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Huang YA, Wang X, Kim JC, Yao X, Sethi A, Strohm A, Doherty TA. PIP-seq identifies novel heterogeneous lung innate lymphocyte population activation after combustion product exposure. Sci Rep 2024; 14:20167. [PMID: 39215111 PMCID: PMC11364781 DOI: 10.1038/s41598-024-70880-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
Innate lymphoid cells (ILCs) are a heterogeneous population that play diverse roles in airway inflammation after exposure to allergens and infections. However, how ILCs respond after exposure to environmental toxins is not well understood. Here we show a novel method for studying the heterogeneity of rare lung ILC populations by magnetic enrichment for lung ILCs followed by particle-templated instant partition sequencing (PIP-seq). Using this method, we were able to identify novel group 1 and group 2 ILC subsets that exist after exposure to both fungal allergen and burn pit-related constituents (BPC) that include dioxin, aromatic hydrocarbon, and particulate matter. Toxin exposure in combination with fungal allergen induced activation of specific ILC1/NK and ILC2 populations as well as promoted neutrophilic lung inflammation. Oxidative stress pathways and downregulation of specific ribosomal protein genes (Rpl41 and Rps19) implicated in anti-inflammatory responses were present after BPC exposure. Increased IFNγ expression and other pro-neutrophilic mediator transcripts were increased in BPC-stimulated lung innate lymphoid cells. Further, the addition of BPC induced Hspa8 (encodes HSC70) and aryl hydrocarbon transcription factor activity across multiple lung ILC subsets. Overall, using an airway disease model that develops after occupational and environmental exposures, we demonstrate an effective method to better understand heterogenous ILC subset activation.
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Affiliation(s)
- Yung-An Huang
- Divison of Allergy and Immunology, Department of Medicine, University of California San Diego, Biomedical Sciences Building, Room 5090, 9500 Gilman Drive, La Jolla, CA, 92093-0635, USA
- Veterans Affairs San Diego Health Care System, San Diego, CA, USA
| | - Xinyu Wang
- Divison of Allergy and Immunology, Department of Medicine, University of California San Diego, Biomedical Sciences Building, Room 5090, 9500 Gilman Drive, La Jolla, CA, 92093-0635, USA
- Veterans Affairs San Diego Health Care System, San Diego, CA, USA
| | - Jong-Chan Kim
- Divison of Allergy and Immunology, Department of Medicine, University of California San Diego, Biomedical Sciences Building, Room 5090, 9500 Gilman Drive, La Jolla, CA, 92093-0635, USA
- Veterans Affairs San Diego Health Care System, San Diego, CA, USA
| | - Xiang Yao
- Divison of Allergy and Immunology, Department of Medicine, University of California San Diego, Biomedical Sciences Building, Room 5090, 9500 Gilman Drive, La Jolla, CA, 92093-0635, USA
- Veterans Affairs San Diego Health Care System, San Diego, CA, USA
| | - Anshika Sethi
- Divison of Allergy and Immunology, Department of Medicine, University of California San Diego, Biomedical Sciences Building, Room 5090, 9500 Gilman Drive, La Jolla, CA, 92093-0635, USA
- Veterans Affairs San Diego Health Care System, San Diego, CA, USA
| | - Allyssa Strohm
- Divison of Allergy and Immunology, Department of Medicine, University of California San Diego, Biomedical Sciences Building, Room 5090, 9500 Gilman Drive, La Jolla, CA, 92093-0635, USA
- Veterans Affairs San Diego Health Care System, San Diego, CA, USA
| | - Taylor A Doherty
- Divison of Allergy and Immunology, Department of Medicine, University of California San Diego, Biomedical Sciences Building, Room 5090, 9500 Gilman Drive, La Jolla, CA, 92093-0635, USA.
- Veterans Affairs San Diego Health Care System, San Diego, CA, USA.
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Huang YA, Wang X, Kim JC, Yao X, Sethi A, Strohm A, Doherty TA. PIP-Seq identifies novel heterogeneous lung innate lymphocyte population activation after combustion product exposure. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.24.600420. [PMID: 38979234 PMCID: PMC11230265 DOI: 10.1101/2024.06.24.600420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Innate lymphoid cells (ILCs) are a heterogeneous population that play diverse roles in airway inflammation after exposure to allergens and infections. However, how ILCs respond after exposure to environmental toxins is not well understood. Here we show a novel method for studying the heterogeneity of rare lung ILC populations by magnetic enrichment for lung ILCs followed by particle-templated instant partition sequencing (PIP-seq). Using this method, we were able to identify novel group 1 and group 2 ILC subsets that exist after exposure to both fungal allergen and burn pit-related constituents (BPC) that include dioxin, aromatic hydrocarbon, and particulate matter. Toxin exposure in combination with fungal allergen induced activation of specific ILC1/NK and ILC2 populations as well as promoted neutrophilic lung inflammation. Oxidative stress pathways and downregulation of specific ribosomal protein genes ( Rpl41 and Rps19 ) implicated in anti-inflammatory responses were present after BPC exposure. Increased IFNγ expression and other pro-neutrophilic mediator transcripts were increased in BPC-stimulated lung innate lymphoid cells. Further, the addition of BPC induced Hspa8 (encodes HSC70) and aryl hydrocarbon transcription factor activity across multiple lung ILC subsets. Overall, using an airway disease model that develops after occupational and environmental exposures, we demonstrate an effective method to better understand heterogenous ILC subset activation.
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Carvalho CJ, Dalton AL, Boothroyd D, Urech TH, Vashi AA. Emergency Department Use Among Combat and Non-Combat Post-9/11 Military Veterans. Mil Med 2024:usae155. [PMID: 38613450 DOI: 10.1093/milmed/usae155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/04/2024] [Accepted: 03/20/2024] [Indexed: 04/15/2024] Open
Abstract
INTRODUCTION Most post-9/11 Veterans have completed at least 1 combat deployment-a known factor associated with adverse health outcomes. Such Veterans are known to have unmet health care needs, and the emergency department (ED) may serve as a safety net, yet little is known about whether combat status is associated with more frequent ED use. We sought to evaluate the relationship between combat status and frequency of ED use among post-9/11 Veterans and assess the most common reasons for ED visits. MATERIALS AND METHODS This retrospective cohort study consisted of post-9/11 Veterans who enrolled in U.S. Department of Veterans Affairs (VA) care between fiscal years (FYs) 2005 and 2015. Data were obtained from the VA Corporate Data Warehouse. Incidence rates for ED visits for combat and non-combat Veterans were compared from FY 2010 to 2019 using zero-inflated negative binomial regression. The most frequent reasons for ED visits were determined using International Classification of Diseases codes. This study was approved by the Stanford Institutional Review Board. RESULTS Among 1.3 million Veterans included in analyses, 70.4% had deployed to a combat zone. The mean (SD) age of our cohort was 32.6 (5.0) years and 83.5% of Veterans were male. After controlling for other factors, combat Veterans had 1.84 times the rate of ED visits compared to non-combat Veterans (95% CI, 1.83-1.85). Only combat Veterans had a mental health-related ED visit (suicidal ideations) among the top 3 reasons for ED presentation. CONCLUSIONS Those who deployed to a combat zone had a significantly higher rate of ED use compared to those who did not. Further, mental health-related ED diagnoses appeared to be more prevalent in combat Veterans. These findings highlight the unique health care needs faced by combat Veterans and emphasize the importance of tailored interventions and support services for this specific population.
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Affiliation(s)
- Christopher J Carvalho
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Aaron L Dalton
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA
| | - Derek Boothroyd
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA 94304, USA
| | - Tracy H Urech
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA
| | - Anita A Vashi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA
- Department of Emergency Medicine, University of California, San Francisco, CA 94143, USA
- Department of Emergency Medicine (Affiliated), Stanford University, Stanford, CA 94304, USA
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Gandhi S, Tonelli R, Murray M, Samarelli AV, Spagnolo P. Environmental Causes of Idiopathic Pulmonary Fibrosis. Int J Mol Sci 2023; 24:16481. [PMID: 38003670 PMCID: PMC10671449 DOI: 10.3390/ijms242216481] [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: 09/25/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF), the most common and severe of the idiopathic interstitial pneumonias, is a chronic and relentlessly progressive disease, which occurs mostly in middle-aged and elderly males. Although IPF is by definition "idiopathic", multiple factors have been reported to increase disease risk, aging being the most prominent one. Several occupational and environmental exposures, including metal dust, wood dust and air pollution, as well as various lifestyle variables, including smoking and diet, have also been associated with an increased risk of IPF, probably through interaction with genetic factors. Many of the predisposing factors appear to act also as trigger for acute exacerbations of the disease, which herald a poor prognosis. The more recent literature on inhalation injuries has focused on the first responders in the World Trade Center attacks and military exposure. In this review, we present an overview of the environmental and occupational causes of IPF and its pathogenesis. While our list is not comprehensive, we have selected specific exposures to highlight based on their overall disease burden.
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Affiliation(s)
- Sheiphali Gandhi
- Division of Occupational and Environmental Medicine, University of California San Francisco, San Francisco, CA 94143-0924, USA; (S.G.); (M.M.)
| | - Roberto Tonelli
- Respiratory Disease Unit, University Hospital of Modena, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 42125 Modena, Italy; (R.T.); (A.V.S.)
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 42121 Modena, Italy
| | - Margaret Murray
- Division of Occupational and Environmental Medicine, University of California San Francisco, San Francisco, CA 94143-0924, USA; (S.G.); (M.M.)
| | - Anna Valeria Samarelli
- Respiratory Disease Unit, University Hospital of Modena, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 42125 Modena, Italy; (R.T.); (A.V.S.)
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
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Abstract
PURPOSE OF REVIEW Military personnel deployed to Southwest Asia and Afghanistan were potentially exposed to high levels of fine particulate matter and other pollutants from multiple sources, including dust storms, burn pit emissions from open-air waste burning, local ambient air pollution, and a range of military service-related activities that can generate airborne exposures. These exposures, individually or in combination, can have adverse respiratory health effects. We review exposures and potential health impacts, providing a framework for evaluation. RECENT FINDINGS Particulate matter exposures during deployment exceeded U.S. National Ambient Air Quality Standards. Epidemiologic studies and case series suggest that in postdeployment Veterans with respiratory symptoms, asthma is the most commonly diagnosed illness. Small airway abnormalities, most notably particularly constrictive bronchiolitis, have been reported in a small number of deployers, but many are left without an established diagnosis for their respiratory symptoms. The Promise to Address Comprehensive Toxics Act was enacted to provide care for conditions presumed to be related to deployment exposures. Rigorous study of long-term postdeployment health has been limited. SUMMARY Veterans postdeployment to Southwest Asia and Afghanistan with respiratory symptoms should undergo an exposure assessment and comprehensive medical evaluation. If required, more advanced diagnostic considerations should be utilized in a setting that can provide multidisciplinary expertise and long-term follow-up.
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Affiliation(s)
- Eric Garshick
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section, Veterans Affairs Boston Healthcare System; Harvard Medical School and Brigham and Women’s, Boston, Massachusetts
| | - Paul D. Blanc
- San Francisco VA Medical Center, UC San Francisco School of Medicine, San Francisco; Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, California, USA
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Falvo MJ, Sotolongo AM, Osterholzer JJ, Robertson MW, Kazerooni EA, Amorosa JK, Garshick E, Jones KD, Galvin JR, Kreiss K, Hines SE, Franks TJ, Miller RF, Rose CS, Arjomandi M, Krefft SD, Morris MJ, Polosukhin VV, Blanc PD, D'Armiento JM. Consensus Statements on Deployment-Related Respiratory Disease, Inclusive of Constrictive Bronchiolitis: A Modified Delphi Study. Chest 2023; 163:599-609. [PMID: 36343686 PMCID: PMC10154857 DOI: 10.1016/j.chest.2022.10.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/10/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The diagnosis of constrictive bronchiolitis (CB) in previously deployed individuals, and evaluation of respiratory symptoms more broadly, presents considerable challenges, including using consistent histopathologic criteria and clinical assessments. RESEARCH QUESTION What are the recommended diagnostic workup and associated terminology of respiratory symptoms in previously deployed individuals? STUDY DESIGN AND METHODS Nineteen experts participated in a three-round modified Delphi study, ranking their level of agreement for each statement with an a priori definition of consensus. Additionally, rank-order voting on the recommended diagnostic approach and terminology was performed. RESULTS Twenty-five of 28 statements reached consensus, including the definition of CB as a histologic pattern of lung injury that occurs in some previously deployed individuals while recognizing the importance of considering alternative diagnoses. Consensus statements also identified a diagnostic approach for the previously deployed individual with respiratory symptoms, distinguishing assessments best performed at a local or specialty referral center. Also, deployment-related respiratory disease (DRRD) was proposed as a broad term to subsume a wide range of potential syndromes and conditions identified through noninvasive evaluation or when surgical lung biopsy reveals evidence of multicompartmental lung injury that may include CB. INTERPRETATION Using a modified Delphi technique, consensus statements provide a clinical approach to possible CB in previously deployed individuals. Use of DRRD provides a broad descriptor encompassing a range of postdeployment respiratory findings. Additional follow-up of individuals with DRRD is needed to assess disease progression and to define other features of its natural history, which could inform physicians better and lead to evolution in this nosology.
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Affiliation(s)
- Michael J Falvo
- Airborne Hazards and Burn Pits Center of Excellence, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ; New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ.
| | - Anays M Sotolongo
- Airborne Hazards and Burn Pits Center of Excellence, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ; New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ
| | - John J Osterholzer
- Pulmonary Section, Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Michelle W Robertson
- Airborne Hazards and Burn Pits Center of Excellence, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Judith K Amorosa
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; University Radiology Group, East Brunswick, NJ
| | - Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Veterans Affairs Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Kirk D Jones
- Department of Anatomic Pathology, University of California, San Francisco, CA
| | - Jeffrey R Galvin
- Department of Radiology and Nuclear Medicine (Chest Imaging), University of Maryland School of Medicine, Baltimore, MD
| | - Kathleen Kreiss
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV
| | - Stella E Hines
- Divisions of Occupational and Environmental Medicine and Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD; VA Maryland Health Care System, Baltimore Veterans Affairs Medical Center, Baltimore, MD
| | - Teri J Franks
- Department of Pulmonary and Mediastinal Pathology, Joint Pathology Center, Department of Defense, Silver Spring, MD
| | - Robert F Miller
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO; Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Denver, CO
| | - Mehrdad Arjomandi
- Department of Anatomic Pathology, University of California, San Francisco, CA; Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Silpa D Krefft
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO; Division of Pulmonary and Critical Care Medicine, Veterans Administration Eastern Colorado Health Care System, Aurora, CO; Division of Pulmonary and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Michael J Morris
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA-Sam Houston, Fort Sam Houston, TX
| | | | - Paul D Blanc
- Department of Anatomic Pathology, University of California, San Francisco, CA; Division of Occupational and Environmental Medicine, University of California, San Francisco, CA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jeanine M D'Armiento
- Center for LAM and Rare Lung Disease, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY
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Olsen T, Caruana D, Cheslack-Postava K, Szema A, Thieme J, Kiss A, Singh M, Smith G, McClain S, Glotch T, Esposito M, Promisloff R, Ng D, He X, Egeblad M, Kew R, Szema A. Iraq/Afghanistan war lung injury reflects burn pits exposure. Sci Rep 2022; 12:14671. [PMID: 36038588 PMCID: PMC9424528 DOI: 10.1038/s41598-022-18252-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/08/2022] [Indexed: 12/25/2022] Open
Abstract
This descriptive case series retrospectively reviewed medical records from thirty-one previously healthy, war-fighting veterans who self-reported exposure to airborne hazards while serving in Iraq and Afghanistan between 2003 and the present. They all noted new-onset dyspnea, which began during deployment or as a military contractor. Twenty-one subjects underwent non-invasive pulmonary diagnostic testing, including maximum expiratory pressure (MEP) and impulse oscillometry (IOS). In addition, five soldiers received a lung biopsy; tissue results were compared to a previously published sample from a soldier in our Iraq Afghanistan War Lung Injury database and others in our database with similar exposures, including burn pits. We also reviewed civilian control samples (5) from the Stony Brook University database. Military personnel were referred to our International Center of Excellence in Deployment Health and Medical Geosciences, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell under the auspices of Northwell IRB: 17-0140-FIMR Feinstein Institution for Medical Research "Clinicopathologic characteristics of Iraq Afghanistan War Lung Injury." We retrospectively examined medical records, including exposure data, radiologic imaging, and non-invasive pulmonary function testing (MGC Diagnostic Platinum Elite Plethysmograph) using the American Thoracic Society (ATS) standard interpretation based on Morgan et al., and for a limited cohort, biopsy data. Lung tissue, when available, was examined for carbonaceous particles, polycyclic aromatic hydrocarbons (Raman spectroscopy), metals, titanium connected to iron (Brookhaven National Laboratory, National Synchrotron Light Source II, Beamline 5-ID), oxidized metals, combustion temperature, inflammatory cell accumulation and fibrosis, neutrophil extracellular traps, Sirius red, Prussian Blue, as well as polarizable crystals/particulate matter/dust. Among twenty-one previously healthy, deployable soldiers with non-invasive pulmonary diagnostic tests, post-deployment, all had severely decreased MEP values, averaging 42% predicted. These same patients concurrently demonstrated abnormal airways reactance (X5Hz) and peripheral/distal airways resistance (D5-D20%) via IOS, averaging - 1369% and 23% predicted, respectively. These tests support the concept of airways hyperresponsiveness and distal airways narrowing, respectively. Among the five soldiers biopsied, all had constrictive bronchiolitis. We detected the presence of polycyclic aromatic hydrocarbons (PAH)-which are products of incomplete combustion-in the lung tissue of all five warfighters. All also had detectable titanium and iron in the lungs. Metals were all oxidized, supporting the concept of inhaling burned metals. Combustion temperature was consistent with that of burned petrol rather than higher temperatures noted with cigarettes. All were nonsmokers. Neutrophil extracellular traps were reported in two biopsies. Compared to our prior biopsies in our Middle East deployment database, these histopathologic results are similar, since all database biopsies have constrictive bronchiolitis, one has lung fibrosis with titanium bound to iron in fixed mathematical ratios of 1:7 and demonstrated polarizable crystals. These results, particularly constrictive bronchiolitis and polarizable crystals, support the prior data of King et al. (N. Engl. J. Med. 365:222-230, 2011) Soldiers in this cohort deployed to Iraq and Afghanistan since 2003, with exposure to airborne hazards, including sandstorms, burn pits, and improvised explosive devices, are at high risk for developing chronic clinical respiratory problems, including: (1) reduction in respiratory muscle strength; (2) airways hyperresponsiveness; and (3) distal airway narrowing, which may be associated with histopathologic evidence of lung damage, reflecting inhalation of burned particles from burn pits along with particulate matter/dust. Non-invasive pulmonary diagnostic tests are a predictor of burn pit-induced lung injury.
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Affiliation(s)
- Timothy Olsen
- grid.16416.340000 0004 1936 9174University of Rochester School of Medicine and Dentistry, Simon Business School, University of Rochester, Rochester, USA
| | - Dennis Caruana
- grid.47100.320000000419368710Yale University School of Medicine, New Haven, USA
| | - Keely Cheslack-Postava
- grid.21729.3f0000000419368729Columbia University Global Psychiatric Epidemiology Group, NYSPI Columbia University Department of Psychiatry, New York, USA
| | - Austin Szema
- grid.261112.70000 0001 2173 3359Northeastern University College of Art, Media, and Design (CAMD) Game Design Program, Boston, USA ,grid.202665.50000 0001 2188 4229Brookhaven National Laboratory National Synchrotron Light Source II Beam ID-5, Upton, USA
| | - Juergen Thieme
- grid.202665.50000 0001 2188 4229Brookhaven National Laboratory National Synchrotron Light Source II Beam ID-5, Upton, USA
| | - Andrew Kiss
- grid.36425.360000 0001 2216 9681Science Coordinator Imaging and Microscopy Program and Department of Geosciences, Stony Brook University, Stony Brook, USA
| | - Malvika Singh
- grid.202665.50000 0001 2188 4229Brookhaven National Laboratory National Synchrotron Radiation Light Source II Bean ID-5, Upton, USA
| | - Gregory Smith
- grid.36425.360000 0001 2216 9681Department of Pharmacological Sciences, Stony Brook University, Stony Brook, USA
| | | | - Timothy Glotch
- grid.36425.360000 0001 2216 9681Center for Space Exploration (CEx) Department of Geosciences, Stony Brook University, Stony Brook, USA
| | - Michael Esposito
- grid.512756.20000 0004 0370 4759Department of Pathology North Shore University Hospital Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Robert Promisloff
- grid.166341.70000 0001 2181 3113Drexel University College of Medicine, Philadelphia, USA
| | - David Ng
- grid.134907.80000 0001 2166 1519Rockefeller University Department of Cancer Biology, New York, USA
| | - Xueyan He
- grid.225279.90000 0004 0387 3667Cold Spring Harbor Laboratory Department of Cancer Biology, Cold Spring Harbor, New York, USA
| | - Mikala Egeblad
- grid.225279.90000 0004 0387 3667Cold Spring Harbor Laboratory Department of Cancer Biology, Cold Spring Harbor, New York, USA
| | - Richard Kew
- grid.36425.360000 0001 2216 9681Department of Pathology Stony Brook University, Stony Brook, NY USA
| | - Anthony Szema
- grid.416477.70000 0001 2168 3646Division of Pulmonary and Critical Care, Division of Allergy/Immunology, Northwell Health, New Hyde Park, USA ,grid.512756.20000 0004 0370 4759Department of Occupational Medicine, Epidemiology and Prevention, International Center of Excellence in Deployment Health and Medical Geosciences, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
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8
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Hines SE, Gaitens JM, Brown CH, Glick DR, Chin KH, Reback M, McDiarmid MA. Self-reported respiratory outcomes associated with blast exposure in post 9/11 veterans. Respir Med 2022; 202:106963. [DOI: 10.1016/j.rmed.2022.106963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
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Davis CW, Rabin AS, Jani N, Osterholzer JJ, Krefft S, Hines SE, Arjomandi M, Robertson MW, Sotolongo AM, Falvo MJ. Postdeployment Respiratory Health: The Roles of the Airborne Hazards and Open Burn Pit Registry and the Post-Deployment Cardiopulmonary Evaluation Network. Fed Pract 2022; 39:337-343. [PMID: 36425809 PMCID: PMC9652027 DOI: 10.12788/fp.0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Following deployment to the Southwest Asia theater of operations and Afghanistan, many service members and veterans report respiratory symptoms and concerns about their military and environmental exposures. The US Department of Veterans Affairs (VA) established the national Airborne Hazards and Open Burn Pit Registry (AHOBPR) in 2014 to help better understand long-term health conditions that may be related to these exposures. Observations The AHOBPR provides an online questionnaire and optional health evaluation performed by a primary care or environmental health clinician. The clinical evaluation provides an opportunity for the service member or veteran to talk with a health care professional about their symptoms, exposures, and potential treatment. Data derived from questionnaire responses and health evaluations facilitate medical surveillance and research. The VA also established a network of specialists, referred to as the Post-Deployment Cardiopulmonary Evaluation Network (PDCEN). The PDCEN identifies veterans within the AHOBPR who self-report certain conditions or have unexplained dyspnea and conducts comprehensive diagnostic evaluations. Primary objectives of PDCEN evaluations are to define respiratory and related conditions that are present, determine whether conditions are related to deployment, and work with the veteran's clinician to identify treatments and/or follow-up care to improve their health. We utilize a case example to illustrate the role of the primary care practitioner in connecting veterans to PDCEN clinical evaluations. Conclusions AHOBPR clinical evaluations represent an initial step to better understand postdeployment health conditions. The PDCEN clinical evaluation extends the AHOBPR evaluation by providing specialty care for certain veterans requiring more comprehensive evaluation while systematically collecting and analyzing clinical data to advance the field.
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Affiliation(s)
- Caroline W Davis
- Veterans Affairs Ann Arbor Health Care System, LTC Charles S. Kettles Veterans Affaris Medical Center, Michigan
- University of Michigan, Ann Arbor
| | - Alexander S Rabin
- Veterans Affairs Ann Arbor Health Care System, LTC Charles S. Kettles Veterans Affaris Medical Center, Michigan
- University of Michigan, Ann Arbor
| | - Nisha Jani
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange
| | - John J Osterholzer
- Veterans Affairs Ann Arbor Health Care System, LTC Charles S. Kettles Veterans Affaris Medical Center, Michigan
- University of Michigan, Ann Arbor
| | - Silpa Krefft
- Veterans Affairs Eastern Colorado Health Care System, Aurora
- National Jewish Health, Division of Environmental and Occupational Health Sciences, Denver, Colorado
- University of Colorado, School of Medicine, Aurora
| | - Stella E Hines
- Veterans Affairs Maryland Health Care System, Baltimore Veterans Affairs Medical Center
- Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Mehrdad Arjomandi
- San Francisco Veterans Affairs Medical Center, California
- Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep Medicine, Department of Medicine, University of California, San Francisco
- Division of Occupational and Environmental Medicine; Department of Medicine, University of California, San Francisco
| | - Michelle W Robertson
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange
| | - Anays M Sotolongo
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange
- Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark
| | - Michael J Falvo
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange
- Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark
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10
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Berman R, Min E, Huang J, Kopf K, Downey GP, Riemondy K, Smith HA, Rose CS, Seibold MA, Chu HW, Day BJ. Single-Cell RNA Sequencing Reveals a Unique Monocyte Population in Bronchoalveolar Lavage Cells of Mice Challenged With Afghanistan Particulate Matter and Allergen. Toxicol Sci 2021; 182:297-309. [PMID: 34051097 DOI: 10.1093/toxsci/kfab065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Upon returning from deployment to Afghanistan, a substantial number of U.S. military personnel report deployment-related lung disease (DRLD) symptoms, including those consistent with an asthma-like airways disease. DRLD is thought to be caused by prolonged inhalation of toxic desert particulate matter, which can persist in the postdeployment setting such as exposure to common household allergens. The goal of this study was to define the transcriptomic responses of lung leukocytes of mice exposed to Afghanistan desert particulate matter (APM) and house dust mite (HDM). C57BL/6 mice (n = 15/group) were exposed to filtered air or aerosolized APM for 12 days, followed by intranasal PBS or HDM allergen challenges for 24 h. Bronchoalveolar lavage (BAL) cells were collected for single-cell RNA sequencing (scRNAseq), and assessment of inflammation and airway hyper-responsiveness. Unsupervised clustering of BAL cell scRNAseq data revealed a unique monocyte population induced only by both APM and allergen treatments. This population of monocytes is characterized by the expression of genes involved in allergic asthma, including Alox15. We validated Alox15 expression in monocytes via immunostaining of lung tissue. APM pre-exposure, followed by the HDM challenge, led to significantly increased total respiratory system resistance compared with filtered air controls. Using this mouse model to mimic DRLD, we demonstrated that inhalation of airborne PM during deployment may prime airways to be more responsive to allergen exposure after returning home, which may be linked to dysregulated immune responses such as induction of a unique lung monocyte population.
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Affiliation(s)
- Reena Berman
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Elysia Min
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Jie Huang
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Katrina Kopf
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Gregory P Downey
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Kent Riemondy
- RNA Bioscience Initiative, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Harry A Smith
- RNA Bioscience Initiative, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Cecile S Rose
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Max A Seibold
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO 80206, USA
| | - Hong Wei Chu
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Brian J Day
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
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11
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Respiratory Health after Military Service in Southwest Asia and Afghanistan. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2020; 16:e1-e16. [PMID: 31368802 PMCID: PMC6774741 DOI: 10.1513/annalsats.201904-344ws] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Since 2001, more than 2.7 million U.S. military personnel have been deployed in support of operations in Southwest Asia and Afghanistan. Land-based personnel experienced elevated exposures to particulate matter and other inhalational exposures from multiple sources, including desert dust, burn pit combustion, and other industrial, mobile, or military sources. A workshop conducted at the 2018 American Thoracic Society International Conference had the goals of: 1) identifying key studies assessing postdeployment respiratory health, 2) describing emerging research, and 3) highlighting knowledge gaps. The workshop reviewed epidemiologic studies that demonstrated more frequent encounters for respiratory symptoms postdeployment compared with nondeployers and for airway disease, predominantly asthma, as well as case series describing postdeployment dyspnea, asthma, and a range of other respiratory tract findings. On the basis of particulate matter effects in other populations, it also is possible that deployers experienced reductions in pulmonary function as a result of such exposure. The workshop also gave particular attention to constrictive bronchiolitis, which has been reported in lung biopsies of selected deployers. Workshop participants had heterogeneous views regarding the definition and frequency of constrictive bronchiolitis and other small airway pathologic findings in deployed populations. The workshop concluded that the relationship of airway disease, including constrictive bronchiolitis, to exposures experienced during deployment remains to be better defined. Future clinical and epidemiologic research efforts should address better characterization of deployment exposures; carry out longitudinal assessment of potentially related adverse health conditions, including lung function and other physiologic changes; and use rigorous histologic, exposure, and clinical characterization of patients with respiratory tract abnormalities.
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12
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Benzo[a]pyrene Perturbs Mitochondrial and Amino Acid Metabolism in Lung Epithelial Cells and Has Similar Correlations With Metabolic Changes in Human Serum. J Occup Environ Med 2020; 61 Suppl 12:S73-S81. [PMID: 31800453 DOI: 10.1097/jom.0000000000001687] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE A study was conducted to identifymetabolic-related effects of benzo[a]pyrene (BaP) on human lung epithelial cells and validate these findings using human sera. METHODS Human lung epithelial cells were treated with BaP, and extracts were analyzed with a global metabolome-wide association study (MWAS) to test for pathways and metabolites altered relative to vehicle controls. RESULTS MWAS results showed that BaP metabolites were among the top metabolites differing between BaP-treated cells and controls. Pathway enrichment analysis further confirmed that fatty acid, lipid, and mitochondrial pathways were altered by BaP. Human sera analysis showed that lipids varied with BaP concentration. BaP associations with amino acid metabolism were found in both models. CONCLUSIONS These findings show that BaP has broad metabolic effects, and suggest that air pollution exacerbates disease processes by altered mitochondrial and amino acid metabolism.
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13
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Holley AB, Boose WD, Perkins M, Sheikh KL, Solomon NP, Dietsch AM, Vossoughi J, Johnson AT, Collen JF. A Rapid, Handheld Device to Assess Respiratory Resistance: Clinical and Normative Evidence. Mil Med 2019; 183:e370-e377. [PMID: 29425367 DOI: 10.1093/milmed/usx224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/30/2017] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Following reports of respiratory symptoms among service members returning from deployment to South West Asia (SWA), an expert panel recommended pre-deployment spirometry be used to assess disease burden. Unfortunately, testing with spirometry is high cost and time-consuming. The airflow perturbation device (APD) is a handheld monitor that rapidly measures respiratory resistance (APD-Rr) and has promising but limited clinical data. Its speed and portability make it ideally suited for large volume pre-deployment screening. We conducted a pilot study to assess APD performance characteristics and develop normative values. MATERIALS AND METHODS We prospectively enrolled subjects and derived reference equations for the APD from those without respiratory symptoms, pulmonary disease, or tobacco exposure. APD testing was conducted by medical technicians who received a 10-min in-service on its use. A subset of subjects performed spirometry and impulse oscillometry (iOS), administered by trained respiratory therapists. APD measures were compared with spirometry and iOS. RESULTS The total study population included 199 subjects (55.8% males, body mass index 27.7 ± 6.0 kg/m2, age 49.9 ± 18.7 yr). Across the three APD trials, mean inspiratory (APD-Ri), expiratory (APD-Re), and average (APD-Ravg) resistances were 3.30 ± 1.0, 3.69 ± 1.2, and 3.50 ± 1.1 cm H2O/L/s. Reference equations were derived from 142 clinically normal volunteers. Height, weight, and body mass index were independently associated with APD-Ri, APD-Re, and APD-Ravg and were combined with age and gender in linear regression models. APD-Ri, APD-Re, and APD-Ravg were significantly inversely correlated with FEV1 (r = -0.39 to -0.42), FVC (r = -0.37 to -0.40), and FEF25-75 (r = -0.31 to -0.35) and positively correlated with R5 (r = 0.61-0.62), R20 (r = 0.50-0.52), X5 (r = -0.57 to -0.59), and FRES (r = 0.42-0.43). Bland-Altman plots showed that the APD-Rr closely approximates iOS when resistance is normal. CONCLUSION Rapid testing was achieved with minimal training required, and reference equations were constructed. APD-Rr correlated moderately with iOS and weakly with spirometry. More testing is required to determine whether the APD has value for pre- and post-deployment respiratory assessment.
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Affiliation(s)
- Aaron B Holley
- Pulmonary/Sleep and Critical Care Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Dr, San Antonio, TX
| | | | | | - Karen L Sheikh
- Respira Medical, Inc. 09 Pinnacle Drive, Suite R, Linthicum, MD
| | - Nancy P Solomon
- Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD
| | | | - Jafar Vossoughi
- Engineering and Scientific Research Associates, 2330 Jeong H. Kim Engineering Building, College Park, MD
| | - Arthur T Johnson
- Fischell Department of Bioengineering University of Maryland, College Park, 2330 Jeong H. Kim Engineering Building College Park, MD
| | - Jacob F Collen
- Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD
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14
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Slatore CG, Falvo MJ, Nugent S, Carlson K. Afghanistan and Iraq War Veterans: Mental Health Diagnoses are Associated with Respiratory Disease Diagnoses. Mil Med 2019; 183:e249-e257. [PMID: 29420832 DOI: 10.1093/milmed/usx108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/10/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Many veterans of the wars in Afghanistan and Iraq have concomitant respiratory conditions and mental health conditions. We wanted to evaluate the association of mental health diagnoses with respiratory disease diagnoses among post-deployment veterans. Methods We conducted a retrospective cohort study of all Afghanistan and Iraq War veterans who were discharged from the military or otherwise became eligible to receive Veterans Health Administration services. The primary exposure was receipt of a mental health diagnosis and the primary outcome was receipt of a respiratory diagnosis as recorded in the electronic health record. We used multivariable adjusted logistic regression to measure the associations of mental health diagnoses with respiratory diagnoses and conducted several analyses exploring the timing of the diagnoses. Results Among 182,338 post-deployment veterans, 14% were diagnosed with a respiratory condition, 77% of whom had a concomitant mental health diagnosis. The incidence rates were 5,363/100,000 person-years (p-y), 587/100,000 p-y, 1,450/100,000 p-y, and 233/100,000 p-y for any respiratory disease diagnosis, bronchitis, asthma, and chronic obstructive lung disease diagnoses, respectively, after the date of first Veterans Health Administration utilization. Any mental health diagnosis was associated with increased odds for any respiratory diagnosis (adjusted odds ratio 1.41, 95% confidence interval 1.37-1.46). The association of mental health diagnoses and subsequent respiratory disease diagnoses was stronger and more consistent than the converse. Conclusion Many Afghanistan and Iraq War veterans are diagnosed with both respiratory and mental illnesses. Comprehensive plans that include care coordination with mental health professionals and treatments for mental illnesses may be important for many veterans with respiratory diseases.
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Affiliation(s)
- Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, (R&D 66) 3710 SW US Veterans Hospital Road, Portland, OR 97239.,Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, OHSU Division of Pulmonary and Critical Care Medicine, 3181 SW Sam Jackson Park Rd, Mail Code UHN6, Portland, OR 97239-3098
| | - Michael J Falvo
- Department of Veterans Affairs, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Ave, Mail Stop 129, East Orange, NJ 07018-1095.,Rutgers Biomedical and Health Sciences, New Jersey Medical School, The State University of New Jersey, Stanley S. Bergen Building, 65 Bergen Street, Newark, NJ 07103
| | - Shannon Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, (R&D 66) 3710 SW US Veterans Hospital Road, Portland, OR 97239
| | - Kathleen Carlson
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, (R&D 66) 3710 SW US Veterans Hospital Road, Portland, OR 97239.,School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, MC: GH230, Portland, OR 97239
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15
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Lin D, Li J, Razi R, Qamar N, Levine L, Zimmerman T, Hamidi SA, Schmidt M, Golightly MG, Rueb T, Harrington A, Garnett M, Antonawich F, McClain S, Szema AM. Rux largely restores lungs in Iraq PM-exposed mice, Up-regulating regulatory T-cells (Tregs). Exp Lung Res 2018; 44:153-166. [PMID: 29737931 PMCID: PMC6462226 DOI: 10.1080/01902148.2018.1459957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
Background Military personnel post-deployment to Iraq and Afghanistan have noted new-onset respiratory illness. This study's primary objective was to further develop an animal model of Iraq Afghanistan War Lung Injury (IAW-LI) and to test a novel class of anti-injury drug called RuX. Methods Particulate Matter (PM) samples were obtained in Iraq then characterized by spectromicroscopy. C57BL/6 mice underwent orotracheal instillation with PM, followed by drinkable treatment with RuX. Lung histology, inspiratory capacity (FlexiVent), thymic/splenic regulatory T cell (Treg) number, and whole-lung genomics were analyzed. Results Tracheal instillation of Iraq PM led to lung septate thickening and lymphocytic inflammation. PM-exposed mice had suppression of thymic/splenic regulatory T-cells (Tregs). Drinking RuX after PM exposure attenuated the histologic lung injury response, improved lung inspiratory capacity, and increased Tregs. Pooled whole lung genomics suggest differences among gene expression of IL-15 among control, PM, and PM + RuX groups. Conclusions RuX, a ruthenium and alpha-lipoic acid complex, attenuates lung injury by improving histology and inspiratory capacity via upregulation of Tregs in Iraq PM-exposed C57BL/6. Plausible genomic effects may involve IL-15 whole lung gene expression.
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Affiliation(s)
- David Lin
- College of Arts and Sciences, New York University, New York, NY
- McClain Laboratories, Smithtown, NY
| | - Jonathan Li
- M Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- McClain Laboratories, Smithtown, NY
| | - Rabail Razi
- D. with Distinction in Research Program, Stony Brook University School of Medicine, Stony Brook, NY
| | - Niha Qamar
- D. with Distinction in Research Program, Stony Brook University School of Medicine, Stony Brook, NY
| | - Laurie Levine
- Division of Laboratory Animal Resources, Stony Brook University, Stony Brook, NY
| | - Thomas Zimmerman
- Division of Laboratory Animal Resources, Stony Brook University, Stony Brook, NY
| | - Sayyed A. Hamidi
- Internal Medicine Residency Program, Bronx VA Medical Center, Bronx, NY
| | - Millicent Schmidt
- Stony Brook University Department of Geosciences Minerals Metals and Metalloids Toxicity Program
| | - Marc G. Golightly
- Flow Cytometry Laboratory, Department of Pathology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Todd Rueb
- Flow Cytometry Laboratory, Department of Pathology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Andrea Harrington
- Department of Environmental Medicine, New York University, New York, NY
| | | | - Frank Antonawich
- Garnett McKeen Laboratory, Bohemia, NY
- Department of Biology, St. Joseph’s College, Patchogue and Brooklyn, NY
| | | | - Anthony M. Szema
- Department of Occupational and Environmental Medicine, Preventive Medicine, and Epidemiology (Population Health), Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
- Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY
- The Stony Brook Medicine SUNY at Stony Brook Internal Medicine Residency Program at John T. Mather Memorial Hospital, Port Jefferson, NY
- Three Village Allergy and Asthma, PLLC, South Setauket, NY
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16
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Parsel SM, Riley CA, McCoul ED. Combat zone exposure and respiratory tract disease. Int Forum Allergy Rhinol 2018; 8:964-969. [PMID: 29601152 DOI: 10.1002/alr.22123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/10/2018] [Accepted: 03/06/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The impact of deployment to combat zones on the respiratory and sinonasal health of U.S. soldiers is an emerging public health concern. Retrospective studies have shown a correlation between deployment and development of post-deployment pathology, particularly of the aerodigestive system. Respiratory disease, including sinusitis, allergic rhinitis, and asthma, are commonly reported in soldiers deployed to the Middle East and Southwest Asia. METHODS Current literature pertaining to combat zone exposure and development of respiratory disease was retrieved using PubMed, Embase, Web of Science, and Google Scholar. RESULTS Several types of combat zone exposures exist that may play an influential role in the development of upper and lower respiratory tract diseases. Exposures including foreign dusts, harsh environments, particulate size, and close living quarters may play a causative role. The effect of combat zone exposures has been better examined for lower respiratory tract diseases; however, with the theory of the unified airway, the upper respiratory tract may also be involved. There is evidence that the upper respiratory tract is susceptible, with an increased risk for development of sinusitis and sinonasal disease; however, the quality of evidence of the present literature is generally low. CONCLUSION More research is necessary to determine a pathophysiologic mechanism between combat zone exposure and the development of sinonasal disease. Practicing otolaryngologists should be aware of the possibility of combat zone exposures that could contribute to rhinologic symptomatology.
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Affiliation(s)
- Sean M Parsel
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, LA
| | - Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, NY
| | - Edward D McCoul
- Department of Otorhinolaryngology-Head and Neck Surgery, Ochsner Health System, New Orleans, LA
- Ochsner Clinical School, University of Queensland School of Medicine, Brisbane, Queensland, Australia
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17
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Pilot Metabolome-Wide Association Study of Benzo(a)pyrene in Serum From Military Personnel. J Occup Environ Med 2018; 58:S44-52. [PMID: 27501104 DOI: 10.1097/jom.0000000000000772] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE A pilot study was conducted to test the feasibility of using Department of Defense Serum Repository (DoDSR) samples to study health and exposure-related effects. METHODS Thirty unidentified human serum samples were obtained from the DoDSR and analyzed for normal serum metabolites with high-resolution mass spectrometry and serum levels of free benzo(a)pyrene (BaP) by gas chromatography-mass spectrometry. Metabolic associations with BaP were determined using a metabolome-wide association study (MWAS) and metabolic pathway enrichment. RESULTS The serum analysis detected normal ranges of glucose, selected amino acids, fatty acids, and creatinine. Free BaP was detected in a broad concentration range. MWAS of BaP showed associations with lipids, fatty acids, and sulfur amino acid metabolic pathways. CONCLUSION The results show that the DoDSR samples are of sufficient quality for chemical profiling of DoD personnel.
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18
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Williams LJ, Chen L, Zosky GR. The respiratory health effects of geogenic (earth derived) PM10. Inhal Toxicol 2017; 29:342-355. [DOI: 10.1080/08958378.2017.1367054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Lewis J. Williams
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Ling Chen
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Graeme R. Zosky
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
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19
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Harrington AD, Schmidt MP, Szema AM, Galdanes K, Tsirka SE, Gordon T, Schoonen MAA. The Role of Iraqi Dust in Inducing Lung Injury in United States Soldiers-An Interdisciplinary Study. GEOHEALTH 2017; 1:237-246. [PMID: 29085918 PMCID: PMC5659319 DOI: 10.1002/2017gh000071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/15/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
United States soldiers are returning from the Greater Middle East with respiratory illnesses ranging from new onset asthma to constrictive bronchiolitis. The etiology of the diseases is unknown. A study was conducted to determine the possible role of local mineral dust in the development of abnormal respiratory illnesses in soldiers during and after deployment in Iraq. A dust sample obtained in proximity to a burn pit in Camp Victory, Iraq, (CVD) was characterized both chemically and mineralogically. For comparison, a dust sample from Fort Irwin, California, (FID) was also collected. The ability of the dust samples to generate reactive oxygen species (ROS) was quantified, as well as their ability to generate an inflammatory stress response (ISR) in human lung epithelial cells. Both samples are comprised of common silicate and carbonate minerals and contain heavy metals with concentration ranges expected for mineral dust. The ISR generated by each sample was within the range of inert material with the minimal stress generated associated with the carbonate phases. The findings based on this one sample suggest that the origin of the disease is not driven by the particles ability to generate ROS. However it is likely that particle overload, and associated complications, or endotoxin contribute extensively to pathogenesis.
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Affiliation(s)
- Andrea D. Harrington
- Astromaterials Acquisition and Curation OfficeNASA Johnson Space CenterHoustonTexasUSA
- Department of GeosciencesStony Brook UniversityStony BrookNew YorkUSA
- Institute of Environmental MedicineNew York University School of MedicineTuxedoNew YorkUSA
| | | | - Anthony M. Szema
- Veterans Affairs Medical CenterNorthportNew YorkUSA
- Departments of Medicine and SurgeryStony Brook University School of MedicineStony BrookNew YorkUSA
| | - Karen Galdanes
- Institute of Environmental MedicineNew York University School of MedicineTuxedoNew YorkUSA
| | - Stella E. Tsirka
- Pharmacological SciencesStony Brook UniversityStony BrookNew YorkUSA
| | - Terry Gordon
- Institute of Environmental MedicineNew York University School of MedicineTuxedoNew YorkUSA
| | - Martin A. A. Schoonen
- Department of GeosciencesStony Brook UniversityStony BrookNew YorkUSA
- Environmental Sciences DepartmentBrookhaven National LaboratoryUptonNew YorkUSA
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20
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Mahaffey BL, Gonzalez A, Farris SG, Zvolensky MJ, Bromet EJ, Luft BJ, Kotov R. Understanding the Connection Between Posttraumatic Stress Symptoms and Respiratory Problems: Contributions of Anxiety Sensitivity. J Trauma Stress 2017; 30:71-79. [PMID: 28099776 DOI: 10.1002/jts.22159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 10/13/2016] [Accepted: 11/06/2016] [Indexed: 12/20/2022]
Abstract
Respiratory problems and posttraumatic stress disorder (PTSD) are the signature health consequences associated with the September 11, 2001 (9/11), World Trade Center disaster and frequently co-occur. The reasons for this comorbidity, however, remain unknown. Anxiety sensitivity is a transdiagnostic trait that is associated with both PTSD and respiratory symptoms. The present study explored whether anxiety sensitivity could explain the experience of respiratory symptoms in trauma-exposed smokers with PTSD symptoms. Participants (N = 135; Mage = 49.18 years, SD = 10.01) were 9/11-exposed daily smokers. Cross-sectional self-report measures were used to assess PTSD symptoms, anxiety sensitivity, and respiratory symptoms. After controlling for covariates and PTSD symptoms, anxiety sensitivity accounted for significant additional variance in respiratory symptoms (ΔR2 = .04 to .08). This effect was specific to the somatic concerns dimension (β = .29, p = .020); somatic concerns contributed significantly to accounting for the overlap between PTSD and respiratory symptoms, b = 0.03, 95% CI [0.01, 0.07]. These findings suggest that the somatic dimension of anxiety sensitivity is important in understanding respiratory symptoms in individuals with PTSD symptoms. These findings also suggest that it may be critical to address anxiety sensitivity when treating patients with comorbid respiratory problems and PTSD.
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Affiliation(s)
- Brittain L Mahaffey
- Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA
| | - Adam Gonzalez
- Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA
| | - Samantha G Farris
- Department of Psychology, University of Houston, Houston, Texas, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA.,Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Evelyn J Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA
| | - Benjamin J Luft
- Department of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA
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21
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Masri S, Garshick E, Hart J, Bouhamra W, Koutrakis P. Use of visual range measurements to predict fine particulate matter exposures in Southwest Asia and Afghanistan. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2017; 67:75-85. [PMID: 27700621 PMCID: PMC5177516 DOI: 10.1080/10962247.2016.1243169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
UNLABELLED Military personnel deployed to Southwest Asia and Afghanistan were exposed to high levels of ambient particulate matter (PM). However, quantitative ambient exposure data for conducting health studies are limited due to a lack of PM monitoring stations. Since visual range (VR) is proportional to particle light extinction, VR can serve as a surrogate for PM2.5 (particulate matter with an aerodynamic diameter ≤2.5 µm) concentrations. We used data on VR, relative humidity (RH), and PM2.5 ground measurements collected in Kuwait from years 2004-2005 to establish the relationship between PM2.5 and VR. Model validation obtained by regressing trimester average PM2.5 predictions against PM2.5 measurements in Kuwait produced an r2 value of 0.84. Cross validation of urban and rural sites in Kuwait also revealed good model fit. We applied this relationship to location-specific visibility data at 104 regional sites between years 2000-2012 to estimate monthly average PM2.5 concentrations. Monthly averages at sites in Iraq, Afghanistan, United Arab Emirates, Kuwait, Djibouti, and Qatar ranged from 10 to 365 µg/m3 during this period, while site averages ranged from 22 to 80 µg/m3, indicating considerable spatial and temporal heterogeneity in ambient PM2.5 across these regions. These data support the use of historical visibility data to estimate location-specific PM2.5 concentrations for application in epidemiological studies. IMPLICATIONS This study demonstrates the ability to use airport visibility to estimate PM2.5 concentrations in Southwest Asian and Afghanistan. This supports the use of historical and ongoing visibility data to estimate PM2.5 exposure in this region of the world, where PM exposure information is otherwise scarce. This is of high utility to epidemiologists investigating the relationship between chronic exposure to PM2.5 and respiratory diseases among deployed military personnel stationed at various military bases throughout the region. Such information will enable the drafting of improved policies relating to military health.
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Affiliation(s)
- Shahir Masri
- Corresponding Author. Shahir Masri. 714-675-9792.
| | - Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston
- Healthcare System, Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jaime Hart
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Walid Bouhamra
- Department of Chemical Engineering, College of Engineering and Petroleum, Kuwait University, Kuwait City, Kuwait
| | - Petros Koutrakis
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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22
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Masri S, Garshick E, Coull BA, Koutrakis P. A novel calibration approach using satellite and visibility observations to estimate fine particulate matter exposures in Southwest Asia and Afghanistan. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2017; 67:86-95. [PMID: 27649895 PMCID: PMC5177520 DOI: 10.1080/10962247.2016.1230079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 08/20/2016] [Indexed: 05/12/2023]
Abstract
In order to study effects of ambient particulate matter (PM) it was previously necessary to have access to a comprehensive air monitoring network. However, there are locations in the world where PM levels are above generally accepted exposure standards but lack a monitoring infrastructure. This is true in Iraq and other locations in Southwest Asia and Afghanistan where U.S. and other coalition troops were deployed beginning in 2001. Since aerosol optical depth (AOD), determined by satellite, and visibility are both highly related to atmospheric PM2.5 (particulate matter with an aerodynamic diameter ≤2.5 μm) concentrations, we employed a novel approach that took advantage of historic airport visibility measurements to calibrate the AOD-visibility relationship and determine visibility spatially and temporally (2006-2007) over an approximately 17,000 km2 region of Iraq. We obtained daily visibility predictions that were highly associated with satellite-based 1x1 km AOD daily observations (R2=0.87). Based on a previously derived calibration between PM2.5 and visibility, we were able to predict spatially and temporally resolved PM2.5 concentrations. Variability of PM2.5 among sites was high, with daily concentrations differing by as much as ~30 μg/m3. This study demonstrates the feasibility of characterizing historic PM2.5 exposures in Iraq and other locations in Southwest Asia and Afghanistan with similar climate characteristics. This is of utility for epidemiologists seeking to assess the potential health effects related to PM2.5 exposures among previously deployed military personnel and of the population of the region. IMPLICATIONS This study demonstrates the ability to utilize aerosol optical depth to successfully estimate visibility spatially and temporally in Southwest Asia and Afghanistan. This enables for the estimation of spatially resolved PM2.5 concentrations in the region. The ability to caracterize PM2.5 concentrations in Southwest Asia and Afghanistan is highly important for epidemiologists investigating the relationship between chronic exposure to PM2.5 and respiratory diseases among military personnel deployed to the region. This information will better position policy makers to draft meaningful legislation relating to military health.
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Affiliation(s)
- Shahir Masri
- a Exposure, Epidemiology, and Risk Program, Department of Environmental Health , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Eric Garshick
- b Pulmonary, Allergy, Sleep, and Critical Care Medicine Section , Medical Service, VA Boston Healthcare System , Boston , MA , USA
- c Channing Division of Network Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA
| | - Brent A Coull
- d Department of Biostatistics , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Petros Koutrakis
- a Exposure, Epidemiology, and Risk Program, Department of Environmental Health , Harvard T.H. Chan School of Public Health , Boston , MA , USA
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Holley AB, Sobieszczyk M, Perkins M, Cohee BM, Costantoth CB, Mabe DL, Liotta R, Abraham JH, Holley PR, Sherner J. Lung function abnormalities among service members returning from Iraq or Afghanistan with respiratory complaints. Respir Med 2016; 118:84-87. [DOI: 10.1016/j.rmed.2016.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 07/09/2016] [Accepted: 07/22/2016] [Indexed: 11/25/2022]
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Blasch K, Kolivosky J, Hill B. Occupational exposures among personnel working near combined burn pit and incinerator operations at Bagram Airfield, Afghanistan. Inhal Toxicol 2016; 28:216-25. [DOI: 10.3109/08958378.2016.1145768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - John Kolivosky
- US Army Institute for Public Health, Aberdeen Prvoing Ground, MD, USA, and
| | - Barry Hill
- United States Air Force School of Aerospace Medicine, Wright Patterson AFB, OH, USA
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Bronchodilator Responsiveness and Airflow Limitation Are Associated With Deployment Length in Iraq and Afghanistan Veterans. J Occup Environ Med 2016; 58:325-8. [DOI: 10.1097/jom.0000000000000675] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Szema A, Mirsaidi N, Patel B, Viens L, Forsyth E, Li J, Dang S, Dukes B, Giraldo J, Kim P, Burns M. Proposed Iraq/Afghanistan War-Lung Injury (IAW-LI) Clinical Practice Recommendations: National Academy of Sciences' Institute of Medicine Burn Pits Workshop. Am J Mens Health 2015; 11:1653-1663. [PMID: 26669772 DOI: 10.1177/1557988315619005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
High rates of respiratory symptoms (14%) and new-onset asthma in previously healthy soldiers (6.6%) have been reported among military personnel post-deployment to Iraq and Afghanistan. The term Iraq/Afghanistan War-Lung Injury (IAW-LI) is used to describe the constellation of respiratory diseases related to hazards of war, such as exposure to burning trash in burn pits, improvised explosive devices, and sandstorms. Burnpits360.org is a nonprofit civilian website which voluntarily tracks medical symptoms among soldiers post-deployment to the Middle East. Subsequent to initiation of the Burnpits360.org website, the Department of Veterans Affairs started the Airborne Hazards and Open Burn Pit registry. This paper: (a) analyzes the latest 38 patients in the Burnpits360.org registry, validated by DD214 Forms; (b) compares strengths and weaknesses of both registries as outlined at the National Academy of Sciences Institute of Medicine Burn Pits Workshop;
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Affiliation(s)
- Anthony Szema
- 1 Hofstra North Shore-LIJ School of Medicine at Hofstra University, Department of Occupational and Environmental Medicine, Preventive Medicine, and Epidemiology, Hempstead, NY, USA.,2 Stony Brook University, Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook, NY, USA
| | - Niely Mirsaidi
- 2 Stony Brook University, Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook, NY, USA
| | - Bhumika Patel
- 2 Stony Brook University, Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook, NY, USA
| | - Laura Viens
- 2 Stony Brook University, Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook, NY, USA
| | - Edward Forsyth
- 2 Stony Brook University, Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook, NY, USA
| | - Jonathan Li
- 2 Stony Brook University, Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook, NY, USA
| | - Sophia Dang
- 2 Stony Brook University, Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook, NY, USA
| | - Brittany Dukes
- 2 Stony Brook University, Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook, NY, USA
| | - Jheison Giraldo
- 2 Stony Brook University, Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook, NY, USA
| | | | - Matthew Burns
- 2 Stony Brook University, Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook, NY, USA
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Porter KL, Green FHY, Harley RA, Vallyathan V, Castranova V, Waldron NR, Leonard SS, Nelson DE, Lewis JA, Jackson DA. Evaluation of the Pulmonary Toxicity of Ambient Particulate Matter From Camp Victory, Iraq. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2015; 78:1385-1408. [PMID: 26594896 PMCID: PMC4714599 DOI: 10.1080/15287394.2015.1072611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Anecdotal reports in the press and epidemiological studies suggest that deployment to Iraq and Afghanistan may be associated with respiratory diseases and symptoms in U.S. military personnel and veterans. Exposures during military operations were complex, but virtually all service members were exposed to high levels of respirable, geogenic dust. Inhalation of other dusts has been shown to be associated with adverse health effects, but the pulmonary toxicity of ambient dust from Iraq has not been previously studied. The relative toxicity of Camp Victory dust was evaluated by comparing it to particulate matter from northern Kuwait, a standard U.S. urban dust, and crystalline silica using a single intratracheal instillation in rats. Lung histology, protein levels, and cell counts were evaluated in the bronchoalveolar lavage fluid 1-150 d later. The Iraq dust provoked an early significant, acute inflammatory response. However, the level of inflammation in response to the Iraq dust, U.S. urban dust, and Kuwait dust rapidly declined and was nearly at control levels by the end of the study At later times, animals exposed to the Iraq, U.S. urban, or Kuwait dusts showed increased small airway remodeling and emphysema compared to silica-exposed and control animals without evidence of fibrosis or premalignant changes. The severity and persistence of pulmonary toxicity of these three dusts from the Middle East resemble those of a U.S. urban dust and are less than those of silica. Therefore, Iraq dust exposure is not highly toxic, but similar to other poorly soluble low-toxicity dusts.
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Affiliation(s)
| | | | - R. A. Harley
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - V. Vallyathan
- National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - V. Castranova
- West Virginia University School of Pharmacy, Morgantown, West Virginia, USA
| | - N. R. Waldron
- National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - S. S. Leonard
- National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | | | - J. A. Lewis
- U.S. Army Center for Environmental Health Research, Fort Detrick, Maryland, USA
| | - D. A. Jackson
- U.S. Army Center for Environmental Health Research, Fort Detrick, Maryland, USA
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Falvo MJ, Osinubi OY, Sotolongo AM, Helmer DA. Airborne Hazards Exposure and Respiratory Health of Iraq and Afghanistan Veterans. Epidemiol Rev 2015; 37:116-30. [DOI: 10.1093/epirev/mxu009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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DelVecchio SP, Collen JF, Zacher LL, Morris MJ. The impact of combat deployment on asthma diagnosis and severity. J Asthma 2014; 52:363-9. [PMID: 25290816 DOI: 10.3109/02770903.2014.973502] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Environmental exposures during military deployments to Iraq and Afghanistan may lead to higher rates of respiratory complaints and diagnoses. This study investigates whether there is a relationship between rates of asthma diagnosis and severity associated with military deployment. METHODS Retrospective review of active duty Army personnel underwent fitness for duty evaluation (Medical Evaluation Board) for asthma. The electronic medical record was reviewed for onset of diagnosis (pre- or post-deployment), disease severity, screening spirometry, bronchodilator response and bronchoprovocation testing. We compared patients with and without a history of combat deployment to Operations Iraqi Freedom/Enduring Freedom. RESULTS Four hundred consecutive Army personnel with a clinical diagnosis of asthma were evaluated. Equal numbers of patients had deployed (48.5%) versus never deployed (51.5%). Of those who deployed, 98 (24.5%) were diagnosed post-deployment. The diagnosis of asthma was objectively confirmed in 74.8% of patients by obstructive screening spirometry, bronchodilator response, and/or methacholine challenge testing. There were no significant differences in spirometry between deployers and non-deployers or based on pre- and post-deployment diagnosis. Similarly, asthma severity classification did not differ between deployed and non-deployed service members, or by pre- and post-deployment diagnosis status. CONCLUSIONS Among active duty military personnel with career limiting asthma, there is no significant relationship between rates of diagnosis or severity based on history of deployment to Southwest Asia.
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Affiliation(s)
- Sally P DelVecchio
- Pulmonary/Critical Care Service, Womack Army Medical Center , Fort Bragg, NC , USA
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Szema AM, Reeder RJ, Harrington AD, Schmidt M, Liu J, Golightly M, Rueb T, Hamidi SA. Iraq dust is respirable, sharp, and metal-laden and induces lung inflammation with fibrosis in mice via IL-2 upregulation and depletion of regulatory T cells. J Occup Environ Med 2014; 56:243-51. [PMID: 24603199 PMCID: PMC4037815 DOI: 10.1097/jom.0000000000000119] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Determine whether surface dust grab samples taken from a large military base in Iraq are toxic and respirable. METHODS X-ray diffraction for mineral content, x-ray fluorescence for elemental content, in vivo mouse dust challenges for assessment of histological changes, bronchoalveolar lavage for cytokines, polarizing light microscopy for crystals in lung tissue, and Fluorescence Activated Cell Sorting for cell surface and intracellular markers were utilized. RESULTS Camp Victory, Iraq dust taken during wartime contains respirable particles 2.5 microns in size, constituting particulate matter air pollution. Dust particles are angular and have sharp edges. Trace metals (including titanium) calcium and silicon are present. Mice with airway instillation of dust have polarizable crystals in lung and septate inflammation. Regulatory T cells (CD4⁺CD25⁺FOXP3⁺) are decreased in thymus and spleen. Interleukin-2 (IL-2) is upregulated in bronchoalveolar lavage. CONCLUSIONS Respirable Iraq dust leads to lung inflammation in mice similar to that seen in patients with polarizable crystals, which seem to be titanium.
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Affiliation(s)
- Anthony M. Szema
- Department of Medicine, Stony Brook University School of Medicine, Stony Brook, NY
| | | | | | | | - Jingxuan Liu
- Department of Pathology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Marc Golightly
- Department of Pathology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Todd Rueb
- Department of Pathology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Sayyed A. Hamidi
- Department of Medicine, Stony Brook University School of Medicine, Stony Brook, NY
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Abstract
PURPOSE OF REVIEW New literature from 2009 to 2012 regarding occupational constrictive bronchiolitis challenges textbook descriptions of this disease, formerly thought to be limited to fixed airflow limitation arising in the wake of accidental overexposure to noxious chemicals. Indolent evolution of dyspnea without a recognized hazardous exposure is a more common presentation. RECENT FINDINGS Biopsy-confirmed case series of constrictive bronchiolitis from US soldiers, Iranian survivors of sulfur mustard gassing, hospital-based studies, and flavoring-related cases document that indolent constrictive bronchiolitis cases can have normal spirometry or either restrictive or obstructive abnormalities. High-resolution computerized tomography studies can be normal or reflect air-trapping and mosaic attenuation on expiratory films. Thus, in the absence of noninvasive abnormalities, the diagnosis in dyspneic patients may require thoracoscopic biopsy in settings in which exposure risk has not been recognized. Many workers with occupational constrictive bronchiolitis stabilize with cessation of exposures causing bronchiolar epithelial necrosis. SUMMARY Clinicians need a high index of suspicion for constrictive bronchiolitis in young patients with rapidly progressing exertional dyspnea, regardless of spirometric and radiologic findings. Identification of novel causes and exposure-response relations for known causes are needed to provide guidance for protecting workers at risk for this largely irreversible lung disease.
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Abstract
A task force of the American Thoracic Society has defined work-exacerbated asthma (WEA) as the worsening of asthma caused by conditions at work. Occupational asthma (OA) is asthma that is initiated by occupational exposures in people without prior asthma. In contrast, WEA is asthma (already present or coincident [new onset]) that is worsened because of conditions at work. This difference is critical because asthma is a common disease (present in approximately 7% of working adults). Among working adults with asthma, approximately 20% may have WEA. WEA has potential implications regarding asthma morbidity, health care use, and the economy.
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Affiliation(s)
- Anthony M Szema
- Department of Medicine, Allergy Section, Veterans Affairs Medical Center, Northport, NY 11768, USA.
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Nindl BC, Castellani JW, Warr BJ, Sharp MA, Henning PC, Spiering BA, Scofield DE. Physiological Employment Standards III: physiological challenges and consequences encountered during international military deployments. Eur J Appl Physiol 2013; 113:2655-72. [DOI: 10.1007/s00421-013-2591-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 01/15/2013] [Indexed: 11/30/2022]
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Szema AM. Occupational Lung Diseases among Soldiers Deployed to Iraq and Afghanistan. ACTA ACUST UNITED AC 2013; 1. [PMID: 24443711 DOI: 10.4172/2329-6879.1000117] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Military personnel deployed to Iraq and Afghanistan, from 2004 to the present, has served in a setting of unique environmental conditions. Among these are exposures to burning trash in open air "burn pits" lit on fire with jet fuel JP-8. Depending on trash burned--water bottles, styrofoam trays, medical waste, unexploded munitions, and computers--toxins may be released such as dioxins and n-hexane and benzene. Particulate matter air pollution culminates from these fires and fumes. Additional environmental exposures entail sandstorms (Haboob, Shamal, and Sharqi) which differ in direction and relationship to rain. These wars saw the first use of improvised explosive devices (roadside phosphate bombs),as well as vehicle improvised explosive devices (car bombs), which not only potentially aerosolize metals, but also create shock waves to induce lung injury via blast overpressure. Conventional mortar rounds are also used by Al Qaeda in both Iraq and Afghanistan. Outdoor aeroallergens from date palm trees are prevalent in southern Iraq by the Tigris and Euphrates rivers, while indoor aeroallergen aspergillus predominates during the rainy season. High altitude lung disease may also compound the problem, particularly in Kandahar, Afghanistan. Clinically, soldiers may present with new-onset asthma or fixed airway obstruction. Some have constrictive bronchiolitis and vascular remodeling on open lung biopsy - despite having normal spirometry and chest xrays and CT scans of the chest. Others have been found to have titanium and other metals in the lung (rare in nature). Still others have fulminant biopsy-proven sarcoidiosis. We found DNA probe-positive Mycobacterium Avium Complex in lung from a soldier who had pneumonia, while serving near stagnant water and camels and goats outside Abu Gharib. This review highlights potential exposures, clinical syndromes, and the Denver Working Group recommendations on post-deployment health.
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Affiliation(s)
- Anthony M Szema
- New York State Center for Biotechnology Stony Brook University School of Medicine, Stony Brook, NY 11794, USA ; Chief, Allergy Section, Veterans Affairs Medical Center, Northport, NY, 11768, USA
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Abstract
There is a long history of Veterans returning from war with concerns regarding environmental hazards that they may have experienced while in theater. The author describes some of the tools in place within the Department of Defense to capture the frequency and nature of exposure concerns of returning troops. This article then reviews the exposures of concern to Service members returning from military service in the current and recent conflicts in Afghanistan and Iraq. The author then presents some of the recent published literature on these concerns. To address these exposure concerns of Veterans, there is then a brief discussion of a new program being put in place at the Department of Veterans Affairs.
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Woodall BD, Yamamoto DP, Gullett BK, Touati A. Emissions from small-scale burns of simulated deployed U.S. military waste. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2012; 46:10997-11003. [PMID: 22947082 DOI: 10.1021/es3021556] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
U.S. military forces have historically relied on open burning as an expedient method of volume reduction and treatment of solid waste during the conflicts in Afghanistan and Iraq. This study is the first effort to characterize a broad range of pollutants and their emission factors during the burning of military waste and the effects that recycling efforts, namely removing plastics, might have on emissions. Piles of simulated military waste were constructed, burned, and emissions sampled at the U.S. Environmental Protection Agency (EPA) Open Burn Testing Facility (OBTF), Research Triangle Park, NC. Three tests contained polyethylene terephthalate (PET #1 or PET) plastic water bottles and four did not. Emission factors for polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), particulate matter (PM(10), PM(2.5)), polychlorinated and polybrominated dioxins/furans (PCDD/F and PBDD/F), and criteria pollutants were determined and are contained within. The average PCDD/F emission factors were 270 ng-toxic equivalency (TEQ) per kg carbon burned (ng-TEQ/kg Cb), ranging from 35 to 780 ng-TEQ/kg Cb. Limited testing suggests that targeted removal of plastic water bottles has no apparent effect on reducing pollutants and may even promote increased emissions.
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Affiliation(s)
- Brian D Woodall
- U.S. Air Force Institute of Technology, Department of Systems and Engineering Management, 2950 Hobson Way, Wright-Patterson AFB, Ohio 45433, USA
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A Case-Crossover Study of Ambient Particulate Matter and Cardiovascular and Respiratory Medical Encounters Among US Military Personnel Deployed to Southwest Asia. J Occup Environ Med 2012; 54:733-9. [DOI: 10.1097/jom.0b013e318253356c] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Respiratory symptoms necessitating spirometry among soldiers with Iraq/Afghanistan war lung injury. J Occup Environ Med 2012; 53:1356-7; author reply 1357-8. [PMID: 22157643 DOI: 10.1097/jom.0b013e3182398da8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Authors' Response. J Occup Environ Med 2011. [DOI: 10.1097/jom.0b013e31823d870b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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