Role of Immune Mediators in Pathophysiology of Snakebite Envenoming: A Scoping Review Protocol

Introduction: Snakebite is a neglected tropical disease and a common medical emergency in the tropics. Envenoming in humans activates both innate and adaptive immune responses, which play a pivotal role in host defence against venom toxins. On the other hand, a dysregulated immune response triggers devastating pathophysiological effects related to venom-induced, immune-mediated host damage, causing tissue injury or organ damage, oxidative stress, angiogenesis, and fibrosis in diverse target tissues. While there is evidence of an association between immune dysregulation and the clinical features of severe envenoming, the role of immune mediators in the pathophysiology of snakebite envenoming, contributing to the development of severe clinical features, remains to be elucidated. Our scoping review aims to summarise the role of immune mediators in pathophysiological events following snakebite envenoming and antivenom treatment.
Method and analysis: The scoping review will follow Arksey and O'Malley's scoping review framework and the guidance recommended by the Joanna Briggs Institute (JBI). MEDLINE/PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases will be searched using predefined keywords to gather the peer-reviewed, English-language articles reporting original data from 2000 to the present. All reviews will involve two or more reviewers. Data will be presented in a descriptive manner, and tables and figures will be used when necessary.
Ethics and dissemination: A scoping review does not require ethics approval since it will rely on secondary data. Once the review is completed, we anticipate submitting it for publication in a peer-reviewed journal.