Nerve Agents

Among lethal CW agents, the nerve agents have had an entirely dominant role since the Second World War. Nerve agents acquired their name because they affect the transmission of nerve impulses in the nervous system. All nerve agents belong chemically to the group of organo-phosphorus compounds. They are stable and easily dispersed, highly toxic and have rapid effects both when absorbed through the skin and via respiration. Nerve agents can be manufactured by means of fairly simple chemical techniques. The raw materials are inexpensive and generally readily available.

It was not until the early 1930's that German chemists observed that organo-phosphorus compounds could be poisonous. In 1934, Dr. Gerhard Schrader, a chemist at IG Farben, was given the task of developing a pesticide. Two years later a phosphorus compound with extremely high toxicity was produced for the first time. According to contemporary regulations, discoveries with military implications had to be reported to the military authorities, which was also done with Schrader's discovery. This phosphorus compound, given the name tabun, was the first of the substances later referred to as nerve agents.

A factory for production of the new CW agent was built and a total of 12 000 tones of tabun were produced during the years 1942-1945. At the end of the war the Allies seized large quantities of this nerve agent. Up to the end of the war, Schrader and his co-workers synthesized about 2 000 new organo-phosphorus compounds, including sarin (1938). The third of the "classic" nerve agents, soman, was first produced in 1944. These three nerve agents are known as G agents in the American nomenclature. The manufacture of sarin never started properly and up to 1945 only about 0.5 tone of this nerve agent was produced in a pilot plant.

Immediately after the war, research was mainly concentrated on studies of the mechanisms of the nerve agents in order to discover more effective forms of protection against these new CW agents. The results of these efforts led, however, not only to better forms of` protection but also to new types of agents closely related to the earlier ones.

By the mid-1950's a group of more stable nerve agents had been developed, known as the V-agents in the American nomenclature. They are approximately ten-fold more poisonous than sarin and are thus among the most toxic substances ever synthesized.

The first publication of these substances appeared in 1955. The authors, R. Ghosh and J.F. Newman, described one of the substances, known as Amiton, as being particularly effective against mites. At this time, intensive research was being devoted to the organo-phosphorus insecticides both in Europe and in the United States. At least three chemical firms appear to have independently discovered the remarkable toxicity of these phosphorus compounds during the years 1952-53. Surprisingly enough, some of these substances were available on the market as pesticides. Nonetheless, they were soon withdrawn owing to their considerable toxicity also to mammals.

In the United States, the choice fell in 1958 on a substance known by its code name VX as suitable as a CW agent of persistent type. Full-scale production of VX started in April 1961 but its structure was not published until 1972.

The most important nerve agents included in modern CW arsenals are:

Tabun, O-ethyl dimethylamidophosphorylcyanide, with the American denomination GA. This nerve agent is the easiest to manufacture. Consequently, it is more likely that developing countries start their CW arsenal with this nerve agent whereas industrialized countries consider tabun to be out-of-date and of limited use.

Sarin, isopropyl methylphosphonofluoridate, with the American denomination GB, a volatile substance mainly taken up through inhalation.

Soman, pinacolyl methylphosphonofluoridate, with the American denomination GD, a moderately volatile substance which can be taken up by inhalation or skin contact.

Cyclohexyl methylphosphonofluoridate, with the American denomination GF, a substance with low volatility which is taken up through skin contact and inhalation of the substance either as a gas or aerosol.

O-ethyl S-diisopropylaminomethyl methylphosphonothiolate, better known under the American denomination VX, a persistent substance which can remain on material, equipment and terrain for long periods. Uptake is mainly through the skin but also through inhalation of the substance as a gas or aerosol.

 

The formulae for these nerve agents are:

Tabun, GA: (CH3)2N-P(=O)(-CN)(-OC2H5)

Sarin, GB: CH3-P(=O)(-F)(-OCH(CH33)2)

Soman, GD: CH3-P(=O)(-F)(-CH(CH3)C(CH3)3

GF: CH3-P(=O)(-F)(cyklo-C6H11)

VX: CH3-P(=O)(-SCH2CH2N[CH(CH3)2]2)(-OC2H5)

 

The same type of phosphorus compounds are used as, for example, insecticides. In the structure of insecticides P(=O) has generally been replaced by P(=S) and a less reactive group than (-F), (-CN) or (-SCH2CH2N[CH(CH3)2]2) is used.

All nerve agents in pure state are colorless liquids. Their volatility varies widely. The consistency of VX may be likened to an involatile oil and is therefore classified as belonging to the group of persistent CW agents. Its effect is mainly through direct contact with the skin. Sarin is at the opposite extreme, being an easily volatile liquid (comparable with, e.g., water), and mainly taken up through the respiratory organs. The volatility of soman, tabun and GF are between those of sarin and VX.

By addition of a thickener it is possible for, e.g., soman, to be transferred from the category of volatile CW agents to the persistent agents.

Sarin is very soluble in water whereas other nerve agents are more sparingly soluble. VX has the unexpected property of being soluble in cold water but sparingly soluble in warm water (>9.5C).

The most important chemical reactions of nerve agents take place directly at the phosphorus atom. The P-X bond is easily broken by nucleophilic reagents, such as water or hydroxyl ions (alkali). In aqueous solution at neutral pH the nerve agents decompose slowly, whereas the reaction is greatly accelerated following the addition of alkali. The result is a non-toxic phosphoric acid.

The pH-dependence on the rate of hydrolysis for sarin and VX at 25C expressed as half-life (hours). The curves have been calculated from laboratory experiments where pH was kept constant. On moist ground or snow, hydrolysis may be faster than shown in the figure as a result of auto-catalysis. The acidic hydrolysis products formed namely lead to a gradually lower pH and thus faster degradation.

The formation of the non-toxic phosphoric acid is also accelerated by rise in temperature or by a catalyst (e.g., hypochlorite ions from bleaching powder). This hydrolysis forms the basis of most decontamination procedures utilizing decomposition. In general, we may assume that an area exposed to G-agents decontaminates itself within a few days. However, V-agents may remain on the ground for several weeks because of their greater stability with respect to water and their much lower volatility. At pH-levels between 7 and 10 large quantities of VX are transformed into an extremely non-volatile product of hydrolysis which is incapable of penetrating skin. Admittedly, this is less toxic than VX but still implies a risk during decontamination.

The nucleophilic attack on the phosphorous atom (P) also forms the basis of different types of color reaction used in detecting nerve agents.

Most chemical ammunition can be described as unitary, which implies that it contains one active ready-to-use CW agent. Binary technology implies that the final stage in the synthesis of the nerve agent is moved from the factory into the warhead, which thus functions as a chemical reactor. Two initial substances which are stored in separate containers are mixed and allowed to react and form the nerve agent when the ammunition (bomb, projectile, grenade, etc.) is on its way towards the target.

Until the actual moment of use, the ammunition contains only relatively non-toxic initial substances. It is therefore considered to be safer to manufacture, store, transport and, finally, destroy. However, some critics question whether this practically untested type of new ammunition is reliable. The technique for mixing substances in bombs and rockets is complicated and requires space. The reaction has to be controlled (e.g., the temperature) and the process should preferably take place without solvents.

The principle for the use of binary weapons. Two canisters with the two liquid components are placed one after the other in the shell. When the shell is fired, forces of inertia will press the liquid contents in the front canister backwards and burst the wall separating the canisters. The rifling in the barrel gives the shell a spinning velocity of about 15,000 r.p.m. which contributes to the mixing.

In 1991 Iraq declared to the United Nations Special Commission (UNSCOM) a different binary munitions concept. According to this the munitions were stored containing one component. Shortly before use the munitions were opened and the second component was added. Thus the reaction began even before the munitions were launched.

Binary components for the three most common nerve agents (American code names are given in brackets) are the following:

Sarin (GB-2): methylphosphoryldifluoride (DF) + isopropanol. The isopropanol is included in a mixture (OPA) with isopropylamine which binds the hydrogen fluoride generated.

Soman (GD-2): methylphosphoryldifluorid (DF) + pinacolylalcohol.

VX-2: O-ethyl O-2-diisopropylaminoethyl methylphosphonite (QL) + sulphur.

A characteristic of nerve agents is that they are extremely toxic and that they have very rapid effect. The nerve agent, either as a gas, aerosol or liquid, enters the body through inhalation or through the skin. Poisoning may also occur through consumption of liquids or foods contaminated with nerve agents.

The route for entering the body is of importance for the period required for the nerve agent to start having effect. It also influences the symptoms developed and, to some extent, the sequence of the different symptoms. Generally, the poisoning works faster when the agent is absorbed through the respiratory system than via other routes. This is because the lungs contain numerous blood vessels and the inhaled nerve agent can therefore rapidly diffuse into the blood circulation and thus reach the target organs. Among these organs, the respiratory system is one of the most important. If a person is exposed to a high concentration of nerve agent, e.g., 200 mg sarin/m3 (see table) death may occur within a couple of minutes.

Poisoning takes longer when the nerve agent enters the body through the skin. Nerve agents are more or less fat-soluble and can penetrate the outer layers of the skin. However, it takes some time before the poison reaches the deeper blood vessels. Consequently, the first symptoms do not occur until 20-30 minutes after the initial exposure but subsequently the poisoning process may be rapid if the total dose of nerve agent is high. The toxic effect of nerve agents depends on them becoming bound to an enzyme, acetylcholinesterase, and thereby inhibit this vital enzyme's normal biological activity in the cholinergic nervous system.

When exposed to a low dose of nerve agent, causing minor poisoning, characteristic symptoms are increased production of saliva, a running nose and a feeling of pressure on the chest. The pupil of the eye becomes contracted (miosis) which impairs night-vision. The accommodation capacity of the eye is also reduced so that short-range vision deteriorates and the victim feels pain when he tries to focus on an object nearby. This is accompanied by headache. More unspecific symptoms are tiredness, slurred speech, hallucinations and nausea.

Exposure to a higher dose leads to a more dramatic development and symptoms are more pronounced. Bronchoconstriction and secretion of mucous in the respiratory system leads to difficulty in breathing and to coughing. Discomfort in the gastrointestinal tract may develop into cramp and vomiting. Involuntary discharge of urine and defecation may also form part of the picture. The discharge of saliva is powerful and the victim may experience running eyes and sweating. Symptoms from the skeletal muscles are very typical. If the poisoning is moderate, this may express itself as muscular weakness, local tremors or convulsions.

When exposed to a high dose of nerve agent, the muscular symptoms are more pronounced. The victim may suffer convulsions and lose consciousness. To some extent, the poisoning process may be so rapid that earlier mentioned symptoms may never have time to develop.

Muscular paralysis caused by nerve agents also affects the respiratory muscles. Nerve agents also affect the respiratory center of the central nervous system. The combination of these two effects is the direct cause of death. Consequently, death caused by nerve agents is a kind of death by suffocation.

The toxic effect depends on both the concentration of nerve agent in the air inhaled (C) and the time of exposure (t). In extremely high concentrations there is a simple relationship, C t, which gives a certain toxic effect. Inhalation of sarin vapor with a concentration of 100 mg/m3 for one minute gives the same result as inhalation of 50 mg/m3 for two minutes. However, at low concentrations this relationship does not apply since the human body is capable of some degree of detoxification. In order to obtain a corresponding effect, it is then necessary to have relatively longer periods of exposure. The values given in the table for toxicity of nerve agents apply to high concentrations.

Nerve agents have an extremely rapid effect. If medical methods of treatment are to serve any purpose, they must be introduced immediately. In many countries, the armed forces have access to an auto-injector containing antidotes to nerve agents. It is so simple to use that the soldier can easily give himself or another person an intramuscular injection.

One example is the Swedish auto-injector, which contains two active components: HI-6 (500 mg) and atropine (2 mg). HI-6 is an oxime which directly reacts with the cause of the injury, i.e., nerve agent-inhibited acetylcholinesterase. HI-6 functions as a reactivator which restores the enzyme to an operational condition. Oximes have a poor penetration capacity into the brain and thus mainly work in the peripheral nervous system.

The various nerve agents cause poisoning which are more or less easy to treat with oximes. From this standpoint, VX and sarin are the easiest to treat and all oximes used increase the chances of surviving poisoning with these nerve agents. Obidoxime is the most effective against tabun poisoning but also HI-6 has a positive effect. Soman causes the most difficulty treated poisoning and can only be treated with HI-6.

Soman poisoning is complicated by the inhibited enzyme going through an "ageing" process. Following the ageing the enzyme cannot be reactivated by any oxime. It is possible that HI-6 has some further positive antidote effect in addition to its reactivating ability.

The other active component in the auto-injector is atropine. Atropine is the classical antidote in cases of poisoning by organo-phosphorus compounds. It is a medication which relieves the symptoms but does not attack the cause of the injury. Atropine becomes bound to the receptors for acetylcholine, which are present in the cholinergic synapse (see figure). When acetylcholine is bound, the signal is transmitted but if atropine has become bound to the receptor, then no such transmission takes place. Atropine thus gives protection against the excess of acetylcholine which results from inhibition of acetylcholinesterase. Atropine has effects only within certain parts of the cholinergic nervous system.

There are two types of acetylcholine receptors, the nicotinic which are found, e.g., in the skeletal muscles, and the muscarinic, which are found in, e.g., smooth muscles, glands and the central nervous system. Atropine blocks the muscarinic receptors. Atropine and oxime may therefore be considered to complement each other and the two antidotes also have a synergetic effect, i.e., they boost each other.

An additional auto-injector can be given to victims of nerve agents if their situation does not improve within ten minutes. Subsequently, the victim should be treated by qualified medical staff who should initially inject additional atropine and an anti-convulsant drug, diazepam. In cases of severe poisoning by nerve agents, large doses of atropine (grams) may be required. The level of operational acetylcholinesterase is gradually restored by the body's own production but this process requires at least two weeks. During this period, and possibly also later, the victim may require medical care not only for mental disorders such as difficulty in sleeping, amnesia, difficulties in concentrating, and anxiety, but also for muscular weakness. Mental problems may also occur after long exposure to extremely low concentrations to nerve agents.

There are also medical antidotes which can be taken preventively. These antidotes are taken as tablets and used when ordered in connection with maximum C-preparedness. One of the tablets contains a carbamate, pyridostigmine, as active ingredient. Pyridostigmine inhibits acetylcholinesterase and protects the enzyme against inhibitory effects of nerve agents. The dose is low and leads to about 25 per cent inhibition. The pyridostigmine-inhibited enzyme is continuously released to active state and thereby can reasonably effectively maintain the transfer of nerve impulses despite injury caused by nerve agents. The effect is restricted to the peripheral cholinergic nervous system since the substance does not enter the brain.

Pyridostigmine does not cause any side effects since there is a large excess of enzyme in the cholinergic synapse. In actual fact, 1-2 per cent of functional enzyme is sufficient to have a functioning synapse. This explains why carbamate pretreatment has such good effect.

Pretreatment with carbamate should be combined with oxime therapy (the auto-injector) after the poisoning in order to provide maximum effect. This combination reduces the toxic effects of all nerve agents.

A diazepam tablet is also generally given as a pretreatment, primarily affecting the central nervous system. Diazepam strengthens the effect of other nerve agent antidotes. There will be better prospects of survival and less injury. Diazepam also provides protection against permanent brain damage which may result from heavy exposure to nerve agents.

Pretreatment has best effect if a warning system is available and operative, since the tablets need about 30 min. to have effect after being swallowed. The best protective effect is achieved after about two hours, which is followed by decreasing efficacy. If the situation so requires, treatment can be repeated at eight-hourly intervals for some days. The tablets should not be taken once nerve agent injury has occurred. Admittedly, diazepam has a positive effect but pyridostigmine at that stage will aggravate the injury.