Comparative venom proteomes of Malaysian snake species from regions in Southeast Asia obtained by shotgun proteomics: A systematic review

Snakebite envenoming (SBE) is a critical yet neglected public health issue in ASEAN countries, including Malaysia. Antivenom immunotherapy is the primary treatment for SBE, functioning by neutralising toxic venom components through antibodies raised from immunised animals. Current antivenoms come with potential reduced efficacy due to regional venom variability. The aim of this systematic review is to consolidate and compare the venom proteome composition from Malaysian venomous snakes (elapids and viperids) sampled from Malaysia, with their counterparts sampled across other Southeast Asia (SEA) regions. Literature search on ScienceDirect, PubMed, and Ovid MEDLINE databases were done on relevant studies published in English from Jan 2014 to Dec 2024. A total of 630 studies were imported for screening. 68 articles received full text assessment to determine their eligibility, and finally, 36 articles were eligible for the systematic review. Among these, proteomic compositions from 9 elapid and 5 viperid species from Malaysia, and their counterparts in other SEA regions were consolidated, with 3 studies investigated both elapids and viperids, 26 studies investigated only elapid(s), and 7 studies investigated only viperid(s). Results revealed geographical variability between venom proteomes at the inter- and intra- specific level. Comparative analysis of venom proteomes between Malaysian venomous snakes and their counterparts located across SEA enables correlation between intra-species variation and clinical toxinology, supporting efforts towards the development of a more effective antivenom (i.e., species- and region-specific, as well as 'universal'), and providing valuable information for clinicians in administering a more appropriate antivenom.