Abstract
Tetrodotoxin (TTX) is a crystalline, weakly basic, colorless organic substance and is one of the most potent marine toxins known. Although TTX was first isolated from pufferfish, it has been found in numerous other marine organisms and a few terrestrial species. Moreover, tetrodotoxication is still an important health problem today, as TTX has no known antidote. TTX poisonings were most commonly reported from Japan, Thailand, and China, but today the risk of TTX poisoning is spreading around the world. Recent studies have shown that TTX-containing fish are being found in other regions of the Pacific and in the Indian Ocean, as well as the Mediterranean Sea. This review aims to summarize pertinent information available to date on the structure, origin, distribution, mechanism of action of TTX and analytical methods used for the detection of TTX, as well as on TTX-containing organisms, symptoms of TTX poisoning, and incidence worldwide.
Highlights
Sometimes lethal effects when ingested by humans at high doses
This study suggested TTX may potentially relieve moderate to severe, treatment-resistant cancer pain in a large proportion of patients, and often for prolonged periods following treatment, but further study is warranted using a composite primary endpoint
Long-term treatment with TTX is associated with acceptable toxicity and, in a substantial minority of patients, resulted in a sustained analgesic effect
Summary
Mar. Drugs 2022, Tetrodotoxin (TTX) is one of the most potent natural marine toxins, which acts by selectively blocking the action potentials of voltage-gated Na+ channels along nerves, skeletal and cardiac muscle membranes, without changing the resting membrane potentials. TTX was named after the Tetraodontidae pufferfish family, from which it was initially isolated and is considered the most lethal toxin found in the marine environment [1,2]. Sometimes lethal effects when ingested by humans at high doses 9 ng/mL), when administered at much lower levels, TTX exhibits therapeutic properties, so far mainly targeted to treating cancer-related, neuropathic and/or visceral pain [5]. TTX is a crystalline, weak basic, colorless substance with a molecular formula of
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