Comprehensive identification of VX-adducted plasma proteins using high-resolution mass spectrometry

VX is one of the chemical warfare agents that attack victims' nervous systems and ultimately lead to their death. Upon VX exposure, circulating proteins in the bloodstream can be modified with VX that may produce diagnostic VX adducts. Thus, these adducts would be key evidence for the forensic investigation against chemical warfare or terrorism. In this study, we discovered a list of potential blood protein biomarkers for VX exposure. To do so, we employed high-resolution mass spectrometry-based proteomics and identified 18 VX-adducted proteins with 32 adduct sites from VX-treated human plasma samples. Furthermore, we examined these targets using a data-independent acquisition method and obtained eight practically detectable biomarkers. Our results may serve as a valuable resource for verifying nerve agent exposure under chemical attack.