Sarin poisoning Tokyo subway attacks

Fidder and coworkers (50) developed a versatile procedure that identifies phosphylated butyrylcholi-nesterase. Adducted butyrylcholinesterase is isolated from plasma by affinity chromatography (procainamide column), digested with pepsin, and a nonapep-tide containing the phosphylated active-site serine residue detected using LC/ESI/MS/MS (quadrupole-TOF hybrid instrument). A C18 150 x 0.3-mm LC column was used, eluted with a gradient of water-acetonitrile-0.2 % formic acid. The method was applied successfully to casualties of sarin poisoning from the Tokyo subway attack (see Chapter 17). 

Murata, K., S. Araki, K. Yokoyama, T. Okumura, S. Ishimatsu, N. Takasu, and R.F. White. 1997. Asymptomatic sequelae to acute sarin poisoning in the central and autonomic nervous system 6 months after the Tokyo subway attack. J. Neurol. 244 601-606. 

Yokoyama, K., Ogura, Y., Kishimoto, M., Hinoshita, F., Hara, S., Yamada, A., Mimura, N., Seki, A., Sakai, O. (1995). Blood purification for severe sarin poisoning after the Tokyo subway attack. J. Am. Med. Assoc. 274 379. 

Yokoyama K, Yamada A, MimuraN. Clinical profiles of patients with sarin poisoning after the Tokyo subway attack. Am J Med 1996 May 100(5) 586. 

Yokoyama K, Ogura Y, Kishimoto M et al. (1995). Blood purification for severe sarin poisoning after the Tokyo subway attack. JAMA, 274, 379. 

The Matsumoto sarin attack occurred on June 27, 1994, one year before the Tokyo subway sarin attack, and although the group responsible for the Matsumoto attack was not known at the time of the Tokyo subway attack, emergency doctors in Japan knew that the diagnosis and treatment of sarin poisoning should follow that of accidental organophosphorus poisoning. 

Discovered in the late 1930s in Germany as improved poisonous insecticides, organophosphorus ChEIs were developed as chemical warfare agents (e.g. sarin, soman, and tabun) and were more recently employed in the 1995 terrorist attack in the Tokyo subway system [5]. 

Organophosphate and carbamate cholinesterase inhibitors (see Chapter 7) are widely used to kill insects and other pests. Most cases of serious organophosphate or carbamate poisoning result from intentional ingestion by a suicidal person, but poisoning has also occurred at work (pesticide application or packaging) or, rarely, as a result of food contamination or terrorist attack (eg, release of the chemical warfare nerve agent sarin in the Tokyo subway system in 1995). 

The only reported incidents of nerve agent poisoning, where biomedical samples have been obtained, are those resulting from terrorist dissemination of sarin in Matsumoto (1994) and the Tokyo subway (1995), plus an assassination using VX, also in Japan (60). In contrast to the CW incidents involving sulfur mustard, many of the biomedical samples associated with these terrorist attacks were collected within hours of the event. 

Yamada, Y., Takatori, T., Nagao, M., Iwase, H., Kurada, N., Yanagida, J., Shinozuka, T. (2001). Expression of paraoxonase isoform did not confer protection from acute sarin poisoning in the Tokyo subway terrorist attack. Int. J. Leg. Med. 115 82-4. Yamasaki, Y., Sakamoto, K., Watade, H., Kajimoto, Y., Hori, M. (1997). The Argi92 isoform of paraoxonase with low sarinhydrolyzing activity is dominant in the Japanese. Hum. Genet. 101 67-8. 

On 20 March 1995, a terrorist attack occurred in the Tokyo subway system during rush hour. Sarin was placed in five subway cars on three separate lines in plastic bags opened so that the agent, which is liquid under temperate conditions, could evaporate. Over 5000 casualties sought medical attention of whom 984 were moderately poisoned and 54 were severely poisoned 12 died. However, a substantial number of those... 

Ieki R (1997). Overview of the Tokyo Subway sarin attack. In Organophosphorus Poisoning (Sarin Poisoning) (R Ieki, ed.), pp. 1-3. Tokyo, Japan Sindan to Chiryo sha. 

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