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Krengel M, Keating D, Chao L, Dugas J, Koo B, Heeren T, Quinn E, Toomey R, Steele L, Klimas N, Samonte F, Abdullah L, Sullivan K. Characterizing 1991 Gulf War women veterans from the Boston Biorepository and Integrative Network for Gulf War Illness: demographics, exposures, neuroimaging and cognitive outcomes. Clin Neuropsychol 2024:1-14. [PMID: 38692856 DOI: 10.1080/13854046.2024.2344263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/13/2024] [Indexed: 05/03/2024]
Abstract
Objective: Gulf War Illness (GWI) is a debilitating multisymptom condition that affects nearly a third of 1990-91 Gulf War (GW) veterans. Symptoms include pain, fatigue, gastrointestinal issues, and cognitive decrements. Our work has shown that GWI rates and potential causes for symptoms vary between men and women veterans. Studies have documented neuropsychological and neuroimaging findings mostly in men or combined sex datasets. Data are lacking for women veterans due to lack of power and repositories of women veteran samples. Methods: We characterized GW women veterans in terms of demographics, exposures, neuropsychological and neuroimaging outcomes from the newly collated Boston, Biorepository and Integrative Network (BBRAIN) for GWI. Results: BBRAIN women veterans are highly educated with an average age of 54 years. 81% met GWI criteria, 25% met criteria for current PTSD, 78% were white, and 81% served in the Army. Exposure to combined acetylcholinesterase inhibitors (AChEi) including skin pesticides, fogs/sprays and/or pyridostigmine bromide (PB) anti-nerve gas pill exposure resulted in slower processing speed on attentional tasks and a trend for executive impairment compared with non-exposed women. Brain imaging outcomes showed lower gray matter volumes and smaller caudate in exposed women. Conclusions: Although subtle and limited findings were present in this group of women veterans, it suggests that continued follow-up of GW women veterans is warranted. Future research should continue to evaluate differences between men and women in GW veteran samples. The BBRAIN women sub-repository is recruiting and these data are available to the research community for studies of women veterans.
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Affiliation(s)
- Maxine Krengel
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Dylan Keating
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Linda Chao
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA, USA
| | - Julianne Dugas
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - BangBon Koo
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Emily Quinn
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Rosemary Toomey
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, Boston, MA, USA
| | - Lea Steele
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine Neuropsychiatry Division, Houston, TX, USA
| | - Nancy Klimas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
- Geriatric Research Education and Clinical Center, Miami VA Medical Center, Miami, FL, USA
| | - Francis Samonte
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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Tamariz L, Bast E, Klimas N, Palacio A. Low-dose Naltrexone Improves post-COVID-19 condition Symptoms. Clin Ther 2024; 46:e101-e106. [PMID: 38267326 DOI: 10.1016/j.clinthera.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/29/2023] [Accepted: 12/24/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE Treatments for myalgic encephalomyelitis and chronic fatigue syndrome can be adapted for post-COVID-19 condition. Our aim was to compare treatments in patients from our post-COVID-19 clinic. METHODS We conducted a retrospective cohort study and included consecutive patients enrolled in our post-COVID-19 clinic. We included patients who received low-dose naltrexone, amitriptyline, duloxetine, and physical therapy, and evaluated improvements in fatigue, pain, dyspnea, and brain fog recorded in the electronic health record. We calculated the adjusted relative hazard of improvement using Cox proportional models. We adjusted for demographic characteristics, comorbidities, and prior COVID-19 hospitalization. FINDINGS We included the first 108 patients with post-COVID-19 enrolled in the clinic. Most of the patients received amitriptyline. The relative hazard of improvement for those taking low-dose naltrexone was 5.04 (95% CI, 1.22-20.77; P = 0.02) compared with physical therapy alone. Both fatigue and pain were improved in patients taking low-dose naltrexone; only fatigue was improved in patients taking amitriptyline. IMPLICATIONS Post-COVID-19 condition symptoms may improve in patients taking medications adapted from myalgic encephalomyelitis and chronic fatigue syndrome. Randomized controlled trials should evaluate these medications and translational studies should further evaluate their mechanisms of action.
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Affiliation(s)
- Leonardo Tamariz
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Miami, Florida; Department of Public Health Sciences, University of MIami, Miami, Florida.
| | - Elizabeth Bast
- Department of Ambulatory Medicine, Veterans Affairs Medical Center, Miami, Florida
| | - Nancy Klimas
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Miami, Florida; Institute for Neuro Immune Medicine, Dr. Kiran Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, Florida
| | - Ana Palacio
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Miami, Florida; Department of Public Health Sciences, University of MIami, Miami, Florida
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Gil A, Hoag GE, Salerno JP, Hornig M, Klimas N, Selin LK. Identification of CD8 T-cell dysfunction associated with symptoms in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long COVID and treatment with a nebulized antioxidant/anti-pathogen agent in a retrospective case series. Brain Behav Immun Health 2024; 36:100720. [PMID: 38327880 PMCID: PMC10847863 DOI: 10.1016/j.bbih.2023.100720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Background Patients with post-acute sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection (PASC, i.e., Long COVID) have a symptom complex highly analogous to many features of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), suggesting they may share some aspects of pathogenesis in these similar disorders. ME/CFS is a complex disease affecting numerous organ systems and biological processes and is often preceded by an infection-like episode. It is postulated that the chronic manifestations of illness may result from an altered host response to infection or inability to resolve inflammation, as is being reported in Long COVID. The immunopathogenesis of both disorders is still poorly understood. Here, we show data that suggest Long COVID and ME/CFS may be due to an aberrant response to an immunological trigger-like infection, resulting in a dysregulated immune system with CD8 T-cell dysfunction reminiscent of some aspects of T-cell clonal exhaustion, a phenomenon associated with oxidative stress. As there is an urgent need for diagnostic tools and treatment strategies for these two related disabling disorders, here, in a retrospective case series, we have also identified a potential nebulized antioxidant/anti-pathogen treatment that has evidence of a good safety profile. This nebulized agent is comprised of five ingredients previously reported individually to relieve oxidative stress, attenuate NF-κB signaling, and/or to act directly to inhibit pathogens, including viruses. Administration of this treatment by nebulizer results in rapid access of small doses of well-studied antioxidants and agents with anti-pathogen potential to the lungs; components of this nebulized agent are also likely to be distributed systemically, with potential to enter the central nervous system. Methods and Findings: We conducted an analysis of CD8 T-cell function and severity of symptoms by self-report questionnaires in ME/CFS, Long COVID and healthy controls. We developed a CD8 T-cell functional assay, assessing CD8 T-cell dysfunction by intracellular cytokine staining (ICS) in a group of ME/CFS (n = 12) and Long COVID patients (n = 8), comparing to healthy controls (HC) with similar age and sex (n = 10). Magnet-enriched fresh CD8 T-cells in both patient groups had a significantly diminished capacity to produce both cytokines, IFNγ or TNFα, after PMA stimulation when compared to HC. The symptom severity questionnaire showed similar symptom profiles for the two disorders. Fortuitously, through a retrospective case series, we were able to examine the ICS and questionnaire data of 4 ME/CFS and 4 Long COVID patients in conjunction with their treatment (3-15 months). In parallel with the treatment pursued electively by participants in this retrospective case series, there was an increase in CD8 T-cell IFNγ and TNFα production and a decrease in overall self-reported symptom severity score by 54%. No serious treatment-associated side effects or laboratory anomalies were noted in these patients. Conclusions Here, in this small study, we present two observations that appear potentially fundamental to the pathogenesis and treatment of Long COVID and ME/CFS. The first is that both disorders appear to be characterized by dysfunctional CD8 T-cells with severe deficiencies in their abilities to produce IFNγ and TNFα. The second is that in a small retrospective Long COVID and ME/CFS case series, this immune dysfunction and patient health improved in parallel with treatment with an immunomodulatory, antioxidant pharmacological treatment with anticipated anti-pathogen activity. This work provides evidence of the potential utility of a biomarker, CD8 T-cell dysfunction, and suggests the potential for benefit from a new nebulized antioxidant/anti-pathogen treatment. These immune biomarker data may help build capacity for improved diagnosis and tracking of treatment outcomes during clinical trials for both Long COVID and ME/CFS while providing clues to new treatment avenues that suggest potential efficacy for both conditions.
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Affiliation(s)
- Anna Gil
- University of Massachusetts Chan Medical School, Department of Pathology, Worcester, MA, USA
| | | | - John P. Salerno
- Inspiritol, Inc., Fairfield, CT, USA
- The Salerno Center for Complementary Medicine, New York, USA
| | - Mady Hornig
- Columbia University Mailman School of Public Health, New York, USA
| | - Nancy Klimas
- Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Liisa K. Selin
- University of Massachusetts Chan Medical School, Department of Pathology, Worcester, MA, USA
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May M, Milrad SF, Perdomo DM, Czaja SJ, Jutagir DR, Hall DL, Klimas N, Antoni MH. Videoconference-delivered group Cognitive Behavioral Stress Management for ME/CFS patients who present with severe PEM: A randomized controlled trial. Fatigue 2024; 12:101-122. [PMID: 38736736 PMCID: PMC11086677 DOI: 10.1080/21641846.2024.2306801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/15/2024] [Indexed: 05/14/2024]
Abstract
Background In Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), post-exertional malaise (PEM) is associated with greater distress and symptoms. Cognitive Behavioral Stress Management (CBSM) has demonstrated beneficial effects for ME/CFS and may mitigate stress-related triggers of PEM. We tested a virtual CBSM intervention to increase access, and we report on its effects on stress and symptoms in ME/CFS patients with severe PEM. Methods Data were from a randomized controlled trial (NCT01650636) comparing 10-week videoconference-delivered group CBSM (V-CBSM, n=75) to a 10-week Health Information active control (V-HI, n=75) in Fukuda criteria ME/CFS patients (71 classified as highPEM, 79 lowPEM). Linear regression explored PEM-by-Treatment interactions on overall symptom frequency and intensity, perceived stress, and fatigue-specific interference and intensity, at 5-month follow-up. Logistic regression tested V-CBSM effects on 5-month PEM status. Analyses controlled for age, gender, race/ethnicity, mode of symptom onset, and time since diagnosis. Results The sample was middle-aged (47.96±10.89 years), mostly women (87%) and non-Hispanic White (65%), with no group differences on these variables or baseline PEM. For highPEM patients, V-CBSM (versus V-HI) demonstrated medium to large effects on follow-up symptom frequency, symptom intensity, fatigue interference, and fatigue intensity (p's < .05) and trending to significant reductions in perceived stress (p =.07). Differences were not evident for lowPEM patients. Treatment predicted follow-up PEM status at a trend (p = .058), with patients receiving V-CBSM demonstrating half the risk of highPEM classification versus V-HI. Conclusions V-CBSM demonstrates benefits for ME/CFS patients presenting with severe PEM and may reduce the expression of PEM over time.
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Affiliation(s)
| | | | | | | | | | | | - Nancy Klimas
- Nova Southeastern University, Miami VA Medical Center
Geriatric Research Education and Clinical Center
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Sultana E, Shastry N, Kasarla R, Hardy J, Collado F, Aenlle K, Abreu M, Sisson E, Sullivan K, Klimas N, Craddock TJA. Disentangling the effects of PTSD from Gulf War Illness in male veterans via a systems-wide analysis of immune cell, cytokine, and symptom measures. Mil Med Res 2024; 11:2. [PMID: 38167090 PMCID: PMC10759613 DOI: 10.1186/s40779-023-00505-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND One-third of veterans returning from the 1990-1991 Gulf War reported a myriad of symptoms including cognitive dysfunction, skin rashes, musculoskeletal discomfort, and fatigue. This symptom cluster is now referred to as Gulf War Illness (GWI). As the underlying mechanisms of GWI have yet to be fully elucidated, diagnosis and treatment are based on symptomatic presentation. One confounding factor tied to the illness is the high presence of post-traumatic stress disorder (PTSD). Previous research efforts have demonstrated that both GWI and PTSD are associated with immunological dysfunction. As such, this research endeavor aimed to provide insight into the complex relationship between GWI symptoms, cytokine presence, and immune cell populations to pinpoint the impact of PTSD on these measures in GWI. METHODS Symptom measures were gathered through the Multidimensional fatigue inventory (MFI) and 36-item short form health survey (SF-36) scales and biological measures were obtained through cytokine & cytometry analysis. Subgrouping was conducted using Davidson Trauma Scale scores and the Structured Clinical Interview for Diagnostic and statistical manual of mental disorders (DSM)-5, into GWI with high probability of PTSD symptoms (GWIH) and GWI with low probability of PTSD symptoms (GWIL). Data was analyzed using Analysis of variance (ANOVA) statistical analysis along with correlation graph analysis. We mapped correlations between immune cells and cytokine signaling measures, hormones and GWI symptom measures to identify patterns in regulation between the GWIH, GWIL, and healthy control groups. RESULTS GWI with comorbid PTSD symptoms resulted in poorer health outcomes compared with both Healthy control (HC) and the GWIL subgroup. Significant differences were found in basophil levels of GWI compared with HC at peak exercise regardless of PTSD symptom comorbidity (ANOVA F = 4.7, P = 0.01,) indicating its potential usage as a biomarker for general GWI from control. While the unique identification of GWI with PTSD symptoms was less clear, the GWIL subgroup was found to be delineated from both GWIH and HC on measures of IL-15 across an exercise challenge (ANOVA F > 3.75, P < 0.03). Additional differences in natural killer (NK) cell numbers and function highlight IL-15 as a potential biomarker of GWI in the absence of PTSD symptoms. CONCLUSION We conclude that disentangling GWI and PTSD by defining trauma-based subgroups may aid in the identification of unique GWI biosignatures that can help to improve diagnosis and target treatment of GWI more effectively.
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Affiliation(s)
- Esha Sultana
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
| | - Nandan Shastry
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
| | - Rishabh Kasarla
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
| | - Jacob Hardy
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
| | - Fanny Collado
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Miami Veterans Affairs Medical Center, Miami, FL, 33125, USA
| | - Kristina Aenlle
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Miami Veterans Affairs Medical Center, Miami, FL, 33125, USA
| | - Maria Abreu
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Miami Veterans Affairs Medical Center, Miami, FL, 33125, USA
| | - Emily Sisson
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Miami Veterans Affairs Medical Center, Miami, FL, 33125, USA
| | - Travis J A Craddock
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA.
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA.
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA.
- Department of Computer Science, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA.
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Sanchez V, Kim C, Locatelli EV, Cohen A, Cabrera K, Aenlle K, Klimas N, O’Brien R, Galor A. Dry eye symptoms and signs in United States Gulf War era veterans with myalgic encephalomyelitis/chronic fatigue syndrome. Clin Exp Ophthalmol 2024; 52:10-21. [PMID: 37953685 PMCID: PMC10873051 DOI: 10.1111/ceo.14313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND To examine ocular symptoms and signs of veterans with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) diagnosis, ME/CFS symptoms, and controls. METHODS This was a prospective, cross-sectional study of 124 South Florida veterans in active duty during the Gulf War era. Participants were recruited at an ophthalmology clinic at the Miami Veterans Affairs Hospital and evaluated for a diagnosis of ME/CFS, or symptoms of ME/CFS (intermediate fatigue, IF) using the Canadian Consensus criteria. Ocular symptoms were assessed via standardised questionnaires and signs via comprehensive slit lamp examination. Inflammatory blood markers were analysed and compared across groups. RESULTS Mean age was 55.1 ± 4.7 years, 88.7% identified as male, 58.1% as White, and 39.5% as Hispanic. Ocular symptoms were more severe in the ME/CFS (n = 32) and IF (n = 48) groups compared to controls (n = 44) across dry eye (DE; Ocular Surface Disease Index [OSDI]: 48.9 ± 22.3 vs. 38.8 ± 23.3 vs. 19.1 ± 17.8, p < 0.001; 5 item Dry Eye Questionnaire [DEQ-5]: 10.8 ± 3.9 vs. 10.0 ± 4.6 vs. 6.6 ± 4.2, p < 0.001) and pain-specific questionnaires (Numerical Rating Scale 1-10 [NRS] right now: 2.4 ± 2.8 vs. 2.4 ± 2.9 vs 0.9 ± 1.5; p = 0.007; Neuropathic Pain Symptom Inventory modified for the Eye [NPSI-E]: 23.0 ± 18.6 vs. 19.8 ± 19.1 vs. 6.5 ± 9.0, p < 0.001). Ocular surface parameters and blood markers of inflammation were generally similar across groups. CONCLUSION Individuals with ME/CFS report increased ocular pain but similar DE signs, suggesting that mechanisms beyond the ocular surface contribute to symptoms.
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Affiliation(s)
- Victor Sanchez
- New York University Grossman School of Medicine, New York, New York, USA
| | - Colin Kim
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | | - Kimberly Cabrera
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, Florida, USA
| | - Kristina Aenlle
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, Florida, USA
- Institute for Neuro-Immune Medicine, K. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, K. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
- Miami Veterans Affairs Center for Geriatric Research and Clinical Care Center, Miami, Florida, USA
| | - Robert O’Brien
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Anat Galor
- Miami Veterans Affairs Center for Geriatric Research and Clinical Care Center, Miami, Florida, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
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Keating D, Krengel M, Dugas J, Toomey R, Chao L, Steele L, Janulewicz LP, Heeren T, Quinn E, Klimas N, Sullivan K. Cognitive decrements in 1991 Gulf War veterans: associations with Gulf War illness and neurotoxicant exposures in the Boston Biorepository, Recruitment, and Integrative Network (BBRAIN) cohorts. Environ Health 2023; 22:68. [PMID: 37794452 PMCID: PMC10548744 DOI: 10.1186/s12940-023-01018-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND During deployment, veterans of the 1991 Gulf War (GW) were exposed to multiple war-related toxicants. Roughly a third of these veterans continue to exhibit neurotoxicant induced symptoms of Gulf War Illness (GWI), a multi-faceted condition that includes fatigue, pain and cognitive decrements. When studied empirically, both deployed veterans with exposures and those who meet the criteria for GWI are more likely to show deficits in the area of neuropsychological functioning. Although studies have shown cognitive impairments in small sample sizes, it is necessary to revisit these findings with larger samples and newer cohorts to see if other areas of deficit emerge with more power to detect such differences. A group of researchers and clinicians with expertise in the area of GWI have identified common data elements (CDE) for use in research samples to compare data sets. At the same time, a subgroup of researchers created a new repository to share these cognitive data and biospecimens within the GWI research community. METHODS The present study aimed to compare cognitive measures of attention, executive functioning, and verbal memory in a large sample of GWI cases and healthy GW veteran controls using neuropsychological tests recommended in the CDEs. We additionally subdivided samples based on the specific neurotoxicant exposures related to cognitive deficits and compared exposed versus non-exposed veterans regardless of case criteria status. The total sample utilized cognitive testing outcomes from the newly collated Boston, Biorepository, Recruitment, and Integrative Network (BBRAIN) for GWI. RESULTS Participants included 411 GW veterans, 312 GWI (cases) and 99 healthy veterans (controls). Veterans with GWI showed significantly poorer attention, executive functioning, learning, and short-and-long term verbal memory than those without GWI. Further, GW veterans with exposures to acetylcholinesterase inhibiting pesticides and nerve gas agents, had worse performance on executive function tasks. Veterans with exposure to oil well fires had worse performance on verbal memory and those with pyridostigmine bromide anti-nerve gas pill exposures had better verbal memory and worse performance on an attention task compared to unexposed veterans. CONCLUSIONS This study replicates prior results regarding the utility of the currently recommended CDEs in determining impairments in cognitive functioning in veterans with GWI in a new widely-available repository cohort and provides further evidence of cognitive decrements in GW veterans related to war-related neurotoxicant exposures.
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Affiliation(s)
- D Keating
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, T4W, Boston, MA, 02118, USA
| | - M Krengel
- Department of Neurology, Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA
| | - J Dugas
- Department of Biostatistics, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - R Toomey
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, 900 Commonwealth Ave, Boston, MA, USA
| | - L Chao
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA, 94143, USA
| | - L Steele
- Baylor College of Medicine Neuropsychiatry Division, Department of Psychiatry and Behavioral Sciences, Houston, TX, 77030, USA
| | - Lloyd P Janulewicz
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, T4W, Boston, MA, 02118, USA
| | - T Heeren
- Department of Biostatistics, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - E Quinn
- Department of Biostatistics, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - N Klimas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL, 33314, USA
- Geriatric Research Education and Clinical Center, Miami VA Medical Center, Miami, FL, 33125, USA
| | - K Sullivan
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, T4W, Boston, MA, 02118, USA.
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8
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Raizen DM, Mullington J, Anaclet C, Clarke G, Critchley H, Dantzer R, Davis R, Drew KL, Fessel J, Fuller PM, Gibson EM, Harrington M, Ian Lipkin W, Klerman EB, Klimas N, Komaroff AL, Koroshetz W, Krupp L, Kuppuswamy A, Lasselin J, Lewis LD, Magistretti PJ, Matos HY, Miaskowski C, Miller AH, Nath A, Nedergaard M, Opp MR, Ritchie MD, Rogulja D, Rolls A, Salamone JD, Saper C, Whittemore V, Wylie G, Younger J, Zee PC, Craig Heller H. Beyond the symptom: the biology of fatigue. Sleep 2023; 46:zsad069. [PMID: 37224457 PMCID: PMC10485572 DOI: 10.1093/sleep/zsad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/24/2023] [Indexed: 05/26/2023] Open
Abstract
A workshop titled "Beyond the Symptom: The Biology of Fatigue" was held virtually September 27-28, 2021. It was jointly organized by the Sleep Research Society and the Neurobiology of Fatigue Working Group of the NIH Blueprint Neuroscience Research Program. For access to the presentations and video recordings, see: https://neuroscienceblueprint.nih.gov/about/event/beyond-symptom-biology-fatigue. The goals of this workshop were to bring together clinicians and scientists who use a variety of research approaches to understand fatigue in multiple conditions and to identify key gaps in our understanding of the biology of fatigue. This workshop summary distills key issues discussed in this workshop and provides a list of promising directions for future research on this topic. We do not attempt to provide a comprehensive review of the state of our understanding of fatigue, nor to provide a comprehensive reprise of the many excellent presentations. Rather, our goal is to highlight key advances and to focus on questions and future approaches to answering them.
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Affiliation(s)
- David M Raizen
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Janet Mullington
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Christelle Anaclet
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Gerard Clarke
- Department of Psychiatry and Neurobehavioural Science, and APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Hugo Critchley
- Brighton and Sussex Medical School Department of Neuroscience, University of Sussex, Brighton, UK
| | - Robert Dantzer
- Department of Symptom Research, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ronald Davis
- Department of Biochemistry and Genetics, Stanford University, Palo Alto, CA, USA
| | - Kelly L Drew
- Department of Chemistry and Biochemistry, Institute of Arctic Biology, Center for Transformative Research in Metabolism, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Josh Fessel
- Division of Clinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Patrick M Fuller
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Erin M Gibson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Mary Harrington
- Department of Psychology, Neuroscience Program, Smith College, Northampton, MA, USA
| | - W Ian Lipkin
- Center for Infection and Immunity, and Departments of Neurology and Pathology, Columbia University, New York City, NY, USA
| | - Elizabeth B Klerman
- Division of Sleep Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Nancy Klimas
- Department of Clinical Immunology, College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Anthony L Komaroff
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Walter Koroshetz
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Lauren Krupp
- Department of Neurology, NYU Grossman School of Medicine, NYC, NY, USA
| | - Anna Kuppuswamy
- University College London, Queen Square Institute of Neurology, London, England
| | - Julie Lasselin
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Laura D Lewis
- Center for Systems Neuroscience, Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Pierre J Magistretti
- Biological and Environmental Science and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Kingdom of Saudi Arabia
| | - Heidi Y Matos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Andrew H Miller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Avindra Nath
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Maiken Nedergaard
- Departments of Neurology and Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Mark R Opp
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Marylyn D Ritchie
- Department of Genetics, Institute for Biomedical Informatics, Penn Center for Precision Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dragana Rogulja
- Department of Neurobiology, Harvard University, Boston, MA, USA
| | - Asya Rolls
- Rappaport Institute for Medical Research, Technion, Israel Institute of Technology, Haifa, Israel
| | - John D Salamone
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Clifford Saper
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Vicky Whittemore
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Glenn Wylie
- Rocco Ortenzio Neuroimaging Center at Kessler Foundation, East Hanover, NJ, USA
| | - Jarred Younger
- Department of Psychology, University of Alabama, Birmingham, Birmingham, AL, USA
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - H Craig Heller
- Department of Biology, Stanford University and Sleep Research Society, Stanford, CA, USA
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9
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Abdullah L, Nkiliza A, Niedospial D, Aldrich G, Bartenfelder G, Keegan A, Hoffmann M, Mullan M, Klimas N, Baraniuk J, Crawford F, Krengel M, Chao L, Sullivan K. Genetic association between the APOE ε4 allele, toxicant exposures and Gulf war illness diagnosis. Environ Health 2023; 22:51. [PMID: 37415220 PMCID: PMC10324249 DOI: 10.1186/s12940-023-01002-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Exposure to nerve agents, pyridostigmine bromide (PB), pesticides, and oil-well fires during the 1991 Gulf War (GW) are major contributors to the etiology of Gulf War Illness (GWI). Since the apolipoprotein E (APOE) ε4 allele is associated with the risk of cognitive decline with age, particularly in the presence of environmental exposures, and cognitive impairment is one of the most common symptoms experienced by veterans with GWI, we examined whether the ε4 allele was associated with GWI. METHODS Using a case-control design, we obtained data on APOE genotypes, demographics, and self-reported GW exposures and symptoms that were deposited in the Boston Biorepository and Integrative Network (BBRAIN) for veterans diagnosed with GWI (n = 220) and healthy GW control veterans (n = 131). Diagnosis of GWI was performed using the Kansas and/or Center for Disease Control (CDC) criteria. RESULTS Age- and sex-adjusted analyses showed a significantly higher odds ratio for meeting the GWI case criteria in the presence of the ε4 allele (Odds ratio [OR] = 1.84, 95% confidence interval [CI = 1.07-3.15], p ≤ 0.05) and with two copies of the ε4 allele (OR = 1.99, 95% CI [1.23-3.21], p ≤ 0.01). Combined exposure to pesticides and PB pills (OR = 4.10 [2.12-7.91], p ≤ 0.05) as well as chemical alarms and PB pills (OR = 3.30 [1.56-6.97] p ≤ 0.05) during the war were also associated with a higher odds ratio for meeting GWI case criteria. There was also an interaction between the ε4 allele and exposure to oil well fires (OR = 2.46, 95% CI [1.07-5.62], p ≤ 0.05) among those who met the GWI case criteria. CONCLUSION These findings suggest that the presence of the ε4 allele was associated with meeting the GWI case criteria. Gulf War veterans who reported exposure to oil well fires and have an ε4 allele were more likely to meet GWI case criteria. Long-term surveillance of veterans with GWI, particularly those with oil well fire exposure, is required to better assess the future risk of cognitive decline among this vulnerable population.
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Affiliation(s)
- L Abdullah
- Roskamp Institute, Sarasota, FL, USA.
- James A. Haley VA Hospital, Tampa, FL, USA.
| | - A Nkiliza
- James A. Haley VA Hospital, Tampa, FL, USA
| | | | - G Aldrich
- Roskamp Institute, Sarasota, FL, USA
- James A. Haley VA Hospital, Tampa, FL, USA
| | | | - A Keegan
- Roskamp Institute, Sarasota, FL, USA
| | | | - M Mullan
- Roskamp Institute, Sarasota, FL, USA
| | - N Klimas
- Nova Southeastern University, Ft Lauderdale, FL, USA
- Miami VA Medical Center GRECC, Miami, FL, USA
| | - J Baraniuk
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - F Crawford
- Roskamp Institute, Sarasota, FL, USA
- James A. Haley VA Hospital, Tampa, FL, USA
| | - M Krengel
- Boston University School of Medicine, Boston, MA, USA
| | - L Chao
- University of California, San Francisco, CA, USA
| | - K Sullivan
- Boston University School of Public Health, Boston, MA, USA
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10
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Gamer J, Van Booven DJ, Zarnowski O, Arango S, Elias M, Kurian A, Joseph A, Perez M, Collado F, Klimas N, Oltra E, Nathanson L. Sex-Dependent Transcriptional Changes in Response to Stress in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Pilot Project. Int J Mol Sci 2023; 24:10255. [PMID: 37373402 DOI: 10.3390/ijms241210255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/23/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, multi-symptom illness characterized by debilitating fatigue and post-exertional malaise (PEM). Numerous studies have reported sex differences at the epidemiological, cellular, and molecular levels between male and female ME/CFS patients. To gain further insight into these sex-dependent changes, we evaluated differential gene expression by RNA-sequencing (RNA-Seq) in 33 ME/CFS patients (20 female, 13 male) and 34 matched healthy controls (20 female and 14 male) before, during, and after an exercise challenge intended to provoke PEM. Our findings revealed that pathways related to immune-cell signaling (including IL-12) and natural killer cell cytotoxicity were activated as a result of exertion in the male ME/CFS cohort, while female ME/CFS patients did not show significant enough changes in gene expression to meet the criteria for the differential expression. Functional analysis during recovery from an exercise challenge showed that male ME/CFS patients had distinct changes in the regulation of specific cytokine signals (including IL-1β). Meanwhile, female ME/CFS patients had significant alterations in gene networks related to cell stress, response to herpes viruses, and NF-κβ signaling. The functional pathways and differentially expressed genes highlighted in this pilot project provide insight into the sex-specific pathophysiology of ME/CFS.
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Affiliation(s)
- Jackson Gamer
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Derek J Van Booven
- Dr. J.P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Oskar Zarnowski
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Sebastian Arango
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Mark Elias
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Asha Kurian
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Andrew Joseph
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Melanie Perez
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Fanny Collado
- Department of Veterans Affairs, Miami VA Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Miami, FL 33125, USA
- South Florida Veterans Affairs Foundation for Research and Education Inc., Fort Lauderdale, FL 33125, USA
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
- Department of Veterans Affairs, Miami VA Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Miami, FL 33125, USA
- South Florida Veterans Affairs Foundation for Research and Education Inc., Fort Lauderdale, FL 33125, USA
| | - Elisa Oltra
- School Medicine, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain
| | - Lubov Nathanson
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
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11
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Van Booven DJ, Gamer J, Joseph A, Perez M, Zarnowski O, Pandya M, Collado F, Klimas N, Oltra E, Nathanson L. Stress-Induced Transcriptomic Changes in Females with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Reveal Disrupted Immune Signatures. Int J Mol Sci 2023; 24:2698. [PMID: 36769022 PMCID: PMC9916639 DOI: 10.3390/ijms24032698] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023] Open
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic, complex multi-organ illness characterized by unexplained debilitating fatigue and post-exertional malaise (PEM), which is defined as a worsening of symptoms following even minor physical or mental exertion. Our study aimed to evaluate transcriptomic changes in ME/CFS female patients undergoing an exercise challenge intended to precipitate PEM. Our time points (baseline before exercise challenge, the point of maximal exertion, and after an exercise challenge) allowed for the exploration of the transcriptomic response to exercise and recovery in female patients with ME/CFS, as compared to healthy controls (HCs). Under maximal exertion, ME/CFS patients did not show significant changes in gene expression, while HCs demonstrated altered functional gene networks related to signaling and integral functions of their immune cells. During the recovery period (commonly during onset of PEM), female ME/CFS patients showed dysregulated immune signaling pathways and dysfunctional cellular responses to stress. The unique functional pathways identified provide a foundation for future research efforts into the disease, as well as for potential targeted treatment options.
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Affiliation(s)
- Derek J. Van Booven
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Jackson Gamer
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Andrew Joseph
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Melanie Perez
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Oskar Zarnowski
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Meha Pandya
- Halmos College of Arts and Sciences, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
- Farquhar Honors College, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Fanny Collado
- Department of Veterans Affairs, Miami VA Healthcare System, Research Service, Miami, FL 33125, USA
- South Florida Veterans Affairs Foundation for Research and Education Inc., Fort Lauderdale, FL 33125, USA
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
- Department of Veterans Affairs, Miami VA Healthcare System, Research Service, Miami, FL 33125, USA
| | - Elisa Oltra
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain
| | - Lubov Nathanson
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
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12
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Jean-Pierre M, Michalovicz LT, Kelly KA, O'Callaghan JP, Nathanson L, Klimas N, J. A. Craddock T. A pilot reverse virtual screening study suggests toxic exposures caused long-term epigenetic changes in Gulf War Illness. Comput Struct Biotechnol J 2022; 20:6206-6213. [DOI: 10.1016/j.csbj.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
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13
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Bose D, Chatterjee S, Older E, Seth R, Janulewicz P, Saha P, Mondal A, Carlson JM, Decho AW, Sullivan K, Klimas N, Lasley S, Li J, Chatterjee S. Host gut resistome in Gulf War chronic multisymptom illness correlates with persistent inflammation. Commun Biol 2022; 5:552. [PMID: 35672382 PMCID: PMC9174162 DOI: 10.1038/s42003-022-03494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Chronic multisymptom illness (CMI) affects a subsection of elderly and war Veterans and is associated with systemic inflammation. Here, using a mouse model of CMI and a group of Gulf War (GW) Veterans' with CMI we show the presence of an altered host resistome. Results show that antibiotic resistance genes (ARGs) are significantly altered in the CMI group in both mice and GW Veterans when compared to control. Fecal samples from GW Veterans with persistent CMI show a significant increase of resistance to a wide class of antibiotics and exhibited an array of mobile genetic elements (MGEs) distinct from normal healthy controls. The altered resistome and gene signature is correlated with mouse serum IL-6 levels. Altered resistome in mice also is correlated strongly with intestinal inflammation, decreased synaptic plasticity, reversible with fecal microbiota transplant (FMT). The results reported might help in understanding the risks to treating hospital acquired infections in this population.
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Affiliation(s)
- Dipro Bose
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Somdatta Chatterjee
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Ethan Older
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, SC, USA
| | - Ratanesh Seth
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Patricia Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Punnag Saha
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Ayan Mondal
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jeffrey M Carlson
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Alan W Decho
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Nancy Klimas
- Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Stephen Lasley
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Jie Li
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, SC, USA
| | - Saurabh Chatterjee
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- Columbia VA Medical Center, Columbia, SC, USA.
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14
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Sanchez V, Baksh BS, Cabrera K, Choudhury A, Jensen K, Klimas N, Galor A. Dry Eye Symptoms and Signs in US Veterans With Gulf War Illness. Am J Ophthalmol 2022; 237:32-40. [PMID: 34780800 PMCID: PMC9035031 DOI: 10.1016/j.ajo.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To examine dry eye (DE) symptoms and signs in individuals with vs without Gulf War illness (GWI). DESIGN Prospective cross-sectional study. METHODS We performed a prospective, cross-sectional study of South Florida veterans who were active duty during the Gulf War era (GWE; 1990-1991) and seen at an eye clinic between October 1, 2020, and March 13, 2021. Veterans were split into 2 groups: those who met Kansas criteria for GWI (cases, n = 30) and those who did not (controls, n = 41). DE symptoms were assessed via standardized questionnaires whereas DE signs were assessed using a series of ocular surface parameters. Differences between groups were assessed via Mann-Whitney U test. Linear regression analyses were used to examine which GWI symptoms most closely aligned with DE symptoms. RESULTS Veterans with GWI had higher DE symptoms scores compared to controls (Ocular Surface Disease Index [OSDI] scores: mean 41.20±22.92 vs 27.99±24.03, P = .01). In addition, veterans with GWI had higher eye pain scores compared with controls (average eye pain over past week: 2.63±2.72 vs 1.22±1.50, P = .03), including on neuropathic ocular pain questionnaires (Neuropathic Pain Symptom Inventory modified for the Eye [NPSI-E]: 17.33±17.20 vs 9.63±12.64, P = .03). DE signs were mostly similar between the groups. GWI symptoms "nausea or upset stomach" (β=14.58, SE = 3.02, P < .001) and "headache" (β=7.90, SE = 2.91, P = .011) correlated with higher OSDI scores. CONCLUSION Individuals with GWI have more severe DE symptoms and ocular pain scores but similar tear and ocular surface parameters compared to controls without GWI. This finding suggests that mechanisms beyond tear dysfunction drive eye symptoms in GWI.
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Affiliation(s)
- Victor Sanchez
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Brandon S Baksh
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Kimberly Cabrera
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Anjalee Choudhury
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Katherine Jensen
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Nancy Klimas
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Anat Galor
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA..
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15
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Tamariz L, Bast E, Abad M, Klimas N, Caralis P, Palacio A. Letter to the editor: Post COVID-19 joint pain: Preliminary report of the relationship with antinuclear antibodies and inflammation. J Med Virol 2022; 94:3479-3481. [PMID: 35355291 PMCID: PMC9088578 DOI: 10.1002/jmv.27753] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/12/2022]
Abstract
This case series of 15 patients shows in a cross-sectional design the association between antinuclear antibodies and joint pain in post covid syndrome. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Leonardo Tamariz
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL.,the Veterans Affairs Medical Center, Miami, FL
| | | | - Maria Abad
- Universidad Catolica Santiago de Guayaquil
| | - Nancy Klimas
- the Veterans Affairs Medical Center, Miami, FL.,Neuroinmune institute, NOVA Southeastern University
| | - Pat Caralis
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL.,the Veterans Affairs Medical Center, Miami, FL
| | - Ana Palacio
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL.,the Veterans Affairs Medical Center, Miami, FL
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16
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Shastry N, Sultana E, Jeffrey M, Collado F, Kibler J, DeLucia C, Fletcher MA, Klimas N, Craddock TJA. The impact of post-traumatic stress on quality of life and fatigue in women with Gulf War Illness. BMC Psychol 2022; 10:42. [PMID: 35216624 PMCID: PMC8876751 DOI: 10.1186/s40359-022-00752-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/11/2022] [Indexed: 12/01/2022] Open
Abstract
Background Gulf War Illness (GWI) is a chronic, multi-symptomatic disorder characterized by fatigue, muscle pain, cognitive problems, insomnia, rashes, and gastrointestinal issues affecting an estimated 30% of the ~ 750,000 returning military Veterans of the 1990–1991 Persian Gulf War. Female Veterans deployed to combat in this war report medical symptoms, like cognition and respiratory troubles, at twice the rate compared to non-deployed female Veterans of the same era. The heterogeneity of GWI symptom presentation complicates diagnosis as well as the identification of effective treatments. This is exacerbated by the presence of co-morbidities. Defining subgroups of the illness may help alleviate these complications. One clear grouping is along the lines of gender. Our aim is to determine if women with GWI can be further subdivided into distinct subgroups based on post-traumatic stress disorder (PTSD) symptom presentation. Methods Veterans diagnosed with GWI (n = 35) and healthy sedentary controls (n = 35) were recruited through the Miami Veterans Affairs Medical Health Center. Symptoms were assessed via the RAND short form health survey, the multidimensional fatigue inventory, and the Davidson trauma scale. Hierarchal regression modeling was performed on measures of health and fatigue with PTSD symptoms as a covariate. This was followed by univariate analyses conducted with two separate GWI groups based on a cut-point of 70 for their total Davidson trauma scale value and performing heteroscedastic t-tests across all measures. Results Based on the distinct differences found in PTSD symptomology regarding all health and trauma symptoms, two subgroups were derived within female GWI Veterans. Hierarchical regression models displayed the comorbid effects of GWI and PTSD, as both conditions had measurable impacts on quality of life and fatigue (ΔR2 = 0.08–0.672), with notable differences in mental and emotional measures. Overall, a cut point analysis indicated poorer quality of life and greater fatigue within all measures for women with GWI and PTSD symptoms in comparison to those women with GWI without PTSD symptoms and healthy controls. Conclusions Our current findings support the understanding that comorbid symptoms of GWI and PTSD subsequently result in poorer quality of life and fatigue, along with establishing the possibility of varying clinical presentations.
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Affiliation(s)
- Nandan Shastry
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.,Department of Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Esha Sultana
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.,Department of Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Mary Jeffrey
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.,Department of Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, FL, USA.,Geriatric Research, Education, and Clinical Center, Miami Veterans Affairs Medical Center, Miami, USA
| | - Fanny Collado
- Geriatric Research, Education, and Clinical Center, Miami Veterans Affairs Medical Center, Miami, USA
| | - Jeffrey Kibler
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Christian DeLucia
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Mary Ann Fletcher
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.,Geriatric Research, Education, and Clinical Center, Miami Veterans Affairs Medical Center, Miami, USA.,Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.,Geriatric Research, Education, and Clinical Center, Miami Veterans Affairs Medical Center, Miami, USA.,Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Travis J A Craddock
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA. .,Department of Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, FL, USA. .,Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, USA. .,Department of Computer Science, Nova Southeastern University, Fort Lauderdale, FL, USA.
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Oberlin S, Nkiliza A, Parks M, Evans JE, Klimas N, Keegan AP, Sullivan K, Krengel MH, Mullan M, Crawford F, Abdullah L. Sex-specific differences in plasma lipid profiles are associated with Gulf War Illness. J Transl Med 2022; 20:73. [PMID: 35123492 PMCID: PMC8817550 DOI: 10.1186/s12967-022-03272-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background Nearly 250,000 veterans from the 1990–1991 Gulf War have Gulf War Illness (GWI), a condition with heterogeneous pathobiology that remains difficult to diagnose. As such, availability of blood biomarkers that reflect the underlying biology of GWI would help clinicians provide appropriate care to ill veterans. In this study, we measured blood lipids to examine the influence of sex on the association between blood lipids and GWI diagnosis. Methods Plasma lipid extracts from GWI (n = 100) and control (n = 45) participants were subjected to reversed-phase nano-flow liquid chromatography-mass spectrometry analysis. Results An influence of sex and GWI case status on plasma neutral lipid and phospholipid species was observed. Among male participants, triglycerides, diglycerides, and phosphatidylcholines were increased while cholesterol esters were decreased in GWI cases compared to controls. In female participants, ceramides were increased in GWI cases compared to controls. Among male participants, unsaturated triglycerides, phosphatidylcholine and diglycerides were increased while unsaturated cholesterol esters were lower in GWI cases compared to controls. The ratio of arachidonic acid- to docosahexaenoic acid-containing triglyceride species was increased in female and male GWI cases as compared to their sex-matched controls. Conclusion Differential modulation of neutral lipids and ratios of arachidonic acid to docosahexaenoic acid in male veterans with GWI suggest metabolic dysfunction and inflammation. Increases in ceramides among female veterans with GWI also suggest activation of inflammatory pathways. Future research should characterize how these lipids and their associated pathways relate to GWI pathology to identify biomarkers of the disorder. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03272-3.
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Keating D, Zundel CG, Abreu M, Krengel M, Aenlle K, Nichols MD, Toomey R, Chao LL, Golier J, Abdullah L, Quinn E, Heeren T, Groh JR, Koo BB, Killiany R, Loggia ML, Younger J, Baraniuk J, Janulewicz P, Ajama J, Quay M, Baas PW, Qiang L, Conboy L, Kokkotou E, O'Callaghan JP, Steele L, Klimas N, Sullivan K. Boston biorepository, recruitment and integrative network (BBRAIN): A resource for the Gulf War Illness scientific community. Life Sci 2021; 284:119903. [PMID: 34453948 DOI: 10.1016/j.lfs.2021.119903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/31/2021] [Accepted: 08/17/2021] [Indexed: 12/26/2022]
Abstract
AIMS Gulf War Illness (GWI), a chronic debilitating disorder characterized by fatigue, joint pain, cognitive, gastrointestinal, respiratory, and skin problems, is currently diagnosed by self-reported symptoms. The Boston Biorepository, Recruitment, and Integrative Network (BBRAIN) is the collaborative effort of expert Gulf War Illness (GWI) researchers who are creating objective diagnostic and pathobiological markers and recommend common data elements for GWI research. MAIN METHODS BBRAIN is recruiting 300 GWI cases and 200 GW veteran controls for the prospective study. Key data and biological samples from prior GWI studies are being merged and combined into retrospective datasets. They will be made available for data mining by the BBRAIN network and the GWI research community. Prospective questionnaire data include general health and chronic symptoms, demographics, measures of pain, fatigue, medical conditions, deployment and exposure histories. Available repository biospecimens include blood, plasma, serum, saliva, stool, urine, human induced pluripotent stem cells and cerebrospinal fluid. KEY FINDINGS To date, multiple datasets have been merged and combined from 15 participating study sites. These data and samples have been collated and an online request form for repository requests as well as recommended common data elements have been created. Data and biospecimen sample requests are reviewed by the BBRAIN steering committee members for approval as they are received. SIGNIFICANCE The BBRAIN repository network serves as a much needed resource for GWI researchers to utilize for identification and validation of objective diagnostic and pathobiological markers of the illness.
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Affiliation(s)
- D Keating
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
| | - C G Zundel
- Boston University School of Medicine, Behavioral Neuroscience Program, 72 East Concord St., Boston, MA 02118, USA.
| | - M Abreu
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; Geriatric Research Education and Clinical Center, Miami VA Medical Center, Miami, FL 33125, USA.
| | - M Krengel
- Boston University School of Medicine, Department of Neurology, 72 East Concord St., Boston, MA 02118, USA.
| | - K Aenlle
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; Geriatric Research Education and Clinical Center, Miami VA Medical Center, Miami, FL 33125, USA.
| | - M D Nichols
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA
| | - R Toomey
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, USA.
| | - L L Chao
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA 94143, USA.
| | - J Golier
- James J. Peters VA Medical Center, OOMH-526, 130 West Kingsbridge Road, Bronx, NY 10468, USA; Psychiatry Department, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029, USA.
| | - L Abdullah
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL 34243, USA; Open University, Milton Keynes, United Kingdom; James A. Haley Veterans' Hospital, Tampa, FL, USA.
| | - E Quinn
- Boston University School of Public Health, Department of Biostatistics, 715 Albany St., Boston, MA 02118, USA.
| | - T Heeren
- Boston University School of Public Health, Department of Biostatistics, 715 Albany St., Boston, MA 02118, USA.
| | - J R Groh
- Boston University School of Medicine, Behavioral Neuroscience Program, 72 East Concord St., Boston, MA 02118, USA.
| | - B B Koo
- Boston University School of Medicine, Department of Anatomy and Neurobiology, 72 East Concord St., Boston, MA 02118, USA.
| | - R Killiany
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA; Boston University School of Medicine, Department of Neurology, 72 East Concord St., Boston, MA 02118, USA; Boston University School of Medicine, Department of Anatomy and Neurobiology, 72 East Concord St., Boston, MA 02118, USA.
| | - M L Loggia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
| | - J Younger
- Neuroinflammation, Pain & Fatigue Lab, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - J Baraniuk
- Department of Medicine, Georgetown University, Washington, DC, USA.
| | - P Janulewicz
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
| | - J Ajama
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
| | - M Quay
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
| | - P W Baas
- Drexel University College of Medicine, Department of Neurobiology and Anatomy, 2900 Queen Lane, Philadelphia, PA 19129, USA.
| | - L Qiang
- Drexel University College of Medicine, Department of Neurobiology and Anatomy, 2900 Queen Lane, Philadelphia, PA 19129, USA.
| | - L Conboy
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.
| | - E Kokkotou
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.
| | - J P O'Callaghan
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV, USA.
| | - L Steele
- Baylor College of Medicine Neuropsychiatry Division, Department of Psychiatry and Behavioral Sciences, Houston, TX 77030, USA.
| | - N Klimas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; Geriatric Research Education and Clinical Center, Miami VA Medical Center, Miami, FL 33125, USA.
| | - K Sullivan
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
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Coller JK, Tuke J, Wain TJ, Quinn E, Steele L, Abreu M, Aenlle K, Klimas N, Sullivan K. Associations of Immune Genetic Variability with Gulf War Illness in 1990-1991 Gulf War Veterans from the Gulf War Illness Consortium (GWIC) Multisite Case-Control Study. Brain Sci 2021; 11:brainsci11111410. [PMID: 34827409 PMCID: PMC8615505 DOI: 10.3390/brainsci11111410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/16/2022] Open
Abstract
Gulf War illness (GWI) encompasses a constellation of persistent debilitating symptoms associated with significant changes in central nervous system (CNS) and immune functioning. Currently, there is no validated biomarker for GWI risk susceptibility. Given the impact of immune responses linked to GWI symptomology, genetic variability that causes persistent inflammatory/immune alterations may be key. This Boston University-based Gulf War Illness Consortium (GWIC) study investigated the impact of single nucleotide polymorphisms (SNPs) in variants of immune and pain genetic markers IL1B, IL2, IL6, IL6R, IL10, TNF, TGF, TLR2, TLR4, MD2, MYD88, BDNF, CRP, ICE, COMT and OPRM1 on GWI occurrence in a Caucasian subset of Gulf War (GW) veterans with (cases, n = 170) and without (controls, n = 34) GWI. Logistic regression modeling created a prediction model of GWI risk that associated genetic variability in TGF (rs1800469, p = 0.009), IL6R (rs8192284, p = 0.004) and TLR4 (rs4986791, p = 0.013) with GWI occurrence. This prediction model was specific and sensitive, with a receiver operator characteristic area under the curve of 71.4%. This is the first report of immune genetic variability being predictive of GWI and warrants validation in larger independent cohorts. Future reports will present interactions of these genetic risk factors with other characteristics of GW service.
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Affiliation(s)
- Janet K. Coller
- Discipline of Pharmacology, School of Biomedicine, University of Adelaide, Adelaide 5005, South Australia, Australia;
- Correspondence:
| | - Jonathan Tuke
- School of Mathematical Sciences, University of Adelaide, Adelaide 5005, South Australia, Australia;
| | - Taylor J. Wain
- Discipline of Pharmacology, School of Biomedicine, University of Adelaide, Adelaide 5005, South Australia, Australia;
| | - Emily Quinn
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA 02118, USA;
| | - Lea Steele
- Veterans Health Research Program, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Maria Abreu
- Institute for Neuroimmune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (M.A.); (K.A.); (N.K.)
- Department of Veterans Affairs, Research Service, Miami VA Healthcare System, Miami, FL 33125, USA
| | - Kristina Aenlle
- Institute for Neuroimmune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (M.A.); (K.A.); (N.K.)
- Department of Veterans Affairs, Research Service, Miami VA Healthcare System, Miami, FL 33125, USA
| | - Nancy Klimas
- Institute for Neuroimmune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (M.A.); (K.A.); (N.K.)
- Department of Veterans Affairs, Miami VA Healthcare System Geriatric Research Education and Clinical Center Healthcare System, Miami, FL 33125, USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA;
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20
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Nkiliza A, Parks M, Cseresznye A, Oberlin S, Evans JE, Darcey T, Aenlle K, Niedospial D, Mullan M, Crawford F, Klimas N, Abdullah L. Sex-specific plasma lipid profiles of ME/CFS patients and their association with pain, fatigue, and cognitive symptoms. J Transl Med 2021; 19:370. [PMID: 34454515 PMCID: PMC8401202 DOI: 10.1186/s12967-021-03035-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/09/2021] [Indexed: 12/19/2022] Open
Abstract
Background Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex illness which disproportionally affects females. This illness is associated with immune and metabolic perturbations that may be influenced by lipid metabolism. We therefore hypothesized that plasma lipids from ME/CFS patients will provide a unique biomarker signature of disturbances in immune, inflammation and metabolic processes associated with ME/CFS. Methods Lipidomic analyses were performed on plasma from a cohort of 50 ME/CFS patients and 50 controls (50% males and similar age and ethnicity per group). Analyses were conducted with nano-flow liquid chromatography (nLC) and high-performance liquid chromatography (HPLC) systems coupled with a high mass accuracy ORBITRAP mass spectrometer, allowing detection of plasma lipid concentration ranges over three orders of magnitude. We examined plasma phospholipids (PL), neutral lipids (NL) and bioactive lipids in ME/CFS patients and controls and examined the influence of sex on the relationship between lipids and ME/CFS diagnosis. Results Among females, levels of total phosphatidylethanolamine (PE), omega-6 arachidonic acid-containing PE, and total hexosylceramides (HexCer) were significantly decreased in ME/CFS compared to controls. In males, levels of total HexCer, monounsaturated PE, phosphatidylinositol (PI), and saturated triglycerides (TG) were increased in ME/CFS patients compared to controls. Additionally, omega-6 linoleic acid-derived oxylipins were significantly increased in male ME/CFS patients versus male controls. Principal component analysis (PCA) identified three major components containing mostly PC and a few PE, PI and SM species—all of which were negatively associated with headache and fatigue severity, irrespective of sex. Correlations of oxylipins, ethanolamides and ME/CFS symptom severity showed that lower concentrations of these lipids corresponded with an increase in the severity of headaches, fatigue and cognitive difficulties and that this association was influenced by sex. Conclusion The observed sex-specific pattern of dysregulated PL, NL, HexCer and oxylipins in ME/CFS patients suggests a possible role of these lipids in promoting immune dysfunction and inflammation which may be among the underlying factors driving the clinical presentation of fatigue, chronic pain, and cognitive difficulties in ill patients. Further evaluation of lipid metabolism pathways is warranted to better understand ME/CFS pathogenesis. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-03035-6.
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Affiliation(s)
- Aurore Nkiliza
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA. .,James A. Haley Veterans' Hospital, 2040 Whitfield Ave, Tampa, FL, USA.
| | - Megan Parks
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, 2040 Whitfield Ave, Tampa, FL, USA
| | - Adam Cseresznye
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, 2040 Whitfield Ave, Tampa, FL, USA
| | - Sarah Oberlin
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, 2040 Whitfield Ave, Tampa, FL, USA
| | - James E Evans
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, 2040 Whitfield Ave, Tampa, FL, USA
| | - Teresa Darcey
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, 2040 Whitfield Ave, Tampa, FL, USA
| | - Kristina Aenlle
- Institute for NeuroImmune Medicine, VAMC, GRECC, Nova Southeastern University, Miami, USA
| | - Daniel Niedospial
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, 2040 Whitfield Ave, Tampa, FL, USA
| | - Michael Mullan
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, 2040 Whitfield Ave, Tampa, FL, USA
| | - Fiona Crawford
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, 2040 Whitfield Ave, Tampa, FL, USA
| | - Nancy Klimas
- Institute for NeuroImmune Medicine, VAMC, GRECC, Nova Southeastern University, Miami, USA
| | - Laila Abdullah
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, 2040 Whitfield Ave, Tampa, FL, USA
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21
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Steele L, Klimas N, Krengel M, Quinn E, Toomey R, Little D, Abreu M, Aenlle K, Killiany R, Koo BB, Janulewicz P, Heeren T, Clark AN, Ajama J, Cirillo J, Buentello G, Lerma V, Coller JK, Sullivan K. Brain-Immune Interactions as the Basis of Gulf War Illness: Clinical Assessment and Deployment Profile of 1990-1991 Gulf War Veterans in the Gulf War Illness Consortium (GWIC) Multisite Case-Control Study. Brain Sci 2021; 11:brainsci11091132. [PMID: 34573153 PMCID: PMC8467437 DOI: 10.3390/brainsci11091132] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022] Open
Abstract
The Boston University-based Gulf War Illness Consortium (GWIC) is a multidisciplinary initiative developed to provide detailed understanding of brain and immune alterations that underlie Gulf War illness (GWI), the persistent multisymptom disorder associated with military service in the 1990–1991 Gulf War. The core GWIC case-control clinical study conducted in-depth brain and immune evaluation of 269 Gulf War veterans (223 GWI cases, 46 controls) at three U.S. sites that included clinical assessments, brain imaging, neuropsychological testing, and analyses of a broad range of immune and immunogenetic parameters. GWI cases were similar to controls on most demographic, military, and deployment characteristics although on average were two years younger, with a higher proportion of enlisted personnel vs. officers. Results of physical evaluation and routine clinical lab tests were largely normal, with few differences between GWI cases and healthy controls. However, veterans with GWI scored significantly worse than controls on standardized assessments of general health, pain, fatigue, and sleep quality and had higher rates of diagnosed conditions that included hypertension, respiratory and sinus conditions, gastrointestinal conditions, and current or lifetime depression and post-traumatic stress disorder. Among multiple deployment experiences/exposures reported by veterans, multivariable logistic regression identified just two significant GWI risk factors: extended use of skin pesticides in theater (adjusted OR = 3.25, p = 0.005) and experiencing mild traumatic brain injury during deployment (OR = 7.39, p = 0.009). Gulf War experiences associated with intense stress or trauma (e.g., participation in ground combat) were not associated with GWI. Data and samples from the GWIC project are now stored in a repository for use by GWI researchers. Future reports will present detailed findings on brain structure and function, immune function, and association of neuroimmune measures with characteristics of GWI and Gulf War service.
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Affiliation(s)
- Lea Steele
- Veterans Health Research Program, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; (G.B.); (V.L.)
- Correspondence: (L.S.); (K.S.)
| | - Nancy Klimas
- Institute for Neuroimmune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (N.K.); (M.A.); (K.A.)
- Department of Veterans Affairs, Miami VA Healthcare System, Miami, FL 33125, USA
| | - Maxine Krengel
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Emily Quinn
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (T.H.)
| | - Rosemary Toomey
- Department of Psychological and Brain Sciences, Boston University College of Arts and Sciences, Boston, MA 02215, USA;
| | - Deborah Little
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - Maria Abreu
- Institute for Neuroimmune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (N.K.); (M.A.); (K.A.)
| | - Kristina Aenlle
- Institute for Neuroimmune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (N.K.); (M.A.); (K.A.)
- Department of Veterans Affairs, Miami VA Healthcare System, Miami, FL 33125, USA
| | - Ronald Killiany
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Bang-Bon Koo
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Patricia Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (T.H.)
| | - Allison N. Clark
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Joy Ajama
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Joanna Cirillo
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Gerardo Buentello
- Veterans Health Research Program, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; (G.B.); (V.L.)
| | - Vanesa Lerma
- Veterans Health Research Program, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; (G.B.); (V.L.)
| | - Janet K. Coller
- Discipline of Pharmacology, School of Biomedicine, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
- Correspondence: (L.S.); (K.S.)
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Carrera Arias FJ, Aenlle K, Abreu M, Holschbach MA, Michalovicz LT, Kelly KA, Klimas N, O’Callaghan JP, Craddock TJA. Modeling Neuroimmune Interactions in Human Subjects and Animal Models to Predict Subtype-Specific Multidrug Treatments for Gulf War Illness. Int J Mol Sci 2021; 22:ijms22168546. [PMID: 34445252 PMCID: PMC8395153 DOI: 10.3390/ijms22168546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 01/03/2023] Open
Abstract
Gulf War Illness (GWI) is a persistent chronic neuroinflammatory illness exacerbated by external stressors and characterized by fatigue, musculoskeletal pain, cognitive, and neurological problems linked to underlying immunological dysfunction for which there is no known treatment. As the immune system and the brain communicate through several signaling pathways, including the hypothalamic–pituitary–adrenal (HPA) axis, it underlies many of the behavioral and physiological responses to stressors via blood-borne mediators, such as cytokines, chemokines, and hormones. Signaling by these molecules is mediated by the semipermeable blood–brain barrier (BBB) made up of a monocellular layer forming an integral part of the neuroimmune axis. BBB permeability can be altered and even diminished by both external factors (e.g., chemical agents) and internal conditions (e.g., acute or chronic stress, or cross-signaling from the hypothalamic–pituitary–gonadal (HPG) axis). Such a complex network of regulatory interactions that possess feed-forward and feedback connections can have multiple response dynamics that may include several stable homeostatic states beyond normal health. Here we compare immune and hormone measures in the blood of human clinical samples and mouse models of Gulf War Illness (GWI) subtyped by exposure to traumatic stress for subtyping this complex illness. We do this via constructing a detailed logic model of HPA–HPG–Immune regulatory behavior that also considers signaling pathways across the BBB to neuronal–glial interactions within the brain. We apply conditional interactions to model the effects of changes in BBB permeability. Several stable states are identified in the system beyond typical health. Following alignment of the human and mouse blood profiles in the context of the model, mouse brain sample measures were used to infer the neuroinflammatory state in human GWI and perform treatment simulations using a genetic algorithm to optimize the Monte Carlo simulations of the putative treatment strategies aimed at returning the ill system back to health. We identify several ideal multi-intervention strategies and potential drug candidates that may be used to treat chronic neuroinflammation in GWI.
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Affiliation(s)
- Francisco J. Carrera Arias
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (F.J.C.A.); (K.A.); (M.A.); (N.K.)
| | - Kristina Aenlle
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (F.J.C.A.); (K.A.); (M.A.); (N.K.)
- Department of Clinical Immunology, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
- Miami Veterans Affairs Healthcare System, Miami, FL 33125, USA
| | - Maria Abreu
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (F.J.C.A.); (K.A.); (M.A.); (N.K.)
- Department of Clinical Immunology, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
- Miami Veterans Affairs Healthcare System, Miami, FL 33125, USA
| | - Mary A. Holschbach
- Department of Psychology & Neuroscience, College of Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA;
| | - Lindsay T. Michalovicz
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA; (L.T.M.); (K.A.K.); (J.P.O.)
| | - Kimberly A. Kelly
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA; (L.T.M.); (K.A.K.); (J.P.O.)
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (F.J.C.A.); (K.A.); (M.A.); (N.K.)
- Department of Clinical Immunology, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
- Miami Veterans Affairs Healthcare System, Miami, FL 33125, USA
| | - James P. O’Callaghan
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA; (L.T.M.); (K.A.K.); (J.P.O.)
| | - Travis J. A. Craddock
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (F.J.C.A.); (K.A.); (M.A.); (N.K.)
- Department of Clinical Immunology, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
- Department of Psychology & Neuroscience, College of Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA;
- Department of Computer Science, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
- Correspondence: ; Tel.: +1-954-262-2868
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23
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Cohen DE, Sullivan KA, McNeil RB, Klimas NG, McNeil R, Ashford W, Bested A, Bunker J, Cheema A, Cohen D, Cook D, Cournoyer J, Craddock T, Golier J, Hardie A, Helmer D, Lindheimer JB, Lloyd PJ, Kerr K, Krengel M, Nadkarni S, Nugent S, Paris B, Reinhard M, Rumm P, Schneiderman A, Sims KJ, Steele L, Turner M, Sullivan K, Abdullah L, Abreu M, Abu-Donia M, Aenlle K, Arocho J, Balbin E, Baraniuk J, Block K, Block M, DeBeer B, Engdahl B, Filipov N, Fletcher MA, Kalasinsky V, Kokkotou E, Lidie K, Little D, Loging W, Morris M, Nathanson L, Nichols MD, Pasinetti G, Shungu D, Waziry P, VanLeeuwen J, Younger J, Klimas N. A common language for Gulf War Illness (GWI) research studies: GWI common data elements. Life Sci 2021; 290:119818. [PMID: 34352259 DOI: 10.1016/j.lfs.2021.119818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022]
Abstract
AIMS The Gulf War Illness programs (GWI) of the United States Department of Veteran Affairs and the Department of Defense Congressionally Directed Medical Research Program collaborated with experts to develop Common Data Elements (CDEs) to standardize and systematically collect, analyze, and share data across the (GWI) research community. MAIN METHODS A collective working group of GWI advocates, Veterans, clinicians, and researchers convened to provide consensus on instruments, case report forms, and guidelines for GWI research. A similar initiative, supported by the National Institute of Neurologic Disorders and Stroke (NINDS) was completed for a comparative illness, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and provided the foundation for this undertaking. The GWI working group divided into two sub-groups (symptoms and systems assessment). Both groups reviewed the applicability of instruments and forms recommended by the NINDS ME/CFS CDE to GWI research within specific domains and selected assessments of deployment exposures. The GWI CDE recommendations were finalized in March 2018 after soliciting public comments. KEY FINDINGS GWI CDE recommendations are organized in 12 domains that include instruments, case report forms, and guidelines. Recommendations were categorized as core (essential), supplemental-highly recommended (essential for specified conditions, study types, or designs), supplemental (commonly collected, but not required), and exploratory (reasonable to use, but require further validation). Recommendations will continually be updated as GWI research progresses. SIGNIFICANCE The GWI CDEs reflect the consensus recommendations of GWI research community stakeholders and will allow studies to standardize data collection, enhance data quality, and facilitate data sharing.
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Affiliation(s)
- Devra E Cohen
- Miami VA Healthcare System, Miami, FL, United States; Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States.
| | - Kimberly A Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | | | - Nancy G Klimas
- Miami VA Healthcare System, Miami, FL, United States; Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | | | | | | | - Wes Ashford
- War Related Illness and Injury Study Center, VA Palo Healthcare System, Palo Alto, CA, United States
| | - Alison Bested
- Nova Southeastern University, Ft. Lauderdale, FL, United States
| | - James Bunker
- National Gulf War Resource Center, Inc., Topeka, KS, United States
| | | | - Devra Cohen
- Miami VA Healthcare System, Nova Southeastern University, Ft. Lauderdale, FL, United States
| | - Dane Cook
- University of Wisconsin-Madison, Madison, WI, United States
| | | | - Travis Craddock
- Nova Southeastern University, Ft. Lauderdale, FL, United States
| | - Julia Golier
- James J. Peters VA Medical Center; Icahn School of Medicine at Mount Sinai, Bronx, NY, United States
| | - Anthony Hardie
- Veterans for Common Sense and former U.S. Army, Bradenton, FL, United States
| | - Drew Helmer
- War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, United States
| | - Jacob B Lindheimer
- William S. Middleton Veterans Memorial Hospital, University of Wisconsin- Madison, Madison, WI, United States
| | | | | | - Maxine Krengel
- Boston VA Healthcare System; Boston University, Boston, MA, United States
| | - Shree Nadkarni
- War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, United States
| | - Shannon Nugent
- VA Portland Health Care System, Portland, OR, United States
| | - Bonnie Paris
- VA Information Resource Center (VIReC), Hines, IL, United States
| | - Matthew Reinhard
- War Related Illness and Injury Study Center, Washington DC VA Medical Center, Washington, DC, United States
| | - Peter Rumm
- US Department of Veterans Affairs, Washington, DC, United States
| | | | - Kellie J Sims
- VA Cooperative Studies Program Epidemiology Center, Durham, NC, United States
| | - Lea Steele
- Baylor College of Medicine, Houston, TX, United States
| | - Marsha Turner
- Durham VA Cooperative Studies Program, Durham, NC, United States
| | | | | | | | - Maria Abreu
- Miami VA Healthcare System, Nova Southeastern University, Ft. Lauderdale, FL, United States
| | | | - Kristina Aenlle
- Miami VA Healthcare System, Nova Southeastern University, Ft. Lauderdale, FL, United States
| | - Jimmy Arocho
- United States Army, Nova Southeastern University, Ft. Lauderdale, FL, United States
| | - Elizabeth Balbin
- Miami VA Healthcare System, Nova Southeastern University, Ft. Lauderdale, FL, United States
| | | | - Karen Block
- Office of Research and Development, US Department of Veterans Affairs, Washington, DC, United States
| | | | - Bryann DeBeer
- Texas A&M Health Science Center, Central Texas Veterans Healthcare System, Waco, TX, United States
| | - Brian Engdahl
- Minneapolis VA Health Care System, University of Minnesota, Minneapolis, MN, United States
| | | | - Mary Ann Fletcher
- Miami VA Healthcare System, Nova Southeastern University, Ft. Lauderdale, FL, United States
| | - Victor Kalasinsky
- Office of Research and Development, US Department of Veterans Affairs, Washington, DC, United States
| | - Efi Kokkotou
- Harvard University, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | | | | | | | - Marianna Morris
- Nova Southeastern University, Ft. Lauderdale, FL, United States
| | - Lubov Nathanson
- Nova Southeastern University, Ft. Lauderdale, FL, United States
| | | | - Giulio Pasinetti
- Icahn School of Medicine at Mount Sinai, Bronx, NY, United States
| | - Dikoma Shungu
- Weill Cornell Medical Center, New York, NY, United States
| | - Paula Waziry
- Nova Southeastern University, Ft. Lauderdale, FL, United States
| | - Jon VanLeeuwen
- University of California, VA Research Advisory Committee on Gulf War Veterans' Illnesses, San Francisco, CA, United States
| | - Jarred Younger
- The University of Alabama, Birmingham, AL, United States
| | | | - Nancy Klimas
- Miami VA Healthcare System, Nova Southeastern University, Ft. Lauderdale, FL, United States
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Saha P, Skidmore PT, Holland LA, Mondal A, Bose D, Seth RK, Sullivan K, Janulewicz PA, Horner R, Klimas N, Nagarkatti M, Nagarkatti P, Lim ES, Chatterjee S. Andrographolide Attenuates Gut-Brain-Axis Associated Pathology in Gulf War Illness by Modulating Bacteriome-Virome Associated Inflammation and Microglia-Neuron Proinflammatory Crosstalk. Brain Sci 2021; 11:brainsci11070905. [PMID: 34356139 PMCID: PMC8304847 DOI: 10.3390/brainsci11070905] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022] Open
Abstract
Gulf War Illness (GWI) is a chronic multi-symptomatic illness that is associated with fatigue, pain, cognitive deficits, and gastrointestinal disturbances and presents a significant challenge to treat in clinics. Our previous studies show a role of an altered Gut–Brain axis pathology in disease development and symptom persistence in GWI. The present study utilizes a mouse model of GWI to study the role of a labdane diterpenoid andrographolide (AG) to attenuate the Gut–Brain axis-linked pathology. Results showed that AG treatment in mice (100 mg/kg) via oral gavage restored bacteriome alterations, significantly increased probiotic bacteria Akkermansia, Lachnospiraceae, and Bifidobacterium, the genera that are known to aid in preserving gut and immune health. AG also corrected an altered virome with significant decreases in virome families Siphoviridae and Myoviridae known to be associated with gastrointestinal pathology. AG treatment significantly restored tight junction proteins that correlated well with decreased intestinal proinflammatory mediators IL-1β and IL-6 release. AG treatment could restore Claudin-5 levels, crucial for maintaining the BBB integrity. Notably, AG could decrease microglial activation and increase neurotrophic factor BDNF, the key to neurogenesis. Mechanistically, microglial conditioned medium generated from IL-6 stimulation with or without AG in a concentration similar to circulating levels found in the GWI mouse model and co-incubated with neuronal cells in vitro, decreased Tau phosphorylation and neuronal apoptosis. In conclusion, we show that AG treatment mitigated the Gut–Brain-Axis associated pathology in GWI and may be considered as a potential therapeutic avenue for the much-needed bench to bedside strategies in GWI.
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Affiliation(s)
- Punnag Saha
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (P.S.); (A.M.); (D.B.); (R.K.S.)
| | - Peter T. Skidmore
- Center for Fundamental and Applied Microbiomics, The Biodesign Institute, Arizona State University, Tempe, AZ 85281, USA; (P.T.S.); (L.A.H.); (E.S.L.)
| | - LaRinda A. Holland
- Center for Fundamental and Applied Microbiomics, The Biodesign Institute, Arizona State University, Tempe, AZ 85281, USA; (P.T.S.); (L.A.H.); (E.S.L.)
| | - Ayan Mondal
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (P.S.); (A.M.); (D.B.); (R.K.S.)
| | - Dipro Bose
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (P.S.); (A.M.); (D.B.); (R.K.S.)
| | - Ratanesh K. Seth
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (P.S.); (A.M.); (D.B.); (R.K.S.)
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (K.S.); (P.A.J.)
| | - Patricia A. Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (K.S.); (P.A.J.)
| | - Ronnie Horner
- College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA;
| | - Mitzi Nagarkatti
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA; (M.N.); (P.N.)
| | - Prakash Nagarkatti
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA; (M.N.); (P.N.)
| | - Efrem S. Lim
- Center for Fundamental and Applied Microbiomics, The Biodesign Institute, Arizona State University, Tempe, AZ 85281, USA; (P.T.S.); (L.A.H.); (E.S.L.)
- School of Life Sciences, Arizona State University, Tempe, AZ 85281, USA
| | - Saurabh Chatterjee
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (P.S.); (A.M.); (D.B.); (R.K.S.)
- Columbia VA Medical Center, Columbia, SC 29209, USA
- Correspondence: ; Tel.: +1-803-777-8120 or +1-919-599-2278
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25
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Cheema AK, McNeil RB, Craddock T, Broderick G, Abreu MM, Aenlle K, Helmer DA, Ashford JW, Sullivan K, Bested A, Cohen DE, Shungu D, Chandler H, Fletcher MA, Krengel M, Klimas N. Gulf War Illness Clinical Trials and Interventions Consortium (GWICTIC): A collaborative research infrastructure for intervention and implementation. Life Sci 2021; 278:119636. [PMID: 34015289 DOI: 10.1016/j.lfs.2021.119636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/17/2022]
Abstract
AIMS There is an inadequate portfolio of treatments for Gulf War Illness (GWI), a complex disease involving multiple organ systems, and early-phase clinical trials are hampered by many logistical problems. To address these challenges, the Gulf War Illness Clinical Trials and Interventions Consortium (GWICTIC) was formed with the aims of (i) creating a collaborative consortium of clinical and scientific researchers that will rapidly implement rigorous and innovative phase I and II clinical trials for GWI, (ii) perform at least four phase I or II clinical trials, (iii) provide a foundation of scalable infrastructure and management in support of the efficient and successful operation of the GWICTIC, and (iv) partner with the Boston Biorepository, Recruitment & Integrated Network for GWI and other GWI investigators to develop a common data element platform for core assessments and outcomes. MAIN METHODS The GWICTIC brings together a multidisciplinary team of researchers at several institutions to provide scientific innovation, statistical and computational rigor, and logistical efficiency in the development and implementation of early-phase low-risk clinical trials for GWI. The GWICTIC core trials adhere to a Veteran-centered philosophy and focus on interventions with multiple mechanistic targets to maximize the likelihood of efficacy. To support rapid and efficient study startup and implementation across the GWI research community, the GWICTIC will share infrastructure with investigator-initiated research studies funded under separate mechanisms. SIGNIFICANCE The GWICTIC will leverage the efficiencies of centralized research support and innovative trial designs to address several longstanding needs in the GWI interventions research community.
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Affiliation(s)
- Amanpreet K Cheema
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Department of Nutrition, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Halmos College of Natural Sciences and Oceanography, Nova Southeastern University, Fort Lauderdale, FL, United States.
| | | | - Travis Craddock
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Department of Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, FL, United States; Department of Computer Science, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - Maria M Abreu
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Miami VA Healthcare System, Miami, FL, United States
| | - Kristina Aenlle
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Miami VA Healthcare System, Miami, FL, United States
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - J Wesson Ashford
- War Related Illness & Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States; Department of Psychiatry & Behavioral Sciences, College of Medicine, Stanford University, Palo Alto, CA, United States
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Alison Bested
- Department of Integrative Medicine, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, United States
| | - Devra E Cohen
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Miami VA Healthcare System, Miami, FL, United States
| | - Dikoma Shungu
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Helena Chandler
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States
| | - Mary Ann Fletcher
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Maxine Krengel
- VA Boston Healthcare System, Boston, MA, United States; Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Nancy Klimas
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Miami VA Healthcare System, Miami, FL, United States
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Krengel M, Sullivan K, Heboyan V, Zundel CG, Wilson CC, Klimas N, Coughlin SS. Neurotoxicant exposures and rates of Chronic Multisymptom Illness and Kansas Gulf War Illness criteria in Gulf War deployed women veterans. Life Sci 2021; 280:119623. [PMID: 34004246 DOI: 10.1016/j.lfs.2021.119623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 12/18/2022]
Abstract
AIMS This study analyzed deployment-related exposures and risk of Persian Gulf War Illness (GWI) in women veterans from the Veterans Affairs (VA) Cooperative Studies Program 585 Gulf War Era Cohort and Biorepository (GWECB CSP#585). MAIN METHODS We examined the associations between GW deployment-related exposures and case definitions for GWI in deployed GW women. Multivariate regression analyses controlling for demographic outcomes were performed. KEY FINDINGS Surveys were obtained from 202 GW deployed women veterans. Self-reported exposure to smoke from oil well fires as well as chemical and biological warfare were the only exposures significantly associated with the Center for Disease Control and Prevention (CDC) GWI criteria. Seventy-nine women were excluded from the rest of the analyses as they met Kansas GW illness exclusion criteria. Eligible women who self-reported deployment-related exposure to smoke from oil wells, pyridostigmine bromide (PB) pills, pesticide cream, pesticide treated uniforms, and insect baits were significantly more likely to meet the Kansas GWI criteria (n = 123) than those unexposed and exposures were related to Kansas symptom subdomain endorsements. SIGNIFICANCE These results suggest that women GW veterans reporting deployment related exposures of pesticide, oil well fire and PB pills are significantly more likely to meet the Kansas GWI criteria in this national cohort of GW women suggesting its utility in future studies. In addition, based on these results it appears that women exposed to particular toxicants during the war may benefit from more targeted treatment strategies dependent upon the mechanism of exposure of their toxicant induced outcomes.
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Affiliation(s)
- Maxine Krengel
- Boston University School of Medicine, United States of America; VA Boston Healthcare System, Boston, MA, United States of America.
| | - Kimberly Sullivan
- Boston University School of Public Health, Boston, MA, United States of America
| | - Vahé Heboyan
- Health Economics and Modeling Division, Population Health Sciences Department, Medical College of Georgia, Augusta University, Augusta, GA, United States of America
| | - Clara G Zundel
- Boston University School of Medicine, United States of America; VA Boston Healthcare System, Boston, MA, United States of America
| | - Col Candy Wilson
- Uniformed Services University Graduate School of Nursing, Bethesda, MD, United States of America
| | - Nancy Klimas
- Miami VA Healthcare System, Miami, FL, United States of America; Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America
| | - Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, United States of America; Research Service, Charlie Norwood Veterans Administration Medical Center, Augusta, GA, United States of America
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Saha P, Skidmore P, Holland L, Mondal A, Bose D, Seth R, Sullivan K, Janulewicz P, Horner R, Klimas N, Nagarkatti M, Nagarkatti P, Lim E, Chatterjee S. Andrographolide Treatment Lessens Localized, Systemic Inflammation and Improves Other Pathophysiological Traits in a Mouse Model of Gulf War Illness. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.03556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Punnag Saha
- Environmental Health SciencesUniversity Of South CarolinaColumbiaSC
| | | | | | - Ayan Mondal
- Environmental Health SciencesUniversity Of South CarolinaColumbiaSC
| | - Dipro Bose
- Environmental Health SciencesUniversity Of South CarolinaColumbiaSC
| | - Ratanesh Seth
- Environmental Health SciencesUniversity Of South CarolinaColumbiaSC
| | - Kimberly Sullivan
- Dept of Environmental HealthBoston University School of Public HealthBostonMA
| | - Patricia Janulewicz
- Dept of Environmental HealthBoston University School of Public HealthBostonMA
| | - Ronnie Horner
- Health Services Policy and ManagementUniversity Of South CarolinaColumbiaSC
| | - Nancy Klimas
- Department of Clinical ImmunologyNova Southeastern UniversityFort LauderdaleFL
| | - Mitzi Nagarkatti
- Dept. of Pathology, Microbiology and ImmunologyUniversity of South Carolina School of MedicineColumbiaSC
| | - Prakash Nagarkatti
- Dept. of Pathology, Microbiology and ImmunologyUniversity of South Carolina School of MedicineColumbiaSC
| | - Efrem Lim
- The Biodesign InstituteArizona State UniversityTempeAZ
- School of Life SciencesArizona State UniversityTempeAZ
| | - Saurabh Chatterjee
- Environmental Health SciencesUniversity Of South CarolinaColumbiaSC
- Wm. Jennings Bryan Dorn VA Medical CenterColumbiaSC
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28
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Seth R, Saha P, Bose D, Mondal A, Sullivan K, Janulewicz Lloyd P, Horner R, Klimas N, Chatterjee S. Nexinhib 20 ameliorates hepatic extracellular HMGB1 mediated M1 polarization and liver inflammation in a mouse model of Gulf War Illness. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.04667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Dipro Bose
- ENHSUniversity of South CarolinaColumbiaSC
| | | | | | | | | | - Nancy Klimas
- Department of Clinical ImmunologyNova Southeastern UniversityFort LauderdaleFL
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Bose D, Mondal A, Saha P, Seth R, Sullivan K, Janulewicz P, Horner R, Klimas N, Chatterjee S. Prolonged Antibiotic Use Worsens Neuroinflammation and Increases the Risk of Neurodegeneration via Elevated Expression of Systemic IL‐6 in Gulf War Illness Symptom Persistence Murine Model. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.03563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Dipro Bose
- Department of Environmental Health SciencesUniversity of South CarolinaColumbiaSC
| | - Ayan Mondal
- Department of Environmental Health SciencesUniversity of South CarolinaColumbiaSC
| | - Punnag Saha
- Department of Environmental Health SciencesUniversity of South CarolinaColumbiaSC
| | - Ratanesh Seth
- Department of Environmental Health SciencesUniversity of South CarolinaColumbiaSC
| | | | | | - Ronnie Horner
- DEPARMENT OF HEALTH SERVICES POLICY AND MGTUniversity of South CarolinaColumbiaSC
| | | | - Saurabh Chatterjee
- Department of Environmental Health SciencesUniversity of South CarolinaColumbiaSC
- Wm. Jennings Bryan Dorn VA Medical CenterColumbiaSC
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Jeffrey M, Collado F, Kibler J, DeLucia C, Messer S, Klimas N, Craddock TJA. Post-traumatic stress impact on health outcomes in Gulf War Illness. BMC Psychol 2021; 9:57. [PMID: 33879264 PMCID: PMC8056666 DOI: 10.1186/s40359-021-00561-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/05/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Gulf War Illness (GWI) is a chronic, multi-symptomatic disorder affecting an estimated 25-32% of the returning military veterans of the 1990-1991 Persian Gulf War. GWI presents with a wide range of symptoms including fatigue, muscle pain, cognitive problems, insomnia, rashes and gastrointestinal issues and continues to be a poorly understood illness. This heterogeneity of GWI symptom presentation complicates diagnosis as well as the identification of effective treatments. Defining subgroups of the illness may help alleviate these complications. Our aim is to determine if GWI can be divided into distinct subgroups based on PTSD symptom presentation. METHODS Veterans diagnosed with GWI (n = 47) and healthy sedentary veteran controls (n = 52) were recruited through the Miami Affairs (VA) Medical Health Center. Symptoms were assessed via the RAND short form health survey (36), the multidimensional fatigue inventory, and the Davidson trauma scale. Hierarchal regression modeling was performed on measures of health and fatigue with PTSD symptoms as a covariate. This was followed by univariate analyses conducted with two separate GWI groups based on a cut-point of 70 for their total Davidson Trauma Scale value and performing heteroscedastic t-tests across all measures. RESULTS Overall analyses returned two symptom-based subgroups differing significantly across all health and trauma symptoms. These subgroups supported PTSD symptomatology as a means to subgroup veterans. Hierarchical models showed that GWI and levels of PTSD symptoms both impact measures of physical, social, and emotional consequences of poor health (ΔR2 = 0.055-0.316). However, GWI appeared to contribute more to fatigue measures. Cut-point analysis retained worse health outcomes across all measures for GWI with PTSD symptoms compared to those without PTSD symptoms, and healthy controls. Significant differences were observed in mental and emotional measures. CONCLUSIONS Therefore, this research supports the idea that comorbid GWI and PTSD symptoms lead to worse health outcomes, while demonstrating how GWI and PTSD symptoms may uniquely contribute to clinical presentation.
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Affiliation(s)
- Mary Jeffrey
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
- Department of Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, FL, USA
- Miami Veterans Affairs Medical Center, Miami, USA
| | | | - Jeffrey Kibler
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Christian DeLucia
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Steven Messer
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
- Miami Veterans Affairs Medical Center, Miami, USA
- Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Travis J A Craddock
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.
- Department of Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, FL, USA.
- Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, USA.
- Department of Computer Science, Nova Southeastern University, Fort Lauderdale, FL, USA.
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Bose D, Mondal A, Saha P, Kimono D, Sarkar S, Seth RK, Janulewicz P, Sullivan K, Horner R, Klimas N, Nagarkatti M, Nagarkatti P, Chatterjee S. TLR Antagonism by Sparstolonin B Alters Microbial Signature and Modulates Gastrointestinal and Neuronal Inflammation in Gulf War Illness Preclinical Model. Brain Sci 2020; 10:brainsci10080532. [PMID: 32784362 PMCID: PMC7463890 DOI: 10.3390/brainsci10080532] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 02/07/2023] Open
Abstract
The 1991 Persian Gulf War veterans presented a myriad of symptoms that ranged from chronic pain, fatigue, gastrointestinal disturbances, and cognitive deficits. Currently, no therapeutic regimen exists to treat the plethora of chronic symptoms though newer pharmacological targets such as microbiome have been identified recently. Toll-like receptor 4 (TLR4) antagonism in systemic inflammatory diseases have been tried before with limited success, but strategies with broad-spectrum TLR4 antagonists and their ability to modulate the host-microbiome have been elusive. Using a mouse model of Gulf War Illness, we show that a nutraceutical, derived from a Chinese herb Sparstolonin B (SsnB) presented a unique microbiome signature with an increased abundance of butyrogenic bacteria. SsnB administration restored a normal tight junction protein profile with an increase in Occludin and a parallel decrease in Claudin 2 and inflammatory mediators high mobility group box 1 (HMGB1), interleukin-1β (IL-1β), and interleukin-6 (IL-6) in the distal intestine. SsnB also decreased neuronal inflammation by decreasing IL-1β and HMGB1, while increasing brain-derived neurotrophic factor (BDNF), with a parallel decrease in astrocyte activation in vitro. Mechanistically, SsnB inhibited the binding of HMGB1 and myeloid differentiation primary response protein (MyD88) to TLR4 in the intestine, thus attenuating TLR4 downstream signaling. Studies also showed that SsnB was effective in suppressing TLR4-induced nod-like receptor protein 3 (NLRP3) inflammasome activation, a prominent inflammatory disease pathway. SsnB significantly decreased astrocyte activation by decreasing colocalization of glial fibrillary acid protein (GFAP) and S100 calcium-binding protein B (S100B), a crucial event in neuronal inflammation. Inactivation of SsnB by treating the parent molecule by acetate reversed the deactivation of NLRP3 inflammasome and astrocytes in vitro, suggesting that SsnB molecular motifs may be responsible for its anti-inflammatory activity.
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Affiliation(s)
- Dipro Bose
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (D.B.); (A.M.); (P.S.); (D.K.); (S.S.); (R.K.S.)
| | - Ayan Mondal
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (D.B.); (A.M.); (P.S.); (D.K.); (S.S.); (R.K.S.)
| | - Punnag Saha
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (D.B.); (A.M.); (P.S.); (D.K.); (S.S.); (R.K.S.)
| | - Diana Kimono
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (D.B.); (A.M.); (P.S.); (D.K.); (S.S.); (R.K.S.)
| | - Sutapa Sarkar
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (D.B.); (A.M.); (P.S.); (D.K.); (S.S.); (R.K.S.)
| | - Ratanesh K. Seth
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (D.B.); (A.M.); (P.S.); (D.K.); (S.S.); (R.K.S.)
| | - Patricia Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (P.J.); (K.S.)
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (P.J.); (K.S.)
| | - Ronnie Horner
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC 29208, USA;
| | - Nancy Klimas
- Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA;
- Miami VA Medical Center, Miami, FL 33125, USA
| | - Mitzi Nagarkatti
- Department of Pathology Microbiology and Immunology, USC School of Medicine, Columbia, SC 29209, USA; (M.N.); (P.N.)
| | - Prakash Nagarkatti
- Department of Pathology Microbiology and Immunology, USC School of Medicine, Columbia, SC 29209, USA; (M.N.); (P.N.)
| | - Saurabh Chatterjee
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; (D.B.); (A.M.); (P.S.); (D.K.); (S.S.); (R.K.S.)
- Columbia VA Medical Center, Columbia, SC 29209, USA
- Correspondence: ; Tel.: +1-803-777-8120; Fax: +1-803-777-3391
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Kimono D, Bose D, Seth RK, Mondal A, Saha P, Janulewicz P, Sullivan K, Lasley S, Horner R, Klimas N, Chatterjee S. Host Akkermansia muciniphila Abundance Correlates With Gulf War Illness Symptom Persistence via NLRP3-Mediated Neuroinflammation and Decreased Brain-Derived Neurotrophic Factor. Neurosci Insights 2020; 15:2633105520942480. [PMID: 32832901 PMCID: PMC7440889 DOI: 10.1177/2633105520942480] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/25/2020] [Indexed: 12/16/2022] Open
Abstract
Neurological disorders are commonly reported among veterans who returned from the Gulf war. Veterans who suffer from Gulf War illness (GWI) complain of continued symptom persistence that includes neurological disorders, muscle weakness, headaches, and memory loss, that developed during or shortly after the war. Our recent research showed that chemical exposure associated microbial dysbiosis accompanied by a leaky gut connected the pathologies in the intestine, liver, and brain. However, the mechanisms that caused the symptoms to persist even 30 years after the war remained elusive to investigators. In this study, we used a rodent model of GWI to investigate the persistence of microbiome alterations, resultant chronic inflammation, and its effect on neurotrophic and synaptic plasticity marker BDNF. The results showed that exposure to GW chemicals (the pesticide permethrin and prophylactic drug pyridostigmine bromide) resulted in persistent pathology characterized by the low relative abundance of the probiotic bacteria Akkermansia muciniphila in the gut, which correlated with high circulatory HMGB1 levels, blood-brain barrier dysfunction, neuroinflammation and lowered neurotrophin BDNF levels. Mechanistically, we used mice lacking the NLRP3 gene to investigate this inflammasome's role in observed pathology. These mice had significantly decreased inflammation and a subsequent increase in BDNF in the frontal cortex. This suggests that a persistently low species abundance of Akkermansia muciniphila and associated chronic inflammation due to inflammasome activation might be playing a significant role in contributing to chronic neurological problems in GWI. A therapeutic approach with various small molecules that can target both the restoration of a healthy microbiome and decreasing inflammasome activation might have better outcomes in treating GWI symptom persistence.
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Affiliation(s)
- Diana Kimono
- Environmental Health and Disease Laboratory, NIEHS Center for Oceans and Human Health on Climate Change Interactions, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, USA
| | - Dipro Bose
- Environmental Health and Disease Laboratory, NIEHS Center for Oceans and Human Health on Climate Change Interactions, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, USA
| | - Ratanesh K Seth
- Environmental Health and Disease Laboratory, NIEHS Center for Oceans and Human Health on Climate Change Interactions, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, USA
| | - Ayan Mondal
- Environmental Health and Disease Laboratory, NIEHS Center for Oceans and Human Health on Climate Change Interactions, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, USA
| | - Punnag Saha
- Environmental Health and Disease Laboratory, NIEHS Center for Oceans and Human Health on Climate Change Interactions, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, USA
| | - Patricia Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Stephen Lasley
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Ronnie Horner
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
| | - Nancy Klimas
- Department of Clinical Immunology, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Saurabh Chatterjee
- Environmental Health and Disease Laboratory, NIEHS Center for Oceans and Human Health on Climate Change Interactions, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, USA
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Cournoyer J, Balbin E, Leaks-Gutierrez P, Collado F, Freeman D, Tercero A, Klimas N. The Predictive Value Of The Sf-36 Questionnaire In Determining CPET Performance In Patients With ME/CFS. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000675296.08816.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sullivan K, Krengel M, Heboyan V, Schildroth S, Wilson CC, Iobst S, Klimas N, Coughlin SS. Prevalence and Patterns of Symptoms Among Female Veterans of the 1991 Gulf War Era: 25 Years Later. J Womens Health (Larchmt) 2020; 29:819-826. [DOI: 10.1089/jwh.2019.7705] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Vahé Heboyan
- Department of Interdisciplinary Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, Georgia
| | | | - Col Candy Wilson
- Uniformed Services University Graduate School of Nursing, Bethesda, Maryland
| | - Stacey Iobst
- Henry M. Jackson Foundation at the Uniformed Services University Graduate School of Nursing, Bethesda, Maryland
| | - Nancy Klimas
- Miami VA Healthcare System, Miami, Florida
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | - Steven S. Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia
- Research Service, Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia
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35
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Seth RK, Bose D, Saha P, Kimono D, Mondal A, Lloyd PJ, Klimas N, Horner RD, Sullivan K, Lim ES, Nagarkatti M, Nagarkatti PS, Chatterjee S. Altered Gut DNA virome diversity associated HMGB1 release regulates reactive Astrocytes-induced IL6 release preferably via TLR4-NFkB pathway in experimental Gulf War Illness. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.64.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
In a recent study, we showed that the gut DNA bacteriophage dysbiosis in Gulf War Illness (GWI) was strongly associated with compromised intestinal epithelial cell integrity, increased circulatory IL6 and neuroinflammation. The current study further investigates the mechanism of DNA bacteriophage-IL6 axis in neuroinflammation. Advancing the previous findings, we show that viral dysbiosis positively correlated with high mobility group box protein 1 (HMGB1; a damage-associated molecular pattern) expression and release in circulation following GWI induction in mice. The circulatory HMGB1 activated brain Astrocytes via altering brain endothelial tight junction proteins and crossing the blood-brain barrier. Interestingly, both in GWI mice and mouse primary Astrocytes cell culture showed an increased brain IL6 mRNA and subsequent protein expression. However, GWI mice treated with Ribavirin (used for partial gut viral sterility) showed decreased intestinal HMGB1 and brain IL6 expression. Mechanistically, HMGB1 activated innate immune response via IRAKs-IKKα-NFkB instead of either RAGE-MAPK or PI3K-mTOR pathway. Surprisingly, inhibition of RAGE or PI3K pathway in HMGB1 primed mouse Astrocyte cells showed a significant increase in IL6 expression and release suggesting NFkB activation as a preferential pathway in GWI-Astrocyte-induced IL6 release. In summary, GWI-associated gut viral dysbiosis associated intestinal HMGB1 release activates brain Astrocytes and IL6 release via toll-like receptor 4-NFkB dependent pathway, thus causing neuroinflammation in GWI. The above mechanism can form a basis for studying inflammation-associated neurocognitive abnormalities in GWI.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Efrem S Lim
- 4The Biodesign Institute, Arizona state University
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36
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Joshi U, Evans JE, Pearson A, Saltiel N, Cseresznye A, Darcey T, Ojo J, Keegan AP, Oberlin S, Mouzon B, Paris D, Klimas N, Sullivan K, Mullan M, Crawford F, Abdullah L. Targeting sirtuin activity with nicotinamide riboside reduces neuroinflammation in a GWI mouse model. Neurotoxicology 2020; 79:84-94. [PMID: 32343995 DOI: 10.1016/j.neuro.2020.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/26/2020] [Accepted: 04/20/2020] [Indexed: 12/15/2022]
Abstract
Gulf War Illness (GWI) affects 30% of veterans from the 1991 Gulf War (GW), who suffer from symptoms that reflect ongoing mitochondria dysfunction. Brain mitochondria bioenergetics dysfunction in GWI animal models corresponds with astroglia activation and neuroinflammation. In a pilot study of GW veterans (n = 43), we observed that blood nicotinamide adenine dinucleotide (NAD) and sirtuin 1 (Sirt1) protein levels were decreased in the blood of veterans with GWI compared to healthy GW veterans. Since nicotinamide riboside (NR)-mediated targeting of Sirt1 is shown to improve mitochondria function, we tested whether NR can restore brain bioenergetics and reduce neuroinflammation in a GWI mouse model. We administered a mouse diet supplemented with NR at 100μg/kg daily for 2-months to GWI and control mice (n = 27). During treatment, mice were assessed for fatigue-type behavior using the Forced Swim Test (FST), followed by euthanasia for biochemistry and immunohistochemistry analyses. Fatigue-type behavior was elevated in GWI mice compared to control mice and lower in GWI mice treated with NR compared to untreated GWI mice. Levels of plasma NAD and brain Sirt1 were low in untreated GWI mice, while GWI mice treated with NR had higher levels, similar to those of control mice. Deacetylation of the nuclear-factor κB (NFκB) p65 subunit and peroxisome proliferator-activated receptor gamma coactivator 1-α (PGC-1α) was an increase in the brains of NR-treated GWI mice. This corresponded with a decrease in pro-inflammatory cytokines and lipid peroxidation and an increase in markers of mitochondrial bioenergetics in the brains of GWI mice. These findings suggest that targeting NR mediated Sirt1 activation restores brain bioenergetics and reduces inflammation in GWI mice. Further evaluation of NR in GWI is warranted to determine its potential efficacy in treating GWI.
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Affiliation(s)
- Utsav Joshi
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, United States; Open University, Milton Keynes, United Kingdom; James A. Haley Veterans' Hospital, Tampa, Florida, United States
| | - James E Evans
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, United States; James A. Haley Veterans' Hospital, Tampa, Florida, United States
| | - Andrew Pearson
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, United States; Open University, Milton Keynes, United Kingdom; James A. Haley Veterans' Hospital, Tampa, Florida, United States
| | - Nicole Saltiel
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, United States; James A. Haley Veterans' Hospital, Tampa, Florida, United States
| | - Adam Cseresznye
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, United States; James A. Haley Veterans' Hospital, Tampa, Florida, United States
| | - Teresa Darcey
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, United States; James A. Haley Veterans' Hospital, Tampa, Florida, United States
| | - Joseph Ojo
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, United States; James A. Haley Veterans' Hospital, Tampa, Florida, United States
| | - Andrew P Keegan
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, United States; James A. Haley Veterans' Hospital, Tampa, Florida, United States
| | - Sarah Oberlin
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, United States
| | - Benoit Mouzon
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, United States; Open University, Milton Keynes, United Kingdom; James A. Haley Veterans' Hospital, Tampa, Florida, United States
| | - Daniel Paris
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, United States; Open University, Milton Keynes, United Kingdom; James A. Haley Veterans' Hospital, Tampa, Florida, United States
| | - Nancy Klimas
- Nova Southeastern University, Fort Lauderdale, United States
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States
| | - Michael Mullan
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, United States; Open University, Milton Keynes, United Kingdom
| | - Fiona Crawford
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, United States; Open University, Milton Keynes, United Kingdom; James A. Haley Veterans' Hospital, Tampa, Florida, United States
| | - Laila Abdullah
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, United States; Open University, Milton Keynes, United Kingdom; James A. Haley Veterans' Hospital, Tampa, Florida, United States.
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May M, Milrad SF, Perdomo DM, Czaja SJ, Fletcher MA, Jutagir DR, Hall DL, Klimas N, Antoni MH. Post-exertional malaise is associated with greater symptom burden and psychological distress in patients diagnosed with Chronic Fatigue Syndrome. J Psychosom Res 2020; 129:109893. [PMID: 31884303 PMCID: PMC7007968 DOI: 10.1016/j.jpsychores.2019.109893] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Post-exertional malaise (PEM) is often considered a cardinal symptom of Chronic Fatigue Syndrome (CFS). There is no gold standard diagnostic method for CFS, however, and the Centers for Disease Control (CDC) Fukuda case definition does not require PEM. Research has identified differences in symptom burden between patients according to PEM, but whether it is associated with psychological distress has not been investigated. METHODS The CDC CFS Inventory, Fatigue Symptom Inventory, Profile of Mood States, Center for Epidemiologic Studies Depression Scale, Perceived Stress Scale, and subscales of the Sickness Impact Profile were administered to 261 patients diagnosed with the Fukuda criteria. PEM status (loPEM/hiPEM) was determined via self-reported post-exertional fatigue severity. Analyses of covariance (ANCOVA), controlling for age and gender, assessed cross-sectional group differences, and cross-sectional linear regressions using the continuous PEM severity predictor paralleled these analyses. RESULTS hiPEM patients reported greater symptom intensity, frequency, and interference than loPEM counterparts (p's < .001). hiPEM patients also reported greater social disruption, depressive symptoms, and mood disturbance (p's ≤ .011). Groups did not differ in recent negative life experiences, perceived stress, or demographic variables. The results of regression analyses mirrored those of ANCOVAs. CONCLUSION This study replicates the association between PEM and symptom burden and additionally associates PEM with psychological distress; psychological distress could, however, be a consequence of symptom burden. Differences between hiPEM and loPEM CFS patients highlight the heterogeneity of diagnoses resulting from the Fukuda criteria. It is also possible that PEM identifies particularly distressed patients for whom psychological intervention would be most beneficial.
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Affiliation(s)
- Marcella May
- Department of Psychology, University of Miami, USA.
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Jaundoo R, Bohmann J, Gutierrez GE, Klimas N, Broderick G, Craddock TJA. Towards a Treatment for Gulf War Illness: A Consensus Docking Approach. Mil Med 2020; 185:554-561. [PMID: 32074351 PMCID: PMC7029833 DOI: 10.1093/milmed/usz299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction Gulf War Illness (GWI) currently has no known cure and affects soldiers deployed during the Persian Gulf War. It is thought to originate from exposure to neurotoxicants combined with battlefield stress, and previous research indicates that treatment first involves inhibition of interleukin-2 and tumor necrosis factor alpha, followed by the glucocorticoid receptor. However, the off-target effects of pharmaceuticals hinder development of a drug treatment therapy. Materials and Methods AutoDock 4.2, AutoDock Vina, and Schrodinger’s Glide were used to perform consensus docking, a computational technique where pharmaceuticals are screened against targets using multiple scoring algorithms to obtain consistent binding affinities. FDA approved pharmaceuticals were docked against the above-mentioned immune and stress targets to determine a drug therapy for GWI. Additionally, the androgen and estrogen targets were screened to avoid pharmaceuticals with off-target interactions. Results While suramin bound to both immune targets with high affinity, top binders of the hormonal and glucocorticoid targets were non-specific towards their respective proteins, possibly due to high structure similarity between these proteins. Conclusions Development of a drug treatment therapy for GWI is threatened by the tight interplay between the immune and hormonal systems, often leading to drug interactions. Increasing knowledge of these interactions can lead to break-through therapies.
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Affiliation(s)
- Rajeev Jaundoo
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Psychology & Neuroscience, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Clinical Immunology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796
| | - Jonathan Bohmann
- Pharmaceuticals and Bioengineering Department, Southwest Research Institute, 6220 Culebra Road, San Antonio, TX 78238-5166
| | - Gloria E Gutierrez
- Pharmaceuticals and Bioengineering, Chemistry and Chemical Engineering Division, Southwest Research Institute, 6220 Culebra Road, San Antonio, TX 78238-5166
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Clinical Immunology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Miami Veterans Affairs Medical Center, 1201 N.W. 16th Street, Miami, FL 33125
| | - Gordon Broderick
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Psychology & Neuroscience, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Clinical Immunology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Rochester Institute of Technology, One Lomb Memorial Drive, Rochester, NY 14623-5603.,Centre for Clinical Systems Biology, Rochester General Hospital Research Institute, 100 Kings Highway South, Rochester, NY 14617
| | - Travis J A Craddock
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Psychology & Neuroscience, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Clinical Immunology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Computer Science, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796
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Kimono D, Sarkar S, Albadrani M, Seth R, Bose D, Mondal A, Li Y, Kar AN, Nagarkatti M, Nagarkatti P, Sullivan K, Janulewicz P, Lasley S, Horner R, Klimas N, Chatterjee S. Dysbiosis-Associated Enteric Glial Cell Immune-Activation and Redox Imbalance Modulate Tight Junction Protein Expression in Gulf War Illness Pathology. Front Physiol 2019; 10:1229. [PMID: 31680990 PMCID: PMC6802578 DOI: 10.3389/fphys.2019.01229] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/09/2019] [Indexed: 12/19/2022] Open
Abstract
About 14% of veterans who suffer from Gulf war illness (GWI) complain of some form of gastrointestinal disorder but with no significant markers of clinical pathology. Our previous studies have shown that exposure to GW chemicals resulted in altered microbiome which was associated with damage associated molecular pattern (DAMP) release followed by neuro and gastrointestinal inflammation with loss of gut barrier integrity. Enteric glial cells (EGC) are emerging as important regulators of the gastrointestinal tract and have been observed to change to a reactive phenotype in several functional gastrointestinal disorders such as IBS and IBD. This study is aimed at investigating the role of dysbiosis associated EGC immune-activation and redox instability in contributing to observed gastrointestinal barrier integrity loss in GWI via altered tight junction protein expression. Using a mouse model of GWI and in vitro studies with cultured EGC and use of antibiotics to ensure gut decontamination we show that exposure to GW chemicals caused dysbiosis associated change in EGCs. EGCs changed to a reactive phenotype characterized by activation of TLR4-S100β/RAGE-iNOS pathway causing release of nitric oxide and activation of NOX2 since gut sterility with antibiotics prevented this change. The resulting peroxynitrite generation led to increased oxidative stress that triggered inflammation as shown by increased NLRP-3 inflammasome activation and increased cell death. Activated EGCs in vivo and in vitro were associated with decrease in tight junction protein occludin and selective water channel aquaporin-3 with a concomitant increase in Claudin-2. The tight junction protein levels were restored following a parallel treatment of GWI mice with a TLR4 inhibitor SsnB and butyric acid that are known to decrease the immunoactivation of EGCs. Our study demonstrates that immune-redox mechanisms in EGC are important players in the pathology in GWI and may be possible therapeutic targets for improving outcomes in GWI symptom persistence.
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Affiliation(s)
- Diana Kimono
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, United States
| | - Sutapa Sarkar
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, United States
| | - Muayad Albadrani
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, United States
| | - Ratanesh Seth
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, United States
| | - Dipro Bose
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, United States
| | - Ayan Mondal
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, United States
| | - Yuxi Li
- Department of Basic Medical Sciences, Nanjing Medical University, Nanjing, China
| | - Amar N. Kar
- Department of Biological Sciences, University of South Carolina, Columbia, SC, United States
| | - Mitzi Nagarkatti
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Prakash Nagarkatti
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Kimberly Sullivan
- Department of Environmental Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Patricia Janulewicz
- Department of Environmental Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Stephen Lasley
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States
| | - Ronnie Horner
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, United States
| | - Nancy Klimas
- Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Saurabh Chatterjee
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, United States
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40
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Janulewicz PA, Seth RK, Carlson JM, Ajama J, Quinn E, Heeren T, Klimas N, Lasley SM, Horner RD, Sullivan K, Chatterjee S. The Gut-Microbiome in Gulf War Veterans: A Preliminary Report. Int J Environ Res Public Health 2019; 16:E3751. [PMID: 31590322 PMCID: PMC6801913 DOI: 10.3390/ijerph16193751] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/17/2019] [Accepted: 10/01/2019] [Indexed: 01/07/2023]
Abstract
Gulf War Illness (GWI) is a chronic multi-symptom disorder affecting the central nervous system (CNS), immune and gastrointestinal (GI) systems of Gulf War veterans (GWV). We assessed the relationships between GWI, GI symptoms, gut microbiome and inflammatory markers in GWV from the Boston Gulf War Illness Consortium (GWIC). Three groups of GWIC veterans were recruited in this pilot study; GWV without GWI and no gastrointestinal symptoms (controls), GWV with GWI and no gastrointestinal symptoms (GWI-GI), GWV with GWI who reported gastrointestinal symptoms (GW+GI). Here we report on a subset of the first thirteen stool samples analyzed. Results showed significantly different gut microbiome patterns among the three groups and within the GWI +/-GI groups. Specifically, GW controls had a greater abundance of firmicutes and the GWI+GI group had a greater abundance of the phyla bacteroidetes, actinobacteria, euryarchaeota, and proteobacteria as well as higher abundances of the families Bacteroidaceae, Erysipelotrichaceae, and Bifidobacteriaceae. The GWI+GI group also showed greater plasma levels of the inflammatory cytokine TNF-RI and they endorsed significantly more chemical weapons exposure during the war and reported significantly greater chronic pain, fatigue and sleep difficulties than the other groups. Studies with larger samples sizes are needed to confirm these initial findings.
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Affiliation(s)
- Patricia A Janulewicz
- Environmental Health Department, Boston University School of Public Health, Boston, MA 02118, USA.
| | - Ratanesh K Seth
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Jeffrey M Carlson
- Environmental Health Department, Boston University School of Public Health, Boston, MA 02118, USA
| | - Joy Ajama
- Environmental Health Department, Boston University School of Public Health, Boston, MA 02118, USA
| | - Emily Quinn
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA 02118, USA
| | - Timothy Heeren
- Biostatistics Department, Boston University School of Public Health, Boston, MA 02118, USA
| | - Nancy Klimas
- Department of Clinical Immunology, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328, USA
| | - Steven M Lasley
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine Peoria, Peoria, IL 61605, USA
| | - Ronnie D Horner
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Kimberly Sullivan
- Environmental Health Department, Boston University School of Public Health, Boston, MA 02118, USA
| | - Saurabh Chatterjee
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
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41
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Joshi U, Pearson A, Evans JE, Langlois H, Saltiel N, Ojo J, Klimas N, Sullivan K, Keegan AP, Oberlin S, Darcey T, Cseresznye A, Raya B, Paris D, Hammock B, Vasylieva N, Hongsibsong S, Stern LJ, Crawford F, Mullan M, Abdullah L. A permethrin metabolite is associated with adaptive immune responses in Gulf War Illness. Brain Behav Immun 2019; 81:545-559. [PMID: 31325531 PMCID: PMC7155744 DOI: 10.1016/j.bbi.2019.07.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/17/2019] [Accepted: 07/11/2019] [Indexed: 10/31/2022] Open
Abstract
Gulf War Illness (GWI), affecting 30% of veterans from the 1991 Gulf War (GW), is a multi-symptom illness with features similar to those of patients with autoimmune diseases. The objective of the current work is to determine if exposure to GW-related pesticides, such as permethrin (PER), activates peripheral and central nervous system (CNS) adaptive immune responses. In the current study, we focused on a PER metabolite, 3-phenoxybenzoic acid (3-PBA), as this is a common metabolite previously shown to form adducts with endogenous proteins. We observed the presence of 3-PBA and 3-PBA modified lysine of protein peptides in the brain, blood and liver of pyridostigmine bromide (PB) and PER (PB+PER) exposed mice at acute and chronic post-exposure timepoints. We tested whether 3-PBA-haptenated albumin (3-PBA-albumin) can activate immune cells since it is known that chemically haptenated proteins can stimulate immune responses. We detected autoantibodies against 3-PBA-albumin in plasma from PB + PER exposed mice and veterans with GWI at chronic post-exposure timepoints. We also observed that in vitro treatment of blood with 3-PBA-albumin resulted in the activation of B- and T-helper lymphocytes and that these immune cells were also increased in blood of PB + PER exposed mice and veterans with GWI. These immune changes corresponded with elevated levels of infiltrating monocytes in the brain and blood of PB + PER exposed mice which coincided with alterations in the markers of blood-brain barrier disruption, brain macrophages and neuroinflammation. These studies suggest that pesticide exposure associated with GWI may have resulted in the activation of the peripheral and CNS adaptive immune responses, possibly contributing to an autoimmune-type phenotype in veterans with GWI.
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Affiliation(s)
- Utsav Joshi
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, USA,Open University, Milton Keynes, UK,James A. Haley VA Hospital, Tampa, FL, USA
| | - Andrew Pearson
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, USA,Open University, Milton Keynes, UK,James A. Haley VA Hospital, Tampa, FL, USA
| | - James E. Evans
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, USA,James A. Haley VA Hospital, Tampa, FL, USA
| | - Heather Langlois
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, USA,James A. Haley VA Hospital, Tampa, FL, USA
| | - Nicole Saltiel
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, USA,James A. Haley VA Hospital, Tampa, FL, USA
| | - Joseph Ojo
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, USA,Open University, Milton Keynes, UK,James A. Haley VA Hospital, Tampa, FL, USA
| | - Nancy Klimas
- NOVA Southeastern University, Ft. Lauderdale, FL, USA,Miami VAMC, Miami, FL, USA
| | | | | | - Sarah Oberlin
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, USA,James A. Haley VA Hospital, Tampa, FL, USA
| | - Teresa Darcey
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, USA,James A. Haley VA Hospital, Tampa, FL, USA
| | - Adam Cseresznye
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, USA,James A. Haley VA Hospital, Tampa, FL, USA
| | - Balaram Raya
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, USA,James A. Haley VA Hospital, Tampa, FL, USA
| | - Daniel Paris
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, USA,Open University, Milton Keynes, UK,James A. Haley VA Hospital, Tampa, FL, USA
| | - Bruce Hammock
- Department of Entomology and Nematology, UCD Comprehensive Cancer Center, University of California Davis, Davis, CA, USA
| | - Natalia Vasylieva
- Department of Entomology and Nematology, UCD Comprehensive Cancer Center, University of California Davis, Davis, CA, USA
| | - Surat Hongsibsong
- Environment and Health Research Unit, Research Institute for Health Science, Chiang Mai University, Chiang, Thailand
| | - Lawrence J. Stern
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA, USA,Department of Pathology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Fiona Crawford
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, USA,Open University, Milton Keynes, UK,James A. Haley VA Hospital, Tampa, FL, USA
| | - Michael Mullan
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, USA,Open University, Milton Keynes, UK,James A. Haley VA Hospital, Tampa, FL, USA
| | - Laila Abdullah
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, USA; Open University, Milton Keynes, UK; James A. Haley VA Hospital, Tampa, FL, USA.
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42
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McIntosh R, Antoni M, Seay J, Fletcher MA, Ironson G, Klimas N, Kumar M, Schneiderman N. Associations Among Trajectories of Sleep Disturbance, Depressive Symptomology and 24-Hour Urinary Cortisol in HIV+ Women Following a Stress Management Intervention. Behav Sleep Med 2019; 17:605-620. [PMID: 29461096 DOI: 10.1080/15402002.2018.1435545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: The burden of sleep disturbance and depressive symptomology is high for persons living with HIV and particularly so for women. While cognitive behavioral stress management (CBSM) is shown to reduce symptoms of depression and 24-hr urinary free cortisol output (CORT) in HIV+ men, less is known about the effects of CBSM on mood and concomitant sleep disturbance in HIV+ women. The study aim is to model longitudinal change in sleep disturbance, depressive symptomology, and CORT for HIV+ women exposed to a 12-week CBSM intervention or control condition. Methods: Self-reported sleep quality and depressive symptomology, along with CORT, was collected from surveys at baseline and approximately every three months thereafter for nine months from 130 HIV+ women (Mage = 38.44, SD = 7.73). The data was used to specify a parallel process latent growth model with CORT as a time-varying covariate. Results: The model showed acceptable fit. There was a linear decline in sleep disturbance (β = -0.32, p < .05) and logarithmic decline in depressive symptomology (β = -0.33, p < .05) for those receiving the intervention. Decline in sleep disturbance predicted lower CORT at nine months. Furthermore, having less depressive symptoms at baseline was associated with lower initial levels of sleep disturbance and greater improvement in sleep quality over time. There was no discernible association between sleep and mood disturbance in the control group. Across groups, there was a consistent association between older age and greater sleep disturbance (r = 0.34, p < .01). Conclusion: Sleep disturbance appears to be a behavioral target for CBSM in HIV+ women although older age, preintervention levels of depressive mood, and time-varying levels of CORT output may limit improvement in sleep quality over time.
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Affiliation(s)
- Roger McIntosh
- a Department of Psychology, University of Miami , Coral Gables , Florida , USA
| | - Michael Antoni
- a Department of Psychology, University of Miami , Coral Gables , Florida , USA.,b Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami , Miami , Florida , USA.,e Departments of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Julia Seay
- b Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami , Miami , Florida , USA
| | - Mary Ann Fletcher
- c Miami Veterans Affairs Medical Center , Miami , Florida , USA.,d Institute for Neuro-immune Medicine, Nova Southeastern University , Davie , Florida , USA
| | - Gail Ironson
- a Department of Psychology, University of Miami , Coral Gables , Florida , USA
| | - Nancy Klimas
- c Miami Veterans Affairs Medical Center , Miami , Florida , USA.,d Institute for Neuro-immune Medicine, Nova Southeastern University , Davie , Florida , USA
| | - Mahendra Kumar
- e Departments of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Neil Schneiderman
- a Department of Psychology, University of Miami , Coral Gables , Florida , USA.,c Miami Veterans Affairs Medical Center , Miami , Florida , USA.,f Behavioral Medicine Research Center, Miller School of Medicine, University of Miami , Miami , Florida , USA
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43
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Joshi U, Evans JE, Joseph R, Emmerich T, Saltiel N, Lungmus C, Oberlin S, Langlois H, Ojo J, Mouzon B, Paris D, Mullan M, Jin C, Klimas N, Sullivan K, Crawford F, Abdullah L. Author Correction: Oleoylethanolamide treatment reduces neurobehavioral deficits and brain pathology in a mouse model of Gulf War Illness. Sci Rep 2019; 9:11011. [PMID: 31337781 PMCID: PMC6650485 DOI: 10.1038/s41598-019-46255-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Utsav Joshi
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA. .,Open University, Milton Keynes, United Kingdom. .,James A. Haley Veterans' Hospital, Tampa, Florida, USA.
| | - James E Evans
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Ross Joseph
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Tanja Emmerich
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Nicole Saltiel
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Carlyn Lungmus
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Sarah Oberlin
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA
| | - Heather Langlois
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Joseph Ojo
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,Open University, Milton Keynes, United Kingdom
| | - Benoit Mouzon
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Daniel Paris
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Michael Mullan
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Chao Jin
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA
| | - Nancy Klimas
- NOVA Southeastern University, Ft. Lauderdale, FL, USA.,Miami VAMC, Miami, FL, USA
| | | | - Fiona Crawford
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Laila Abdullah
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL, 34243, USA.,Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, Florida, USA
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44
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Milrad SF, Hall DL, Jutagir DR, Lattie EG, Czaja SJ, Perdomo DM, Ironson G, Doss BD, Mendez A, Fletcher MA, Klimas N, Antoni MH. Relationship satisfaction, communication self-efficacy, and chronic fatigue syndrome-related fatigue. Soc Sci Med 2019; 237:112392. [PMID: 31377502 DOI: 10.1016/j.socscimed.2019.112392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 05/21/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
Abstract
RATIONALE Relationship dissatisfaction has been linked with worse health outcomes in many patient populations, though the mechanism(s) underlying this effect are unclear. Among patients with chronic fatigue syndrome (CFS) and their partners, there is evidence for a bi-directional association between poorer relationship satisfaction and the severity of CFS-related fatigue. OBJECTIVE Here, we hypothesized that relationship dissatisfaction negatively impacts fatigue severity through greater depression and less patient satisfaction about communication about symptoms to partners. METHOD Baseline data were drawn from diagnosed CFS patients (N = 150) participating in a trial testing the efficacy of a stress management intervention. Data derived from fatigue severity (Fatigue Symptom Index, FSI), depression (Center for Epidemiologic Survey-Depression, CES-D), relationship quality (Dyadic Adjustment Scale, DAS) and communication satisfaction (Patient Symptom Disclosure Satisfaction, PSDS) questionnaires were used for bootstrapped indirect effect analyses using parallel mediation structural equation modeling in Mplus (v8). Age and BMI were entered as covariates. RESULTS Greater relationship satisfaction predicted greater communication satisfaction (p < 0.01) and lower CES-D scores (p < 0.01), which in turn were each significantly related to greater fatigue severity (p < 0.05). Tests of the indirect paths indicated that relationship satisfaction had a significant effect on fatigue severity through both constructs, but primarily via depression. There was no direct association between relationship satisfaction and fatigue severity after the intermediate variables (depression, communication satisfaction) were included in the model. CONCLUSION Results highlight the importance of considering depression and communication-related factors when examining the effects of relationship satisfaction on CFS symptoms such as fatigue. Further mechanism-based, longitudinal research might identify relationship-related mediating variables that can be targeted therapeutically.
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Affiliation(s)
| | - Daniel L Hall
- Department of Psychiatry, Massachusetts General Hospital/ Harvard Medical School, USA
| | - Devika R Jutagir
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, USA
| | - Emily G Lattie
- Department of Medical Social Sciences, Northwestern University, Chicago IL, USA
| | - Sara J Czaja
- Department of Psychiatry and Behavioral Sciences, University of Miami, USA
| | - Dolores M Perdomo
- Department of Psychiatry and Behavioral Sciences, University of Miami, USA
| | - Gail Ironson
- Department of Psychology, University of Miami, USA
| | - Brian D Doss
- Department of Psychology, University of Miami, USA
| | | | - Mary Ann Fletcher
- Institute for Neuro Immune Medicine, Nova Southeastern University, USA
| | - Nancy Klimas
- Institute for Neuro Immune Medicine, Nova Southeastern University, USA
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45
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Coughlin SS, Heboyan V, Sullivan K, Krengel M, Wilson CC, Iobst S, Klimas N. Cardiovascular Disease among Female Veterans of the 1991 Gulf War Era. ACTA ACUST UNITED AC 2019; 5:24-25. [PMID: 31403084 PMCID: PMC6688166 DOI: 10.15436/2378-6841.19.2455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA.,Research Service, Charlie Norwood Veterans Administration Medical Center, Augusta, GA
| | - Vahe Heboyan
- Department of Interdisciplinary Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA
| | | | | | - Col Candy Wilson
- Uniformed Services University Graduate School of Nursing, Bethesda, MD
| | - Stacey Iobst
- Henry M. Jackson Foundation at the Uniformed Services University Graduate School of Nursing, Bethesda, MD
| | - Nancy Klimas
- Miami VA Healthcare System, Miami, FL.,Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
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46
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Hall DL, Lattie EG, Milrad SF, Czaja S, Fletcher MA, Klimas N, Perdomo D, Antoni MH. Telephone-administered versus live group cognitive behavioral stress management for adults with CFS. J Psychosom Res 2017; 93:41-47. [PMID: 28107891 PMCID: PMC5270375 DOI: 10.1016/j.jpsychores.2016.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 10/12/2016] [Accepted: 12/03/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Chronic fatigue syndrome (CFS) symptoms have been shown to be exacerbated by stress and ameliorated by group-based psychosocial interventions such as cognitive behavioral stress management (CBSM). Still, patients may have difficulty attending face-to-face groups. This study compared the effects of a telephone-delivered (T-CBSM) vs a live (L-CBSM) group on perceived stress and symptomology in adults with CFS. METHODS Intervention data from 100 patients with CFS (mean age 50years; 90% female) participating in T-CBSM (N=56) or L-CBSM (N=44) in previously conducted randomized clinical trials were obtained. Perceived Stress Scale (PSS) and the Centers for Disease Control and Prevention symptom checklist scores were compared with repeated measures analyses of variance in adjusted and unadjusted analyses. RESULTS Participants across groups showed no differences in most demographic and illness variables at study entry and had similar session attendance. Both conditions showed significant reductions in PSS scores, with L-CBSM showing a large effect (partial ε2=0.16) and T-CBSM a medium effect (partial ε2=0.095). For CFS symptom frequency and severity scores, L-CBSM reported large effect size improvements (partial ε2=0.19-0.23), while T-CBSM showed no significant changes over time. CONCLUSIONS Two different formats for delivering group-based CBSM-live and telephone-showed reductions in perceived stress among patients with CFS. However, only the live format was associated with physical symptom improvements, with specific effects on post-exertional malaise, chills, fever, and restful sleep. The added value of the live group format is discussed, along with implications for future technology-facilitated group interventions in this population.
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Affiliation(s)
- Daniel L. Hall
- Department of Psychology, University of Miami, Coral Gables, FL, USA,Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA,Corresponding Author Information: Daniel L. Hall, PhD, Massachusetts General Hospital/Harvard Medical School, Department of Psychiatry, One Bowdoin Square, 7th Floor, Boston, MA 02114, , Phone: (617) 724-6300 ext. 111-133-1766, Fax: (617) 724-8690
| | - Emily G. Lattie
- Department of Psychology, University of Miami, Coral Gables, FL, USA,Center for Behavioral Intervention Technologies (CBITs), Northwestern University, Chicago, IL USA
| | - Sara F. Milrad
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Sara Czaja
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA
| | - Mary Ann Fletcher
- Institute for Neuro Immune Medicine, Nova Southeastern University, Davie, FL, USA
| | - Nancy Klimas
- Institute for Neuro Immune Medicine, Nova Southeastern University, Davie, FL, USA
| | - Dolores Perdomo
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA
| | - Michael H. Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, USA,Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA
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Milrad SF, Hall DL, Jutagir DR, Lattie EG, Ironson GH, Wohlgemuth W, Nunez MV, Garcia L, Czaja SJ, Perdomo DM, Fletcher MA, Klimas N, Antoni MH. Poor sleep quality is associated with greater circulating pro-inflammatory cytokines and severity and frequency of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) symptoms in women. J Neuroimmunol 2016; 303:43-50. [PMID: 28038892 DOI: 10.1016/j.jneuroim.2016.12.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 12/07/2016] [Accepted: 12/12/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Poor sleep quality has been linked to inflammatory processes and worse disease outcomes in the context of many chronic illnesses, but less is known in conditions such as chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). This study examines the relationships between sleep quality, pro-inflammatory cytokines, and CFS/ME symptoms. METHODS Sixty women diagnosed with CFS/ME were assessed using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Symptom Inventory (FSI) and Center for Disease Control and Prevention (CDC)-based CFS/ME symptom questionnaires. Circulating plasma pro-inflammatory cytokine levels were measured by ELISA. Multiple regression analyses examined associations between sleep, cytokines and symptoms, controlling for age, education, and body mass index. RESULTS Poor sleep quality (PSQI global score) was associated with greater pro-inflammatory cytokine levels: interleukin-1β (IL-1β) (β=0.258, p=0.043), IL-6 (β=0.281, p=0.033), and tumor necrosis factor-alpha (TNF-α) (β=0.263, p=0.044). Worse sleep quality related to greater fatigue severity (β=0.395, p=0.003) and fatigue-related interference with daily activities (β=0.464, p<0.001), and more severe and frequent CDC-defined core CFS/ME symptoms (β=0.499, p<0.001, and β=0.556, p<0.001, respectively). CONCLUSIONS Results underscore the importance of managing sleep-related difficulties in this patient population. Further research is needed to identify the etiology of sleep disruptions in CFS/ME and mechanistic factors linking sleep quality to symptom severity and inflammatory processes.
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Affiliation(s)
- Sara F Milrad
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Miami, FL 33133, USA
| | - Daniel L Hall
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA
| | - Devika R Jutagir
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Miami, FL 33133, USA
| | - Emily G Lattie
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr. Suite 1400, Chicago, IL 60611, USA
| | - Gail H Ironson
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Miami, FL 33133, USA
| | - William Wohlgemuth
- Department of Sleep Medicine, Miami Veteran Affairs Hospital, 1201 NW 16th St, Miami, FL 33125, USA
| | - Maria Vera Nunez
- Institute for Neuro Immune Medicine, Nova Southeastern University, 8501 SW 124th Ave #111, Miami, FL 33183, USA
| | - Lina Garcia
- Department of Psychiatry and Behavioral Sciences, University of Miami, 1120 NW 14th St., Miami, FL 33136, USA
| | - Sara J Czaja
- Department of Psychiatry and Behavioral Sciences, University of Miami, 1120 NW 14th St., Miami, FL 33136, USA
| | - Dolores M Perdomo
- Department of Psychiatry and Behavioral Sciences, University of Miami, 1120 NW 14th St., Miami, FL 33136, USA
| | - Mary Ann Fletcher
- Institute for Neuro Immune Medicine, Nova Southeastern University, 8501 SW 124th Ave #111, Miami, FL 33183, USA
| | - Nancy Klimas
- Institute for Neuro Immune Medicine, Nova Southeastern University, 8501 SW 124th Ave #111, Miami, FL 33183, USA
| | - Michael H Antoni
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Miami, FL 33133, USA.
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48
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Abdullah L, Evans JE, Joshi U, Crynen G, Reed J, Mouzon B, Baumann S, Montague H, Zakirova Z, Emmerich T, Bachmeier C, Klimas N, Sullivan K, Mullan M, Ait-Ghezala G, Crawford F. Translational potential of long-term decreases in mitochondrial lipids in a mouse model of Gulf War Illness. Toxicology 2016; 372:22-33. [DOI: 10.1016/j.tox.2016.10.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/19/2016] [Accepted: 10/27/2016] [Indexed: 11/26/2022]
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49
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Sobieska M, Laudańska-Krzemińska I, Walczak A, Klimas N, Kroll P, Gajewska E. Acute phase proteins disturbances indicate uncompensated obesity declining physical fitness. Eur Rev Med Pharmacol Sci 2016; 20:2382-2388. [PMID: 27338065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The correlation between physical fitness and health indicators still requires a research aimed at improving the knowledge about physical fitness and the impact of obesity on the health status in children and adolescents. The aim of this study is an analysis of the results of the EUROFIT battery tests in relation to routine laboratory parameters and the inflammation markers. PATIENTS AND METHODS In the group of 123 Polish adolescents the routine parameters of lipid metabolism and acute phase proteins were investigated, and compared with EUROFIT motor fitness tests results, expressed as percentiles of the results achieved by healthy Polish population. RESULTS Most of the EUROFIT tests battery were performed by overweight adolescent girls on an insufficient level. Children who were described by parameters indicating more advanced obesity performed the EUROFIT tests worse. There was showed a negative correlation between the concentration of HDL cholesterol and the long jump (rho=-0.304) as well as with the speed of limb movement (rho=-0.277). There was a positive correlation between the speed of limb movement and the concentration of triglycerides (rho=0.335), LDL cholesterol (rho=0.305) and the percentage of the A4 (rho=0.239). CONCLUSIONS Disturbed lipid parameters, as well as altered glycosylation profiles of acute phase proteins, were observed in all overweight children, and the intensity of alterations correlated with worse fitness.
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Affiliation(s)
- M Sobieska
- Chair for Rheumatology and Rehabilitation, Poznań University of Medical Sciences, Poland.
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50
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White RF, Steele L, O'Callaghan JP, Sullivan K, Binns JH, Golomb BA, Bloom FE, Bunker JA, Crawford F, Graves JC, Hardie A, Klimas N, Knox M, Meggs WJ, Melling J, Philbert MA, Grashow R. Recent research on Gulf War illness and other health problems in veterans of the 1991 Gulf War: Effects of toxicant exposures during deployment. Cortex 2015; 74:449-75. [PMID: 26493934 PMCID: PMC4724528 DOI: 10.1016/j.cortex.2015.08.022] [Citation(s) in RCA: 278] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 08/19/2015] [Accepted: 08/28/2015] [Indexed: 11/01/2022]
Abstract
Veterans of Operation Desert Storm/Desert Shield - the 1991 Gulf War (GW) - are a unique population who returned from theater with multiple health complaints and disorders. Studies in the U.S. and elsewhere have consistently concluded that approximately 25-32% of this population suffers from a disorder characterized by symptoms that vary somewhat among individuals and include fatigue, headaches, cognitive dysfunction, musculoskeletal pain, and respiratory, gastrointestinal and dermatologic complaints. Gulf War illness (GWI) is the term used to describe this disorder. In addition, brain cancer occurs at increased rates in subgroups of GW veterans, as do neuropsychological and brain imaging abnormalities. Chemical exposures have become the focus of etiologic GWI research because nervous system symptoms are prominent and many neurotoxicants were present in theater, including organophosphates (OPs), carbamates, and other pesticides; sarin/cyclosarin nerve agents, and pyridostigmine bromide (PB) medications used as prophylaxis against chemical warfare attacks. Psychiatric etiologies have been ruled out. This paper reviews the recent literature on the health of 1991 GW veterans, focusing particularly on the central nervous system and on effects of toxicant exposures. In addition, it emphasizes research published since 2008, following on an exhaustive review that was published in that year that summarizes the prior literature (RACGWI, 2008). We conclude that exposure to pesticides and/or to PB are causally associated with GWI and the neurological dysfunction in GW veterans. Exposure to sarin and cyclosarin and to oil well fire emissions are also associated with neurologically based health effects, though their contribution to development of the disorder known as GWI is less clear. Gene-environment interactions are likely to have contributed to development of GWI in deployed veterans. The health consequences of chemical exposures in the GW and other conflicts have been called "toxic wounds" by veterans. This type of injury requires further study and concentrated treatment research efforts that may also benefit other occupational groups with similar exposure-related illnesses.
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Affiliation(s)
- Roberta F White
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States.
| | - Lea Steele
- Baylor University Institute of Biomedical Studies, Waco, TX, United States.
| | - James P O'Callaghan
- Molecular Neurotoxicology, Toxicology & Molecular Biology Branch (MS-3014), Health Effects Laboratory Division, Centers for Disease Control and Prevention - NIOSH, Morgantown, WV, United States.
| | - Kimberly Sullivan
- Boston University School of Public Health, Department of Environmental Health, Boston, MA, United States.
| | - James H Binns
- Research Advisory Committee on Gulf War Veterans' Illnesses, Phoenix, AZ, United States.
| | | | - Floyd E Bloom
- Molecular & Integrative Neuroscience Department, The Scripps Research Institute, La Jolla, CA, United States.
| | - James A Bunker
- National Gulf War Resource Center, Topeka, KS, United States.
| | - Fiona Crawford
- Director, TBI Research Program, Roskamp Institute, Sarasota, FL, United States.
| | - Joel C Graves
- Captain, U.S. Army, Retired, Crestview, FL, United States.
| | - Anthony Hardie
- Veterans for Common Sense, Bradenton, FL, United States.
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Miami, FL, United States.
| | - Marguerite Knox
- McEntire Joint National Guard Base, Eastover, SC, United States.
| | - William J Meggs
- Department of Emergency Medicine, 3ED311, The Brody School of Medicine, East Carolina University School of Medicine, Greenville, NC, United States.
| | - Jack Melling
- U.S. Government Accountability Office, Salisbury, Wiltshire, UK.
| | | | - Rachel Grashow
- Northeastern University, Department of Civil and Environmental Engineering, Boston, MA, United States.
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