# Role of Serum IL-33 in Bothrops Snakebite Victims: Linking Inflammation and Endothelial Dysfunction

## TL;DR

This study explores how a protein called IL-33 is linked to bleeding and kidney issues in patients bitten by Bothrops snakes.

## Contribution

The study identifies IL-33 as a novel biomarker associated with bleeding and endothelial dysfunction in Bothrops snakebite victims.

## Key findings

- Elevated IL-33 levels correlate with bleeding and endothelial dysfunction in snakebite patients.
- IL-33 levels are linked to early kidney involvement in Bothrops envenoming.
- IL-33 shows potential as a predictive biomarker for bleeding (AUC = 0.739).

## Abstract

Bothrops snakebites pose a significant public health challenge in low- and middle-income regions, often resulting in inflammation, coagulopathy, and renal complications even after antivenom therapy. This study investigated the role of interleukin-33 (IL-33) and endothelial biomarkers in patients with Bothrops envenoming to better understand the mechanisms associated with bleeding and kidney dysfunction. In a prospective cohort of 31 patients from Northeast Brazil, serum levels of IL-33, von Willebrand factor A2 (vWF-A2), angiopoietin-1, angiopoietin-2, syndecan-1, and VCAM-1 were measured at admission and at 10 and 20 h after antivenom administration. Fourteen patients (45%) presented with bleeding at baseline. Traditional clinical and laboratory parameters did not differ between the bleeding and non-bleeding groups on admission; however, IL-33 levels were significantly higher in patients with bleeding. Elevated IL-33 on admission correlated positively with vWF-A2 and estimated glomerular filtration rate, and negatively with angiopoietin-1, suggesting links between inflammation, endothelial dysfunction, and early renal involvement. IL-33 showed a good performance in bleeding patients (AUC = 0.739; IC 95% 0.562–0.917). These findings identified the link between IL-33, early hemorrhage, endothelial dysfunction, and renal involvement in acute Bothrops envenoming. After antivenom therapy, IL-33 levels presented dynamic changes in all patients and require further studies.