Cell Death Mechanisms in Sulfur Mustard Injury: Basis for Therapeutics Development

Sulfur mustard (SM, bis-(2-chloroethyl) sulfide), commonly called mustard gas, is a vesicant chemical warfare agent and a potential terrorism agent. SM is relatively easy to make and to deploy, which makes this chemical most likely to be used. SM exposure causes debilitating skin blisters (vesication) and injury to the eyes and the respiratory tract. Therefore, developing an effective medical countermeasure to protect against the dermal, ocular and airway injuries due to this dreaded chemical agent is an urgent priority of the US Army. SM pathophysiology is consistent with epithelial cell damage, particularly basal cell apoptosis. SM-induced apoptosis may occur via multiple pathways dependent on one or more of the following: (a) abnormal Ca2plus homeostasis, (b) disturbed cellular bioenergetics, and (c) Fas (death receptor) response. Apoptosis pathways are characterized by the involvement of the pathway-specific caspases (cysteine aspartase). We determined caspase activity by assay of fluorogenic caspase type-specific peptide substrate hydrolysis. We studied caspase processing, i.e., proteolytic conversion of procaspase to active caspase by immunoblot analyses utilizing caspase type-specific antibodies. Our results in cell culture models of both human epidermal keratinocytes and human airway epithelial cells indicated that SM activates (a) caspase-9, an indicator of the Ca2plus/CaM-mediated mitochondrial pathway, (b) caspase-8, a marker for the Fas-mediated pathway, and (c) caspase-3, the executioner caspase involved in both pathways. A peptide caspase inhibitor, specific for caspase-3 (AC-DEVD-CHO), added to cells prior to SM decreased apoptosis. These observations suggest apoptosis as a mechanism of SM toxicity and caspase inhibitors as prospective medical countermeasures.(author)