1
|
Siew K, Nestler KA, Nelson C, D'Ambrosio V, Zhong C, Li Z, Grillo A, Wan ER, Patel V, Overbey E, Kim J, Yun S, Vaughan MB, Cheshire C, Cubitt L, Broni-Tabi J, Al-Jaber MY, Boyko V, Meydan C, Barker P, Arif S, Afsari F, Allen N, Al-Maadheed M, Altinok S, Bah N, Border S, Brown AL, Burling K, Cheng-Campbell M, Colón LM, Degoricija L, Figg N, Finch R, Foox J, Faridi P, French A, Gebre S, Gordon P, Houerbi N, Valipour Kahrood H, Kiffer FC, Klosinska AS, Kubik A, Lee HC, Li Y, Lucarelli N, Marullo AL, Matei I, McCann CM, Mimar S, Naglah A, Nicod J, O'Shaughnessy KM, Oliveira LCD, Oswalt L, Patras LI, Lai Polo SH, Rodríguez-Lopez M, Roufosse C, Sadeghi-Alavijeh O, Sanchez-Hodge R, Paul AS, Schittenhelm RB, Schweickart A, Scott RT, Choy Lim Kam Sian TC, da Silveira WA, Slawinski H, Snell D, Sosa J, Saravia-Butler AM, Tabetah M, Tanuwidjaya E, Walker-Samuel S, Yang X, Yasmin, Zhang H, Godovac-Zimmermann J, Sarder P, Sanders LM, Costes SV, Campbell RAA, Karouia F, Mohamed-Alis V, Rodriques S, Lynham S, Steele JR, Baranzini S, Fazelinia H, Dai Z, Uruno A, Shiba D, Yamamoto M, A C Almeida E, Blaber E, Schisler JC, Eisch AJ, Muratani M, Zwart SR, Smith SM, Galazka JM, Mason CE, Beheshti A, Walsh SB. Cosmic kidney disease: an integrated pan-omic, physiological and morphological study into spaceflight-induced renal dysfunction. Nat Commun 2024; 15:4923. [PMID: 38862484 PMCID: PMC11167060 DOI: 10.1038/s41467-024-49212-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024] Open
Abstract
Missions into Deep Space are planned this decade. Yet the health consequences of exposure to microgravity and galactic cosmic radiation (GCR) over years-long missions on indispensable visceral organs such as the kidney are largely unexplored. We performed biomolecular (epigenomic, transcriptomic, proteomic, epiproteomic, metabolomic, metagenomic), clinical chemistry (electrolytes, endocrinology, biochemistry) and morphometry (histology, 3D imaging, miRNA-ISH, tissue weights) analyses using samples and datasets available from 11 spaceflight-exposed mouse and 5 human, 1 simulated microgravity rat and 4 simulated GCR-exposed mouse missions. We found that spaceflight induces: 1) renal transporter dephosphorylation which may indicate astronauts' increased risk of nephrolithiasis is in part a primary renal phenomenon rather than solely a secondary consequence of bone loss; 2) remodelling of the nephron that results in expansion of distal convoluted tubule size but loss of overall tubule density; 3) renal damage and dysfunction when exposed to a Mars roundtrip dose-equivalent of simulated GCR.
Collapse
Affiliation(s)
- Keith Siew
- London Tubular Centre, Department of Renal Medicine, University College London, London, UK.
| | - Kevin A Nestler
- The Institute for Biomedical Sciences (IBS), The George Washington University, Washington, DC, USA
| | - Charlotte Nelson
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Viola D'Ambrosio
- London Tubular Centre, Department of Renal Medicine, University College London, London, UK
- Department of Experimental and Translational Medicine, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - Chutong Zhong
- London Tubular Centre, Department of Renal Medicine, University College London, London, UK
| | - Zhongwang Li
- London Tubular Centre, Department of Renal Medicine, University College London, London, UK
- Centre for Advanced Biomedical Imaging, University College London, London, UK
- Centre for Computational Medicine, University College London, London, UK
| | - Alessandra Grillo
- London Tubular Centre, Department of Renal Medicine, University College London, London, UK
| | - Elizabeth R Wan
- London Tubular Centre, Department of Renal Medicine, University College London, London, UK
| | - Vaksha Patel
- Department of Renal Medicine, University College London, London, UK
| | - Eliah Overbey
- Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY, USA
| | - JangKeun Kim
- Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY, USA
| | - Sanghee Yun
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael B Vaughan
- School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
- Tissue Engineering and Biomaterials Group, Ghent University, Ghent, Belgium
- Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Chris Cheshire
- Bioinformatics and Computational Biology Laboratory, The Francis Crick Institute, London, UK
| | - Laura Cubitt
- Applied Biotechnology Laboratory, The Francis Crick Institute, London, UK
| | - Jessica Broni-Tabi
- Sainsbury Wellcome Centre for Neural Circuits and Behaviour, University College London, London, UK
| | | | - Valery Boyko
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, USA
| | - Cem Meydan
- Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY, USA
| | - Peter Barker
- MRC MDU Mouse Biochemistry Laboratory, University of Cambridge, Cambridge, UK
| | - Shehbeel Arif
- Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Fatemeh Afsari
- Department of Medicine-Nephrology & Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Noah Allen
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Mohammed Al-Maadheed
- Anti-Doping Laboratory Qatar, Doha, Qatar
- Centre of Metabolism and Inflammation, University College London, London, UK
| | - Selin Altinok
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nourdine Bah
- Applied Biotechnology Laboratory, The Francis Crick Institute, London, UK
| | - Samuel Border
- Department of Medicine-Nephrology & Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Amanda L Brown
- Pharmacology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keith Burling
- MRC MDU Mouse Biochemistry Laboratory, University of Cambridge, Cambridge, UK
| | - Margareth Cheng-Campbell
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
- Blue Marble Space Institute of Science, Seattle, WA, USA
| | - Lorianna M Colón
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
| | - Lovorka Degoricija
- KBR, Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, USA
| | - Nichola Figg
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Rebecca Finch
- School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Jonathan Foox
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY, USA
- The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY, USA
| | - Pouya Faridi
- Monash Proteomics and Metabolomics Platform, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Alison French
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, USA
| | - Samrawit Gebre
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, USA
| | - Peter Gordon
- Sainsbury Wellcome Centre for Neural Circuits and Behaviour, University College London, London, UK
| | - Nadia Houerbi
- Physiology, Biophysics & Systems Biology, Weill Cornell Medical College, New York, NY, USA
| | - Hossein Valipour Kahrood
- Monash Proteomics and Metabolomics Platform, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
- Monash Bioinformatics Platform, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Frederico C Kiffer
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aleksandra S Klosinska
- Division of Experimental Medicine & Immunotherapeutics (EMIT), Department of Medicine, University of Cambridge, Cambridge, UK
| | - Angela Kubik
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Han-Chung Lee
- Monash Proteomics and Metabolomics Platform, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Yinghui Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Nicholas Lucarelli
- Department of Medicine-Nephrology & Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Anthony L Marullo
- School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Irina Matei
- Cornell Center for Immunology, Cornell University, Ithaca, NY, USA
- Children's Cancer and Blood Foundation Laboratories, Departments of Pediatrics and Cell and Developmental Biology, Drukier Institute for Children's Health, Meyer Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Colleen M McCann
- Pharmacology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sayat Mimar
- Department of Medicine-Nephrology & Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Ahmed Naglah
- Department of Medicine-Nephrology & Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Jérôme Nicod
- Advanced Sequencing Facility, The Francis Crick Institute, London, UK
| | - Kevin M O'Shaughnessy
- Division of Experimental Medicine & Immunotherapeutics (EMIT), Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Leah Oswalt
- Pharmacology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - San-Huei Lai Polo
- KBR, Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, USA
| | | | - Candice Roufosse
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | | | | | - Anindya S Paul
- Department of Medicine-Nephrology & Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Ralf Bernd Schittenhelm
- Monash Proteomics and Metabolomics Platform, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Annalise Schweickart
- Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Ryan T Scott
- KBR, Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, USA
| | - Terry Chin Choy Lim Kam Sian
- Monash Proteomics and Metabolomics Platform, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Willian A da Silveira
- School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
- International Space University, 67400, Illkirch-Graffenstaden, France
| | - Hubert Slawinski
- Advanced Sequencing Facility, The Francis Crick Institute, London, UK
| | - Daniel Snell
- Advanced Sequencing Facility, The Francis Crick Institute, London, UK
| | - Julio Sosa
- University Health Network, Toronto, ON, Canada
| | | | - Marshall Tabetah
- Department of Agricultural and Biological Engineering, Purdue University, West Lafayette, IN, USA
| | - Erwin Tanuwidjaya
- Monash Proteomics and Metabolomics Platform, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Simon Walker-Samuel
- Centre for Advanced Biomedical Imaging, University College London, London, UK
- Centre for Computational Medicine, University College London, London, UK
| | | | - Yasmin
- Division of Experimental Medicine & Immunotherapeutics (EMIT), Department of Medicine, University of Cambridge, Cambridge, UK
| | - Haijian Zhang
- Monash Proteomics and Metabolomics Platform, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | | | - Pinaki Sarder
- Department of Medicine-Quantitative Health Section, University of Florida, Gainesville, FL, USA
- Departments of Biomedical Engineering and Electrical and Computer Engineering, University of Florida, Gainesville, FL, USA
| | - Lauren M Sanders
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, USA
- Blue Marble Space Institute of Science, Seattle, WA, USA
| | - Sylvain V Costes
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, USA
| | - Robert A A Campbell
- Sainsbury Wellcome Centre for Neural Circuits and Behaviour, University College London, London, UK
| | - Fathi Karouia
- Blue Marble Space Institute of Science, Seattle, WA, USA
- Space Research Within Reach, San Francisco, CA, USA
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Vidya Mohamed-Alis
- Anti-Doping Laboratory Qatar, Doha, Qatar
- Centre of Metabolism and Inflammation, University College London, London, UK
| | - Samuel Rodriques
- Applied Biotechnology Laboratory, The Francis Crick Institute, London, UK
| | | | - Joel Ricky Steele
- Monash Proteomics and Metabolomics Platform, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Sergio Baranzini
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Hossein Fazelinia
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
| | - Zhongquan Dai
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Akira Uruno
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
| | - Dai Shiba
- Mouse Epigenetics Project, ISS/Kibo experiment, Japan Aerospace Exploration Agency (JAXA), Tsukuba, Ibaraki, Japan
- JEM Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency (JAXA), Tsukuba, Ibaraki, Japan
| | - Masayuki Yamamoto
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Department of Medical Biochemistry, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Eduardo A C Almeida
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, USA
| | - Elizabeth Blaber
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
- Center for Biotechnology & Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY, USA
- Stanley Center for Psychiatric Research, Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Jonathan C Schisler
- Pharmacology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amelia J Eisch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neuroscience, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Masafumi Muratani
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Sara R Zwart
- Department of Preventative Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Jonathan M Galazka
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, USA
| | - Christopher E Mason
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY, USA
- The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY, USA
- The WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medical College, New York, NY, USA
- The Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA
| | - Afshin Beheshti
- KBR, Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, USA
- Broad Institute, Cambridge, MA, USA
- Space Biosciences Division, Universities Space Research Association (USRA), Washington, DC, USA
| | - Stephen B Walsh
- London Tubular Centre, Department of Renal Medicine, University College London, London, UK.
| |
Collapse
|
2
|
Olde Engberink RHG, van Oosten PJ, Weber T, Tabury K, Baatout S, Siew K, Walsh SB, Valenti G, Chouker A, Boutouyrie P, Heer M, Jordan J, Goswami N. The kidney, volume homeostasis and osmoregulation in space: current perspective and knowledge gaps. NPJ Microgravity 2023; 9:29. [PMID: 37005397 PMCID: PMC10067832 DOI: 10.1038/s41526-023-00268-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 03/13/2023] [Indexed: 04/04/2023] Open
Abstract
Although we have sent humans into space for more than 50 years crucial questions regarding kidney physiology, volume regulation and osmoregulation remain unanswered. The complex interactions between the renin-angiotensin-aldosterone system, the sympathetic nervous system, osmoregulatory responses, glomerular function, tubular function, and environmental factors such as sodium and water intake, motion sickness and ambient temperature make it difficult to establish the exact effect of microgravity and the subsequent fluid shifts and muscle mass loss on these parameters. Unfortunately, not all responses to actual microgravity can be reproduced with head-down tilt bed rest studies, which complicates research on Earth. Better understanding of the effects of microgravity on kidney function, volume regulation and osmoregulation are needed with the advent of long-term deep space missions and planetary surface explorations during which orthostatic intolerance complaints or kidney stone formation can be life-threatening for astronauts. Galactic cosmic radiation may be a new threat to kidney function. In this review, we summarise and highlight the current understandings of the effects of microgravity on kidney function, volume regulation and osmoregulation and discuss knowledge gaps that future studies should address.
Collapse
Affiliation(s)
- Rik H G Olde Engberink
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands.
| | - Paula J van Oosten
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Tobias Weber
- Space Medicine Team, European Astronaut Centre (EAC), Cologne, Germany
- KBR GmbH, Cologne, Germany
| | - Kevin Tabury
- Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Mol, Belgium
| | - Sarah Baatout
- Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Mol, Belgium
| | - Keith Siew
- London Tubular Centre, UCL Department of Renal Medicine, University College London, London, UK
| | - Stephen B Walsh
- London Tubular Centre, UCL Department of Renal Medicine, University College London, London, UK
| | - Giovanna Valenti
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari Aldo Moro, Bari, Italy
| | - Alexander Chouker
- Laboratory of Translational Research Stress and Immunity, Department of Anesthesiology, Hospital of the Ludwig-Maximilians-University (LUM), Munich, Germany
| | - Pierre Boutouyrie
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
- Service de Pharmacologie, DMU CARTE, AP-HP, Hôpital Européen Georges Pompidou, FR-75015, Paris, France
| | - Martina Heer
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
- Institute of Nutritional and Food Sciences, University of Bonn, Bonn, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR) and University of Cologne, Cologne, Germany
| | - Nandu Goswami
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Löwi Research Center of Vascular Biology, Inflammation, and Immunity, Medical University of Graz, Graz, Austria
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| |
Collapse
|
3
|
Chen X, Yang J, Lv H, Che J, Wang J, Zhang B, Shang P. The potential benefits of melatonin in the prevention and treatment of bone loss in response to microgravity. ACTA ASTRONAUTICA 2023; 202:48-57. [DOI: org/10.1016/j.actaastro.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
|
4
|
Sides MB, Johnston SL, Sirek A, Lee PH, Blue RS, Antonsen EL, Basner M, Douglas GL, Epstein A, Flynn-Evans EE, Gallagher MB, Hayes J, Lee SMC, Lockley SW, Monseur B, Nelson NG, Sargsyan A, Smith SM, Stenger MB, Stepanek J, Zwart SR. Bellagio II Report: Terrestrial Applications of Space Medicine Research. Aerosp Med Hum Perform 2021; 92:650-669. [PMID: 34503618 DOI: 10.3357/amhp.5843.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractINTRODUCTION: For over 50 yr, investigators have studied the physiological adaptations of the human system during short- and long-duration spaceflight exposures. Much of the knowledge gained in developing health countermeasures for astronauts onboard the International Space Station demonstrate terrestrial applications. To date, a systematic process for translating these space applications to terrestrial human health has yet to be defined.METHODS: In the summer of 2017, a team of 38 international scientists launched the Bellagio ll Summit Initiative. The goals of the Summit were: 1) To identify space medicine findings and countermeasures with highest probability for future terrestrial applications; and 2) To develop a roadmap for translation of these countermeasures to future terrestrial application. The team reviewed public domain literature, NASA databases, and evidence books within the framework of the five-stage National Institutes of Health (NIH) translation science model, and the NASA two-stage translation model. Teams then analyzed and discussed interdisciplinary findings to determine the most significant evidence-based countermeasures sufficiently developed for terrestrial application.RESULTS: Teams identified published human spaceflight research and applied translational science models to define mature products for terrestrial clinical practice.CONCLUSIONS: The Bellagio ll Summit identified a snapshot of space medicine research and mature science with the highest probability of translation and developed a Roadmap of terrestrial application from space medicine-derived countermeasures. These evidence-based findings can provide guidance regarding the terrestrial applications of best practices, countermeasures, and clinical protocols currently used in spaceflight.Sides MB, Johnston SL III, Sirek A, Lee PH, Blue RS, Antonsen EL, Basner M, Douglas GL, Epstein A, Flynn-Evans EE, Gallagher MB, Hayes J, Lee SMC, Lockley SW, Monseur B, Nelson NG, Sargsyan A, Smith SM, Stenger MB, Stepanek J, Zwart SR; Bellagio II Team. Bellagio II report: terrestrial applications of space medicine research. Aerosp Med Hum Perform. 2021; 92(8):650669.
Collapse
|
5
|
Stones, Space, and Dr. Abraham T. K. Cockett: A History of Urolithiasis and Aerospace Medicine. Urology 2020; 137:9-13. [DOI: 10.1016/j.urology.2019.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/18/2019] [Accepted: 10/01/2019] [Indexed: 11/16/2022]
|
6
|
Frings-Meuthen P, Bernhardt G, Buehlmeier J, Baecker N, May F, Heer M. The negative effect of unloading exceeds the bone-sparing effect of alkaline supplementation: a bed rest study. Osteoporos Int 2019; 30:431-439. [PMID: 30255228 DOI: 10.1007/s00198-018-4703-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/04/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED Potassium bicarbonate was administrated to an already alkaline diet in seven male subjects during a 21-day bed rest study and was able to decrease bed rest induced increased calcium excretion but failed to prevent bed rest-induced bone resorption. INTRODUCTION Supplementation with alkali salts appears to positively influence calcium and bone metabolism and, thus, could be a countermeasure for population groups with an increased risk for bone loss. However, the extent to which alkalization counteracts acid-induced bone resorption or whether it merely has a calcium and bone maintenance effect is still not completely understood. In the present study, we hypothesized that additional alkalization to an already alkaline diet can further counteract bed rest-induced bone loss. METHODS Seven healthy male subjects completed two parts of a crossover designed 21-day bed rest study: bed rest only (control) and bed rest supplemented with 90 mmol potassium bicarbonate (KHCO3) daily. RESULTS KHCO3supplementation during bed rest resulted in a more alkaline status compared to the control intervention, demonstrated by the increase in pH and buffer capacity level (pH p = 0.023, HCO3p = 0.02, ABE p = 0.03). Urinary calcium excretion was decreased during KHCO3 supplementation (control 6.05 ± 2.74 mmol/24 h; KHCO3 4.87 ± 2.21 mmol/24 h, p = 0.03); whereas, bone formation was not affected by additional alkalization (bAP p = 0.58; PINP p = 0.60). Bone resorption marker UCTX tended to be lower during alkaline supplementation (UCTX p = 0.16). CONCLUSIONS The more alkaline acid-base status, achieved by KHCO3 supplementation, reduced renal calcium excretion during bed rest, but was not able to prevent immobilization-induced bone resorption. However, advantages of alkaline salts on bone metabolism may occur under acidic metabolic conditions or with respect to the positive effect of reduced calcium excretion within a longer time frame. TRIAL REGISTRATION Trial number: NCT01509456.
Collapse
Affiliation(s)
- P Frings-Meuthen
- German Aerospace Center (DLR), Institute of Aerospace Medicine, 51147, Cologne, Germany.
| | - G Bernhardt
- German Aerospace Center (DLR), Institute of Aerospace Medicine, 51147, Cologne, Germany
- Novartis AG, Basel, Switzerland
| | - J Buehlmeier
- German Aerospace Center (DLR), Institute of Aerospace Medicine, 51147, Cologne, Germany
- University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - N Baecker
- German Aerospace Center (DLR), Institute of Aerospace Medicine, 51147, Cologne, Germany
- Department of Nutrition and Food Science, University of Bonn, Bonn, Germany
| | - F May
- German Aerospace Center (DLR), Institute of Aerospace Medicine, 51147, Cologne, Germany
| | - M Heer
- German Aerospace Center (DLR), Institute of Aerospace Medicine, 51147, Cologne, Germany
- Department of Nutrition and Food Science, University of Bonn, Bonn, Germany
| |
Collapse
|
7
|
Leapman MS, Jones JA, Coutinho K, Sagalovich D, Garcia MM, Olsson CA, Stock JA. Up and Away: Five Decades of Urologic Investigation in Microgravity. Urology 2017; 106:18-25. [PMID: 28495507 DOI: 10.1016/j.urology.2017.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 11/17/2022]
Abstract
A renewed global interest in manned space exploration has emerged, propelled by the challenge of reaching a new frontier: travel to the Red Planet, Mars. As the physiological changes induced by microgravity bear direct relevance to the safety and viability of these goals, we provide a historical narrative of the urologic investigations in space. We review the significant contributions to the understanding of the urologic consequences associated with exposure to microgravity, considerations for prolonged missions, and forward-looking efforts to manage emergent conditions remotely. Historical insights gleaned are poised to inform interplanetary travel, where urologic pathology will remain an important practical consideration.
Collapse
Affiliation(s)
- Michael S Leapman
- Department of Urology, Yale University School of Medicine, New Haven, CT.
| | - Jeffrey A Jones
- Department of Urology and Center for Space Medicine, Baylor College of Medicine, Houston, TX
| | | | | | - Maurice M Garcia
- Department of Urology, University of California San Francisco, San Francisco, CA
| | | | | |
Collapse
|
8
|
Kassemi M, Thompson D. Prediction of renal crystalline size distributions in space using a PBE analytic model. 2. Effect of dietary countermeasures. Am J Physiol Renal Physiol 2016; 311:F531-8. [PMID: 27279491 DOI: 10.1152/ajprenal.00402.2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 06/02/2016] [Indexed: 11/22/2022] Open
Abstract
An analytic Population Balance Equation model is used to assess the efficacy of citrate, pyrophosphate, and augmented fluid intake as dietary countermeasures aimed at reducing the risk of renal stone formation for astronauts. The model uses the measured biochemical profile of the astronauts as input and predicts the steady-state size distribution of the nucleating, growing, and agglomerating renal calculi subject to biochemical changes brought about by administration of these dietary countermeasures. Numerical predictions indicate that an increase in citrate levels beyond its average normal ground-based urinary values is beneficial but only to a limited extent. Unfortunately, results also indicate that any decline in the citrate levels during space travel below its normal urinary values on Earth can easily move the astronaut into the stone-forming risk category. Pyrophosphate is found to be an effective inhibitor since numerical predictions indicate that even at quite small urinary concentrations, it has the potential of shifting the maximum crystal aggregate size to a much smaller and plausibly safer range. Finally, our numerical results predict a decline in urinary volume below 1.5 liters/day can act as a dangerous promoter of renal stone development in microgravity while urinary volume levels of 2.5-3 liters/day can serve as effective space countermeasures.
Collapse
Affiliation(s)
- Mohammad Kassemi
- National Center for Space Exploration Research, NASA Glenn Research Center, Cleveland, Ohio
| | - David Thompson
- National Center for Space Exploration Research, NASA Glenn Research Center, Cleveland, Ohio
| |
Collapse
|
9
|
Kassemi M, Thompson D. Prediction of renal crystalline size distributions in space using a PBE analytic model. 1. Effect of microgravity-induced biochemical alterations. Am J Physiol Renal Physiol 2016; 311:F520-30. [PMID: 27279490 DOI: 10.1152/ajprenal.00401.2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 06/02/2016] [Indexed: 11/22/2022] Open
Abstract
An analytical Population Balance Equation model is developed and used to assess the risk of critical renal stone formation for astronauts during future space missions. The model uses the renal biochemical profile of the subject as input and predicts the steady-state size distribution of the nucleating, growing, and agglomerating calcium oxalate crystals during their transit through the kidney. The model is verified through comparison with published results of several crystallization experiments. Numerical results indicate that the model is successful in clearly distinguishing between 1-G normal and 1-G recurrent stone-former subjects based solely on their published 24-h urine biochemical profiles. Numerical case studies further show that the predicted renal calculi size distribution for a microgravity astronaut is closer to that of a recurrent stone former on Earth rather than to a normal subject in 1 G. This interestingly implies that the increase in renal stone risk level in microgravity is relatively more significant for a normal person than a stone former. However, numerical predictions still underscore that the stone-former subject carries by far the highest absolute risk of critical stone formation during space travel.
Collapse
Affiliation(s)
- Mohammad Kassemi
- National Center for Space Exploration Research, NASA Glenn Research Center, Cleveland, Ohio
| | - David Thompson
- National Center for Space Exploration Research, NASA Glenn Research Center, Cleveland, Ohio
| |
Collapse
|
10
|
Grimm D, Grosse J, Wehland M, Mann V, Reseland JE, Sundaresan A, Corydon TJ. The impact of microgravity on bone in humans. Bone 2016; 87:44-56. [PMID: 27032715 DOI: 10.1016/j.bone.2015.12.057] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/17/2015] [Accepted: 12/18/2015] [Indexed: 12/22/2022]
Abstract
Experiencing real weightlessness in space is a dream for many of us who are interested in space research. Although space traveling fascinates us, it can cause both short-term and long-term health problems. Microgravity is the most important influence on the human organism in space. The human body undergoes dramatic changes during a long-term spaceflight. In this review, we will mainly focus on changes in calcium, sodium and bone metabolism of space travelers. Moreover, we report on the current knowledge on the mechanisms of bone loss in space, available models to simulate the effects of microgravity on bone on Earth as well as the combined effects of microgravity and cosmic radiation on bone. The available countermeasures applied in space will also be evaluated.
Collapse
Affiliation(s)
- Daniela Grimm
- Department of Biomedicine, Aarhus University, DK-8000 Aarhus C, Denmark.
| | - Jirka Grosse
- Department of Nuclear Medicine Germany, University of Regensburg, D-93042 Regensburg, Germany
| | - Markus Wehland
- Clinic for Plastic, Aesthetic and Hand Surgery, Otto-von-Guericke University, D-39120 Magdeburg, Germany
| | - Vivek Mann
- Department of Biology, Texas Southern University, 3100 Cleburne, Houston, TX 77004, USA
| | - Janne Elin Reseland
- Department of Biomaterials, Faculty of Dentistry, University of Oslo, N-0317 Oslo, Norway
| | - Alamelu Sundaresan
- Department of Biology, Texas Southern University, 3100 Cleburne, Houston, TX 77004, USA
| | | |
Collapse
|
11
|
Morgan JLL, Heer M, Hargens AR, Macias BR, Hudson EK, Shackelford LC, Zwart SR, Smith SM. Sex-specific responses of bone metabolism and renal stone risk during bed rest. Physiol Rep 2014; 2:2/8/e12119. [PMID: 25107989 PMCID: PMC4246590 DOI: 10.14814/phy2.12119] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to directly assess sex differences in bone loss, bone biochemistry, and renal stone risk in bed rest. Bed rest simulates some spaceflight effects on human physiology and can be used to address the potential existence of sex‐specific effects on bone metabolism and renal stone risk in space. We combined data from the control subjects in five head‐down‐tilt bed rest studies (combined n = 50 men, 24 women) of differing durations (14–90 days). All subjects were healthy volunteers. Mean age was 35 ± 9 years for women and 33 ± 8 years for men. The main outcome measures were bone density and biochemistry, and renal stone risk chemistry. Before bed rest began, men had higher bone mineral density and content (P < 0.001), and excreted more biomarkers of bone resorption and calcium per day than did women (P < 0.05). These differences remained during bed rest. A number of urine chemistry analytes increased (e.g., calcium) or decreased (e.g., sodium, citrate, and urine volume) significantly for men and women during bed rest. These changes may predispose men to higher stone risk. Men and women do not have substantially different responses to the skeletal unloading of bed rest. We report here that bed rest‐induced bone loss, bone biochemistry, and renal stone risk in humans does not depend on sex. These data are a compilation and analysis of original data from our multiple (published) studies; none of those were adequately powered to assess sex differences. Thus, the resulting findings provide an important new look at the data.
Collapse
Affiliation(s)
- Jennifer L L Morgan
- Oak Ridge Associated Universities/NASA, NASA Johnson Space Center, Houston, Texas, USA
| | - Martina Heer
- Institute of Nutritional Physiology, University of Bonn, Bonn, Germany
| | - Alan R Hargens
- University of California San Diego, San Diego, California, USA
| | | | - Edgar K Hudson
- JES Tech, NASA Johnson Space Center, Houston, Texas, USA
| | | | - Sara R Zwart
- Universities Space Research Association, Houston, Texas, USA
| | - Scott M Smith
- NASA, NASA Johnson Space Center, Houston, Texas, USA
| |
Collapse
|
12
|
Smith S, Abrams S, Davis-Street J, Heer M, O'Brien K, Wastney M, Zwart S. Fifty Years of Human Space Travel: Implications for Bone and Calcium Research. Annu Rev Nutr 2014; 34:377-400. [DOI: 10.1146/annurev-nutr-071813-105440] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S.M. Smith
- Biomedical Research and Environmental Sciences Division, NASA Lyndon B. Johnson Space Center, Houston, Texas 77058;
| | - S.A. Abrams
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030;
| | - J.E. Davis-Street
- Chevron Services Company, Corporate Health and Medical, Houston, Texas 77002;
| | - M. Heer
- Profil, 41460 Neuss, Germany;
- University of Bonn, Department of Nutrition and Food Science, Nutrition Physiology, 53115 Bonn, Germany
| | - K.O. O'Brien
- Cornell University, Division of Nutritional Sciences, Ithaca, New York 14853;
| | - M.E. Wastney
- Metabolic Modeling Services, West Lafayette, Indiana 47906;
| | - S.R. Zwart
- Division of Space Life Sciences, Universities Space Research Association, Houston, Texas 77058;
| |
Collapse
|
13
|
Hackney KJ, English KL. Protein and Essential Amino Acids to Protect Musculoskeletal Health during Spaceflight: Evidence of a Paradox? Life (Basel) 2014; 4:295-317. [PMID: 25370374 PMCID: PMC4206848 DOI: 10.3390/life4030295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/19/2014] [Accepted: 06/23/2014] [Indexed: 11/17/2022] Open
Abstract
Long-duration spaceflight results in muscle atrophy and a loss of bone mineral density. In skeletal muscle tissue, acute exercise and protein (e.g., essential amino acids) stimulate anabolic pathways (e.g., muscle protein synthesis) both independently and synergistically to maintain neutral or positive net muscle protein balance. Protein intake in space is recommended to be 12%-15% of total energy intake (≤1.4 g∙kg-1∙day-1) and spaceflight is associated with reduced energy intake (~20%), which enhances muscle catabolism. Increasing protein intake to 1.5-2.0 g∙kg-1∙day-1 may be beneficial for skeletal muscle tissue and could be accomplished with essential amino acid supplementation. However, increased consumption of sulfur-containing amino acids is associated with increased bone resorption, which creates a dilemma for musculoskeletal countermeasures, whereby optimizing skeletal muscle parameters via essential amino acid supplementation may worsen bone outcomes. To protect both muscle and bone health, future unloading studies should evaluate increased protein intake via non-sulfur containing essential amino acids or leucine in combination with exercise countermeasures and the concomitant influence of reduced energy intake.
Collapse
Affiliation(s)
- Kyle J Hackney
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58102, USA.
| | - Kirk L English
- Exercise Physiology and Countermeasures Laboratory, JES Tech, Houston, TX 77058, USA.
| |
Collapse
|
14
|
Smith SM, Zwart SR, Heer M, Hudson EK, Shackelford L, Morgan JL. Men and women in space: bone loss and kidney stone risk after long-duration spaceflight. J Bone Miner Res 2014; 29:1639-45. [PMID: 24470067 DOI: 10.1002/jbmr.2185] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 01/14/2014] [Accepted: 01/20/2014] [Indexed: 11/08/2022]
Abstract
Bone loss, a key concern for long-duration space travelers, is typically considered a female issue. The number of women who have flown long-duration space missions is now great enough to allow a quantitative comparison of changes in bone and renal stone risk by sex. Participants were 42 astronauts (33 men and 9 women) on long-duration missions to the International Space Station. Bone mineral density (by dual-energy X-ray absorptiometry) and biochemical markers of bone metabolism (from blood and urine samples) were evaluated before and after flight. Data were analyzed in two groups, based on available resistance exercise equipment. Missions were 49 to 215 days in duration, flown between 2000 and 2012. The bone density response to spaceflight was the same for men and women in both exercise groups. The bone mineral density response to flight was the same for men and women, and the typical decrease in bone mineral density (whole body and/or regional) after flight was not observed for either sex for those using an advanced resistive exercise device. Biochemical markers of bone formation and resorption responded similarly in male and female astronauts. The response of urinary supersaturation risk to spaceflight was not significantly different between men and women, although risks were typically increased after flight in both groups, and risks were greater in men than in women before and after flight. The responses of men and women to spaceflight with respect to these measures of bone health were not different.
Collapse
Affiliation(s)
- Scott M Smith
- Human Health and Performance Directorate, NASA Lyndon B. Johnson Space Center, Houston, TX, USA
| | | | | | | | | | | |
Collapse
|
15
|
Assimos DG. Re: Comparison of Serum and Urinary Calcium Profile of Immobilized and Ambulant Trauma Patients. J Urol 2014; 191:1812. [DOI: 10.1016/j.juro.2014.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
16
|
Moran ME. The Urologist’s Guide to the Galaxy. Urolithiasis 2014. [DOI: 10.1007/978-1-4614-8196-6_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
17
|
Assimos D. Re: Bone Metabolism and Nutritional Status During 30-Day Head-Down Tilt Bed Rest. J Urol 2013; 189:574. [DOI: 10.1016/j.juro.2012.10.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2012] [Indexed: 11/17/2022]
|
18
|
Smith SM, McCoy T, Gazda D, Morgan JLL, Heer M, Zwart SR. Space flight calcium: implications for astronaut health, spacecraft operations, and Earth. Nutrients 2012; 4:2047-68. [PMID: 23250146 PMCID: PMC3546622 DOI: 10.3390/nu4122047] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 11/13/2012] [Accepted: 12/10/2012] [Indexed: 11/21/2022] Open
Abstract
The space flight environment is known to induce bone loss and, subsequently, calcium loss. The longer the mission, generally the more bone and calcium are lost. This review provides a history of bone and calcium studies related to space flight and highlights issues related to calcium excretion that the space program must consider so that urine can be recycled. It also discusses a novel technique using natural stable isotopes of calcium that will be helpful in the future to determine calcium and bone balance during space flight.
Collapse
Affiliation(s)
- Scott M. Smith
- Human Health and Performance Directorate, NASA Lyndon B. Johnson Space Center, Houston, TX 77058, USA; E-Mail:
| | - Torin McCoy
- Human Health and Performance Directorate, NASA Lyndon B. Johnson Space Center, Houston, TX 77058, USA; E-Mail:
| | - Daniel Gazda
- Wyle Science, Technology & Engineering Group, Houston, TX 77058, USA; E-Mail:
| | - Jennifer L. L. Morgan
- Oak Ridge Associated Universities/NASA Post-Doctoral Fellow, NASA Lyndon B. Johnson Space Center, Houston, TX 77058, USA; E-Mail:
| | - Martina Heer
- Profil, 41460 Neuss, Germany; E-Mail:
- University of Bonn, 53115 Bonn, Germany
| | - Sara R. Zwart
- Division of Space Life Sciences, Universities Space Research Association, Houston, TX 77058, USA; E-Mail:
| |
Collapse
|
19
|
Determination of uric acid in human urine by ion chromatography with conductivity detector. CHINESE CHEM LETT 2011. [DOI: 10.1016/j.cclet.2010.10.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
20
|
Effect of Potassium Citrate Therapy on the Risk of Renal Stone Formation During Spaceflight. J Urol 2009; 182:2490-6. [DOI: 10.1016/j.juro.2009.07.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Indexed: 11/17/2022]
|
21
|
Zwart SR, Crawford GE, Gillman PL, Kala G, Rodgers AS, Rogers A, Inniss AM, Rice BL, Ericson K, Coburn S, Bourbeau Y, Hudson E, Mathew G, DeKerlegand DE, Sams CF, Heer MA, Paloski WH, Smith SM. Effects of 21 days of bed rest, with or without artificial gravity, on nutritional status of humans. J Appl Physiol (1985) 2009; 107:54-62. [PMID: 19074571 PMCID: PMC4073965 DOI: 10.1152/japplphysiol.91136.2008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 12/01/2008] [Indexed: 11/22/2022] Open
Abstract
Spaceflight and bed rest models of microgravity have profound effects on physiological systems, including the cardiovascular, musculoskeletal, and immune systems. These effects can be exacerbated by suboptimal nutrient status, and therefore it is critical to monitor nutritional status when evaluating countermeasures to mitigate negative effects of spaceflight. As part of a larger study to investigate the usefulness of artificial gravity as a countermeasure for musculoskeletal and cardiovascular deficits during bed rest, we tested the hypothesis that artificial gravity would have an effect on some aspects of nutritional status. Dietary intake was recorded daily before, during, and after 21 days of bed rest with artificial gravity (n = 8) or bed rest alone (n = 7). We examined body composition, hematology, general blood chemistry, markers of oxidative damage, and blood levels of selected vitamins and minerals before, during, and after the bed rest period. Several indicators of vitamin status changed in response to diet changes: serum alpha- and gamma-tocopherol and urinary 4-pyridoxic acid decreased (P < 0.001) and plasma beta-carotene increased (P < 0.001) in both groups during bed rest compared with before bed rest. A decrease in hematocrit (P < 0.001) after bed rest was accompanied by a decrease in transferrin (P < 0.001), but transferrin receptors were not changed. These data provide evidence that artificial gravity itself does not negatively affect nutritional status during bed rest. Likewise, artificial gravity has no protective effect on nutritional status during bed rest.
Collapse
Affiliation(s)
- S. R. Zwart
- Universities Space Research Association, Houston; Enterprise Advisory Services, Inc., Houston; University of Texas Medical Branch, Galveston, Texas; Department of Chemistry, Indiana University-Purdue University Fort Wayne, Fort Wayne, Indiana; JES Tech, Houston; Human Adaptation and Countermeasures Division, National Aeronautics and Space Administration Johnson Space Center, Houston, Texas; and German Aerospace Center-Institute of Aerospace Medicine, Linder Hoehe, Cologne, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Zerwekh JE, Odvina CV, Wuermser LA, Pak CYC. Reduction of Renal Stone Risk by Potassium-Magnesium Citrate During 5 Weeks of Bed Rest. J Urol 2007; 177:2179-84. [PMID: 17509313 DOI: 10.1016/j.juro.2007.01.156] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE Exposure to the microgravity environment of space increases the risk of kidney stone formation, particularly for calcium oxalate and uric acid stones. This study was performed to evaluate the efficacy of potassium alkali as potassium-magnesium citrate in reducing renal stone risk and bone turnover. MATERIALS AND METHODS This study was performed as a double-blind, placebo controlled trial. We studied 20 normocalciuric subjects randomized to either placebo or potassium-magnesium citrate (42 mEq potassium, 21 mEq magnesium, 63 mEq citrate per day) before and during 5 weeks of strict bed rest. The study was performed in the General Clinical Research Center and under a controlled dietary regimen composed of 100 mEq of sodium, 800 mg of calcium, 0.8 gm/kg animal protein and 2,200 kcal per day. Two 24-hour urine collections were obtained under oil each week for assessment of stone risk parameters and relative saturation of calcium oxalate, brushite and undissociated uric acid. Blood was also collected for determination of serum immunoreactive parathyroid hormone and vitamin D metabolites. RESULTS Bed rest promoted a rapid increase in urinary calcium excretion of approximately 50 mg per day in both groups. Despite this increase subjects treated with potassium-magnesium citrate demonstrated significant decreases in the relative saturation of calcium oxalate and in the concentration of undissociated uric acid compared to placebo. Immunoreactive parathyroid hormone, serum 1,25-dihydroxyvitamin D and intestinal calcium absorption all decreased in both groups with no difference in response between the 2 treatment arms. CONCLUSIONS Provision of alkali as potassium-magnesium citrate is an effective countermeasure for the increased risk of renal stone disease associated with immobilization. Despite an increase in urine calcium concentration, the relative saturation of calcium oxalate decreased due to citrate chelation of calcium and the concentration of undissociated uric acid decreased due to the significant increase in urine pH.
Collapse
Affiliation(s)
- Joseph E Zerwekh
- Center for Mineral Metabolism and Clinical Research, and the Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | | | | | | |
Collapse
|
23
|
Monga M, Macias B, Groppo E, Kostelec M, Hargens A. Renal stone risk in a simulated microgravity environment: impact of treadmill exercise with lower body negative pressure. J Urol 2006; 176:127-31. [PMID: 16753386 DOI: 10.1016/s0022-5347(06)00572-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE Prolonged exposure to microgravity during spaceflight causes metabolic changes that increase the risk of renal stone formation. Studies during the Gemini, Apollo, Skylab and Shuttle missions demonstrated alterations in renal function, fluid homeostasis and bone resorption that result in increased urinary supersaturation of calcium oxalate, brushite, sodium urate and uric acid. Developing countermeasures to increased urinary supersaturation is an important priority as the duration of space missions increases. MATERIALS AND METHODS A total of 11 sets of identical twins remained on 6-degree head down, tilt bed rest for 30 days to simulate prolonged microgravity. One twin per pair was randomly selected to exercise while supine in a lower body negative pressure chamber 6 days weekly for 40 minutes, followed by 5 minutes of resting lower body negative pressure at 50 mm Hg. The other twin served as a nonexercise control. Pressure in the exercise lower body negative pressure chamber (52 to 63 mm Hg) was adjusted to produce footward forces equivalent to those for upright running on Earth at 1.0 to 1.2 x body weight. Pre-bed rest urinary stone risk profiles were done elsewhere after 5 days of a standardized diet, consisting of 170 mEq sodium, 1,000 mg calcium, 0.8 gm/kg animal protein and 2,500 kcal, and then throughout the bed rest and recovery phases of the protocol. RESULTS A significant increase in urinary calcium after just 1 week of bed rest was noted in the nonexercise control group (p = 0.001). However, no such increase was noted in the exercise group. Brushite supersaturation increased significantly from bed rest in each group, although the increase was significantly higher in the nonexercise control group than in the exercise group (p = 0.006). Calcium oxalate supersaturation increased during bed rest in the exercise group (p = 0.004). It trended toward a higher level in the nonexercise control group, although this did not achieve significance (p = 0.055) Mean urine volume +/- SD was significantly higher in the nonexercise control group than in the exercise group at bed rest week 2 and at week 3 (2.01 +/- 0.21 vs 1.63 0.18 l and 2.03 +/- 0.22 vs 1.81 +/- 0.20, respectively). Urinary pH was significantly higher in the nonexercise control group than in the exercise group at week 1 and week 3 (6.62 +/- 0.7 vs 6.49 +/- 0.5 and 6.58 +/- 0.6 vs 6.49 +/- 0.8, respectively, p = 0.01). CONCLUSIONS Bed rest significantly alters the urinary environment to favor calculous formation. Lower body negative pressure chamber treadmill exercise offers some protection against increases in stone risk during simulated microgravity, particularly with regard to the risks of hypercalciuria and brushite stone formation. The use of lower body negative pressure to augment aerobic exercise in space may decrease the risk of stone formation in astronauts. Adjunct measures, including aggressive hydration and alkalinization therapy, should be considered.
Collapse
Affiliation(s)
- Manoj Monga
- Department of Urologic Surgery, University of Minnesota, 1420 Delaware Street, Minneapolis, MN 55455, USA.
| | | | | | | | | |
Collapse
|
24
|
Abstract
There is a growing body of evidence from the National Aeronautics and Space Administration and the Russian space program showing that humans exposed to the microgravity environment of space have a greater risk for developing renal stones. Increased bone resorption and the attendant hypercalciuria and hyperphosphaturia contribute significantly to raising the urinary state of saturation with respect to the calcium salts, namely calcium oxalate and calcium phosphate. In addition, other environmental and dietary factors may adversely affect urine composition and increase stone formation risk during space flight. For example, reductions in urinary volume, pH, and citrate contribute to raising stone formation risk. In addition to raising the risk for calcium stone formation, this metabolic profile is conducive to the formation of uric acid stones. Although observations to date have suggested that there may actually be a reduced food intake during the early phase of flight, crew members on longer-duration flights may increase food intake and be at increased risk for stone formation. Taken together, these findings support the use of nutritional recommendations for crew members that would serve to reduce the stone-forming propensity of the urinary environment. Pharmacologic intervention should be directed at raising urinary volumes, diminishing bone losses, and preventing reductions in urinary pH and citrate. Success in reducing the risk for stone formation in astronauts would also be of potential major benefit to the estimated 20 million Americans with nephrolithiasis.
Collapse
Affiliation(s)
- Joseph E Zerwekh
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
| |
Collapse
|
25
|
Abstract
Weightlessness induces bone loss. Understanding the nature of this loss and developing means to counteract it are significant challenges to potential human exploration missions. This article reviews the existing information from studies of bone and calcium metabolism conducted during space flight. It also highlights areas where nutrition may play a specific role in this bone loss, and where countermeasures may be developed to mitigate that loss.
Collapse
Affiliation(s)
- Scott M Smith
- Human Adaptation and Countermeasures Office, NASA Johnson Space Center, Houston, Texas 77058, USA.
| | | |
Collapse
|
26
|
Abstract
The final decade of the millennium has seen an enormous amount of on-orbit life sciences research, including both short- and long-duration flight research. Life sciences dedicated Space Shuttle flights have made intensive research opportunities available to study on the acute adaptation to weightlessness. The NASA/Mir Science Program combined resources of the USA and Russia to provide the first long-duration flight opportunities for the United States since the Skylab program of the early 1970s. Many of the results of these studies are still being evaluated, and in some cases data are still being collected to assess long-term readaptation to gravity after several months in weightlessness. The surge in life sciences research during this decade serves as a preamble to the opportunities to be provided by the latest addition to the Earth-orbiting structures--the International Space Station.
Collapse
Affiliation(s)
- S M Smith
- Life Sciences Research Laboratories/SD3, NASA Johnson Space Center, Houston, TX 77058, USA.
| | | |
Collapse
|
27
|
Jones JA, Johnston S, Campbell M, Miles B, Billica R. Endoscopic surgery and telemedicine in microgravity: developing contingency procedures for exploratory class spaceflight. Urology 1999; 53:892-7. [PMID: 10223479 DOI: 10.1016/s0090-4295(99)00024-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The risk of a urinary calculus during an extended duration mission into the reduced gravity environment of space is significant. For medical operations to develop a comprehensive strategy for the spaceflight stone risk, both preventive countermeasures and contingency management (CM) plans must be included. METHODS A feasibility study was conducted to demonstrate the potential CM technique of endoscopic ureteral stenting with ultrasound guidance for the possible in-flight urinary calculus contingency. The procedure employed the International Space Station/Human Research Facility ultrasound unit for guide wire and stent localization, a flexible cystoscope for visual guidance, and banded, biocompatible soft ureteral stents to successfully stent porcine ureters bilaterally in zero gravity (0g). RESULTS The study demonstrated that downlinked endoscopic surgical and ultrasound images obtained in 0g are comparable in quality to 1g images, and therefore are useful for diagnostic clinical utility via telemedicine transmission. CONCLUSIONS In order to be successful, surgical procedures in 0g require excellent positional stability of the operating surgeon, assistant, and patient, relative to one another. The technological development of medical procedures for long-duration spaceflight contingencies may lead to improved terrestrial patient care methodology and subsequently reduced morbidity.
Collapse
Affiliation(s)
- J A Jones
- National Aeronautics and Space Administration/Johnson Spacecraft Center and University of Texas Medical Branch Aerospace Medicine Program, Houston, Texas 77058, USA
| | | | | | | | | |
Collapse
|
28
|
Smith SM, Nillen JL, Leblanc A, Lipton A, Demers LM, Lane HW, Leach CS. Collagen cross-link excretion during space flight and bed rest. J Clin Endocrinol Metab 1998; 83:3584-91. [PMID: 9768669 DOI: 10.1210/jcem.83.10.5169] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Extended exposure to weightlessness results in bone loss. However, little information exists as to the precise nature or time course of this bone loss. Bone resorption results in the release of collagen breakdown products, including N-telopeptide and the pyridinium (PYD) cross-links, pyridinoline and deoxypyridinoline. Urinary pyridinoline and deoxypyridinoline are known to increase during bed rest. We assessed excretion of PYD cross-links and N-telopeptide before, during, and after long (28-day, 59-day, and 84-day) Skylab missions, as well as during short (14-day) and long (119-day) bed-rest studies. During space flight, the urinary cross-link excretion level was twice those observed before flight. Urinary excretion levels of the collagen breakdown products were also 40-50% higher, during short and long bed rest, than before. These results clearly show that the changes in bone metabolism associated with space flight involve increased resorption. The rate of response (i.e. within days to weeks) suggests that alterations in bone metabolism are an early effect of weightlessness. These studies are important for a better understanding of bone metabolism in space crews and in those who are bedridden.
Collapse
Affiliation(s)
- S M Smith
- Life Sciences Research Laboratories, National Aeronautics and Space Administration, Johnson Space Center, Houston, Texas 77058, USA.
| | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
PURPOSE The metabolic and environmental factors influencing renal stone formation before, during, and after Space Shuttle flights were assessed. We established the contributing roles of dietary factors in relationship to the urinary risk factors associated with renal stone formation. MATERIALS AND METHODS 24-hr. urine samples were collected prior to, during space flight, and following landing. Urinary and dietary factors associated with renal stone formation were analyzed and the relative urinary supersaturation of calcium oxalate, calcium phosphate (brushite), sodium urate, struvite and uric acid were calculated. RESULTS Urinary composition changed during flight to favor the crystallization of calcium-forming salts. Factors that contributed to increased potential for stone formation during space flight were significant reductions in urinary pH and increases in urinary calcium. Urinary output and citrate, a potent inhibitor of calcium-containing stones, were slightly reduced during space flight. Dietary intakes were significantly reduced for a number of variables, including fluid, energy, protein, potassium, phosphorus and magnesium. CONCLUSIONS This is the first in-flight characterization of the renal stone forming potential in astronauts. With the examination of urinary components and nutritional factors, it was possible to determine the factors that contributed to increased risk or protected from risk. In spite of the protective components, the negative contributions to renal stone risk predominated and resulted in a urinary environment that favored the supersaturation of stone-forming salts. Dietary and pharmacologic therapies need to be assessed to minimize the potential for renal stone formation in astronauts during/after space flight.
Collapse
Affiliation(s)
- P A Whitson
- Medical Sciences Division, NASA/Johnson Space Center, KRUG Life Sciences Inc., Houston, Texas 77058, USA
| | | | | |
Collapse
|
30
|
Chen Y, Pietrzyk RA, Whitson PA. Quantification of urinary uric acid in the presence of thymol and thimerosal by high-performance liquid chromatography. J Chromatogr A 1997; 763:187-92. [PMID: 9129322 DOI: 10.1016/s0021-9673(96)00740-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A high-performance liquid chromatographic method was developed as an alternative to automated enzymatic analysis of uric acid in human urine preserved with thymol and/or thimerosal. Uric acid (tR = 10 min) and creatinine (tR = 5 min) were separated and quantified during isocratic elution (0.025 M acetate buffer, pH 4.5) from a mu Bondapak C18 column. The uric-acid peak was identified chemically by incubating urine samples with uricase. The thymol/thimerosal peak appeared at 31 min during the washing step and did not interfere with the analysis. We validated the high-performance liquid chromatographic method for linearity, precision and accuracy, and the results were found to be excellent.
Collapse
Affiliation(s)
- Y Chen
- KRUG Life Sciences Inc., Houston, TX 77058, USA
| | | | | |
Collapse
|
31
|
Kumei Y, Shimokawa H, Katano H, Hara E, Akiyama H, Hirano M, Mukai C, Nagaoka S, Whitson PA, Sams CF. Microgravity induces prostaglandin E2 and interleukin-6 production in normal rat osteoblasts: role in bone demineralization. J Biotechnol 1996; 47:313-24. [PMID: 8987571 DOI: 10.1016/0168-1656(96)01412-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
It has been suggested that microgravity alters bone metabolism. Evidence for this phenomenon includes the negative calcium balance and decreased bone density in astronauts, as well as, inhibition of bone formation in rats flown for 2 to 3 weeks. However, the specific mechanisms that modulate these changes in microgravity are unknown. The purpose of this study was to clarify the mechanism of microgravity-induced bone demineralization using normal rat osteoblasts obtained from femur marrow cultures. The osteoblasts were cultured for 5 days during a Shuttle-Spacelab flight (STS-65). After collection of the culture medium, the cellular DNA and RNA were fixed on board. Enzyme-immunoassay of the culture medium for prostaglandin E2 (PGE2) indicated that microgravity induced a 4.5- to 136-fold increase in flight samples as compared to the ground control cultures. This increase of PGE2 production was consistent with a 3.3- to 9.5-fold elevation of inducible prostaglandin G/H synthase-2 (PGHS-2) mRNA, quantitated by reverse transcription-polymerase chain reaction (RT-PCR). The mRNA induction for the constitutive isozyme PGHS-1 was less than that for PGHS-2. The interleukin-6 (IL-6) mRNA was also increased (6.4- to 9.3-fold) in microgravity as compared to the ground controls. Since PGE2 and IL-6 are both known to play a role in osteoclast formation and bone resorption, these data provide molecular mechanisms that contribute to our understanding of microgravity-induced alterations in the bone resorption process.
Collapse
Affiliation(s)
- Y Kumei
- Faculty of Dentistry, Tokyo Medical and Dental University, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|