Two UC-San Diego Researchers Aim to Help Gulf War Veterans with Gulf War Illness

"This is just as much about future combat operations as it is about the past"

Healthy and Ill 1991 Gulf War Veteran Research Study Participants Needed

Written by Anthony Hardie, 91outcomes.com

(91outcomes.com) -  Two medical research researchers at the University of California-San Diego are aiming to help veterans of the 1991 Gulf War suffering from Gulf War Illness by working to improve the scientific understanding of precisely what is going on in GWI patients' bodies.

One of the unrelated UCSD medical research projects is led by Dr. Beatrice Golomb, whose groundbreaking study found CoQ10 to be the first treatment proven successful in reducing some of GWI's symptoms, including post-exertional fatigue.  She is also the author of a 1990s RAND Institute study on Pyridostigmine Bromide (PB) anti-nerve agent protective pills, which found PB to be associated with Gulf War Illness patients' adverse health outcomes.  

The second is led by Dr. Bruce Zuraw, a widely published Professor of Medicine at the UCSD Medical School and Program Director of the UCSD Allergy and Immunology Fellowship Program.  His research interests include allergic inflammation in humans.  

Both medical research projects studies received their funding separately from the peer reviewed Gulf War Illness (GWI) Congressionally Directed Medical Research Program (CDMRP), an activity of the U.S. Department of Defense that receives its specific direction, peer review requirements, and funding on an annual basis from Congress.  

Dr. Beatrice Golomb: Developing a Biomarker for Oxidative Damage in GWI

The first UCSD study is led by Dr. Beatrice Golomb and is a follow-on to her landmark CoQ10 GWI treatment study.  CoQ10 is believed to be effective because it helps alleviate ongoing oxidative damage at the cellular level, called "oxidative stress".  

Dr. Golomb's new study is seeking 40 participants -- all ill -- and this time involves measuring the oxidative damage resulting in Gulf War veterans with GWI.  

Entitled simply "Oxidative Stress"(GW093063), this study will look at potential oxidative damage biomarkers for GWI taken from samples of a blood draw and excreted in the urine.  

The study is narrowly focused.  Study participants must:

• Be a Veteran of the U.S. Armed Forces; and
• Have U.S. military service service in the Persian Gulf Region at any time during the one-year period commencing August 2, 1990 and ending July 31, 1991; and
• Be between the ages of 35 and 73; and
• Meet recognized diagnostic criteria for Gulf War Illness (to be determined by the study team).

Participation involves a short telephone interview and in-person testing during a visit of about 3 hours to the UCSD campus.  

Dr. Bruce Zuraw: Developing a Biomarker for GWI with Respiratory Symptoms

The second UCSD GWI study, focused on respiratory issues inherent in many GWI patients' disease, is slightly larger and is seeking 60 veterans of the 1991 Gulf War, including 30 "healthy" and 30 "ill" veterans.  

The study is being led by Bruce Zuraw, M.D. of the Veterans Medical Research Foundation of San Diego, and is entitled "Epithelial Cell TRPV1-Mediated Airway Sensitivity as a Mechanism for Respiratory Symptoms Associated with Gulf War Illness (GW080156).”

Dr. Zuraw is hoping the project will help determine a possible test for diagnosing GWI with respiratory symptoms (a distinction he terms, "GWI-R").  No such test currently exists, making it difficult to distinguish between GWI or GWI-R and other chronic multisymptom illness conditions for which causes -- and perhaps more importantly, treatments -- may be wildly different.  

According to a San Diego Union-Times article about his study:

Zuraw and his research team are focusing on Gulf War illnesses featuring respiratory problems, drawing on his work as director of the Allergy and Immunology Section at both the VA San Diego Healthcare System and the University of California San Diego.  Researchers have noticed that Gulf War veterans often have symptoms of inflammatory lung diseases such as asthma or chronic bronchitis, but they test negative for them.  The paradox led the San Diego team to an examination of transient receptor potential channels, or TRPs, in the lining of the lungs and nerves, and their role in increased airway sensitivity. They hypothesize that in patients with Gulf War illness, the receptors are locked in a harmful cycle: receptors in the epithelial cells of the lungs alert the nerves, the resulting nerve response irritates the lining of the lung, and the process repeats indefinitely, resulting in respiratory distress.  By isolating and documenting the interplay, they hope to create a means of diagnosing a distinct illness, and perhaps a means of stopping the cycle and its irritating effect on the lungs.  .... “It’s a gift when veterans offer their time to clinical research,” said Kerstin Lynam, the CEO of Veterans Medical Research Foundation. “Only through their participation can we learn more about this evasive disease.

Congress Directs the Funding

The result of an odd twist of events, most Gulf War Illness research is now being conducted outside the U.S. Department of Veterans Affairs (VA), the agency that purports to be veterans' "chief advocate".
Gulf War veteran activists recently discovered an unannounced, two-thirds budget cut in the VA's current budget proposal, which would reduced already limited GWI medical research at VA to less than $5 million annually.  By contrast, peer reviewed treatment-focused GWI research was funded by Congress in the Department of Defense at $10 million last year.

As the name would suggest, Congress specifically directs the funding for the Congressionally Directed Medical Research Program, which is administered by the U.S. Army Medical Research and Materiel Command at Ft. Detrick, Maryland.  

Programs within the CDMRP portfolio are generally created by Congress at the request of patients suffering from a disease or disorder, and the GWI programs are no different.  Created under the Fiscal Year 2006 Defense Appropriations Act, the GWI program has existed -- and grown -- ever since.  Gulf War veterans sought the creation of the GWI CDMRP, and Gulf War Illness patients and their advocates are active in the program's annual funding decisions by Congress. 

Funding decisions about individually submitted medical research proposals are determined through a multi-tiered process that includes Congressionally-mandated peer review -- review of each proposal's merits by other members of the scientific community.  CDMRP programs also include consumer reviewers -- individuals affected by the specific disease or condition -- at every step of the process.  

Congressional language authorizing the GWI CDMRP program has remained unchanged over the years.  It is perhaps most notable for what kinds of medical research studies are allowed -- "studies of treatments" and "identification of objective markers for [GWI]" -- and what are not -- "no studies based on psychiatric illness and psychological stress as the central cause of Gulf War Illness". 

The committee directs the Secretary of the Army to utilize the authorized funding for this program to undertake research on Gulf War illnesses. The committee directs that activities under the program should include studies of treatments for the complex of symptoms commonly referred to as Gulf War Illness, and identification of objective markers for Gulf War Illness. The committee recommends that no studies based on psychiatric illness and psychological stress as the central cause of Gulf War Illness be funded under the program. The committee directs that the program be conducted using competitive selection and peer review for the identification of research with the highest technical merit and military value. Further, the committee directs that this program be coordinated with similar activities in the Department of Veterans Affairs and the National Institutes of Health.

In April 2010, the highly reputable Institute of Medicine issue a report that found Gulf War Illness to be a unique diagnostic condition that affects about 250,000 veterans of the 1991 Gulf War as well as other U.S. Forces.

John, a former military police Gulf War veteran from Washington State in his early 40s who asked that his last name be withheld to protect his medical privacy, agreed to be interviewed by the San Diego newspaper staff and supported the study, seemed to agree with those last six words, "as well as other U.S. forces."  

"This is just as much about future combat operations as it is about the past," John told the reporters.

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TO PARTICIPATE

If you are a U.S. military veteran of the 1991 Gulf War (Aug. 2, 1990 - Jul. 31, 1991), you appear to meet the basic study criteria information, and you’re willing and able to participate:

For the new Golomb study at UCSD:

• Call:  (858) 558-4950 extension 203 (Janis) or 210 (Kate)
• Email:  jbritchie@ucsd.edu or cbloom@ucsd.edu
• A small compensation stipend is provided; travel is not covered.

For the Zuraw study at UCSD:

• Call (858) 822-6599
• Gulf War veterans who are both ill (with Gulf War Illness and GWI-related respiratory symptoms) and healthy are needed.
• A small compensation stipend is provided; travel is not covered.