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Meyer JN, Pan WK, Ryde IT, Alexander T, Klein-Adams JC, Ndirangu DS, Falvo MJ. Bioenergetic function is decreased in peripheral blood mononuclear cells of veterans with Gulf War Illness. PLoS One 2023; 18:e0287412. [PMID: 37910447 PMCID: PMC10619881 DOI: 10.1371/journal.pone.0287412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023] Open
Abstract
Gulf War Illness (GWI) is a major health problem for approximately 250,000 Gulf War (GW) veterans, but the etiology of GWI is unclear. We hypothesized that mitochondrial dysfunction is an important contributor to GWI, based on the similarity of some GWI symptoms to those occurring in some mitochondrial diseases; the plausibility that certain pollutants to which GW veterans were exposed affect mitochondria; mitochondrial effects observed in studies in laboratory models of GWI; and previous evidence of mitochondrial outcomes in studies in GW veterans. A primary role of mitochondria is generation of energy via oxidative phosphorylation. However, direct assessment of mitochondrial respiration, reflecting oxidative phosphorylation, has not been carried out in veterans with GWI. In this case-control observational study, we tested multiple measures of mitochondrial function and integrity in a cohort of 114 GW veterans, 80 with and 34 without GWI as assessed by the Kansas definition. In circulating white blood cells, we analyzed multiple measures of mitochondrial respiration and extracellular acidification, a proxy for non-aerobic energy generation; mitochondrial DNA (mtDNA) copy number; mtDNA damage; and nuclear DNA damage. We also collected detailed survey data on demographics; deployment; self-reported exposure to pesticides, pyridostigmine bromide, and chemical and biological warfare agents; and current biometrics, health and activity levels. We observed a 9% increase in mtDNA content in blood in veterans with GWI, but did not detect differences in DNA damage. Basal and ATP-linked oxygen consumption were respectively 42% and 47% higher in veterans without GWI, after adjustment for mtDNA amount. We did not find evidence for a compensatory increase in anaerobic energy generation: extracellular acidification was also lower in GWI (12% lower at baseline). A subset of 27 and 26 veterans returned for second and third visits, allowing us to measure stability of mitochondrial parameters over time. mtDNA CN, mtDNA damage, ATP-linked OCR, and spare respiratory capacity were moderately replicable over time, with intraclass correlation coefficients of 0.43, 0.44, 0.50, and 0.57, respectively. Other measures showed higher visit-to-visit variability. Many measurements showed lower replicability over time among veterans with GWI compared to veterans without GWI. Finally, we found a strong association between recalled exposure to pesticides, pyridostigmine bromide, and chemical and biological warfare agents and GWI (p < 0.01, p < 0.01, and p < 0.0001, respectively). Our results demonstrate decreased mitochondrial respiratory function as well as decreased glycolytic activity, both of which are consistent with decreased energy availability, in peripheral blood mononuclear cells in veterans with GWI.
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Affiliation(s)
- Joel N. Meyer
- Nicholas School of the Environment, Duke University, Durham, NC, United States of America
| | - William K. Pan
- Nicholas School of the Environment, Duke University, Durham, NC, United States of America
| | - Ian T. Ryde
- Nicholas School of the Environment, Duke University, Durham, NC, United States of America
| | - Thomas Alexander
- Department of Veterans Affairs, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
| | - Jacquelyn C. Klein-Adams
- Department of Veterans Affairs, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
| | - Duncan S. Ndirangu
- Department of Veterans Affairs, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
| | - Michael J. Falvo
- Department of Veterans Affairs, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
- New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ, United States of America
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Golomb BA, Sanchez Baez R, Schilling JM, Dhanani M, Fannon MJ, Berg BK, Miller BJ, Taub PR, Patel HH. Mitochondrial impairment but not peripheral inflammation predicts greater Gulf War illness severity. Sci Rep 2023; 13:10739. [PMID: 37438460 DOI: 10.1038/s41598-023-35896-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/25/2023] [Indexed: 07/14/2023] Open
Abstract
Gulf War illness (GWI) is an important exemplar of environmentally-triggered chronic multisymptom illness, and a potential model for accelerated aging. Inflammation is the main hypothesized mechanism for GWI, with mitochondrial impairment also proposed. No study has directly assessed mitochondrial respiratory chain function (MRCF) on muscle biopsy in veterans with GWI (VGWI). We recruited 42 participants, half VGWI, with biopsy material successfully secured in 36. Impaired MRCF indexed by complex I and II oxidative phosphorylation with glucose as a fuel source (CI&CIIOXPHOS) related significantly or borderline significantly in the predicted direction to 17 of 20 symptoms in the combined sample. Lower CI&CIIOXPHOS significantly predicted GWI severity in the combined sample and in VGWI separately, with or without adjustment for hsCRP. Higher-hsCRP (peripheral inflammation) related strongly to lower-MRCF (particularly fatty acid oxidation (FAO) indices) in VGWI, but not in controls. Despite this, whereas greater MRCF-impairment predicted greater GWI symptoms and severity, greater inflammation did not. Surprisingly, adjusted for MRCF, higher hsCRP significantly predicted lesser symptom severity in VGWI selectively. Findings comport with a hypothesis in which the increased inflammation observed in GWI is driven by FAO-defect-induced mitochondrial apoptosis. In conclusion, impaired mitochondrial function-but not peripheral inflammation-predicts greater GWI symptoms and severity.
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Affiliation(s)
- Beatrice A Golomb
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive #0995, La Jolla, CA, 92093-0995, USA.
| | - Roel Sanchez Baez
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive #0995, La Jolla, CA, 92093-0995, USA
- San Ysidro Health Center, San Diego, CA, 92114, USA
| | - Jan M Schilling
- VA San Diego Healthcare System and Department of Anesthesiology, University of California, San Diego, San Diego, CA, 92161, USA
| | - Mehul Dhanani
- VA San Diego Healthcare System and Department of Anesthesiology, University of California, San Diego, San Diego, CA, 92161, USA
- Avidity Biosciences, San Diego, CA, 92121, USA
| | - McKenzie J Fannon
- VA San Diego Healthcare System and Department of Anesthesiology, University of California, San Diego, San Diego, CA, 92161, USA
| | - Brinton K Berg
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive #0995, La Jolla, CA, 92093-0995, USA
| | - Bruce J Miller
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive #0995, La Jolla, CA, 92093-0995, USA
| | - Pam R Taub
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Hemal H Patel
- VA San Diego Healthcare System and Department of Anesthesiology, University of California, San Diego, San Diego, CA, 92161, USA
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Bach RR, Rudquist RR. Gulf war illness inflammation reduction trial: A phase 2 randomized controlled trial of low-dose prednisone chronotherapy, effects on health-related quality of life. PLoS One 2023; 18:e0286817. [PMID: 37319244 PMCID: PMC10270619 DOI: 10.1371/journal.pone.0286817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/28/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Gulf War illness (GWI) is a deployment-related chronic multisymptom illness impacting the health-related quality of life (HRQOL) of many U.S. Military Veterans of the 1990-91 Gulf War. A proinflammatory blood biomarker fingerprint was discovered in our initial study of GWI. This led to the hypothesis that chronic inflammation is a component of GWI pathophysiology. OBJECTIVES The GWI inflammation hypothesis was tested in this Phase 2 randomized controlled trial (RCT) by measuring the effects of an anti-inflammatory drug and placebo on the HRQOL of Veterans with GWI. The trial is registered at ClinicalTrials.gov, Identifier: NCT02506192. RCT DESIGN AND METHODS Gulf War Veterans meeting the Kansas case definition for GWI were randomized to receive either 10 mg modified-release prednisone or matching placebo. The Veterans RAND 36-Item Health Survey was used to assess HRQOL. The primary outcome was a change from baseline in the physical component summary (PCS) score, a measure of physical functioning and symptoms. A PCS increase indicates improved physical HRQOL. RESULTS For subjects with a baseline PCS <40, there was a 15.2% increase in the mean PCS score from 32.9±6.0 at baseline to 37.9±9.0 after 8 weeks on modified-release prednisone. Paired t-test analysis determined the change was statistically significant (p = 0.004). Eight weeks after cessation of the treatment, the mean PCS score declined to 32.7±5.8. CONCLUSIONS The prednisone-associated improvement in physical HRQOL supports the GWI inflammation hypothesis. Determining the efficacy of prednisone as a treatment for GWI will require a Phase 3 RCT.
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Affiliation(s)
- Ronald R. Bach
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
| | - Rebecca R. Rudquist
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
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Fatigue and Pain Severity in Gulf War Illness Is Associated With Changes in Inflammatory Cytokines and Positive Acute Phase Proteins. J Occup Environ Med 2022; 64:905-911. [PMID: 35902364 DOI: 10.1097/jom.0000000000002625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of the study is to investigate relationships between inflammatory analytes and symptoms of pain and fatigue in Gulf War illness (GWI). METHODS In this preliminary study, 12 male veterans meeting GWI criteria provided daily blood samples and symptom ratings over 25 days. Linear mixed models were used to analyze associations between symptoms and sera concentrations of cytokines, acute phase proteins, insulin, and brain-derived neurotropic factor. RESULTS Analyses included 277 days with both blood draws and self-reports. Days with worse fatigue severity were associated with higher C-reactive protein and serum amyloid A, and lower eotaxin 1. Muscle pain and joint pain were associated with leptin, monocyte chemoattractant protein 1, and interferon γ-induced protein. Joint pain was further associated with serum amyloid A and eotaxin 3. CONCLUSIONS Gulf War illness involves fatigue and pain associated with inflammation. Conventional and novel anti-inflammatories should be further explored for the treatment of GWI.
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Powers AA, Jones KE, Eisenberg SH, Rigatti LH, Ryan JP, Luketich JD, Lotze MT, LaRue AC, Dhupar R, Soloff AC. Experimental respiratory exposure to putative Gulf War toxins promotes persistent alveolar macrophage recruitment and pulmonary inflammation. Life Sci 2021; 282:119839. [PMID: 34293400 DOI: 10.1016/j.lfs.2021.119839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 02/04/2023]
Abstract
AIMS Respiratory disorders are a prominent component of Gulf War Illness. Although much of the underlying mechanisms of Gulf War Illness remain undefined, chronic immune dysfunction is a consistent feature of this multi-symptomatic, multi-organ disorder. Alveolar macrophages represent the predominant mononuclear phagocytes of the pulmonary mucosa, orchestrating the host response to pathogens and environmental stimuli. Herein, we sought to characterize the innate immune response of the pulmonary mucosa, with a focus on macrophages, to experimental respiratory exposure to two putative Gulf War Toxins (GWTs). MATERIALS AND METHODS Utilizing commercially available instrumentation, we evaluated the effect of aerosolized exposure to the pesticide malathion and diesel exhaust particulate (DEP) on the immune composition and inflammatory response of the lung in FVB/N mice using multiparametric spectral cytometry, cytokine analysis, and histology. KEY FINDINGS Aerosolized GWTs induced gross pulmonary pathology with transient recruitment of neutrophils and sustained accumulation of alveolar macrophages to the lung for up to two weeks after exposure cessation. High-dimensional cytometry and unbiased computational analysis identified novel myeloid subsets recruited to the lung post-exposure driven by an influx of peripheral monocyte-derived progenitors. DEP and malathion, either alone or in combination, induced soluble mediators in bronchoalveolar lavage indicative of oxidative stress (PGF2α), inflammation (LTB4, TNFα, IL-12), and immunosuppression (IL-10), that were sustained or increased two weeks after exposures concluded. SIGNIFICANCE These findings indicate that macrophage accumulation and pulmonary inflammation induced by GWTs continue in the absence of toxin exposure and may contribute to the immunopathology of respiratory Gulf War Illness.
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Affiliation(s)
- Amy A Powers
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Katherine E Jones
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Seth H Eisenberg
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lora H Rigatti
- Division of Laboratory Animal Resources, University of Pittsburgh, Pittsburgh, PA, USA; UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - John P Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael T Lotze
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA; Department of Surgery, Division of Surgical Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amanda C LaRue
- Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA; Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Rajeev Dhupar
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA; Surgical Services Division, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Adam C Soloff
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA.
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Gean EG, Ayers CK, Winchell KA, Freeman M, Press AM, Paynter R, Kansagara D, Nugent SM. Biological measures and diagnostic tools for Gulf War Illness - A systematic review. Life Sci 2021; 275:119360. [PMID: 33741418 DOI: 10.1016/j.lfs.2021.119360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/22/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
AIMS Gulf War Illness (GWI) is a chronic multisymptom illness with debated etiology and pathophysiology. This systematic review catalogues studies of validated biological tests for diagnosing GWI and of associations between biological measures and GWI for their promise as biomarkers. MAIN METHODS We searched multiple sources through February 2020 for studies of diagnostic tests of GWI and of associations between biological measures and GWI. We abstracted data on study design, demographics, and outcomes. We assessed the risk of bias of included studies. KEY FINDINGS We did not identify any studies validating tests of biomarkers that distinguish cases of GWI from non-cases. We included the best-fitting studies, 32 completed and 24 ongoing or unpublished studies, of associations between GWI and biological measures. The less well-fitting studies (n = 77) were included in a Supplementary Table. Most studies were of the central nervous and immune systems and indicated a significant association of the biological measure with GWI case status. Biological measures were heterogeneous across studies. SIGNIFICANCE Our review indicates that there are no existing validated biological tests to determine GWI case status. Many studies have assessed the potential association between a variety of biological measures and GWI, the majority of which pertain to the immune and central nervous systems. More importantly, while most studies indicated a significant association between biological measures and GWI case status, the biological measures across studies were extremely heterogeneous. Due to the heterogeneity, the focus of the review is to map out what has been examined, rather than synthesize information.
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Affiliation(s)
- Emily G Gean
- Scientific Resource Center for the Agency for Healthcare Research and Quality Evidence-based Practice Center, Portland VA Research Foundation, United States of America.
| | - Chelsea K Ayers
- VA Portland Health Care System Evidence Synthesis Program, United States of America
| | - Kara A Winchell
- VA Portland Health Care System Evidence Synthesis Program, United States of America
| | - Michele Freeman
- VA Portland Health Care System Evidence Synthesis Program, United States of America
| | - Ashlyn M Press
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States of America
| | - Robin Paynter
- VA Portland Health Care System Evidence Synthesis Program, United States of America
| | - Devan Kansagara
- VA Portland Health Care System Evidence Synthesis Program, United States of America
| | - Shannon M Nugent
- VA Portland Health Care System Evidence Synthesis Program, United States of America
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Naviaux RK, Naviaux JC, Li K, Wang L, Monk JM, Bright AT, Koslik HJ, Ritchie JB, Golomb BA. Metabolic features of Gulf War illness. PLoS One 2019; 14:e0219531. [PMID: 31348786 PMCID: PMC6660083 DOI: 10.1371/journal.pone.0219531] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 06/27/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND More than 230,000 veterans-about 1/3 of US personnel deployed in the 1990-1991 Persian Gulf War-developed chronic, multi-symptom health problems now called "Gulf War illness" (GWI), for which mechanisms and objective diagnostic signatures continue to be sought. METHODS Targeted, broad-spectrum serum metabolomics was used to gain insights into the biology of GWI. 40 male participants, included 20 veterans who met both Kansas and CDC diagnostic criteria for GWI and 20 nonveteran controls without similar symptoms that were 1:1 matched to GWI cases by age, sex, and ethnicity. Serum samples were collected and archived at -80° C prior to testing. 358 metabolites from 46 biochemical pathways were measured by hydrophilic interaction liquid chromatography and tandem mass spectrometry. RESULTS Veterans with GWI, compared to healthy controls, had abnormalities in 8 of 46 biochemical pathways interrogated. Lipid abnormalities accounted for 78% of the metabolic impact. Fifteen ceramides and sphingomyelins, and four phosphatidylcholine lipids were increased. Five of the 8 pathways were shared with the previously reported metabolic phenotype of males with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). However, 4 of the 5 shared pathways were regulated in opposite directions; key pathways that were up-regulated in GWI were down-regulated in ME/CFS. The single pathway regulated in the same direction was purines, which were decreased. CONCLUSIONS Our data show that despite heterogeneous exposure histories, a metabolic phenotype of GWI was clearly distinguished from controls. Metabolomic differences between GWI and ME/CFS show that common clinical symptoms like fatigue can have different chemical mechanisms and different diagnostic implications. Larger studies will be needed to validate these findings.
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Affiliation(s)
- Robert K. Naviaux
- The Mitochondrial and Metabolic Disease Center, University of California San Diego School of Medicine, San Diego, California, United States of America
- Department of Medicine, Division of Medical Genetics, University of California San Diego School of Medicine, San Diego, California, United States of America
- Department of Pediatrics, Division of Genetics, University of California San Diego School of Medicine, San Diego, California, United States of America
- Department of Pathology, Division of Comparative Pathology, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Jane C. Naviaux
- The Mitochondrial and Metabolic Disease Center, University of California San Diego School of Medicine, San Diego, California, United States of America
- Department of Neurosciences, Division of Pediatric Neurology, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Kefeng Li
- The Mitochondrial and Metabolic Disease Center, University of California San Diego School of Medicine, San Diego, California, United States of America
- Department of Medicine, Division of Medical Genetics, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Lin Wang
- The Mitochondrial and Metabolic Disease Center, University of California San Diego School of Medicine, San Diego, California, United States of America
- Department of Medicine, Division of Medical Genetics, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Jonathan M. Monk
- The Mitochondrial and Metabolic Disease Center, University of California San Diego School of Medicine, San Diego, California, United States of America
- Department of Medicine, Division of Medical Genetics, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - A. Taylor Bright
- The Mitochondrial and Metabolic Disease Center, University of California San Diego School of Medicine, San Diego, California, United States of America
- Department of Medicine, Division of Medical Genetics, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Hayley J. Koslik
- Department of Medicine, Division of General Internal Medicine, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Janis B. Ritchie
- Department of Medicine, Division of General Internal Medicine, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Beatrice A. Golomb
- Department of Medicine, Division of General Internal Medicine, University of California San Diego School of Medicine, San Diego, California, United States of America
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Golomb BA, Koslik HJ, Christians U, Ritchie J, Wilson P, Elkins N, Klawitter J, Klawitter J, Smith D, Repine JE. Depressed prostaglandins and leukotrienes in veterans with Gulf War illness. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART. B, PESTICIDES, FOOD CONTAMINANTS, AND AGRICULTURAL WASTES 2019; 54:623-639. [PMID: 31033394 DOI: 10.1080/03601234.2019.1596001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background: There is need to understand biological markers and mechanisms in Gulf War illness (GWI). Goal: To examine whether and how eicosanoids - prostaglandins and leukotrienes - are altered in veterans with GWI. Methods: Seventy participants including 37 GWI and 33 healthy controls, shared exposure information, and had plasma eicosanoids assessed - prostaglandin F2 alpha (pgf2α), prostaglandin D2 (pgd2), leukotriene B4 (lb4) among others. Values were compared for GWI versus controls. Eicosanoid intercorrelations were compared in cases vs. controls. For the most significantly altered eicosanoid in GWI, exposure and symptom relations were assessed. Results: Prostaglandins and leukotrienes were depressed in GWI, strongest for pgf2α, then lb4. Eicosanoid intercorrelations differed in GWI vs. controls. Fuel-solvent, pesticide, radioactive chemicals and metal exposures related negatively to pgf2α; as, in GWI, did chemical attack and vaccines. Multivariate predictors included fuels-solvents and radioactive chemicals (negative); tetanus vaccine and herbicides (positive). Fuels-solvents and radioactive chemicals predicted lower pgf2α in cases, controls, and all participants controlled for case status. Lower pgf2α related to GWI "Kansas criteria" domains of pain, respiratory, and (borderline significantly) skin symptoms. Conclusion: Multiple eicosanoids are depressed in GWI, particularly pgf2α and lb4. Prior fuel-solvent exposures, radioactive chemicals, and (in GWI cases) vaccines were linked to lower pgf2α.
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Affiliation(s)
| | - Hayley J Koslik
- Department of Medicine, University of California , San Diego, La Jolla , CA , USA
| | - Uwe Christians
- Department of Anesthesiology, University of Colorado , Aurora , CO , USA
| | - Janis Ritchie
- Department of Medicine, University of California , San Diego, La Jolla , CA , USA
| | - Paul Wilson
- Department of Medicine, University of Colorado , Aurora , CO , USA
| | - Nancy Elkins
- Department of Medicine, University of Colorado , Aurora , CO , USA
| | - Jelena Klawitter
- Department of Anesthesiology, University of Colorado , Aurora , CO , USA
| | - Jost Klawitter
- Department of Anesthesiology, University of Colorado , Aurora , CO , USA
| | - Dwight Smith
- Department of Chemistry and Biochemistry, University of Denver , Denver , CO , USA
| | - John E Repine
- Department of Medicine, University of Colorado , Aurora , CO , USA
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Petrescu AD, Grant S, Frampton G, McMillin M, Kain J, Kodali M, Shetty AK, DeMorrow S. Gulf war illness-related chemicals increase CD11b/c + monocyte infiltration into the liver and aggravate hepatic cholestasis in a rodent model. Sci Rep 2018; 8:13147. [PMID: 30177688 PMCID: PMC6120951 DOI: 10.1038/s41598-018-31599-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/16/2018] [Indexed: 12/25/2022] Open
Abstract
Gulf War Illness (GWI) is a chronic multisymptom disorder affecting veterans of the 1990-91 Gulf war. GWI was linked with exposure to chemicals including the nerve gas prophylactic drug pyridostigmine-bromide (PB) and pesticides (DEET, permethrin). Veterans with GWI exhibit prolonged, low-level systemic inflammation, though whether this impacts the liver is unknown. While no evidence exists that GWI-related chemicals are hepatotoxic, the prolonged inflammation may alter the liver's response to insults such as cholestatic injury. We assessed the effects of GWI-related chemicals on macrophage infiltration and its subsequent influence on hepatic cholestasis. Sprague Dawley rats were treated daily with PB, DEET and permethrin followed by 15 minutes of restraint stress for 28 days. Ten weeks afterward, GWI rats or naïve age-matched controls underwent bile duct ligation (BDL) or sham surgeries. Exposure to GWI-related chemicals alone increased IL-6, and CD11b+F4/80- macrophages in the liver, with no effect on biliary mass or hepatic fibrosis. However, pre-exposure to GWI-related chemicals enhanced biliary hyperplasia and fibrogenesis caused by BDL, compared to naïve rats undergoing the same surgery. These data suggest that GWI patients could be predisposed to developing worse liver pathology due to sustained low-level inflammation of the liver when compared to patients without GWI.
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Affiliation(s)
- Anca D Petrescu
- Department of Medical Physiology, Texas A&M College of Medicine, Temple, 76504, USA
- Central Texas Veterans Healthcare System, Temple, 76504, USA
| | - Stephanie Grant
- Department of Medical Physiology, Texas A&M College of Medicine, Temple, 76504, USA
- Central Texas Veterans Healthcare System, Temple, 76504, USA
| | - Gabriel Frampton
- Department of Medical Physiology, Texas A&M College of Medicine, Temple, 76504, USA
- Central Texas Veterans Healthcare System, Temple, 76504, USA
| | | | - Jessica Kain
- Department of Medical Physiology, Texas A&M College of Medicine, Temple, 76504, USA
| | - Maheedhar Kodali
- Central Texas Veterans Healthcare System, Temple, 76504, USA
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M College of Medicine, College Station, 77843, USA
| | - Ashok K Shetty
- Central Texas Veterans Healthcare System, Temple, 76504, USA
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M College of Medicine, College Station, 77843, USA
| | - Sharon DeMorrow
- Department of Medical Physiology, Texas A&M College of Medicine, Temple, 76504, USA.
- Central Texas Veterans Healthcare System, Temple, 76504, USA.
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10
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Falvo MJ, Chen Y, Klein JC, Ndirangu D, Condon MR. Abnormal rheological properties of red blood cells as a potential marker of Gulf War Illness: A preliminary study. Clin Hemorheol Microcirc 2018; 68:361-370. [DOI: 10.3233/ch-170262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michael J. Falvo
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
- New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Yang Chen
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
- New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Jacquelyn C. Klein
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
| | - Duncan Ndirangu
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
| | - Michael R. Condon
- New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
- Surgical Service, Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
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James LM, Christova P, Engdahl BE, Lewis SM, Carpenter AF, Georgopoulos AP. Human Leukocyte Antigen (HLA) and Gulf War Illness (GWI): HLA-DRB1*13:02 Spares Subcortical Atrophy in Gulf War Veterans. EBioMedicine 2017; 26:126-131. [PMID: 29137891 PMCID: PMC5832612 DOI: 10.1016/j.ebiom.2017.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 10/31/2017] [Accepted: 11/06/2017] [Indexed: 12/23/2022] Open
Abstract
Background Gulf War Illness (GWI) is a multisystem disorder that has affected a substantial number of veterans who served in the 1990–91 Gulf War. The brain is prominently affected, as manifested by the presence of neurological, cognitive and mood symptoms. We reported previously on the protective role of six Human Leukocyte Antigen (HLA) alleles in GWI (Georgopoulos et al., 2016) and their association with regional brain function (James et al., 2016). More recently, we reported on the presence of subcortical brain atrophy in GWI (Christova et al., 2017) and discussed its possible relation to immune mechanisms. Here we focused on one of the six HLA GWI-protective HLA alleles, DRB1*13:02, which has been found to have a protective role in a broad range of autoimmune diseases (Furukawa et al., 2017), and tested its effects on brain volumes. Methods Seventy-six Gulf War veterans (55 with GWI and 21 healthy controls) underwent a structural Magnetic Resonance Imaging (sMRI) scan to measure the volumes of 9 subcortical brain regions to assess differences between participants with (N = 11) and without (N = 65) HLA class II allele DRB1*13:02. Findings We found that DRB1*13:02 spared subcortical brain atrophy in Gulf War veterans; overall subcortical volume was 6.6% higher in carriers of DRB1*13:02 (P = 0.007). The strongest effect was observed in the volume of cerebellar gray matter which was 9.6% higher (P = 0.007) in carriers of DRB1*13:02 than in non-carriers. By contrast, DRB1*13:01 had no effect. Interpretation These findings document the protective effect of DRB1*13:02 on brain atrophy in Gulf War veterans and are in keeping with recent results documenting sharing of brain mechanisms between GWI and other immune-related diseases (Georgopoulos et al., 2017). We hypothesize that the protective role of DRB1*13:02 is due to its successful elimination of external antigens to which Gulf War veterans were exposed, antigens that otherwise would persist causing low-grade inflammation and possibly leading to autoimmunity. Funding source U.S. Department of Defense (W81XWH-15-1-0520), Department of Veterans Affairs, American Legion Brain Sciences Chair, and University of Minnesota. Subcortical brain atrophy is spared in Gulf War veterans with DRB1*13:02 allele and unaffected by the DRB1*13:01 allele. The strongest protective effect of the DRB1*13:02 allele was observed for cerebellar gray matter volume. No significant effects were observed at the DRB1*13 gene level, highlighting the importance of 4-digit HLA protein level.
Gulf War Illness (GWI) is a chronic, debilitating disorder that prominently involves the brain and is characterized, in particular, by subcortical brain atrophy. Protective effects of specific Human Leukocyte Antigen (HLA) Class II alleles on GWI have been observed, suggesting immune system involvement in GWI. Here we evaluated protective effects of DRB1*13:02 on subcortical brain volume in Gulf War veterans. The results demonstrate a protective effect of DRB1*13:02 on brain atrophy, with a marked effect on cerebellar gray matter volume. Given the goal of HLA Class II alleles is to eliminate pathogens by producing antibodies against them, the present study provides compelling insights into the likely role of persistent, pathogenic antigens resulting from the absence of DRB1*13:02 in those with GWI.
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Affiliation(s)
- Lisa M James
- Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN 5541, USA; Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN 55455, USA; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Peka Christova
- Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN 5541, USA; Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Brian E Engdahl
- Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN 5541, USA; Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN 55455, USA; Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Scott M Lewis
- Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN 5541, USA; Department of Neurology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Adam F Carpenter
- Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN 5541, USA; Department of Neurology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Apostolos P Georgopoulos
- Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN 5541, USA; Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN 55455, USA; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA; Department of Neurology, University of Minnesota Medical School, Minneapolis, MN 55455, USA.
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The effect of pravastatin on carotid artery thrombosis in rats under the stimulus of C-reactive protein. Thromb Res 2016; 144:213-4. [PMID: 27416543 DOI: 10.1016/j.thromres.2016.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 11/24/2022]
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Johnson GJ, Slater BCS, Leis LA, Rector TS, Bach RR. Blood Biomarkers of Chronic Inflammation in Gulf War Illness. PLoS One 2016; 11:e0157855. [PMID: 27352030 PMCID: PMC4924830 DOI: 10.1371/journal.pone.0157855] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/06/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND More than twenty years following the end of the 1990-1991 Gulf War it is estimated that approximately 300,000 veterans of this conflict suffer from an unexplained chronic, multi-system disorder known as Gulf War Illness (GWI). The etiology of GWI may be exposure to chemical toxins, but it remains only partially defined, and its case definition is based only on symptoms. Objective criteria for the diagnosis of GWI are urgently needed for diagnosis and therapeutic research. OBJECTIVE This study was designed to determine if blood biomarkers could provide objective criteria to assist diagnosis of GWI. DESIGN A surveillance study of 85 Gulf War Veteran volunteers identified from the Department of Veterans Affairs Minnesota Gulf War registry was performed. All subjects were deployed to the Gulf War. Fifty seven subjects had GWI defined by CDC criteria, and 28 did not have symptomatic criteria for a diagnosis of GWI. Statistical analyses were performed on peripheral blood counts and assays of 61 plasma proteins using the Mann-Whitney rank sum test to compare biomarker distributions and stepwise logistic regression to formulate a diagnostic model. RESULTS Lymphocyte, monocyte, neutrophil, and platelet counts were higher in GWI subjects. Six serum proteins associated with inflammation were significantly different in GWI subjects. A diagnostic model of three biomarkers-lymphocytes, monocytes, and C reactive protein-had a predicted probability of 90% (CI 76-90%) for diagnosing GWI when the probability of having GWI was above 70%. SIGNIFICANCE The results of the current study indicate that inflammation is a component of the pathobiology of GWI. Analysis of the data resulted in a model utilizing three readily measurable biomarkers that appears to significantly augment the symptom-based case definition of GWI. These new observations are highly relevant to the diagnosis of GWI, and to therapeutic trials.
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Affiliation(s)
- Gerhard J. Johnson
- Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, 55417, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, 55455, United States of America
| | - Billie C. S. Slater
- Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, 55417, United States of America
| | - Linda A. Leis
- Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, 55417, United States of America
| | - Thomas S. Rector
- Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, 55417, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, 55455, United States of America
| | - Ronald R. Bach
- Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, 55417, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, 55455, United States of America
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Georgopoulos AP, James LM, Mahan MY, Joseph J, Georgopoulos A, Engdahl BE. Reduced Human Leukocyte Antigen (HLA) Protection in Gulf War Illness (GWI). EBioMedicine 2015; 3:79-85. [PMID: 26870819 PMCID: PMC4739436 DOI: 10.1016/j.ebiom.2015.11.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/16/2015] [Accepted: 11/20/2015] [Indexed: 11/29/2022] Open
Abstract
Background Gulf War Illness (GWI) is a disease of unknown etiology with symptoms suggesting the involvement of an immune process. Here we tested the hypothesis that Human Leukocyte Antigen (HLA) composition might differ between veterans with and without GWI. Methods We identified 144 unique alleles of Class I and II HLA genes in 82 veterans (66 with and 16 without GWI). We tested the hypothesis that a subset of HLA alleles may classify veterans in their respective group using a stepwise linear discriminant analysis. In addition, each participant rated symptom severity in 6 domains according to established GWI criteria, and an overall symptom severity was calculated. Findings We found 6 Class II alleles that classified participants 84.1% correctly (13/16 control and 56/66 GWI). The number of copies of the 6 alleles was significantly higher in the control group, suggesting a protective role. This was supported by a significant negative dependence of overall symptom severity on the number of allele copies, such that symptom severity was lower in participants with larger numbers of allele copies. Interpretation These results indicate a reduced HLA protection (i.e. genetic susceptibility) in veterans with GWI. Funding University of Minnesota and U.S. Department of Veterans Affairs. Differences in Human Leukocyte Antigen distinguished veterans with Gulf War Illness (GWI) from healthy Gulf War era veterans. Veterans with GWI show genetic susceptibility which is associated with increased severity of hallmark symptoms of GWI.
A large number of Gulf War veterans suffer from diffuse and debilitating symptoms that resemble altered immune functioning. This study evaluated whether the Human Leukocyte Antigen (HLA) gene, which is central to immune functioning, differs between veterans with GWI and unaffected Gulf War veterans. The findings highlight robust differences in HLA composition between the two groups and suggest that veterans with GWI are characterized by genetic susceptibility that confers risk for typical GWI symptoms. These findings provide compelling genetic evidence of immune dysfunction in GWI.
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Affiliation(s)
- Apostolos P Georgopoulos
- Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN 55417, USA; Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN 55455, USA; Department of Neurology, University of Minnesota Medical School, Minneapolis, MN 55455, USA; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA; Center for Cognitive Sciences, University of Minnesota, Minneapolis, MN 55455, USA; Graduate Program in Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Lisa M James
- Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN 55417, USA; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA; Center for Cognitive Sciences, University of Minnesota, Minneapolis, MN 55455, USA
| | - Margaret Y Mahan
- Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN 55417, USA; Graduate Program in Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jasmine Joseph
- Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN 55417, USA; Graduate Program in Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Angeliki Georgopoulos
- Metabolic Service, Department of Medicine, Department of Veterans Affairs Health Care System, Minneapolis, MN 55417, USA; Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Brian E Engdahl
- Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN 55417, USA; Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN 55455, USA; Center for Cognitive Sciences, University of Minnesota, Minneapolis, MN 55455, USA; Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA
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Gulf War illnesses are autoimmune illnesses caused by increased activity of the p38/MAPK pathway in CD4+ immune system cells, which was caused by nerve agent prophylaxis and adrenergic load. Med Hypotheses 2013; 81:1002-3. [DOI: 10.1016/j.mehy.2013.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 07/19/2013] [Accepted: 09/08/2013] [Indexed: 12/17/2022]
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