Inflammatory Activation and Nitric Oxide Oxidation in Exertional Dyspnea in Southwest Asia Deployed Military Veterans

Abstract

Post deployment personnel of the Southwest Asia theater of war present with significant exertional dyspnea. While deployed, these service men and women were exposed to a variety of inhaled toxicants including geological dust, burn pit smoke, and heavy metals. Upon examination, a large portion of these veterans display near‐normal pulmonary function and gas exchange in the lung, making diagnosis and treatment difficult. The aim of this study is to define the physiological and biochemical profiles of individuals with unexplained exertional dyspnea. We hypothesized that exposure to airborne toxicants has led to a chronic activated inflammatory state in the systemic vasculature, resulting in increased oxidative stress and reducing the bioavailability of nitric oxide (NO), contributing to the symptoms of dyspnea.Eligible veterans were tested for lung function by spirometry including diffusing capacity for carbon monoxide (DLco). Resting blood samples were taken and immediately separated into plasma and cellular components. Granuloyctes were removed from whole blood by magnetic separation, and subsequent leukocytes were collected and gated on expression of the myeloid marker CD45. Within CD45+ cells, flow cytometry was used to analyze the expression of inflammatory macrophage activation markers CD87, CD11b, CD163, HLA‐DR, CD195, CD192, CD14, CD16. Circulating levels of nitrite and nitrate (oxidation products of NO) were measured in plasma via reductive chemiluminescence, and the ratio of nitrate/nitrite (NOx ratio) was used as a marker for reduced bioavailability of NO. Increased expression of inflammatory marker CD87 in CD11b+ cells was positively correlated with expression of CD163 in HLA‐DR+ and CD14 in CD16+ (rho = .54, p <.01; rho= .36, p= .047; n =30), but not CD195 in CD192+ (rho =‐.3, p =.1). Similar observations were observed in granulocytic cells regarding CD66b expression. This correlation between activation markers within the circulating myeloid‐derived cells is consistent with the presence of monocyte activation in the systemic vasculature. NOx levels were within normally observable bounds, however, the NOx ratio was negatively correlated with FEV1/FVC (a marker of lung obstruction) but not with %predicted DLco(rho =‐.56, p =.016; rho =.01, p = .96, n = 18). The reduction in FEV1/FVC with increased NOx ratio suggests potential loss of endothelial function, which may be contributing to exertional dyspnea and is currently under investigation.