molecules, along with an identification of the complementarity-determining and framework regions contained therein. Thus, the invention provides the specific V H H and novel V H H that may be constructed by assembling a V H H according to the general formula FR1-CDR1-FR2-CDR2-FR3-CDR3-FR4 from the component domains described herein. 
     I. Construction of V H H Antibody Fragment Library 
     A phage-displayed V H H library was constructed from a llama hyperimmunized with the crude venoms of twelve medically relevant species (Table 9) with distinct toxin compositions. Venom from each species constitutes 1/12th of the total immunization mixture by volume. This method was chosen to generate high diversity in the library and to ultimately obtain high affinity binders to a wide range of snake venom toxins. 
     Table 1. Venomous snake species contributing to crude venom immunization mixture in generation of V H H antibody fragment library. 
     
       
         
           
               
             
               
                 TABLE 9 
               
             
            
               
                   
               
               
                 Snake Species Contributing Crude Venom To Immunization Mixture 
               
            
           
           
               
               
            
               
                 Scientific Name 
                 Common Name 
               
               
                   
               
               
                 Agkistrodon piscivorus 
                 Water moccasin; cottonmouth 
               
               
                 Bungarus candidus 
                 Blue krait 
               
               
                 Calloselasma rhodostoma 
                 Malayan pit viper 
               
               
                 Crotalus adamanteus 
                 Eastern diamondback rattlesnake 
               
               
                 Crotalus atrox 
                 Western diamondback rattlesnake 
               
               
                 Crotalus oreganus helleri 
                 Southern pacific rattlesnake 
               
               
                 Crotalus scutulatus (A) 
                 Mojave rattlesnake (Toxin Type A) 
               
               
                 Crotalus scutulatus (B) 
                 Mojave rattlesnake (Toxin Type B) 
               
               
                 Deinagkistrodon acutus 
                 Sharp nosed pit viper 
               
               
                 Naja (Naja) siamensis 
                 Indochinese Cobra 
               
               
                 Naja (Naja) sputatrix 
                 Javan spitting cobra 
               
               
                 Ophiophagus Hannah 
                 King cobra 
               
               
                   
               
            
           
         
       
     
     The llama was immunized over a period of approximately 17 weeks with bleeds taken at three points during the schedule (Table 10). The serum titers from each of these bleeds were assayed for immune response to the immunization mixture using ELISA ( FIG. 1 ).  FIG. 1  demonstrates increased binding of llama serum titers of venom-binding antibodies (including single-domain antibodies) with post-immunization bleed (post-immunization bleed 1; square tracer) as compared to pre-immunization bleed (tilted square tracer) at different serum dilutions. 
     
       
         
           
               
             
               
                 TABLE 10 
               
             
            
               
                   
               
               
                 Llama Immunization Schedule 
               
            
           
           
               
               
               
               
               
            
               
                 Day 
                 Procedure 
                 Dose (mg) 
                 Adjuvant 
                 Endpoints 
               
               
                   
               
            
           
           
               
               
               
               
               
            
               
                  0 
                 Pre-Immune Bleed 
                   
                   
                 ELISA/PBMC 
               
               
                  5 
                 Immunization 1 
                 0.25 
                 CFA 
                   
               
               
                  20 
                 Immunization 2 
                 0.5 
                 IFA 
                   
               
               
                  40 
                 Immunization 3 
                 0.75 
                 IFA 
                   
               
               
                  47 
                 Bleed 1 
                   
                   
                 ELISA/PBMC 
               
               
                  61 
                 Immunization 4 
                 1 
                 IFA 
                   
               
               
                  78 
                 Immunization 5 
                 1.25 
                 IFA 
                   
               
               
                  85 
                 Bleed 2 
                   
                   
                 ELISA/PBMC 
               
               
                  96 
                 Immunization 6 
                 1.5 
                 IFA 
                   
               
               
                 119 
                 Immunization 7 
                 2 
                 IFA 
                   
               
               
                 126 
                 Bleed 3 
                   
                   
                 ELISA/PBMC 
               
               
                   
               
            
           
         
       
     
     ELISA results show binding of post-immunized llama serum to purified toxins: α-cobratoxin, Cobrotoxin, β-Bungarotoxin, PLA2, and SVMP ( FIG. 2 ). The results demonstrate that the post-immunized llama serum contains antibodies against these toxins. As a control, BSA protein is used and the post-immunized llama serum does not bind to BSA showing that the serum has overabundance of toxin-specific antibodies. 
     II. Anti-Snake Venom Metalloproteinase (SVMP) 
     Purified, lyophilized snake venom metalloproteinase (SVMP) from Crotalus atrox venom was obtained from the National Natural Toxin Research Center (Kingsville, Tex.) and reconstituted in phosphate buffered saline (PBS, pH 7.4) to a final concentration of 1 mg/ml. This was stored in 20 μl aliquots at −20° C., and used in all subsequent panning, ELISA and in vitro protease assay experiments. 
     Panning for SVMP-Binding V H H Antibodies 
     Panning procedures using a V H H library generated from one venom-immunized Llama (see section I for immunogen formulation and immunization schedule) were performed according to well-established procedures described elsewhere with minor modifications. Briefly, a single well of a 96-well microtiter plate (Nunc Maxisorp, Thermofisher, CA USA) was coated with 100 μl of SVMP (0.1 mg/ml in PBS) for 2 hours at 4° C. The coating solution was removed, and the wells blocked with 250 μl of PBS-TB blocking solution (PBS, 0.05% Tween-20, 2% BSA) overnight at 4° C. The blocking solution was removed, and 1011 V H H-phages were added to the well, which was then incubated at 37° C. for 1 hour. The well was washed 10 times with PBS (250 μl), then a further 3 times with PBS containing 0.1% Tween-20, and bound phages were eluted with 100 μl of a solution containing 0.2 M Glycine (pH 2.2), 1 mg/ml BSA. The eluted phages were used to infect 400 μl of a log-phase  E coli  (TG1) culture for library amplification, or plated on 2XTY agar plates containing 50 μg/ml carbenicillin and 2% glucose and incubated overnight at 37° C. 
     Screening for SVMP-Specific V H H Antibodies 
     Screening for SVMP-specific V H H antibodies was carried out by phage ELISA according to procedures described elsewhere. Briefly, individual colonies of V H H-phagemid transformed TG1 cells were inoculated into the wells of round-bottom, 96-well microtiter plate containing 100 μl of 2XTY medium supplemented with 50 μg/ml carbenicillin and 2% glucose (2XTYBG). The plate was incubated with shaking (200 rpm) overnight at 37° C. 100 of the overnight cultures were transferred to 90 μl of fresh 2XTYBG dispensed into the wells of a fresh microtiter plate, and the cultures incubated at 37° C. for a further 1-2 hours (until the OD600 reached approximately 0.6). The remaining cultures were used to make master stocks by adding glycerol to a final concentration of 15%—these were stored at −80° C. 
     1011 helper phages (M13K07, Antibody Design Labs, CA USA) were added to each well of the log-phase cultures, and the plate was incubated at 37° C. with shaking for 1 hr. The plate was centrifuged at 3000×g for 15 minutes, the supernatants removed and the cell pellets resuspended in 150 μl of fresh 2XTY medium containing 50 μg/ml carbenicillin and 50 μg/ml of kanamycin (2XTYCK). This was incubated at 30° C. overnight with shaking. 
     After overnight incubation, the plate was centrifuged at 3000×g for 15 minutes, and the supernatants carefully removed and dispensed into a fresh 96-well microtiter plate. The presence of SVMP-binding V H H-phages in the cell culture supernatants was then tested by phage ELISA according to well-established procedures. Briefly, a 96-well Maxisorp microtiter plate was coated with purified SVMP (1 μg/ml in PBS) and blocked with PBS-TB as described in section II(i). After removing the blocking solution, 50 μl of each supernatant was added to the SVMP-coated wells, and the plate was incubated at 37° C. for 1 hour. After washing 5 times with 300 μl of PBS containing 0.05% Tween-20 (PBS-T)—the standard ELISA washing procedure—the wells were probed with 100 μl of an anti-M13 phage antibody (Antibody Design Labs, CA USA; 1 μg/ml) for 1 hour at room temperature. The wells were washed, incubated with 100 μl of an HRP-conjugated secondary mouse antibody (1 μg/ml, Thermofisher), washed again, and bound phages detected colorimetrically following incubation with 50 μl of TMB Ultra ELISA substrate (Thermofisher). 
     Sequencing of SVMP-Binding V H H Antibodies. 
     Clones producing SVMP-binding V H H-phages were selected and cultured by inoculating 5 μl of V H H-phage expressing glycerol stock into 150 μl of 2XTYCG medium pre-dispensed into the wells of a 96-well round-bottom microtiter plate. The plate was incubated at 37° C. for 16 hours with shaking, and frozen at −80° C. prior to direct sequencing of V H H-encoding cassettes using a phi-S2 primer (ATGAAATACCTATTGCCTACGG; SEQ ID NO: 41). Sequencing was performed by Quintara Biosciences (San Francisco, Calif. USA). 
     Purification of SVMP-Binding V H H Antibodies 
     5 μl of TG1 glycerol stocks containing SVMP-binding, V H H-encoding phagemid were inoculated into 5 ml of 2XTYCG medium, which was incubated at 37° C. for 16 hours with shaking (250 rpm). Recombinant V H H-expressing phagemids were isolated from the overnight cultures by standard plasmid extraction procedures. These were used to transform SS320  E. coli , a non-suppressor of amber stop codons enabling direct phagemid-based V H H expression and secretion. Briefly, single colonies of transformed SS320 cells were inoculated into 100 ml of 2XTY medium containing 50 μg/ml of carbenicillin (2XTYC), which was incubated at 37° C. with shaking (250 rpm) until the culture OD600 reached approximately 0.6. Isopropyl β-D-1-thiogalactopyranoside (IPTG) was added to each culture to a final concentration of 1 mM, and these were incubated for a further 16 hours with shaking at 25° C. Expressed V H H antibodies were purified from isolated periplasmic fractions by affinity chromatography according to well-established procedures described elsewhere. The purity and integrity of purified V H Hs was analyzed by SDS-PAGE and Western Blotting. 
     V H H-SVMP Binding ELISA Assay 
     Binding of purified V H Hs to SVMP was assessed by ELISA according to methods outlined in section II(ii), with the following modifications. Following coating of 96-well Maxisorp microtiter plates with SVMP (1 μg/ml) or crude snake venom (5 μg/ml) and blocking with PBS-TB, wells were incubated with purified V H H samples (1 μg/ml in PBS-T) for 1 hour at 37° C. After washing by standard procedures (5×, 300 PBS-T), bound V H H was incubated with an HRP-conjugated his-tag-binding probe (HisProbe, 0.5 μg/ml, ThermoFisher, CA USA), and detected colorimetrically by standard methods. 
     In Vitro Protease Inhibition Assay 
     The ability of purified V H Hs to inhibit SVMP activity was assessed in vitro by azo-casein proteolysis assay. This analysis relies on the protease-dependent release of azo dye into solution following digestion of substrate azo-casein conjugates. 60 ul reactions containing purified SVMP (0.05-0.5 mg/ml), V H H (0.5-0.1 mg/ml) and azo-casein (10 mg/ml) in 50 mM Tris 150 mM NaCl, 5 mM CaCl2 (pH 8.0) were set up and incubated at 37° C. for 2 hours. Control reactions did not contain V H H, and reference reactions did not contain SVMP. The reactions were stopped with 100 ul of a 5% trichloroacetic acid solution, and then centrifuged at 12000×g for 5 minutes at room temperature. The supernatant (100 ul) was removed carefully and neutralized with 100 ul of 0.5 M NaOH before measuring the absorbances at 490 nm. 
     Amino acid sequences of lead purified V H H candidates binding to SVMP are shown in Table 1 and provided as SEQ ID NOs: 1-5. 
     III. Generation of V H H Antibodies Against svPLA2, β-Bungarotoxin, and Cobrotoxin 
     V H H antibodies targeting svPLA2, β-bungarotoxin, and cobrotoxin were generated by following the same procedures described in section II (i-v), using the following purified proteins (reconstituted to 1 mg/ml in PBS) for panning and post-panning analysis: PLA2 ( C. adamanteus , Worthington Labs;  C. rhodostoma , Venomtech, Inc.); β-bungarotoxin ( B. multicentis , Miami Serpentarium, FL USA); Cobrotoxin ( N. Atra , Miami Serpentarium, FL USA). 
     Amino acid sequences of lead purified V H H candidates binding to PLA2, β-bungarotoxin, and cobrotoxin are shown in Table 1 above. 
     IV. Binding of Lead Purified V H H Candidates to Venoms of Different Snake Species 
     Binding of lead purified V H H candidates against different toxins, i.e., PLA2, β-bungarotoxin, cobrotoxin and SVMP, were tested for venoms of different snake species using ELISA ( FIG. 5 ). The numbers and the density of shading is indicative of strength of binding compared with a negative control BSA. “x” indicates that these combinations have not been tested yet. The V H H candidate against PLA2 showed binding to at least 10 out of 18 venoms of different snake species. Similarly, the V H H candidate against β-bungarotoxin showed binding to at least 10 out of 18 venoms of different snake species. The V H H candidate against cobrotoxin showed binding to at least 6 out of 11 venoms of different snake species. The V H H candidate against SVMP showed binding to at least 8 out of 11 venoms of different snake species. These results demonstrate that the purified V H H candidates are capable of binding to venoms of different snake species. 
     The disclosed embodiments are susceptible to various modifications and alternative forms, and specific examples thereof have been shown by way of example in the drawings and are herein described in detail. It should be understood, however, that the disclosed embodiments are not to be limited to the particular forms or methods disclosed, but to the contrary, the disclosed embodiments are to cover all modifications, equivalents, and alternatives. 
     V. Cross Species Neutralization of PLA2 Activity by a Lead Purified V H H Candidate against PLA2 
     An in vitro enzymatic assay for the lead purified V H H candidate against PLA2 was performed to test neutralization of PLA2 activity on venoms of three different snake species:  Crotalus adamanteus, Crotalus atrox  and  Crotalus oreganus helleri  ( FIG. 3 ). In  FIG. 3 , the y-axis shows percent PLA2 activity. On the x-axis three different snake species are shown:  C. adamanteus, C. atrox  and  C. oreganus helleri . For each snake species, the four bars from left to right represent (1) no V H H, (2) anti-PLA2 V H H (2.4 μM), (3) anti-PLA2 (12 μM) and (4) Varespladib (65 μM). Varespladib is a small molecule inhibitor of PLA2 and is used as a positive control. 
     As shown in  FIG. 3 , both concentrations (2.4 μM and 12 μM) of the lead purified V H H candidate against PLA2 reduced PLA2 activity in all three species as compared to control. These results demonstrate that the lead purified V H H candidate against PLA2 is capable of cross species neutralization of PLA2 activity. 
     VI. Stability of Lead Purified V H H Candidate against PLA2 
     In order to test the stability of lead purified V H H candidates, a non-specific (NS) V H H candidate and an anti-PLA2 V H H candidate were left in room temperature (25° C.) for two weeks.  FIG. 4  demonstrated that after two weeks in room temperature the NS V H H candidate exhibited multiple bands above 20 kDa as compared to the anti-PLA2 V H H candidate which had only a single major band at the expected molecular weight (15 kDa). The multiple bands of higher molecular weight suggest substantial aggregation of the NS V H H candidate. The results indicate that there was substantial change in stability for the NS V H H candidate. These findings suggest that stability varies among different V H H antibodies. 
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