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

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.

Association of Gulf War Illness-Related Symptoms with Military Exposures among 1990–1991 Gulf War Veterans Evaluated at the War-Related Illness and Injury Study Center (WRIISC)

“…Overall, our findings are consistent with previous studies of Gulf War veterans that have identified pesticides and use of PB/NAPP pills as the most prominent risk factors for GWI, after adjusting for other exposures in theater [1,7,[21][22][23][24], as well as with individual types of symptoms and symptom domains [7,[25][26][27]]. An association between GWI and indicators of possible exposure to chemical weapons during the Gulf War has, overall, been less consistent [1,7].…”

Association of Gulf War Illness with Characteristics in Deployed vs. Non-Deployed Gulf War Era Veterans in the Cooperative Studies Program 2006/Million Veteran Program 029 Cohort: A Cross-Sectional Analysis

“…Findings from our study revealed that older age was associated with lower odds of meeting the GWI phenotypes than younger age. Although this association has been reported in other studies of deployed GW veterans [6,10,24], in this current study, somewhat surprisingly, this finding held in both non-deployed and deployed samples-even after adjusting for military rank during the war. Previous explanations for the observed relationship between younger age and greater risk of GWI included the lower educational attainment of the younger servicemembers at the time of the deployment, their relative inexperience and sense of control during deployment reflected in their lower military rank, and their greater likelihood of being directly exposed to deployment-related toxins that may be associated with GWI.…”

Living With Toxic Wounds: The Voices and Visual Self-Representations of Gulf War Veterans

“…Today, approximately 30% or 200,000 of Gulf War veterans remain affected by the persistent and largely unexplained physical symptoms collectively known as Gulf War Illness (GWI; Maule et al, 2018). Although a recent study linked the chronic symptoms to brain and inflammatory alterations triggered by combined deployment exposures or toxic wounds (Steele et al, 2021), more research is needed to fully understand the pathophysiology of GWI given varying locations of deployment and exposure. In addition, despite years of scientific investigations, an accepted unified case definition for GWI is lacking as are viable and effective treatments and definitive guidelines for healthcare providers (Baldwin et al, 2019; Kaimal & Dieterich-Hartwell, 2020).…”