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Bydgoszcz 20-01-2006 J Vet Res 63, 579-586, 2019 DOI:10.2478/jvetres-2019-0060 REVIEW ARTICLE Marine tetrodotoxin as a risk for human health Anna Madejska, Mirosław Michalski, Jacek Osek Department of Hygiene of Food of Animal Origin National Veterinary Research Institute, 24-100 Puławy, Poland [email protected] Received: January 31, 2019 Accepted: September 16, 2019 Abstract Tetrodotoxin (TTX) is a toxin mainly occurring naturally in contaminated puffer fish, which are a culinary delicacy in Japan. It is also detected in various marine organisms like globefish, starfish, sunfish, stars, frogs, crabs, snails, Australian blue- ringed octopuses, and bivalve molluscs. TTX is produced by marine bacteria that are consumed mainly by fish of the Tetraodontidae family and other aquatic animals. TTX poisoning through consuming marine snails has recently begun to occur over a wider geographical extent through Taiwan, China, and Europe. This neurotoxin causes food intoxication and poses an acute risk to public health. The aim of this review is to present the most recent information about TTX and its analogues with particular regard to toxicity, methods of analysis, and risk to humans of exposure. Keywords: marine shellfish, tetrodotoxin, toxicity, detection, health risk. Introduction which are a prized delicacy in Japanese cuisine (3). TTX content is different in various parts of the fish Tetrodotoxin (TTX) is a strong marine neurotoxin body – the highest level of the toxin being found in the acting by blocking sodium channels of the neuron cell skin and some internal organs like the liver and ovaries. membrane. This toxin is a water-soluble heterocyclic This toxin also occurs in the body of marine gastropods guanidine compound, which is stable in neutral and (e.g. Nassarius glans, Nassarius papillosus, Zeuxis weak acidic solutions and cannot be inactivated by heat scalaris, Zeuxis samiplicutus, Zeuxis siquijorensis, treatment (3, 15, 24). TTX was isolated for the first Niotha clathrata, Charonia sauliae, Charonia lampas, time in 1909 by the Japanese researcher Yoshizumi Babylonia japonica, and Tutufa lissostoma), oysters, Tahara from ovaries of globefish (5, 15). Thirty mussels, fish other than puffer fish (e.g. the members of naturally occurring analogues of tetrodotoxin have been the Gobiidae subfamily Yongeichthys nebulosus, detected and many of them have also been shown to Parachaeturichthys polynema, and Radigobius Caninus have toxic potential in humans and experimental and the sillaginid Sillago japonica), and the horseshoe animals. The main mechanism of tetrodotoxin crab (Carcinoscorpius rotundicauda) (3, 14, 44, 47, 55, accumulation in fish is the food chain, which begins 57, 59, 61, 62). TTX intoxication caused by the with toxin-synthesising bacteria, including consumption of marine gastropods has been observed Pseudoalteromonas haloplanktis tetraodonis, marine not only in Japan, but also in Taiwan, China, New microorganisms belonging to the genera of Vibrio (e.g. Zealand, and Europe, indicating the further spread of Vibrio alginolyticus) and Shewanella, (e.g. Shewanella organisms containing this toxin around the world (8, algae and Shewanella putrefaciens) or Alteromonas 19, 38, 39, 55). tetraodoni (3, 26, 47, 51). The main TTX sources for humans are fish from the Tetraodontidae family (puffer Chemistry of TTX fish), such as Takifugu spp., Lagocephalus spp., Tetrodotoxin has the chemical formula Tetraodon alboreticulatus, Chelonodon patoca, C11H17N3O8 and a molecular mass of 319.1 g/M. Its Arothron firmamentum, and Canthigaster rivulata, structural formula is shown in Fig. 1. © 2019 A. Madejska et al. This is an open access article distributed under the Creative Commons Attribution- NonCommercial-NoDerivs license (http://creativecommons.org/licenses/by-nc-nd/3.0/) 580 A. Madejska et al./J Vet Res/63 (2019) 579-586 at the C-6 and C-11 carbon atoms has a significant impact on the binding of TTX analogues to the sodium channels through their participation in hydrogen binding. Moreover, Pires et al. (52) proved that analogue 11-oxoTTX is 4–5 times more toxic than tetrodotoxin. There are still many analogues which have not been studied for their toxicity, so it is important that further analysis of TTX derivatives be carried out. Such studies are very important in assessment of the risk posed by this kind of toxin to public health. Fig. 1. Structural formula of tetrodotoxin (3) TTX analogues found in puffer fish can be categorised into following families (65): To date 30 structural analogues of TTX have been 1) analogues chemically equivalent to TTX (4-epiTTX studied and it has been proved that their toxicity is and 4,9-anhydroTTX); connected with their structure (4). Previous studies 2) deoxy analogues (5-deoxyTTX, 11-deoxyTTX, 5,11- indicated that the hydroxyl substituents cause that the dideoxyTTX, 6,11-dideoxyTTX and 5,6,11- analogues are more toxic than TTX, while the trideoxyTTX); analogues with deoxy substituents are less harmful. The 3) 11-CH2OH oxidised analogue (11-oxoTTX); toxicity of analogues depends on the number and 4) C11-lacking analogues (11-norTTX-6(S)-ol and 11- position of hydroxyl substituents in their structure (4). norTTX-6(R)-ol). Yotsu-Yamashita et al. (67) performed studies Such structures as have been found and analysed assessing the effect of the position of the hydroxyl for several natural TTX analogues in puffer fish and group in the TTX molecule on the ability of this amphibians are shown in Fig. 2. neurotoxin to penetrate rat meninges. The obtained results revealed that the location of the hydroxyl groups Fig. 2. The structures of natural tetrodotoxin (TTX) analogues (64) A. Madejska et al./J Vet Res/63 (2019) 573-586 581 Toxicity Until the very recent past, TTX poisoning was considered a problem confined to Japan and other Tetrodotoxin is one of the most toxic substances to Asian countries. Currently, tetrodotoxin poisoning is humans known. Its lethal dose is 275 times lower than seen in regions that were previously recognised as safe. cyanides and 50 times lower than strychnine and curare It is thought that the rapid growth of the geographical (15). In mice, the 50% lethal dose (LD50) of TTX extent of this toxin is due to rising water temperatures administered orally is 334 μg/kg while intravenously it around the world (9). The first case of TTX poisoning is 8 μg/kg (10). The toxic dose for humans has not been in Europe was reported in Malaga, Spain, after the established, but a single dose of 1–2 mg of purified consumption of a trumpet shell by a 49-year-old man TTX can be lethal (15). (54). Table 1 shows the reported cases and outbreaks of TTX inhibits neuronal firing of action potentials TTX poisoning in various parts of the world. by binding to the voltage-gated sodium channels in nerve cell membranes, and as a result blocks the flow of sodium ions into the neurons (24). For this reason Legislation tetrodotoxin is called a sodium channel blocker. The toxin affects action potential generation and impulse Commission Regulation (EC) No 853/2004 conduction, resulting in blockade of the neuron and establishes detailed regulations for hygiene in muscle paralysis. It leads to the following acute foodstuffs in the European Union. Section VIII, chapter symptoms: tingling (paraesthesia) of the tongue and V indicates that fishery products derived from lips, motor paralysis, incoordination, slurred speech, poisonous fish of the Tetraodontidae, Molidae, aphonia, hypotension, bradycardia, cardiac dysrhythmia, Diodontidae, and Canthigasteridae families are banned and unconsciousness (18). The clinical symptoms of from the market (7). In Japan, a regulatory limit of TTX intoxication appear very quickly and depend on the 2 mg equivalent of TTX/kg was laid down for toxin amount consumed. In severe cases, death is caused tetrodotoxin, while in Europe appropriate criteria have by respiratory and heart failure. The treatment is not been determined (4, 19). symptomatic and supportive because there is no specific antidote against TTX, and is based on careful observation and repeated neurological assessment for the Detection of TTX early implementation of measures to counter respiratory failure and cardiovascular disorders (45). Bioassays. There are several methods for TTX detection. The first methods used were biological tests, including the mouse bioassay (MBA), tissue culture Table 1. Cases of TTX poisoning bioassay, and ELISA, available as commercial kits Number of Country Source of TTX Reference (63). Bioassays allow the toxicity of the sample to be cases Japan Puffer fish 1 (49) assessed, but it is not possible to identify individual Japan Puffer fish 11 (13) toxins. Eggs of horseshoe crab The mouse bioassay was used for the first time as Thailand (Carcinoscorpius 71 (31) a method for the analysis of TTX by Hashimoto and rotundicauda) Japan Puffer fish 1 (64) Migita (16) in 1951 in puffer fish sample examination. Bangladesh Puffer fish 8 (37) Currently, because of limitations in using the MBA due China Gastropods 30 (59) to ethical reasons, its continued use for some marine Australia Puffer fish 11 (25) toxin groups is only as the reference method (46). In Taiwan Gastropods 4 (21) Taiwan Puffer fish 6 (18) mouse bioassays, seafood extracts are given to Taiwan Gastropods 1 (23) laboratory animals and then symptoms and time to Australia Toadfish 7 (50) death are monitored. In addition to the ethical concerns Taiwan Gastropods 6 (22) around the use of the MBA method prompted by the Bangladesh Puffer fish 36 (1) Japan Puffer fish 7 (2) killing of experimental animals, other numerous Taiwan Puffer fish 5 (20) disadvantages of this technique exist which are Taiwan Gastropods 1 (29) technical, such as low sensitivity and accuracy. For this Taiwan Gastropods 3 (30) reason, in recent years, a serious attempt has been made Trumpet shell Spain 1 (55) (Charonia lampas) to introduce other techniques for detection of TTX. Puffer fish, A tissue culture bioassay may be used as an Japan Thread-sail filefish, 3 (3) alternative method to the MBA (32, 33).
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