Gulf War Illness (GWI) is a chronic debilitating disorder characterized by symptoms including fatigue, joint pain, memory and concentration problems, headaches, and gastrointestinal problems. It is thought to affect approximately 30% of the 697,000 Veterans who served in the 1991 Gulf War. Despite significant research over the years, GWI remains a disorder primarily diagnosed by self-report of symptoms, making clear diagnosis, treatment development, and access to benefits and care difficult for many GW Veterans. However, our recent research and that of others has shown important preliminary evidence for objective blood and other physical markers (biomarkers) that have been associated with the chronic symptoms of GWI including pain, fatigue, gastrointestinal and memory problems. There remain, however, no definitive studies of these markers because these studies must be replicated in different and larger groups of GW Veterans to be formally accepted as objective diagnostic tests for GWI.

Our research group has taken a team approach to solving the mystery of GWI and we are well-poised to design and implement an important and necessary GWI Biorepository Network of experienced and dedicated GWI researchers to tackle and solve this problem of devising more definitive diagnostic markers of GWI. The “Boston Biorepository, Recruitment and Innovative Network (BBRAIN) for GWI” will be based on the infrastructure of our currently funded and extremely productive Boston GWI consortium (GW120037; Sullivan, Principal Investigator [PI]). As part of this nine-site GWI consortium (GWIC), we have created a large multi-site dataset with cognitive, brain imaging, health symptom data, and biorepository blood and saliva specimens for several hundred GW Veterans and cerebrospinal fluid (CSF) and PET imaging data on a smaller group of Veterans. GWIC funds also allowed us to create a core biorepository of blood, saliva, and human-induced pluripotent stem cells (hiPCS) that our Veteran participants agreed to share for research collaborations. It has been stated that the success of a biorepository is not in how many samples are collected but in how many are shared that lead to important new results. Our biorepository approach has been highly productive resulting in 12 published scientific papers, 24 presentations at scientific meetings, and 15 new biomarker studies funded over the past 4 years, thus greatly expanding our ability to explore and identify specific “objective” biomarkers and potential targeted or “personalized” treatment strategies for Veterans with GWI.

It is the goal of the BBRAIN to bring the same leadership, skills, and expert scientific, laboratory, and data management team under the leadership of Dr. Kimberly Sullivan from Boston University School of Public Health that the GWIC has established to the rest of the GWI research community by providing the infrastructure, scientific expertise, biological specimens, and collaborative nature to vastly speed up objective biomarker discovery and treatments for GWI. The BBRAIN Network will utilize the data management and statistical expertise of the BUSPH Data Coordinating Center (DCC) and the NOVA Southeastern University/Miami VA EM Papper Biorepository Laboratory, which have both been in existence for data management, recruitment, laboratory, and biorepository coordination for the past 30 years. We welcome the opportunity to grow this valuable biorepository resource by replenishing our GWIC samples and by working with leading researchers from eight additional sites (Harvard University, Georgetown University, Roskamp Institute, Boston VA, Bronx VA, San Francisco VA, University of Alabama, Massachusetts General Hospital). These sites will share existing samples including CSF, blood, and cutting-edge brain imaging data along with three other well-established repositories with GWI, fibromyalgia, and chronic fatigue syndrome blood samples. The BBRAIN will also recruit 500 GW Veterans (300 GWI cases, 200 controls) to provide new biorepository blood, saliva, urine, and fecal samples to share with other researchers. We will also obtain health symptom surveys, cognitive (memory) testing and blood pressure, sleep, and heart rate variability measures (using Fitbit wristbands) that can be compared with blood and saliva markers to compare objective biomarkers with the symptoms of GWI. Remote data collection will be available for interested Veterans by utilizing local phlebotomy clinics and mail-back urine and fecal sample kits. Monthly web conference meetings of the BBRAIN working groups of all BBRAIN members are planned to ensure research progress and sharing of results across individual institutions. Veteran advocates will be involved in each part of the BBRAIN studies. Our team approach of sharing samples will maximize research study funds and lead to faster identification of diagnostic tests for GWI and targeted personalized medicine treatments for ill Veterans. For Veterans who have remained ill for 26 years, the importance of identifying diagnostic tests and effective treatments for GWI cannot be overstated.