WWII discovery would counter terrorist use of chemical warfare agent, say IUSM researchers

By Meg Mettler

Researchers studying British anti-lewisite (BAL) provide an overview of its historical uses, development and clinical implications today of the heavy metal chelating agent, detailed in the March issue of the Annals of Emergency Medicine. BAL is a medical therapy to remove metal poisonings from the body.

"BAL was secretly developed more than six decades ago by biochemists at Oxford University and is still stocked in many hospital pharmacies and used occasionally by emergency physicians," said article co-author Joel Vilensky, professor of anatomy at the Fort Wayne Center for Medical Education.

Kent Redman, associate professor of biochemistry and molecular biology, co-authored the study with Vilensky.

"The possible threat of terrorism gives this World War II discovery renewed significance among emergency physicians because it is a treatment for lewisite, a chemical warfare agent that produces immediate pain and blistering on contact and can cause blindness if it gets into the eyes," Vilensky noted. "Lewisite is a threat because it is easy for any country to manufacture with simple pesticide-manufacturing technology." Iraq is believed to have used Lewisite in its earlier war with Iran.

Developed for use during World War I, lewisite is an arsenic-based liquid chemical compound that, similar to mustard, is easily vaporized into a poison gas and is capable of penetrating ordinary clothing and rubber. When inhaled in high concentrations, it may be fatal in as few as 10 minutes.

Fear of German use of Lewisite led British scientists at the beginning of World War II to develop an antidote, 2,3-dimercaptopropanol, which came to be known as BAL. The treatment is capable of removing heavy metals such as arsenic, copper, mercury and lead from the human body.

After the war, BAL was put to clinical use by becoming the first successful treatment for Wilson’s disease, a genetic disorder that causes the body to retain copper. If not treated, Wilson's disease can cause severe brain damage, liver failure, and death. Today, BAL is one recommended treatment for children with very high blood lead levels in conjunction with other agents, the IUSM researchers noted in their article.

"Little did those Oxford biochemists working on the antidote to a greatly feared chemical warfare agent realize that BAL would still be needed 60 years later for heavy metal poisoning," Redman noted. "In the process, BAL helped change clinical medicine and perhaps altered the course of World War II by reducing the fear of Lewisite’s use on the battlefield."

The Annals of Emergency Medicine is the journal of the American College of Emergency Physicians, an organization of 23,000 members. The IUSM is the second largest medical school in the United States with more than 1,200 students. It has nine medical centers in Indiana for first- and second-year students, including the Fort Wayne Center for Medical Education. All medical students complete their final two years at the school’s main campus in Indianapolis.

http://histo.ipfw.edu/