ALS outbreak among Gulf War veterans likely has common cause, says leading researcher

Written by Anthony Hardie

(91outcomes.com - June 28, 2010) - During today’s meeting of the Congressionally chartered U.S. Department of Veterans Affairs (VA) Research Advisory Committee on Gulf War Veterans’ illnesses (RACGWVI), Dr. Ronnie Horner of the University of Cincinnati  gave a presentation entitled, “Occurrence of ALS among Gulf War veterans,” which discussed what is known about the well-documented outbreak of ALS among veterans who served during the 1991 Gulf War that included both the deployed and the non-deployed.

Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is an invariably deadly neurodegenerative disease, with an average lifespan of only two to five years from time of diagnosis to time of death.   ALS kills motor neurons, the large cells of the spinal cord, which send nerve fibers out to control the muscles.

The disease is typically associated with older age; ALS nearly always affects men over the age of 55.
And, there is some relation to genetics, with about ten percent of ALS patients having a family history of ALS.

Horner discussed several peer-reviewed medical journal articles including two of his own published about ALS, regarding the epidemic of ALS cased among veterans of the 1991 Gulf War.  Several factors that made the ALS among 1991 Gulf War veterans unique.

First, more than half of Gulf War veterans diagnosed with ALS were under age 25 and 98 percent under the age of 55 – a far different picture than that of ALS almost exclusively in men over age 55.
And, he found that there was shorter survival time for Gulf War deployed (40 months) versus non-deployed Gulf War era veterans (57 months).

As is typical for ALS, there was some familial effect among the Gulf War ALS cases, with three of 40 studied cases having a family history.

He noted that there were two peaks in the epidemic, one in 1991, and another in 1996, with about 48 cases among the deployed and 76 among the non-deployed, far, far higher than would be expected among healthy young military service members. It remains unclear why there were two different peaks in the outbreak, but Horner suggested that there may have been multiple causes, or that there may have been other factors.
 
Search for a Common Source or Common Time Point of Exposure

Horner’s research shows a two-fold higher risk of ALS among 1991 Gulf War veterans. The cause(s) remain uncertain; exposures immediately prior to or during deployment may be involved.

Horner noted that scientists have focused on several factors to find clues that may finally unlock the secrets of ALS.  Because of the timing of the outbreak, he said it is generally assumed that there is a common source or time point of exposure or exposures.

One study, conducted by Miranda et al, was a GIS analysis of “Hot Spots” with more cases of ALS. 
And, science has shown that another neurodegenerative disease that shares some common features with ALS -- multiple sclerosis (MS) – also saw a dramatic increase  after the 1991 Gulf War, this time in the Kuwaiti population who remained in Kuwait during the Gulf War.  The increase of this disease that affects primarily women affected irregularly large numbers of both among men and women, though more Kuwaiti women were affected than Kuwaiti men.

Another study cited by Horner (Weiskopf et al)  found a higher risk of ALS among people with any military service than civilians. The highest risk was service in the U.S. Army and U.S. Navy, but not the U.S. Air Force. There was also an increased risk associated with the number of wars during their military service, but no association with the number of total years of military service, suggesting that military service in an of itself is probably not the cause of the ALS, but instead it is something that happens during military service, especially during wartime.

Horner’s current hypothesis is that there was one common exposure during the Gulf War. The data shows an elevated risk associated with being exposed near, in both place and time, to the Khamisiyah demolition in March 1991, in which U.S. troops detonated large amounts of Iraqi munitions later learned to contain sarin and cyclosarin nerve agents and possibly mustard gas – a vessicant – and other chemical or biological warfare agents.

Among the theories of what may have caused the Gulf War ALS outbreak, Horner described the possibility of exposure to cyanobacteria that produce neurotoxic chemicals (BMAA, Cox et al), neurotoxicity of heavy metals in the desert soil (Capt. Mark Lyles, DMD, PhD), adjuvants in the anthrax vaccine (including Aluminum Hydroxide and Squalene), and/or head trauma.

Horner said that science has shown that head trauma has often been associated with ALS. And, increased blood lead levels are also associated with a greater risk of ALS.

Horner suggested that the Gulf War ALS outbreak could be multiple exposures to one agent, exposures to multiple agents, or a rapid time to a toxic dose.

The Future for ALS research

Horner posed the question of whether the pathology (progression/ development) of neurodegenerative conditions reflects a common mechanism to protect neurons, key cells in the brain?

Could there be a common mechanism to protect neurons?

Based on the science Horner says he believes that finding the answer to these questions – essentially, how to protect the brain’s neurons -- may provide life-changing or life-saving treatments for ALS and other neurodegenerative diseases.
 

ADDITIONAL INFORMATION:

• Living with ALS (Huntsville Times)
• The ALS Association
The ALS Association symbolizes the hopes of people everywhere that Amyotrophic Lateral Sclerosis will one day be a disease of the past – relegated to historical status, studied in medical textbooks, conquered by the dedication of thousands who have worked ceaselessly to understand and eradicate this perplexing killer.
Until that day comes, The ALS Association relentlessly pursues its mission to help people living with ALS and to leave no stone unturned in search for the cure of the progressive neurodegenerative disease that took the life and name of Baseball Legend Lou Gehrig.
As the only not-for-profit voluntary health agency dedicated solely to the fight against ALS, we direct the largest privately-funded research enterprise engaged to uncover the mystery of a disease that affects as many as 30,000 annually. With more than 5,600 people diagnosed each year – an average of 15 new cases each day – our mission is urgent. The search for answers knows no bounds.