The puff adder (Bitis arietans) is a clinically relevant viper species found throughout Africa, and it is responsible for a greater incidence of health-related envenomations than all other snake species on the continent combined. Unresolved skeletal muscle damage is a common consequence of B. arietans envenomation that can result in long-term morbidity and even death. Antivenom treatment can mitigate the systemic effects of the venom but offers little protection against local tissue damage. Identifying the mechanisms through which B. arietans venom induces tissue damage and impedes skeletal muscle regeneration could identify possible treatment alternatives that could help alleviate the long-term consequences of envenomation. Skeletal muscle has an innate ability to regenerate, but constituents within the venom can impede multiple stages of this regeneration process. In this study, we employed a combination of biochemical analyses, cell-based assays, and in vivo experiments to assess the toxicological implications of B. arietans envenomation and its impacts on key processes of regeneration. Our findings demonstrate that the pathological characteristics of permanent muscle damage resulting from B. arietans envenomation may be attributed to the venom’s effects on muscle stem cell precursors, the extracellular matrix (ECM), and the influence of blood-borne proteins that promote fibrosis.

Viper bite envenoming often results in prominent skeletal muscle damage. According to our previous studies, the prolonged presence of Crotalus atrox venom toxins induced extensive muscle damage, which mimicked the outcome of chronic muscle damage often seen in human muscular dystrophies. In the case of chronic muscle damage, two critical processes occur: muscle regeneration is impaired, and fibrosis develops. Myostatin/activin signalling is a key regulator of both of these processes. Myostatin and its closely related molecules, in particular activin, inhibit the proliferation and differentiation of myocytes while promoting proliferation of fibroblasts and expression of extracellular matrix proteins. Thus, attenuating myostatin/activin signalling offers an attractive means of promoting muscle development while decreasing fibrosis. Hence, we have used the soluble activin receptor type IIb, which acts as a ligand trap for both myostatin and activin, to dampen signalling and assessed whether this intervention could alter the pathological trajectory of C. atrox venom-induced muscle damage in mice. We report that the soluble activin receptor type IIb treatment increased the size of regenerating fibres while reducing the level of fibrotic tissues in venom-damaged muscle.