Neurotoxicity of organophosphate nerve agents

Abstract Organophosphate nerve agents of the G-series (tabun, GA; sarin, GB; cyclosarin, GF, and soman, GD) and V-series (VX, RVX, Novichok, etc.) were developed prior to, during and after World War II. These are all toxic ester derivatives of phosphonic acid containing a cyanide (GA), fluoride (GD or GF), or sulfur (VX) substituent and are commonly termed “nerve” agents as a consequence of their anticholinesterase properties as well as their effects on both the central nervous system (CNS) and the peripheral nervous system (PNS). These nerve agents produce toxicity primarily in the CNS and skeletal muscles by cholinergic and noncholinergic mechanisms involving various neurotransmitters, receptors, enzymes, and other molecules. Various biomarkers of exposure, effects and susceptibility to nerve agents have been identified. Treatment of OP poisoning rests with specific antidotes (atropine sulfate and oximes). Since no single oxime is effective against all nerve agents, a specific oxime can be indicated only against a particular nerve agent(s). Various decontaminating products are available, which are found to be very effective in removing or minimizing nerve agents' residue, thereby avoiding further exposure to victims and emergency responders.