ANNALS OF THE NEW YORK ACADEMY OF SCIENCES
Issue: Countermeasures Against Chemical Threats

Desire D. Tshala-Katumbay,1,2,3 Nadege N. Ngombe,4 Daniel Okitundu,2 Larry David,5
Shawn K. Westaway,1 Michael J. Boivin,6 Ngoyi D. Mumba,7,8 and Jean-Pierre Banea3

1Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon. 2Department of
Neurology, University of Kinshasa, Kinshasa, Congo. 3National Nutrition Program, Ministry of Health, and Kinshasa School of
Public Health, Kinshasa, Congo. 4School of Pharmacy, University of Kinshasa, Kinshasa, Congo. 5Department of
Biochemistry and Proteomic Share Resource, Oregon Health & Science University, Portland, Oregon. 6Department of
Psychiatry and Neurology/Ophthalmology, Michigan State University, East Lansing, Michigan. 7Department of Tropical
Medicine, University of Kinshasa, Kinshasa, Congo. 8Institut National de Recherches Biom´edicales (INRB), Kinshasa, Congo
Address for correspondence: Desire D. Tshala-Katumbay, M.D., M.P.H., Ph.D., Department of Neurology, School of Medicine,
Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR 97239. tshalad@ohsu.edu

Threats by fundamentalist leaders to use chemical weapons have resulted in renewed interest in cyanide toxicity.
Relevant insights may be gained from studies on cyanide mass intoxication in populations relying on cyanogenic cassava as the main source of food. In these populations, sublethal concentrations (up to 80 mol/l) of cyanide in the blood are commonplace and lead to signs of acute toxicity. Long-term toxicity signs include a distinct and irreversible spastic paralysis, known as konzo, and cognition deficits,mainly in sequential processing (visual–spatial analysis) domains. Toxic culprits include cyanide (mitochondrial toxicant), thiocyanate (AMPA-receptor chaotropic cyanide metabolite), cyanate (protein-carbamoylating cyanide metabolite), and 2-iminothiazolidine-4-carboxylic acid (seizure inducer). Factors of susceptibility include younger age, female gender, protein-deficient diet, and, possibly, the gut functional metagenome. The existence of uniquely exposed and neurologically affected populations offers invaluable research opportunities to develop a comprehensive understanding of cyanide toxicity and test or validate point-of-care diagnostic tools and treatment options to be included in preparedness kits in response to cyanide-related threats.

Keywords: cassava; cyanide; paralysis; neurocognition; warfare

Ann. N.Y. Acad. Sci. ISSN 0077-8923

doi: 10.1111/nyas.13159
Ann. N.Y. Acad. Sci. xxxx (2016) 1–8 C 2016 New York Academy of Sciences.