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Space Medicine - Aiming Sky High

Space Medicine – Aiming Sky High

With long-distance missions to Mars and commercial space travels coming closer, questions on how to keep astronauts and passengers healthy during and after space flights are getting more attention.  

In space, everything works differently 

Living in space for a prolonged time comes along with major challenges for our health: microgravity, radiation, social isolation and a disrupted circadian rhythm are extreme environmental conditions that can be associated to numerous physical and psychological conditions. Your organs slightly change their location in your body, as does the distribution of liquid. Muscles start wasting, eyesight worsens, the immunity is altered, and bone mass decreases, making them susceptible to fractures and osteoporosis. These are consequences astronauts can face in space, just to name a few.  

Finding ways how to maintain health during space travel, therefore, increasingly shifts into focus of research, opening the field of “space medicine”. Particularly in view of long-distance missions to the moon or Mars, where telemedical communication is slow and immediate evacuation is not possible, astronauts will need to be able to monitor their health and handle also medical emergencies themselves.  

Tracking the passengers’ health status will be an integral part in avoiding some of such possible emergencies. For example, NASA developed a diagnostic device that can monitor astronauts’ health status during long space travels by measuring specific biomarkers in the blood, saliva and breath. Researchers have estimated that during a 900-day mission of a crew of six, nonetheless, one emergency can be expected.  

Especially when it comes to surgery in space, microgravity will be a major complicating factor. It is not only for unsterile particles and microbes flying around which pose a risk, but also the surgery itself. It already begins with anaesthesia, as leakage of the inhaled anaesthetic drug could affect the operating crew members. Intravenously administered drugs, hence, would be safer to use. Still, surgeons will need to take the altered response to vasoactive drugs and anaesthetics carefully into account to avoid incidences like the unexpected death of a primate post-anaesthesia during the Bion 11 mission in 1997. According to Michael Barratt, medical doctor and NASA astronaut, liquid containment poses a second risk factor. In an interview with BBC, he said that if, for example, an artery was nicked, the arterial pressure would be high enough that the blood would leak into the atmosphere, impeding the surgeon’s work. These are only some of the challenges to space surgery, and many more would need to be resolved before surgeries will prove safe for space. 

Ilaria Cinelli, Emerging Space Leader Scholar and Associate Fellow of the Aerospace Medical Association who will be a speaker at the XPOMET© Medicinale, comments on research performed for deep space missions: “Scientists assign a priority to any risk concerning human health on a manned space mission.  Up to date, mitigation strategies have been established for identifying targeted countermeasures to hazard of human health. By looking at incoming crewed missions to Mars or the Moon, medical research is now moving towards comprehensive countermeasures for sustaining permanent human presence in space. The endeavour of human exploration of space shall be accompanied by simultaneous efforts in research conducted in ground-based simulators and translation science. This last is essential for testing and validating the efficacy of mitigations at a larger scale for reaching high accuracy and precision.”  

If companies like SpaceX, Virgin Galactic or Blue Origin want to make space travel available to the broad population, too, it needs to be made safe also for people who are not in perfect physical shape. So far, not few astronauts who went to space have been people of military background or in very good physical condition and underwent an intense training. More thorough research will, therefore, be needed to further explore the health limitations to commercial space travel and ways how health of people of “imperfect” physical shape can be maintained in space.  

Medtronic’s Micra pacemaker, for example, was reported to survive a 13-minute suborbital space flight, paving the way for further in-depth investigations. Although this is not a green light for people with pacemakers to be suited for commercial space travels, it raises hope that in the future, space flights might also be open to people carrying medical devices. Further studies also indicated that people of high age or controlled chronic disease tolerate suborbital flight centrifuge training. Probably the most well-known person with a medical condition who experienced zero-gravity would be Stephen Hawking back in 2007.  

Still, this is only the beginning, and there are many question marks to resolve when it comes to the translation to such results to longer-duration deep space flights.  

Health in Space is Health on Earth 

Another very interesting aspect of space medicine and research is that the potential that the insights scientists gain from space can be translated to earth. Ilaria Cinelli commented, that investments in space medicine reached significant impact when the knowledge and the technology enabling space health were transferred to medicine on Earth. And, as scientist-astronaut Shawna Pandya, who will be a speaker at the XPOMET© Medicinale 2020, phrased in the Inside XPOMET© podcast: “There is all too often the popular perception that we are investing so much money in space and space exploration where there are so many challenges on earth that we need to solve first. But in reality, it is a false dichotomy, because the benefits that we have got from studying health in space in what is keeping people healthy in space is translated into benefits for earth.” As an example, she mentions the charged coupled devices in the Hubble telescope, whose technology improved image quality of breast cancer imaging.  

A Different Type of Drug Manufactory in Space 

Interestingly, challenges arising in space are also pushing creativity of biotech research. Not only the astronauts, but also the drugs carried in the spacecraft are exposed to radiation, affecting their half-life and thereby accelerate their degradation. Karen McDonald, Professor at the UC Davis, investigates an intriguing idea: instead of carrying manufactured drugs from earth, why not have them synthesised by CRISPR-genetically modified plants on board? If the technology proves feasible, drug-producing plants would offer many advantages, among others that their seeds are easy to store on longer journeys. Having them produced only when they are needed will avoid the challenge of a too early expiration and would enable sustained provision with the drug. If the drug is orally administered, production should be easy, however it gets more difficult if the drug needs to be administered intravenously, as it would need thorough purification. What today still is in early development could become reality sooner than one would expect. As we have seen with the development of the CRISPR/Cas9 technology, science can move fast. 

Space medicine is a promising field of medicine and research, of which both astronauts and people on earth will largely benefit. With commercial space travel becoming more popular and missions to Mars coming closer, we can be sure that many interesting developments will follow. At the XPOMET© Medicinale, top-notch referees like Shawna Pandya and Ilaria Cinelli will share their insights from space health.  

References and further reading: 

doi: 10.1056/NEJMra1609012 
doi: 10.1093/bja/aex336 
https://www.bbc.com/future/article/20151125-the-challenges-of-carrying-out-surgery-in-space
https://www.medgadget.com/2016/02/diagnostic-device-keeps-astronauts-checked-up-for-distant-space-trips.html
https://soundcloud.com/user-305935192/shawna-pandya
https://www.space.com/space-tourism-flights-health-risks.html
https://www.medtronic.com/us-en/about/news/pacemaker-in-space.html
https://lsda.jsc.nasa.gov/Mission/miss/135?
https://www.labiotech.eu/features/space-medicine-plants/
https://www.pharmaceutical-technology.com/features/medicines-in-space-astronauts-make-own-drugs/

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