An article published Online First exposes the facts of the poisoning of Ukrainian President Victor Yushchenko in 2004. It is the work of Professor Jean Saurat, from the Swiss Centre for Human Applied Toxicology, and the University Hospital, in Geneva, Switzerland, and his collaborators. It establishes that there is a need for routine analytical techniques to test for metabolites of TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin) which is a type of dioxin and the poison that was used. This will help to provide proper treatment.

Victor Yushchenko was poisoned with TCDD in late December of 2004. There was a high concentration of it in his blood which was more than 50,000 times that of the general population. The medical team identified TCDD and its metabolites. For three years they monitored levels using different chemical techniques. They analyzed samples of blood, fatty tissue, feces, skin, urine, and sweat.

They found that during the three years, 60 percent of the TCDD that was eliminated was in its original form and had not been metabolized. Two metabolites of TCDD were identified in the feces, blood, and urine. The feces contained the highest concentration of TCDD metabolites. They appeared as the main route of elimination. Overall, the various routes of elimination of TCDD and its metabolites accounted for 98 percent of the loss of the toxin from the body. In Mr Yushchenko's case, the time taken for the amount of TCDD in the body to halve or half-life, was 15 months.

The study shows seventeen different types of dioxin were analyzed in Mr Yushchenko. Only TCDD levels were higher than those in the general population. This indicates a severe intoxication of pure TCDD. The authors say: "The highest levels of metabolites were detected in faeces, whereas only traces were found in the blood serum. The metabolite to TCDD ratio was 50-fold lower in the blood serum than in faeces. These findings indicate that these metabolites were unlikely to have been ingested with TCDD, and that TCDD is slowly metabolised, probably by the liver and skin." They remark that high concentrations of TCDD might be needed to activate enzymes in the skin responsible for its metabolism. This might explain why the half-life of TCDD varies with level of exposure.

The authors write in conclusion: "Although not done previously, levels of TCDD and its metabolites in tissue, faeces, and body fluids should be monitored in a patient with severe dioxin poisoning because they are indicators of what the follow-up period and treatment strategy should be. The poisoning of Victor Yushchenko with TCDD has changed from a story reported in the news to a medical model. This model of TCDD poisoning indicates that methods need to be designed for the routine analysis of TCDD metabolites in human beings, and the main aims of research into TCDD poisoning in the metabolomic era should be the analysis of factors that are involved in the metabolism of this toxin."

Professor Saurat comments: "This is the first medical report in a peer-reviewed journal on the extraordinary case of Victor Yushchenko. The team was confronted in late December 2004 with a patient severely affected with what was likely to be dioxin poisoning. To cope with such a severe and painful disease, with no established specific treatment, we designed a strategy based on an aggressive monitoring of the poison, nature, distribution, and elimination - the subject of this report. We also designed a search for molecular medicine-based solutions to treat the various organs involved - likely to be the subject of future reports."

In an associated note, Professor Martin McKee, from the London School of Hygiene and Tropical Medicine, UK, remarks: "So who poisoned Victor Yushchenko? The obvious suspects are those members of the security service present at the dinner just before he fell ill, yet during the protests in December they and their colleagues gave covert support to Yushchenko, pre-empting a planned crack-down by Interior Ministry troops. Unfortunately for those seeking an answer, there were many people, within Ukraine and outside it, who had a motive. We might never know and, as Sorg and colleagues note, had Yushchenko died at the time, as he might easily have done, we would probably never even have known that he had been poisoned."

"2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) poisoning in Victor Yushchenko: identification and measurement of TCDD metabolites"
O Sorg, M Zennegg, P Schmid, R Fedosyuk, R Valikhnovskyi, O Gaide, V Kniazevych, J-H Saurat
DOI: 10.1016/S0140-6736(09)60912-0
The Lancet

Written by Stephanie Brunner (B.A.)