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Chao LL, Sullivan K, Krengel MH, Killiany RJ, Steele L, Klimas NG, Koo BB. The prevalence of mild cognitive impairment in Gulf War veterans: a follow-up study. Front Neurosci 2024; 17:1301066. [PMID: 38318196 PMCID: PMC10838998 DOI: 10.3389/fnins.2023.1301066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/18/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Gulf War Illness (GWI), also called Chronic Multisymptom Illness (CMI), is a multi-faceted condition that plagues an estimated 250,000 Gulf War (GW) veterans. Symptoms of GWI/CMI include fatigue, pain, and cognitive dysfunction. We previously reported that 12% of a convenience sample of middle aged (median age 52 years) GW veterans met criteria for mild cognitive impairment (MCI), a clinical syndrome most prevalent in older adults (e.g., ≥70 years). The current study sought to replicate and extend this finding. Methods We used the actuarial neuropsychological criteria and the Montreal Cognitive Assessment (MoCA) to assess the cognitive status of 952 GW veterans. We also examined regional brain volumes in a subset of GW veterans (n = 368) who had three Tesla magnetic resonance images (MRIs). Results We replicated our previous finding of a greater than 10% rate of MCI in four additional cohorts of GW veterans. In the combined sample of 952 GW veterans (median age 51 years at time of cognitive testing), 17% met criteria for MCI. Veterans classified as MCI were more likely to have CMI, history of depression, and prolonged (≥31 days) deployment-related exposures to smoke from oil well fires and chemical nerve agents compared to veterans with unimpaired and intermediate cognitive status. We also replicated our previous finding of hippocampal atrophy in veterans with MCI, and found significant group differences in lateral ventricle volumes. Discussion Because MCI increases the risk for late-life dementia and impacts quality of life, it may be prudent to counsel GW veterans with cognitive dysfunction, CMI, history of depression, and high levels of exposures to deployment-related toxicants to adopt lifestyle habits that have been associated with lowering dementia risk. With the Food and Drug Administration's recent approval of and the VA's decision to cover the cost for anti-amyloid β (Aβ) therapies, a logical next step for this research is to determine if GW veterans with MCI have elevated Aβ in their brains.
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Affiliation(s)
- Linda L. Chao
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Maxine H. Krengel
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Ronald J. Killiany
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, United States
| | - Lea Steele
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Nancy G. Klimas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
- Geriatric Research Education and Clinical Center (GRECC), Miami VA Medical Center, Miami, FL, United States
| | - Bang-Bong Koo
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, United States
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Zhang Y, Moore M, Jennings JS, Clark JD, Bayley PJ, Ashford JW, Furst AJ. The role of the brainstem in sleep disturbances and chronic pain of Gulf War and Iraq/Afghanistan veterans. Front Mol Neurosci 2024; 16:1266408. [PMID: 38260809 PMCID: PMC10800562 DOI: 10.3389/fnmol.2023.1266408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Gulf War Illness is a type of chronic multisymptom illness, that affects about 30% of veterans deployed to the 1990-91 Persian Gulf War. Veterans deployed to Iraq/Afghanistan after 2000 are reported to have a similar prevalence of chronic multisymptom illness. More than 30 years after the Persian Gulf War, Gulf War Illness still has an unexplained symptom complex, unknown etiology and lacks definitive diagnostic criteria and effective treatments. Our recent studies have found that substantially smaller brainstem volumes and lower fiber integrity are associated with increased sleep difficulty and pain intensity in 1990-91 Persian Gulf War veterans. This study was conducted to investigate whether veterans deployed to Iraq/Afghanistan present similar brainstem damage, and whether such brainstem structural differences are associated with major symptoms as in Gulf War Illness. Methods Here, we used structural magnetic resonance imaging and diffusion tensor imaging to measure the volumes of subcortices, brainstem subregions and white matter integrity of brainstem fiber tracts in 188 veterans including 98 Persian Gulf War veterans and 90 Iraq/Afghanistan veterans. Results We found that compared to healthy controls, veterans of both campaigns presented with substantially smaller volumes in brainstem subregions, accompanied by greater periaqueductal gray matter volumes. We also found that all veterans had reduced integrity in the brainstem-spinal cord tracts and the brainstem-subcortical tracts. In veterans deployed during the 1990-91 Persian Gulf War, we found that brainstem structural deficits significantly correlated with increased sleep difficulties and pain intensities, but in veterans deployed to Iraq/Afghanistan, no such effect was observed. Discussion These structural differences in the brainstem neurons and tracts may reflect autonomic dysregulation corresponding to the symptom constellation, which is characteristic of Gulf War Illness. Understanding these neuroimaging and neuropathological relationships in Gulf War and Iraq/Afghanistan veterans may improve clinical management and treatment strategies for modern war related chronic multisymptom illness.
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Affiliation(s)
- Yu Zhang
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Matthew Moore
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jennifer S. Jennings
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - J. David Clark
- Anesthesiology Service, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Peter J. Bayley
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - J. Wesson Ashford
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Ansgar J. Furst
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
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Plummer AM, Matos YL, Lin HC, Ryman SG, Birg A, Quinn DK, Parada AN, Vakhtin AA. Gut-brain pathogenesis of post-acute COVID-19 neurocognitive symptoms. Front Neurosci 2023; 17:1232480. [PMID: 37841680 PMCID: PMC10568482 DOI: 10.3389/fnins.2023.1232480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Approximately one third of non-hospitalized coronavirus disease of 2019 (COVID-19) patients report chronic symptoms after recovering from the acute stage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Some of the most persistent and common complaints of this post-acute COVID-19 syndrome (PACS) are cognitive in nature, described subjectively as "brain fog" and also objectively measured as deficits in executive function, working memory, attention, and processing speed. The mechanisms of these chronic cognitive sequelae are currently not understood. SARS-CoV-2 inflicts damage to cerebral blood vessels and the intestinal wall by binding to angiotensin-converting enzyme 2 (ACE2) receptors and also by evoking production of high levels of systemic cytokines, compromising the brain's neurovascular unit, degrading the intestinal barrier, and potentially increasing the permeability of both to harmful substances. Such substances are hypothesized to be produced in the gut by pathogenic microbiota that, given the profound effects COVID-19 has on the gastrointestinal system, may fourish as a result of intestinal post-COVID-19 dysbiosis. COVID-19 may therefore create a scenario in which neurotoxic and neuroinflammatory substances readily proliferate from the gut lumen and encounter a weakened neurovascular unit, gaining access to the brain and subsequently producing cognitive deficits. Here, we review this proposed PACS pathogenesis along the gut-brain axis, while also identifying specific methodologies that are currently available to experimentally measure each individual component of the model.
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Affiliation(s)
- Allison M. Plummer
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Yvette L. Matos
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, United States
| | - Henry C. Lin
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, NM, United States
- Section of Gastroenterology, New Mexico Veterans Affairs Health Care System, Albuquerque, NM, United States
| | - Sephira G. Ryman
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, United States
- Nene and Jamie Koch Comprehensive Movement Disorder Center, Department of Neurology, University of New Mexico, Albuquerque, NM, United States
| | - Aleksandr Birg
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, NM, United States
- Section of Gastroenterology, New Mexico Veterans Affairs Health Care System, Albuquerque, NM, United States
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Alisha N. Parada
- Division of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Andrei A. Vakhtin
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, United States
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Bhatti G, Villalon A, Li R, Elammari M, Price A, Steele L, Garcia JM, Marcelli M, Jorge R. Hormonal changes in veterans with Gulf War Illness. Life Sci 2023; 328:121908. [PMID: 37406768 DOI: 10.1016/j.lfs.2023.121908] [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: 05/01/2023] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023]
Abstract
AIMS Gulf War Illness (GWI) is a multi-system condition of complex etiology and pathophysiology without specific treatment. There is an overlap between the symptoms of GWI and endocrinopathies. This study aimed to identify hormonal alterations in 1990-91 Gulf War (GW) veterans and the relationship between GWI and hormonal dysregulation. MAIN METHODS Data from 81 GW veterans (54 with GWI and 27 controls without GWI) was analyzed in a cross-sectional, case-control observational study. Participants completed multiple questionnaires, neuropsychiatric assessments, and a comprehensive set of hormone assays including a glucagon stimulation test (GST) for adult growth hormone deficiency (AGHD) and a high-dose adrenocorticotropic hormone (ACTH) stimulation test for adrenal insufficiency. KEY FINDINGS The GWI group had lower quality of life and greater severity of all symptoms compared to controls. Pain intensity and pain-related interference with general activity were also higher in the GWI group. AGHD was observed in 18 of 51 veterans with GWI (35.3 %) and 2 of 26 veterans without GWI (7.7 %) (p = 0.012 for interaction). Veterans with GWI also exhibited reduced insulin-like growth factor 1 (IGF-1) levels and IGF-1 Z-scores compared to controls. One participant with GWI met the criteria for adrenal insufficiency. No significant changes were observed in other hormonal axes. SIGNIFICANCE The frequency of AGHD was significantly higher in veterans with GWI compared to controls. Recombinant human growth hormone replacement therapy (GHRT) may become a breakthrough therapeutic option for this subgroup. A large clinical trial is needed to evaluate the efficacy of GHRT in patients with GWI and AGHD.
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Affiliation(s)
- Gursimrat Bhatti
- Michael E. DeBakey VA Medical Center, Seattle, WA, USA; Beth K and Stuart C Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Seattle, WA, USA
| | - Audri Villalon
- Michael E. DeBakey VA Medical Center, Seattle, WA, USA; Beth K and Stuart C Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Seattle, WA, USA
| | - Ruosha Li
- UT Health Science Center School of Public Health, Seattle, WA, USA
| | - Mohamed Elammari
- Michael E. DeBakey VA Medical Center, Seattle, WA, USA; Beth K and Stuart C Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Seattle, WA, USA
| | - Alexandra Price
- Beth K and Stuart C Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Seattle, WA, USA
| | - Lea Steele
- Beth K and Stuart C Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Seattle, WA, USA
| | - Jose M Garcia
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, and Gerontology and Geriatric Medicine-Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Ricardo Jorge
- Michael E. DeBakey VA Medical Center, Seattle, WA, USA; Beth K and Stuart C Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Seattle, WA, USA.
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Ocular and inflammatory markers associated with Gulf War illness symptoms. Sci Rep 2023; 13:3512. [PMID: 36864130 PMCID: PMC9981620 DOI: 10.1038/s41598-023-30544-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
To examine the utility of ocular coherence tomography (OCT) metrics, in conjunction with systemic markers of inflammation, in identifying individuals with Gulf War Illness (GWI) symptoms. Prospective case-control study of 108 Gulf War Era veterans, split into 2 groups based on the presence of GWI symptoms, defined by the Kansas criteria. Information on demographics, deployment history, and co-morbidities were captured. 101 individuals underwent OCT imaging and 105 individuals provided a blood sample which was analyzed for inflammatory cytokines using an enzyme-linked immunosorbent assay-based chemiluminescent assay. The main outcome measure was predictors of GWI symptoms, examined with multivariable forward stepwise logistic regression analysis followed by receiver operating characteristic (ROC) analysis. The mean age of the population was 55 ± 4, 90.7% self-identified as male, 53.3% as White, and 54.3% as Hispanic. A multivariable model that considered demographics and co-morbidities found that a lower inferior temporal ganglion cell layer-inner plexiform layer (GCL‒IPL) thickness, higher temporal nerve fiber layer (NFL) thickness, lower interleukin (IL)-1β levels, higher IL-1α levels, and lower tumor necrosis factor-receptor I levels correlated with GWI symptoms. ROC analysis demonstrated an area under the curve of 0.78 with the best cut-off value for the prediction model having a sensitivity of 83% and specificity of 58%. RNFL and GCL‒IPL measures, namely increased temporal thickness and decreased inferior temporal thickness, respectively, in conjunction with a number of inflammatory cytokines, had a reasonable sensitivity for the diagnosis of GWI symptoms in our population.
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Sharma A, Muresanu DF, Tian ZR, Nozari A, Lafuente JV, Buzoianu AD, Sjöquist PO, Feng L, Wiklund L, Sharma HS. Co-Administration of Nanowired Monoclonal Antibodies to Inducible Nitric Oxide Synthase and Tumor Necrosis Factor Alpha Together with Antioxidant H-290/51 Reduces SiO 2 Nanoparticles-Induced Exacerbation of Pathophysiology of Spinal Cord Trauma. ADVANCES IN NEUROBIOLOGY 2023; 32:195-229. [PMID: 37480462 DOI: 10.1007/978-3-031-32997-5_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Military personnel are often exposed to silica dust during combat operations across the globe. Exposure to silica dust in US military or service personnel could cause Desert Strom Pneumonitis also referred to as Al Eskan disease causing several organs damage and precipitate autoimmune dysfunction. However, the effects of microfine particles of sand inhalation-induced brain damage on the pathophysiology of traumatic brain or spinal cord injury are not explored. Previously intoxication of silica nanoparticles (50-60 nm size) is shown to exacerbates spinal cord injury induces blood-spinal cord barrier breakdown, edema formation and cellular changes. However, the mechanism of silica nanoparticles-induced cord pathology is still not well known. Spinal cord injury is well known to alter serotonin (5-hydroxytryptamine) metabolism and induce oxidative stress including upregulation of nitric oxide synthase and tumor necrosis factor alpha. This suggests that these agents are involved in the pathophysiology of spinal cord injury. In this review, we examined the effects of combined nanowired delivery of monoclonal antibodies to neuronal nitric oxide synthase (nNOS) together with tumor necrosis factor alpha (TNF-α) antibodies and a potent antioxidant H-290/51 to induce neuroprotection in spinal cord injury associated with silica nanoparticles intoxication. Our results for the first time show that co-administration of nanowired delivery of antibodies to nNOS and TNF-α with H-290/51 significantly attenuated silica nanoparticles-induced exacerbation of spinal cord pathology, not reported earlier.
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Affiliation(s)
- Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Dafin F Muresanu
- Department Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania
- "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Z Ryan Tian
- Department Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, USA
| | - Ala Nozari
- Anesthesiology & Intensive Care, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - José Vicente Lafuente
- LaNCE, Department Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Per-Ove Sjöquist
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lianyuan Feng
- Department of Neurology, Bethune International Peace Hospital, Zhongshan, Hebei Province, China
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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Ashford JW, Tatem SB. Michelangelo's Presentations in the Sistine Chapel: Brain Evolution and the Relationship of the Brain to Specific Cognitive Functions. Neuroscientist 2022:10738584221136091. [PMID: 36408533 DOI: 10.1177/10738584221136091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Michelangelo Buonarroti (1475-1564) presented some of the most spectacular artworks of all times in frescos on the ceiling and behind the altar of the Sistine Chapel. While Michelangelo's presentations depict events described in the Bible, there is broad consensus that Michelangelo was conveying his knowledge and theoretical ideas gleaned from his experiences with anatomic dissection. Michelangelo appears to have communicated several ideas about the brain in the images of the Days of Creation and the Last Judgment. Taking the Days of Creation and the Last Judgment together, Michelangelo appears to be symbolizing that God is in the brain, specifically the brainstem, and the brain performs mental functions. The five images on the ceiling of the chapel showing Days of Creation may be interpreted as reflecting the course of vertebrate brain evolution. There are further suggestions about brain function, including perceiving light and complex images and giving spirit to Adam. Furthermore, on the front wall of the Sistine Chapel behind the altar, within the work titled the Last Judgment, the central ellipse, in which Jesus is sitting, appears to represent a midcoronal cross section of a human brain, suggesting that it is the brain that renders judgments about good and evil.
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Affiliation(s)
- J Wesson Ashford
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, 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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Review of the Midbrain Ascending Arousal Network Nuclei and Implications for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), Gulf War Illness (GWI) and Postexertional Malaise (PEM). Brain Sci 2022; 12:brainsci12020132. [PMID: 35203896 PMCID: PMC8870178 DOI: 10.3390/brainsci12020132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 12/10/2022] Open
Abstract
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS and Gulf War Illness (GWI) share features of post-exertional malaise (PEM), exertional exhaustion, or postexertional symptom exacerbation. In a two-day model of PEM, submaximal exercise induced significant changes in activation of the dorsal midbrain during a high cognitive load working memory task (Washington 2020) (Baraniuk this issue). Controls had no net change. However, ME/CFS had increased activity after exercise, while GWI had significantly reduced activity indicating differential responses to exercise and pathological mechanisms. These data plus findings of the midbrain and brainstem atrophy in GWI inspired a review of the anatomy and physiology of the dorsal midbrain and isthmus nuclei in order to infer dysfunctional mechanisms that may contribute to disease pathogenesis and postexertional malaise. The nuclei of the ascending arousal network were addressed. Midbrain and isthmus nuclei participate in threat assessment, awareness, attention, mood, cognition, pain, tenderness, sleep, thermoregulation, light and sound sensitivity, orthostatic symptoms, and autonomic dysfunction and are likely to contribute to the symptoms of postexertional malaise in ME/CFS and GWI.
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Avery TJ, Mathersul DC, Schulz-Heik RJ, Mahoney L, Bayley PJ. Self-Reported Autonomic Dysregulation in Gulf War Illness. Mil Med 2021; 188:usab546. [PMID: 34966941 DOI: 10.1093/milmed/usab546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/30/2021] [Accepted: 12/22/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Autonomic nervous system dysregulation is commonly observed in Gulf War illness (GWI). Using a new sample, we sought to replicate and extend findings from a previous study that found autonomic symptoms predicted physical functioning in Veterans with GWI. MATERIALS AND METHODS A linear regression model was used to predict physical functioning (36-item Short Form Health Survey (SF-36); n = 73, 75% male). First, we examined the predictive value of independent variables individually in the model including: the 31-item Composite Autonomic Symptom Score (COMPASS-31) total score, body mass index (BMI), mental health burden (i.e., post-traumatic stress disorder [PTSD] and/or depression), and COMPASS-31 subscales: orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor. Next, we estimated linear regression models containing the three variables (autonomic symptoms, BMI, and mental health burden) identified as predictors of physical functioning from the prior study. RESULTS These linear regression models significantly predicted physical functioning and accounted for 15% of the variance with COMPASS-31, 36.6% of variance with COMPASS-31 and BMI, and 38.2% of variance with COMPASS-31, BMI, and mental health burden. Then, forward step-wise linear regressions were applied to explore new models including COMPASS-31 subscales. Two new models accounted for more of the variance in physical functioning: 39.3% with added gastrointestinal symptoms (β = -2.206, P = .001) and 43.4% of variance with both gastrointestinal (β = -1.592, P = .008) and secretomotor subscales (β = -1.533, P = .049). Unlike the previous study we intended to replicate, mental health burden was not a significant predictor in any of our models. CONCLUSIONS Treatments that address autonomic dysregulation should be prioritized for research and clinical recommendations for Veterans with GWI who experience chronic pain.
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Affiliation(s)
- Timothy J Avery
- U.S. Department of Veterans Affairs, War Related Illness and Injury Study Center, VA Palo Alto Heath Care System, Palo Alto, CA 94301, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA 94025, USA
| | - Danielle C Mathersul
- U.S. Department of Veterans Affairs, War Related Illness and Injury Study Center, VA Palo Alto Heath Care System, Palo Alto, CA 94301, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
- Discipline of Psychology, Murdoch University, Murdoch, WA 6150, Australia
| | - R Jay Schulz-Heik
- U.S. Department of Veterans Affairs, War Related Illness and Injury Study Center, VA Palo Alto Heath Care System, Palo Alto, CA 94301, USA
| | - Louise Mahoney
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Peter J Bayley
- U.S. Department of Veterans Affairs, War Related Illness and Injury Study Center, VA Palo Alto Heath Care System, Palo Alto, CA 94301, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
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Steele L, Klimas N, Krengel M, Quinn E, Toomey R, Little D, Abreu M, Aenlle K, Killiany R, Koo BB, Janulewicz P, Heeren T, Clark AN, Ajama J, Cirillo J, Buentello G, Lerma V, Coller JK, Sullivan K. Brain-Immune Interactions as the Basis of Gulf War Illness: Clinical Assessment and Deployment Profile of 1990-1991 Gulf War Veterans in the Gulf War Illness Consortium (GWIC) Multisite Case-Control Study. Brain Sci 2021; 11:brainsci11091132. [PMID: 34573153 PMCID: PMC8467437 DOI: 10.3390/brainsci11091132] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022] Open
Abstract
The Boston University-based Gulf War Illness Consortium (GWIC) is a multidisciplinary initiative developed to provide detailed understanding of brain and immune alterations that underlie Gulf War illness (GWI), the persistent multisymptom disorder associated with military service in the 1990–1991 Gulf War. The core GWIC case-control clinical study conducted in-depth brain and immune evaluation of 269 Gulf War veterans (223 GWI cases, 46 controls) at three U.S. sites that included clinical assessments, brain imaging, neuropsychological testing, and analyses of a broad range of immune and immunogenetic parameters. GWI cases were similar to controls on most demographic, military, and deployment characteristics although on average were two years younger, with a higher proportion of enlisted personnel vs. officers. Results of physical evaluation and routine clinical lab tests were largely normal, with few differences between GWI cases and healthy controls. However, veterans with GWI scored significantly worse than controls on standardized assessments of general health, pain, fatigue, and sleep quality and had higher rates of diagnosed conditions that included hypertension, respiratory and sinus conditions, gastrointestinal conditions, and current or lifetime depression and post-traumatic stress disorder. Among multiple deployment experiences/exposures reported by veterans, multivariable logistic regression identified just two significant GWI risk factors: extended use of skin pesticides in theater (adjusted OR = 3.25, p = 0.005) and experiencing mild traumatic brain injury during deployment (OR = 7.39, p = 0.009). Gulf War experiences associated with intense stress or trauma (e.g., participation in ground combat) were not associated with GWI. Data and samples from the GWIC project are now stored in a repository for use by GWI researchers. Future reports will present detailed findings on brain structure and function, immune function, and association of neuroimmune measures with characteristics of GWI and Gulf War service.
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Affiliation(s)
- Lea Steele
- Veterans Health Research Program, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; (G.B.); (V.L.)
- Correspondence: (L.S.); (K.S.)
| | - Nancy Klimas
- Institute for Neuroimmune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (N.K.); (M.A.); (K.A.)
- Department of Veterans Affairs, Miami VA Healthcare System, Miami, FL 33125, USA
| | - Maxine Krengel
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Emily Quinn
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (T.H.)
| | - Rosemary Toomey
- Department of Psychological and Brain Sciences, Boston University College of Arts and Sciences, Boston, MA 02215, USA;
| | - Deborah Little
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - Maria Abreu
- Institute for Neuroimmune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (N.K.); (M.A.); (K.A.)
| | - Kristina Aenlle
- Institute for Neuroimmune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (N.K.); (M.A.); (K.A.)
- Department of Veterans Affairs, Miami VA Healthcare System, Miami, FL 33125, USA
| | - Ronald Killiany
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Bang-Bon Koo
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Patricia Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (T.H.)
| | - Allison N. Clark
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Joy Ajama
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Joanna Cirillo
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Gerardo Buentello
- Veterans Health Research Program, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; (G.B.); (V.L.)
| | - Vanesa Lerma
- Veterans Health Research Program, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; (G.B.); (V.L.)
| | - Janet K. Coller
- Discipline of Pharmacology, School of Biomedicine, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
- Correspondence: (L.S.); (K.S.)
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A randomized phase II remote study to assess Bacopa for Gulf War Illness associated cognitive dysfunction: Design and methods of a national study. Life Sci 2021; 282:119819. [PMID: 34256038 DOI: 10.1016/j.lfs.2021.119819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 12/31/2022]
Abstract
AIMS Gulf War Illness (GWI) is a chronic, debilitating, multi-symptom condition affecting as many as one-third of the nearly 700,000 U.S. troops deployed to the Middle East during the 1990-1991 Gulf War (GW). The treatment of GWI relies on symptom management. A common challenge in studying the efficacy of interventions for symptom management is participant recruitment related to factors such as the burden of travelling to study sites and the widespread dispersion of Veterans with GWI. The goal of this study is to assess the efficacy of a novel low-risk therapeutic agent, Bacopa monnieri, for cognitive function in Veterans with GWI and to evaluate the utility of a remote patient-centric study design developed to promote recruitment and minimize participant burden. MAIN METHODS To promote effective participant recruitment, we developed a remote patient-centric study design. Participants will be recruited online through social media and through a web-based research volunteer list of GW Veterans. An online assessment platform will be used, and laboratory blood draws will be performed at clinical laboratory sites that are local to participants. Furthermore, the assigned intervention will be mailed to each participant. SIGNIFICANCE These study design adaptations will open participation to Veterans nearly nationwide and reduce administrative costs while maintaining methodologic rigor and participant safety in a randomized, placebo-controlled phase II clinical trial.
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13
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Addiego FM, Zajur K, Knack S, Jamieson J, Rayhan RU, Baraniuk JN. Subcortical brain segment volumes in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Life Sci 2021; 282:119749. [PMID: 34214570 DOI: 10.1016/j.lfs.2021.119749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/20/2021] [Accepted: 06/11/2021] [Indexed: 01/29/2023]
Abstract
AIMS There is controversy about brain volumes in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (CFS) and Gulf War Illness (GWI). Subcortical regions were assessed because of significant differences in blood oxygenation level dependent signals in the midbrain between these diseases. MATERIALS AND METHOD Magnetization-prepared rapid acquisition with gradient echo (MPRAGE) images from 3 Tesla structural magnetic resonance imaging scans from sedentary control (n = 34), CFS (n = 38) and GWI (n = 90) subjects were segmented in FreeSurfer. Segmented subcortical volumes were regressed against intracranial volume and age, then iteratively analyzed by multivariate general linear modeling with disease status, gender and demographics as independent co-variates. KEY FINDINGS The optimal model for all subjects used disease status and gender as fixed factors with independent variables eliminated after iteration. Volumes of anterior and midanterior corpus callosum were significantly larger in GWI than CFS. Gender was a significant variable for many segment volumes, and so female and male subjects were analyzed separately. CFS females had smaller left putamen, right caudate and left cerebellum white matter than control women. CFS males had larger left hippocampus than GWI males. Orthostatic status and posttraumatic distress syndrome were not significant covariates. SIGNIFICANCE CFS and GWI were appropriate "illness controls" for each other. The different patterns of adjusted segment volumes suggested that sexual dimorphisms contributed to pathological changes. Previous volumetric studies may need to be reevaluated to account for gender differences. The findings are framed by comparison to the spectrum of magnetic resonance imaging outcomes in the literature.
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Affiliation(s)
| | - Kristina Zajur
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA
| | - Sarah Knack
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA
| | - Jessie Jamieson
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA
| | - Rakib U Rayhan
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA
| | - James N Baraniuk
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA.
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14
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Zhang Y, Vakhtin AA, Dietch J, Jennings JS, Yesavage JA, Clark JD, Bayley PJ, Ashford JW, Furst AJ. Brainstem damage is associated with poorer sleep quality and increased pain in gulf war illness veterans. Life Sci 2021; 280:119724. [PMID: 34144059 DOI: 10.1016/j.lfs.2021.119724] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 11/19/2022]
Abstract
AIMS Gulf War Illness (GWI) is manifested as multiple chronic symptoms, including chronic pain, chronic fatigue, sleep problems, neuropsychiatric disorders, respiratory, gastrointestinal, and skin problems. No single target tissue or unifying pathogenic process has been identified that accounts for this variety of symptoms. The brainstem has been suspected to contribute to this multiple symptomatology. The aim of this study was to assess the role of the brainstem in chronic sleep problems and pain in GWI veterans. MATERIALS AND METHODS We enrolled 90 veterans (Age = 50 ± 5, 87% Male) who were deployed to the 1990-91 Gulf War and presented with GWI symptoms. Sleep quality was evaluated using the global Pittsburgh Sleep Quality Index. Pain intensities were obtained with the Brief Pain Inventory sum score. Volumes in cortical, subcortical, brainstem, and brainstem subregions and diffusion tensor metrics in 10 bilateral brainstem tracts were tested for correlations with symptom measures. KEY FINDINGS Poorer sleep quality was significantly correlated with atrophy of the whole brainstem and brainstem subregions (including midbrain, pons, medulla). Poorer sleep quality also significantly correlated with lower fractional anisotropy in the nigrostriatal tract, medial forebrain tract, and the dorsal longitudinal fasciculus. There was a significant correlation between increased pain intensity and decreased fractional anisotropy in the dorsal longitudinal fasciculus. These correlations were not altered after controlling for age, sex, total intracranial volumes, or additional factors, e.g., depression and neurological conditions. SIGNIFICANCE These findings suggest that the brainstem plays an important role in the aberrant neuromodulation of sleep and pain symptoms in GWI.
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Affiliation(s)
- Yu Zhang
- War Related Illness & Injury Study Center (WRIISC), VA Palo Alto Health Care System, Palo Alto, CA, United States.
| | | | - Jessica Dietch
- War Related Illness & Injury Study Center (WRIISC), VA Palo Alto Health Care System, Palo Alto, CA, United States; Stanford University, Stanford, CA, United States
| | - Jennifer S Jennings
- War Related Illness & Injury Study Center (WRIISC), VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Jerome A Yesavage
- War Related Illness & Injury Study Center (WRIISC), VA Palo Alto Health Care System, Palo Alto, CA, United States; Stanford University, Stanford, CA, United States
| | - J David Clark
- War Related Illness & Injury Study Center (WRIISC), VA Palo Alto Health Care System, Palo Alto, CA, United States; Stanford University, Stanford, CA, United States
| | - Peter J Bayley
- War Related Illness & Injury Study Center (WRIISC), VA Palo Alto Health Care System, Palo Alto, CA, United States; Stanford University, Stanford, CA, United States
| | - J Wesson Ashford
- War Related Illness & Injury Study Center (WRIISC), VA Palo Alto Health Care System, Palo Alto, CA, United States; Stanford University, Stanford, CA, United States
| | - Ansgar J Furst
- War Related Illness & Injury Study Center (WRIISC), VA Palo Alto Health Care System, Palo Alto, CA, United States; Stanford University, Stanford, CA, United States
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15
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Nkiliza A, Joshi U, Evans JE, Ait-Ghezala G, Parks M, Crawford F, Mullan M, Abdullah L. Adaptive Immune Responses Associated with the Central Nervous System Pathology of Gulf War Illness. Neurosci Insights 2021; 16:26331055211018458. [PMID: 34104887 PMCID: PMC8155779 DOI: 10.1177/26331055211018458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/26/2021] [Indexed: 11/17/2022] Open
Abstract
Gulf War Illness is a multisymptomatic condition which affects 30% of veterans
from the 1991 Gulf War. While there is evidence for a role of peripheral
cellular and humoral adaptive immune responses in Gulf War Illness, a potential
role of the adaptive immune system in the central nervous system pathology of
this condition remains unknown. Furthermore, many of the clinical features of
Gulf War Illness resembles those of autoimmune diseases, but the biological
processes are likely different as the etiology of Gulf War Illness is linked to
hazardous chemical exposures specific to the Gulf War theatre. This review
discusses Gulf War chemical–induced maladaptive immune responses and a potential
role of cellular and humoral immune responses that may be relevant to the
central nervous system symptoms and pathology of Gulf War Illness. The
discussion may stimulate investigations into adaptive immunity for developing
novel therapies for Gulf War Illness.
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Wang X, Ali N, Lin CLG. Emerging role of glutamate in the pathophysiology and therapeutics of Gulf War illness. Life Sci 2021; 280:119609. [PMID: 33991547 DOI: 10.1016/j.lfs.2021.119609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/20/2022]
Abstract
Gulf War illness (GWI) is a chronic and multi-symptomatic disorder affecting veterans who served in the Gulf War. The commonly reported symptoms in GWI veterans include mood problems, cognitive impairment, muscle and joint pain, migraine/headache, chronic fatigue, gastrointestinal complaints, skin rashes, and respiratory problems. Neuroimaging studies have revealed significant brain structure alterations in GWI veterans, including subcortical atrophy, decreased volume of the hippocampus, reduced total grey and white matter, and increased brain white matter axial diffusivity. These brain changes may contribute to or increase the severities of the GWI-related symptoms. Epidemiological studies have revealed that neurotoxic exposures and stress may be significant contributors to the development of GWI. However, the mechanism underlying how the exposure and stress could contribute to the multi-symptomatic disorder of GWI remains unclear. We and others have demonstrated that rodent models exposed to GW-related agents and stress exhibited higher extracellular glutamate levels, as well as impaired structure and function of glutamatergic synapses. Restoration of the glutamatergic synapses ameliorated the GWI-related pathological and behavioral deficits. Moreover, recent studies showed that a low-glutamate diet reduced multiple symptoms in GWI veterans, suggesting an important role of the glutamatergic system in GWI. Currently, growing evidence has indicated that abnormal glutamate neurotransmission may contribute to the GWI symptoms. This review summarizes the potential roles of glutamate dyshomeostasis and dysfunction of the glutamatergic system in linking the initial cause to the multi-symptomatic outcomes in GWI and suggests the glutamatergic system as a therapeutic target for GWI.
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Affiliation(s)
- Xueqin Wang
- Department of Neuroscience, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Noor Ali
- Department of Neuroscience, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Chien-Liang Glenn Lin
- Department of Neuroscience, College of Medicine, The Ohio State University, Columbus, OH, USA.
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Mathersul DC, Dixit K, Avery TJ, Schulz-Heik RJ, Zeitzer JM, Mahoney LA, Cho RH, Bayley PJ. Heart rate and heart rate variability as outcomes and longitudinal moderators of treatment for pain across follow-up in Veterans with Gulf War illness. Life Sci 2021; 277:119604. [PMID: 33984356 DOI: 10.1016/j.lfs.2021.119604] [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: 01/18/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
AIMS Accumulating evidence suggests Gulf War illness (GWI) is characterised by autonomic nervous system dysfunction (higher heart rate [HR], lower heart rate variability [HRV]). Yoga - an ancient mind-body practice combining mindfulness, breathwork, and physical postures - is proposed to improve autonomic dysfunction yet this remains untested in GWI. We aimed to determine (i) whether HR and HRV improve among Veterans with GWI receiving either yoga or cognitive behavioural therapy (CBT) for pain; and (ii) whether baseline autonomic functioning predicts treatment-related pain outcomes across follow-up. MAIN METHODS We present secondary analyses of 24-hour ambulatory cardiac data (mean HR, square root of the mean squared differences between successive R-R intervals [RMSSD], high frequency power [HF-HFV], and low-to-high frequency ratio [LF/HF] extracted from a 5-min window during the first hour of sleep) from our randomised controlled trial of yoga versus CBT for pain among Veterans with GWI (ClinicalTrials.govNCT02378025; N = 75). KEY FINDINGS Veterans who received CBT tended towards higher mean HR at end-of-treatment. Better autonomic function (lower mean HR, higher RMSSD/HF-HRV) at baseline predicted greater reductions in pain across follow-up, regardless of treatment group. Better baseline autonomic function (mid-range-to-high RMSSD/HF-HRV) also predicted greater pain reductions with yoga, while worse baseline autonomic function (higher mean HR, lower RMSSD/HF-HRV) predicted greater pain reductions with CBT. SIGNIFICANCE To our knowledge, this is the first study to suggest that among Veterans with GWI, HR may increase with CBT yet remain stable with yoga. Furthermore, HR and HRV moderated pain outcome across follow-up for yoga and CBT.
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Affiliation(s)
- Danielle C Mathersul
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States of America; Discipline of Psychology, Murdoch University, Murdoch, WA 6150, Australia.
| | - Kamini Dixit
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Timothy J Avery
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States of America; National Centre for Posttraumatic Stress Disorder (NCPTSD), Veterans Affairs Menlo Park Health Care System, Menlo Park, CA 94025, United States of America
| | - R Jay Schulz-Heik
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States of America; Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Louise A Mahoney
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Rachael H Cho
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Peter J Bayley
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States of America
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Madhu LN, Kodali M, Attaluri S, Shuai B, Melissari L, Rao X, Shetty AK. Melatonin improves brain function in a model of chronic Gulf War Illness with modulation of oxidative stress, NLRP3 inflammasomes, and BDNF-ERK-CREB pathway in the hippocampus. Redox Biol 2021; 43:101973. [PMID: 33933884 PMCID: PMC8105671 DOI: 10.1016/j.redox.2021.101973] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 02/07/2023] Open
Abstract
Persistent cognitive and mood dysfunction is the primary CNS symptom in veterans afflicted with Gulf War Illness (GWI). This study investigated the efficacy of melatonin (MEL) for improving cognitive and mood function with antioxidant, antiinflammatory, and pro-cognitive effects in a rat model of chronic GWI. Six months after exposure to GWI-related chemicals and stress, rats were treated with vehicle or MEL (5, 10, 20, 40, and 80 mg/kg) for eight weeks. Behavioral tests revealed cognitive and mood dysfunction in GWI rats receiving vehicle, which were associated with elevated oxidative stress, reduced NRF2, catalase and mitochondrial complex proteins, astrocyte hypertrophy, activated microglia with NLRP3 inflammasomes, elevated proinflammatory cytokines, waned neurogenesis, and synapse loss in the hippocampus. MEL at 10 mg/kg alleviated simple and associative recognition memory dysfunction and anhedonia, along with reduced oxidative stress, enhanced glutathione and complex III, and reduced NLRP3 inflammasomes, IL-18, TNF-α, and IFN-γ. MEL at 20 mg/kg also normalized NRF2 and catalase and increased microglial ramification. MEL at 40 mg/kg, in addition, reduced astrocyte hypertrophy, activated microglia, NF-kB-NLRP3-caspase-1 signaling, IL-1β, MCP-1, and MIP-1α. Moreover, MEL at 80 mg/kg activated the BDNF-ERK-CREB signaling pathway, enhanced neurogenesis and diminished synapse loss in the hippocampus, and improved a more complex hippocampus-dependent cognitive function. Thus, MEL therapy is efficacious for improving cognitive and mood function in a rat model of chronic GWI, and MEL's effect was dose-dependent. The study provides the first evidence of MEL's promise for alleviating neuroinflammation and cognitive and mood impairments in veterans with chronic GWI. A low dose of Melatonin alleviated recognition memory dysfunction and anhedonia in a model of chronic GWI. A moderate dose of Melatonin improved more complex cognitive function in a model of chronic GWI. Melatonin treatment reduced oxidative stress and enhanced mitochondrial complex proteins in the GWI brain. Melatonin inhibited NLRP3 inflammasomes and proinflammatory cytokines in the GWI brain. Melatonin activated the BDNF-ERK-CREB signaling pathway and enhanced neurogenesis in the GWI brain.
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Affiliation(s)
- Leelavathi N Madhu
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University College of Medicine, College Station, TX, USA
| | - Maheedhar Kodali
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University College of Medicine, College Station, TX, USA
| | - Sahithi Attaluri
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University College of Medicine, College Station, TX, USA
| | - Bing Shuai
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University College of Medicine, College Station, TX, USA
| | - Laila Melissari
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University College of Medicine, College Station, TX, USA
| | - Xiaolan Rao
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University College of Medicine, College Station, TX, USA
| | - Ashok K Shetty
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University College of Medicine, College Station, TX, USA.
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Dickey B, Madhu LN, Shetty AK. Gulf War Illness: Mechanisms Underlying Brain Dysfunction and Promising Therapeutic Strategies. Pharmacol Ther 2020; 220:107716. [PMID: 33164782 DOI: 10.1016/j.pharmthera.2020.107716] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022]
Abstract
Gulf War Illness (GWI), a chronic multisymptom health problem, afflicts ~30% of veterans served in the first GW. Impaired brain function is among the most significant symptoms of GWI, which is typified by persistent cognitive and mood impairments, concentration problems, headaches, chronic fatigue, and musculoskeletal pain. This review aims to discuss findings from animal prototypes and veterans with GWI on mechanisms underlying its pathophysiology and emerging therapeutic strategies for alleviating brain dysfunction in GWI. Animal model studies have linked brain impairments to incessantly elevated oxidative stress, chronic inflammation, inhibitory interneuron loss, altered lipid metabolism and peroxisomes, mitochondrial dysfunction, modified expression of genes relevant to cognitive function, and waned hippocampal neurogenesis. Furthermore, the involvement of systemic alterations such as the increased intensity of reactive oxygen species and proinflammatory cytokines in the blood, transformed gut microbiome, and activation of the adaptive immune response have received consideration. Investigations in veterans have suggested that brain dysfunction in GWI is linked to chronic activation of the executive control network, impaired functional connectivity, altered blood flow, persistent inflammation, and changes in miRNA levels. Lack of protective alleles from Class II HLA genes, the altered concentration of phospholipid species and proinflammatory factors in the circulating blood have also been suggested as other aiding factors. While some drugs or combination therapies have shown promise for alleviating symptoms in clinical trials, larger double-blind, placebo-controlled trials are needed to validate such findings. Based on improvements seen in animal models of GWI, several antioxidants and anti-inflammatory compounds are currently being tested in clinical trials. However, reliable blood biomarkers that facilitate an appropriate screening of veterans for brain pathology need to be discovered. A liquid biopsy approach involving analysis of brain-derived extracellular vesicles in the blood appears efficient for discerning the extent of neuropathology both before and during clinical trials.
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Affiliation(s)
- Brandon Dickey
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, TX, USA; Texas A&M University Health Science Center College of Medicine, Temple, TX, USA
| | - Leelavathi N Madhu
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, TX, USA
| | - Ashok K Shetty
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, TX, USA.
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20
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Neurotoxicity in Gulf War Illness and the potential role of glutamate. Neurotoxicology 2020; 80:60-70. [DOI: 10.1016/j.neuro.2020.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023]
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21
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Mathersul DC, Eising CM, DeSouza DD, Spiegel D, Bayley PJ. Brain and Physiological Markers of Autonomic Function Are Associated With Treatment-Related Improvements in Self-Reported Autonomic Dysfunction in Veterans With Gulf War Illness: An Exploratory Pilot Study. Glob Adv Health Med 2020; 9:2164956120922812. [PMID: 32426178 PMCID: PMC7218338 DOI: 10.1177/2164956120922812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/25/2020] [Accepted: 04/01/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Gulf War Illness (GWI) is a poorly understood condition characterized by a constellation of mood, cognitive, and physical symptoms. A growing body of evidence demonstrates autonomic nervous system (ANS) dysfunction. Few published treatment studies exist for GWI. METHOD We recently completed a randomized controlled trial comparing a 10-week group yoga intervention to 10-week group cognitive behavioral therapy (CBT) for veterans with GWI. Here, we present exploratory data on ANS biomarkers of treatment response from a small pilot exploratory neurophysiological add-on study (n = 13) within that larger study. RESULTS Findings suggest that veterans with GWI receiving either yoga or CBT for pain improved following treatment and that changes in biological ANS-especially for the yoga group-moved in the direction of healthy profiles: lower heart rate, higher square root of the mean squared differences between successive R-R intervals (RMSSD), greater parasympathetic activation/dominance (increased high-frequency heart rate variability [HF-HRV], decreased low-frequency/high-frequency [LF/HF] ratio), reduced right amygdala volume, and stronger amygdala-default mode/amygdala-salience network connectivity, both immediately posttreatment and at 6-month follow-up. Biological mechanisms of CBT appeared to underlie improvements in more psychologically loaded symptoms such as self-reported fatigue and energy. Higher tonic arousal and/or more sympathetic dominance (higher skin conductance, lower RMSSD, lower HF-HRV, higher LF/HF ratio) pretreatment predicted greater treatment-related improvements in self-reported ANS for both the yoga and CBT group. CONCLUSION These exploratory pilot data provide preliminary support for the suggestion that treatment (yoga, CBT) is associated with improvements in both biological and self-reported ANS dysfunctions in GWI. The major limitation for these findings is the small sample size. Larger and more controlled studies are needed to replicate these findings and directly compare biomarkers of yoga versus CBT.
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Affiliation(s)
- Danielle C Mathersul
- War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Carla M Eising
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Department of Clinical Psychology Science, Maastricht University, Maastricht, the Netherlands
| | - Danielle D DeSouza
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Peter J Bayley
- War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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