conotoxin

A conotoxin is one of a group of neurotoxic peptides isolated from the venom of the marine cone
snail, genus Conus.

Conotoxins, which are peptides consisting of 10 to 30 amino acid residues, typically have one or
more disulfide bonds. Conotoxins have a variety of mechanisms of actions, most of which have
not been determined. However, it appears that many of these peptides modulate the activity of
ion channels. Over the last few decades conotoxins have been the subject of pharmacological
interest.

Toxicokinetics

Within the snail venom, there are various “conotoxins” in combinations specific to the species.
These toxins have a variety of neuromuscular effects through glutamate, adrenergic (chi
conotoxin), serotonin, and cholinergic pathways. Some conotoxins exert their effects on sodium
(delta conotoxin), potassium, and calcium ion channels. Additionally, more obscure targets exist,
such as toxins that act on hormonal receptors, simulating the effects of oxytocin and
vasopressin (conopressins). Another integral part of cone snail venom is various
alpha-conotoxins. These toxins specifically act on nicotinic receptors, which are responsible for
skeletal muscle contraction. This mechanism is similar to botulinum toxin in that they act on the
same pathway.

symptoms
The initial symptoms of envenomation vary depending on the species of cone snail and the
victim. When stung by a piscivorous cone snail, one may feel anything from a sharp pricking
sensation to unbearable pain. At the envenomation site, local numbness, ischemia, cyanosis,
and necrosis may occur and sometimes involves entire regions of the body. Given that the
affected neurotransmitter pathways exist throughout the body, systemic symptoms may develop.
These progress from initial weakness, sweating, and visual changes to generalized muscle
paralysis, respiratory failure, cardiovascular collapse, and coma.

Treatment / Management

The most important intervention after cone snail envenomation is to seek urgent hospital-based
therapy and to ensure that the patient’s airway, breathing, and circulation remain intact. Once
the patient arrives at the hospital, mechanical ventilation and supportive therapies are enacted.