Researchers at the University of Nebraska Medical Center received a $3 million, four-year grant from the U.S. Department of Defense to assess the impact of airborne biohazards in the development of lung disease and associated autoimmunity in military personnel, first responders and veterans.  

The research team will explore the relationship of airborne hazards in developing rheumatoid arthritis (RA) and rheumatoid arthritis-lung disease to better understand the condition. A major goal is to develop biomarkers to identify those at risk for rheumatoid arthritis-lung disease and explore targets for new therapeutic approaches. 

During the four-year grant from the DoD’s United States Army Medical Research Acquisition Activity, researchers will gather information from the VA’s Rheumatoid Arthritis Registry that includes donated blood samples from patients.  

Toxins implicated in the development of arthritis and arthritis-associated lung disease include not only cigarette smoke exposure, but other exposures related to military duties such as burn pits, bacterial products, organic dusts and military waste disposal. Exposures common to first responders include those in flooded buildings, high air pollution environments and dusts. 

“In rheumatoid arthritis, inhalant toxins are strong disease risk factors in the development and severity of RA and strongly linked to lung diseases such as asthma, interstitial lung disease, emphysema, as well as inflammatory lung disease complicating RA,” said Jill Poole, MD, co-principal investigator of the grant and chief of the?UNMC?Department of Internal Medicine's?Division of Allergy and Immunology. “The combination from occupational exposure is not always well-known. 

“This unique research project will use a new mouse model and human studies to investigate the mechanisms of the relationship of airborne hazard-induced respiratory health disease and rheumatoid arthritis,” she said. 

The grant capitalizes on UNMC’s collective expertise in lung immunology and rheumatologic disease/arthritis, Dr. Poole said. UNMC faculty on the grant, who also conduct research at the Omaha VA Hospital, include Ted Mikuls, MD, co-principal investigator and co-investigators Bryant England, MD, PhD, Geoffrey Thiele, PhD, and Debra Romberger, MD. 

Dr. Mikuls, a rheumatologist -- a specialist who treats these patients with rheumatic diseases -- said lung involvement in rheumatoid arthritis is fairly common with about one in 10 patients experiencing significant interstitial lung disease -- diseases that cause scarring of the lungs.  

“There are no available therapies and, as a result, no guidelines to help clinicians,” said Dr. Mikuls, Umbach Professor of Rheumatology and vice chair for research, UNMC Department of Internal Medicine. “Ultimately, we would hope that lessons learned from this research identify targets for new therapies or rationale for our repurposing of existing therapies.” 

Dr. Mikuls said research involving rheumatic diseases is a major focus of patient care and research at UNMC, including a recent clinical collaboration led by Dr. England to develop a clinic that is specifically tailored for rheumatic disease patients with lung disease. 

Arthritis is a leading cause of disability among U.S. military veterans and the second leading cause of medical discharge from the U.S. Army with one in three veterans diagnosed with arthritis, compared to one in four members of the general U.S. population. (U.S. Centers for Disease Control and Prevention)