This is thought to be a major contributor to SM pathogenesis. The intermediate has 2 chemically active regions (see Figure 1) that, when bound to DNA, cause cross-linking and eventual cell death.
SM is an alkylating agent which, upon absorption, binds readily to a range of biologically important molecules, including proteins and nucleic acids. 10,11 Mechanism of Action and Physical Properties 9 In addition to intentional exposures, accidental or occupational exposures can occur when an individual comes into contact with an improperly discarded munition or container. 7,8 However, the presence of stockpiled chemical agents and associated munitions in unstable regions of the world raises the potential for terrorist acquisition of these weapons. 5,6 Under the aegis of the Cooperative Threat Reduction program, the United States and Russia are in the process of destroying the stockpiles of chemical weapons they accumulated during the Cold War. Use of SM and other chemical warfare agents during armed conflict is proscribed by the 1925 Geneva Protocol and the Chemical Weapons Convention (CWC). SM was most recently deployed during the Iran-Iraq War of the 1980s. SM was a technological innovation that produced increased morbidity, eventually earning it the moniker "King of the Battle Gases." 1 While not exceptionally lethal (mortality due to SM exposure was ~2-3%), SM caused large numbers of causalities that required medical care and support. Use as a Chemical Warfare Agentīefore blister agents were introduced in 1917, most of the chemical weapons in use were choking agents-chlorine and phosgene gas-which necessitated the use of gas masks for respiratory protection. Other examples of blister agents include Lewisite 2 and nitrogen mustard, 3 which has also been used as a chemotherapeutic agent. 1 The prototypical and most common blister agent is sulfur mustard (SM) (bis-(2-chloroethyl) sulfide), commonly referred to as mustard gas. Blister agents, also known as vesicants, are a class of chemical weapon first used in combat during World War I.
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