Cone snail toxins are well known blockers of voltage-gated sodium channels, a property that is of broad interest in biology and therapeutically in treating neuropathic pain and neurological disorders. Although most conotoxin channel blockers function by direct binding to a channel and disrupting its normal ion movement, conotoxin O §-GVIIJ channel blocking is unique, using both favorable binding interactions with the channel and a direct tether via an intermolecular disulfide bond. Disulfide exchange is possible because conotoxin O §-GVIIJ contains an S-cysteinylated Cys-24 residue that is capable of exchanging with a free cysteine thiol on the channel surface. Here, we present the solution structure of an analog of O §-GVIIJ (GVIIJ[C24S]) and the results of structure-activity studies with synthetic O §-GVIIJ variants. GVIIJ[C24S] adopts an inhibitor cystine knot structure, with two antiparallel -strands stabilized by three disulfide bridges. The loop region linking the -strands (loop 4) presents residue 24 in a configuration where it could bind to the proposed free cysteine of the channel (Cys-910, rat Na V 1.2 numbering; at site 8). The structure-activity study shows that three residues (Lys-12, Arg-14, and Tyr-16) located in loop 2 and spatially close to residue 24 were also important for functional activity. We propose that the interaction of O §-GVIIJ with the channel depends on not only disulfide tethering via Cys-24 to a free cysteine at site 8 on the channel but also the participation of key residues of O §-GVIIJ on a distinct surface of the peptide.Marine snails of the genus Conus employ a complex venom mixture to subdue prey and as an effective means of defending against predation. The active venoms contain an array of peptides that bind to and modulate the properties of ion channels, G-protein-coupled receptors, and neurotransmitter receptors (1). Several peptides modulate the activities of voltage-gated sodium channels (VGSCs), 4 which are implicated in numerous neurological disorders, as well as neuropathic pain. Four classes of conopeptides have been shown to affect VGSC activity. Peptides belonging to the -and ␦-families promote activation and inhibit inactivation, respectively, whereas the -and O-conotoxins inhibit VGSCs by either blocking the Na ϩ conductance pore or preventing channel activation, respectively (2, 3). Recently, the founding member of a fifth class of VGSC inhibitors was identified that blocks the channel through interaction with a previously unidentified neurotoxin binding site, site 8 (Fig. 1A) (4).O §-GVIIJ is a 35-residue peptide isolated from the venom of the piscivorous snail Conus geographus (Fig. 1B). In vitro folding of linear O §-GVIIJ with thiol-reactive oxidants (i.e. glutathione, L-cystine, or cystamine) resulted in adducts where Cys-24 was disulfide-bonded with glutathione, cysteine, or cysteamine, respectively (abbreviated as GVIIJ SSG , GVIIJ SSC , and GVIIJ SSEA , respectively; see Fig. 1C for structures). Of these, the GVIIJ SSC variant most closely resembled ...