Ketamine in Veterans With Gulf War Illness

• Status: Recruiting
• Trial end date: 2021-09-01
• Target enrollment: 0
• Participant gender: All

Summary

Up to one third of the 700,000 U.S. military veterans of the 1990-91 Gulf War have Gulf War Illness (GWI), a symptom complex characterized by a combination of chronic pain, cognitive impairment, debilitating fatigue, gastrointestinal complications, and other persistent symptoms. Epidemiologic studies of 1990-1991 Gulf War veterans have identified the short but intense combined exposure to insecticides (e.g., organophosphates, DEET, permethrin), pills with anti-nerve gas agent pyridostigmine bromide (PB), and low-level chemical nerve agents as likely candidates of GWI. Animal models have shown that these neurotoxicants could induce neuroinflammation which is marked by enhanced inflammatory cytokines, and activated microglia and astrocytes. Inflammation has been linked to GWI. Secondary effects of neuroinflammation and glia activation could be excessive glutamate-mediated neuronal activation. There is currently no treatment for symptoms of GWI. Ketamine is an N-methyl-D-aspartate receptor (NMDAR) antagonist. Besides blocking activation of NMDARs, a sub-anesthetic dose (0.5 mg/kg over 40 minutes) of ketamine could be an anti-inflammatory agent, and could protect microglia and astrocytes from being activated by inflammatory agents. This low dose of ketamine has also been shown to improve fatigue within 24 hours after a single infusion, and to improve inflammatory pain. This makes ketamine a feasible candidate for the treatment of inflammation-associated symptoms of GWI. This pilot study will examine if GWI is related to NMDAR functioning, testing effects of a single 40-minute intravenous infusion of 0.5 mg/kg of ketamine on GWI symptom severity in 21 veterans of the 1990-1991 Gulf War who meet Kansas case definition criteria of GWI.

• Phase: Early Phase 1
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Baylor College of Medicine
• Collaborators: Michael Debakey Veterans Affairs Medical Center; Michael E. DeBakey VA Medical Center
• Treatments: Ketamine

Criteria

Inclusion Criteria:

• Military veterans who served for any period of time in the Gulf War Theater of Operations between August of 1990 and July of 1991.

• Cases must meet Kansas GWI case definition criteria.

• Understand the study as described in the informed consent form, and be able to consent for study participation.

Exclusion Criteria:

• A physical or psychiatric illness explaining GWI case definition symptoms at the discretion of the PI.

• History of seizures.

• History of ECT or deep brain stimulation.

• History of head injury with loss-of-consciousness over 15 minutes or no recollection of events.

• Unstable serious illness at the discretion of the PI or study physician, including:

• hepatic disease

• renal disease

• gastroenterologic disease

• respiratory disease,

• cardiovascular disease (including ischemic heart disease)

• endocrinologic disease

• neurologic disease

• immunologic disease

• hematologic disease.

• Clinically significant EKG or laboratory values at the discretion of the study physician.

• Uncontrolled hypertension (systolic BP >160 mm Hg or diastolic BP >90 mm Hg).

• Family history or own history of schizophrenia or psychosis.

• For at least two weeks before ketamine infusion, use of:

• Antibiotics

• Antiviral medication

• anti-inflammatory medications (including NSAIDS) for at least two weeks before ketamine infusion.

• Being pregnant or breastfeeding.