World Trade Center disaster responders exhibit persistent symptoms of post-traumatic stress disorder (PTSD) and respiratory illness linked to the severity of their exposures. One-quarter of responders affected by these conditions suffer from both, resulting in increased disability and utilization of medical services. This study will examine the potential mechanisms underlying PTSD/respiratory co-morbidity that may facilitate the development of more effective, theory-driven interventions for these difficult to treat patients.
As a direct result of the toxic exposure at the World Trade Center, responders exhibit persistent symptoms of post-traumatic stress disorder (PTSD) and respiratory illness. Indeed, one-quarter of responders affected by these conditions suffer from both mental and physical comorbidity.
The overall goal of this study is to explicate the mechanisms linking PTSD and lower respiratory symptoms (LRS) in WTC responders through an epigenetics approach. Given longitudinal findings from observational data on the pathway from WTC exposures to PTSD to respiratory illness and supportive biological data, ecogenomics is the logical next step for understanding immune dysregulation and thus increased persistence of symptoms over time. In the long-term, identification of biomarkers using an epigenetic approach may help to uncover new tools to genetically characterize different pathways to PTSD and respiratory illness in responders.
Specifically, we will determine and compare the methylation pattern of the peripheral blood DNA of patients with WTC-PTSD and patients who never developed PTSD. In a similar manner we will compare patients with chronic WTC-PTSD and those with PTSD in remission
We will also examine differences in methylation patterns among responders with (a) comorbid WTC-PTSD and respiratory illness, (b) only respiratory illness, (c) only WTC-PTSD, and (d) neither respiratory illness nor WTC-PTSD. We expect to recruit 400 responders for this genetic analysis. It is hoped that ultimately this information will lead to new diagnostic and therapeutic approaches to the disease associated with the WTC disaster.
Our research program has shown that mental and physical health have walked arm-in-arm throughout the 12 years since 9/11. For WTC responders, PTSD and lower respiratory distress are particularly impacted. One reason is that both conditions arose from the horrific environmental and psychological exposures at the WTC site. Another reason, as our work suggests, is that these exposures led to basic biological changes that impact both mental and physical health. Consistent with this picture, we documented that both aspects of health place a significant burden on occupational, social, and family functioning. The lesson learned is that adequate medical care requires an integrated approach that treats both the mind and the body simultaneously.
Evelyn Bromet, Ph.D., Distinguished Professor, Director, Epidemiology Research Group, Department of Psychiatry, SUNY at Stony Brook; Roman Kotov, M.D., Assistant Professor, Department of Psychiatry, SUNY at Stony Brook; Karestan Koenen, Ph.D., Associate Professor, Director, Psychiatric-Neurological Epidemiology Cluster Department of Epidemiology, Mailman School of Public Health, Columbia University; Guia Guffanti, Ph.D., Assistant Professor of Clinical Neurobiology in Psychiatry, Department of Psychiatry, Division of Epidemiology & Division of Child and Adolescent Psychiatry, Columbia University/NYSPI
Kuan P, Waszczuk M, Kotov R, et al. 2017. An epigenome-wide DNA methylation study of PTSD and depression in World Trade Center responders. Transl Psychiatry 7(6):e1158.
Kuan PF, Waszczuk MA, Kotov R, Clouston S, Yang X, Singh PK, Glenn ST, Cortes Gomez E, Wang J, Bromet E, Luft BJ. Gene expression associated with PTSD in World Trade Center responders: An RNA sequencing study. Transl Psychiatry. 2017 Dec 18;7(12):1297.
