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Krengel M, Keating D, Chao L, Dugas J, Koo B, Heeren T, Quinn E, Toomey R, Steele L, Klimas N, Samonte F, Abdullah L, Sullivan K. Characterizing 1991 Gulf War women veterans from the Boston Biorepository and Integrative Network for Gulf War Illness: Demographics, exposures, neuroimaging and cognitive outcomes. Clin Neuropsychol 2024; 38:1454-1467. [PMID: 38692856 DOI: 10.1080/13854046.2024.2344263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/13/2024] [Indexed: 05/03/2024]
Abstract
Objective: Gulf War Illness (GWI) is a debilitating multisymptom condition that affects nearly a third of 1990-91 Gulf War (GW) veterans. Symptoms include pain, fatigue, gastrointestinal issues, and cognitive decrements. Our work has shown that GWI rates and potential causes for symptoms vary between men and women veterans. Studies have documented neuropsychological and neuroimaging findings mostly in men or combined sex datasets. Data are lacking for women veterans due to lack of power and repositories of women veteran samples. Methods: We characterized GW women veterans in terms of demographics, exposures, neuropsychological and neuroimaging outcomes from the newly collated Boston, Biorepository and Integrative Network (BBRAIN) for GWI. Results: BBRAIN women veterans are highly educated with an average age of 54 years. 81% met GWI criteria, 25% met criteria for current PTSD, 78% were white, and 81% served in the Army. Exposure to combined acetylcholinesterase inhibitors (AChEi) including skin pesticides, fogs/sprays and/or pyridostigmine bromide (PB) anti-nerve gas pill exposure resulted in slower processing speed on attentional tasks and a trend for executive impairment compared with non-exposed women. Brain imaging outcomes showed lower gray matter volumes and smaller caudate in exposed women. Conclusions: Although subtle and limited findings were present in this group of women veterans, it suggests that continued follow-up of GW women veterans is warranted. Future research should continue to evaluate differences between men and women in GW veteran samples. The BBRAIN women sub-repository is recruiting and these data are available to the research community for studies of women veterans.
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Affiliation(s)
- Maxine Krengel
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Dylan Keating
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Linda Chao
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA, USA
| | - Julianne Dugas
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - BangBon Koo
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Emily Quinn
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Rosemary Toomey
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, Boston, MA, USA
| | - Lea Steele
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine Neuropsychiatry Division, Houston, TX, USA
| | - Nancy Klimas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
- Geriatric Research Education and Clinical Center, Miami VA Medical Center, Miami, FL, USA
| | - Francis Samonte
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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Kovarik Z, Moshitzky G, Maček Hrvat N, Soreq H. Recent advances in cholinergic mechanisms as reactions to toxicity, stress, and neuroimmune insults. J Neurochem 2024; 168:355-369. [PMID: 37429600 DOI: 10.1111/jnc.15887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 07/12/2023]
Abstract
This review presents recent studies of the chemical and molecular regulators of acetylcholine (ACh) signaling and the complexity of the small molecule and RNA regulators of those mechanisms that control cholinergic functioning in health and disease. The underlying structural, neurochemical, and transcriptomic concepts, including basic and translational research and clinical studies, shed new light on how these processes inter-change under acute states, age, sex, and COVID-19 infection; all of which modulate ACh-mediated processes and inflammation in women and men and under diverse stresses. The aspect of organophosphorus (OP) compound toxicity is discussed based on the view that despite numerous studies, acetylcholinesterase (AChE) is still a vulnerable target in OP poisoning because of a lack of efficient treatment and the limitations of oxime-assisted reactivation of inhibited AChE. The over-arching purpose of this review is thus to discuss mechanisms of cholinergic signaling dysfunction caused by OP pesticides, OP nerve agents, and anti-cholinergic medications; and to highlight new therapeutic strategies to combat both the acute and chronic effects of these chemicals on the cholinergic and neuroimmune systems. Furthermore, OP toxicity was examined in view of cholinesterase inhibition and beyond in order to highlight improved small molecules and RNA therapeutic strategies and assess their predicted pitfalls to reverse the acute toxicity and long-term deleterious effects of OPs.
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Affiliation(s)
- Zrinka Kovarik
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Gilli Moshitzky
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
- The Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Hermona Soreq
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
- The Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
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Baas PW, Sullivan KA, Terry AV, Case K, Yates PL, Sun X, Raghupathi R, Huber BR, Qiang L. Is Gulf War Illness a prolonged early phase tauopathy? Cytoskeleton (Hoboken) 2024; 81:41-46. [PMID: 37702426 PMCID: PMC10841075 DOI: 10.1002/cm.21786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
The work of the Gulf War Illness (GWI) Consortium and that of basic and clinical researchers across the USA have resulted in a better understanding in recent years of the pathological basis of GWI, as well as of the mechanisms underlying the disorder. Among the most concerning symptoms suffered by veterans with GWI are cognitive decrements including those related to memory functioning. These decrements are not severe enough to meet dementia criteria, but there is significant concern that the mild cognitive impairment of these veterans will progress to dementia as they become older. Recent studies on GWI using human brain organoids as well as a rat model suggest that one potential cause of the cognitive problems may be elevated levels of tau in the brain, and this is supported by high levels of tau autoantibodies in the blood of veterans with GWI. There is urgency in finding treatments and preventive strategies for these veterans before they progress to dementia, with added value in doing so because their current status may represent an early phase of tauopathy common to many neurodegenerative diseases.
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Affiliation(s)
- Peter W. Baas
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Kimberly A. Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Alvin V. Terry
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Kendra Case
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Philip L. Yates
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Xiaohuan Sun
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Ramesh Raghupathi
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Bertrand R. Huber
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA; VA Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts, USA; Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
| | - Liang Qiang
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
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Materer N, Apblett A, Kadossov E, Shaikh S, Teicheira M. Application of Nanoconfinement Technology for Highly Effective Monitoring of Chemical Exposure During Military Service. Mil Med 2023; 188:363-368. [PMID: 37948272 DOI: 10.1093/milmed/usad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/25/2023] [Accepted: 04/29/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION There is myriad of volatile compounds to which military personnel are exposed that can potentially have negative effects on their health. Military service occurs in a broad array of environments so it is difficult to predict the hazardous compounds to which the personnel might be exposed. XploSafe is developing passive diffusive samplers to facilitate the sampling and quantification of a wide range of chemical vapor exposures that personnel may be exposed to in the workplace. MATERIALS AND METHODS Passive diffusive samplers were constructed by filling porous Teflon tubes with OSU-6, a nanoporous silica sorbent, to produce sampler tokens. Three of these tokens were placed within a badge to fabricate passive samplers. Absorption experiments were performed to determine linear exposure regimes, sampling rates, and limits of quantification for 11 compounds, representing 8 chemical classes. RESULTS The sampling rates were determined for 11 compounds representing 8 chemical classes. The measured linear ranges for the studied compounds are sufficiently large to allow effective sampling for 8 hours or longer. Accurate dosimetry is possible even with exposure times of days or weeks. The samplers were able to detect the presence of five airborne compounds in a paint booth of a military contractor located in Bristow, Oklahoma, and determine their average exposure concentrations. CONCLUSIONS OSU-6 based sampler badges were able to detect the presence and quantify the average exposures of five airborne compounds in a paint booth of a military contractor located in Bristow, Oklahoma. Experiments show that these samplers can adsorb and quantify a broad array of different volatile organic compounds whose high sampling rates coupled with high capacity provide both sensitivity and the ability to quantify over a large range of exposures. This technology can meet the requirements for personal samplers to create Individual Longitudinal Exposure Record for each military person.
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Affiliation(s)
- Nicholas Materer
- XploSafe, Stillwater, OK 74074, USA
- Department of Chemistry, Oklahoma State University, Stillwater, OK 74078, USA
| | - Allen Apblett
- XploSafe, Stillwater, OK 74074, USA
- Department of Chemistry, Oklahoma State University, Stillwater, OK 74078, USA
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Abdullah L, Nkiliza A, Niedospial D, Aldrich G, Bartenfelder G, Keegan A, Hoffmann M, Mullan M, Klimas N, Baraniuk J, Crawford F, Krengel M, Chao L, Sullivan K. Genetic association between the APOE ε4 allele, toxicant exposures and Gulf war illness diagnosis. Environ Health 2023; 22:51. [PMID: 37415220 PMCID: PMC10324249 DOI: 10.1186/s12940-023-01002-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Exposure to nerve agents, pyridostigmine bromide (PB), pesticides, and oil-well fires during the 1991 Gulf War (GW) are major contributors to the etiology of Gulf War Illness (GWI). Since the apolipoprotein E (APOE) ε4 allele is associated with the risk of cognitive decline with age, particularly in the presence of environmental exposures, and cognitive impairment is one of the most common symptoms experienced by veterans with GWI, we examined whether the ε4 allele was associated with GWI. METHODS Using a case-control design, we obtained data on APOE genotypes, demographics, and self-reported GW exposures and symptoms that were deposited in the Boston Biorepository and Integrative Network (BBRAIN) for veterans diagnosed with GWI (n = 220) and healthy GW control veterans (n = 131). Diagnosis of GWI was performed using the Kansas and/or Center for Disease Control (CDC) criteria. RESULTS Age- and sex-adjusted analyses showed a significantly higher odds ratio for meeting the GWI case criteria in the presence of the ε4 allele (Odds ratio [OR] = 1.84, 95% confidence interval [CI = 1.07-3.15], p ≤ 0.05) and with two copies of the ε4 allele (OR = 1.99, 95% CI [1.23-3.21], p ≤ 0.01). Combined exposure to pesticides and PB pills (OR = 4.10 [2.12-7.91], p ≤ 0.05) as well as chemical alarms and PB pills (OR = 3.30 [1.56-6.97] p ≤ 0.05) during the war were also associated with a higher odds ratio for meeting GWI case criteria. There was also an interaction between the ε4 allele and exposure to oil well fires (OR = 2.46, 95% CI [1.07-5.62], p ≤ 0.05) among those who met the GWI case criteria. CONCLUSION These findings suggest that the presence of the ε4 allele was associated with meeting the GWI case criteria. Gulf War veterans who reported exposure to oil well fires and have an ε4 allele were more likely to meet GWI case criteria. Long-term surveillance of veterans with GWI, particularly those with oil well fire exposure, is required to better assess the future risk of cognitive decline among this vulnerable population.
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Affiliation(s)
- L Abdullah
- Roskamp Institute, Sarasota, FL, USA.
- James A. Haley VA Hospital, Tampa, FL, USA.
| | - A Nkiliza
- James A. Haley VA Hospital, Tampa, FL, USA
| | | | - G Aldrich
- Roskamp Institute, Sarasota, FL, USA
- James A. Haley VA Hospital, Tampa, FL, USA
| | | | - A Keegan
- Roskamp Institute, Sarasota, FL, USA
| | | | - M Mullan
- Roskamp Institute, Sarasota, FL, USA
| | - N Klimas
- Nova Southeastern University, Ft Lauderdale, FL, USA
- Miami VA Medical Center GRECC, Miami, FL, USA
| | - J Baraniuk
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - F Crawford
- Roskamp Institute, Sarasota, FL, USA
- James A. Haley VA Hospital, Tampa, FL, USA
| | - M Krengel
- Boston University School of Medicine, Boston, MA, USA
| | - L Chao
- University of California, San Francisco, CA, USA
| | - K Sullivan
- Boston University School of Public Health, Boston, MA, USA
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Shi J, Liu D, Jin Q, Chen X, Zhang R, Shi T, Zhu S, Zhang Y, Zong X, Wang C, Li L. Whole-Transcriptome Analysis of Repeated Low-Level Sarin-Exposed Rat Hippocampus and Identification of Cerna Networks to Investigate the Mechanism of Sarin-Induced Cognitive Impairment. BIOLOGY 2023; 12:biology12040627. [PMID: 37106826 PMCID: PMC10136365 DOI: 10.3390/biology12040627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
Sarin is a potent organophosphorus nerve agent that causes cognitive dysfunction, but its underlying molecular mechanisms are poorly understood. In this study, a rat model of repeated low-level sarin exposure was established using the subcutaneous injection of 0.4 × LD50 for 21 consecutive days. Sarin-exposed rats showed persistent learning and memory impairment and reduced hippocampal dendritic spine density. A whole-transcriptome analysis was applied to study the mechanism of sarin-induced cognitive impairment, and a total of 1035 differentially expressed mRNA (DEmRNA), including 44 DEmiRNA, 305 DElncRNA, and 412 DEcircRNA, were found in the hippocampus of sarin-treated rats. According to Gene Ontology (GO) annotation, Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment, and Protein-Protein Interaction (PPI) analysis, these DERNAs were mainly involved in neuronal synaptic plasticity and were related to the pathogenesis of neurodegenerative diseases. The circRNA/lncRNA-miRNA-mRNA ceRNA network was constructed, in which Circ_Fmn1, miR-741-3p, miR-764-3p, miR-871-3p, KIF1A, PTPN11, SYN1, and MT-CO3 formed one circuit, and Circ_Cacna1c, miR-10b-5p, miR-18a-5p, CACNA1C, PRKCD, and RASGRP1 constituted another circuit. The balance between the two circuits was crucial for maintaining synaptic plasticity and may be the regulatory mechanism by which sarin causes cognitive impairment. Our study reveals the ceRNA regulation mechanism of sarin exposure for the first time and provides new insights into the molecular mechanisms of other organophosphorus toxicants.
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Affiliation(s)
- Jingjing Shi
- State Key Laboratory of NBC Protection for Civilians, Beijing 102205, China
| | - Dongxin Liu
- State Key Laboratory of NBC Protection for Civilians, Beijing 102205, China
| | - Qian Jin
- State Key Laboratory of NBC Protection for Civilians, Beijing 102205, China
| | - Xuejun Chen
- State Key Laboratory of NBC Protection for Civilians, Beijing 102205, China
| | - Ruihua Zhang
- State Key Laboratory of NBC Protection for Civilians, Beijing 102205, China
| | - Tong Shi
- State Key Laboratory of NBC Protection for Civilians, Beijing 102205, China
| | - Siqing Zhu
- State Key Laboratory of NBC Protection for Civilians, Beijing 102205, China
| | - Yi Zhang
- State Key Laboratory of NBC Protection for Civilians, Beijing 102205, China
| | - Xingxing Zong
- State Key Laboratory of NBC Protection for Civilians, Beijing 102205, China
| | - Chen Wang
- State Key Laboratory of NBC Protection for Civilians, Beijing 102205, China
| | - Liqin Li
- State Key Laboratory of NBC Protection for Civilians, Beijing 102205, China
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Cruz-Hernandez A, Roney A, Goswami DG, Tewari-Singh N, Brown JM. A review of chemical warfare agents linked to respiratory and neurological effects experienced in Gulf War Illness. Inhal Toxicol 2022; 34:412-432. [PMID: 36394251 PMCID: PMC9832991 DOI: 10.1080/08958378.2022.2147257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
Over 40% of veterans from the Persian Gulf War (GW) (1990-1991) suffer from Gulf War Illness (GWI). Thirty years since the GW, the exposure and mechanism contributing to GWI remain unclear. One possible exposure that has been attributed to GWI are chemical warfare agents (CWAs). While there are treatments for isolated symptoms of GWI, the number of respiratory and cognitive/neurological issues continues to rise with minimum treatment options. This issue does not only affect veterans of the GW, importantly these chronic multisymptom illnesses (CMIs) are also growing amongst veterans who have served in the Afghanistan-Iraq war. What both wars have in common are their regions and inhaled exposures. In this review, we will describe the CWA exposures, such as sarin, cyclosarin, and mustard gas in both wars and discuss the various respiratory and neurocognitive issues experienced by veterans. We will bridge the respiratory and neurological symptoms experienced to the various potential mechanisms described for each CWA provided with the most up-to-date models and hypotheses.
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Affiliation(s)
- Angela Cruz-Hernandez
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Roney
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Dinesh G Goswami
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Neera Tewari-Singh
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Jared M Brown
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Carpenter JM, Brown KA, Veltmaat L, Ludwig HD, Clay KB, Norberg T, Harn DA, Wagner JJ, Filipov NM. Evaluation of delayed LNFPIII treatment initiation protocol on improving long-term behavioral and neuroinflammatory pathology in a mouse model of Gulf War Illness. Brain Behav Immun Health 2022; 26:100553. [DOI: 10.1016/j.bbih.2022.100553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/29/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
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Shi M, Zhang R, Jin Q, Cui Y, Shi J, Chen X, Shi T, Zhang Y, Zhu S, Zong X, Xu J, Wang C, Li L. Subacute sarin exposure disrupted the homeostasis of purine and pyrimidine metabolism in guinea pig striatum studied by integrated metabolomic, lipidomic and proteomic analysis. Toxicol Lett 2022; 367:48-58. [PMID: 35868497 DOI: 10.1016/j.toxlet.2022.07.008] [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: 09/20/2021] [Revised: 05/10/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022]
Abstract
Sarin was used as a chemical weapon due to its high neurotoxicity and mortality. Subacute sarin induced cognitive and behavioral disorder. However, the underlying mechanism is still unclear. Here we offered a multi-omic approach for the analysis of altered metabolites, lipids, and proteins to explore the neurotoxicity of subacute sarin. Guinea pigs were administered between the shoulder blades 16.8 μg/kg of sarin in a volume of 1.0 ml/kg body weight by subcutaneous injection once daily for 14 days. At the end of the final injection, guinea pigs were sacrificed, and striatum were dissected for analysis. A total of 138 different metabolites were identified in the metabolome analysis. Lipids and lipid-like molecules is the largest group (38.41%). For lipidomic analysis, a total of 216 lipids were identified. In proteomic study, over 4300 proteins were identified and quantified. By integrating these enriched components, we demonstrated that the joint pathways disturbed by subacute sarin mainly involving lipid, purine and pyrimidine metabolism in guinea pig striatum. Overall, this study highlights the powerfulness of omics platforms to deepen the understanding of nerve agents caused neurotoxicity.
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Affiliation(s)
- Meng Shi
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Ruihua Zhang
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Qian Jin
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Yalan Cui
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Jingjing Shi
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Xuejun Chen
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Tong Shi
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Yi Zhang
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Siqing Zhu
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Xingxing Zong
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Jianfu Xu
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China
| | - Chen Wang
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China.
| | - Liqin Li
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China.
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Zundel CG, Price K, Grasso CM, Spiro A, Heeren T, Sullivan K, Krengel MH. The impact of neurotoxicant exposures on posttraumatic stress disorder trajectories: The Ft. Devens Gulf War Veterans Cohort. J Trauma Stress 2022; 35:955-966. [PMID: 35150175 PMCID: PMC9541763 DOI: 10.1002/jts.22802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022]
Abstract
Gulf War veterans (GWVs) were exposed to neurotoxicants, including sarin nerve gas, anti-nerve agent pills, pesticides, oil well fires, and fumes from unvented tent heaters, all of which have been associated with subsequent adverse health. Posttraumatic stress disorder (PTSD) symptoms have also been associated with GW deployment; however, associations between exposures and PTSD symptoms have not been investigated. We assessed PTSD symptom trajectories and associations with neurotoxicant exposures in Ft. Devens Cohort (FDC) veterans (N = 259) who endorsed trauma exposure during deployment and completed the PTSD Checklist at three follow-ups (1992-1993, 1997-1998, 2013-2017). Results indicate that among veterans with more severe initial PTSD symptoms, symptoms remained significantly higher across follow-ups, Bs = -1.489-1.028, whereas among those with low initial PTSD symptoms, symptom severity increased significantly over time, Bs = 1.043-10.304. Additionally, neurotoxicant exposure was associated with a significant increase in PTSD symptoms, Bs = -1.870-9.003. Significant interactions between time and exposures were observed for PTSD symptom clusters, suggesting that among participants with high initial PTSD symptom, unexposed veterans experienced symptom alleviation, whereas exposed veterans' PTSD symptoms remained high. In GWVs with low initial PTSD symptoms, both unexposed and exposed veterans experienced PTSD symptom exacerbations over time; however, this occurred at a faster rate among exposed veterans. These findings suggest that in the years following deployment, GWVs who were exposed to both traumatic events and neurotoxicants may experience more severe and chronic PTSD symptoms than those without neurotoxicant exposures.
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Affiliation(s)
- Clara G. Zundel
- Research ServiceVA Boston Healthcare SystemBostonMassachusettsUSA,Behavioral Neuroscience ProgramBoston University School of MedicineBostonMassachusettsUSA
| | - Kathryn Price
- Research ServiceVA Boston Healthcare SystemBostonMassachusettsUSA,Department of PsychologyUniversity of Massachusetts–BostonBostonMassachusettsUSA
| | | | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information CenterVA Boston Healthcare SystemBostonMassachusettsUSA,Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA,Department of PsychiatryBoston University School of MedicineBostonMassachusettsUSA
| | - Timothy Heeren
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Kimberly Sullivan
- Department of Environmental HealthBoston University School of Public HealthBostonMassachusettsUSA
| | - Maxine H. Krengel
- Research ServiceVA Boston Healthcare SystemBostonMassachusettsUSA,Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
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11
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Haley RW, Kramer G, Xiao J, Dever JA, Teiber JF. Evaluation of a Gene-Environment Interaction of PON1 and Low-Level Nerve Agent Exposure with Gulf War Illness: A Prevalence Case-Control Study Drawn from the U.S. Military Health Survey's National Population Sample. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:57001. [PMID: 35543525 PMCID: PMC9093163 DOI: 10.1289/ehp9009] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Consensus on the etiology of 1991 Gulf War illness (GWI) has been limited by lack of objective individual-level environmental exposure information and assumed recall bias. OBJECTIVES We investigated a prestated hypothesis of the association of GWI with a gene-environment (GxE) interaction of the paraoxonase-1 (PON1) Q192R polymorphism and low-level nerve agent exposure. METHODS A prevalence sample of 508 GWI cases and 508 nonpaired controls was drawn from the 8,020 participants in the U.S. Military Health Survey, a representative sample survey of military veterans who served during the Gulf War. The PON1 Q192R genotype was measured by real-time polymerase chain reaction (RT-PCR), and the serum Q and R isoenzyme activity levels were measured with PON1-specific substrates. Low-level nerve agent exposure was estimated by survey questions on having heard nerve agent alarms during deployment. RESULTS The GxE interaction of the Q192R genotype and hearing alarms was strongly associated with GWI on both the multiplicative [prevalence odds ratio (POR) of the interaction=3.41; 95% confidence interval (CI): 1.20, 9.72] and additive (synergy index=4.71; 95% CI: 1.82, 12.19) scales, adjusted for measured confounders. The Q192R genotype and the alarms variable were independent (adjusted POR in the controls=1.18; 95% CI: 0.81, 1.73; p=0.35), and the associations of GWI with the number of R alleles and quartiles of Q isoenzyme were monotonic. The adjusted relative excess risk due to interaction (aRERI) was 7.69 (95% CI: 2.71, 19.13). Substituting Q isoenzyme activity for the genotype in the analyses corroborated the findings. Sensitivity analyses suggested that recall bias had forced the estimate of the GxE interaction toward the null and that unmeasured confounding is unlikely to account for the findings. We found a GxE interaction involving the Q-correlated PON1 diazoxonase activity and a weak possible GxE involving the Khamisiyah plume model, but none involving the PON1 R isoenzyme activity, arylesterase activity, paraoxonase activity, butyrylcholinesterase genotypes or enzyme activity, or pyridostigmine. DISCUSSION Given gene-environment independence and monotonicity, the unconfounded aRERI>0 supports a mechanistic interaction. Together with the direct evidence of exposure to fallout from bombing of chemical weapon storage facilities and the extensive toxicologic evidence of biochemical protection from organophosphates by the Q isoenzyme, the findings provide strong evidence for an etiologic role of low-level nerve agent in GWI. https://doi.org/10.1289/EHP9009.
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Affiliation(s)
- Robert W. Haley
- Division of Epidemiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gerald Kramer
- Division of Epidemiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Junhui Xiao
- Division of Epidemiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jill A. Dever
- RTI International, Washington, District of Columbia, USA
| | - John F. Teiber
- Division of Epidemiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Dassanayake TL, Weerasinghe VS, Gawarammana IB, Buckley NA. Changes of attention-related brain activity over 6 months after acute organophosphate pesticide poisoning: a prospective follow-up study. Clin Toxicol (Phila) 2021; 60:576-584. [PMID: 34904500 DOI: 10.1080/15563650.2021.2010742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONTEXT Ingestion of organophosphate (OP) pesticides is a common method of self-harm in developing countries. Apart from acute cholinergic effects, limited evidence implicates OP poisoning in long-term neurocognitive deficits. However, prospective neurophysiological evidence of long-term deficits is scarce in humans. We aimed to determine long-term cognitive changes of acute OP pesticide self-poisoning in a prospective follow-up study, using event-related potentials (ERPs), an electroencephalographic index of cognitive functioning. METHODS We recruited 203 patients (147 men) hospitalised with OP pesticide ingestion (OP group; all had significant erythrocyte cholinesterase inhibition) and 50 patients (23 men) with paracetamol overdose (control group) as a means of self-harm. We recorded their ERPs and behavioural performance in a selective attention task at three post-exposure time points: on discharge from hospital (around 14 days post-ingestion), 6 weeks and 6 months post-ingestion. We compared the reaction time and ERP components of the two groups at each time point, adjusting for sex, age, education and comorbid depression in multiple regression models. RESULTS OP group had significantly slower reaction times than the control group on discharge and at 6 weeks, but not at 6 months. On discharge, the OP group also showed significantly prolonged latency of the parietal P3b component, signifying delayed attentional processing. P3b amplitudes were also significantly smaller in the OP group on discharge and at 6 months. Within the OP group, greater clinical severity of poisoning was associated with smaller P3b amplitudes. Early pre-attentive cortical processing (as indexed by N1 ERP component) showed no significant intergroup differences. CONCLUSIONS Acute OP pesticide poisoning was associated with impaired behavioural and neurophysiological indices of selective attention. These deficits outlast the cholinergic phase of intoxication. The neurobehavioral impairment disappears over months, but neurophysiological deficits seem to last even after 6 months. This impairment could potentially compromise the performance and safety of patients for months following clinical recovery.
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Affiliation(s)
- Tharaka L Dassanayake
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,School of Psychological Sciences, The University of Newcastle, Callaghan, Australia
| | - Vajira S Weerasinghe
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika B Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nicholas A Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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Brady CB, Robey I, Stein TD, Huber BR, Riley J, Abdul Rauf N, Spencer KR, Walt G, Adams L, Averill JG, Walker S, McKee AC, Thomson SP, Kowall NW. The Department of Veterans Affairs Gulf War Veterans' Illnesses Biorepository: Supporting Research on Gulf War Veterans' Illnesses. Brain Sci 2021; 11:1349. [PMID: 34679413 PMCID: PMC8533803 DOI: 10.3390/brainsci11101349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 12/27/2022] Open
Abstract
AIMS To introduce a resource supporting research on Gulf War illness (GWI) and related disorders, the Gulf War Veterans' Illnesses Biorepository (GWVIB). METHODS Gulf War era veterans (GWVs) are recruited nationally and enrolled via telephone and email/postal mail. Enrolled veterans receive annual telephone and mail follow-up to collect health data until their passing. A postmortem neuropathological examination is performed, and fixed and frozen brain and spinal cord samples are banked to support research. Investigators studying GWI and related disorders may request tissue and data from the GWVIB. RESULTS As of September 2021, 127 GWVs from 39 states were enrolled; 60 met the criteria for GWI, and 14 met the criteria for chronic multisymptom illness (CMI). Enrollees have been followed up to six years. Postmortem tissue recoveries were performed on 14 GWVs. The most commonly found neuropathologies included amyotrophic lateral sclerosis, chronic traumatic encephalopathy, and Lewy body disease. Tissue was of good quality with an average RNA integrity number of 5.8 (SD = 1.0) and ≥4.8 in all of the cases. DISCUSSION The availability of health data and high-quality CNS tissue from this well-characterized GWV cohort will support research on GWI and related disorders affecting GWVs. Enrollment is ongoing.
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Affiliation(s)
- Christopher B. Brady
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA; (B.R.H.); (N.W.K.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Ian Robey
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
- Department of Endocrinology, University of Arizona, Tucson, AZ 85724, USA
| | - Thor D. Stein
- Pathology Service, VA Boston Healthcare System, Boston, MA 02130, USA; (T.D.S.); (A.C.M.)
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
- Department of Veterans Affairs Medical Center, Bedford, MA 01730, USA
| | - Bertrand R. Huber
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA; (B.R.H.); (N.W.K.)
- Pathology Service, VA Boston Healthcare System, Boston, MA 02130, USA; (T.D.S.); (A.C.M.)
- National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA 02130, USA
| | - Jessica Riley
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Nazifa Abdul Rauf
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Keith R. Spencer
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Gabriel Walt
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Latease Adams
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - James G. Averill
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
| | - Sean Walker
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
| | - Ann C. McKee
- Pathology Service, VA Boston Healthcare System, Boston, MA 02130, USA; (T.D.S.); (A.C.M.)
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Stephen P. Thomson
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
- Department of Endocrinology, University of Arizona, Tucson, AZ 85724, USA
| | - Neil W. Kowall
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA; (B.R.H.); (N.W.K.)
- Neurology Service, VA Boston Healthcare System, Boston, MA 02130, USA
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Carpenter JM, Brown KA, Diaz AN, Dockman RL, Benbow RA, Harn DA, Norberg T, Wagner JJ, Filipov NM. Delayed treatment with the immunotherapeutic LNFPIII ameliorates multiple neurological deficits in a pesticide-nerve agent prophylactic mouse model of Gulf War Illness. Neurotoxicol Teratol 2021; 87:107012. [PMID: 34256162 DOI: 10.1016/j.ntt.2021.107012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 12/20/2022]
Abstract
Residual effects of the 1990-1991 Gulf War (GW) still plague veterans 30 years later as Gulf War Illness (GWI). Thought to stem mostly from deployment-related chemical overexposures, GWI is a disease with multiple neurological symptoms with likely immunological underpinnings. Currently, GWI remains untreatable, and the long-term neurological disease manifestation is not characterized fully. The present study sought to expand and evaluate the long-term implications of prior GW chemicals exposure on neurological function 6-8 months post GWI-like symptomatology induction. Additionally, the beneficial effects of delayed treatment with the glycan immunotherapeutic lacto-N-fucopentaose III (LNFPIII) were evaluated. Male C57BL/6J mice underwent a 10-day combinational exposure (i.p.) to GW chemicals, the nerve agent prophylactic pyridostigmine bromide (PB) and the insecticide permethrin (PM; 0.7 and 200 mg/kg, respectively). Beginning 4 months after PB/PM exposure, a subset of the mice were treated twice a week until study completion with LNFPIII. Evaluation of cognition/memory, motor function, and mood was performed beginning 1 month after LNFPIII treatment initiation. Prior exposure to PB/PM produced multiple locomotor, neuromuscular, and sensorimotor deficits across several motor tests. Subtle anxiety-like behavior was also present in PB/PM mice in mood tests. Further, PB/PM-exposed mice learned at a slower rate, mostly during early phases of the learning and memory tests employed. LNFPIII treatment restored or improved many of these behaviors, particularly in motor and cognition/memory domains. Electrophysiology data collected from hippocampal slices 8 months post PB/PM exposure revealed modest aberrations in basal synaptic transmission and long-term potentiation in the dorsal or ventral hippocampus that were improved by LNFPIII treatment. Immunohistochemical analysis of tyrosine hydroxylase (TH), a dopaminergic marker, did not detect major PB/PM effects along the nigrostriatal pathway, but LNFPIII increased striatal TH. Additionally, neuroinflammatory cells were increased in PB/PM mice, an effect reduced by LNFPIII. Collectively, long-term neurobehavioral and neurobiological dysfunction associated with prior PB/PM exposure was characterized; delayed LNFPIII treatment provided multiple behavioral and biological beneficial effects in the context of GWI, highlighting its potential as a GWI therapeutic.
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Affiliation(s)
- Jessica M Carpenter
- Department of Physiology and Pharmacology, University of Georgia, Athens, GA, United States; Neuroscience Program, University of Georgia, Athens, GA, United States
| | - Kyle A Brown
- Department of Physiology and Pharmacology, University of Georgia, Athens, GA, United States; Interdisciplinary Toxicology Program, University of Georgia, Athens, GA, United States
| | - Alexa N Diaz
- Department of Physiology and Pharmacology, University of Georgia, Athens, GA, United States
| | - Rachel L Dockman
- Department of Microbiology, University of Georgia, Athens, GA, United States
| | - Robert A Benbow
- Department of Physiology and Pharmacology, University of Georgia, Athens, GA, United States
| | - Donald A Harn
- Department of Infectious Diseases, University of Georgia, Athens, GA, United States; Center for Tropical and Emerging Infectious Diseases, University of Georgia, Athens, GA, United States
| | - Thomas Norberg
- Department of Chemistry, University of Uppsala, Uppsala, Sweden
| | - John J Wagner
- Department of Physiology and Pharmacology, University of Georgia, Athens, GA, United States; Neuroscience Program, University of Georgia, Athens, GA, United States; Interdisciplinary Toxicology Program, University of Georgia, Athens, GA, United States.
| | - Nikolay M Filipov
- Department of Physiology and Pharmacology, University of Georgia, Athens, GA, United States; Neuroscience Program, University of Georgia, Athens, GA, United States; Interdisciplinary Toxicology Program, University of Georgia, Athens, GA, United States.
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15
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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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Van Booven D, Zarnowski O, Perez M, Sarria L, Collado F, Hansotia K, Riegle S, Finger T, Fletcher MA, Klimas NG, Nathanson L. The effect of stress on the transcriptomes of circulating immune cells in patients with Gulf War Illness. Life Sci 2021; 281:119719. [PMID: 34144055 DOI: 10.1016/j.lfs.2021.119719] [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: 02/23/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022]
Abstract
AIMS In an effort to gain further insight into the underlying mechanisms tied to disease onset and progression of Gulf War Illness (GWI), our team evaluated GWI patient response to stress utilizing RNA-Seq. MAIN METHODS The protocol included blood collection before exercise challenge (baseline), at maximal exertion, and after exercise challenge (recovery - four hours post-exercise challenge). Peripheral blood mononuclear cell (PBMC) transcriptomics data were analyzed to understand why GWI patients process stressors differently from their healthy counterparts. KEY FINDINGS Our findings validate previously identified dysregulation of immune and inflammatory pathways among GWI patients as well as highlight novel immune and inflammatory markers of disease activity. These results provide a foundation for future research efforts in understanding GWI pathophysiology and creating targeted treatments. SIGNIFICANCE Gulf War Illness is a complex, chronic, and debilitating multi-system illness impacting 25%-30% of the U.S. troops deployed to the 1990-1991 Gulf War. The condition is characterized by medically unexplained fatigue and affects multiple organ systems. Because the underlying mechanisms are largely unknown, patients receive symptom-based treatment, rather than targeting fundamental biological processes. To the best of our knowledge, this is the first study that applies RNA-Seq to analyze the effect of GWI, and the response to stressors in GWI, on the transcriptomic changes in circulating immune cells.
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Affiliation(s)
- Derek Van Booven
- Dr. J. P. Hussman Institute for Human Genomics Miller School of Medicine University of Miami, Miami, FL, United States of America
| | - Oskar Zarnowski
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America; Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America
| | - Melanie Perez
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America; Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America
| | - Leonor Sarria
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America
| | - Fanny Collado
- Department of Veterans Affairs, Miami VA Healthcare System, Research Service, Miami, FL, United States of America; South Florida Veterans Affairs Foundation for Research and Education Inc, Fort Lauderdale, FL, United States of America
| | - Kyle Hansotia
- Halmos College of Arts and Sciences, Nova Southeastern University, Fort Lauderdale, FL, United States of America; Farquhar Honors College, Nova Southeastern University, Fort Lauderdale, FL, United States of America
| | - Sean Riegle
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America
| | - Tali Finger
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America
| | - Mary Ann Fletcher
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America; Department of Veterans Affairs, Miami VA Healthcare System, Research Service, Miami, FL, United States of America
| | - Nancy G Klimas
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America; Department of Veterans Affairs, Miami VA Healthcare System, Research Service, Miami, FL, United States of America
| | - Lubov Nathanson
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
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Geretto M, Ferrari M, De Angelis R, Crociata F, Sebastiani N, Pulliero A, Au W, Izzotti A. Occupational Exposures and Environmental Health Hazards of Military Personnel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5395. [PMID: 34070145 PMCID: PMC8158372 DOI: 10.3390/ijerph18105395] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/05/2021] [Accepted: 05/09/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Military personnel are frequently exposed to environmental pollutants that can cause a variety of diseases. METHODS This review analyzed publications regarding epidemiological and biomonitoring studies on occupationally-exposed military personnel. RESULTS The exposures include sulfur mustard, organ chlorines, combustion products, fuel vapors, and ionizing and exciting radiations. Important factors to be considered are the lengths and intensities of exposures, its proximity to the sources of environmental pollutants, as well as confounding factors (cigarette smoke, diet, photo-type, healthy warrior effect, etc.). Assessment of environmental and individual exposures to pollutants is crucial, although often omitted, because soldiers have often been evaluated based on reported health problems rather than on excessive exposure to pollutants. Biomarkers of exposures and effects are tools to explore relationships between exposures and diseases in military personnel. Another observation from this review is a major problem from the lack of suitable control groups. CONCLUSIONS This review indicates that only studies which analyzed epidemiological and molecular biomarkers in both exposed and control groups would provide evidence-based conclusions on exposure and disease risk in military personnel.
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Affiliation(s)
- Marta Geretto
- Department of Experimental Medicine, University of Genoa, 16132 Genoa, Italy;
| | - Marco Ferrari
- Texas Biomedical Research Institute, 8715 W. Military Drive, San Antonio, TX 78227, USA;
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Filippo Crociata
- General Inspectorate of Military Health, 00184 Rome, Italy; (F.C.); (N.S.)
| | - Nicola Sebastiani
- General Inspectorate of Military Health, 00184 Rome, Italy; (F.C.); (N.S.)
| | | | - William Au
- Faculty of Medicine, Pharmacy, Science and Technology University of Medicine, Pharmacy, Science and Technology, 540142 Targu Mures, Romania;
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Alberto Izzotti
- Department of Experimental Medicine, University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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Bullman T, Schneiderman A, Dursa E. Cause-specific mortality risks among U.S. veterans: 25 years after their service in the 1990-1991 gulf war. Ann Epidemiol 2021; 57:1-6. [PMID: 33581241 DOI: 10.1016/j.annepidem.2021.01.005] [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: 09/15/2020] [Revised: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE There is concern about adverse health effects related to military service in the 1990-1991 Gulf War. This study assessed cause-specific mortality risks among Veterans who served in the war. METHODS The mortality of 621,244 veterans deployed to the Gulf War was compared to that of 745,704 Veterans who served during the war but were not deployed to the Gulf Theater. Cause-specific mortality of both deployed and nondeployed was also compared to that of the US general population. RESULTS There was no increased risk of disease-specific mortality among deployed Veterans compared to nondeployed. Deployed Veterans did have an increased risk of motor vehicle deaths compared to nondeployed Veterans, (hazard ratio, 1.12, 95% confidence interval, 1.04-1.21). Cause-specific mortality of both deployed and non-deployed Veterans was less than that of the US population. When stratified by gender, only female Veterans, both deployed and nondeployed, had increased risks of suicide compared to the female US population (standardized mortality ratio, 1.40; 95% confidence interval, 1.13-1.71 and standardized mortality ratio, 1.22; 95% confidence interval, 1.05-1.40, respectively). CONCLUSION There was no increased risk of disease mortality among Veterans of the 1990-1991 Gulf War. Both deployed and nondeployed female Veterans had increased risks of suicide compared to US female population.
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Affiliation(s)
- Tim Bullman
- Post Deployment Health Services, US Department of Veterans Affairs, Washington DC.
| | - Aaron Schneiderman
- Post Deployment Health Services, US Department of Veterans Affairs, Washington DC
| | - Erin Dursa
- Post Deployment Health Services, US Department of Veterans Affairs, Washington DC
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19
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Shi M, Deng S, Cui Y, Chen X, Shi T, Song L, Zhang R, Zhang Y, Xu J, Shi J, Wang C, Li L. Repeated low-dose exposures to sarin disrupted the homeostasis of phospholipid and sphingolipid metabolism in guinea pig hippocampus. Toxicol Lett 2020; 338:32-39. [PMID: 33253782 DOI: 10.1016/j.toxlet.2020.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 01/22/2023]
Abstract
Repeated low-level exposure to sarin results to hippocampus dysfunction. Metabonomics involves a holistic analysis of a set of metabolites in an organism in the search for a relationship between these metabolites and physiological or pathological changes. The objective of the present study was to evaluate the effects of repeated exposure to low-level sarin on the metabonomics in hippocampus of a guinea pig model. Guinea pigs were divided randomly into control and sarin treated groups (n = 14). Guinea pigs in the control group received saline; while the sarin-treated group received 0.4×LD50 (16.8 μg/kg) sarin. Daily injections (a total of 14 days) were administered sc between the shoulder blades in a volume of 1.0 ml/kg body weight. At the end of the final injection, 6 animals in each group were chosen for Morris water maze test. The rest guinea pigs (n = 8 for each group) were sacrificed by decapitation, and hippocampus were dissected for analysis. Compared with the control-group, the escape latency in sarin-group was significantly (p < 0.05) longer while the crossing times were significantly decreased in the Morris water task (p < 0.05). Sarin inhibited activities of acetylcholinesterase (AChE) and neuropathy target esterase (NTE) in hippocampus. The AChE activity of hippocampus from sarin-treated groups is equivalent to 59.9 ± 6.4 %, and the NTE activity of hippocampus from sarin-groups is equivalent to 78.1 ± 8.3 % of that from control-group. Metabolites were identified and validated. A total of 14 variables were selected as potential biomarkers. Phospholipids [phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidic acid (PA), phosphatidylglycerol (PG), phosphatidylinositol (PI), Lysophosphatidylethanolamine (LysoPE or LPE)] and sphingolipids (SPs) [sphinganine (SA), phytosphingosine (PSO) and sphinganine-1-phosphate (SA1P)] were clearly modified. In conclusion, repeated low-dose exposures to sarin disrupted the homeostasis of phospholipid and sphingolipid metabolism in guinea pig hippocampus and may lead to a neuronal-specific function disorders. Identified metabolites such as SA1P need to be studied more deeply on their biological function that against sarin lesions. In future research, we should pay more attention to characterize the physiological roles of lipid metabolism enzymes as well as their involvement in pathologies induced by repeated low-level sarin exposure.
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Affiliation(s)
- Meng Shi
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, PR China
| | - Shikun Deng
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, PR China
| | - Yalan Cui
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, PR China
| | - Xuejun Chen
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, PR China
| | - Tong Shi
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, PR China
| | - Liangcai Song
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, PR China
| | - Ruihua Zhang
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, PR China
| | - Yi Zhang
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, PR China
| | - Jianfu Xu
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, PR China
| | - Jingjing Shi
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, PR China
| | - Chen Wang
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, PR China.
| | - Liqin Li
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, PR China.
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Dursa EK, Tadesse BE, Carter CE, Culpepper WJ, Schneiderman AI, Rumm PD. Respiratory illness among Gulf War and Gulf War era veterans who use the Department of Veterans Affairs for healthcare. Am J Ind Med 2020; 63:980-987. [PMID: 32851693 DOI: 10.1002/ajim.23172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/29/2020] [Accepted: 08/05/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Veterans of the 1990-1991 Gulf War were exposed to a variety of toxic substances during their service that included several airborne hazards, but only a few small studies have assessed respiratory outcomes in Gulf War veterans. This paper presents population prevalence estimates and prevalence ratios of respiratory disease among Gulf War and Gulf War Era veterans who use VA healthcare. METHODS A total of 360,909 Gulf War deployed veterans and 323,638 Gulf War Era non-deployed veterans were included in the analysis. Ten-year period prevalence rates (PRs) for fifteen respiratory diseases were calculated for Gulf War and Gulf War Era veterans and period prevalence ratios comparing Gulf War veterans to Gulf War Era veterans were calculated. RESULTS The five respiratory conditions with the highest prevalence per 100,000 veterans across both Gulf War deployed and Gulf War Era non-deployed veterans (respectively) were: allergic rhinitis (8,400 and 8,041), chronic obstructive pulmonary disease (4,763 and 4,795), asthma (4,685 and 4,477), chronic airway obstruction (3,983 and 4,059), and chronic sinusitis (2,863 and 2,672). The adjusted PRs showed a small, but significantly increased, elevation in Gulf War-deployed compared to Gulf War Era non-deployed veterans for chronic bronchitis (PR 1.19; 95% CI 1.10, 1.28), emphysema (PR 1.11; 95% CI 1.01, 1.21), chronic airway obstruction (PR 1.09; 95% CI 1.07, 1.12), and chronic obstructive pulmonary disease (PR 1.09; 1.07, 1.11). DISCUSSION Gulf War veterans should continue to be monitored in the future to better evaluate the potential long-term consequences on respiratory health.
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Affiliation(s)
- Erin K. Dursa
- Post‐Deployment Health Services Department of Veterans Affairs Washington District of Columbia
| | | | | | - William J. Culpepper
- Post‐Deployment Health Services Department of Veterans Affairs Washington District of Columbia
| | - Aaron I. Schneiderman
- Post‐Deployment Health Services Department of Veterans Affairs Washington District of Columbia
| | - Peter D. Rumm
- Post‐Deployment Health Services Department of Veterans Affairs Washington District of Columbia
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Putra M, Gage M, Sharma S, Gardner C, Gasser G, Anantharam V, Thippeswamy T. Diapocynin, an NADPH oxidase inhibitor, counteracts diisopropylfluorophosphate-induced long-term neurotoxicity in the rat model. Ann N Y Acad Sci 2020; 1479:75-93. [PMID: 32037612 PMCID: PMC7415478 DOI: 10.1111/nyas.14314] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/14/2020] [Accepted: 01/25/2020] [Indexed: 12/18/2022]
Abstract
Organophosphate (OP) nerve agents are a threat to both the military and civilians. OP exposure causes cholinergic crisis and status epilepticus (SE) because of irreversible inhibition of acetylcholinesterase that can be life-threatening if left untreated. OP survivors develop long-term morbidity, such as cognitive impairment and motor dysfunction, because of oxidative stress and progressive neuroinflammation and neurodegeneration, which act as disease promoters. Current medical countermeasures (MCMs) do not mitigate these pathologies. Therefore, our goal was to target these disease promoters using diapocynin (DPO), an NADPH oxidase inhibitor, in addition to MCMs, in a rat diisopropylfluorophosphate (DFP) model. The DFP-intoxicated rats were treated with DPO (300 mg/kg, oral, six doses, 12-h intervals) or vehicle 2 h following behavioral SE termination with diazepam. The DPO treatment significantly rescued DFP-induced motor impairment and attenuated epileptiform spiking during the first 72 h after DFP exposure in severely seizing rats despite no difference in epileptiform spike rate between the vehicle and DPO groups in mild SE rats. DPO significantly reduced DFP-induced reactive astrogliosis, neurodegeneration, GP91phox , glutathiolated protein, serum nitrite, and proinflammatory cytokines and chemokines, such as interleukins (ILs) IL-1α, IL-6, IL-2, IL-17A, leptin, and IP-10, in the hippocampus. Collectively, these data support a neuroprotective role of DPO in an OP-induced neurotoxicity model.
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Affiliation(s)
- Marson Putra
- Neuroscience Graduate Program, Iowa State University, Ames, IA 50011
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Meghan Gage
- Neuroscience Graduate Program, Iowa State University, Ames, IA 50011
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Shaunik Sharma
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Cara Gardner
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | | | | | - Thimmasettappa Thippeswamy
- Neuroscience Graduate Program, Iowa State University, Ames, IA 50011
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
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Cheng CH, Koo BB, Calderazzo S, Quinn E, Aenlle K, Steele L, Klimas N, Krengel M, Janulewicz P, Toomey R, Michalovicz LT, Kelly KA, Heeren T, Little D, O’Callaghan JP, Sullivan K. Alterations in high-order diffusion imaging in veterans with Gulf War Illness is associated with chemical weapons exposure and mild traumatic brain injury. Brain Behav Immun 2020; 89:281-290. [PMID: 32745586 PMCID: PMC7755296 DOI: 10.1016/j.bbi.2020.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/11/2020] [Accepted: 07/08/2020] [Indexed: 01/02/2023] Open
Abstract
The complex etiology behind Gulf War Illness (GWI) has been attributed to the combined exposure to neurotoxicant chemicals, brain injuries, and some combat experiences. Chronic GWI symptoms have been shown to be associated with intensified neuroinflammatory responses in animal and human studies. To investigate the neuroinflammatory responses and potential causes in Gulf War (GW) veterans, we focused on the effects of chemical/biological weapons (CBW) exposure and mild traumatic brain injury (mTBI) during the war. We applied a novel MRI diffusion processing method, Neurite density imaging (NDI), on high-order diffusion imaging to estimate microstructural alterations of brain imaging in Gulf War veterans with and without GWI, and collected plasma proinflammatory cytokine samples as well as self-reported health symptom scores. Our study identified microstructural changes specific to GWI in the frontal and limbic regions due to CBW and mTBI, and further showed distinctive microstructural patterns such that widespread changes were associated with CBW and more focal changes on diffusion imaging were observed in GW veterans with an mTBI during the war. In addition, microstructural alterations on brain imaging correlated with upregulated blood proinflammatory cytokine markers TNFRI and TNFRII and with worse outcomes on self-reported symptom measures for fatigue and sleep functioning. Taken together, these results suggest TNF signaling mediated inflammation affects frontal and limbic regions of the brain, which may contribute to the fatigue and sleep symptoms of the disease and suggest a strong neuroinflammatory component to GWI. These results also suggest exposures to chemical weapons and mTBI during the war are associated with different patterns of peripheral and central inflammation and highlight the brain regions vulnerable to further subtle microscale morphological changes and chronic signaling to nearby glia.
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Affiliation(s)
| | - Bang-Bon Koo
- School of Medicine, Boston University, Boston, MA, US
| | | | - Emily Quinn
- School of Public Health, Boston University, Boston MA USA
| | - Kristina Aenlle
- Nova Southeastern University, Fort Lauderdale, FL, USA
- Department of Veterans Affairs, Miami VA Healthcare System, Research Service, Miami, FL, USA
| | - Lea Steele
- Baylor College of Medicine, Houston, TX, USA
| | - Nancy Klimas
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Maxine Krengel
- School of Public Health, Boston University, Boston MA USA
| | | | | | - Lindsay T. Michalovicz
- Health Effects Laboratory Division, Center for Disease Control and Prevention – National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Kimberly A Kelly
- Health Effects Laboratory Division, Center for Disease Control and Prevention – National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Timothy Heeren
- School of Public Health, Boston University, Boston MA USA
| | | | - James P. O’Callaghan
- Health Effects Laboratory Division, Center for Disease Control and Prevention – National Institute for Occupational Safety and Health, Morgantown, WV, USA
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Yee MK, Zundel CG, Maule AL, Heeren T, Proctor SP, Sullivan KA, Krengel MH. Longitudinal Assessment of Health Symptoms in Relation to Neurotoxicant Exposures in 1991 Gulf War Veterans: The Ft. Devens Cohort. J Occup Environ Med 2020; 62:663-668. [PMID: 32890202 PMCID: PMC7478220 DOI: 10.1097/jom.0000000000001910] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This analysis examined the relationship between Gulf War (GW) exposures and health symptoms reported in three time periods over 20 years in Ft. Devens Cohort veterans. METHODS Repeated logistic regression models examined the association of exposures and health symptoms over time. Models included baseline age, active duty status, post-traumatic stress disorder status, sex, and time since deployment as covariates. RESULTS Exposure to tent heaters was associated with increased odds of crying easily and muscle twitching. Exposure to pyridostigmine bromide (PB) pills was associated with increased odds of depression and fatigue. Exposure to the Khamisiyah sarin plume was associated with increased odds of trouble concentrating and crying easily. CONCLUSION This longitudinal analysis demonstrated an association between neurotoxicant exposures and increased odds of cognitive/mood, fatigue, and neurological symptoms. In addition, most symptoms increased over time since deployment regardless of exposure.
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Affiliation(s)
- Megan K Yee
- Research Service, VA Boston Healthcare System, Boston, Massachusetts (Yee, Zundel, Dr Proctor, Dr Krengel); Behavioral Neuroscience Program, Boston University School of Medicine, Boston, Massachusetts (Zundel); Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts (Drs Maule, Sullivan); Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts (Drs Maule, Proctor); Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts (Dr Heeren); and Department of Neurology, Boston University School of Medicine, Boston, Massachusetts (Dr Krengel)
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24
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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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25
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Chambers JE, Dail MB, Meek EC. Oxime-mediated reactivation of organophosphate-inhibited acetylcholinesterase with emphasis on centrally-active oximes. Neuropharmacology 2020; 175:108201. [PMID: 32544483 DOI: 10.1016/j.neuropharm.2020.108201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 01/25/2023]
Abstract
This review provides an overview of the global research leading to the large number of compounds developed as reactivators of acetylcholinesterase inhibited by a variety of organophosphate compounds, most of which are nerve agents but also some insecticides. A number of these organophosphates are highly toxic and effective therapy by reactivators contributes to saving lives. Two major challenges for more effective therapy with reactivators are identification of a broad spectrum reactivator efficacious against a variety of organophosphate structures, and a reactivator that can cross the blood-brain barrier to protect the brain. The most effective of the reactivators developed are the nucleophilic pyridinium oximes, which bear a permanent positive charge from the quaternary nitrogen in the pyridinium ring. The permanent positive charge retards the oximes from crossing the blood-brain barrier and therefore restoration of normal cholinergic function in the brain is unlikely. A number of laboratories have developed nucleophiles, mostly oximes, that are theorized to cross the blood-brain barrier by several strategies. At the present time, no reactivator is optimally broad spectrum across the wide group of organophosphate chemistries. Some oximes, including the substituted phenoxyalkyl pyridinium oximes invented by our laboratories, have the potential to provide neuroprotection in the brain and show evidence of efficacy against both nerve agent and insecticidal chemistries, so these novel oximes have promise for future development. This article is part of the special issue entitled 'Acetylcholinesterase Inhibitors: From Bench to Bedside to Battlefield'.
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Affiliation(s)
- Janice E Chambers
- Center for Environmental Health Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762-6100, USA.
| | - Mary B Dail
- Center for Environmental Health Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762-6100, USA
| | - Edward C Meek
- Center for Environmental Health Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762-6100, USA
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26
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Michalovicz LT, Kelly KA, Sullivan K, O'Callaghan JP. Acetylcholinesterase inhibitor exposures as an initiating factor in the development of Gulf War Illness, a chronic neuroimmune disorder in deployed veterans. Neuropharmacology 2020; 171:108073. [PMID: 32247728 PMCID: PMC7398580 DOI: 10.1016/j.neuropharm.2020.108073] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/26/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022]
Abstract
Gulf War Illness (GWI) is a chronic multi-symptom disorder, characterized by symptoms such as fatigue, pain, cognitive and memory impairment, respiratory, skin and gastrointestinal problems, that is experienced by approximately one-third of 1991 Gulf War veterans. Over the nearly three decades since the end of the war, investigators have worked to elucidate the initiating factors and underlying causes of GWI. A significant portion of this research has indicated a strong correlation between GWI and exposure to a number of different acetycholinesterase inhibitors (AChEIs) in theater, such as sarin and cyclosarin nerve agents, chlorpyrifos and dichlorvos pesticides, and the anti-nerve agent prophylactic pyridostigmine bromide. Through studying these exposures and their relationship to the symptoms presented by ill veterans, it has become increasingly apparent that GWI is the likely result of an underlying neuroimmune disorder. While evidence indicates that AChEIs are a key exposure in the development of GWI, particularly organophosphate AChEIs, the mechanism(s) by which these chemicals instigate illness appears to be related to "off-target", non-cholinergic effects. In this review, we will discuss the role of AChEI exposure in the development and persistence of GWI; in particular, how these chemicals, combined with other exposures, have led to a chronic neuroimmune disorder. This article is part of the special issue entitled 'Acetylcholinesterase Inhibitors: From Bench to Bedside to Battlefield'.
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Affiliation(s)
- Lindsay T Michalovicz
- Health Effects Laboratory Division, Centers for Disease Control and Prevention - National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Kimberly A Kelly
- Health Effects Laboratory Division, Centers for Disease Control and Prevention - National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | | | - James P O'Callaghan
- Health Effects Laboratory Division, Centers for Disease Control and Prevention - National Institute for Occupational Safety and Health, Morgantown, WV, USA.
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27
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Brown KA, Filipov NM, Wagner JJ. Dorsoventral-Specific Effects of Nerve Agent Surrogate Diisopropylfluorophosphate on Synaptic Transmission in the Mouse Hippocampus. J Pharmacol Exp Ther 2020; 373:10-23. [DOI: 10.1124/jpet.119.263053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/16/2019] [Indexed: 11/22/2022] Open
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Carpenter JM, Gordon HE, Ludwig HD, Wagner JJ, Harn DA, Norberg T, Filipov NM. Neurochemical and neuroinflammatory perturbations in two Gulf War Illness models: Modulation by the immunotherapeutic LNFPIII. Neurotoxicology 2019; 77:40-50. [PMID: 31866310 DOI: 10.1016/j.neuro.2019.12.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 01/06/2023]
Abstract
Gulf War Illness (GWI) manifests a multitude of symptoms, including neurological and immunological, and approximately a third of the 1990-1991 Gulf War (GW) veterans suffer from it. This study sought to characterize the acute neurochemical (monoamine) and neuroinflammatory profiles of two established GWI animal models and examine the potential modulatory effects of the novel immunotherapeutic Lacto-N-fucopentaose III (LNFPIII). In Model 1, male C57BL/6 J mice were treated for 10 days with pyridostigmine bromide (PB) and permethrin (PM). In Model 2, a separate cohort of mice were treated for 14 days with PB and N,N-Diethyl-methylbenzamide (DEET), plus corticosterone (CORT) via drinking water on days 8-14 and diisopropylfluorophosphate (DFP) on day 15. LNFPIII was administered concurrently with GWI chemicals treatments. Brain and spleen monoamines and hippocampal inflammatory marker expression were examined by, respectively, HPLC-ECD and qPCR, 6 h post treatment cessation. Serotonergic (5-HT) and dopaminergic (DA) dyshomeostasis caused by GWI chemicals was apparent in multiple brain regions, primarily in the nucleus accumbens (5-HT) and hippocampus (5-HT, DA) for both models. Splenic levels of 5-HT (both models) and norepinephrine (Model 2) were also disrupted by GWI chemicals. LNFPIII treatment prevented many of the GWI chemicals induced monoamine alterations. Hippocampal inflammatory cytokines were increased in both models, but the magnitude and spread of inflammation was greater in Model 2; LNFPIII was anti-inflammatory, more so in the apparently milder Model 1. Overall, in both models, GWI chemicals led to monoamine disbalance and neuroinflammation. LNFPIII co-treatment prevented many of these disruptions in both models, which is indicative of its promise as a potential GWI therapeutic.
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Affiliation(s)
- J M Carpenter
- Department of Physiology and Pharmacology, Athens, GA, United States
| | - H E Gordon
- Department of Physiology and Pharmacology, Athens, GA, United States
| | - H D Ludwig
- Department of Physiology and Pharmacology, Athens, GA, United States
| | - J J Wagner
- Department of Physiology and Pharmacology, Athens, GA, United States
| | - D A Harn
- Department of Infectious Diseases, Athens, GA, United States; Center for Tropical and Emerging Infectious Diseases, University of Georgia, Athens, GA, United States
| | - T Norberg
- Department of Chemistry, University of Uppsala, Uppsala, Sweden
| | - N M Filipov
- Department of Physiology and Pharmacology, Athens, GA, United States.
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Kerr K, Morse G, Graves D, Zuo F, Lipowicz A, Carpenter DO. A Detoxification Intervention for Gulf War Illness: A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4143. [PMID: 31661809 PMCID: PMC6862571 DOI: 10.3390/ijerph16214143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 01/17/2023]
Abstract
Approximately 30% of the 700,000 US veterans of the 1990-1991 Persian Gulf War developed multiple persistent symptoms called Gulf War illness. While the etiology is uncertain, several toxic exposures including pesticides and chemical warfare agents have shown associations. There is no effective medical treatment. An intervention to enhance detoxification developed by Hubbard has improved quality of life and/or reduced body burdens in other cohorts. We evaluated its feasibility and efficacy in ill Gulf War (GW) veterans in a randomized, waitlist-controlled, pilot study at a community-based rehabilitation facility in the United States. Eligible participants (n = 32) were randomly assigned to the intervention (n = 22) or a four-week waitlist control (n = 10). The daily 4-6 week intervention consisted of exercise, sauna-induced sweating, crystalline nicotinic acid and other supplements. Primary outcomes included recruitment, retention and safety; and efficacy was measured via Veteran's Short Form-36 (SF-36) quality of life, McGill pain, multidimensional fatigue inventory questionnaires and neuropsychological batteries. Scoring of outcomes was blinded. All 32 completed the trial and 21 completed 3-month follow-up. Mean SF-36 physical component summary score after the intervention was 6.9 (95% CI; -0.3, 14.2) points higher compared to waitlist control and 11 of 16 quality of life, pain and fatigue measures improved, with no serious adverse events. Most improvements were retained after 3 months. The Hubbard regimen was feasible, safe and might offer relief for symptoms of GW illness.
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Affiliation(s)
- Kathleen Kerr
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada.
| | - Gayle Morse
- Department of Psychology, The Sage Colleges, Troy, NY 12180, USA.
- Institute for Health and the Environment, University at Albany, Albany, NY 12144, USA.
| | - Donald Graves
- Department of Psychology, The Sage Colleges, Troy, NY 12180, USA.
| | - Fei Zuo
- Applied Health Research Centre, St. Michael's Hospital, Toronto, ON M5G 1B1, Canada.
| | - Alain Lipowicz
- Trillium Gift of Life Network, Ministry of Health and Long-Term Care, Toronto, ON M5G 2C9, Canada.
| | - David O Carpenter
- Institute for Health and the Environment, University at Albany, Albany, NY 12144, USA.
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Jeffrey MG, Krengel M, Kibler JL, Zundel C, Klimas NG, Sullivan K, Craddock TJA. Neuropsychological Findings in Gulf War Illness: A Review. Front Psychol 2019; 10:2088. [PMID: 31616335 PMCID: PMC6775202 DOI: 10.3389/fpsyg.2019.02088] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 08/28/2019] [Indexed: 12/11/2022] Open
Abstract
This review paper summarizes the accumulation of research investigating neuropsychological outcomes in veterans with Gulf War illness (GWI). Earlier research focused on Gulf War veterans (GW) who were deployed versus non-deployed, as well as those who were symptomatic versus asymptomatic, or compared neuropsychological test results to published norms. Further research became more sophisticated, investigating specific GWI criteria, as well as the result of neurotoxicant exposure and the relationship to possible neurocognitive outcomes. As the early research supported both psychological and physiological effects on GWI; current research as summarized in this literature review supports the presence of neuropsychological deficits, particularly in the domains of attention, executive functioning, memory, and motor functioning related to chemical exposures that can be exacerbated by comorbid mood-related conditions. The same test battery has not been used consistently making it difficult to compare results among studies. Therefore, researchers created a resource to provide recommendations for the recently listed Neuropsychological Tests for Common Data Elements (CDEs) for use in all future GWI studies. Future research is necessary to further understand patterns of neuropsychological test data and how these decrements may relate to immunological or other biological markers, and the impact of trauma from physical and psychological stressors. In conclusion, there is consistent evidence that GWI is characterized by neuropsychological decrements - with future research these findings may aid in the diagnosis and assessment of treatment trial efficacy of GW veterans.
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Affiliation(s)
- Mary G. Jeffrey
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | | | - Jeffrey L. Kibler
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Clara Zundel
- VA Boston Healthcare System, Boston, MA, United States
| | - Nancy G. Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
- Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, United States
- Miami VA Medical Center, Miami, FL, United States
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Travis J. A. Craddock
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
- Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, United States
- Department of Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, FL, United States
- Department of Computer Science, Nova Southeastern University, Fort Lauderdale, FL, United States
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Pearson-Smith JN, Patel M. Antioxidant drug therapy as a neuroprotective countermeasure of nerve agent toxicity. Neurobiol Dis 2019; 133:104457. [PMID: 31028872 PMCID: PMC7721294 DOI: 10.1016/j.nbd.2019.04.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/12/2022] Open
Abstract
The use of chemical warfare agents is an ongoing, significant threat to both civilians and military personnel worldwide. Nerve agents are by far the most formidable toxicants in terms of their lethality and toxicity. Nerve agents initiate neurotoxicity by the irreversible inhibition of acetylcholinesterase and resultant accumulation of acetylcholine in excitable tissues. The cholinergic toxidrome presents as miosis, lacrimation, diarrhea, fasciculations, seizures, respiratory arrest and coma. Current medical countermeasures can attenuate acute mortality and confer limited protection against secondary neuronal injury when given rapidly after exposure. However, there is an urgent need for the development of novel, add-on neuroprotective therapies to prevent mortality and long-term toxicity of nerve agents. Increasing evidence suggests that pathways other than direct acetylcholinesterase inhibition contribute to neurotoxicity and secondary neuronal injury. Among these, oxidative stress is emerging as a key therapeutic target for nerve agent toxicity. In this review, we discuss the rationale for targeting oxidative stress in nerve agent toxicity and highlight research investigating antioxidant therapy as a neuroprotective medical countermeasure to attenuate oxidative stress, neuroinflammation and neurodegeneration.
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Affiliation(s)
- Jennifer N Pearson-Smith
- Department of Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, 80045, United States of America
| | - Manisha Patel
- Department of Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, 80045, United States of America.
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Zundel CG, Krengel MH, Heeren T, Yee MK, Grasso CM, Janulewicz Lloyd PA, Coughlin SS, Sullivan K. Rates of Chronic Medical Conditions in 1991 Gulf War Veterans Compared to the General Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060949. [PMID: 30884809 PMCID: PMC6466358 DOI: 10.3390/ijerph16060949] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 11/16/2022]
Abstract
Prevalence of nine chronic medical conditions in the population-based Ft. Devens Cohort (FDC) of GW veterans were compared with the population-based 2013–2014 National Health and Nutrition Examination Survey (NHANES) cohort. Excess prevalence was calculated as the difference in prevalence estimates from the Ft. Devens and NHANES cohorts; and confidence intervals and p-values are based on the standard errors for the two prevalence estimates. FDC males were at increased risk for reporting seven chronic medical conditions compared with NHANES males. FDC females were at decreased risk for high blood pressure and increased risk for diabetes when compared with NHANES females. FDC veterans reporting war-related chemical weapons exposure showed higher risk of high blood pressure; diabetes; arthritis and chronic bronchitis while those reporting taking anti-nerve gas pills had increased risk of heart attack and diabetes. GW veterans are at higher risk of chronic conditions than the general population and these risks are associated with self-reported toxicant exposures.
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Affiliation(s)
- Clara G Zundel
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA.
- Division of Graduate Medical Sciences, Behavioral Neuroscience, Boston University School of Medicine, Boston, MA 02118, USA.
| | - Maxine H Krengel
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA.
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA.
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA.
| | - Megan K Yee
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA.
| | - Claudia M Grasso
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA.
| | | | - Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA 30912, USA.
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA.
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The Multiple Hit Hypothesis for Gulf War Illness: Self-Reported Chemical/Biological Weapons Exposure and Mild Traumatic Brain Injury. Brain Sci 2018; 8:brainsci8110198. [PMID: 30428552 PMCID: PMC6266762 DOI: 10.3390/brainsci8110198] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 12/22/2022] Open
Abstract
The Gulf War Illness Consortium (GWIC) was designed to identify objective biomarkers of Gulf War Illness (GWI) in 1991 Gulf War veterans. The symptoms of GWI include fatigue, pain, cognitive problems, gastrointestinal, respiratory, and skin problems. Neurotoxicant exposures during deployment, such as pesticides, sarin, and pyridostigmine bromide pills have been identified as contributors to GWI. We have also found an association between mild traumatic brain injury (mTBI) and increased rates of GWI. However, the combined impact of these physical and chemical exposures has not yet been explored in GWI. The objective of this study was to examine both self-reported mTBI and exposure to chemical/biological weapons (CBW) as a multiple or two hit model for increased risk of GWI and other chronic health conditions. The study population included 125 Gulf War (GW) veterans from the Boston GWIC. Exposure to CBW was reported in 47.2% of the study population, and 35.2% reported sustaining a mTBI during the war. Results confirmed that those with both exposures (mTBI and CBW) had higher rates of comorbid chronic health conditions while rates of GWI were equivalent for mTBI and CBW or mTBI alone. The timing of exposure to mTBI was found to be strikingly different between those with GWI and those without it. Correspondingly, 42.3% of GWI cases reported experiencing a mTBI during military service while none of the controls did (p = 0.0002). Rates of mTBI before and after the war did not differ between the cases and controls. In addition, 54% of cases compared to 14.3% of controls (p = <0.001) reported being exposed to CBW during military service. The current study examined the relation of the separate and combined effects of exposure to mTBI and CBW in 1991 GW veterans. The findings from this study suggest that both exposure to mTBI and CBW are associated with the development of GWI and multiple chronic health conditions and that combined exposure appears to lead to higher risk of chronic health effects.
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Vysloužil J, Vetchý D, Zeman J, Farsa O, Franc A, Gajdziok J, Vysloužil J, Ficeriová K, Kulich P, Kobliha Z, Pitschmann V. Pellet patented technology for fast and distinct visual detection of cholinesterase inhibitors in liquids. J Pharm Biomed Anal 2018; 161:206-213. [DOI: 10.1016/j.jpba.2018.08.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/13/2018] [Accepted: 08/24/2018] [Indexed: 01/14/2023]
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Effects of low-level sarin and cyclosarin exposure on hippocampal microstructure in Gulf War Veterans. Neurotoxicol Teratol 2018; 68:36-46. [PMID: 29733897 DOI: 10.1016/j.ntt.2018.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/13/2018] [Accepted: 05/02/2018] [Indexed: 12/18/2022]
Abstract
In early March 1991, shortly after the end of the Gulf War (GW), a munitions dump was destroyed at Khamisiyah, Iraq. Later, in 1996, the dump was found to have contained the organophosphorus (OP) nerve agents sarin and cyclosarin. We previously reported evidence of smaller hippocampal volumes in GW veterans with predicted exposure to the Khamisiyah plume compared to unexposed GW veterans. To investigate whether these macroscopic hippocampal volume changes are accompanied by microstructural alterations in the hippocampus, the current study acquired diffusion-tensor imaging (DTI), T1-, and T2-weighted images from 170 GW veterans (mean age: 53 ± 7 years), 81 of whom had predicted exposure to the Khamisiyah plume according to Department of Defense (DOD) plume modeling. We examined fractional anisotropy (FA), mean diffusivity (MD), and grey matter (GM) density from a hippocampal region of interest (ROI). Results indicate that, even after accounting for total hippocampal GM density (or hippocampal volume), age, sex, apolipoprotein ε4 genotype, and potential confounding OP pesticide exposures, hippocampal MD significantly predicted Khamisiyah exposure status (model p = 0.005, R2 = 0.215, standardized coefficient β = 0.26, t = 2.85). Hippocampal MD was also inversely correlated with verbal memory learning performance in the entire study sample (p = 0.001). There were no differences in hippocampal FA or GM density; however, veterans with predicted Khamisiyah exposure had smaller hippocampal volumes compared to unexposed veterans. Because MD is sensitive to general microstructural disruptions that lead to increased extracellular spaces due to neuronal death, inflammation and gliosis, and/or to axonal loss or demyelination, these findings suggest that low-level exposure to the Khamisiyah plume has a detrimental, lasting effects on both macro- and micro-structure of the hippocampus.
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Sullivan K, Krengel M, Bradford W, Stone C, Thompson TA, Heeren T, White RF. Neuropsychological functioning in military pesticide applicators from the Gulf War: Effects on information processing speed, attention and visual memory. Neurotoxicol Teratol 2018; 65:1-13. [DOI: 10.1016/j.ntt.2017.11.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 11/25/2022]
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Early changes in M2 muscarinic acetylcholine receptors (mAChRs) induced by sarin intoxication may be linked to long lasting neurological effects. Neurotoxicology 2017; 65:248-254. [PMID: 29128314 DOI: 10.1016/j.neuro.2017.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/05/2017] [Accepted: 11/05/2017] [Indexed: 01/08/2023]
Abstract
The effect of sarin on the binding parameters (KD & Bmax) of M2 muscarinic acetylcholine receptor (mAChR) was studied 24h and 1 week post exposure. Male & female Sprague-Daweley rats were poisoned with 1XLD50 sarin (80μg/kg, im) followed by treatment of trimedoxime bromide and atropine (7.5:5mg/kg, im) 1min later. Brains were removed and analyzed for M2 mAChR binding, using [3H]AFDX384, an M2 selective antagonist. A significant increase in KD of M2 mAChR was found in the cortex 24h post poisoning, displaying elevation from 4.65±1.16 to 8.45±1.06nM and 5.24±0.93 to 9.29±1.56nM in male and female rats, respectively. A rise in KD was also noted 1 week following exposure from 5.04±1.20 to 11.75±2.78 and from 5.37±1.02 to 11.66±1.73nM, presenting an added increase of 51 and 40% (compared to 24h) in males and females, respectively. Analysis of M2 receptor density (Bmax) revealed a significant reduction of 68% in males and insignificant reduction of 22% in females, 24h after sarin exposure which was followed by 37% recovery in males and 100% recovery in females, 1 week later. These results indicate that sarin induces a long-term decreased affinity in M2 mAChR (elevated KDs) and a transient effect on the number of this receptor subtype (Bmax). We hypothesize that the reduced affinity of the M2 receptors (negative auto-regulatory receptors) may cause long-term brain deficits by impairing the normal regulation release of ACh into the synaptic cleft.
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Barth SK, Dursa EK, Bossarte RM, Schneiderman AI. Trends in brain cancer mortality among U.S. Gulf War veterans: 21 year follow-up. Cancer Epidemiol 2017; 50:22-29. [PMID: 28780478 DOI: 10.1016/j.canep.2017.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 07/13/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Previous mortality studies of U.S. Gulf War veterans through 2000 and 2004 have shown an increased risk of brain cancer mortality among some deployed individuals. When veterans possibly exposed to environmental contaminants associated with demolition of the Khamisiyah Ammunition Storage Facility at Khamisiyah, Iraq, have been compared to contemporaneously deployed unexposed veterans, the results have suggested increased risk for mortality from brain cancer among the exposed. Brain cancer mortality risk in this cohort has not been updated since 2004. METHODS This study analyzes the risk for brain cancer mortality between 1991-2011 through two series of comparisons: U.S. Gulf War deployed and non-deployed veterans from the same era; and veterans possibly exposed to environmental contaminants at Khamisiyah compared to contemporaneously deployed but unexposed U.S. Gulf War veterans. Risk of brain cancer mortality was determined using logistic regression. Life test hazard models were created to plot comparisons of annual hazard rates. Joinpoint regression models were applied to assess trends in hazard rates for brain cancer mortality. RESULTS U.S. Army veterans possibly exposed at Khamisiyah had similar rates of brain cancer mortality compared to those not possibly exposed; however, veterans possibly exposed had a higher risk of brain cancer in the time period immediately following the Gulf War. CONCLUSION Results from these analyses suggest that veterans possibly exposed at Khamisiyah experienced different patterns of brain cancer mortality risk compared to the other groups.
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Affiliation(s)
- Shannon K Barth
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA; West Virginia University Injury Control Research Center, Morgantown, WV, USA.
| | - Erin K Dursa
- Post Deployment Health Epidemiology Program, Office of Patient Care Services, Veterans Health Administration, Department of Veterans Affairs, USA
| | - Robert M Bossarte
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA; West Virginia University Injury Control Research Center and Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Aaron I Schneiderman
- Post Deployment Health Epidemiology Program, Office of Patient Care Services, Veterans Health Administration, Department of Veterans Affairs, USA
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Huprikar NA, Deas SD, Skabelund AJ. Non-traumatic Pulmonary Emergencies in the Deployed Setting. CURRENT PULMONOLOGY REPORTS 2017; 6:138-145. [PMID: 32288987 PMCID: PMC7102247 DOI: 10.1007/s13665-017-0180-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Pulmonary disorders accounted for up to 8% of the over 70,000 medical evacuations conducted from Iraq and Afghanistan in the past 15 years. This review of non-traumatic pulmonary emergencies provides an overview of deployed military medical treatment capabilities and highlights pulmonary emergencies requiring aeromedical evacuation from theater. RECENT FINDINGS Recent studies have improved the epidemiologic evaluation of non-traumatic pulmonary disease, highlighted specific parenchymal diseases, and revealed infection pathologies unique to the deployed setting. Literature regarding possible chemical exposures in the current deployed environment remains limited. SUMMARY Respiratory disorders requiring medical evacuation represent a wide variety of diseases. Complications such as pulmonary emboli, infectious pathogens, and hazardous chemical exposures threaten the deployed warfighter. Adequate medical care requires an understanding of these potential environmental exposures. This review serves as a general overview of this topic; however, more research regarding epidemiologic and environmental exposures is required.
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Affiliation(s)
- Nikhil A. Huprikar
- Pulmonary/Critical Care Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Fort Sam Houston, San Antonio, TX 78234 USA
| | - Steven D. Deas
- Pulmonary/Critical Care Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Fort Sam Houston, San Antonio, TX 78234 USA
| | - Andrew J. Skabelund
- Pulmonary/Critical Care Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Fort Sam Houston, San Antonio, TX 78234 USA
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Rao AN, Patil A, Brodnik ZD, Qiang L, España RA, Sullivan KA, Black MM, Baas PW. Pharmacologically increasing microtubule acetylation corrects stress-exacerbated effects of organophosphates on neurons. Traffic 2017; 18:433-441. [PMID: 28471062 DOI: 10.1111/tra.12489] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/30/2017] [Accepted: 05/01/2017] [Indexed: 12/18/2022]
Abstract
Many veterans of the 1990-1991 Gulf War contracted Gulf War Illness (GWI), a multisymptom disease that primarily affects the nervous system. Here, we treated cultures of human or rat neurons with diisopropyl fluorophosphate (DFP), an analog of sarin, one of the organophosphate (OP) toxicants to which the military veterans were exposed. All observed cellular defects produced by DFP were exacerbated by pretreatment with corticosterone or cortisol, which, in rat and human neurons, respectively, serves in our experiments to mimic the physical stress endured by soldiers during the war. To best mimic the disease, DFP was used below the level needed to inhibit acetylcholinesterase. We observed a diminution in the ratio of acetylated to total tubulin that was correctable by treatment with tubacin, a drug that inhibits HDAC6, the tubulin deacetylase. The reduction in microtubule acetylation was coupled with deficits in microtubule dynamics, which were correctable by HDAC6 inhibition. Deficits in mitochondrial transport and dopamine release were also improved by tubacin. Thus, various negative effects of the toxicant/stress exposures were at least partially correctable by restoring microtubule acetylation to a more normal status. Such an approach may have therapeutic benefit for individuals suffering from GWI or other neurological disorders linked to OP exposure.
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Affiliation(s)
- Anand N Rao
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Ankita Patil
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Zachary D Brodnik
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Liang Qiang
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Rodrigo A España
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | - Mark M Black
- Department of Anatomy and Cell Biology, Temple University, Philadelphia, Pennsylvania
| | - Peter W Baas
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Janulewicz PA, Krengel MH, Maule A, White RF, Cirillo J, Sisson E, Heeren T, Sullivan K. Neuropsychological characteristics of Gulf War illness: A meta-analysis. PLoS One 2017; 12:e0177121. [PMID: 28520755 PMCID: PMC5435307 DOI: 10.1371/journal.pone.0177121] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/21/2017] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Gulf War illness (GWI) is a disorder related to military service in the 1991 GW. Prominent symptoms include fatigue, pain and cognitive problems. These symptoms were reported by GW Veterans (GWV) immediately after the war and were eventually incorporated into case definitions of GWI. Neuropsychological function in GW veterans has been studied both among deployed GWV and in GWV diagnosed with GWI. Results have been inconsistent between and across GW populations. The purpose of the present investigation was to better characterize neuropsychological function in this veteran population. METHODS Meta-analysis techniques were applied to published studies on neuropsychological performance in GWV to identify domains of dysfunction in deployed vs. non-deployed GW-era veterans and symptomatic vs. non-symptomatic GWVs. RESULTS Significantly decreased performance was found in three functional domains: attention and executive function, visuospatial skills and learning/memory. CONCLUSIONS These findings document the cognitive decrements associated with GW service, validate current GWI case definitions using cognitive criteria, and identify test measures for use in GWI research assessing GWI treatment trial efficacy.
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Affiliation(s)
- Patricia A. Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Maxine H. Krengel
- VA Boston Healthcare System, Jamaica Plain, Massachusetts, United States of America
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Alexis Maule
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Roberta F. White
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Joanna Cirillo
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Emily Sisson
- Data Coordinating Center, Boston University, Boston, Massachusetts, United States of America
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
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Screening for novel central nervous system biomarkers in veterans with Gulf War Illness. Neurotoxicol Teratol 2017; 61:36-46. [DOI: 10.1016/j.ntt.2017.03.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 12/19/2022]
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Althaus AL, McCarren HS, Alqazzaz A, Jackson C, McDonough JH, Smith CD, Hoffman E, Hammond RS, Robichaud AJ, Doherty JJ. The synthetic neuroactive steroid SGE-516 reduces status epilepticus and neuronal cell death in a rat model of soman intoxication. Epilepsy Behav 2017; 68:22-30. [PMID: 28109985 DOI: 10.1016/j.yebeh.2016.12.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/18/2016] [Accepted: 12/17/2016] [Indexed: 12/18/2022]
Abstract
Organophosphorus nerve agents (OPNAs) are irreversible inhibitors of acetylcholinesterase that pose a serious threat to public health because of their use as chemical weapons. Exposure to high doses of OPNAs can dramatically potentiate cholinergic synaptic activity and cause status epilepticus (SE). Current standard of care for OPNA exposure involves treatment with cholinergic antagonists, oxime cholinesterase reactivators, and benzodiazepines. However, data from pre-clinical models suggest that OPNA-induced SE rapidly becomes refractory to benzodiazepines. Neuroactive steroids (NAS), such as allopregnanolone, retain anticonvulsant activity in rodent models of benzodiazepine-resistant SE, perhaps because they modulate a broader variety of GABAA receptor subtypes. SGE-516 is a novel, next generation NAS and a potent and selective GABAA receptor positive allosteric modulator (PAM). The present study first established that SGE-516 reduced electrographic seizures in the rat lithium-pilocarpine model of pharmacoresistant SE. Then the anticonvulsant activity of SGE-516 was investigated in the soman-intoxication model of OPNA-induced SE. SGE-516 (5.6, 7.5, and 10mg/kg, IP) significantly reduced electrographic seizure activity compared to control when administered 20min after SE onset. When 10mg/kg SGE-516 was administered 40min after SE onset, seizure activity was still significantly reduced compared to control. In addition, all cohorts of rats treated with SGE-516 exhibited significantly reduced neuronal cell death as measured by FluoroJade B immunohistochemistry. These data suggest synthetic NASs that positively modulate both synaptic and extrasynaptic GABAA receptors may be candidates for further study in the treatment of OPNA-induced SE.
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Affiliation(s)
| | - Hilary S McCarren
- United States Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Aymen Alqazzaz
- United States Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Cecelia Jackson
- United States Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - John H McDonough
- United States Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Carl D Smith
- United States Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Ethan Hoffman
- Drug Discovery, Sage Therapeutics, Inc., Cambridge, MA, USA
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Abou-Donia MB, Siracuse B, Gupta N, Sobel Sokol A. Sarin (GB, O-isopropyl methylphosphonofluoridate) neurotoxicity: critical review. Crit Rev Toxicol 2016; 46:845-875. [PMID: 27705071 PMCID: PMC5764759 DOI: 10.1080/10408444.2016.1220916] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Sarin (GB, O-isopropyl methylphosphonofluoridate) is a potent organophosphorus (OP) nerve agent that inhibits acetylcholinesterase (AChE) irreversibly. The subsequent build-up of acetylcholine (ACh) in the central nervous system (CNS) provokes seizures and, at sufficient doses, centrally-mediated respiratory arrest. Accumulation of ACh at peripheral autonomic synapses leads to peripheral signs of intoxication and overstimulation of the muscarinic and nicotinic receptors, which is described as "cholinergic crisis" (i.e. diarrhea, sweating, salivation, miosis, bronchoconstriction). Exposure to high doses of sarin can result in tremors, seizures, and hypothermia. More seriously, build-up of ACh at neuromuscular junctions also can cause paralysis and ultimately peripherally-mediated respiratory arrest which can lead to death via respiratory failure. In addition to its primary action on the cholinergic system, sarin possesses other indirect effects. These involve the activation of several neurotransmitters including gamma-amino-butyric acid (GABA) and the alteration of other signaling systems such as ion channels, cell adhesion molecules, and inflammatory regulators. Sarin exposure is associated with symptoms of organophosphate-induced delayed neurotoxicity (OPIDN) and organophosphate-induced chronic neurotoxicity (OPICN). Moreover, sarin has been involved in toxic and immunotoxic effects as well as organophosphate-induced endocrine disruption (OPIED). The standard treatment for sarin-like nerve agent exposure is post-exposure injection of atropine, a muscarinic receptor antagonist, accompanied by an oxime, an AChE reactivator, and diazepam.
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Affiliation(s)
- Mohamed B Abou-Donia
- a Department of Pharmacology and Cancer Biology , Duke University , Durham , NC , USA
| | - Briana Siracuse
- a Department of Pharmacology and Cancer Biology , Duke University , Durham , NC , USA
| | - Natasha Gupta
- a Department of Pharmacology and Cancer Biology , Duke University , Durham , NC , USA
| | - Ashly Sobel Sokol
- a Department of Pharmacology and Cancer Biology , Duke University , Durham , NC , USA
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Barth SK, Kang HK, Bullman T. All-Cause Mortality Among US Veterans of the Persian Gulf War: 13-Year Follow-up. Public Health Rep 2016; 131:822-830. [PMID: 28123229 DOI: 10.1177/0033354916676278] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We determined cause-specific mortality prevalence and risks of Gulf War deployed and nondeployed veterans to determine if deployed veterans were at greater risk than nondeployed veterans for death overall or because of certain diseases or conditions up to 13 years after conflict subsided. METHODS Follow-up began when the veteran left the Gulf War theater or May 1, 1991, and ended on the date of death or December 31, 2004. We studied 621 901 veterans who served in the 1990-1991 Persian Gulf War and 746 247 veterans who served but were not deployed during the Gulf War. We used Cox proportional hazard models to calculate rate ratios adjusted for age at entry to follow-up, length of follow-up, race, sex, branch of service, and military unit. We compared the mortality of (1) Gulf War veterans with non-Gulf War veterans and (2) Gulf War army veterans potentially exposed to nerve agents at Khamisiyah in March 1991 with those not exposed. We compared standardized mortality ratios of deployed and nondeployed Gulf War veterans with the US population. RESULTS Male Gulf War veterans had a lower risk of mortality than male non-Gulf War veterans (adjusted rate ratio [aRR] = 0.97; 95% confidence interval [CI], 0.95-0.99), and female Gulf War veterans had a higher risk of mortality than female non-Gulf War veterans (aRR = 1.15; 95% CI, 1.03-1.28). Khamisiyah-exposed Gulf War army veterans had >3 times the risk of mortality from cirrhosis of the liver than nonexposed army Gulf War veterans (aRR = 3.73; 95% CI, 1.64-8.48). Compared with the US population, female Gulf War veterans had a 60% higher risk of suicide and male Gulf War veterans had a lower risk of suicide (standardized mortality ratio = 0.84; 95% CI, 0.80-0.88). CONCLUSION The vital status and mortality risk of Gulf War and non-Gulf War veterans should continue to be investigated.
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Affiliation(s)
- Shannon K Barth
- Epidemiology Program, Post-Deployment Health Services, Office of Patient Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Han K Kang
- Epidemiology Program, Post-Deployment Health Services, Office of Patient Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Tim Bullman
- Epidemiology Program, Post-Deployment Health Services, Office of Patient Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
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46
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Associations Between the Self-Reported Frequency of Hearing Chemical Alarms in Theater and Visuospatial Function in Gulf War Veterans. J Occup Environ Med 2016; 58:1014-1020. [DOI: 10.1097/jom.0000000000000851] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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47
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Self-Reported Traumatic Brain Injury, Health and Rate of Chronic Multisymptom Illness in Veterans From the 1990-1991 Gulf War. J Head Trauma Rehabil 2016; 31:320-8. [DOI: 10.1097/htr.0000000000000173] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Smith C, Lee R, Moran A, Sipos M. Repeated low-dose exposures to sarin, soman, or VX affect acoustic startle in guinea pigs. Neurotoxicol Teratol 2016; 54:36-45. [DOI: 10.1016/j.ntt.2016.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/21/2015] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
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49
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Chao LL, Reeb R, Esparza IL, Abadjian LR. Associations between the self-reported frequency of hearing chemical alarms in theater and regional brain volume in Gulf War Veterans. Neurotoxicology 2016; 53:246-256. [PMID: 26920621 DOI: 10.1016/j.neuro.2016.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/01/2016] [Accepted: 02/21/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND We previously reported evidence of reduced cortical gray matter (GM), white matter (WM), and hippocampal volume in Gulf War (GW) veterans with predicted exposure to low-levels of nerve agent according to the 2000 Khamisiyah plume model analysis. Because there is suggestive evidence that other nerve agent exposures may have occurred during the Gulf War, we examined the association between the self-reported frequency of hearing chemical alarms sound during deployment in the Gulf War and regional brain volume in GW veterans. METHODS Ninety consecutive GW veterans (15 female, mean age: 52±8years) participating in a VA-funded study underwent structural magnetic resonance imaging (MRI) on a 3T scanner. Freesurfer (version 5.1) was used to obtain regional measures of cortical GM, WM, hippocampal, and insula volume. Multiple linear regression was used to determine the association between the self-reported frequencies of hearing chemical alarms during the Gulf War and regional brain volume. RESULTS There was an inverse association between the self-reported frequency of hearing chemical alarms sound and total cortical GM (adjusted p=0.007), even after accounting for potentially confounding demographic and clinical variables, the veterans' current health status, and other concurrent deployment-related exposures that were correlated with hearing chemical alarms. Post-hoc analyses extended the inverse relationship between the frequency of hearing chemical alarms to GM volume in the frontal (adjusted p=0.02), parietal (adjusted p=0.01), and occipital (adjusted p=0.001) lobes. In contrast, regional brain volumes were not significantly associated with predicted exposure to the Khamisiyah plume or with Gulf War Illness status defined by the Kansas or Centers for Disease Control and Prevention criteria. CONCLUSIONS Many veterans reported hearing chemical alarms sound during the Gulf War. The current findings suggest that exposure to substances that triggered those chemical alarms during the Gulf War likely had adverse neuroanatomical effects.
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Affiliation(s)
- Linda L Chao
- Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, 114M, San Francisco, CA 94121, United States; Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States; Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States.
| | - Rosemary Reeb
- Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, 114M, San Francisco, CA 94121, United States; Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Iva L Esparza
- Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, 114M, San Francisco, CA 94121, United States
| | - Linda R Abadjian
- Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, 114M, San Francisco, CA 94121, United States
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50
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Piermartiri T, Pan H, Figueiredo TH, Marini AM. α-Linolenic Acid, A Nutraceutical with Pleiotropic Properties That Targets Endogenous Neuroprotective Pathways to Protect against Organophosphate Nerve Agent-Induced Neuropathology. Molecules 2015; 20:20355-80. [PMID: 26569216 PMCID: PMC6332275 DOI: 10.3390/molecules201119698] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 10/29/2015] [Accepted: 11/03/2015] [Indexed: 01/23/2023] Open
Abstract
α-Linolenic acid (ALA) is a nutraceutical found in vegetable products such as flax and walnuts. The pleiotropic properties of ALA target endogenous neuroprotective and neurorestorative pathways in brain and involve the transcription factor nuclear factor kappa B (NF-κB), brain-derived neurotrophic factor (BDNF), a major neuroprotective protein in brain, and downstream signaling pathways likely mediated via activation of TrkB, the cognate receptor of BDNF. In this review, we discuss possible mechanisms of ALA efficacy against the highly toxic OP nerve agent soman. Organophosphate (OP) nerve agents are highly toxic chemical warfare agents and a threat to military and civilian populations. Once considered only for battlefield use, these agents are now used by terrorists to inflict mass casualties. OP nerve agents inhibit the critical enzyme acetylcholinesterase (AChE) that rapidly leads to a cholinergic crisis involving multiple organs. Status epilepticus results from the excessive accumulation of synaptic acetylcholine which in turn leads to the overactivation of muscarinic receptors; prolonged seizures cause the neuropathology and long-term consequences in survivors. Current countermeasures mitigate symptoms and signs as well as reduce brain damage, but must be given within minutes after exposure to OP nerve agents supporting interest in newer and more effective therapies. The pleiotropic properties of ALA result in a coordinated molecular and cellular program to restore neuronal networks and improve cognitive function in soman-exposed animals. Collectively, ALA should be brought to the clinic to treat the long-term consequences of nerve agents in survivors. ALA may be an effective therapy for other acute and chronic neurodegenerative disorders.
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Affiliation(s)
- Tetsade Piermartiri
- Molecular and Cellular Biology Graduate School Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Hongna Pan
- Department of Neurology and Program in Neuroscience, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Taiza H Figueiredo
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Ann M Marini
- Department of Neurology and Program in Neuroscience, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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