Abstract
Animal venoms, particularly Scolopendrid venom, have gained significant attention as therapeutic agents in complementary and alternative medicine, especially for applications in pain management and neuroprotection. In traditional Korean medicine, Scolopendrid venom is administered through pharmacopuncture, a method that combines injection therapy with principals of acupuncture. The present review focuses on the multifaceted effects of Scolopendrid pharmacopuncture, derived from Scolopendra polymorpha, on the peripheral nervous system, and its potential role in addressing the neuropathic dysfunction that often arises from peripheral nerve injuries. Scolopendrid venom exhibits various pharmacological properties, including analgesic, anti-inflammatory, and neuroprotective effects. Experimental studies have shown that Scolopendrid pharmacopuncture significantly reduces neuropathic pain in animal models by modulating ion channels and inflammatory pathways. Clinical investigations have further revealed its efficacy in alleviating pain associated with conditions such as Bell’s palsy and carpal tunnel syndrome. Despite its promising therapeutic potential, the lack of comprehensive clinical research on the toxicity and safety profiles of SPP remains a critical limitation. Future studies should focus on evaluating the safety of Scolopendrid venom as a standalone treatment and incorporate broader data sources to enhance our understanding of its implications in clinical practice.
Keywords:
Scolopendrid venom; animal venom; pharmacopuncture; neuropathic dysfunction; traditional Korean medicine Key Contribution:
This paper identifies Scolopendrid venom from Scolopendra polymorpha as a promising therapeutic agent for neuropathic dysfunction; highlighting its analgesic, anti-inflammatory, and neuroprotective properties. Furthermore, it underscores the need for comprehensive clinical research to evaluate the safety and toxicity profiles of Scolopendrid pharmacopuncture in order to fully realize its therapeutic potential in clinical settings.
1. Introduction
Recently, the exploration of animal venoms as sources of therapeutic agents has gained significant attention in complementary and alternative medicine, particularly for their potential application in pain management and neuroprotection [1]. In traditional Korean medicine, various animal venom-derived pharmacopuncture injections are used to normalize physiological functions and improve pathological conditions in humans [2]. Pharmacopuncture injection therapy involves a procedure in which specific medicinal solutions are injected into trigger points and blood vessels, identified through the stimulation of meridian points or superficial tissues, using a syringe. Therefore, this method allows the combined effects of acupuncture and pharmacological treatment [3]. Among animal venom-derived pharmacopuncture injections, Scolopendrid pharmacopuncture (SPP) involves the extraction of active components from Scolopendrid venom, which are then injected into specific meridian and primary trigger points that are effective for certain diseases from a traditional medicinal perspective.
Scolopendrids, belonging to the suborder Scolopendromorpha (class Chilopoda, phylum Arthropoda), are predatory centipedes characterized by elongated, segmented bodies with one pair of legs per segment [4]. Within Scolopendromorpha, the family Scolopendridae encompasses diverse genera, including Scolopendra, Cormocephalus, and Digitipes, exhibiting distinct morphological and genetic traits [5]. Integrating morphological and molecular phylogenetic data, particularly from mitochondrial and nuclear genes, has refined our understanding of scolopendrid taxonomy and evolutionary relationships, revealing cryptic diversity within this group [6].
Scolopendrid venom exhibits a complex composition comprising diverse proteins, peptides, and enzymes with varied biological functions [7]. Studies have identified numerous toxin-like molecules within this venom, with significant interspecies variation in composition, including 246 unique proteins found in Scolopendra mojiangica [8]. Notable toxin types include alpha-like scorpion neurotoxins and metalloproteinases, exhibiting neurotoxic and enzymatic activities, respectively, with some peptides, such as SsmTP from Scolopendra subspinipes mutilans, demonstrating concentration-dependent cytotoxic and growth factor-like effects [9]. These diverse components confer potential pharmacological applications, including anticoagulant, analgesic, and ion channel-modulating properties [10]. Scolopendrid venom, specifically derived from Scolopendra polymorpha, is a notable candidate because of its unique biochemical composition and multifaceted effects on the peripheral nervous system (PNS) [11].
An impairment of the PNS can lead to neuropathic dysfunction. Peripheral nerve injury or damage is a primary mechanisms linking the PNS to neuropathic dysfunction [12]. This can occur because of various factors, including trauma, infections, toxins, and autoimmune diseases. When the peripheral nerves are damaged, their ability to conduct signals is compromised, leading to aberrant pain processing [13]. In facial nerve palsy, carpal tunnel syndrome, and radial nerve palsy, this can manifest as neuropathic pain, often described as burning, shooting, or tingling sensations that do not correspond to any identifiable injury [14].
The PNS plays a significant role in neuroinflammation, which can exacerbate neuropathic dysfunction. Inflammatory processes can lead to further injury of peripheral nerves, creating a cycle of pain and dysfunction [15]. Conditions such as diabetic neuropathy illustrate how prolonged hyperglycemia can induce inflammatory responses that damage peripheral nerve fibers, contributing to chronic pain and sensory deficits [16].
The PNS is also involved in modulating pain pathways [17]. Abnormalities in the peripheral nociceptors functioning, specialized nerve endings that detect harmful stimuli, can result in heightened sensitivity to pain, known as allodynia and hyperalgesia [18]. Altered pain perception is a hallmark of neuropathic dysfunction and signifies a maladaptive response to injury.
Neuropathic dysfunction, characterized by abnormal pain processing and resistance to traditional analgesic therapies, presents a significant clinical challenge [14,19]. Understanding the mechanisms through which Scolopendrid venom modulates pain pathways and neuroinflammatory responses is crucial for developing innovative treatment strategies.
The multifaceted effects of Scolopendrid venom on the PNS requires comprehensive investigation. By contributing to the understanding of the mechanisms by which this venom influences pain pathways, inflammation, and nerve health, this review provides valuable insights into its therapeutic potential. These findings may pave the way for novel treatment modalities that address the challenges associated with neuropathic pain and nerve injury, ultimately enhancing clinical outcomes in affected patients.
2. Mechanisms of Action of Scolopendrid Venom in the Peripheral Nerve System
Scolopendrid venom comprises a complex mixture of bioactive peptides and proteins that exhibit extensive pharmacological properties. It contains various bioactive peptides and proteins that target and modulate ion channels and play essential roles in neuronal excitability and neurotransmission [20].
2.1. Influence on Ion Channel Gating in Terms of Peripheral Nerve System
Scolopendrid venom exerts analgesic effects through various mechanisms that target ion channels in the PNS [21]. The components of the venom, particularly neurotoxins, interact with voltage-gated calcium channels, resulting in reduced nociceptive transmission. Notably, Scolopendrid venom contains peptides that act as high-voltage-activated calcium channel blockers, specifically targeting N-type calcium channels [22]. This action reduces calcium influx, thereby decreasing neurotransmitter release and pain signaling. In addition, the recombinant form of Phα1β, known as CTK 01512-2, has potential in modulating TRPA1 channels, further contributing to its analgesic properties [23].
Furthermore, venom-derived peptides selectively inhibit transient receptor potential vanilloid 1 (TRPV1), a receptor crucial for pain perception. By binding to the outer pore region of TRPV1, these peptides modulate its activity, offering a promising pathway for the development of analgesic drugs [24]. Peptides from Scolopendrid venom may also target acid-sensing ion channels (ASICs), which play a significant role in pain pathways; these toxins can alter ASIC gating, leading to analgesic effects in both central and peripheral nerve systems [25]. Additionally, venom components may inhibit voltage-gated sodium channels, particularly target voltage-gated sodium (NaV) 1.7, which is essential for pain signaling. This inhibition effectively reduces pain transmission in peripheral neurons [26].
2.2. Immunomodulatory and Neuroprotective Effects of Scolopendrid Venom on PNS
A prominent mechanism of action involves the modulation of inflammatory responses. Scolopendrid venom and its extracts have been shown to suppress the production of key inflammatory mediators, including tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), nitric oxide (NO), and prostaglandin E2 (PGE2). This suppression is mediated, at least in part, by the inhibition of the nuclear factor kappa beta (NF-κB) signaling pathway, a crucial regulator of inflammatory processes [27,28]. This pathway’s inhibition consequently reduces the expression of pro-inflammatory cytokines, further dampening the inflammatory cascade. This attenuation of glial activation contributes to the overall reduction in neuroinflammation within the PNS.
Beyond its anti-inflammatory actions, Scolopendrid venom exhibits direct neuroprotective effects. It enhances cell viability, likely through the activation of nerve growth factor (NGF) signaling pathways, which are essential for neuronal survival, growth, and repair [29]. This activation of NGF signaling pathways contributes to the observed functional recovery in nerve injury models treated with Scolopendrid venom [30]. Additionally, components of the venom may mitigate oxidative stress, a significant factor contributing to neurodegeneration [31]. This mitigation is potentially achieved by bolstering antioxidant defenses and reducing mitochondrial damage [32,33]. These combined effects—immunomodulation and direct neuroprotection—underscore the therapeutic potential of Scolopendrid venom in addressing neuropathic conditions affecting the PNS.
3. Evidence from Experimental Studies
Experimental studies have indicated that Scolopendrid venom exhibits favorable effects on neuropathic dysfunction, demonstrating its potential as a therapeutic agent for managing neuropathic pain and promoting recovery following nerve injuries [34]. In a rat model of neuropathic pain, Scolopendrid pharmacopuncture significantly reduced the withdrawal response associated with both mechanical and chemical allodynia, as shown by decreased c-fos expression in the midbrain and a reduced white blood cell count [35].
Moreover, the scolopendrid water–alcohol extract (SWAE) applied at the BL23 acupuncture point markedly increased the mechanical threshold of the foot in neuropathic rats for at least 4 h, indicating a partial alleviation of pain. This analgesic effect was comparable to that of conventional anticonvulsant medications such as gabapentin. The analgesic properties of the SWAE are linked to the suppression of NO production and the expression of inducible and neuronal nitric oxide synthases (NOSs), further supporting its role in modulating pain pathways [36].
In addition, pharmacopuncture with scolopendrid extracts improved functional recovery and reduced pain severity in sciatic nerve injury models. Treatment was associated with decreased expressions of inflammatory markers, including cyclooxygenase-2 (COX-2) and TNF-α, and enhanced neurofilament expression, which is indicative of neuronal health. Furthermore, Scolopendrid extracts demonstrated anti-inflammatory effects by inhibiting the NF-κB signaling pathway and reducing the production of inflammatory mediators, both in vitro and in vivo [37].
Collectively, these results highlight the therapeutic potential of Scolopendrid venom in alleviating neuropathic pain and facilitating recovery from peripheral nerve injuries and shows its multifaceted mechanisms of action involving anti-inflammatory, analgesic, and neuroprotective effects. The study designs and results are presented in Table 1.
Table 1.
Designs of preclinical experimental studies.
4. Evidence from Clinical Studies
In a clinical investigation focused on the efficacy of SPP in alleviating postauricular pain, patients diagnosed with Bell’s palsy exhibited significant reductions in pain when treated with SPP in conjunction with conventional therapies. The treated group reported a marked decrease in postauricular pain compared to those receiving conventional treatment alone and experienced a shorter duration of pain, indicating enhanced therapeutic benefits [46].
A comparative study on the effects of scolopendrid and sweet bee venom pharmacopuncture on carpal tunnel syndrome revealed that both treatment modalities led to significant improvements in patient-reported outcomes, as measured using the visual analog scale and pain rating scale. Although no significant differences were noted between the two groups, the results suggest that SPP effectively alleviates the symptoms associated with neuropathic conditions [47].
Moreover, SPP has shown promise for reducing mechanical allodynia and thermal hyperalgesia in animal models of neuropathic pain. In these studies, scolopendrid extracts improved pain thresholds and showed anti-inflammatory effects by downregulating the expression of pro-inflammatory cytokines and enhancing neuroprotective mechanisms [48]. Collectively, these findings underscore the potential of scolopendrid venom as a therapeutic agent for managing neuropathic pain and promoting recovery in various clinical settings. Treatment properties and outcomes are listed in Table 2.
Table 2.
Designs of clinical studies included in this review.
5. Discussion
5.1. For Safe Injections
While existing studies highlight the complex composition of scolopendrid venom, comprising up to 246 types of peptides and proteins with diverse bioactivities, the subsequent discussion of preclinical and limited clinical data suggests a relatively low toxicity profile for the crude venom, particularly when administered via pharmacopuncture at controlled dosages. This apparent discrepancy between the venom’s complex composition and its observed low toxicity warrants further consideration. Several factors may contribute to this phenomenon. First, the specific peptides and proteins responsible for pain and local swelling may be present in relatively low concentrations within the crude venom. Second, the pharmacopuncture administration technique, involving small injection volumes and potentially targeting specific sites, may limit systemic exposure to the venom’s components. Third, it is possible that synergistic interactions between the various components of the venom, while contributing to its therapeutic effects, may also modulate its overall toxicity, perhaps through counteracting or buffering mechanisms. Research has indicated that SPP does not exhibit significant toxicological effects when administered at controlled doses, suggesting a favorable safety profile for this practice. A study involving SD rats demonstrated that SPP administered at doses of 0.21, 0.42, and 0.84 mg/kg did not result in any deaths or significant adverse effects, with parameters such as weight, food intake, and organ health remaining stable. Notably, the lethal dose (LD50) for SPP was determined to be >0.84 mg/kg, indicating a relatively high safety margin [49].
Although direct human studies on SPP are limited, insights have been gained from research on other venom-based treatments, such as bee venom pharmacopuncture, which reported a 10% incidence of mild side effects, all of which resolved without lasting effects [50]. However, the potential for allergic reactions or adverse effects cannot be overlooked, as has been observed in other venom studies. Therefore, although current animal studies suggest that SPP is safe, further clinical research is essential to fully elucidate its implications in humans.
In terms of delivery, the injectable route ensures rapid absorption and immediate therapeutic effects, which are essential in emergencies. Injectable forms facilitate the quick systemic distribution of venom, which is crucial in cases of envenomation where time is essential. Furthermore, intramuscular or subcutaneous injections can directly target affected tissues, thereby enhancing the therapeutic effect of the venom [51].
From a safety perspective, studies have indicated that injectable Scolopendrid venom administration does not exhibit significant toxicological changes, suggesting a safer profile than oral delivery, which may lead to gastrointestinal complications. In addition, injectables allow precise dosing and minimize the risk of overdose or adverse reactions that can occur with oral administration [3].
5.2. Limitations and Future Research Directions
The absence of clinical research data regarding the toxicity of SPP during actual application poses a significant challenge in substantiating its beneficial effects on neuropathic dysfunction. Current studies are limited by small sample sizes and have primarily assessed the safety of combined treatments rather than evaluating the safety of SPP as a standalone intervention. This limitation arises from the nature of traditional Korean medical practices, which typically use multiple interventions simultaneously, instead of relying solely on a single treatment modality. Therefore, future safety studies should focus on rigorously assessing the safety of SPP when administered independently instead of within the context of complex treatment regimens.
Furthermore, the current understanding of the safety of the subcutaneous administration of this venom is limited by the scarcity of clinical studies. The available LD50 data, while informative regarding acute toxicity in preclinical models, does not adequately address potential long-term or subacute effects in humans. Comparing the toxicity of this venom to that of bee venom, a substance with a distinct pharmacological profile and commonly used in Korean traditional medicine, is of limited value. The observed lack of significant toxicity in animal models, as evidenced by stable physiological parameters and high LD50 values, may not fully reflect the potential for localized reactions or long-term effects. Further research, including detailed analysis of individual venom components and their interactions, as well as more extensive clinical trials evaluating both local and systemic effects of SPP, is necessary to fully reconcile the complex nature of the venom with its observed safety profile.
Finally, preclinical and clinical studies highlighted in this research underscore a significant limitation, owing to the lack of findings from internationally recognized databases. This reliance on medical databases from the Republic of Korea and China raises concerns about selection bias and the potential inability of this study to provide contrasting or complementary perspectives within a broader international context. Acknowledging these limitations is crucial as it emphasizes the need for caution when generalizing the findings of studies.
6. Conclusions
The findings presented in this review highlight the therapeutic potential of Scolopendrid venom, particularly through its pharmacopuncture application in the management of neuropathic dysfunction. Its multifaceted mechanisms of action, including analgesic, anti-inflammatory, and neuroprotective effects, underscore its potential as a novel treatment modality for conditions characterized by neuropathic pain and peripheral nerve injuries. Experimental and clinical studies have demonstrated that Scolopendrid venom alleviates pain and facilitates functional recovery, indicating its capacity to address significant clinical challenges associated with neuropathic conditions. The favorable safety profile observed in animal studies further supports the viability of SPP as a therapeutic option.
While the findings presented here offer promising insights into the therapeutic potential of Scolopendrid venom, particularly for neuropathic pain management, further research employing a comprehensive approach with diverse, internationally recognized databases is warranted to strengthen these observations. Such investigations, focusing on rigorous clinical trials, including assessments of its safety as a standalone treatment, will be essential to definitively establish the efficacy and safety profile of Scolopendrid venom for integration into clinical practice and ultimately optimize patient care.
Author Contributions
Conceptualization, J.-H.K. and T.-Y.K.; methodology, J.-H.K. and T.-Y.K.; software, J.-H.K. and T.-Y.K.; validation, B.G.; formal analysis, J.-H.K. and T.-Y.K.; investigation, B.G.; resources, S.-S.N.; data curation, J.-H.K. and T.-Y.K.; writing—original draft preparation, J.-H.K. and T.-Y.K.; writing—review and editing, J.-H.K. and T.-Y.K.; visualization, B.G.; supervision, S.-S.N.; project administration, S.-S.N.; funding acquisition, S.-S.N. All authors have read and agreed to the published version of the manuscript.
Funding
This study was funded by the Traditional Korean Medicine R&D program, which is funded by the Ministry of Health and Welfare through the Korea Health Industry Development Institute (KHIDI) (RS-2020-KH087887).
Institutional Review Board Statement
Not applicable.
Informed Consent Statement
Not applicable.
Conflicts of Interest
The authors declare no conflict of interest.
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