King Cobra (
Ophiophagus hannah
) has a significant place in many
cultures, and is a medically important venomous snake in the world. Envenomation
by this snake is highly lethal, manifested mainly by neurotoxicity and local
tissue damage. King Cobra may be part of a larger species complex, and is widely
distributed across Southeast Asia, southern China, northern and eastern regions
as well as the Western Ghats of India, indicating potential geographical
variation in venom composition. There is, however, only one species-specific
King Cobra antivenom available worldwide that is produced in Thailand, using
venom from the snake of Thai origin. Issues relating to the management of King
Cobra envenomation (
e.g.
, variation in the composition and
toxicity of the venom, limited availability and efficacy of antivenom), and
challenges faced in the research of venom (in particular proteomics), are rarely
addressed. This article reviews the natural history and sociocultural importance
of King Cobra, cases of snakebite envenomation caused by this species, current
practice of management (preclinical and clinical), and major toxinological
studies of the venom with a focus on venom proteomics, toxicity and
neutralization. Unfortunately, epidemiological data of King Cobra bite is
scarce, and venom proteomes reported in various studies revealed marked
discrepancies in details. Challenges, such as inconsistency in snake venom
sampling, varying methodology of proteomic analysis, lack of mechanistic and
antivenomic studies, and controversy surrounding antivenom use in treating King
Cobra envenomation are herein discussed. Future directions are proposed,
including the effort to establish a standard, comprehensive Pan-Asian proteomic
database of King Cobra venom, from which the venom variation can be determined.
Research should be undertaken to characterize the toxin antigenicity, and to
develop an antivenom with improved efficacy and wider geographical utility. The
endeavors are aligned with the WHO´s roadmap that aims to reduce the disease
burden of snakebite by 50% before 2030.