CoQ10 in Gulf War Illness

As many as a third of the nearly 700,000 military personnel deployed during Desert Shield and
Desert Storm (Aug 2, 1990 to July 31, 1991) in the Kuwaiti Theater of Operations are
suffering from Gulf War Illness (GWI), an unexplained chronic illness characterized by
multiple symptoms. Gulf War Veterans experienced environmental exposures that are known to be
oxidative stressors which contribute to cell injury, resulting in mitochondrial dysfunction
Exploratory studies using interventions that support cell functioning and prevent or repair
stress mediators suggest a role for these targeted interventions, such as Coenzyme Q10. The
goal of this clinical trial is to determine if Coenzyme Q10 is effective in increasing
physical functioning for Veterans with Gulf War Illness.

This is a randomized, two group, double blind, placebo controlled, Phase III clinical trial.
The treatment group will receive a (2x200 mg for 2 months and 1x200 mg for 4 months) once a
day of ubiquinol for 6 months. The placebo group will receive matching placebo (2x200 mg for
2 months and 1x200 mg for 4 months) once a day of ubiquinol for 6 months. The primary outcome
measure for this clinical trial is a change from baseline of SF-36, with respect to physical
functioning and symptoms. The secondary outcome measures include changes from baseline of
peripheral blood levels of biomarkers, and of GWI-associated symptoms of chronic pain,
fatigue, sleep issues, and cognitive impairment.

Inclusion Criteria:

- Male and female Veterans who were deployed in 1990 -1991 Gulf War.

- Veterans who currently meet the Kansas Gulf War Study Case Definition for Gulf War
Illness.

- Veterans who were in good health based on medical history prior to 1990.

- Veterans whose severity of illness is moderate to severe, evidenced by scoring less
than 30 of 100 on the physical domain of SF36.

Exclusion Criteria:

- Veteran has a condition that may interfere with the ability to accurately report
symptoms, such as:

- severe psychiatric problems

- schizophrenia

- bipolar disorder

- major depression with psychotic or melancholic features

- delusional disorders alcohol or drug dependence requiring hospitalization, or
regular illegal drug use or other psychiatric condition requiring inpatient stay
in the 6 months prior to study entry.

- Has dementias of any type

- Currently does not have exclusionary conditions that could reasonably be
responsible for the symptoms in multi-symptom disorders, as determined by
Investigator (based on Reeves et al.2003).

- Is pregnant or breastfeeding or plans to become pregnant within the next 6
months.

- Medical conditions excluded:

- organ failure

- defined rheumatologic inflammatory disorders

- chronic active infections such as HIV, hepatitis B and C, or transplant

- primary sleep disorders

- Medications that could potentially impact immune function excluded:

- steroids

- immune-suppressives

- nutraceuticals that are formulated to impact mitochondrial function or oxidative
stress

- Biologic response modifiers within 3 months of study entry.

- Current use of Coumadin (given the vitamin K structural similarity of CoQ10)

- Known allergy to CoQ10 and/or inactive ingredients of active and placebo soft gelatin
capsules

- Willingness to have 12 weeks of washout of current CoQ10, ubiquinol, or ubiquinone
supplements will be required between the screening and baseline visits.

- Common multivitamin preparations will be allowed if taken without change throughout
the protocol.