Abstract
Glioblastoma, the most aggressive primary brain tumor, carries a dismal prognosis, with median survival remaining under 15 months despite standard therapies. This is largely because of the tumor's infiltrative nature, the restrictive blood-brain barrier, and intratumoral heterogeneity. Chlorotoxin (CTX), a 36-amino acid peptide derived from scorpion venom, has emerged as a promising multifunctional agent with high specificity for neuroectodermal tumors. In this comprehensive review, we highlight CTX's potential to address critical limitations of current glioma treatments by bridging diagnostic and therapeutic modalities. Diagnostic advancements include CTX-conjugated near-IF fluorophores and nanoparticles for fluorescence-guided surgery and multimodal imaging to enhance intraoperative accuracy. On the therapeutic front, CTX enables targeted delivery of siRNA, radioisotopes, and novel immunotherapies such as CTX-directed chimeric antigen receptor T cells. We also examine emerging clinical data supporting the safety and preliminary efficacy of CTX-based interventions. Collectively, CTX represents a paradigm shift in neuro-oncology, offering a single molecule with both diagnostic and therapeutic capabilities. Its utility may also extend beyond gliomas to metastases and other malignancies within and beyond the central nervous system.