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Collier CA, Salikhova A, Sabir S, Foncerrada S, Raghavan SA. Crisis in the gut: navigating gastrointestinal challenges in Gulf War Illness with bioengineering. Mil Med Res 2024; 11:45. [PMID: 38978144 PMCID: PMC11229309 DOI: 10.1186/s40779-024-00547-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 06/26/2024] [Indexed: 07/10/2024] Open
Abstract
Gulf War Illness (GWI) is characterized by a wide range of symptoms that manifests largely as gastrointestinal symptoms. Among these gastrointestinal symptoms, motility disorders are highly prevalent, presenting as chronic constipation, stomach pain, indigestion, diarrhea, and other conditions that severely impact the quality of life of GWI veterans. However, despite a high prevalence of gastrointestinal impairments among these veterans, most research attention has focused on neurological disturbances. This perspective provides a comprehensive overview of current in vivo research advancements elucidating the underlying mechanisms contributing to gastrointestinal disorders in GWI. Generally, these in vivo and in vitro models propose that neuroinflammation alters gut motility and drives the gastrointestinal symptoms reported in GWI. Additionally, this perspective highlights the potential and challenges of in vitro bioengineering models, which could be a crucial contributor to understanding and treating the pathology of gastrointestinal related-GWI.
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Affiliation(s)
- Claudia A Collier
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - Aelita Salikhova
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - Sufiyan Sabir
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - Steven Foncerrada
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - Shreya A Raghavan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843, USA.
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Fedele B, McKenzie D, Williams G, Giles R, Olver J. A comparison of agreement between actigraphy and polysomnography for assessing sleep during posttraumatic amnesia. J Clin Sleep Med 2022; 18:2605-2616. [PMID: 35912692 PMCID: PMC9622995 DOI: 10.5664/jcsm.10174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep disturbance often emerges in the early recovery phase following a moderate to severe traumatic brain injury, known as posttraumatic amnesia. Actigraphy is commonly employed to assess sleep, as it is assumed that patients in posttraumatic amnesia (who display confusion, restlessness, and agitation) would better tolerate this measure over gold-standard polysomnography (PSG). This study evaluated the agreement between PSG and actigraphy for determining (sleep/wake time, sleep efficiency, sleep latency, and awakenings) in patients experiencing posttraumatic amnesia. It also compared the epoch-by-epoch sensitivity, specificity, and accuracy between the Actigraph device's 4 wake threshold settings (low, medium, high, and automatic) to PSG. METHODS The sample consisted of 24 inpatients recruited from a traumatic brain injury inpatient rehabilitation unit. Ambulatory PSG was recorded overnight at bedside and a Philips Actiwatch was secured to each patient's wrist for the same period. RESULTS There were poor correlations between PSG and actigraphy for all parameters (Lin's concordance correlation coefficient = < 0.80). The low threshold displayed the highest correlation with PSG for wake and sleep time, albeit still low. Actigraphy displayed low specificity (ranging from 17.1% to 36.6%). There appears to be a greater disparity between actigraphy and PSG for patients with increased wake time. CONCLUSIONS Actigraphy, while convenient, demonstrated poorer performance in determining sleep-wake parameters in patients with significantly disturbed sleep. Ambulatory PSG can provide a clearer understanding of the extent of sleep disturbances in these patients with reduced mobility during early rehabilitation. Study findings can help design future protocols of sleep assessment during posttraumatic amnesia and optimize treatment. CITATION Fedele B, McKenzie D, Williams G, Giles R, Olver J. A comparison of agreement between actigraphy and polysomnography for assessing sleep during posttraumatic amnesia. J Clin Sleep Med. 2022;18(11):2605-2616.
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Affiliation(s)
- Bianca Fedele
- Department of Rehabilitation, Epworth HealthCare, Melbourne, Australia
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Dean McKenzie
- Research Development and Governance Unit, Epworth HealthCare, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gavin Williams
- Department of Rehabilitation, Epworth HealthCare, Melbourne, Australia
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Robert Giles
- Sleep Unit, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
| | - John Olver
- Department of Rehabilitation, Epworth HealthCare, Melbourne, Australia
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
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The association of pre-war medical conditions to Gulf War Illness. Life Sci 2021; 282:119795. [PMID: 34233148 DOI: 10.1016/j.lfs.2021.119795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/17/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022]
Abstract
AIMS Gulf War Illness (GWI) remains a significant health concern for many veterans. The relation of pre-war health conditions and symptoms to GWI could aid in developing a more accurate case definition of GWI. The objective of this study was to investigate pre-war predictors of GWI in a population-based sample of Gulf War veterans using two definitions of GWI. MAIN METHODS Data come from the 1995-1997 National Health Survey of Persian Gulf War Era Veterans, a survey of a representative sample of deployed and non-deployed US veterans. Using two definitions of GWI (CDC/Kansas and a newly developed 3-domain definition), we conducted a series of multivariable logistic regression analyses to assess the associations of demographic, lifestyle factors, and pre-war medical conditions and symptoms to subsequent GWI. KEY FINDINGS All pre-war symptom predictor domains were significantly and positively associated with GWI using a new 3-domain definition with aORs for individual domains ranging from 2.17 (95% CI = 1.99-2.38) for dermatologic conditions to 3.06 (95% CI = 2.78-3.37) for neurological conditions. All symptom predictor domains were associated with significantly increased likelihood of GWI using the CDC/Kansas definition, with aORs ranging from 2.54 (95% CI = 2.31-2.81) for inflammatory conditions to 3.22 (95% CI = 2.94-3.55) for neurological conditions. These estimates were attenuated but remained significant after inclusion of all significant symptom predictor domains. SIGNIFICANCE Results from this study suggest that demographic/lifestyle factors and pre-war medical conditions are strong predictors of GWI. Additional research is needed to confirm these findings, and to clarify the unique characteristics of this common, but still poorly understood illness.
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Radhakrishnan K, Hauser ER, Polimanti R, Helmer DA, Provenzale D, McNeil RB, Maffucci A, Quaden R, Zhao H, Whitbourne SB, Harrington KM, Vahey J, Gelernter J, Levey DF, Huang GD, Gaziano JM, Concato J, Aslan M. Genomics of Gulf War Illness in U.S. Veterans Who Served during the 1990-1991 Persian Gulf War: Methods and Rationale for Veterans Affairs Cooperative Study #2006. Brain Sci 2021; 11:brainsci11070845. [PMID: 34202057 PMCID: PMC8301942 DOI: 10.3390/brainsci11070845] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Approximately 697,000 members of the U.S. Armed Forces were deployed to the Persian Gulf in support of the 1990–1991 Persian Gulf War (GW). Subsequently, many deployed and some non-deployed veterans developed a chronic multi-symptom illness, now named Gulf War Illness (GWI). This manuscript outlines the methods and rationale for studying the genomics of GWI within the Million Veteran Program (MVP), a VA-based national research program that has linked medical records, surveys, and genomic data, enabling genome-wide association studies (GWASs). Methods: MVP participants who served in the military during the GW era were contacted by mail and invited to participate in the GWI study. A structured health questionnaire, based on a previously tested instrument, was also included in the mailing. Data on deployment locations and exposures, symptoms associated with GWI, clinical diagnoses, personal habits, and health care utilization were collected. Self-reported data will be augmented with chart reviews and structured international classification of disease codes, to classify participants by GWI case status. We will develop a phenotyping algorithm, based on two commonly used case definitions, to determine GWI status, and then conduct a nested case-control GWAS. Genetic variants associated with GWI will be investigated, and gene–gene and gene–environment interactions studied. The genetic overlap of GWI with, and causative mechanisms linking this illness to, other health conditions and the effects of genomic regulatory mechanisms on GWI risk will also be explored. Conclusions: The proposed initial GWAS described in this report will investigate the genomic underpinnings of GWI with a large sample size and state-of-the-art genomic analyses and phenotyping. The data generated will provide a rich and expansive foundation on which to build additional analyses.
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Affiliation(s)
- Krishnan Radhakrishnan
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA;
- College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Elizabeth R. Hauser
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27705, USA
| | - Renato Polimanti
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
| | - Drew A. Helmer
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence:
| | - Dawn Provenzale
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27705, USA
| | - Rebecca B. McNeil
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
| | - Alysia Maffucci
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
| | - Rachel Quaden
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
| | - Hongyu Zhao
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520, USA
| | - Stacey B. Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Kelly M. Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Jacqueline Vahey
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Computational Biology and Bioinformatics Program, Duke University, Durham, NC 27705, USA
| | - Joel Gelernter
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
| | - Daniel F. Levey
- Division of Human Genetics, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06511, USA;
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, CT 06516, USA
| | - Grant D. Huang
- Cooperative Studies Program, VA Office of Research and Development, Washington, DC 20420, USA;
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - John Concato
- School of Medicine, Yale University, New Haven, CT 06511, USA;
- Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Mihaela Aslan
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
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Ribeiro ACR, Deshpande LS. A review of pre-clinical models for Gulf War Illness. Pharmacol Ther 2021; 228:107936. [PMID: 34171340 DOI: 10.1016/j.pharmthera.2021.107936] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023]
Abstract
Gulf War Illness (GWI) is a chronic multisymptomatic disorder that afflicts over 1/3rd of the 1991 GW veterans. It spans multiple bodily systems and presents itself as a syndrome exhibiting diverse symptoms including fatigue, depression, mood, and memory and concentration deficits, musculoskeletal pain and gastrointestinal distress in GW veterans. The etiology of GWI is complex and many factors, including chemical, physiological, and environmental stressors present in the GW arena, have been implicated for its development. It has been over 30 years since the end of the GW but, GWI has been persistent in suffering veterans who are also dealing with paucity of effective treatments. The multifactorial aspect of GWI along with genetic heterogeneity and lack of available data surrounding war-time exposures have proved to be challenging in developing pre-clinical models of GWI. Despite this, over a dozen GWI animal models exist in the literature. In this article, following a brief discussion of GW history, GWI definitions, and probable causes for its pathogenesis, we will expand upon various experimental models used in GWI laboratory research. These animal models will be discussed in the context of their attempts at mimicking GW-related exposures with regards to the variations in chemical combinations, doses, and frequency of exposures. We will discuss their advantages and limitations in modeling GWI followed by a discussion of behavioral and molecular findings in these models. The mechanistic data obtained from these preclinical studies have offered multiple molecular pathways including chronic inflammation, mitochondrial dysfunction, oxidative stress, lipid disturbances, calcium homeostatic alterations, changes in gut microbiota, and epigenetic modifications, amongst others for explaining GWI development and its persistence. Finally, these findings have also informed us on novel druggable targets in GWI. While, it has been difficult to conceive a single pre-clinical model that could express all the GWI signs and exhibit biological complexity reflective of the clinical presentation in GWI, animal models have been critical for identifying molecular underpinnings of GWI and evaluating treatment strategies for GWI.
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Affiliation(s)
- Ana C R Ribeiro
- Departments of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Laxmikant S Deshpande
- Departments of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA; Departments of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
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Obesity Worsens Gulf War Illness Symptom Persistence Pathology by Linking Altered Gut Microbiome Species to Long-Term Gastrointestinal, Hepatic, and Neuronal Inflammation in a Mouse Model. Nutrients 2020; 12:nu12092764. [PMID: 32927823 PMCID: PMC7551189 DOI: 10.3390/nu12092764] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/30/2020] [Accepted: 09/08/2020] [Indexed: 12/18/2022] Open
Abstract
Persistence of Gulf War illness (GWI) pathology among deployed veterans is a clinical challenge even after almost three decades. Recent studies show a higher prevalence of obesity and metabolic disturbances among Gulf War veterans primarily due to the existence of post-traumatic stress disorder (PTSD), chronic fatigue, sedentary lifestyle, and consumption of a high-carbohydrate/high-fat diet. We test the hypothesis that obesity from a Western-style diet alters host gut microbial species and worsens gastrointestinal and neuroinflammatory symptom persistence. We used a 5 month Western diet feeding in mice that received prior Gulf War (GW) chemical exposure to mimic the home phase obese phenotype of the deployed GW veterans. The host microbial profile in the Western diet-fed GWI mice showed a significant decrease in butyrogenic and immune health-restoring bacteria. The altered microbiome was associated with increased levels of IL6 in the serum, Claudin-2, IL6, and IL1β in the distal intestine with concurrent inflammatory lesions in the liver and hyperinsulinemia. Microbial dysbiosis was also associated with frontal cortex levels of increased IL6 and IL1β, activated microglia, decreased levels of brain derived neurotrophic factor (BDNF), and higher accumulation of phosphorylated Tau, an indicator of neuroinflammation-led increased risk of cognitive deficiencies. Mechanistically, serum from Western diet-fed mice with GWI significantly increased microglial activation in transformed microglial cells, increased tyrosyl radicals, and secreted IL6. Collectively, the results suggest that an existing obese phenotype in GWI worsens persistent gastrointestinal and neuronal inflammation, which may contribute to poor outcomes in restoring cognitive function and resolving fatigue, leading to the deterioration of quality of life.
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Zundel CG, Heeren T, Grasso CM, Spiro A, Proctor SP, Sullivan K, Krengel M. Changes in Health Status in the Ft. Devens Gulf War Veterans Cohort: 1997-2017. Neurosci Insights 2020; 15:2633105520952675. [PMID: 32914090 PMCID: PMC7444112 DOI: 10.1177/2633105520952675] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022] Open
Abstract
Gulf War veterans (GWVs) were exposed to numerous neurotoxicants during deployment. Upon returning home, many reported a multitude of symptoms including fatigue, pain, gastrointestinal and respiratory issues, and neurological, cognitive, and mood complaints, collectively termed "Gulf War Illness (GWI)." Now, nearly 30 years post-war, many GWVs continue to suffer from these symptoms, in addition to health concerns associated with normal aging. While most research on GWVs has been cross-sectional, it is important to evaluate the progression and onset of new GWI symptoms longitudinally. The current study investigated the health of GWVs 25+ years after the war by resurveying the Ft. Devens Cohort and comparing their current health to their health reported 15 to 20 years earlier. The sample consists of 317 GWVs (~54 years old at the latest survey, 38 women) who responded to both surveys (1997-1998 and 2013-2017). Multivariable regression analyses were used to assess changes in GWI symptomatology and prevalence of medical conditions. The rates of 12 of 25 health symptoms increased significantly from the prior 1997-1998 survey. Anxiety, numbness in extremities, depressed mood, and joint pain had the greatest increase in endorsement. The rates of 7 of 16 medical conditions increased significantly from the prior 1997-1998 survey. High blood pressure, diabetes, and cancer had the greatest increase in prevalence. In summary, this study demonstrates that both symptoms and physician-diagnosed medical conditions associated with GW deployment/exposure increased in prevalence. For GWVs, focus by providers on the treatment of cognitive and mental health issues as well as cardiovascular and cerebrovascular risk factors is warranted. Targeting symptom alleviation would help improve the quality of life in these veterans until treatments addressing the entire illness become available.
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Affiliation(s)
- Clara G Zundel
- Research Service, VA Boston Healthcare System, Boston, MA, USA
- Behavioral Neuroscience Program, Boston University School of Medicine, Boston, MA, USA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | | | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Susan P Proctor
- Research Service, VA Boston Healthcare System, Boston, MA, USA
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Maxine Krengel
- Research Service, VA Boston Healthcare System, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
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Zhang Y, Avery T, Vakhtin AA, Mathersul DC, Tranvinh E, Wintermark M, Massaband P, Ashford JW, Bayley PJ, Furst AJ. Brainstem atrophy in Gulf War Illness. Neurotoxicology 2020; 78:71-79. [PMID: 32081703 DOI: 10.1016/j.neuro.2020.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/30/2020] [Accepted: 02/16/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Gulf War Illness (GWI) is a condition that affects about 30 % of veterans who served in the 1990-91 Persian Gulf War. Given its broad symptomatic manifestation, including chronic pain, fatigue, neurological, gastrointestinal, respiratory, and skin problems, it is of interest to examine whether GWI is associated with changes in the brain. Existing neuroimaging studies, however, have been limited by small sample sizes, inconsistent GWI diagnosis criteria, and potential comorbidity confounds. OBJECTIVES Using a large cohort of US veterans with GWI, we assessed regional brain volumes for their associations with GWI, and quantified the relationships between any regional volumetric changes and GWI symptoms. METHODS Structural magnetic resonance imaging (MRI) scans from 111 veterans with GWI (Age = 49 ± 6, 88 % Male) and 59 healthy controls (age = 51 ± 9, 78 % male) were collected at the California War Related Illness and Injury Study Center (WRIISC-CA) and from a multicenter study of the Parkinson's Progression Marker Initiative (PPMI), respectively. Individual MRI volumes were segmented and parcellated using FreeSurfer. Regional volumes of 19 subcortical, 68 cortical, and 3 brainstem structures were evaluated in the GWI cohort relative to healthy controls. The relationships between regional volumes and GWI symptoms were also assessed. RESULTS We found significant subcortical atrophy, but no cortical differences, in the GWI group relative to controls, with the largest effect detected in the brainstem, followed by the ventral diencephalon and the thalamus. In a subsample of 58 veterans with GWI who completed the Chronic Fatigue Scale (CFS) inventory of Centers for Disease Control and Prevention (CDC), smaller brainstem volumes were significantly correlated with increased severities of fatigue and depressive symptoms. CONCLUSION The findings suggest that brainstem volume may be selectively affected by GWI, and that the resulting atrophy could in turn mediate or moderate GWI-related symptoms such as fatigue and depression. Consequently, the brain stem should be carefully considered in future research focusing on GWI pathology.
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Affiliation(s)
- Yu Zhang
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, USA.
| | - Timothy Avery
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, USA; Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Andrei A Vakhtin
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, USA; Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Danielle C Mathersul
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, USA; Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Eric Tranvinh
- Neuroradiology, Stanford University School of Medicine, USA
| | - Max Wintermark
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, USA; Neuroradiology, Stanford University School of Medicine, USA
| | - Payam Massaband
- Radiology, VA Palo Alto Health Care System, USA; Radiology, Stanford University School of Medicine, USA
| | - J Wesson Ashford
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, USA; Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Peter J Bayley
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, USA; Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Ansgar J Furst
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, USA; Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA; Neurology and Neurological Sciences, Stanford University, USA; Polytrauma System of Care (PSC), VA Palo Alto Health Care System, USA
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Prevalence of Chronic Multisymptom Illness/Gulf War Illness Over Time Among Millennium Cohort Participants, 2001 to 2016. J Occup Environ Med 2020; 62:4-10. [DOI: 10.1097/jom.0000000000001716] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Maule AL, Janulewicz PA, Sullivan KA, Krengel MH, Yee MK, McClean M, White RF. Meta-analysis of self-reported health symptoms in 1990-1991 Gulf War and Gulf War-era veterans. BMJ Open 2018; 8:e016086. [PMID: 29440208 PMCID: PMC5829661 DOI: 10.1136/bmjopen-2017-016086] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Across diverse groups of Gulf War (GW) veterans, reports of musculoskeletal pain, cognitive dysfunction, unexplained fatigue, chronic diarrhoea, rashes and respiratory problems are common. GW illness is a condition resulting from GW service in veterans who report a combination of these symptoms. This study integrated the GW literature using meta-analytical methods to characterise the most frequently reported symptoms occurring among veterans who deployed to the 1990-1991 GW and to better understand the magnitude of ill health among GW-deployed veterans compared with non-deployed GW-era veterans. DESIGN Meta-analysis. METHODS Literature databases were searched for peer-reviewed studies published from January 1990 to May 2017 reporting health symptom frequencies in GW-deployed veterans and GW-era control veterans. Self-reported health symptom data were extracted from 21 published studies. A binomial-normal meta-analytical model was used to determine pooled prevalence of individual symptoms in GW-deployed veterans and GW-era control veterans and to calculate combined ORs of health symptoms comparing GW-deployed veterans and GW-era control veterans. RESULTS GW-deployed veterans had higher odds of reporting all 56 analysed symptoms compared with GW-era controls. Odds of reporting irritability (OR 3.21, 95% CI 2.28 to 4.52), feeling detached (OR 3.59, 95% CI 1.83 to 7.03), muscle weakness (OR 3.19, 95% CI 2.73 to 3.74), diarrhoea (OR 3.24, 95% CI 2.51 to 4.17) and rash (OR 3.18, 95% CI 2.47 to 4.09) were more than three times higher among GW-deployed veterans compared with GW-era controls. CONCLUSIONS The higher odds of reporting mood-cognition, fatigue, musculoskeletal, gastrointestinal and dermatological symptoms among GW-deployed veterans compared with GW-era controls indicates these symptoms are important when assessing GW veteran health status.
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Affiliation(s)
- Alexis L Maule
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Patricia A Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kimberly A Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Maxine H Krengel
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Research Service, VA Boston Health Care System, Boston, Massachusetts, USA
| | - Megan K Yee
- Research Service, VA Boston Health Care System, Boston, Massachusetts, USA
| | - Michael McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Roberta F White
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
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Ikin JF, Kelsall HL, McKenzie DP, Gwini SM, Forbes AB, Glass DC, Mc Farlane AC, Clarke D, Wright B, Del Monaco A, Sim MR. Cohort Profile: The Australian Gulf War Veterans' Health Study cohort. Int J Epidemiol 2017; 46:31. [PMID: 27380794 DOI: 10.1093/ije/dyw025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jillian F Ikin
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | - Helen L Kelsall
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | - Dean P McKenzie
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | - Stella M Gwini
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | - Andrew B Forbes
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | - Deborah C Glass
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | | | - David Clarke
- Monash University, School of Clinical Sciences at Monash Health: Psychiatry, Clayton, VIC, Australia
| | - Breanna Wright
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | - Anthony Del Monaco
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | - Malcolm R Sim
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
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Gwini SM, Forbes AB, Sim MR, Kelsall HL. Comparability of health service use by veterans with multisymptom illness and those with chronic diseases. Int J Qual Health Care 2017; 29:90-97. [DOI: 10.1093/intqhc/mzw140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 01/04/2017] [Indexed: 11/12/2022] Open
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13
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New Onset of Chronic Diseases and Changes in Lifestyle Risk Factors Among Gulf War Veterans. J Occup Environ Med 2016; 58:770-7. [DOI: 10.1097/jom.0000000000000799] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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