Acetylcholinesterase (AChE) inhibition

The primary mechanism of toxicity for all organophosphate nerve agents, including sarin, VX, and Novichok compounds. The agent phosphorylates the serine residue at the AChE active site, preventing hydrolysis of acetylcholine at nerve synapses. Red blood cell AChE activity assay is the primary biomarker for exposure; adducted albumin and BChE detected by LC-MS/MS provides confirmatory forensic evidence.