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An D, Xu Y. Environmental risk factors provoke new thinking for prevention and treatment of dementia with Lewy bodies. Heliyon 2024; 10:e30175. [PMID: 38707435 PMCID: PMC11068646 DOI: 10.1016/j.heliyon.2024.e30175] [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: 01/05/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
In recent years, environmental factors have received attention in the pathogenesis of neurodegenerative diseases. Other than genetic factors, the identification of environmental factors and modifiable risk factors may create opportunities to delay the onset or slow the progression of Lewy body disease. Researchers have made significant progress in understanding environmental and modifiable risk factors over the past 30 years. To date, despite the increasing number of articles assessing risk factors for Lewy body disease, few reviews have focused on their role in its onset. In this review, we reviewed the literature investigating the relationship between Lewy body disease and several environmental and other modifiable factors. We found that some air pollutants, exposure to some metals, and infection with some microorganisms may increase the risk of Lewy body disease. Coffee intake and the Mediterranean diet are protective factors. However, it is puzzling that low educational levels and smoking may have some protective effects. In addition, we proposed specific protocols for subsequent research directions on risk factors for neurodegenerative diseases and improved methods. By conducting additional case-control studies, we could explore the role of these factors in the etiopathogenesis of Lewy body disease, establishing a foundation for strategies aimed at preventing and reducing the onset and burden of the disease.
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Affiliation(s)
- Dinghao An
- Department of Neurology, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yun Xu
- Department of Neurology, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing, China
- Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, China
- Nanjing Neurology Clinical Medical Center, Nanjing, China
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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 2024:1-14. [PMID: 38692856 DOI: 10.1080/13854046.2024.2344263] [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: 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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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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Murray KE, Ratliff WA, Delic V, Citron BA. Gulf War toxicant-induced reductions in dendritic arbors and spine densities of dentate granule cells are improved by treatment with a Nrf2 activator. Brain Res 2024; 1823:148682. [PMID: 37989436 DOI: 10.1016/j.brainres.2023.148682] [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: 09/01/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023]
Abstract
Gulf War Illness (GWI) is a chronic multi-symptom disorder affecting approximately 30 % of Veterans deployed to the Persian Gulf from 1990 to 91. GWI encompasses a wide spectrum of symptoms which frequently include neurological problems such as learning and memory impairments, mood disorders, and an increased incidence of neurodegenerative disorders. Combined exposure to both reversible and irreversible acetylcholinesterase (AChE) inhibitors has been identified as a likely risk factor for GWI. It is possible that the exposures affected connectivity in the brain, and it was also unknown whether this could benefit from treatment. We assessed chronic changes in dendritic architecture in granule cells of the dentate gyrus following exposure to pyridostigmine bromide (PB, 0.7 mg/kg), chlorpyrifos (CPF, 12.5 mg/kg), and N,N-diethyl-m-toluamide (DEET, 7.5 mg/kg) in male C57Bl/6J mice. We also evaluated the therapeutic effects of dietary administration for eight weeks of 1 % tert-butylhydroquinone (tBHQ), a Nrf2 activator, on long-term neuronal morphology. We found that Gulf War toxicant exposure resulted in reduced dendritic length and branching as well as overall spine density in dentate granule cells at 14 weeks post-exposure and that these effects were ameliorated by treatment with tBHQ. These findings indicate that Gulf War toxicant exposure results in chronic changes to dentate granule cell morphology and that modulation of neuroprotective transcription factors such as Nrf2 may improve long-term neuronal health in the hippocampus.
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Affiliation(s)
- Kathleen E Murray
- Laboratory of Molecular Biology, Research & Development, Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, NJ 07018, USA; School of Graduate Studies, Rutgers University, Newark, NJ 07103, USA
| | - Whitney A Ratliff
- Research & Development, Department of Veterans Affairs, Bay Pines VA Healthcare System, Bay Pines, FL 33744, USA
| | - Vedad Delic
- Laboratory of Molecular Biology, Research & Development, Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, NJ 07018, USA; School of Graduate Studies, Rutgers University, Newark, NJ 07103, USA; Department of Pharmacology, Physiology, and Neuroscience, Rutgers-New Jersey Medical School, Newark, NJ 07103, USA
| | - Bruce A Citron
- Laboratory of Molecular Biology, Research & Development, Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, NJ 07018, USA; School of Graduate Studies, Rutgers University, Newark, NJ 07103, USA; Department of Pharmacology, Physiology, and Neuroscience, Rutgers-New Jersey Medical School, Newark, NJ 07103, USA.
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Keating D, Krengel M, Dugas J, Toomey R, Chao L, Steele L, Janulewicz LP, Heeren T, Quinn E, Klimas N, Sullivan K. Cognitive decrements in 1991 Gulf War veterans: associations with Gulf War illness and neurotoxicant exposures in the Boston Biorepository, Recruitment, and Integrative Network (BBRAIN) cohorts. Environ Health 2023; 22:68. [PMID: 37794452 PMCID: PMC10548744 DOI: 10.1186/s12940-023-01018-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND During deployment, veterans of the 1991 Gulf War (GW) were exposed to multiple war-related toxicants. Roughly a third of these veterans continue to exhibit neurotoxicant induced symptoms of Gulf War Illness (GWI), a multi-faceted condition that includes fatigue, pain and cognitive decrements. When studied empirically, both deployed veterans with exposures and those who meet the criteria for GWI are more likely to show deficits in the area of neuropsychological functioning. Although studies have shown cognitive impairments in small sample sizes, it is necessary to revisit these findings with larger samples and newer cohorts to see if other areas of deficit emerge with more power to detect such differences. A group of researchers and clinicians with expertise in the area of GWI have identified common data elements (CDE) for use in research samples to compare data sets. At the same time, a subgroup of researchers created a new repository to share these cognitive data and biospecimens within the GWI research community. METHODS The present study aimed to compare cognitive measures of attention, executive functioning, and verbal memory in a large sample of GWI cases and healthy GW veteran controls using neuropsychological tests recommended in the CDEs. We additionally subdivided samples based on the specific neurotoxicant exposures related to cognitive deficits and compared exposed versus non-exposed veterans regardless of case criteria status. The total sample utilized cognitive testing outcomes from the newly collated Boston, Biorepository, Recruitment, and Integrative Network (BBRAIN) for GWI. RESULTS Participants included 411 GW veterans, 312 GWI (cases) and 99 healthy veterans (controls). Veterans with GWI showed significantly poorer attention, executive functioning, learning, and short-and-long term verbal memory than those without GWI. Further, GW veterans with exposures to acetylcholinesterase inhibiting pesticides and nerve gas agents, had worse performance on executive function tasks. Veterans with exposure to oil well fires had worse performance on verbal memory and those with pyridostigmine bromide anti-nerve gas pill exposures had better verbal memory and worse performance on an attention task compared to unexposed veterans. CONCLUSIONS This study replicates prior results regarding the utility of the currently recommended CDEs in determining impairments in cognitive functioning in veterans with GWI in a new widely-available repository cohort and provides further evidence of cognitive decrements in GW veterans related to war-related neurotoxicant exposures.
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Affiliation(s)
- D Keating
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, T4W, Boston, MA, 02118, USA
| | - M Krengel
- Department of Neurology, Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA
| | - J Dugas
- Department of Biostatistics, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - R Toomey
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, 900 Commonwealth Ave, Boston, MA, USA
| | - L Chao
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA, 94143, USA
| | - L Steele
- Baylor College of Medicine Neuropsychiatry Division, Department of Psychiatry and Behavioral Sciences, Houston, TX, 77030, USA
| | - Lloyd P Janulewicz
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, T4W, Boston, MA, 02118, USA
| | - T Heeren
- Department of Biostatistics, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - E Quinn
- Department of Biostatistics, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - N Klimas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL, 33314, USA
- Geriatric Research Education and Clinical Center, Miami VA Medical Center, Miami, FL, 33125, USA
| | - K Sullivan
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, T4W, Boston, MA, 02118, USA.
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Jiménez Barbosa IA, Rodríguez Alvarez MF, Bernal Bechara LC, Khuu SK. Impairment of visual and neurologic functions associated with agrochemical use. PLoS One 2023; 18:e0290263. [PMID: 37611047 PMCID: PMC10446217 DOI: 10.1371/journal.pone.0290263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023] Open
Abstract
To determine whether exposure to occupational levels of agrochemicals is associated with a range of low- (contrast and colour) and higher-level visual functions, particularly the detection of global form and motion coherence. We compared the performance of workers exposed to occupational levels of pesticides and non-exposed individuals on visual tasks that measured colour discrimination (Farnsworth Munsell 100 and Lanthony D15 desaturated) and the contrast sensitivity function (1-16 cpd). Global form and motion detection thresholds were measured using Glass-pattern and global dot motion stimuli. Neurotoxicity symptoms and biological markers associated with pesticide exposure were quantified using the Q16 modified questionnaire and via tests for levels of acetylcholinesterase in blood and substance P from the tear film, respectively. Workers exposed to pesticides had significantly more neurotoxic symptoms than non-exposed workers. No significant difference between groups for acetylcholinesterase levels was found, but there was a significant group difference in Substance P. The exposed group also had significantly poorer contrast sensitivity, colour discrimination and higher coherence detection thresholds for global form and motion perception. Exposure to occupational levels of agrochemicals in workers with signs of neurotoxicity is associated with low and high visual perception deficits.
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Affiliation(s)
| | | | | | - Sieu K. Khuu
- School of Optometry and Vision Science, The University of New South Wales, Sydney NSW, Australia
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Golomb BA, Sanchez Baez R, Schilling JM, Dhanani M, Fannon MJ, Berg BK, Miller BJ, Taub PR, Patel HH. Mitochondrial impairment but not peripheral inflammation predicts greater Gulf War illness severity. Sci Rep 2023; 13:10739. [PMID: 37438460 DOI: 10.1038/s41598-023-35896-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/25/2023] [Indexed: 07/14/2023] Open
Abstract
Gulf War illness (GWI) is an important exemplar of environmentally-triggered chronic multisymptom illness, and a potential model for accelerated aging. Inflammation is the main hypothesized mechanism for GWI, with mitochondrial impairment also proposed. No study has directly assessed mitochondrial respiratory chain function (MRCF) on muscle biopsy in veterans with GWI (VGWI). We recruited 42 participants, half VGWI, with biopsy material successfully secured in 36. Impaired MRCF indexed by complex I and II oxidative phosphorylation with glucose as a fuel source (CI&CIIOXPHOS) related significantly or borderline significantly in the predicted direction to 17 of 20 symptoms in the combined sample. Lower CI&CIIOXPHOS significantly predicted GWI severity in the combined sample and in VGWI separately, with or without adjustment for hsCRP. Higher-hsCRP (peripheral inflammation) related strongly to lower-MRCF (particularly fatty acid oxidation (FAO) indices) in VGWI, but not in controls. Despite this, whereas greater MRCF-impairment predicted greater GWI symptoms and severity, greater inflammation did not. Surprisingly, adjusted for MRCF, higher hsCRP significantly predicted lesser symptom severity in VGWI selectively. Findings comport with a hypothesis in which the increased inflammation observed in GWI is driven by FAO-defect-induced mitochondrial apoptosis. In conclusion, impaired mitochondrial function-but not peripheral inflammation-predicts greater GWI symptoms and severity.
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Affiliation(s)
- Beatrice A Golomb
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive #0995, La Jolla, CA, 92093-0995, USA.
| | - Roel Sanchez Baez
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive #0995, La Jolla, CA, 92093-0995, USA
- San Ysidro Health Center, San Diego, CA, 92114, USA
| | - Jan M Schilling
- VA San Diego Healthcare System and Department of Anesthesiology, University of California, San Diego, San Diego, CA, 92161, USA
| | - Mehul Dhanani
- VA San Diego Healthcare System and Department of Anesthesiology, University of California, San Diego, San Diego, CA, 92161, USA
- Avidity Biosciences, San Diego, CA, 92121, USA
| | - McKenzie J Fannon
- VA San Diego Healthcare System and Department of Anesthesiology, University of California, San Diego, San Diego, CA, 92161, USA
| | - Brinton K Berg
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive #0995, La Jolla, CA, 92093-0995, USA
| | - Bruce J Miller
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive #0995, La Jolla, CA, 92093-0995, USA
| | - Pam R Taub
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Hemal H Patel
- VA San Diego Healthcare System and Department of Anesthesiology, University of California, San Diego, San Diego, CA, 92161, 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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Truax LE, Huang JJ, Jensen K, Locatelli EVT, Cabrera K, Peterson HO, Cohen NK, Mangwani-Mordani S, Jensen A, Goldhardt R, Galor A. Pyridostigmine Bromide Pills and Pesticides Exposure as Risk Factors for Eye Disease in Gulf War Veterans. J Clin Med 2023; 12:jcm12062407. [PMID: 36983407 PMCID: PMC10059791 DOI: 10.3390/jcm12062407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/08/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
To examine associations between the pyridostigmine bromide (PB) pill and/or pesticide exposure during the 1990-1991 Gulf War (GW) and eye findings years after deployment. A cross-sectional study of South Florida veterans who were deployed on active duty during the GW Era (GWE). Information on GW exposures and ocular surface symptoms were collected via standardized questionnaires and an ocular surface examination was performed. Participants underwent spectral domain-ocular coherence tomography (SD-OCT) imaging that included retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and macular maps. We examined for differences in eye findings between individuals exposed versus not exposed to PB pills or pesticides during service. A total of 40.7% (n = 44) of individuals reported exposure to PB pills and 41.7% (n = 45) to pesticides; additionally, 24 reported exposure to both in the GW arena. Demographics were comparable across groups. Individuals exposed to PB pills reported higher dry eye (DE) symptoms scores (the 5-Item Dry Eye Questionnaire, DEQ-5: 9.3 ± 5.3 vs. 7.3 ± 4.7, p = 0.04) and more intense ocular pain (average over the last week: 2.4 ± 2.6 vs. 1.5 ± 1.8, p = 0.03; Neuropathic Pain Symptom Inventory modified for the Eye (NPSI-E): 18.2 ± 20.0 vs. 10.8 ± 13.8, p = 0.03) compared to their non-exposed counterparts. DE signs were comparable between the groups. Individuals exposed to PB pills also had thicker OCT measurements, with the largest difference in the outer temporal segment of the macula (268.5 ± 22.2 μm vs. 260.6 ± 14.5 μm, p = 0.03) compared to non-exposed individuals. These differences remained significant when examined in multivariable models that included demographics and deployment history. Individuals exposed to pesticides had higher neuropathic ocular pain scores (NPSI-E: 17.1 ± 21.1 vs. 11.6 ± 12.9, p = 0.049), but this difference did not remain significant in a multivariable model. Individuals exposed to PB pills during the GWE reported more severe ocular surface symptoms and had thicker OCT measures years after deployment compared to their non-exposed counterparts.
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Affiliation(s)
- Lauren E Truax
- Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Jaxon J Huang
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
| | - Katherine Jensen
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA
| | - Elyana V T Locatelli
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
| | - Kimberly Cabrera
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA
| | - Haley O Peterson
- Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Noah K Cohen
- Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
| | | | - Andrew Jensen
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA
| | - Raquel Goldhardt
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
| | - Anat Galor
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
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10
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Yates PL, Case K, Sun X, Sullivan K, Baas PW, Qiang L. Veteran-derived cerebral organoids display multifaceted pathological defects in studies on Gulf War Illness. Front Cell Neurosci 2022; 16:979652. [PMID: 36619675 PMCID: PMC9816432 DOI: 10.3389/fncel.2022.979652] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Approximately 30% of the veterans who fought in the 1991 Gulf War (GW) suffer from a disease called Gulf War Illness (GWI), which encompasses a constellation of symptoms including cognitive deficits. A coalescence of evidence indicates that GWI was caused by low-level exposure to organophosphate pesticides and nerve agents in combination with physical stressors of the battlefield. Until recently, progress on mechanisms and therapy had been limited to rodent-based models. Using peripheral blood mononuclear cells from veterans with or without GWI, we recently developed a bank of human induced pluripotent stem cells that can be differentiated into a variety of cellular fates. With these cells, we have now generated cerebral organoids, which are three-dimensional multicellular structures that resemble the human brain. We established organoid cultures from two GW veterans, one with GWI and one without. Immunohistochemical analyses indicate that these organoids, when treated with a GW toxicant regimen consisting of the organophosphate diisopropyl fluorophosphate (a sarin analog) and cortisol (to mimic battlefield stress), display multiple indicators consistent with cognitive deficits, including increased astrocytic reactivity, enhanced phosphorylation of tau proteins, decreased microtubule stability, and impaired neurogenesis. Interestingly, some of these phenotypes were more pronounced in the organoids derived from the veteran with GWI, potentially reflecting a stronger response to the toxicants in some individuals compared to others. These results suggest that veteran-derived human cerebral organoids not only can be used as an innovative human model to uncover the cellular responses to GW toxicants but can also serve as a platform for developing personalized medicine approaches for the veterans.
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Affiliation(s)
- Philip L. Yates
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Kendra Case
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Xiaohuan Sun
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Peter W. Baas
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Liang Qiang
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States,*Correspondence: Liang Qiang,
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11
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Reinhard MJ, Allen N, Crock LE, McCarron KK, Veltkamp GM, Brewster RC. Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Clinical Normative Data for Gulf War Veterans. J Occup Environ Med 2022; 64:e799-e804. [PMID: 36190917 PMCID: PMC9729373 DOI: 10.1097/jom.0000000000002706] [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] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Heterogenous test batteries and methods applied in neurocognitive research on Gulf War Veterans (GWVs) limit the translation of findings to clinical practice. A clinical data set is necessary. METHODS Neurocognitive screening data from treatment-seeking GWVs were collected from multiple sites and compiled, informed by consideration of performance validity. RESULTS Repeatable Battery for the Assessment of Neuropsychological Status scores revealed the cognitive profile for GWVs (n = 189) as poorer across multiple domains when compared with similarly educated, nonveteran peers. However, mean scores generally remained within normal clinical limits. Data tables are presented to establish a comparison group for use in clinical care. CONCLUSIONS When assessing cognitive symptoms in GWVs, attention to education level and interpretation of subtle deficits is warranted. Current results highlight the importance of nuanced translation of neurocognitive research findings into clinical practice with GWVs.
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Affiliation(s)
- Mathew J. Reinhard
- War Related Illness and Injury Study Center at the
Washington DC VA Medical Center (WRIISC-DC), Washington, DC, United States of
America
| | - Nathaniel Allen
- War Related Illness and Injury Study Center at the
Washington DC VA Medical Center (WRIISC-DC), Washington, DC, United States of
America
| | - Lucas E. Crock
- War Related Illness and Injury Study Center at the
Washington DC VA Medical Center (WRIISC-DC), Washington, DC, United States of
America
| | - Kelly K. McCarron
- War Related Illness and Injury Study Center at the VA New
Jersey Healthcare System (WRIISC-NJ), East Orange, NJ, United States of America. The
work for this article was conducted during my work as an employee of the Department
of Veterans Affairs
| | - Gladys M. Veltkamp
- War Related Illness and Injury Study Center at the VA Palo
Alto Health Care System (WRIISC-CA), Palo Alto, CA, United States of America
| | - Ryan C. Brewster
- War Related Illness and Injury Study Center at the
Washington DC VA Medical Center (WRIISC-DC), Washington, DC, United States of
America
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12
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Ibrahim AE, Ghantarchyan H, Le T, Bhagat A, Maknouni B, Arabian S. A Rare Presentation of Severe Organophosphate Poisoning: A Case Report and Review of Literature. Cureus 2022; 14:e31497. [DOI: 10.7759/cureus.31497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
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13
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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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14
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François S, Mondot S, Gerard Q, Bel R, Knoertzer J, Berriche A, Cavallero S, Baati R, Orset C, Dal Bo G, Thibault K. Long-Term Anxiety-Like Behavior and Microbiota Changes Induced in Mice by Sublethal Doses of Acute Sarin Surrogate Exposure. Biomedicines 2022; 10:biomedicines10051167. [PMID: 35625901 PMCID: PMC9138233 DOI: 10.3390/biomedicines10051167] [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: 02/25/2022] [Revised: 05/07/2022] [Accepted: 05/16/2022] [Indexed: 12/10/2022] Open
Abstract
Anxiety disorder is one of the most reported complications following organophosphorus (OP) nerve agent (NA) exposure. The goal of this study was to characterize the long-term behavioral impact of a single low dose exposure to 4-nitrophenyl isopropyl methylphosphonate (NIMP), a sarin surrogate. We chose two different sublethal doses of NIMP, each corresponding to a fraction of the median lethal dose (one mild and one convulsive), and evaluated behavioral changes over a 6-month period following exposure. Mice exposed to both doses showed anxious behavior which persisted for six-months post-exposure. A longitudinal magnetic resonance imaging examination did not reveal any anatomical changes in the amygdala throughout the 6-month period. While no cholinesterase activity change or neuroinflammation could be observed at the latest timepoint in the amygdala of NIMP-exposed mice, important modifications in white blood cell counts were noted, reflecting a perturbation of the systemic immune system. Furthermore, intestinal inflammation and microbiota changes were observed at 6-months in NIMP-exposed animals regardless of the dose received. This is the first study to identify long-term behavioral impairment, systemic homeostasis disorganization and gut microbiota alterations following OP sublethal exposure. Our findings highlight the importance of long-term care for victims of NA exposure, even in asymptomatic cases.
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Affiliation(s)
- Sabine François
- Department of Radiation Biological Effects, Armed Forces Biomedical Research Institute, 91220 Bretigny sur Orge, France; (S.F.); (S.C.)
| | - Stanislas Mondot
- Micalis Institute, AgroParisTech, Université Paris-Saclay, INRAE, 78350 Jouy-en-Josas, France;
| | - Quentin Gerard
- Department of Toxicology and Chemical Risks, Armed Forces Biomedical Research Institute, 91220 Bretigny sur Orge, France; (Q.G.); (R.B.); (J.K.); (A.B.)
- Institut Blood and Brain@caen-normandie Cyceron, Caen-Normandie University, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), 14000 Caen, France;
| | - Rosalie Bel
- Department of Toxicology and Chemical Risks, Armed Forces Biomedical Research Institute, 91220 Bretigny sur Orge, France; (Q.G.); (R.B.); (J.K.); (A.B.)
| | - Julie Knoertzer
- Department of Toxicology and Chemical Risks, Armed Forces Biomedical Research Institute, 91220 Bretigny sur Orge, France; (Q.G.); (R.B.); (J.K.); (A.B.)
| | - Asma Berriche
- Department of Toxicology and Chemical Risks, Armed Forces Biomedical Research Institute, 91220 Bretigny sur Orge, France; (Q.G.); (R.B.); (J.K.); (A.B.)
- CEA, 92260 Fontenay aux Roses, France
| | - Sophie Cavallero
- Department of Radiation Biological Effects, Armed Forces Biomedical Research Institute, 91220 Bretigny sur Orge, France; (S.F.); (S.C.)
| | - Rachid Baati
- ICPEES UMR CNRS 7515, Institut de Chimie des Procédés, pour l’Energie, l’Environnement, et la Santé, 67000 Strasbourg, France;
| | - Cyrille Orset
- Institut Blood and Brain@caen-normandie Cyceron, Caen-Normandie University, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), 14000 Caen, France;
| | - Gregory Dal Bo
- Department of Toxicology and Chemical Risks, Armed Forces Biomedical Research Institute, 91220 Bretigny sur Orge, France; (Q.G.); (R.B.); (J.K.); (A.B.)
- Correspondence: (G.D.B.); (K.T.)
| | - Karine Thibault
- Department of Toxicology and Chemical Risks, Armed Forces Biomedical Research Institute, 91220 Bretigny sur Orge, France; (Q.G.); (R.B.); (J.K.); (A.B.)
- Correspondence: (G.D.B.); (K.T.)
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15
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Sanchez V, Baksh BS, Cabrera K, Choudhury A, Jensen K, Klimas N, Galor A. Dry Eye Symptoms and Signs in US Veterans With Gulf War Illness. Am J Ophthalmol 2022; 237:32-40. [PMID: 34780800 PMCID: PMC9035031 DOI: 10.1016/j.ajo.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To examine dry eye (DE) symptoms and signs in individuals with vs without Gulf War illness (GWI). DESIGN Prospective cross-sectional study. METHODS We performed a prospective, cross-sectional study of South Florida veterans who were active duty during the Gulf War era (GWE; 1990-1991) and seen at an eye clinic between October 1, 2020, and March 13, 2021. Veterans were split into 2 groups: those who met Kansas criteria for GWI (cases, n = 30) and those who did not (controls, n = 41). DE symptoms were assessed via standardized questionnaires whereas DE signs were assessed using a series of ocular surface parameters. Differences between groups were assessed via Mann-Whitney U test. Linear regression analyses were used to examine which GWI symptoms most closely aligned with DE symptoms. RESULTS Veterans with GWI had higher DE symptoms scores compared to controls (Ocular Surface Disease Index [OSDI] scores: mean 41.20±22.92 vs 27.99±24.03, P = .01). In addition, veterans with GWI had higher eye pain scores compared with controls (average eye pain over past week: 2.63±2.72 vs 1.22±1.50, P = .03), including on neuropathic ocular pain questionnaires (Neuropathic Pain Symptom Inventory modified for the Eye [NPSI-E]: 17.33±17.20 vs 9.63±12.64, P = .03). DE signs were mostly similar between the groups. GWI symptoms "nausea or upset stomach" (β=14.58, SE = 3.02, P < .001) and "headache" (β=7.90, SE = 2.91, P = .011) correlated with higher OSDI scores. CONCLUSION Individuals with GWI have more severe DE symptoms and ocular pain scores but similar tear and ocular surface parameters compared to controls without GWI. This finding suggests that mechanisms beyond tear dysfunction drive eye symptoms in GWI.
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Affiliation(s)
- Victor Sanchez
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Brandon S Baksh
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Kimberly Cabrera
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Anjalee Choudhury
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Katherine Jensen
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Nancy Klimas
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Anat Galor
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA..
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16
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Weisskopf MG, Sullivan KA. Invited Perspective: Causal Implications of Gene by Environment Studies Applied to Gulf War Illness. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:51301. [PMID: 35543506 PMCID: PMC9093160 DOI: 10.1289/ehp11057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/04/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Marc G. Weisskopf
- Departments of Environmental Health and Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Kimberly A. Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
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17
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Ribeiro AC, Hawkins E, Jahr FM, McClay JL, Deshpande LS. Repeated exposure to chlorpyrifos is associated with a dose-dependent chronic neurobehavioral deficit in adult rats. Neurotoxicology 2022; 90:172-183. [DOI: 10.1016/j.neuro.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/16/2022] [Accepted: 03/25/2022] [Indexed: 11/16/2022]
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18
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Oberlin S, Nkiliza A, Parks M, Evans JE, Klimas N, Keegan AP, Sullivan K, Krengel MH, Mullan M, Crawford F, Abdullah L. Sex-specific differences in plasma lipid profiles are associated with Gulf War Illness. J Transl Med 2022; 20:73. [PMID: 35123492 PMCID: PMC8817550 DOI: 10.1186/s12967-022-03272-3] [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: 11/24/2021] [Accepted: 01/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background Nearly 250,000 veterans from the 1990–1991 Gulf War have Gulf War Illness (GWI), a condition with heterogeneous pathobiology that remains difficult to diagnose. As such, availability of blood biomarkers that reflect the underlying biology of GWI would help clinicians provide appropriate care to ill veterans. In this study, we measured blood lipids to examine the influence of sex on the association between blood lipids and GWI diagnosis. Methods Plasma lipid extracts from GWI (n = 100) and control (n = 45) participants were subjected to reversed-phase nano-flow liquid chromatography-mass spectrometry analysis. Results An influence of sex and GWI case status on plasma neutral lipid and phospholipid species was observed. Among male participants, triglycerides, diglycerides, and phosphatidylcholines were increased while cholesterol esters were decreased in GWI cases compared to controls. In female participants, ceramides were increased in GWI cases compared to controls. Among male participants, unsaturated triglycerides, phosphatidylcholine and diglycerides were increased while unsaturated cholesterol esters were lower in GWI cases compared to controls. The ratio of arachidonic acid- to docosahexaenoic acid-containing triglyceride species was increased in female and male GWI cases as compared to their sex-matched controls. Conclusion Differential modulation of neutral lipids and ratios of arachidonic acid to docosahexaenoic acid in male veterans with GWI suggest metabolic dysfunction and inflammation. Increases in ceramides among female veterans with GWI also suggest activation of inflammatory pathways. Future research should characterize how these lipids and their associated pathways relate to GWI pathology to identify biomarkers of the disorder. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03272-3.
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19
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Krengel MH, Zundel CG, Heeren T, Yee M, Spiro A, Proctor SP, Grasso CM, Sullivan K. Health symptom trajectories and neurotoxicant exposures in Gulf War veterans: the Ft. Devens cohort. Environ Health 2022; 21:7. [PMID: 34998396 PMCID: PMC8742929 DOI: 10.1186/s12940-021-00812-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/25/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Thirty years ago, Gulf War (GW) veterans returned home with numerous health symptoms that have been associated with neurotoxicant exposures experienced during deployment. The health effects from these exposures have been termed toxic wounds. Most GW exposure-outcome studies utilize group analyses and thus individual fluctuations in symptoms may have been masked. This study investigates health symptom trajectories in the same veterans over 25 years. METHODS Veterans were categorized into 5 a priori trajectory groups for each health symptom and Chronic Multisymptom Illness (CMI) clinical case status. Multinomial logistic regression models were used to investigate associations between these trajectories and neurotoxicant exposures. RESULTS Results indicate that more than 21 Pyridostigmine Bromide (PB) pill exposure was associated with consistent reporting of fatigue, pain, and cognitive/mood symptoms as well as the development of six additional symptoms over time. Chemical weapons exposure was associated with both consistent reporting and development of neurological symptoms over time. Reported exposure to tent heater exhaust was associated with later development of gastrointestinal and pulmonary symptoms. Veterans reporting exposure to more than 21 PB pills were more than 8 times as likely to consistently meet the criteria for CMI over time. CONCLUSION This study highlights the importance of the continued documentation of the health impacts experienced by GW veterans', their resulting chronic health symptoms, and the importance of exposure-outcome relationships in these veterans now 30 years post-deployment.
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Affiliation(s)
- Maxine H. Krengel
- Research Service, VA Boston Healthcare System, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 USA
| | - Clara G. Zundel
- Research Service, VA Boston Healthcare System, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 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
| | - Megan Yee
- Research Service, VA Boston Healthcare System, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 USA
- Department of Environmental Health, 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, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 USA
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA USA
| | - Claudia M. Grasso
- Research Service, VA Boston Healthcare System, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA USA
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20
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BXD Recombinant Inbred Mice as a Model to Study Neurotoxicity. Biomolecules 2021; 11:biom11121762. [PMID: 34944406 PMCID: PMC8698863 DOI: 10.3390/biom11121762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/20/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022] Open
Abstract
BXD recombinant inbred (RI) lines represent a genetic reference population derived from a cross between C57BL/6J mice (B6) and DBA/2J mice (D2), which through meiotic recombination events possesses recombinant chromosomes containing B6 or D2 haplotype segments. The quantitative trait loci (QTLs) are the locations of segregating genetic polymorphisms and are fundamental to understanding genetic diversity in human disease susceptibility and severity. QTL mapping represents the typical approach for identifying naturally occurring polymorphisms that influence complex phenotypes. In this process, genotypic values at markers of known genomic locations are associated with phenotypic values measured in a segregating population. Indeed, BXD RI strains provide a powerful tool to study neurotoxicity induced by different substances. In this review, we describe the use of BXD RI lines to understand the underlying mechanisms of neurotoxicity in response to ethanol and cocaine, as well as metals and pesticide exposures.
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21
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Michalovicz LT, Kelly KA, Miller DB, Sullivan K, O'Callaghan JP. The β-adrenergic receptor blocker and anti-inflammatory drug propranolol mitigates brain cytokine expression in a long-term model of Gulf War Illness. Life Sci 2021; 285:119962. [PMID: 34563566 PMCID: PMC9047058 DOI: 10.1016/j.lfs.2021.119962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 12/03/2022]
Abstract
Aims: Growing evidence suggests that Gulf War Illness (GWI) is the result of underlying neuroimmune dysfunction. For example, previously we found that several GWI-relevant organophosphate acetylcholinesterase inhibitors produce heightened neuroinflammatory responses following subchronic exposure to stress hormone as a mimic of high physiological stress. The goal of the current study was to evaluate the potential for the β-adrenergic receptor inhibitor and anti-inflammatory drug, propranolol, to treat neuroinflammation in a novel long-term mouse model of GWI. Main methods: Adult male C57BL/6J mice received a subchronic exposure to corticosterone (CORT) at levels mimicking high physiological stress followed by exposure to the sarin surrogate, diisopropyl fluorophosphate (DFP). These mice were then re-exposed to CORT every other week for a total of five weeks, followed by a systemic immune challenge with lipopolysaccharide (LPS). Animals receiving the propranolol treatment were given a single dose (20 mg/kg, i.p.) either four or 11 days prior to the LPS challenge. The potential anti-neuroinflammatory effects of propranolol were interrogated by analysis of cytokine mRNA expression. Key findings: We found that our long-term GWI model produces a primed neuroinflammatory response to subsequent immune challenge that is dependent upon GWI-relevant organophosphate exposure. Propranolol treatment abrogated the elaboration of inflammatory cytokine mRNA expression in the brain instigated in our model, having no treatment effects in non-DFP exposed groups. Significance: Our results indicate that propranolol may be a promising therapy for GWI with the potential to treat the underlying neuroinflammation associated with the illness.
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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
| | - Diane B Miller
- 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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22
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Keating D, Zundel CG, Abreu M, Krengel M, Aenlle K, Nichols MD, Toomey R, Chao LL, Golier J, Abdullah L, Quinn E, Heeren T, Groh JR, Koo BB, Killiany R, Loggia ML, Younger J, Baraniuk J, Janulewicz P, Ajama J, Quay M, Baas PW, Qiang L, Conboy L, Kokkotou E, O'Callaghan JP, Steele L, Klimas N, Sullivan K. Boston biorepository, recruitment and integrative network (BBRAIN): A resource for the Gulf War Illness scientific community. Life Sci 2021; 284:119903. [PMID: 34453948 DOI: 10.1016/j.lfs.2021.119903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/31/2021] [Accepted: 08/17/2021] [Indexed: 12/26/2022]
Abstract
AIMS Gulf War Illness (GWI), a chronic debilitating disorder characterized by fatigue, joint pain, cognitive, gastrointestinal, respiratory, and skin problems, is currently diagnosed by self-reported symptoms. The Boston Biorepository, Recruitment, and Integrative Network (BBRAIN) is the collaborative effort of expert Gulf War Illness (GWI) researchers who are creating objective diagnostic and pathobiological markers and recommend common data elements for GWI research. MAIN METHODS BBRAIN is recruiting 300 GWI cases and 200 GW veteran controls for the prospective study. Key data and biological samples from prior GWI studies are being merged and combined into retrospective datasets. They will be made available for data mining by the BBRAIN network and the GWI research community. Prospective questionnaire data include general health and chronic symptoms, demographics, measures of pain, fatigue, medical conditions, deployment and exposure histories. Available repository biospecimens include blood, plasma, serum, saliva, stool, urine, human induced pluripotent stem cells and cerebrospinal fluid. KEY FINDINGS To date, multiple datasets have been merged and combined from 15 participating study sites. These data and samples have been collated and an online request form for repository requests as well as recommended common data elements have been created. Data and biospecimen sample requests are reviewed by the BBRAIN steering committee members for approval as they are received. SIGNIFICANCE The BBRAIN repository network serves as a much needed resource for GWI researchers to utilize for identification and validation of objective diagnostic and pathobiological markers of the illness.
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Affiliation(s)
- D Keating
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
| | - C G Zundel
- Boston University School of Medicine, Behavioral Neuroscience Program, 72 East Concord St., Boston, MA 02118, USA.
| | - M Abreu
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; Geriatric Research Education and Clinical Center, Miami VA Medical Center, Miami, FL 33125, USA.
| | - M Krengel
- Boston University School of Medicine, Department of Neurology, 72 East Concord St., Boston, MA 02118, USA.
| | - K Aenlle
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; Geriatric Research Education and Clinical Center, Miami VA Medical Center, Miami, FL 33125, USA.
| | - M D Nichols
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA
| | - R Toomey
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, USA.
| | - L L Chao
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA 94143, USA.
| | - J Golier
- James J. Peters VA Medical Center, OOMH-526, 130 West Kingsbridge Road, Bronx, NY 10468, USA; Psychiatry Department, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029, USA.
| | - L Abdullah
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL 34243, USA; Open University, Milton Keynes, United Kingdom; James A. Haley Veterans' Hospital, Tampa, FL, USA.
| | - E Quinn
- Boston University School of Public Health, Department of Biostatistics, 715 Albany St., Boston, MA 02118, USA.
| | - T Heeren
- Boston University School of Public Health, Department of Biostatistics, 715 Albany St., Boston, MA 02118, USA.
| | - J R Groh
- Boston University School of Medicine, Behavioral Neuroscience Program, 72 East Concord St., Boston, MA 02118, USA.
| | - B B Koo
- Boston University School of Medicine, Department of Anatomy and Neurobiology, 72 East Concord St., Boston, MA 02118, USA.
| | - R Killiany
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA; Boston University School of Medicine, Department of Neurology, 72 East Concord St., Boston, MA 02118, USA; Boston University School of Medicine, Department of Anatomy and Neurobiology, 72 East Concord St., Boston, MA 02118, USA.
| | - M L Loggia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
| | - J Younger
- Neuroinflammation, Pain & Fatigue Lab, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - J Baraniuk
- Department of Medicine, Georgetown University, Washington, DC, USA.
| | - P Janulewicz
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
| | - J Ajama
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
| | - M Quay
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
| | - P W Baas
- Drexel University College of Medicine, Department of Neurobiology and Anatomy, 2900 Queen Lane, Philadelphia, PA 19129, USA.
| | - L Qiang
- Drexel University College of Medicine, Department of Neurobiology and Anatomy, 2900 Queen Lane, Philadelphia, PA 19129, USA.
| | - L Conboy
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.
| | - E Kokkotou
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.
| | - J P O'Callaghan
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV, USA.
| | - L Steele
- Baylor College of Medicine Neuropsychiatry Division, Department of Psychiatry and Behavioral Sciences, Houston, TX 77030, USA.
| | - N Klimas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; Geriatric Research Education and Clinical Center, Miami VA Medical Center, Miami, FL 33125, USA.
| | - K Sullivan
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
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Yates PL, Patil A, Sun X, Niceforo A, Gill R, Callahan P, Beck W, Piermarini E, Terry AV, Sullivan KA, Baas PW, Qiang L. A cellular approach to understanding and treating Gulf War Illness. Cell Mol Life Sci 2021; 78:6941-6961. [PMID: 34580742 PMCID: PMC9669894 DOI: 10.1007/s00018-021-03942-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/30/2021] [Accepted: 09/14/2021] [Indexed: 01/04/2023]
Abstract
Gulf War Illness (GWI), a disorder suffered by approximately 200,000 veterans of the first Gulf War, was caused by exposure to low-level organophosphate pesticides and nerve agents in combination with battlefield stress. To elucidate the mechanistic basis of the brain-related symptoms of GWI, human-induced pluripotent stem cells (hiPSCs) derived from veterans with or without GWI were differentiated into forebrain glutamatergic neurons and then exposed to a Gulf War (GW) relevant toxicant regimen consisting of a sarin analog and cortisol, a human stress hormone. Elevated levels of total and phosphorylated tau, reduced microtubule acetylation, altered mitochondrial dynamics/transport, and decreased neuronal activity were observed in neurons exposed to the toxicant regimen. Some of the data are consistent with the possibility that some veterans may have been predisposed to acquire GWI. Wistar rats exposed to a similar toxicant regimen showed a mild learning and memory deficit, as well as cell loss and tau pathology selectively in the CA3 region of the hippocampus. These cellular responses offer a mechanistic explanation for the memory loss suffered by veterans with GWI and provide a cell-based model for screening drugs and developing personalized therapies for these veterans.
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Affiliation(s)
- Philip L Yates
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Ankita Patil
- 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
| | - Alessia Niceforo
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Ramnik Gill
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Patrick Callahan
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Wayne Beck
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Emanuela Piermarini
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Alvin V Terry
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Kimberly A Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Peter W Baas
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA
| | - Liang Qiang
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA.
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Association of the tissue microstructural diffusivity and translocator protein PET in Gulf War Illness. Brain Behav Immun Health 2021; 18:100364. [PMID: 34693367 PMCID: PMC8515380 DOI: 10.1016/j.bbih.2021.100364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/01/2021] [Accepted: 10/02/2021] [Indexed: 02/05/2023] Open
Abstract
About a third of all United States veterans who served in the 1991 Gulf War (GW) report a range of chronic health symptoms including fatigue, neurocognitive symptoms, and musculoskeletal pain. There is growing evidence supporting the detrimental effects of maladaptive neuroimmune reactions in this multi-symptom illness. Indeed, recent studies using positron emission tomography (PET) using the radioligand [11C]PBR28, which binds the neuroinflammation marker 18 kDa translocator protein (TSPO), and diffusion magnetic resonance imaging (dMRI) have independently identified the anterior cingulate (ACC) and midcingulate cortices (MCC) as key regions for differentiating GWI veterans from healthy controls (HC). Here, we used integrated (i.e., simultaneous) PET/MRI imaging techniques, paired with dMRI processing methods (neurite density imaging, NDI, and free-water diffusion tensor model to single-shell high-order dMRI), to directly evaluate the relationship between ACC and MCC microstructural tissue parameters, TSPO signal and clinical parameters in the same cohorts of 10 GWI veterans and 19 HCs. Within the regions evaluated, TSPO signal elevations were associated with restricted diffusivity in the extracellular compartment, while clinical measures were best explained by neurite density and cellular structure complexity measures. Our study is the first to provide evidence of a relationship between PET and dMRI modalities in GWI and suggests that microstructural changes in the ACC and MCC are correlated to mood symptoms and cognitive performances in GWI veterans.
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Arora K, Xu L, Bhagianadh D. Dementia and Cognitive Decline in Older Adulthood: Are Agricultural Workers at Greater Risk? J Gerontol B Psychol Sci Soc Sci 2021; 76:1629-1643. [PMID: 33406265 DOI: 10.1093/geronb/gbab005] [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: 07/23/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To examine whether long-term exposure to agricultural work is associated with dementia prevalence and the rate of cognitive change in older adulthood. METHOD We employed data from the Health and Retirement Study (1998-2014). Multiple logistic regression was used to determine whether a longest-held job in the agricultural sector was associated with differences in dementia prevalence. We examined if hearing impairment, depression, and physical health indicators mediated the relationship between agricultural work and cognitive functioning. Subgroup analyses were done by age, retirement status, job tenure, and cognitive domain. We employed growth curve models to investigate implications of agricultural work on age trajectories of cognitive functioning. RESULTS Longest-held job in agriculture, fishing, and forestry (AFF) was associated with 46% greater odds of having dementia. The relationship between AFF exposure and cognitive functioning was not mediated by hearing impairment, depression, or physical health indicators. Results were stronger among younger and retired older adults as well as those with extensive job tenure. AFF exposure was associated with lower scores in working memory and attention and processing speed. Growth curve models indicated that while agricultural work exposure was associated with lower initial levels of cognitive functioning, over time, the pattern reversed with individuals in non-AFF jobs, showing more accelerated cognitive decline. DISCUSSION Consistent with European studies, results from the United States also demonstrate a higher prevalence of dementia among agricultural workers. The cognitive reserve framework may explain the seemingly paradoxical result on age patterning of cognitive performance across older adults with different work histories.
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Affiliation(s)
- Kanika Arora
- Department of Health Management and Policy, University of Iowa, USA
| | - Lili Xu
- Department of Health Management and Policy, University of Iowa, USA
| | - Divya Bhagianadh
- Department of Health Management and Policy, University of Iowa, USA
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26
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Hawkey AB, Holloway Z, Dean C, Koburov R, Slotkin TA, Seidler FJ, Levin ED. Neurobehavioral anomalies in zebrafish after sequential exposures to DDT and chlorpyrifos in adulthood: Do multiple exposures interact? Neurotoxicol Teratol 2021; 87:106985. [PMID: 33901621 PMCID: PMC8440335 DOI: 10.1016/j.ntt.2021.106985] [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: 09/03/2020] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 02/07/2023]
Abstract
A sequence of different classes of synthetic insecticides have been used over the past 70 years. Over this period, the widely-used organochlorines were eventually replaced by organophosphates, with dichlorodiphenyltrichloroethane (DDT) and chlorpyrifos (CPF) as the principal prototypes. Considerable research has characterized the risks of DDT and CPF individually, but little is known about the toxicology of transitioning from one class of insecticides to another, as has been commonplace for agricultural and pest control workers. This study used adult zebrafish to investigate neurobehavioral toxicity following 5-week chronic exposure to either DDT or CPF, to or their sequential exposure (DDT for 5 weeks followed by CPF for 5 weeks). At the end of the exposure period, a subset of fish were analyzed for brain cholinesterase activity. Behavioral effects were initially assessed one week following the end of the CPF exposure and again at 14 months of age using a behavioral test battery covering sensorimotor responses, anxiety-like functions, predator avoidance and social attraction. Adult insecticide exposures, individually or sequentially, were found to modulate multiple behavioral features, including startle responsivity, social approach, predator avoidance, locomotor activity and novel location recognition and avoidance. Locomotor activity and startle responsivity were each impacted to a greater degree by the sequential exposures than by individual compounds, with the latter being pronounced at the early (1-week post exposure) time point, but not 3-4 months later in aging. Social approach responses were similarly impaired by the sequential exposure as by CPF-alone at the aging time point. Fleeing responses in the predator test showed flee-enhancing effects of both compounds individually versus controls, and no additive impact of the two following sequential exposure. Each compound was also associated with changes in recognition or avoidance patterns in a novel place recognition task in late adulthood, but sequential exposures did not enhance these phenotypes. The potential for chemical x chemical interactions did not appear related to changes in CPF metabolism to the active oxon, as prior DDT exposure did not affect the cholinesterase inhibition resulting from CPF. This study shows that the effects of chronic adult insecticide exposures may be relevant to behavioral health initially and much later in life, and that the effects of sequential exposures may be unpredictable based on their constituent exposures.
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Affiliation(s)
- Andrew B Hawkey
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Zade Holloway
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Cassandra Dean
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Reese Koburov
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Theodore A Slotkin
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Frederic J Seidler
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Edward D Levin
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA; Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC 27710, USA.
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27
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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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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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29
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Golomb BA, Devaraj S, Messner AK, Koslik HJ, Han JH, Yik B. Lower blood malondialdehyde is associated with past pesticide exposure: findings in Gulf War illness and healthy controls. Mil Med Res 2021; 8:46. [PMID: 34399857 PMCID: PMC8369730 DOI: 10.1186/s40779-021-00337-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/03/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Malondialdehyde (MDA) is a candidate general marker of oxidative stress (OS). We sought to assess the relation of MDA to Gulf War illness (GWI) and to a variety of exposures. METHODS This is an observational study involving subjects from Southern California recruited from October 2011 to May 2014. MDA was assessed in 81 participants (41 GWI-cases, 40 controls). General and Gulf-specific exposures were elicited. MDA case-control comparison was restricted to 40 matched pairs. The potential association between MDA and exposures was assessed using regression analyses. Gulf-specific exposures were incorporated into a case-specific model. RESULTS Plasma MDA was significantly lower in GWI-cases than controls. Composite pesticide and fuel-solvent exposures negatively predicted MDA in the total sample, as well as in the analyses that included either GWI-cases or controls only. Self-reported exposure to organophosphate (OP) nerve gas was a strong predictor for lower MDA level in veterans with GWI. CONCLUSION Past pesticide exposures predicted lower MDA in both veterans with GWI and in healthy controls.
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Affiliation(s)
- Beatrice Alexandra Golomb
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, 92093, USA.
| | - Sridevi Devaraj
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Alexis K Messner
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, 92093, USA.,Swedish Medical Center, Seattle, WA, 98109, USA
| | - Hayley Jean Koslik
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, 92093, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, San Diego, CA, 92134, USA
| | - Jun Hee Han
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Barnabas Yik
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, 92093, USA.,Santa Clara Valley Medical Center, San Jose, CA, 95128, USA
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Longitudinal Assessment of Health Symptoms in Relation to Neurotoxicant Exposures in 1991 Gulf War Veterans: The Ft. Devens Cohort. J Occup Environ Med 2021; 62:663-668. [PMID: 32890202 PMCID: PMC7478220 DOI: 10.1097/jom.0000000000001910] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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.
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Elevated somatic mutation and evidence of genomic instability in veterans with Gulf War illness. Life Sci 2021; 281:119746. [PMID: 34181965 DOI: 10.1016/j.lfs.2021.119746] [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: 01/31/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 11/20/2022]
Abstract
AIMS Gulf War illness (GWI) is thought to be associated with exposures experienced by soldiers deployed in the 1991 Gulf War. A major question is how these exposures continue to influence the health of these individuals three decades later. One potentially permanent effect of such exposures is the induction of genetic mutations. We investigated whether veterans with GWI exhibited persistently elevated levels of somatic mutation. MATERIALS AND METHODS We applied the blood-based glycophorin A (GPA) somatic mutation assay to a cohort of veterans diagnosed with GWI and a set of both concurrent and historic age-matched controls. This assay quantifies red blood cells with a phenotype consistent with loss of one allele at the genetic determinant for the MN blood group, the GPA gene. KEY FINDINGS As a population, those affected with GWI exhibited an uninduced mutation frequency at the GPA locus that was effectively twice that observed in controls, a result that was statistically significant. This result was influenced by an increase in the incidence of individuals with aberrantly high mutation frequencies, seemingly higher than would be expected by dose extrapolation and consistent with the induction of localized genomic instability in the hematopoietic bone marrow stem cells. When these "outliers" were removed from consideration, the remaining affected population retained a significantly higher mean allele loss mutation frequency, suggesting that both dose-dependent bone marrow genotoxicity and induction of genomic instability are contributing to the elevation in mutation frequency in these affected veterans. SIGNIFICANCE This study provides evidence that manifestation of GWI is associated with increased cumulative exposure to agents capable of inducing persistent mutations in bone marrow stem cells. Whether these mutations are involved in the clinical aspects of the condition or are simply biomarkers of overall exposure has yet to be determined. The increased incidence of genomic instability suggests that this persistent mutation can have important delayed effects on cellular integrity.
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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: 10] [Impact Index Per Article: 3.3] [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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Brown KA, Carpenter JM, Preston CJ, Ludwig HD, Clay KB, Harn DA, Norberg T, Wagner JJ, Filipov NM. Lacto-N-fucopentaose-III ameliorates acute and persisting hippocampal synaptic plasticity and transmission deficits in a Gulf War Illness mouse model. Life Sci 2021; 279:119707. [PMID: 34102195 DOI: 10.1016/j.lfs.2021.119707] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/19/2021] [Accepted: 06/01/2021] [Indexed: 12/12/2022]
Abstract
AIMS The present study investigated if treatment with the immunotherapeutic, lacto-N-fucopentaose-III (LNFPIII), resulted in amelioration of acute and persisting deficits in synaptic plasticity and transmission as well as trophic factor expression along the hippocampal dorsoventral axis in a mouse model of Gulf War Illness (GWI). MAIN METHODS Mice received either coadministered or delayed LNFPIII treatment throughout or following, respectively, exposure to a 15-day GWI induction paradigm. Subsets of animals were subsequently sacrificed 48 h, seven months, or 11 months post GWI-related (GWIR) exposure for hippocampal qPCR or in vitro electrophysiology experiments. KEY FINDINGS Progressively worsened impairments in hippocampal synaptic plasticity, as well as a biphasic effect on hippocampal synaptic transmission, were detected in GWIR-exposed animals. Dorsoventral-specific impairments in hippocampal synaptic responses became more pronounced over time, particularly in the dorsal hippocampus. Notably, delayed LNFPIII treatment ameliorated GWI-related aberrations in hippocampal synaptic plasticity and transmission seven and 11 months post-exposure, an effect that was consistent with enhanced hippocampal trophic factor expression and absence of increased interleukin 6 (IL-6) in animals treated with LNFPIII. SIGNIFICANCE Approximately a third of Gulf War Veterans have GWI; however, GWI therapeutics are presently limited to targeted and symptomatic treatments. As increasing evidence underscores the substantial role of persisting neuroimmune dysfunction in GWI, efficacious neuroactive immunotherapeutics hold substantial promise in yielding GWI remission. The findings in the present report indicate that LNFPIII may be an efficacious candidate for ameliorating persisting neurological abnormalities presented in GWI.
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Affiliation(s)
- 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
| | - Jessica M Carpenter
- Department of Physiology and Pharmacology, University of Georgia, Athens, GA, United States; Neuroscience Program, University of Georgia, Athens, GA, United States
| | - Collin J Preston
- Department of Physiology and Pharmacology, University of Georgia, Athens, GA, United States; Interdisciplinary Toxicology Program, University of Georgia, Athens, GA, United States
| | - Helaina D Ludwig
- Department of Physiology and Pharmacology, University of Georgia, Athens, GA, United States; Interdisciplinary Toxicology Program, University of Georgia, Athens, GA, United States
| | - Kendall B Clay
- Neuroscience Program, 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 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; Interdisciplinary Toxicology Program, University of Georgia, Athens, GA, United States; Neuroscience Program, University of Georgia, Athens, GA, United States.
| | - Nikolay M Filipov
- Department of Physiology and Pharmacology, University of Georgia, Athens, GA, United States; Interdisciplinary Toxicology Program, University of Georgia, Athens, GA, United States; Neuroscience Program, University of Georgia, Athens, GA, United States.
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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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35
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Naughton SX, Beck WD, Wei Z, Wu G, Baas PW, Terry AV. The Carbamate, Physostigmine does not Impair Axonal Transport in Rat Cortical Neurons. Neurosci Insights 2021; 16:26331055211020289. [PMID: 34104889 PMCID: PMC8155748 DOI: 10.1177/26331055211020289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/07/2021] [Indexed: 11/21/2022] Open
Abstract
Among the various chemicals that are commonly used as pesticides,
organophosphates (OPs), and to a lesser extent, carbamates, are most frequently
associated with adverse long-term neurological consequences. OPs and the
carbamate, pyridostigmine, used as a prophylactic drug against potential nerve
agent attacks, have also been implicated in Gulf War Illness (GWI), which is
often characterized by chronic neurological symptoms. While most OP- and
carbamate-based pesticides, and pyridostigmine are relatively potent
acetylcholinesterase inhibitors (AChEIs), this toxicological mechanism is
inadequate to explain their long-term health effects, especially when no signs
of acute cholinergic toxicity are exhibited. Our previous work suggests that a
potential mechanism of the long-term neurological deficits associated with OPs
is impairment of axonal transport (AXT); however, we had not previously
evaluated carbamates for this effect. Here we thus evaluated the carbamate,
physostigmine (PHY), a highly potent AChEI, on AXT using an in
vitro neuronal live imaging assay that we have previously found to
be very sensitive to OP-related deficits in AXT. We first evaluated the OP,
diisopropylfluorophosphate (DFP) (concentration range 0.001-10.0 µM) as a
reference compound that we found previously to impair AXT and subsequently
evaluated PHY (concentration range 0.01-100 nM). As expected, DFP impaired AXT
in a concentration-dependent manner, replicating our previously published
results. In contrast, none of the concentrations of PHY (including
concentrations well above the threshold for impairing AChE) impaired AXT. These
data suggest that the long-term neurological deficits associated with some
carbamates are not likely due to acute impairments of AXT.
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Affiliation(s)
- Sean X Naughton
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Wayne D Beck
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Zhe Wei
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Guangyu Wu
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Peter W Baas
- Department of Neurobiology and Anatomy, Drexel University, College of Medicine, Philadelphia, PA, USA
| | - Alvin V Terry
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, USA
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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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Krengel M, Sullivan K, Heboyan V, Zundel CG, Wilson CC, Klimas N, Coughlin SS. Neurotoxicant exposures and rates of Chronic Multisymptom Illness and Kansas Gulf War Illness criteria in Gulf War deployed women veterans. Life Sci 2021; 280:119623. [PMID: 34004246 DOI: 10.1016/j.lfs.2021.119623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 12/18/2022]
Abstract
AIMS This study analyzed deployment-related exposures and risk of Persian Gulf War Illness (GWI) in women veterans from the Veterans Affairs (VA) Cooperative Studies Program 585 Gulf War Era Cohort and Biorepository (GWECB CSP#585). MAIN METHODS We examined the associations between GW deployment-related exposures and case definitions for GWI in deployed GW women. Multivariate regression analyses controlling for demographic outcomes were performed. KEY FINDINGS Surveys were obtained from 202 GW deployed women veterans. Self-reported exposure to smoke from oil well fires as well as chemical and biological warfare were the only exposures significantly associated with the Center for Disease Control and Prevention (CDC) GWI criteria. Seventy-nine women were excluded from the rest of the analyses as they met Kansas GW illness exclusion criteria. Eligible women who self-reported deployment-related exposure to smoke from oil wells, pyridostigmine bromide (PB) pills, pesticide cream, pesticide treated uniforms, and insect baits were significantly more likely to meet the Kansas GWI criteria (n = 123) than those unexposed and exposures were related to Kansas symptom subdomain endorsements. SIGNIFICANCE These results suggest that women GW veterans reporting deployment related exposures of pesticide, oil well fire and PB pills are significantly more likely to meet the Kansas GWI criteria in this national cohort of GW women suggesting its utility in future studies. In addition, based on these results it appears that women exposed to particular toxicants during the war may benefit from more targeted treatment strategies dependent upon the mechanism of exposure of their toxicant induced outcomes.
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Affiliation(s)
- Maxine Krengel
- Boston University School of Medicine, United States of America; VA Boston Healthcare System, Boston, MA, United States of America.
| | - Kimberly Sullivan
- Boston University School of Public Health, Boston, MA, United States of America
| | - Vahé Heboyan
- Health Economics and Modeling Division, Population Health Sciences Department, Medical College of Georgia, Augusta University, Augusta, GA, United States of America
| | - Clara G Zundel
- Boston University School of Medicine, United States of America; VA Boston Healthcare System, Boston, MA, United States of America
| | - Col Candy Wilson
- Uniformed Services University Graduate School of Nursing, Bethesda, MD, United States of America
| | - Nancy Klimas
- Miami VA Healthcare System, Miami, FL, United States of America; Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America
| | - Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, United States of America; Research Service, Charlie Norwood Veterans Administration Medical Center, Augusta, GA, United States of America
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Latimer JJ, Alhamed A, Sveiven S, Almutairy A, Klimas NG, Abreu M, Sullivan K, Grant SG. Preliminary Evidence for a Hormetic Effect on DNA Nucleotide Excision Repair in Veterans with Gulf War Illness. Mil Med 2021; 185:e47-e52. [PMID: 31334811 PMCID: PMC7353836 DOI: 10.1093/milmed/usz177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Veterans of the 1991 Gulf War were potentially exposed to a mixture of stress, chemicals and radiation that may have contributed to the persistent symptoms of Gulf War Illness (GWI). The genotoxic effects of some of these exposures are mediated by the DNA nucleotide excision repair (NER) pathway. We hypothesized that individuals with relatively low DNA repair capacity would suffer greater damage from cumulative genotoxic exposures, some of which would persist, causing ongoing problems. Materials and Methods Blood samples were obtained from symptomatic Gulf War veterans and age-matched controls. The unscheduled DNA synthesis assay, a functional measurement of NER capacity, was performed on cultured lymphocytes, and lymphocyte mRNA was extracted and analyzed by sequencing. Results Despite our hypothesis that GWI would be associated with DNA repair deficiency, NER capacity in lymphocytes from affected GWI veterans actually exhibited a significantly elevated level of DNA repair (p = 0.016). Both total gene expression and NER gene expression successfully differentiated individuals with GWI from unaffected controls. The observed functional increase in DNA repair capacity was accompanied by an overexpression of genes in the NER pathway, as determined by RNA sequencing analysis. Conclusion We suggest that the observed elevations in DNA repair capacity and NER gene expression are indicative of a “hormetic,” i.e., induced or adaptive protective response to battlefield exposures. Normally such effects are short-term, but in these individuals this response has resulted in a long-term metabolic shift that may also be responsible for the persistent symptoms of GWI.
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Affiliation(s)
- Jean J Latimer
- Department of Pharmaceutical Sciences, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328.,South University Drive, AutoNation Institute for Breast Cancer Research, 3321, Fort Lauderdale, FL 33328
| | - Abdullah Alhamed
- Department of Pharmaceutical Sciences, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328.,South University Drive, AutoNation Institute for Breast Cancer Research, 3321, Fort Lauderdale, FL 33328
| | - Stefanie Sveiven
- South University Drive, AutoNation Institute for Breast Cancer Research, 3321, Fort Lauderdale, FL 33328
| | - Ali Almutairy
- Department of Pharmaceutical Sciences, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328.,South University Drive, AutoNation Institute for Breast Cancer Research, 3321, Fort Lauderdale, FL 33328
| | - Nancy G Klimas
- Department of Clinical Immunology, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328.,Department of Medicine, Miami VA Healthcare System, 1201 NW 16th St, Miami, FL 33313
| | - Maria Abreu
- Department of Clinical Immunology, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St, Boston, MA 02118
| | - Stephen G Grant
- South University Drive, AutoNation Institute for Breast Cancer Research, 3321, Fort Lauderdale, FL 33328.,Department of Public Health, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328
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Sex-Based Differences in Plasma Autoantibodies to Central Nervous System Proteins in Gulf War Veterans versus Healthy and Symptomatic Controls. Brain Sci 2021; 11:brainsci11020148. [PMID: 33498629 PMCID: PMC7911379 DOI: 10.3390/brainsci11020148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023] Open
Abstract
Veterans from the 1991 Gulf War (GW) have suffered from Gulf War illness (GWI) for nearly 30 years. This illness encompasses multiple body systems, including the central nervous system (CNS). Diagnosis and treatment of GWI is difficult because there has not been an objective diagnostic biomarker. Recently, we reported on a newly developed blood biomarker that discriminates GWI from GW healthy controls, and symptomatic controls with irritable bowel syndrome (IBS) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The present study was designed to compare levels of these biomarkers between men and women with GWI, as well as sex-specific effects in comparison to healthy GW veterans and symptomatic controls (IBS, ME/CFS). The results showed that men and women with GWI differ in 2 of 10 plasma autoantibodies, with men showing significantly elevated levels. Men and women with GWI showed significantly different levels of autoantibodies in 8 of 10 biomarkers to neuronal and glial proteins in plasma relative to controls. In summary, the present study addressed the utility of the use of plasma autoantibodies for CNS proteins to distinguish among both men and women veterans with GWI and other healthy and symptomatic control groups.
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Lacagnina MJ, Li J, Lorca S, Rice KC, Sullivan K, O’Callaghan JP, Grace PM. A role for neuroimmune signaling in a rat model of Gulf War Illness-related pain. Brain Behav Immun 2021; 91:418-428. [PMID: 33127584 PMCID: PMC7749855 DOI: 10.1016/j.bbi.2020.10.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/07/2020] [Accepted: 10/24/2020] [Indexed: 12/14/2022] Open
Abstract
More than a quarter of veterans of the 1990-1991 Persian Gulf War suffer from Gulf War Illness (GWI), a chronic, multi-symptom illness that commonly includes musculoskeletal pain. Exposure to a range of toxic chemicals, including sarin nerve agent, are a suspected root cause of GWI. Moreover, such chemical exposures induce a neuroinflammatory response in rodents, which has been linked to several GWI symptoms in rodents and veterans with GWI. To date, a neuroinflammatory basis for pain associated with GWI has not been investigated. Here, we evaluated development of nociceptive hypersensitivity in a model of GWI. Male Sprague Dawley rats were treated with corticosterone in the drinking water for 7 days, to mimic high physiological stress, followed by a single injection of the sarin nerve agent surrogate, diisopropyl fluorophosphate. These exposures alone were insufficient to induce allodynia. However, an additional sub-threshold challenge (a single intramuscular injection of pH 4 saline) induced long-lasting, bilateral allodynia. Such allodynia was associated with elevation of markers for activated microglia/macrophages (CD11b) and astrocytes/satellite glia (GFAP) in the lumbar dorsal spinal cord and dorsal root ganglia (DRG). Additionally, Toll-like receptor 4 (TLR4) mRNA was elevated in the lumbar dorsal spinal cord, while IL-1β and IL-6 were elevated in the lumbar dorsal spinal cord, DRG, and gastrocnemius muscle. Demonstrating a casual role for such neuroinflammatory signaling, allodynia was reversed by treatment with either minocycline, the TLR4 inhibitor (+)-naltrexone, or IL-10 plasmid DNA. Together, these results point to a role for neuroinflammation in male rats in the model of musculoskeletal pain related to GWI. Therapies that alleviate persistent immune dysregulation may be a strategy to treat pain and other symptoms of GWI.
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Affiliation(s)
- Michael J. Lacagnina
- Laboratories of Neuroimmunology, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jiahe Li
- Laboratories of Neuroimmunology, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sabina Lorca
- Laboratories of Neuroimmunology, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kenner C. Rice
- Drug Design and Synthesis Section, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, Bethesda, MD, USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, 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
| | - Peter M. Grace
- Laboratories of Neuroimmunology, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Corresponding author: Peter M. Grace, PhD, 6565 MD Anderson Blvd, Houston TX, 77030, T: 713-792-6673,
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The peroxisome proliferator-activated receptor gamma (PPARγ) agonist, rosiglitazone, ameliorates neurofunctional and neuroinflammatory abnormalities in a rat model of Gulf War Illness. PLoS One 2020; 15:e0242427. [PMID: 33186383 PMCID: PMC7665704 DOI: 10.1371/journal.pone.0242427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background Gulf War (GW) Illness (GWI) is a debilitating condition with a complex constellation of immune, endocrine and neurological symptoms, including cognitive impairment, anxiety and depression. We studied a novel model of GWI based on 3 known common GW exposures (GWE): (i) intranasal lipopolysaccharide, to which personnel were exposed during desert sand storms; (ii) pyridostigmine bromide, used as prophylaxis against chemical warfare; and (iii) chronic unpredictable stress, an inescapable element of war. We used this model to evaluate prophylactic treatment with the PPARγ agonist, rosiglitazone (ROSI). Methods Rats were subjected to the three GWE for 33 days. In series 1 and 2, male and female GWE-rats were compared to naïve rats. In series 3, male rats with GWE were randomly assigned to prophylactic treatment with ROSI (GWE-ROSI) or vehicle. After the 33-day exposures, three neurofunctional domains were evaluated: cognition (novel object recognition), anxiety-like behaviors (elevated plus maze, open field) and depression-like behaviors (coat state, sucrose preference, splash test, tail suspension and forced swim). Brains were analyzed for astrocytic and microglial activation and neuroinflammation (GFAP, Iba1, tumor necrosis factor and translocator protein). Neurofunctional data from rats with similar exposures were pooled into 3 groups: naïve, GWE and GWE-ROSI. Results Compared to naïve rats, GWE-rats showed significant abnormalities in the three neurofunctional domains, along with significant neuroinflammation in amygdala and hippocampus. There were no differences between males and females with GWE. GWE-ROSI rats showed significant attenuation of neuroinflammation and of some of the neurofunctional abnormalities. Conclusion This novel GWI model recapitulates critical neurofunctional abnormalities reported by Veterans with GWI. Concurrent prophylactic treatment with ROSI was beneficial in this model.
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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] [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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Xu F, Ashbrook DG, Gao J, Starlard-Davenport A, Zhao W, Miller DB, O'Callaghan JP, Williams RW, Jones BC, Lu L. Genome-wide transcriptome architecture in a mouse model of Gulf War Illness. Brain Behav Immun 2020; 89:209-223. [PMID: 32574576 PMCID: PMC7787136 DOI: 10.1016/j.bbi.2020.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/18/2020] [Accepted: 06/11/2020] [Indexed: 12/31/2022] Open
Abstract
Gulf War Illness (GWI) is thought to be a chronic neuroimmune disorder caused by in-theater exposure during the 1990-1991 Gulf War. There is a consensus that the illness is caused by exposure to insecticides and nerve agent toxicants. However, the heterogeneity in both development of disease and clinical outcomes strongly suggests a genetic contribution. Here, we modeled GWI in 30 BXD recombinant inbred mouse strains with a combined treatment of corticosterone (CORT) and diisopropyl fluorophosphate (DFP). We quantified transcriptomes from 409 prefrontal cortex samples. Compared to the untreated and DFP treated controls, the combined treatment significantly activated pathways such as cytokine-cytokine receptor interaction and TNF signaling pathway. Protein-protein interaction analysis defined 6 subnetworks for CORT + DFP, with the key regulators being Cxcl1, Il6, Ccnb1, Tnf, Agt, and Itgam. We also identified 21 differentially expressed genes having significant QTLs related to CORT + DFP, but without evidence for untreated and DFP treated controls, suggesting regions of the genome specifically involved in the response to CORT + DFP. We identified Adamts9 as a potential contributor to response to CORT + DFP and found links to symptoms of GWI. Furthermore, we observed a significant effect of CORT + DFP treatment on the relative proportion of myelinating oligodendrocytes, with a QTL on Chromosome 5. We highlight three candidates, Magi2, Sema3c, and Gnai1, based on their high expression in the brain and oligodendrocyte. In summary, our results show significant genetic effects of the CORT + DFP treatment, which mirrors gene and protein expression changes seen in GWI sufferers, providing insight into the disease and a testbed for future interventions.
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Affiliation(s)
- Fuyi Xu
- Department of Genetics, Genomics, and Informatics, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - David G Ashbrook
- Department of Genetics, Genomics, and Informatics, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Jun Gao
- Department of Genetics, Genomics, and Informatics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; Institute of Animal Husbandry and Veterinary Science, Shanghai Academy of Agricultural Sciences, Shanghai 201106, China
| | - Athena Starlard-Davenport
- Department of Genetics, Genomics, and Informatics, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Wenyuan Zhao
- Department of Genetics, Genomics, and Informatics, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Diane B Miller
- Toxicology and Molecular Biology Branch, Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - James P O'Callaghan
- Molecular Neurotoxicology Laboratory, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - Robert W Williams
- Department of Genetics, Genomics, and Informatics, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Byron C Jones
- Department of Genetics, Genomics, and Informatics, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | - Lu Lu
- Department of Genetics, Genomics, and Informatics, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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Abou-Donia MB, Lapadula ES, Krengel MH, Quinn E, LeClair J, Massaro J, Conboy LA, Kokkotou E, Abreu M, Klimas NG, Nguyen DD, Sullivan K. Using Plasma Autoantibodies of Central Nervous System Proteins to Distinguish Veterans with Gulf War Illness from Healthy and Symptomatic Controls. Brain Sci 2020; 10:brainsci10090610. [PMID: 32899468 PMCID: PMC7563126 DOI: 10.3390/brainsci10090610] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 01/02/2023] Open
Abstract
For the past 30 years, there has been a lack of objective tools for diagnosing Gulf War Illness (GWI), which is largely characterized by central nervous system (CNS) symptoms emerging from 1991 Gulf War (GW) veterans. In a recent preliminary study, we reported the presence of autoantibodies against CNS proteins in the blood of veterans with GWI, suggesting a potential objective biomarker for the disorder. Now, we report the results of a larger, confirmatory study of these objective biomarkers in 171 veterans with GWI compared to 60 healthy GW veteran controls and 85 symptomatic civilian controls (n = 50 myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and n = 35 irritable bowel syndrome (IBS)). Specifically, we compared plasma markers of CNS autoantibodies for diagnostic characteristics of the four groups (GWI, GW controls, ME/CFS, IBS). For veterans with GWI, the results showed statistically increased levels of nine of the ten autoantibodies against neuronal "tubulin, neurofilament protein (NFP), Microtubule Associated Protein-2 (MAP-2), Microtubule Associated Protein-Tau (Tau), alpha synuclein (α-syn), calcium calmodulin kinase II (CaMKII)" and glial proteins "Glial Fibrillary Acidic Protein (GFAP), Myelin Associated Glycoprotein (MAG), Myelin Basic Protein (MBP), S100B" compared to healthy GW controls as well as civilians with ME/CFS and IBS. Next, we summed all of the means of the CNS autoantibodies for each group into a new index score called the Neurodegeneration Index (NDI). The NDI was calculated for each tested group and showed veterans with GWI had statistically significantly higher NDI values than all three control groups. The present study confirmed the utility of the use of plasma autoantibodies for CNS proteins to distinguish among veterans with GWI and other healthy and symptomatic control groups.
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Affiliation(s)
- Mohamed B. Abou-Donia
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA;
- Correspondence: (M.B.A.-D.); (K.S.); Tel.: +1-919-684-2221 (M.B.A.-D.)
| | - Elizabeth S. Lapadula
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA;
| | - Maxine H. Krengel
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Emily Quinn
- Departments of Biostatistics and Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (J.L.); (J.M.); (D.D.N.)
| | - Jessica LeClair
- Departments of Biostatistics and Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (J.L.); (J.M.); (D.D.N.)
| | - Joseph Massaro
- Departments of Biostatistics and Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (J.L.); (J.M.); (D.D.N.)
| | - Lisa A. Conboy
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; (L.A.C.); (E.K.)
| | - Efi Kokkotou
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; (L.A.C.); (E.K.)
| | - Maria Abreu
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (M.A.); (N.G.K.)
- Department of Immunology, Miami VA Medical Center, Miami, FL 33125, USA
| | - Nancy G. Klimas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (M.A.); (N.G.K.)
- Department of Immunology, Miami VA Medical Center, Miami, FL 33125, USA
| | - Daniel D. Nguyen
- Departments of Biostatistics and Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (J.L.); (J.M.); (D.D.N.)
| | - Kimberly Sullivan
- Departments of Biostatistics and Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (J.L.); (J.M.); (D.D.N.)
- Correspondence: (M.B.A.-D.); (K.S.); Tel.: +1-919-684-2221 (M.B.A.-D.)
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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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Bose D, Mondal A, Saha P, Kimono D, Sarkar S, Seth RK, Janulewicz P, Sullivan K, Horner R, Klimas N, Nagarkatti M, Nagarkatti P, Chatterjee S. TLR Antagonism by Sparstolonin B Alters Microbial Signature and Modulates Gastrointestinal and Neuronal Inflammation in Gulf War Illness Preclinical Model. Brain Sci 2020; 10:brainsci10080532. [PMID: 32784362 PMCID: PMC7463890 DOI: 10.3390/brainsci10080532] [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: 07/14/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 02/07/2023] Open
Abstract
The 1991 Persian Gulf War veterans presented a myriad of symptoms that ranged from chronic pain, fatigue, gastrointestinal disturbances, and cognitive deficits. Currently, no therapeutic regimen exists to treat the plethora of chronic symptoms though newer pharmacological targets such as microbiome have been identified recently. Toll-like receptor 4 (TLR4) antagonism in systemic inflammatory diseases have been tried before with limited success, but strategies with broad-spectrum TLR4 antagonists and their ability to modulate the host-microbiome have been elusive. Using a mouse model of Gulf War Illness, we show that a nutraceutical, derived from a Chinese herb Sparstolonin B (SsnB) presented a unique microbiome signature with an increased abundance of butyrogenic bacteria. SsnB administration restored a normal tight junction protein profile with an increase in Occludin and a parallel decrease in Claudin 2 and inflammatory mediators high mobility group box 1 (HMGB1), interleukin-1β (IL-1β), and interleukin-6 (IL-6) in the distal intestine. SsnB also decreased neuronal inflammation by decreasing IL-1β and HMGB1, while increasing brain-derived neurotrophic factor (BDNF), with a parallel decrease in astrocyte activation in vitro. Mechanistically, SsnB inhibited the binding of HMGB1 and myeloid differentiation primary response protein (MyD88) to TLR4 in the intestine, thus attenuating TLR4 downstream signaling. Studies also showed that SsnB was effective in suppressing TLR4-induced nod-like receptor protein 3 (NLRP3) inflammasome activation, a prominent inflammatory disease pathway. SsnB significantly decreased astrocyte activation by decreasing colocalization of glial fibrillary acid protein (GFAP) and S100 calcium-binding protein B (S100B), a crucial event in neuronal inflammation. Inactivation of SsnB by treating the parent molecule by acetate reversed the deactivation of NLRP3 inflammasome and astrocytes in vitro, suggesting that SsnB molecular motifs may be responsible for its anti-inflammatory activity.
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Affiliation(s)
- Dipro Bose
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (D.B.); (A.M.); (P.S.); (D.K.); (S.S.); (R.K.S.)
| | - Ayan Mondal
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (D.B.); (A.M.); (P.S.); (D.K.); (S.S.); (R.K.S.)
| | - Punnag Saha
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (D.B.); (A.M.); (P.S.); (D.K.); (S.S.); (R.K.S.)
| | - Diana Kimono
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (D.B.); (A.M.); (P.S.); (D.K.); (S.S.); (R.K.S.)
| | - Sutapa Sarkar
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (D.B.); (A.M.); (P.S.); (D.K.); (S.S.); (R.K.S.)
| | - Ratanesh K. Seth
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (D.B.); (A.M.); (P.S.); (D.K.); (S.S.); (R.K.S.)
| | - Patricia Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (P.J.); (K.S.)
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (P.J.); (K.S.)
| | - Ronnie Horner
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC 29208, USA;
| | - Nancy Klimas
- Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA;
- Miami VA Medical Center, Miami, FL 33125, USA
| | - Mitzi Nagarkatti
- Department of Pathology Microbiology and Immunology, USC School of Medicine, Columbia, SC 29209, USA; (M.N.); (P.N.)
| | - Prakash Nagarkatti
- Department of Pathology Microbiology and Immunology, USC School of Medicine, Columbia, SC 29209, USA; (M.N.); (P.N.)
| | - Saurabh Chatterjee
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (D.B.); (A.M.); (P.S.); (D.K.); (S.S.); (R.K.S.)
- Columbia VA Medical Center, Columbia, SC 29209, USA
- Correspondence: ; Tel.: +1-803-777-8120; Fax: +1-803-777-3391
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In-vivo imaging of neuroinflammation in veterans with Gulf War illness. Brain Behav Immun 2020; 87:498-507. [PMID: 32027960 PMCID: PMC7864588 DOI: 10.1016/j.bbi.2020.01.020] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 12/11/2022] Open
Abstract
Gulf War Illness (GWI) is a chronic disorder affecting approximately 30% of the veterans who served in the 1991 Gulf War. It is characterised by a constellation of symptoms including musculoskeletal pain, cognitive problems and fatigue. The cause of GWI is not definitively known but exposure to neurotoxicants, the prophylactic use of pyridostigmine bromide (PB) pills, and/or stressors during deployment have all been suspected to play some pathogenic role. Recent animal models of GWI have suggested that neuroinflammatory mechanisms may be implicated, including a dysregulated activation of microglia and astrocytes. However, neuroinflammation has not previously been directly observed in veterans with GWI. To measure GWI-related neuroinflammation in GW veterans, we conducted a Positron Emission Tomography (PET) study using [11C]PBR28, which binds to the 18 kDa translocator protein (TSPO), a protein upregulated in activated microglia/macrophages and astrocytes. Veterans with GWI (n = 15) and healthy controls (HC, n = 33, including a subgroup of healthy GW veterans, HCVET, n = 8), were examined using integrated [11C]PBR28 PET/MRI. Standardized uptake values normalized by occipital cortex signal (SUVR) were compared across groups and against clinical variables and circulating inflammatory cytokines (TNF-α, IL-6 and IL-1β). SUVR were validated against volume of distribution ratio (n = 13). Whether compared to the whole HC group, or only the HCVET subgroup, veterans with GWI demonstrated widespread cortical elevations in [11C]PBR28 PET signal, in areas including precuneus, prefrontal, primary motor and somatosensory cortices. There were no significant group differences in the plasma levels of the inflammatory cytokines evaluated. There were also no significant correlations between [11C]PBR28 PET signal and clinical variables or circulating inflammatory cytokines. Our study provides the first direct evidence of brain upregulation of the neuroinflammatory marker TSPO in veterans with GWI and supports the exploration of neuroinflammation as a therapeutic target for this disorder.
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Sullivan K, Krengel M, Heboyan V, Schildroth S, Wilson CC, Iobst S, Klimas N, Coughlin SS. Prevalence and Patterns of Symptoms Among Female Veterans of the 1991 Gulf War Era: 25 Years Later. J Womens Health (Larchmt) 2020; 29:819-826. [DOI: 10.1089/jwh.2019.7705] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Vahé Heboyan
- Department of Interdisciplinary Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, Georgia
| | | | - Col Candy Wilson
- Uniformed Services University Graduate School of Nursing, Bethesda, Maryland
| | - Stacey Iobst
- Henry M. Jackson Foundation at the Uniformed Services University Graduate School of Nursing, Bethesda, Maryland
| | - Nancy Klimas
- Miami VA Healthcare System, Miami, Florida
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | - Steven S. Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia
- Research Service, Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia
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Safety, Tolerability and Efficacy of Dietary Supplementation with Concord Grape Juice in Gulf War Veterans with Gulf War Illness: A Phase I/IIA, Randomized, Double-Blind, Placebo-Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103546. [PMID: 32438639 PMCID: PMC7277758 DOI: 10.3390/ijerph17103546] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/18/2022]
Abstract
Approximately 30 percent of U.S. veterans deployed during the Gulf War (1990–1991) have been diagnosed with Gulf War Illness (GWI), a chronic multi-symptom disorder without widely available specific treatments. We investigated whether the consumption of Concord grape juice (CGJ), rich in anti-inflammatory flavonoids, would be tolerated and safe in individuals with GWI and explored improvement in cognitive function and fatigue. Thirty-six veterans with GWI enrolled in a 24-week randomized, double-blind, Phase I/IIA clinical trial to explore safety, tolerability, and feasibility of 16 ounces daily of commercially available CGJ compared to placebo. Participants completed neurocognitive tests and self-reported surveys at baseline, 12 and 24 weeks. Thirty-one participants (86%) completed the study; no dropouts were related to side effects. Thirty participants (83%) documented ≥80% adherence. There were no statistically significant unadjusted differences between CGJ and placebo groups in change in efficacy measures from baseline to endpoint. We employed general linear regression models controlling for baseline differences between groups which indicated statistically significant improvement in the Halstead Category Test–Russell Revised Version (RCAT) at endpoint in the CGJ group compared to placebo (8.4 points, p = 0.04). Other measures of cognitive functioning did not indicate significant improvements in the adjusted analyses (p-values: 0.09–0.32), nor did the fatigue variable (p = 0.67). CGJ was safe and well-tolerated by veterans with GWI. Our data suggest high tolerability and potential benefit from CGJ in veterans with GWI and can be used to inform future studies of efficacy.
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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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