No promising antidote 25 years after the Tokyo subway sarin attack: A review.

On the battlefields of Syria, many innocent civilians have been killed or injured by sarin poisoning. In Malaysia in February 2017, a North Korean man was assassinated with VX at Kuala Lumpur International Airport. In the face of such threats, a more effective antidote against organophosphonate acetylcholinesterase (AChE) inhibitors is needed, one that can freely penetrate into the central nervous system (CNS) through the blood-brain barrier (BBB). In the 1995 Tokyo subway sarin attack, which produced more than 6,000 victims, 2-pyridinealdoxime methiodide was the most commonly used antidote in hospitals, but it was unable to prevent CNS damage and no other oximes have been approved for use in Japan. Ultimately, 12 people died, and many victims had severe neurological injuries or sequelae. Although more than 25 years have passed since the incident, progress has been slow in the development of a new antidote that can penetrate the BBB, restore AChE activity in the CNS, and definitely prevent brain injury. From the perspectives of countering terrorism and protecting innocent people from nerve agent attacks, the search for nerve agent antidotes should be accelerated with the goals of improving both survival and quality of life. This review gives an overview of a series of our studies on the development of a new antidote since the Tokyo subway sarin attack and emphasizes that there is unfortunately still no promising antidote for saving the CNS in Japan.

[Analysis of Countermeasures against Chemical Terrorism].

As a countermeasure against terrorism involving highly toxic chemical warfare agents, the rapid identification of the causative toxic substances is extremely important. This symposium review describes analytical methods the author's group has developed for detecting nerve gases after either high level or low level exposure. As a method for assessing human exposure to high levels of nerve gases, a technology that detects nerve gas hydrolysis products, i.e., strong anion exchange extraction-tert-butyldimethylsilyl derivatization-selectable one-dimensional or two-dimensional GC-MS, is explained. As a method for assessing human exposure to low levels of nerve gases, two technologies that detect adducts of nerve gas with blood cholinesterase, i.e., adduct purification-enzymatic digestion-LC/MS and fluoride-mediated regeneration-solid phase extraction-large volume introduction GC-MS, are explained.

Multichannel Open Tubular Enzyme Reactor Online Coupled with Mass Spectrometry for Detecting Ricin.

For counterterrorism purposes, a selective nano liquid chromatography-mass spectrometry (nanoLC-MS) platform was developed for detecting the highly lethal protein ricin from castor bean extract. Manual sample preparation steps were omitted by implementing a trypsin/Lys-C enzyme-immobilized multichannel reactor (MCR) consisting of 126 channels (8 µm inner diameter in all channels) that performed online digestion of proteins (5 min reaction time, instead of 4-16 h in previous in-solution methods). Reduction and alkylation steps were not required. The MCR allowed identification of ricin by signature peptides in all targeted mode injections performed, with a complete absence of carry-over in blank injections. The MCRs (interior volume ≈ 1 µL) have very low backpressure, allowing for trivial online coupling with commercial nanoLC-MS systems. The open tubular nature of the MCRs allowed for repeatable within/between-reactor preparation and performance.

Collecting Quality Infrared Spectra from Microscopic Samples of Suspicious Powders in a Sealed Cell.

The infrared (IR) microspectroscopical analysis of samples within a sealed-cell containing barium fluoride is a critical need when identifying toxic agents or suspicious powders of unidentified composition. The dispersive nature of barium fluoride is well understood and experimental conditions can be easily adjusted during reflection-absorption measurements to account for differences in focus between the visible and IR regions of the spectrum. In most instances, the ability to collect a viable spectrum is possible when using the sealed cell regardless of whether visible or IR focus is optimized. However, when IR focus is optimized, it is possible to collect useful data from even smaller samples. This is important when a minimal sample is available for analysis or the desire to minimize risk of sample exposure is important. While the use of barium fluoride introduces dispersion effects that are unavoidable, it is possible to adjust instrument settings when collecting IR spectra in the reflection-absorption mode to compensate for dispersion and minimize impact on the quality of the sample spectrum.

The NIH Countermeasures Against Chemical Threats Program: overview and special challenges.

Intentional exposures to toxic chemicals can stem from terrorist attacks, such as the release of sarin in the Tokyo subway system in 1995, as well as from toxic industrial accidents that are much more common. Developing effective medical interventions is a critical component of the overall strategy to overcome the challenges of chemical emergencies. These challenges include the rapid and lethal mode of action of many toxic chemicals that require equally fast-acting therapies, the large number of chemicals that are considered threats, and the diverse demographics and vulnerabilities of those who may be affected. In addition, there may be long-term deleterious effects in survivors of a chemical exposure. Several U.S. federal agencies are invested in efforts to improve preparedness and response capabilities during and after chemical emergencies. For example, the National Institutes of Health (NIH) Countermeasures Against Chemical Threats (CounterACT) Program supports investigators who are developing therapeutics to reduce mortality and morbidity from chemical exposures. The program awards grants to individual laboratories and includes contract resource facilities and interagency agreements with Department of Defense laboratories. The range of high-quality research within the NIH CounterACT Program network is discussed.

Chemical Sniffing Instrumentation for Security Applications.

Border control for homeland security faces major challenges worldwide due to chemical threats from national and/or international terrorism as well as organized crime. A wide range of technologies and systems with threat detection and monitoring capabilities has emerged to identify the chemical footprint associated with these illegal activities. This review paper investigates artificial sniffing technologies used as chemical sensors for point-of-use chemical analysis, especially during border security applications. This article presents an overview of (a) the existing available technologies reported in the scientific literature for threat screening, (b) commercially available, portable (hand-held and stand-off) chemical detection systems, and (c) their underlying functional and operational principles. Emphasis is given to technologies that have been developed for in-field security operations, but laboratory developed techniques are also summarized as emerging technologies. The chemical analytes of interest in this review are (a) volatile organic compounds (VOCs) associated with security applications (e.g., illegal, hazardous, and terrorist events), (b) chemical "signatures" associated with human presence, and

Federal Funding for Health Security in FY2016.

This article assesses US government funding in 5 domains critical to strengthening health security: biodefense programs, radiological and nuclear programs, chemical programs, pandemic influenza and emerging infectious disease programs, and multiple-hazard and preparedness programs. This year's article also highlights the emergency funding appropriated in FY2015 to enable the international and domestic response to the Ebola outbreak in West Africa.

Integration of stable isotope and trace contaminant concentration for enhanced forensic acetone discrimination.

We analyzed 21 neat acetone samples from 15 different suppliers to demonstrate the utility of a coupled stable isotope and trace contaminant strategy for distinguishing forensically-relevant samples. By combining these two pieces of orthogonal data we could discriminate all of the acetones that were produced by the 15 different suppliers. Using stable isotope ratios alone, we were able to distinguish 8 acetone samples, while the remaining 13 fell into four clusters with highly similar signatures. Adding trace chemical contaminant information enhanced discrimination to 13 individual acetones with three residual clusters. The acetones within each cluster shared a common manufacturer and might, therefore, not be expected to be resolved. The data presented here demonstrates the power of combining orthogonal data sets to enhance sample fingerprinting and highlights the role disparate data could play in future forensic investigations.

Countermeasures against chemical terrorism in Japan.

Japan has experienced numerous incidents of chemical disasters and terrorist attacks. Here we review the history of changes in countermeasures against such incidents. Since 2004, the Civil Protection Law, more formally known as the "Law Concerning the Measures for Protection of the People in Armed Attack Situations etc" was enacted to fully prepare the nation for chemical terrorism. According to this law, the Japanese government must carry out Civil Protection Exercises on an annual basis to gauge response. Problem areas that remain are chosen and addressed one by one until they are judged to be resolved in subsequent exercises.

Estabilidad de la hidroxocobalamina en agua para inyección como antídoto contra cianuros. Elaborado de Farmacia Militar / Stability of hydroxocobalamin in water for injection as cyanide antidote

Introducción: Los cianuros han sido utilizados como agentes de guerra química, y hoy se consideran una amenaza terrorista real. Son también la principal causa de muerte en la intoxicación por inhalación de humo de incendios en espacios cerrados. El éxito en el tratamiento de la intoxicación depende de la rapidez con la que se administren los antídotos, y con la que estos fijen el ión cianuro. La hidroxocobalamina parece ser un antídoto más apropiado que el nitrito sódico para el tratamiento empírico de la intoxicación por inhalación de humo y otras supuestas intoxicaciones por cianuros en el ámbito extra-hospitalario. Se ha estudiado la estabilidad de la hidroxocobalamina en agua para inyección a la dosis como antídoto contra cianuros y en cuatro tipos de envases diferentes. Material y Métodos: La solución inyectable se preparó por vía aséptica sin esterilización terminal, y según las especificaciones de la monografía oficial de la farmacopea de los Estados Unidos. Los cuatro tipos de envase primario utilizados fueron: ampollas de vidrio, bolsas y viales de polipropileno semirígido, y viales de plástico rígido fabricados en un copolímero olefínico complejo (COC). La determinación del contenido en hidroxocobalamina de las soluciones bajo estudio en función del tiempo, conservadas a 4º C, 25º C y 37º C, se llevó a cabo mediante cromatografía líquido-líquido de alta resolución y espectroscopia de absorción molecular. Se han utilizado otras técnicas analíticas complementarias para caracterizar la solución. Resultados: A 4º C el contenido en hidroxocobalamina de las muestras estudiadas permaneció invariable (media 99,81% ± 0,69%; p = 0,95; n = 7; t = 472 días). Resultados muy similares se obtuvieron para las muestras a 25º C (media 100,85% ± 1,79%; p = 0,95; n = 6; t = 353 días). A 37º C se produce una ligera disminución en el contenido en hidroxocobalamina de la solución envasada en ampollas (media = 92,87% ± 6,08%; p = 0,95; n = 4; t = 472 días). La solución envasada en bolsas de polipropileno sufrió un efecto de concentración por pérdida de agua a través del envase. En los dos tipos de viales estudiados el contenido en hidroxocobalamina de la solución se mantuvo en el rango de aceptación especificado en la farmacopea: 102,09% ± 0,47% a 4º C y 102,35% ± 0,60% a 37º C para los viales COC; 101,64% ± 2,16% a 4ºC y 101,19 ± 1,75% a 37º C, para los viales de polipropileno (p = 0,95). El autoclavado de la solución a 115ºC durante 30 minutos redujo el porcentaje de hidroxocobalamina a valores fuera del rango de conformidad (95-115%). Conclusiones: La solución inyectable de cloruro de hidroxocobalamina en agua para inyección a la concentración indicada como antídoto N.B.Q. contra cianuros, lista para administrar, es estable a temperaturas inferiores a 25º C, al menos durante un periodo de 15 meses. Por su inercia química y propiedades físicas, los viales de polipropileno constituyen el envase más adecuado para esta solución, que no puede ser autoclavada, y debe ser preparada por vía aséptica sin esterilización terminal (AU)

Background: Cyanide has been used as an agent for chemical warfare, and today it is also a credible terrorism threat agent. Cyanide poisoning is the first cause of death in victims of smoke inhalation from enclosed space fires. Successful treatment for acute cyanide poisoning depends upon rapid antidotes administration, and fixation of the cyanide ion by antidotes. Hydroxocobalamin seems to be a more appropriate antidote than sodium nitrite for empiric treatment of smoke inhalation and other suspected cyanide intoxication victims in the out-of-hospital setting. Stability of hydroxocobalamin in water for injection at cyanide antidote dose has been studied throughout the time and in four types of containers. Methods: The parenteral solution was prepared by aseptic procedures without terminal sterilization, and according to the United States Pharmacopoeia (USP) specifications. Four types of primary containers were used: glass ampoules, semi-rigid polypropylene bags and vials, and rigid plastic vials made of COC. Hydroxocobalamin content and other parameters from the studied solutions, conserved at 4º C, 25º C and 37º C was carried out using molecular spectrometry, liquid-liquid chromatography and others assays. Results: A 4º C the hydroxocobalamin content in the studied samples was invariable (mean 99,81% ± 0,69%; p = 0,95; n = 7; t = 472 days). Very similar results were obtained for samples at 25º C (mean 100,85% ± 1,79%; p = 0,95; n = 6; t = 353 days). At 37º C there was an small decrease in the ampoules hydroxocobalamin content (mean = 92,87% ± 6,08%; p = 0,95; n = 4; t = 472 days). The solution in polypropylene bags suffered a concentration due to water permeation through the container. Both types of vials had hydroxocobalamin contents in the USP specifications (95-115%). Steam sterilization at 115º C for 30 minutes turned hydroxocobalamin content out of specifications. Conclusion: The parenteral solution of hydroxocobalamin in water for injection at the dose of NBC cyanide antidote, ready to use, is stable at temperature below 25ºC, at least for 15 months. Because of the chemical inertia and physical properties, the polypropylene vials are the more appropriated containers for this parenteral solution, which has to be prepared by aseptic procedures without terminal sterilization (AU)

Countering health threats by chemicals with a potential terrorist background--creating a rapid alert system for Europe.

BACKGROUND: The acronym "ASHT" stands for "Alerting System and Development of a Health Surveillance System for the Deliberate Release of Chemicals by Terrorists". Imagine this scenario: 15 patients with respiratory symptoms following a concert in Rome and 12 patients coughing after lunch in a cafeteria in the Czech Republic; are these events related? Today these events would never be connected as there is no mechanism to allow EU Member States to share this type of information effectively. The main objective of the ASHT project was to improve data sharing between EU Member States. In part, this was achieved by an internet accessible EU-wide alerting system with the aim to detect the deliberate (i.e. criminal or terrorist) or accidental release of chemicals. Nevertheless more information from police, fire brigades and health professionals is needed. METHODS: Description of the design, development, functionality and testing of the relational database system called "RAS-CHEM" (Rapid Alert System for Chemicals). RESULTS: A database structure appropriate for the description of "events" with sophisticated retrieval functions was developed. For evaluation purposes 37 events were entered into the database including 29 scenarios and 8 historical mass intoxications. The alert level was "background information" for 21 events, "suspected mass intoxication" for 6 cases and "confirmed mass intoxication" for 10 events. CONCLUSION: The RAS-CHEM database works and will be integrated into the Health Emergency Operations Facility (HEOF) with other European Rapid Alert Systems. Poisons centres receive a large number of enquiries and could be important sentinels in this field of toxicovigilance.

Development and characterization of an electrostatic particle sampling system for the selective collection of trace explosives.

Detection of trace explosives residues at people and cargo control points has become a key security challenge. A severe obstacle is that all commercial and military high explosives have low to extremely low vapor pressures which make them very hard to detect. With detectable vapors not being present, explosives detection needs to proceed through a series of sequential steps including particle collection, thermal vapor conversion and vapor detection. The present paper describes the design and test of an electrostatic particle precipitator which allows particle residue to be collected from the environment, the collected particle residue to be separated into high- and low-electron affinity fractions and the high-electron-affinity one to be concentrated onto a small-area collector surface for later vaporization. The selectivity of this particle collection and separation process is demonstrated and a full-chain demonstration of a DNT detection experiment is presented (DNT: di-nitro-toluene).

Preparing for chemical terrorism: a study of the stability of expired pralidoxime (2-PAM).

OBJECTIVES: Oximes such as pralidoxime (2-PAM) are essential antidotes for life-threatening organophosphate poisoning. Unfortunately, oximes are expensive, have limited use, and have short shelf lives. As such, maintaining large stockpiles in preparation for terrorist activity is not always possible. We have demonstrated that atropine is stable well beyond its labeled shelf life and that recently expired 2-PAM was clinically efficacious in a series of poisoned patients. Because 2-PAM is often dosed empirically, clinical improvement does not guarantee pharmacological stability. We therefore chose to analyze the chemical stability of expired 2-PAM. METHODS: Samples of lyophylized 2-PAM were maintained according to the manufacturer's recommendations for 20 years beyond the published shelf life. We studied 2-PAM contained in a MARK I autoinjector that was stored properly for 3 years beyond its expiration date. An Agilent LC/MSD 1100 with diode-array detector and an Agilent Sorbax SB-C-18, 4.6 × 150-mm, 5-µm column were used with the following solvent systems: water with 0.01% trifluoroacetic acid and methanol with 0.01% trifluoroacetic acid. Fresh reagent grade 2-PAM was used as a standard. Results were repeated for consistency. RESULTS: Lyophylized 2-PAM was a white powder that was clear and colorless in solution. Liquid chromatography was identical to the standard and resulted in 2 isolated peaks with identical mass spectra, suggesting that they are stereoisomers. The autoinjector discharged a clear, yellowish solution. In addition to the 2 peaks identified for lyophylized 2-PAM, a small third peak was identified with a mass spectra corresponding to the reported N -methyl pyridinium carboxaldehyde degradation product. CONCLUSIONS: When properly stored, lyophylized 2-PAM appears to be chemically stable well beyond its expiration date. Although the relative amount of degradation product found in solubilized (autoinjector) 2-PAM was small, it is unclear whether this may be toxic and therefore is of concern. Further studies performed with lots of drug stored under varied conditions would be required to fully determine the stability of expired 2-PAM.

Chlorine truck attack consequences and mitigation.

We develop and apply an integrated modeling system to estimate fatalities from intentional release of 17 tons of chlorine from a tank truck in a generic urban area. A public response model specifies locations and actions of the populace. A chemical source term model predicts initial characteristics of the chlorine vapor and aerosol cloud. An atmospheric dispersion model predicts cloud spreading and movement. A building air exchange model simulates movement of chlorine from outdoors into buildings at each location. A dose-response model translates chlorine exposures into predicted fatalities. Important parameters outside defender control include wind speed, atmospheric stability class, amount of chlorine released, and dose-response model parameters. Without fast and effective defense response, with 2.5 m/sec wind and stability class F, we estimate approximately 4,000 (half within ∼10 minutes) to 30,000 fatalities (half within ∼20 minutes), depending on dose-response model. Although we assume 7% of the population was outdoors, they represent 60-90% of fatalities. Changing weather conditions result in approximately 50-90% lower total fatalities. Measures such as sheltering in place, evacuation, and use of security barriers and cryogenic storage can reduce fatalities, sometimes by 50% or more, depending on response speed and other factors.

A method to characterise site, urban and regional ambient background radiation.

Control dosemeters are routinely provided to customers to monitor the background radiation so that it can be subtracted from the gross response of the dosemeter to arrive at the occupational dose. Landauer, the largest dosimetry processor in the world with subsidiaries in Australia, Brazil, China, France, Japan, Mexico and the UK, has clients in approximately 130 countries. The Glenwood facility processes over 1.1 million controls per year. This network of clients around the world provides a unique ability to monitor the world's ambient background radiation. Control data can be mined to provide useful historical information regarding ambient background rates and provide a historical baseline for geographical areas. Historical baseline can be used to provide site or region-specific background subtraction values, document the variation in ambient background radiation around a client's site or provide a baseline for measuring the efficiency of clean-up efforts in urban areas after a dirty bomb detonation.

A porous metal-organic replica of α-PbO2 for capture of nerve agent surrogate.

A novel metal-organic replica of α-PbO(2) exhibits high capacity for capture of nerve agent surrogate.

Antidotes and treatments for chemical warfare/terrorism agents: an evidence-based review.

This article reviews the evidence supporting the efficacy of antidotes used or recommended for the potential chemical warfare agents of most concern. Chemical warfare agents considered include cyanide, vesicants, pulmonary irritants such as chlorine and phosgene, and nerve agents. The strength of evidence for most antidotes is weak, highlighting the need for additional research in this area.

Lack of strategic insight: the "dirty bomb" effort.

Multiple countries including the United States and France are investing heavily in countermeasures to the threat of a "dirty bomb." All of the machinery simply involves a variation on a Geiger counter that picks up excess photon irradiation. Classically, a "dirty bomb" is defined as a dangerous radioactive material mixed in a variety of ways with high explosive, so when detonated, radioactive material is dispersed. Solid radioactive material such as Cesium or Cobalt sends off very penetrating ('hard') photons from which one cannot simply be protected by sheet lead or a heavy door. For official occasions with dignitaries of State, such a bomb could prove a modest distraction, but simple radiation physics suggests such a bomb would be limited in the damage it could cause, would largely be a mess to be cleaned up by an appropriately trained crew, would involve a very confined area, and thoroughly fails to comprehend the mentality of al-Queda 'central' that wishes to follow 9/11 with an equal or greater show of terrorist force. The author would argue this sort of mind-think occurs when you have too few people in the hard sciences in your intelligence sections.