A human mission to Mars: Predicting the bone mineral density loss of astronauts

Protective alleles and precision healthcare in crewed spaceflight

Common and rare alleles are now being annotated across millions of human genomes, and omics technologies are increasingly being used to develop health and treatment recommendations. However, these alleles have not yet been systematically characterized relative to aerospace medicine. Here, we review published alleles naturally found in human cohorts that have a likely protective effect, which is linked to decreased cancer risk and improved bone, muscular, and cardiovascular health. Although some technical and ethical challenges remain, research into these protective mechanisms could translate into improved nutrition, exercise, and health recommendations for crew members during deep space missions.

Effect of Spaceflight and Microgravity on the Musculoskeletal System: A Review

With National Aeronautics and Space Administration's plans for longer distance, longer duration spaceflights such as missions to Mars and the surge in popularity of space tourism, the need to better understand the effects of spaceflight on the musculoskeletal system has never been more present. However, there is a paucity of information on how spaceflight affects orthopaedic health. This review surveys existing literature and discusses the effect of spaceflight on each aspect of the musculoskeletal system. Spaceflight reduces bone mineral density at rapid rates because of multiple mechanisms. While this seems to be recoverable upon re-exposure to gravity, concern for fracture in spaceflight remains as microgravity impairs bone strength and fracture healing. Muscles, tendons, and entheses similarly undergo microgravity adaptation. These changes result in decreased muscle mass, increased tendon laxity, and decreased enthesis stiffness, thus decreasing the strength of the muscle-tendon-enthesis unit with variable recovery upon gravity re-exposure. Spaceflight also affects joint health; unloading of the joints facilitates changes that thin and atrophy cartilage similar to arthritic phenotypes. These changes are likely recoverable upon return to gravity with exercise. Multiple questions remain regarding effects of longer duration flights on health and implications of these findings on terrestrial medicine, which should be the target of future research.

Humans at the dawn of the in-body electrical nerve stimulation era

Background

The neuroprosthesis laparoscopic implantation technique for electric pelvic nerve stimulation was introduced to gynaecology over 15 years ago to treat intractable pelvic neuropathic pain. Following this first indication, other applications were developed, particularly in parapleology. The LION procedure developed to assist patients with paraplegia and common problems associated with inertia when confined to a wheelchair could find revolutionary applications in aging medicine and prevention.

Materials and Methods

Spinal cord injured patients who have undergone the Possover's LION procedure.

Main outcome measure

PubMed was systematically searched to identify peer-reviewed articles published in English that reported on LION procedure.

Results

Three independent studies published recently (100 patients worldwide) have shown revolutionary recovery of supra-spinal control in patients with chronic spinal cord injury following pelvic nerves stimulation, with 70% of them establishing a walker/crutches-assisted gait. The same studies have also shown significant whole-body muscle-mass building, peripheral vasodilatation, and an unexpected improvement in bone mineral density.

Conclusion

These ground-breaking findings could find revolutionary applications in aging medicine and the prevention of osteoporosis, with a huge impact on global public health. Humanity is on the cusp of an exciting new era following the introduction of the in-body electrical nerve stimulation technique.

What is new?

In-body electrical nerve stimulation for recovery and/or control of human peripheral somatic and autonomic nervous systems.

Fractionated Proton Irradiation Does Not Impair Hippocampal-Dependent Short-Term or Spatial Memory in Female Mice

The environment outside the Earth's protective magnetosphere is a much more threatening and complex space environment. The dominant causes for radiation exposure, solar particle events and galactic cosmic rays, contain high-energy protons. In space, astronauts need healthy and highly functioning cognitive abilities, of which the hippocampus plays a key role. Therefore, understanding the effects of ¹H exposure on hippocampal-dependent cognition is vital for developing mitigative strategies and protective countermeasures for future missions. To investigate these effects, we subjected 6-month-old female CD1 mice to 0.75 Gy fractionated ¹H (250 MeV) whole-body irradiation at the NASA Space Radiation Laboratory. The cognitive performance of the mice was tested 3 months after irradiation using Y-maze and Morris water maze tests. Both sham-irradiated and ¹H-irradiated mice significantly preferred exploration of the novel arm compared to the familiar and start arms, indicating intact spatial and short-term memory. Both groups statistically spent more time in the target quadrant, indicating spatial memory retention. There were no significant differences in neurogenic and gliogenic cell counts after irradiation. In addition, proteomic analysis revealed no significant upregulation or downregulation of proteins related to behavior, neurological disease, or neural morphology. Our data suggests ¹H exposure does not impair hippocampal-dependent spatial or short-term memory in female mice.

Bone deconditioning during partial weight-bearing in rodents - A systematic review and meta-analysis

Space agencies are preparing to send humans to the Moon (16% Earth's gravity) and Mars (38% Earth's gravity), however, there is limited evidence regarding the effects of hypogravity on the skeletal system. A novel rodent partial weight-bearing (PWB) model may provide insight into how human bone responds to hypogravity. The aim of this study was to perform a systematic review investigating the effect of PWB on the structure and function of rodent bone. Five online databases were searched with the following inclusion criteria: population (rodents), intervention (PWB for ≥1-week), control (full weight-bearing), outcomes (bone structure/function), and study design (animal intervention). Of the 2,993 studies identified, eight were included. The main findings were that partial weight-bearing exposure for 21-28 days at 20%, 40%, and 70% of full loading causes: (1) loss of bone mineral density, (2) loss of trabecular bone volume, thickness, number, and increased separation, (3) loss of cortical area and thickness, and 4) reduced bone stiffness and strength. These findings predominately relate the tibia/femur of young/mature female mice, however, their deconditioning response appeared similar, but not identical, to male rats. A dose-response trend was frequently observed between the magnitude of deconditioning and PWB level. The deconditioning patterns in PWB resembled those in rodents and humans exposed to microgravity and microgravity analogs. The present findings suggest that countermeasures against bone deconditioning may be required for humans exploring the Lunar and Martian surfaces.

Space Medicine: Inspiring a new generation of physicians

Space medicine is critical in enabling safe human exploration of space. The discipline focuses on supporting human survival, health, and performance in the austere environment of space. It is set to grow ever more important as significant transitions in the standard of space operations in the suborbital, low earth orbit (LEO) and beyond LEO domains will take place in the coming years. NASA along with their international and commercial partners have committed to returning to the Moon through the Artemis missions in this decade with the aim of achieving a permanent sustainable human presence on the lunar surface. Additionally, the development of reusable rockets is set to increase the number and frequency of humans going to space by making space travel more accessible. Commercial spaceflight and missions beyond LEO present many new challenges which space medicine physicians and researchers will need to address. Space medicine operates at the frontier of exploration, engineering, science and medicine. Aviation and Space Medicine (ASM) is the latest specialty to be recognised by the Royal College of Physicians and the General Medical Council in the UK. In this paper, we provide an introduction to space medicine, review the effects of spaceflight on human physiology and health along with countermeasures, medical and surgical issues in space, the varied roles of the ASM physician, challenges to UK space medicine practice and related research, and finally we explore the current representation of space medicine within the undergraduate curriculum.

Extraterrestrial Gynecology: Could Spaceflight Increase the Risk of Developing Cancer in Female Astronauts? An Updated Review

Outer space is an extremely hostile environment for human life, with ionizing radiation from galactic cosmic rays and microgravity posing the most significant hazards to the health of astronauts. Spaceflight has also been shown to have an impact on established cancer hallmarks, possibly increasing carcinogenic risk. Terrestrially, women have a higher incidence of radiation-induced cancers, largely driven by lung, thyroid, breast, and ovarian cancers, and therefore, historically, they have been permitted to spend significantly less time in space than men. In the present review, we focus on the effects of microgravity and radiation on the female reproductive system, particularly gynecological cancer. The aim is to provide a summary of the research that has been carried out related to the risk of gynecological cancer, highlighting what further studies are needed to pave the way for safer exploration class missions, as well as postflight screening and management of women astronauts following long-duration spaceflight.

First Void Urinary Calcium for Tracking Bone Loss and Kidney Stone Risk in Space

INTRODUCTION: Microgravity exposure unloads the skeleton. This increases urinary calcium excretion, which reflects both increased bone loss and kidney stone formation risk. We studied the probability that first morning void (FMV) urinary calcium (Uca) measurements would capture the highest Uca concentration in a day.METHODS: For 8 wk, three men and three women collected void-by-void 24-h urine samples weekly. Uca concentration was analyzed using a calcein-based system. Uca concentrations were ranked among all samples from each person. FMV and non-FMV (nFMV) Uca concentrations were compared with a Mann Whitney U-test. The probability that an FMV would capture the highest Uca concentration in a day was assessed.RESULTS: Among 377 voids collected, 46 were FMV and 331 were nFMV. Among all samples, the Uca concentration for FMV was significantly higher than nFMV (P < 0.0001). Out of the 46 FMVs, 24 were highest in Uca concentration for the corresponding 24-h period, giving a 52.2% probability that any given FMV would capture the highest Uca concentration in a day. The probability of measuring the highest Uca concentration from at least 1 d increased to 77.1%, and 89.1% when two or three FMVs were collected respectively.DISCUSSION: Acquiring 2–3 repeated FMVs provides a high likelihood of capturing the highest Uca from a day. This suggests repeated first morning void Uca concentrations could assess the risk of bone loss and kidney stone formation, which may provide ability for real-time implementation of countermeasure programs to prevent bone and renal complications in prolonged spaceflight.Thamer S, Buckey JC. First void urinary calcium for tracking bone loss and kidney stone risk in space. Aerosp Med Hum Perform. 2022; 93(7):546–550.

αKlotho decreases after reduced weight-bearing from both spaceflight and hindlimb unloading

Alpha(α)Klotho, a soluble transmembrane protein, facilitates calcium-phosphorus homeostasis through feedback between bone and kidney and is a potential systemic biomarker for bone-kidney health during spaceflight. We determined if: (1) plasma αKlotho was reduced after both spaceflight aboard the ISS and hindlimb unloading (HU); and (2) deficiency could be reversed with exercise. Both spaceflight and HU lowered circulating plasma αKlotho: plasma αKlotho recovered with exercise after HU.

Exposure to Random Positioning Machine Alters the Mineralization Process and PTX3 Expression in the SAOS-2 Cell Line

Bone loss is among the most frequent changes seen in astronauts during space missions. Although weightlessness is known to cause high bone resorption and a rapid decrease in bone minerals and calcium, the underlying mechanisms are not yet fully understood. In our work, we investigated the influence of random positioning machine (RPM) exposure on the mineralization process in the SAOS-2 cell line, in osteogenic and non-osteogenic conditions, by examining changes in their mineralizing capacity and in the expression of PTX3, a positive regulator of bone mineralization. We analyzed cell viability by MTS assay and the mineralization process after staining with Toluidine Blue and Alizarin Red, while PTX3 expression was investigated by immunocytochemistry and western blotting analysis. Our results showed that RPM exposure increased cells’ viability and improved their mineralizing competence when not treated with osteogenic cocktail. In contrast, in osteogenic conditions, cells exposed to RPM showed a reduction in the presence of calcification-like structures, mineral deposits and PTX3 expression, suggesting that the effects of RPM exposure on mineralizing matrix deposition depend on the presence of osteogenic factors in the culture medium. Further studies will be needed to clarify the role of potential mineralization markers in the cellular response to the simulated biological effects of microgravity, paving the way for a new approach to treating osteoporosis in astronauts exposed to spaceflight.

In Vitro Models of Bone Marrow Remodelling and Immune Dysfunction in Space: Present State and Future Directions

Spaceflight affects the body on every level. Reports on astronaut health identify bone marrow remodelling and dysfunction of the innate immune system as significant health risks of long-term habitation in space. Microgravity-induced alterations of the bone marrow induce physical changes to the bone marrow stem cell niche. Downstream effects on innate immunity are expected due to impaired hematopoiesis and myelopoiesis. To date, few studies have investigated these effects in real microgravity and the sparsely available literature often reports contrasting results. This emphasizes a need for the development of physiologically relevant in vitro models of the bone marrow stem cell niche, capable of delivering appropriate sample sizes for robust statistics. Here, we review recent findings on the impact of spaceflight conditions on innate immunity in in vitro and animal models and discusses the latest in vitro models of the bone marrow stem cell niche and their potential translatability to gravitational biology research.

An Empirical and Subjective Model of Upper Extremity Fatigue Under Hypogravity

In the context of extra-terrestrial missions, the effects of hypogravity (0 < G < 1) on the human body can reduce the well-being of the crew, cause musculoskeletal problems and affect their ability to perform tasks, especially during long-term missions. To date, studies of the effects of hypogravity on human movement are limited to experiments on the lower limbs. Here, we extend the knowledge base to the upper limbs, by conducting experiments to evaluate the effect of hypogravity on upper limb physical fatigue and mental workload in participants. Our hypothesis was that hypogravity would both increase participant productivity, by reducing overall physical fatigue expressed in Endurance Time, and reduce mental workload. Task Intensity-Endurance time curves are developed especially in seated positions, while performing static, dynamic, repetitive tasks. This experiment involved 32 healthy participants without chronic problems of the musculoskeletal system aged 33.59 ± 8.16 years. Using the collected data, fatigue models were constructed for tasks of varying Intensity. In addition, all participants completed the NASA – Task Load Index subjective mental workload assessment, which revealed the level of subjective workload when executing different tasks. We found two trends in the empirical fatigue models associated with the difference between the strength capabilities of males and females. The first is a significant positive (p = 0.002) relation between Endurance time and gravity level (⅙ G Moon, ⅓ G Mars, 1G) with negative coefficient for males and females for a static task. And there is marginal relation (p < 0.1) between overall mental workload and gravity level with a positive coefficient for males and females for the same task. The same trend was observed for dynamic and repetitive tasks. We concluded that the Task Intensity-Endurance Time model, adapted to hypogravity in combination with subjective mental assessment, is useful to human fatigue investigation. The combination of these methods used for ergonomic analysis and digital human modeling, could improve worker productivity. Finally, this study may help prepare astronauts for long-term missions on the Moon and Mars and improve our understanding of how we can prevent musculoskeletal disorders caused by hazardous manual handling under such extreme environments.

Radiation on Earth or in Space: What Does It Change?

After having been an instrument of the Cold War, space exploration has become a major technological, scientific and societal challenge for a number of countries. With new projects to return to the Moon and go to Mars, radiobiologists have been called upon to better assess the risks linked to exposure to radiation emitted from space (IRS), one of the major hazards for astronauts. To this aim, a major task is to identify the specificities of the different sources of IRS that concern astronauts. By considering the probabilities of the impact of IRS against spacecraft shielding, three conclusions can be drawn: (1) The impacts of heavy ions are rare and their contribution to radiation dose may be low during low Earth orbit; (2) secondary particles, including neutrons emitted at low energy from the spacecraft shielding, may be common in deep space and may preferentially target surface tissues such as the eyes and skin; (3) a "bath of radiation" composed of residual rays and fast neutrons inside the spacecraft may present a concern for deep tissues such as bones and the cardiovascular system. Hence, skin melanoma, cataracts, loss of bone mass, and aging of the cardiovascular system are possible, dependent on the dose, dose-rate, and individual factors. This suggests that both radiosusceptibility and radiodegeneration may be concerns related to space exploration. In addition, in the particular case of extreme solar events, radiosensitivity reactions-such as those observed in acute radiation syndrome-may occur and affect blood composition, gastrointestinal and neurologic systems. This review summarizes the specificities of space radiobiology and opens the debate as regards refinements of current radiation protection concepts that will be useful for the better estimation of risks.

No Effect of Microgravity and Simulated Mars Gravity on Final Bacterial Cell Concentrations on the International Space Station: Applications to Space Bioproduction

Microorganisms perform countless tasks on Earth and they are expected to be essential for human space exploration. Despite the interest in the responses of bacteria to space conditions, the findings on the effects of microgravity have been contradictory, while the effects of Martian gravity are nearly unknown. We performed the ESA BioRock experiment on the International Space Station to study microbe-mineral interactions in microgravity, simulated Mars gravity and simulated Earth gravity, as well as in ground gravity controls, with three bacterial species: Sphingomonas desiccabilis, Bacillus subtilis, and Cupriavidus metallidurans. To our knowledge, this was the first experiment to study simulated Martian gravity on bacteria using a space platform. Here, we tested the hypothesis that different gravity regimens can influence the final cell concentrations achieved after a multi-week period in space. Despite the different sedimentation rates predicted, we found no significant differences in final cell counts and optical densities between the three gravity regimens on the ISS. This suggests that possible gravity-related effects on bacterial growth were overcome by the end of the experiment. The results indicate that microbial-supported bioproduction and life support systems can be effectively performed in space (e.g., Mars), as on Earth.