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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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Ikin JF, Kelsall HL, McKenzie DP, Gwini SM, Forbes AB, Glass DC, Mc Farlane AC, Clarke D, Wright B, Del Monaco A, Sim MR. Cohort Profile: The Australian Gulf War Veterans' Health Study cohort. Int J Epidemiol 2017; 46:31. [PMID: 27380794 DOI: 10.1093/ije/dyw025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jillian F Ikin
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | - Helen L Kelsall
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | - Dean P McKenzie
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | - Stella M Gwini
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | - Andrew B Forbes
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | - Deborah C Glass
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | | | - David Clarke
- Monash University, School of Clinical Sciences at Monash Health: Psychiatry, Clayton, VIC, Australia
| | - Breanna Wright
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | - Anthony Del Monaco
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
| | - Malcolm R Sim
- Monash University, School of Public Health and Preventive Medicine, Centre for Occupational and Environmental Health, Clayton, VIC, Australia
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Gwini SM, Forbes AB, Sim MR, Kelsall HL. Comparability of health service use by veterans with multisymptom illness and those with chronic diseases. Int J Qual Health Care 2017; 29:90-97. [DOI: 10.1093/intqhc/mzw140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 01/04/2017] [Indexed: 11/12/2022] Open
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Gwini SM, Kelsall HL, Sim MR, Ikin JF, McFarlane AC, Forbes AB. Stability of symptom patterns in Australian Gulf War veterans: 10-year longitudinal study: Table 1. Occup Environ Med 2016; 73:195-8. [DOI: 10.1136/oemed-2015-103169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/30/2015] [Indexed: 11/03/2022]
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Gwini SM, Forbes AB, Kelsall HL, Ikin JF, Sim MR. Increased symptom reporting persists in 1990-1991 Gulf War veterans 20 years post deployment. Am J Ind Med 2015; 58:1246-54. [PMID: 26497120 DOI: 10.1002/ajim.22490] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Following the 1990-1991 Gulf War, Gulf War veterans (veterans) reported health symptoms more commonly than non-deployed groups. This article examines symptom persistence, incidence and prevalence 20 years on. METHODS In 2000-2003 and 2011-2012, a 63-item symptom checklist was administered to 697 veterans and 659 comparison group. Symptomatology was compared using log-binomial regression. RESULTS Both veterans and comparison group reported significantly increased prevalence (3-52%) over time in more than half the symptoms, with a similar overall rate of increase. Half the symptoms had higher incidence (risk-ratios ranged 1.43-1.50) and a quarter were more persistent (risk-ratios ranged 1.12-1.20) in veterans than the comparison group. CONCLUSIONS Symptomatology increased in both groups over time, but persisted to a similar extent and had higher incidence among veterans than the comparison group. The gap in symptom prevalence between the two groups remained unchanged. These findings suggest enduring health consequences of Gulf War service.
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Affiliation(s)
- Stella M. Gwini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Andrew B Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Helen L. Kelsall
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Jillian F. Ikin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Malcolm R. Sim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
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Amourette C, Lamproglou I, Barbier L, Fauquette W, Zoppe A, Viret R, Diserbo M. Gulf War illness: Effects of repeated stress and pyridostigmine treatment on blood–brain barrier permeability and cholinesterase activity in rat brain. Behav Brain Res 2009; 203:207-14. [DOI: 10.1016/j.bbr.2009.05.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 04/30/2009] [Accepted: 05/03/2009] [Indexed: 11/25/2022]
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Pattison JE, Hugtenburg RP, Green S. Enhancement of natural background gamma-radiation dose around uranium microparticles in the human body. J R Soc Interface 2009; 7:603-11. [PMID: 19776147 DOI: 10.1098/rsif.2009.0300] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Ongoing controversy surrounds the adverse health effects of the use of depleted uranium (DU) munitions. The biological effects of gamma-radiation arise from the direct or indirect interaction between secondary electrons and the DNA of living cells. The probability of the absorption of X-rays and gamma-rays with energies below about 200 keV by particles of high atomic number is proportional to the third to fourth power of the atomic number. In such a case, the more heavily ionizing low-energy recoil electrons are preferentially produced; these cause dose enhancement in the immediate vicinity of the particles. It has been claimed that upon exposure to naturally occurring background gamma-radiation, particles of DU in the human body would produce dose enhancement by a factor of 500-1000, thereby contributing a significant radiation dose in addition to the dose received from the inherent radioactivity of the DU. In this study, we used the Monte Carlo code EGSnrc to accurately estimate the likely maximum dose enhancement arising from the presence of micrometre-sized uranium particles in the body. We found that although the dose enhancement is significant, of the order of 1-10, it is considerably smaller than that suggested previously.
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Affiliation(s)
- John E Pattison
- School of EIE-Applied Physics, University of South Australia, South Australia, Australia.
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McKenzie D. Commentary on "coping with life-threatening events was associated with better self-perceived health in a naval cross-sectional study," by Nils Magerøy, Trond Riise, Bjørn H. Johnsen, and Bente E. Moen. J Psychosom Res 2008; 65:619-21. [PMID: 19027453 DOI: 10.1016/j.jpsychores.2008.07.014] [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: 06/09/2008] [Revised: 07/15/2008] [Accepted: 07/24/2008] [Indexed: 11/30/2022]
Affiliation(s)
- Dean McKenzie
- Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, Australia.
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Greenberg N, Wessely S. Gulf War syndrome: an emerging threat or a piece of history? EMERGING HEALTH THREATS JOURNAL 2008; 1:e10. [PMID: 22460210 PMCID: PMC3167584 DOI: 10.3134/ehtj.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 06/18/2008] [Accepted: 07/15/2008] [Indexed: 11/18/2022]
Abstract
‘Gulf War syndrome’ is a phrase coined after the 1991 Gulf War to group together disparate, unexplained health symptoms in Gulf veterans. This paper examines the many hypotheses that have been put forward about the origins of the concept and gives an overview of the studies that have attempted to explain the lasting health effects associated with Gulf service. Our review finds that although in the UK there has not yet been evidence of a new Gulf War syndrome as a result of the current conflicts in Iraq and Afghanistan, there is a rise in post-conflict psychiatric disorders now being reported in the USA. We postulate that after conflicts military personnel will always face some form of post-conflict syndrome and the nature of the threats experienced is likely to dictate the form the syndrome might take. We also postulate that media reporting is likely to have influenced and to continue unhelpfully to influence the health of service personnel.
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Affiliation(s)
- N Greenberg
- King's College London, Department of Academic Psychological Medicine, Academic Centre for Defence Mental Health, London, UK
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McFarlane AC, Ellis N, Barton C, Browne D, Van Hooff M. The Conundrum of Medically Unexplained Symptoms: Questions to Consider. PSYCHOSOMATICS 2008; 49:369-77. [DOI: 10.1176/appi.psy.49.5.369] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Greenberg N, Wessely S. Gulf War syndrome: an emerging threat or a piece of history? EMERGING HEALTH THREATS JOURNAL 2008. [DOI: 10.3402/ehtj.v1i0.7071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- N Greenberg
- King’s College London, Department of Academic Psychological Medicine, Academic Centre for Defence Mental Health, London, UK
| | - S Wessely
- King’s College London, Department of Academic Psychological Medicine, Academic Centre for Defence Mental Health, London, UK
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Hooper TI, Debakey SF, Nagaraj BE, Bellis KS, Smith B, Smith TC, Gackstetter GD. The long-term hospitalization experience following military service in the 1991 Gulf War among veterans remaining on active duty, 1994-2004. BMC Public Health 2008; 8:60. [PMID: 18271971 PMCID: PMC2263030 DOI: 10.1186/1471-2458-8-60] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 02/13/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite more than a decade of extensive, international efforts to characterize and understand the increased symptom and illness-reporting among veterans of the 1991 Gulf War, concern over possible long-term health effects related to this deployment continue. The purpose of this study was to describe the long-term hospitalization experience of the subset of U.S. Gulf War veterans still on active duty between 1994 and 2004. METHODS Gulf War veterans on active duty rosters as of October 1, 1994, were identified (n = 211 642) and compared with veterans who had separated from military service and then assessed for attrition at three-year intervals during a 10-year follow-up period, examining demographic and military service characteristics, Gulf War exposure variables, and hospitalization data. Cox proportional hazard modeling was used to evaluate independent predictors of all-cause hospitalization among those still on active duty and to estimate cumulative probability of hospitalization, 1994-2004, by service branch. RESULTS Members of our 1994 active duty cohort were more likely to be officers, somewhat older, and married compared with those who had separated from the military after serving in the 1991 Gulf War. Selected war-related exposures or experiences did not appear to influence separation with the exception of in-theater presence during the brief ground combat phase. Overall the top three diagnostic categories for hospitalizations were musculo-skeletal, injury and poisoning, and digestive disorders. Diseases of the circulatory system and symptoms, signs, and ill-defined conditions increased proportionately over time. In-theater hospitalization was the only significant independent predictor of long-term hospitalization risk among selected war-related exposures or experiences examined. The cumulative probability of hospitalization was highest for Army and lowest for Marines. CONCLUSION Our results were generally consistent with a previous hospitalization study of US Gulf War veterans for the period August 1991 to July 1999. Although lack of a comparison group for our study limits interpretation of overall findings, intra-cohort analyses showed no significant associations between long-term hospitalization and war-related exposures or experiences, with the exception of in-theater hospitalization, within our active duty subset of 1991 Gulf War veterans.
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Affiliation(s)
- Tomoko I Hooper
- Department of Preventive Medicine and Biometrics, Uniformed Service University of the Health Sciences, Bethesda, Maryland, USA.
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