24
May
Breakthrough Study Shows Organophosphate Nerve Gas Caused Gulf War Illness
(Beyond Pesticides, May 24, 2022) New research is providing strong causal evidence that Gulf War Illness (GWI) is the result of exposure to sarin gas, an organophosphate nerve agent used by Saddam Hussein as a chemical weapon during the Gulf War. The findings, published earlier this month in Environmental Health Perspectives, have important implications for the hundreds of thousands of American service members suffering from a constellation of chronic symptoms without a true understanding of how they became sick. “Quite simply, our findings prove that Gulf War illness was caused by sarin, which was released when we bombed Iraqi chemical weapons storage and production facilities,” said Robert Haley, MD, lead author of the study and epidemiologist at University of Texas Southwestern. “There are still more than 100,000 Gulf War veterans who are not getting help for this illness and our hope is that these findings will accelerate the search for better treatment.”
Sarin was first synthesized in the late 1930s by Nazi chemists working for IG Farben (a consortium that included Bayer) in an attempt to create stronger and more powerful insecticides. Sarin is a G-series organophosphate (named after the scientists that created them), characterized by high acute toxicity and quick evaporation after release. Exposure to sarin can quickly result in death, though lower levels of exposure have been linked to long-term brain and nervous system impairment. The chemical was identified as a potential chemical weapon but not used per se during World War 2. It was subsequently produced by both the U.S. and USSR during the 1950s. Production ceased near the end of that decade, though stockpiles remained in the U.S. until the 1970s. In the late 1980s, Saddam Hussein used chemical weapons against both Kurdish civilians and Iranian soldiers. Production and stockpiling of sarin was banned under the United Nations Chemical Weapons Convention of 1993.
During the Gulf War, the U.S. military bombed Saddam Hussein’s stockpiles of sarin gas. Satellite imagery from the time show that debris plumes from these bombed sites drifted over to American troop positions. Nerve agent alarms were set off at certain American encampments during the course of the war.
Veterans dealing with Gulf War Illness have described a range of ongoing symptoms, from fever to fatigue, headaches, night sweats and insomnia, difficulty finding words, issues with concentration and retaining information, sexual dysfunction, respiratory problems, dizziness, skin rashes, joint and body pain and diarrhea and indigestion. The U.S. Department of Veterans Affairs refers to the illness as a “chronic multisymptom illness.”
GWI has been investigated and associated with a range of environmental exposures over the years, including depleted uranium, smoke from oil wells, and other chemicals exposures like carbamates, DEET, and permethrin, used extensively to address pest problems among the deployed. Firm epidemiological data showing causation has been elusive due to scientific scrutiny over recall bias from self-reported exposures, selection bias of studied cohorts, and other potential confounding exposures.
“What makes this new study a game-changer is that it links GWI with a very strong gene-environment interaction that cannot be explained away by errors in recalling the environmental exposure or other biases in the data,” Dr. Haley said.
To make their determination, researchers enrolled 1,016 randomly selected veterans deployed during the Gulf War out of over 8,000 that completed a U.S. Military Health Survey. Half of whom developed GWI and half did not. Researchers collected blood and DNA samples from all those enrolled, and completed a questionnaire specifically asking whether- and if so, how often, nerve agent alarms sounded where they were living or working while in Iraq (alarm frequency was used as a measure to gauge exposure amounts).
The enrolled veterans’ DNA – in particular, a gene known as paraoxonase-1 (PON1), were analyzed by researchers. Previous research has found PON1 to be a genetic determinant to human susceptibility to organophosphate poisoning. There are two versions of the gene – a “Q” version that produces a blood enzyme that breaks down sarin and an “R” version that can break down other chemicals but does not do well at neutralizing sarin. Individuals may have QQ, QR, or RR genotypes.
Gulf Veteran’s PON1 genes tied very closely to risk of GWI. Among service members who heard nerve agent alarms during their deployment, QQ genotypes had a 3.75 fold increase risk of GWI, QR a 4.4 fold increased risk, and RR were 8.9 times likely to develop GWI. These results, adequately addressing a range of confounders while showing a strong ‘gold standard’ gene-environment interaction, provide a high degree of confidence of causality, according to the researchers. “Your risk is going up step by step depending on your genotype, because those genes are mediating how well your body inactivates sarin,” said Dr. Haley. “It doesn’t mean you can’t get Gulf War illness if you have the QQ genotype, because even the highest-level genetic protection can be overwhelmed by higher intensity exposure. There’s no other risk factor coming anywhere close to having this level of causal evidence for Gulf War illness.”
Front line service members that put their lives on the line deserve answers regarding how they became and meaningful action to treat their illnesses. Far too many veterans of the Vietnam war are still suffering with illnesses caused by exposure to dioxin present in the notorious herbicide Agent Orange. But after fighting in war, sickened service members have found that they must fight a different sort of fight at home for their own health care. Veterans of the Gulf War are likewise still fighting for care. A 2017 Government Accountability Office report found that 80% of Gulf War veteran disability claims are denied by US Veteran’s Affairs. GWI claims are approved at a rate roughly three times lower than all other potential claimed disabilities. With strong data now on the cause, VA must move rapidly to ensure American veterans get the treatment they deserve.
As the National Capital Poison Control Center notes, pesticides and nerve agents are similar poisons with similar symptoms. Numerous individuals across the country – many of whom reach out to Beyond Pesticides for assistance – are suffering from a debilitating range of environmentally induced chronic symptoms that affect their ability to function in day-to-day life. This constellation of conditions is often referred to as Multiple Chemical Sensitivity, Idiopathic Environmental Illness, or Toxicant Induced Loss of Tolerance. A recent review by a national team of researchers incorporates GWI into its review of chemical sensitivity conditions, with important findings for wider public health.
More investment is needed in both epidemiological approaches to determine the cause of environmental illnesses among service members and the general public, and treatments to address the myriad of chronic conditions one may experience after a triggering exposure. For more information on chemical sensitivities, see read a transcript of a talk given by Doris Rapp, MD published in Beyond Pesticides’ Pesticides and You newsletter, and visit the University of Texas, San Antonio website on the Hoffman TILT program.
All unattributed positions and opinions in this piece are those of Beyond Pesticides.
Source: University of Texas Southwestern Medical Center press release, Environmental Health Perspectives, (Also See Environmental Health Perspectives editorial on the study).
