Paralytic shellfish toxins (PSTs) contamination of seafood has become a growing global problem. However, the molecular response of bivalves, some of the most popular seafoods, to PSP toxins has seldom been reported and the underlying molecular mechanisms of the interactions between Meretrix meretrix bivalves and PSTs-producing dinoflagellates are scarcely known. This study compared the protein expression profiles between PSP toxin-contaminated and non-PSP toxin contaminated M. meretrix, determined proteome responses and identified potential biomarkers based on feeding experiments. Results showed that the content of total PSP toxins in contaminated bivalves was 40.63 ± 4.08 μg saxitoxin (STX) equivalents per gram, with 95.3% in hepatopancreas, followed by gill (1.82%) and foot (1.79%). According to two-dimensional gel electrophoresis (2-DE), 15 differentially expressed proteins (at least 2-fold difference) between the hepatopancreas of bivalves with and without PSP toxins were detected. Eight of them were successfully identified by MALDI-TOF MS. These were catalase, protein ultraspiracle homolog, G2 and S phase-expression protein, paramyosin, Mn-superoxide dismutase, response regulator receiver domain-containing protein, sarcoplasmic calcium-binding protein and major facilitator superfamily transporters. The differences in the expression levels of the last three proteins involving in cell signaling, structure and membrane transport were 4.2, 5.3 and 4.9-fold, respectively. These proteins could be further developed as potential biomarkers. The other two up-regulated proteins, Mn-superoxide dismutase and catalase, were involved in cell defence mechanisms against oxidative stress, suggesting PSP toxin acts as xenobiotics and poses oxidative stress in bivalves. This study gives insights into the response of bivalves to PSP toxin-producing dinoflagellate at the proteomic level and the potential of using 2-DE to develop specific protein markers in bivalves.