Gulf War Illness

Blood Test Could Identify Gulf War Illness

Researchers and Gulf War veterans have fought for decades for recognition of Gulf War Illness (GWI), a set of debilitating symptoms including memory impairment, chronic pain, fatigue, gastrointestinal issues, and earlier onset of age-related chronic diseases.

Now, central nervous system proteins in the blood could be the key to objectively diagnosing GWI, according to a new study co-authored by School of Public Health researchers and published in the journal Brain Sciences (featured on the cover of the September issue).

“This brings us one large step closer to having a simple blood test to diagnose the disorder and to differentiate it from other chronic medical disorders,” says study senior author Kimberly Sullivan, research associate professor of environmental health.

Sullivan is also principal investigator in the Boston Gulf War Illness Consortium (GWIC) and the Boston Biorepository and Integrative Network for Gulf War Illness (BBRAIN), and one of the leading researchers of GWI.

“Right now, Gulf War Illness is diagnosed by self-report of health symptoms,” she says, “and Gulf War veterans have struggled to have their symptoms taken seriously as a unique disorder and not treated as chronic symptoms found after other wars or of those encountered as part of other similar chronic multi-symptom disorders.”

Past studies by Sullivan and other GWI researchers indicate that the symptoms are caused by brain inflammation from exposure to the nerve agent sarin during the war, as well as the pyridostigmine bromide (PB) pills meant to protect against sarin gas, and the pesticides meant to protect soldiers against insect-borne illnesses.

An objective biomarker for GWI, Sullivan explains, will make it much easier for veterans with the disorder—an estimated 250,000, or one-third of those who served in the Gulf War—to receive benefits, including treatment at their local VA hospitals.

The new study also supports brain alterations as the cause of GWI’s physical symptoms, following up on a smaller study indicating that central nervous system proteins in the blood could be a biomarker for GWI.

These proteins “should not be in the blood if they did not at least at some point have damage to the central nervous system and changes to the blood-brain barrier,” Sullivan says.

For the new study, a research team led by Sullivan and Mohamed Abou Donia, professor of pharmacology and cancer biology and of neurobiology at Duke University School of Medicine, compared blood samples from 171 veterans with GWI, 60 healthy Gulf War veterans, and 85 civilians with similar chronic medical conditions (50 with myalgic encephalomyelitis/chronic fatigue syndrome and 35 with irritable bowel syndrome).

Compared to the other groups, the study participants with GWI had significantly higher levels of nine out of the ten kinds of central nervous system proteins measured in the study distinguishing them from both healthy Gulf War veterans and from civilians with these similar medical conditions.

“This study provides objective, blood-based evidence of alterations to the brains of sick Gulf War veterans. It indicates that, at least at some point, these veterans had a leaky blood-brain barrier that allowed these proteins to enter their bloodstream and activate the immune system.”

The researchers also used their findings and analysis to develop a new Neurodegenerative Disease Index (NDI), as a blood-based proxy to determine the extent of central nervous system alterations in an individual.

Beyond recognition of the disease, Sullivan says the NDI will be invaluable as she and colleagues continue to study the disorder and search for treatments. “We will also be able use these blood markers to track treatment trial effectiveness, if we measure these markers pre-and-post treatment,” she says.

The Gulf War Illness Clinical Trials and Interventions Consortium (GWICTIC), which includes Sullivan and researchers from Nova Southeastern University, is currently testing several potential treatments for GWI.

The study was co-authored by Joseph Massaro, professor of biostatistics; Emily Quinn, who was an analyst and research manager at the Biostatistics and Epidemiology Data Analytics Center (BEDAC) while working on the study; Jessica LeClair, doctoral student in biostatistics; Daniel Nguyen, doctoral candidate in environmental health; and Maxine Krengel, assistant professor of neurology at the School of Medicine. The other co-authors are Nancy Klimas and Maria Abreu of Nova Southeastern University; Elizabeth Lapadula of Duke University; and Efi Kokkotou and Lisa Conboy of Harvard University.

—Michelle Samuels

Learn more about the Boston Gulf War Illness Consortium and BBRAIN studies here or on Facebook here. 

The Boston Gulf War Illness Consortium and BBRAIN are recruiting sick and healthy Gulf War veterans for a one-visit study that will include blood and saliva samples, brain imaging, and cognitive testing. This study is designed to develop diagnostic tests and treatments for veterans with Gulf War Illness. Compensation is available. Please contact Megan Quay at 617-358-1717 or email GWIC@bu.edu if you are interested in learning more about participating.