Researchers in NYU Langone’s Division of Pulmonary, Critical Care, and Sleep Medicine are leaders in evaluating the relationships between the destruction of the World Trade Center (WTC) towers on September 11, 2001 (9/11), and airway injury and disease in New York City first responders and residents.

We study different aspects of these relationships:

• World Trade Center airway injury, including lung disease biomarkers discovery
• World Trade Center particulate exposure and systemic inflammation

We conduct much of our research through the following locations: World Trade Center Health Program Clinical Center of Excellence, the World Trade Center Environmental Health Center, and the William N. Rom Environmental Lung Disease Laboratory.

World Trade Center Airway Injury

As a member of both the NYU Langone faculty and the Fire Department of the City of New York (FDNY), Michael D. Weiden, MD, has pioneered studies of adverse health effects in WTC rescue and responder populations. In a study funded by the Centers for Disease Control and Prevention (CDC), Dr. Weiden described high rates of chronic upper and lower airway disease and elevated levels of inflammatory blood biomarkers in symptomatic exposed responders in collaboration with Anna Nolan, MD, and David J. Prezant, MD, chief medical officer at the office of medical affairs for the FDNY.

Dr. Weiden’s current work continues the biomarker discovery program using approximately 8,000 serum samples collected within 6 months of WTC exposure. He aims to identify those at greatest risk for adverse pulmonary outcomes and to define cytokines that predict reduced lung function. More recently, his lab has shown that blood eosinophils are correlated with decreases in forced expiratory volume in one second and WTC-related sinus disease after 9/11. He also documented that low serum IgA is a risk factor for poor lung function. We currently focus on defining the characteristics of patients whose asthma is poorly controlled to assess who is a good candidate for new biological therapies that are designed to improve symptoms and lung function in poorly controlled eosinophilic asthma by inhibiting IL-4.

Recent Publications

Liu C … Weiden MD. Abnormalities on chest computed tomography and lung function following an intense dust exposure: A 17-year longitudinal study. Int J Environ Res Public Health. 2019. DOI.

Putman B … Weiden MD. Low serum IgA and airway injury in World Trade Center-exposed firefighters: A 17-year longitudinal study. Thorax. 2019. DOI.

Putman B … Weiden MD. Risk factors for post-9/11 chronic rhinosinusitis in Fire Department of the City of New York workers. Occup Environ Med. 2018. DOI.

Singh A … Weiden MD. Predictors of asthma/COPD overlap in FDNY firefighters with World Trade Center dust exposure: A longitudinal study. Chest. 2018. DOI.

Zeig-Owens R … Weiden MD. Blood leukocyte concentrations, FEV1 decline, and airflow limitation: A 15-year longitudinal study of World Trade Center–exposed firefighters. Ann Am Thorac Soc. 2017. DOI.

World Trade Center Particulate Exposure and Systemic Inflammation

Dr. Nolan, principal investigator, studies WTC-related lung disease. Using the FDNY cohort, she demonstrates that mediators of metabolic syndrome, vascular disease, and inflammation also predict development of abnormal lung function. Her major focus is to understand the roles of the receptor for advanced glycation end (RAGE) products and lysophosphatidic acid (LPA), a product of LDL cholesterol, in lung disease. Dr. Nolan performs these studies with Ann Marie Schmidt, MD, who discovered RAGE and recently identified LPA as a novel ligand of RAGE.

In collaboration with Lung-Chi Chen, MD, and Terry Gordon, PhD, Dr. Nolan’s group translated the lab’s clinical observations into a murine model of particulate exposure. In addition, Dr. Nolan uses metabolic profiling (the systematic analysis of all metabolites) to identify biomarkers for lung disease with Susan Sumner, PhD, at the National Institutes of Health Eastern Regional Comprehensive Metabolomics Research Core and Research Triangle Institute International.

Dr. Nolan’s laboratory also studies systemic inflammation related to the host response to sepsis. Innate immune mediators such as the costimulatory mediators CD40/80/86 and their associated ligands are key to sepsis. More recent work has focused on understanding clinical predictors of acute hemodynamic decompensation in sepsis. Finally, using a murine model of sepsis, her group is studying the systemic effects of fluid resuscitation, a mainstay of sepsis treatment.

Dr. Nolan is actively recruiting subjects into FIREHOUSE Trial: Food Intake Restriction for Health Outcome Support and Education, a study investigating whether a calorie-restricted Mediterranean dietary intervention improves cardiometabolic risk factors, subclinical indicators of lung and cardiovascular disease, and quality of life in firefighters with WTC lung injury.

Dr. Nolan is also recruiting into CaRVD, a trial that explores the link between WTC-related particulate matter and cardiorespiratory and vascular dysfunction, and BAD-BURN, a trial that explores the link between exposure to WTC-related airborne particulates and aerodigestive disease.

Registry, Funding, and Contact Information

Current clinical trials in this area of research include the following:

• Clinical trials: Registry NCT03581006
• Funding sources: National Institutes of Health, National Institute for Occupational Safety and Health
• For more information, please contact Rachel Lam, research data associate, at rachel.lam@nyulangone.org.

Recent Publications

Crowley G … Nolan A. Assessing the protective metabolome using machine learning in World Trade Center particulate exposed firefighters at risk for lung injury. Sci Rep. 2019. DOI.

Crowley G … Nolan A. Quantitative lung morphology: Semi-automated method of measuring mean linear intercept. BMC Pulm Med. 2019. DOI.

Kwon S … Nolan A. Metabolic syndrome biomarkers of World Trade Center airway hyperreactivity: A 16-year prospective cohort study. Int J Environ Res Public Health. 2019. DOI.

Kwon S … Nolan A. Validation of predictive metabolic syndrome biomarkers of World Trade Center lung injury: A 16-year longitudinal study. Chest. 2019. DOI.

Kwon S … Nolan A. Metabolic syndrome biomarkers of World Trade Center airway hyperreactivity: A 16-year prospective cohort study. Int J Environ Res Public Health. 2019. DOI.

Crowley G … Nolan A. Metabolomics of World Trade Center-lung injury: A machine learning approach. BMJ Open Respir Res. 2018. DOI.

Haider SH … Nolan A. Predictive biomarkers of gastroesophageal reflux disease and Barrett’s esophagus in World Trade Center exposed firefighters: A 15 year longitudinal study. Sci Rep. 2018. DOI.

World Trade Center Health Program Clinical Center of Excellence

NYU Grossman School of Medicine’s World Trade Center (WTC) Health Program Clinical Center of Excellence, led by Denise J. Harrison, MD, is one of seven centers established by the James Zadroga 9/11 Health and Compensation Act of 2010 to provide care at no cost for 9/11 first responders through clinical monitoring, treatment, and research.

Our research program aims to answer important questions about the physical and mental health conditions associated with the WTC terrorist attacks. Our research enables physicians and other providers to better care for patients with specific WTC-related illnesses as determined by the program, which is under the aegis of the U.S. Department of Health and Human Services and administered by the National Institute for Occupational Safety and Health and the CDC. Examples of covered illnesses include WTC-exacerbated chronic obstructive pulmonary disease (COPD), mesothelioma, and post-traumatic stress disorder.

Our World Trade Center Health Program also offers a variety of clinical services to patients and educational opportunities to physicians and other providers.

Recent Publications

Bello GA … Todd AC. Assessment of cumulative health risk in the World Trade Center general responder cohort. Am J Ind Med. 2018. DOI.

Lucchini RG … Todd AC. A comparative assessment of major international disasters: The need for exposure assessment, systematic emergency preparedness, and lifetime health care. BMC Public Health. 2017. DOI.

Haugen PT … Owen J. The role of theory-specific techniques and therapeutic alliance in promoting positive outcomes: Integrative psychotherapy for World Trade Center responders. J Nerv Ment Dis. 2016. DOI.

World Trade Center Environmental Health Center

In collaboration with the New York State Department of Health, Joan Reibman, MD, principal investigator, and her colleagues were the first to document adverse respiratory health effects in the community exposed to the WTC disaster. Her research team includes Angeliki Kazeros, MD; Caralee E. Caplan-Shaw, MD; Kenneth I. Berger, MD; Roberta M. Goldring, MD; Yongzhao Shao, PhD; Mengling Liu, PhD; Ridhwan Y. Baba, MD; Maria Cecilia Crisi, MD; Kerry Hena, MD; and Sophia Kwon, MPH.

Their work expanded to the development of the WTC Environmental Health Center, where experts assess and treat community members, including people who worked at local businesses, cleanup workers, area residents, students, and those who were nearby at the time of the disaster. This program is funded by the CDC under the James Zadroga 9/11 Health and Compensation Act.

Using this cohort, investigators have described persistent lower respiratory symptoms in community members, injury to the small airways, and the underlying pathology of those with severe disease. They have also defined the role of peripheral eosinophils and C-reactive protein as biomarkers of symptoms and damage to small airways. Interdisciplinary studies include collaborations with mental health investigators to understand the interaction of lung disease with post-traumatic stress, studies on neuropathic symptoms, and studies of sleep disorders.

Recent Publications

Hena KM … Reibman J. Clinical evaluation of sarcoidosis in community members with World Trade Center dust exposure. Int J Environ Res Public Health. 2019. DOI.

Pradhan D … Berger KI. Bronchodilator response predicts longitudinal improvement in small airway function in World Trade Center dust exposed community members. Int J Environ Res Public Health. 2019. DOI.

Jordon HT …Berger KI. Risk factors for persistence of lower respiratory symptoms among community members exposed to the 2001 World Trade Center terrorist attacks. Occup Environ Med. 2017. DOI.

Marmor M … Reibman J. Paresthesias among community members exposed to the World Trade Center disaster. J Occup Environ Med. 2017. DOI.

Rosen RL … Galatzer-Levy IR. Elevated C-reactive protein and posttraumatic stress pathology among survivors of the 9/11 World Trade Center attacks. J Psychiatr Res. 2017. DOI.

William N. Rom Environmental Lung Disease Laboratory

Named for the division’s past chair, William N. Rom, MD, MPH, the lab’s research includes clinical studies of WTC-related asthma, cancer, mesothelioma, pulmonary fibrosis, pneumoconioses, obliterative bronchiolitis, airway disorders, cystic fibrosis, and COPD. Dr. Rom also studies adverse health effects of global warming and the mechanisms behind the adverse health effects of asbestos, particulate matter, ozone, sulfur dioxide, and nitrogen oxides.

The James Zadroga 9/11 Health and Compensation Act is a federal law that funds programs for the treatment and study of WTC-related illnesses for first responders and local residents. In recognition of this work, the New York City Council funded construction of the William N. Rom Environmental Lung Disease Laboratory, which is housed at NYC Health + Hospitals/Bellevue.

Recent Publications

Lopatin S … Rom WN. Reduced lung function in smokers in a lung cancer screening cohort with asbestos exposure and pleural plaques. Am J Ind Med. 2016. DOI.

Wang J … Qiu J. Comparative study of autoantibody responses between lung adenocarcinoma and benign pulmonary nodules. J Thorac Oncol. 2016. 11(3):334–345.

Ewart GW … Pinkerton KE. From closing the atmospheric ozone hole to reducing climate change. Lessons learned. Ann Am Thorac Soc. 2015. DOI.