Lewisite: its chemistry, toxicology, and biological effects.

Lewisite is an organic arsenical war gas which is a vesicant with attendant toxicities due to its ability to combine with thiol groups which are essential for activity of a variety of enzymes. Although Lewisite has been designated as a "suspected carcinogen," the indictment is not supported by the available scientific evidence. Indeed, the unwarranted conclusion is based on one specific case history of a former German soldier whose lower right leg was exposed to liquid Lewisite in 1940 with subsequent development of intraepidermal squamous cell carcinoma, and the examination of death certificates of former workers at a Japanese factory that manufactured a variety of war gases including mustard gas, hydrocyanic acid, chloracetophenome, phosgene, diphenylcyanarsine and Lewisite. It is difficult to comprehend why Lewisite was selected out of this group of toxic chemicals as one of those responsible for respiratory cancer in these workers. It would appear to be a difficult task, indeed, to disengage a specific worker from one of the other of several gases at the workplace and assign a specific gas-induced death. The evidence that organic arsenicals are carcinogenic is weak. Although the weight of evidence is such that inorganic arsenical derivatives are considered weak mutagens, the evidence that organic arsenicals are mutagenic is poor. Recent examination of the mutagenic potential of Lewisite using the Ames test has shown that Lewisite is not mutagenic under these circumstances. While oral administration of arsenical compounds, whether inorganic or organic, does not induce teratogenicity except at very high dose levels which are associated with some degree of maternal toxicity, parenteral administration has been associated with teratogenicity but information of maternal toxicity has not always been available. Indeed, maternal toxicity should be considered as an important diagnostic tool in assessing whether a chemical is teratogenic. The significance of parenteral routes for inducing teratogenicity is also problematical. Recently, Lewisite has been shown not to be teratogenic in either rats or rabbits. A monograph on arsenic, succinctly states that "no human epidemiological investigations have been conducted on the carcinogenicity of organic arsenic compounds" (WHO 1981). Indeed, the lack of such evidence eminating from epidemiological sources or from animal studies is resounding. At present, there is no evidence that Lewisite is either carcinogenic, mutagenic or teratogenic. A review of toxicological studies of other organic arsenicals has produced no evidence that they might be carcinogenic, mutagenic or teratogenic.