# Aerodigestive Disease in the World Trade Center Exposed FDNY Cohort: Validation of Biomarkers and Defining Risk to Tailor Therapy

> **NIH ALLCDC U01** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2024 · $349,729

## Abstract

SUMMARY
The destruction of the World Trade Center (WTC) led to the exposure of thousands of first responders and
inhabitants of New York City to WTC-particulate matter (WTC-PM). WTC-PM exposure in our Fire Department
of New York (FDNY) cohort is associated with the development of obstructive airways disease (OAD),
gastroesophageal reflux disease (GERD) and Barrett’s Esophagus (BE). GERD is a well-known risk factor of
the metaplastic changes of BE, which can subsequently lead to adenocarcinoma. GERD is also associated
with occupational or environmental exposure related OAD. Overall, WTC-exposed firefighters with OAD had a
three times higher risk of developing GERD. At least 40% of WTC rescue and recovery workers have
developed GERD symptoms, which is 8.2 times its pre-9/11 prevalence. It is in the context of these findings
that we propose to study, Aerodigestive Disease in the World Trade Center Exposed FDNY Cohort: Validation
of Biomarkers and Defining Risk to Tailor Therapy. This will further define and phenotype
aerodigestive/gastrointestinal health biomarkers, as well as determine impact on lung health to improve care
thereby fulfilling the mandate of the James Zadroga 9/11 Health & Compensation Act: PAR-20-280.
GERD diminishes health-related quality of life and productivity. Complications of GERD can further extend
beyond BE; extra-esophageal reflux can incite or exacerbate allergies, sinusitis, chronic bronchitis, and
asthma. Management of reflux is challenging, as often refractory to therapy, diagnosis can be invasive and
have significant associated costs. Patients with WTC-PM exposure associated asthma more often had
persistent GERD. Furthermore, GERD increases the odds of developing WTC-AHR, independent of exposure
intensity. Although many studies have suggested interdependence between airway and digestive diseases, the
causative factors and specific mechanisms remain unclear. We have successfully identified metabolic,
vascular and inflammatory biomarkers of WTC-airway hyperreactivity (WTC-AHR). We have also identified
biomarkers of GERD/BE in our WTC exposed population with respiratory disease, facilitating the identification
of biologically relevant immune pathways.
We propose the continuation of our two AIMs to explore the HYPOTHESIS that serum biomarkers will
differentiate FDNY rescue and recovery workers with aerodigestive morbidity who proceed to develop
GERD/BE. Noninvasive biomarkers will identify subjects that may require improved treatment. We are
requesting funding of our translational research to leverage the longitudinally phenotyped FDNY-WTC cohort
and identify Biomarkers of Airway Disease, Barrett’s and Underdiagnosed Reflux Noninvasively (BAD-
BURN). We will develop the WTC aerodigestive repository, validate biomarkers of GERD and BE (AIM 1), and
phenotype subgroups with aerodigestive disease to identify noninvasive biomarkers of diagnosis/treatment
efficacy to inform future biologically plausible therapies to improve care...

## Key facts

- **NIH application ID:** 10995131
- **Project number:** 2U01OH012069-04
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** Anna Nolan
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2024
- **Award amount:** $349,729
- **Award type:** 2
- **Project period:** 2024-07-01 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10995131

## Citation

> US National Institutes of Health, RePORTER application 10995131, Aerodigestive Disease in the World Trade Center Exposed FDNY Cohort: Validation of Biomarkers and Defining Risk to Tailor Therapy (2U01OH012069-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10995131. Licensed CC0.

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