Prolonged Antibiotic Use in Gulf War Chronic Multisymptom Illness Induces Renal Fibrosis-Like Pathology Associated with microRNA-21-Mediated PTEN Inhibition
Authors: Trivedi Ayushi , Bose Dipro , Saha Punnag , Roy Subhajit , More Madhura , Chatterjee Saurabh 
Published: May 2024

Gulf War veterans afflicted with chronic multisymptom Illness (GWI) often experience unexplained, debilitating symptoms, including microbiome dysbiosis, gastrointestinal and neuroinflammation. Prolonged antibiotic treatments, especially of fluoroquinolone class are commonly employed in these veterans, raising concerns about their potential side effects. To date, no studies have investigated the effects of Gulf War (GW) chemicals- Pyridostigmine bromide (PB) and insecticide, permethrin exposures on renal dysfunction in the veterans. Therefore, this study aimed to investigate the impact of prolonged antibiotic exposure on renal pathology in GWI and to elucidate the underlying molecular mechanisms leading to renal dysfunction. In this study, we used a persistent Gulf War Illness (GWI) mouse model to study the combined effect of prolonged antibiotic regimen involving Neomycin and Enrofloxacin treatment for 5 months (20 weeks). Our results showed that prolonged antibiotic treatment exacerbated renal inflammation leading to elevated levels of pro- inflammatory cytokines and significant activation of NF-κB signaling over Gulf war chemicals treated (GWI) mice (GWI). Further, we hypothesized the involvement of HMGB1 mediated RAGE activation leading to the inflammatory phenotype in the kidneys of GWI+ AB mice. We observed that prolonged antibiotic exposure in GWI- induced mice led to significant increased HMGB1-mediated RAGE activation compared to GWI mice, which was associated with increased TGF-β production in GWI+ AB mice. Furthermore, miR-21, whose expression is reported to be regulated by TGF-β is widely linked to renal fibrosis, was also significantly upregulated in antibiotic-treated GWI-induced mice. This upregulation was associated with decreased PTEN expression, a direct target of miR-21 in GWI+ AB mice over GWI- mice, resulting in the activation of the AKT signaling pathway and increased extracellular matrix (ECM) deposition in GWI+ AB mice. Furthermore, we examined the involvement of AKT signaling activation in the induction of Epithelial-Mesenchymal Transition (EMT) by assessing the immunoreactivity of α-SMA. The renal tissue of GWI+AB mice exhibited an elevated immunoreactivity of α-SMA, suggesting that the cells were undergoing transition from an epithelial to a mesenchymal state. In contrast, GWI- mice displayed no significant expression of α-SMA or increased fibronectin deposition, indicating that exposure to Gulf War chemicals alone was insuffcient to induce renal fibrosis-like pathology. These findings highlight the complex interplay between GWI, antibiotics, and renal pathology, emphasizing that prolonged antibiotic treatment in Gulf War Chronic Multisymptom Illness leads to renal fibrosis like- pathology by activating TGF- β dependent miR-21/ PTEN/ AKT signaling. This study was supported by VA Merit Award I01CX001923-01 awarded to Dr. Saurabh Chatterjee. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.