This new study was funded by the treatment-focused Gulf War Illness Research Program (GWIRP), part of the Congressionally Directed Medical Research Program (CDMRP) funded by Congress within the U.S. Department of Defense.
SOURCE: ScienceDaily, by the University of Georgia, Feb. 27, 2017
New study tests potential treatment to combat Gulf War Illness
February 27, 2017
University of Georgia
An estimated 25 percent of the 700,000 troops who engaged in the fierce battles of Operation Desert Storm and related Gulf War combat during 1990-91 are fighting a different, but relentless foe: Gulf War illness. A new study tests potential treatment to combat Gulf War illness.
Nick Filipov is an associate professor in the department of physiology and pharmacology in the University of Georgia's College of Veterinary Medicine.
Credit: Amy Ware
An estimated 25 percent of the 700,000 troops who engaged in the fierce battles of Operation Desert Storm and related Gulf War combat during 1990-91 are fighting a different, but relentless foe: Gulf War illness.
"Substantial cognitive, learning and motor deficits are among the most profound and debilitating effects of Gulf War illness," said Nick Filipov, associate professor in the department of physiology and pharmacology in the University of Georgia's College of Veterinary Medicine. Other symptoms include extensive pain, headache, fatigue, breathing problems, gastrointestinal issues and skin abnormalities.
While there is some debate on Gulf War illness's causes, research indicates that soldiers participating in the war experienced unprecedented exposures to pesticides, nerve-agents and other chemicals, which combined with the stresses of war, are likely to blame for the illness.
But, said Filipov, "The most pressing issue is that veterans with Gulf War illness are growing older, so the cognitive symptoms will be amplified as age takes a toll on the brain."
Now, funded by a $750,000 grant from the U.S. Department of Defense, Filipov and colleagues are testing a potential treatment that may allow these veterans to fight back.
"A major research interest of mine is how the brain and the immune system function and malfunction in health and disease," said Filipov, who also studies Parkinson's and other neurological diseases with ties to environmental contaminants. "There's increasing evidence that the immune system is dysfunctional in the veterans with Gulf War illness, and perhaps neuroinflammation plays an important part in the manifestations of the disease."
Other members of the research team include John Wagner, professor in the department of physiology and pharmacology, and Don Harn, professor in the department of infectious diseases.
The researchers will administer a novel sugar-based molecule developed by Harn to mice with exposures similar to those of veterans with Gulf War illness. This molecule, which is likely safe because it's found in human milk, has already been tested in a disease model for multiple sclerosis. The investigators expect to reduce or improve Gulf War illness-associated cognitive decline by restoring the immune system's function and mitigating inflammation in the brain.
The study will look at two established models of Gulf War illness: one that involves timed exposures to a pesticide and the anti-nerve gas medication given to Gulf troops, and a second model that incorporates exposure to a nerve gas surrogate, the chemical insect repellent DEET, and stress, in addition to the same exposures as the first group. The researchers will analyze the exposures' immediate effects and administer treatment several months after all exposures have ended.
"Just as Gulf War veterans are being treated for their illness years after they were exposed to chemicals during the war, the mice in our study will experience a delay before they are treated," Filipov said.
The researchers will assess the treatment's effectiveness in improving brain function and restoring the immune system through behavioral, cellular and molecular testing. Results are expected in approximately two years.
Interested Gulf War veterans should call the phone number listed on the flyer above, or may email Lois Davis at the Roskamp Institute at email@example.com.
This project is funded by the treatment-focused Gulf War Illness Research Program (GWIRP), part of the Congressionally Directed Medical Research Programs (CDMRP) funded under Defense Health programs. More information about this project, funded in Fiscal Year 2015 (FY15), is available at: http://cdmrp.army.mil/search.aspx?LOG_NO=GW150056.
This project is in collaboration with the GWIRP-funded Gulf War Illness Consortium at Boston University. More information about the GWIC is available at: http://sites.bu.edu/gwic/ The GWIC is currently recruiting both healthy 1991 Gulf War veterans and 1991 Gulf War veterans with Gulf War Illness at project sites in Boston, Miami, and Houston.
PHOENIX (CN) – The Ninth Circuit ruled Friday that Maricopa County Sheriff Joe Arpaio’s detention officers must face excessive-force claims in the death of a mentally ill Army veteran.
The officers asked a three-judge panel of the Ninth Circuit last month to grant them qualified immunityfrom a wrongful death lawsuit filed by the family of Ernest “Marty” Atencio, a 44-year-old Gulf War veteran with schizoaffective disorder.
Atencio was arrested in 2011 for allegedly kicking in a woman’s door and was taken to the Fourth Avenue Jail, run by Arpaio.
According to court records, officers described Atencio as “humorous and jovial” while having his mugshot taken, but his behavior shifted once he was moved to a “linescan” room.
In an incident partially caught on videotape, Officer Nicholas French used a chokehold on Atencio, and a number of officers formed a “dog pile” on top of the man after he refused commands to take off his shoes. Sgt. Jason Weiers used a Taser on him three times while he was held down, and Officer Anthony Hatton delivered a number of strikes to Atencio’s face.
Atencio was moved to a cell after the incident, where he was later found unconscious. He died at a hospital.
“Viewing the evidence in the light most favorable to Atencio, including the available video evidence, several of defendants’ acts could be found by a jury to constitute excessive force,” the panel ruled in a memorandum order issued Friday.
The three officers should have known they were “prohibited from the type and amount of force used against Atencio, including multiple strikes to the face, repeated tasering, and a knee strike, when Atencio was at most passively resisting, he posed no threat to the officers, and he was already being physically restrained by several officers,” the panel found.
Ninth Circuit Judges Richard Clifton and Paul Watford sat on the panel. They were joined by Circuit Judge Michael Melloy, sitting by designation from the Eighth Circuit.
“Today the Ninth Circuit found that there is evidence showing law enforcement officers, from both the city of Phoenix and Maricopa County, used excessive force against a United States Army Veteran – Marty Atencio,” Larry Wulkan, an attorney for the Atencio family, said in a statement. “While the Atencio family mourns the loss of Marty each and every day, they look forward to presenting Marty’s case to a jury so that justice may be served and, hopefully, others are not subject to the brutal treatment that resulted in Marty’s death.”
The ruling mostly affirms a decision last year by U.S. District Judge Paul Rosenblatt that the detention officers involved in Atencio’s death do not have immunity.
“There is a genuine factual dispute as to whether these officers were integral participants in the use of excessive force in the linescan room and/or the safe cell, as well as whether these officers violated a duty to intervene to prevent the use of excessive force,” Rosenblatt wrote.
The panel did find qualified immunity should be granted to Sgt. Anthony Scheffner and Officer Patrick Hanlon for their roles in the incident.
Even though Scheffner may have seen Hatton deliver a knee strike to Atencio, “there is no evidence that Sergeant Scheffner directed or otherwise knew that the solitary knee strike would occur, physically participated in the knee strike, or had a realistic opportunity to stop the knee strike from happening.”
The panel found similarly for Hanlon, who grabbed Atencio by the wrist when he disobeyed commands.
“Hanlon could not have reasonably foreseen that his use of a wrist lock would cause or would trigger events ultimately leading to Atencio’s death,” the ruling states.
An attorney for the officers could not be immediately reached for comment.
Arpaio lost re-election to Paul Penzone, a Democrat and former Phoenix Police Department sergeant, last month after legal troubles and declining popularity plagued the six-term lawman.
William Fuzi came home from the first Gulf War suffering from fibromyalgia, irritable bowel syndrome, chronic fatigue, a mysterious rash and intense migraines. When he told the Marine Corps that every joint in his body was inflamed with pain, it diagnosed a bad knee and discharged Fuzi with a $3,500 severance check.
“They told me, ‘If you complain about anything else, it will just take you longer to get out,’” he says. “‘But don’t worry about it, because VA will take care of everything else.’”
Nothing could have been further from reality.
After making the rounds at 10 VA medical centers over the past 25 years, Fuzi is only getting mental-health checkups from a VA nurse practitioner despite the fact that he’s been diagnosed with physical problems long attributed to Gulf War Illness. The care doesn’t resemble anything therapeutic.
“They spend all their time trying to undiagnose me – and telling me Gulf War Illness is all in my head,” Fuzi says. “I’ve lost all hope.”
‘IT’S SO DISCOURAGING’Fuzi’s story is typical of the approximately 200,000 veterans suffering from Gulf War Illness. Even today, VA appears to be less than accepting of research showing that exposure to pesticides, chemical weapons and an experimental medication inflicted debilitating diseases on a third of U.S. servicemembers, and a similar percentage of the British, Australian and Canadian troops who served with the multinational coalition that defeated Saddam Hussein. Instead, VA insists that Gulf War Illness is a psychological problem. Its latest clinical practice guidelines direct medical staff to send Gulf War veterans with complaints like Fuzi’s to mental health treatment.
“I am painfully reminded of the veterans of World War I who were exposed to mustard gas in the trenches of Europe,” says Roberta White, chairwoman of environmental health at the Boston University School of Public Health and former scientific director of the federal Research Advisory Committee on Gulf War Veterans’ Illnesses. “These veterans did not receive support for their health problems or the hardships their families endured due to their disabilities when they returned from combat.”
“It’s so discouraging,” adds Anthony Hardie, who served in the Persian Gulf with the Army. “Gulf War veterans can’t get their claims approved. They are too sick to work. And if they go to VA, they are told they are conspiracy theorists and sent off as if they are children. Twenty-five years later, VA is still utterly failing Gulf War veterans.”
VA did not respond to questions for this story.
Gulf War veterans started experiencing excruciating joint and muscle pain, debilitating fatigue and gastrointestinal problems, rashes, respiratory issues, migraines and other illnesses during and soon after their deployment in 1990 and 1991. As the number of veterans reporting similar problems grew following the war, their collection of medical issues became known as Gulf War Illness. Scientists and servicemembers suspected the cause was chemical exposure. VA, and initially DoD, wrote it off as stress.
Hardie got a dose of this skepticism when he sought medical help for his “Kuwaiti cough” – he’d been expelling black sputum from his lungs for months – upon returning to Fort Bragg, N.C., after the war. “I heard my medic out in the hallway telling a doctor I was ‘another one of those Gulf War veterans who thinks he’s sick,’” he says. “I vowed to never seek treatment again until I was out of the military.”
His VA experience was equally discouraging, he says. “The designated Gulf War doctor at the Madison, Wis., VA told me, ‘There’s nothing wrong with you Gulf War vets. It’s all in your heads. You just need to forget about it … get on with your lives and get past it.’”
Research has consistently shown that Gulf War Illness was not caused by combat stress, which is not surprising given the circumstances. The actual conflict was short: a six-week air campaign followed by a four-day ground war. “Most veterans were never in battlefield areas and didn’t see combat,” says epidemiologist Lea Steele, who conducts Gulf War veterans research at Baylor College of Medicine in Houston. “And PTSD is far less prevalent in Gulf War veterans than in veterans of other conflicts.”
Multiple studies have reinforced the fact that Gulf War Illness wasn’t caused by psychological issues, adds Steele, who like White served as scientific director of the Research Advisory Committee on Gulf War Veterans’ Illnesses. That group reviewed the extensive research into the causes of Gulf War Illness. “The data were very consistent – wartime trauma, stress, service in combat, seeing dead bodies, were not associated with Gulf War Illness,” Steele says.
White was part of a team at the Boston VA that gathered health data on 2,000 Gulf War veterans who returned to the United States through Fort Devens, Mass. That data also showed the rate of PTSD and psychological problems related to the war to be quite low, she says. But veterans who reported pesticide exposure during their Persian Gulf deployment appeared to be sicker.
A few years later, White and her colleagues did more extensive examinations of some of those same Fort Devens veterans at VA’s request. They found that three types of neurotoxic exposure were common among veterans suffering from Gulf War Illness: pesticides, an experimental medication called pyridostigmine bromide (PB) given to troops to protect them from the effects of a possible nerve gas attack, and exposure to chemical weapons released when coalition forces blew up Iraqi ammunition dumps. DoD now estimates that 100,000 of the 700,000 U.S. troops in the Persian Gulf could have been exposed to nerve agents released after the cease-fire, when U.S. forces destroyed massive Iraqi munitions dumps at Khamisiyah, Iraq, in March 1991.
“It’s not an unexplained illness,” says White, referring to a catch-all used by VA to describe many of the medical issues associated with Gulf War Illness. “It’s a chemically induced illness.”
Steele agrees that Gulf War Illness was the result of chemical exposures. “This is the only war in which PB was given to many thousands of U.S. troops,” she says. “The evidence implicating PB is strongest – it’s a significant factor across all studies that have looked at this. Studies also link pesticide use to increased rates of Gulf War Illness.”
And a 2003 DoD investigation concluded that thousands of veterans were overexposed to pesticides during Desert Shield/Desert Storm, including more than a dozen that posed health risks. There’s also a list of other potential toxic exposures with a less definitive tie to Gulf War Illness, ranging from oil-well fires to the massive number of vaccinations given to U.S. troops.
‘TREATED LIKE TRASH’ The toll exacted by Gulf War Illness has been excruciating. Mary Baggett developed fibromyalgia, chronic fatigue, irritable bowel syndrome, persistent rashes and migraines. The painful egg-sized lump that appeared in her armpit during the conflict – characterized as harmless by a doctor she consulted during her tour – proved malignant and was finally removed when she was treated for stage 3 breast cancer three years ago.
Baggett’s oldest son, born two years after the Gulf War, has a rare bone disease and ulcerative colitis. Her youngest son has irritable bowel syndrome. She believes both conditions are linked to Gulf War Illness. Baggett’s former husband, John, also a Desert Shield/Desert Storm veteran, suffered from chronic fatigue, severe diarrhea and digestive problems that began during his Persian Gulf deployment. He fatally shot himself in 2008, weeks after a VA psychiatrist put him on Prozac – the only VA treatment he received.
Joel Krall likewise blames the Gulf War for the loss of his health and his wife, Renee, who was also a Gulf War veteran. She killed herself in December 1998, one of many Gulf War veterans in Krall’s circle who have taken their own lives. Krall also struggles. “I have suicidal ideation,” he says. “I think about it constantly.”
Most of Krall’s symptoms started while he was in the Middle East. The skin problems were the most obvious. “Nobody knows what the fungus is,” he says. “It does the whole-body migration thing. I had it in my crotch, my thighs. It’s not life-threatening, but it can be debilitating.”
Krall also suffered substantial gastrointestinal problems – “I was passing copious amounts of blood” – urinary tract issues and developed multiple chemical sensitivity in the Persian Gulf. Renee killed herself just as Krall was preparing his first VA disability claim. It took 10 years and a major health crisis before he could bring himself to restart the process. Today, he is considered 100 percent disabled by VA for damage to his spine and other problems, but nothing related to Gulf War Illness. That’s not a surprise given that VA rejects 80 percent of all Gulf War Illness claims, according to Veterans for Common Sense.
Like many Gulf War veterans, he believes the unusually high rejection rate is deliberate. “It goes back to what happened with Vietnam veterans and Agent Orange,” he says. “VA’s payout would double overnight.”
Money isn’t the point. “I feel disrespected ... treated like trash,” Krall says. “I think most of us deserve to be taken care of if we were injured in the line of duty.” But he doesn’t have much hope for change. “I think we’re forgotten,” he says of Gulf War veterans. “You don’t see it in the news. Nobody cares that it’s been 25 years.”
During the darkest days of the past two and a half decades, Gulf War veterans such as Hardie and David Winnett have pressed DoD, VA and the medical research community to keep searching for causes and cures. Hardie started a website, www.91outcomes.com, to help Americans who served in the first Gulf War, and Krall and others credit him for helping navigate VA’s complicated claims system.
Winnett, a Marine who worked his way up from private to captain during his 20-year career, was a Gulf War Illness skeptic until bilateral muscle and joint pain, hand and arm tremors and other issues overtook him.
“I was reaching up to close the bed cover on my pickup and it instantly felt like someone hit my hands with a hammer,” Winnett says of the onset of his some of his worst symptoms.
His chronic fatigue, joint pain and cognitive problems became so intense that he had to leave his six-figure job as fleet manager for a large city in Southern California.
Today, Winnett runs a Facebook support group that includes 10,000 Gulf War veterans and families. They help each other with claims, follow research developments and reach out when someone is in despair – which is common not only because VA rejects the majority of disability claims, but also because it insists that Gulf War veterans only need PTSD treatment. When Gulf War veterans gets PTSD ratings, Winnett says, their illnesses will be dismissed as psychosomatic. Worse, many of the medications VA prescribes for PTSD are known for side effects that include suicidal ideation.
Scientists say they are on the cusp of finding promising treatments. And VA’s recent five-year extension on the deadline for filing Gulf War claims gives them a welcome reprieve.
“Veterans don’t get their half of the deal,” White says. “I am so worried that this is going to go away and Gulf War veterans are going to die sick.” She and other scientists with decades of Gulf War Illness expertise say VA must recognize the evidence for the diseases and get behind the search for treatments.
“It’s still very important to find effective treatments and more definitive answers about why veterans became ill,” Steele says. “These veterans deserve to get their health back.”
Ken Olsen is a frequent contributor to The American Legion Magazine.
Studies point to gene-based glitches in ill Gulf War Vets
November 10, 2016
(From left) Drs. Lisa James, Brian Engdahl, and Apostolos Georgopoulos (director) are with the Brain Sciences Center at the Minneapolis VA. They are seen here next to the center's MEG scanner. (Photo by April Eilers
Twenty-five years ago, Brian Zimmerman was a strong 6-foot-1 inch, 185-pound Army infantryman in prime physical condition fighting Iraqi forces in Operation Desert Storm.
He witnessed charred Iraqi bodies on the "Highway of Death," including a dead child, took part in a tank battle, and was close to an Iraqi ammunition depot called Khamisiyah that upon detonation is believed to have released nerve agents such as sarin and cyclosarin in the direction of U.S. troops.
Today, Zimmerman, 45, is still entrenched in a battle, but one worlds apart from his military days. He's one of the estimated 300,000 Veterans with Gulf War illness (GWI), which affects various organs, most notably the brain. He experiences symptoms common with that disorder: fatigue, rashes, serious body aches and joint swelling, gastrointestinal problems, memory loss, depression, anxiety, and chronic headaches.
He says his body is deteriorating, and that everyday tasks like getting out of bed can be a struggle.
"We want to be able to provide targeted treatment that's specific to the Veterans' symptoms and genetic risk factors."
"I get joint pain that's astronomical, to the point where there's nothing that makes it go away," says Zimmerman, who also has PTSD. "My hands are getting disfigured from the swelling that goes on. It's like my knuckles are exploding. Three other members from my squad have identical symptoms in their hands. Our hands will just blow up, and your shoulders, your neck, your hips. You get in such extreme pain, there's no getting rid of it. It's almost like you're burning up from the inside."
VA research gives Veteran a 'ray of hope'
At the same time, Zimmerman believes there's a "ray of hope" due to the extensive research at the Minneapolis VA Health Care System on Gulf War illness. In one endeavor, scientists there are pursuing the theory that GWI stems from abnormal immune responses that lead to neurological-cognitive-mood (NCM), pain, and fatigue symptoms. The theory prompted their investigation of human leukocyte antigen (HLA). HLA genes are located on chromosome 6 and play key roles in immune system functioning.
Brain maps based on MEG scan data highlight differences between Veterans with and without Gulf War illness. (Image courtesy of Brain Sciences Center)
Three VA-funded studies led by Dr. Apostolos Georgopoulos, head of the Brain Sciences Center at the Minneapolis VA, identified brain mechanisms and other areas involved in Gulf War illness and found that certain forms, or alleles, of HLA genes offer protection from GWI. A lack of those alleles has made Veterans vulnerable to developing Gulf War illness symptoms. The Minneapolis team further discovered how this protection is manifested in the brain.
The findings could pave the way for immunotherapy for Vets with GWI, or treating symptoms by providing the missing immune protection, says Dr. Brian Engdahl, a psychologist with the Brain Sciences Center who took part in all three studies.
Gulf War Veterans including Zimmerman participated in the studies, published in the past year in EbioMedicine, part of the British Journal Lancet. The first one, which included 66 Vets with GWI and 16 without, found differences in HLA type, based on blood tests, that distinguished these two groups with 84 percent accuracy. Veterans with GWI, in other words, had genetic susceptibility to developing their symptoms.
Brian Zimmerman served with the Army in Operation Desert Storm and recently participated in Gulf War studies at the Minneapolis VA Health Care System. (Photo courtesy of Brian Zimmerman)
In a follow-up study, published in October 2016, the scientists documented sharp differences in brain function between healthy and ill Gulf War Veterans in the cerebellum and frontal cortex.
Forty Vets with GWI and 46 without underwent a magnetoencephalography (MEG) scan, a brain imaging technique that tracks the firing of neurons. It found, with 94 percent accuracy, distinctions between the two groups in synchronous neural interactions, also known as synchrony. Such differences are "excellent predictors of GWI," the researchers write.
Synchrony is important for cognitive functions including attention, memory, and communication between nerves and muscles. Past studies have shown that cognitively healthy people display similar patterns of synchrony, while abnormal synchrony is linked to PTSD and other disorders.
The third study, now in press, combines the HLA risk factors and the brain miscommunication patterns to explain Gulf War symptoms. Sixty-five Gulf War Veterans with GWI and 16 without had MEG scans to assess neural synchrony. The findings show that HLA affects neural synchrony and predicts symptom types, and they indicate that Gulf War illness is caused by the interactions of genetics and exposures.
"Our working hypothesis is that, when exposed to factors such as vaccines, chemical exposures, and stress, genetically vulnerable Veterans exhibit widespread synchronicity anomalies that contribute to diverse problems included under the NCM, pain, and fatigue domains," the researchers write in that study. "Conversely, the presence of protective HLA alleles would prevent these anomalies."
In addition to VA, the University of Minnesota funded the trio of studies, which Engdahl describes as "groundbreaking" research. He says he knows of no other scientists who have used the MEG scan for this purpose, looked at the HLA genotypes of Gulf War Vets, and applied that information to explain what is leading to Gulf War illness symptoms.
He says the research provides a measure of relief to Gulf War Vets like Brian Zimmerman who have been unable to find successful long-term treatments for GWI.
"When you see the results of a brain scan or pull up a blood test result and say, 'All that points to chronic multi-symptom illness,' they say, 'It's real, it's real, it's not just in my head, I haven't been making this up,' Engdahl says. "There's something about objective test results that line up with what you've suffered from that puts the whole picture together. The next question is what can be done about it."
The Minneapolis researchers believe larger cohorts are needed to better validate the findings from all three studies, and they hope the work will lead to clinical treatments.
Engdahl says one of his team's current proposals aims to show that healthy Gulf War Vets have immune responses that work to prevent the brain malfunction seen in ill Gulf War Veterans. The goal then would be to isolate the components that make the difference.
"We're hoping to do that here in the next two years," he says. "We've already demonstrated this in mouse-brain cell cultures."
He says the ultimate objective is giving Vets with Gulf War illness more precise diagnoses and targeted treatments.
"The ideal situation would be in line with the holy grail of modern medicine, especially cancer treatment, where we are able to immunotype you and then provide targeted molecular therapy for your particular set of symptom patterns," Engdahl says. "So it is quite in line with that buzz phrase 'personalized medicine.' We want to be able to provide targeted treatment that's specific to the Veterans' symptoms and genetic risk factors."
Zimmerman, for his part, insists the vaccinations given to troops during the Gulf War as protection from nerve gas and other chemical weapons are behind "a hell of a lot of our problems." A construction worker who lives in Sandstone, Minnesota, he's been to the Minneapolis VA many times over the years to little avail, although he speaks highly of efforts by physicians at that facility to help him and other Gulf War Vets.
He's excited about the research being pursued by Georgopoulos, Engdahl, and their colleagues.
"I'm certain they'll be able to start helping us in a couple of years," Zimmerman says. "I really am."