Multisystem Toxicity in Cancer: Lessons from NASA's Countermeasures Program.

Astronauts and cancer patients are subject to similar multisystem physiological toxicities. Over the past sixty years, NASA developed a state-of-the-art countermeasures program (CMP) to characterize and mitigate the physiological consequences of spaceflight. Here, we propose a NASA-modeled CMP to elucidate and abrogate physiological toxicities in patients with cancer.

Body mass changes during long-duration spaceflight.

BACKGROUND: During early spaceflights, many crewmembers did not meet their caloric requirements and consequently lost body mass during flight, as assessed by a decrease in postflight body mass. Maintaining body mass during spaceflight is crucial for maintaining crew health and monitoring body mass is thus important to medical operations as well as being a key component of human research. Determining body mass becomes difficult in a microgravity environment. METHODS: We report data from two mass measurement devices on the International Space Station (ISS): the Russian body mass measuring device (BMMD), which uses spring oscillation physics, and NASA's Space Linear Acceleration Mass Measurement Device (SLAMMD), which uses Newton's second law of motion (F = ma). RESULTS: For 25 crewmembers whose body mass was measured on both devices, significant body mass loss occurred compared to preflight (gravimetric scale) and averaged -4.4% as assessed by BMMD and -2.8% as assessed by SLAMMD. After an initial loss in the first 30 d of flight, body mass remained constant through the rest of the mission, as determined using either device. The mean difference between the two devices was 1.1 kg when the closest SLAMMD and BMMD measurements were compared (6.9 ± 6.2 d apart). Dietary intake during flight is approximately 80% of the World Health Organization estimated requirement and the decrease in body mass follows in-flight energy intake closely on average. CONCLUSION: Body mass monitoring is important for monitoring crew health during a mission and to help ensure that crewmembers consume adequate energy intake to mitigate the risks of spaceflight.

Opportunities for research in space life sciences aboard commercial suborbital flights.

The emergence of commercial suborbital spaceflight offers a wide range of new research and development opportunities for those in the space life sciences. Large numbers of diverse flyers, frequent re-flights, and flexible operations provide a fertile ground for both basic and applied science, as well as technology demonstrations. This commentary explores some of the unique features available to the space life science community and encourages engagement with commercial developers and operators during the design phase to help optimize platform designs and operations for future research.

A Year on the International Space Station: Implementing a Long-Duration Biomedical Research Mission.

INTRODUCTION: The year-long mission of American astronaut Scott Kelly and Russian cosmonaut Mikhail Kornienko included the most complex biomedical experiments ever conducted on the International Space Station-and arguably in human spaceflight-to establish insight into human health risks of interplanetary exploration. Focusing on risk mitigation, NASA conducted investigations that addressed spaceflight health hazards to varying degrees. This pilot mission was initiated to gain further knowledge and monitor the physiological, psychological, and medical effects of long-duration exposure to spaceflight.METHODS: NASA's Human Research Program and the Russian Academy of Sciences' Institute of Biomedical Problems identified more than 20 biomedical risk-reduction research investigations to be conducted on the two crewmembers before, during, and after their yearlong expedition. A database of results, as well as observations on programmatic resources, was collected to understand essential elements for future spaceflight health studies.RESULTS: Statistical rigor requires additional testing at a length of 1 yr to demonstrate the presence or absence of unacceptable deleterious effects, and to permit extrapolation to longer durations in space. Review of experimental procedures from this mission suggests potential efficiencies for future investigations.DISCUSSION: The Kelly-Kornienko 1-yr mission demonstrated the importance of continuing joint investigations with the adoption of standard measures for rigorous comparisons across disparate populations. It identified improvements to collaborative processes across national and international scientific research programs. Additional studies will inform the development of an integrated applied research methodology for the space station and future interplanetary expeditions.Charles JB, Pietrzyk RA. A year on the International Space Station: implementing a long-duration biomedical research mission. Aerosp Med Hum Perform. 2019; 90(1):4-11.

Human health and performance for long-duration spaceflight.

Future long-duration spaceflights are now being planned to the Moon and Mars as a part of the "Vision for Space Exploration" program initiated by NASA in 2004. This report describes the design reference missions for the International Space Station, Lunar Base, and eventually a Mars Expedition. There is a need to develop more stringent preflight medical screening for crewmembers to minimize risk factors for diseases which cannot be effectively treated in flight. Since funding for space life sciences research and development has been eliminated to fund program development, these missions will be enabled by countermeasures much like those currently in use aboard the International Space Station. Artificial gravity using centrifugation in a rotating spacecraft has been suggested repeatedly as a "universal countermeasure" against deconditioning in microgravity and could be an option if other countermeasures are found to be ineffective. However, the greatest medical unknown in interplanetary flight may be the effects of radiation exposure. In addition, a Mars expedition would lead to a far greater level of isolation and psychological stress than any space mission attempted previously; because of this, psychiatric decompensation remains a risk. Historically, mortality and morbidity related to illness and injury have accounted for more failures and delays in new exploration than have defective transportation systems. The medical care system on a future Mars expedition will need to be autonomous and self-sufficient due to the extremely long separation from definitive medical care. This capability could be expanded by the presence of a physician in the crew and including simple, low-technology surgical capability.

Biomedical findings from NASA's Project Mercury: a case series.

The United States first sent humans into space during six flights of Project Mercury from May 1961 to May 1963. These flights were brief, with durations ranging from about 15 min to just over 34 h. A primary purpose of the project was to determine if humans could perform meaningful tasks while in space. This was supported by a series of biomedical measurements on each astronaut before, during (when feasible), and after flight to document the effects of exposure to the spaceflight environment. While almost all of the data presented here have been published in technical reports, this is the first integrated summary of the main results. One unexpected finding emerges: the major physiological changes associated with these short-term spaceflights are correlated more strongly with time spent by the astronaut in a spacesuit than with time spent in space per se. Thus, exposure to the direct stressors of short-duration (up to 34 h) spaceflight was not the dominant factor influencing human health and performance. This is relevant to current spaceflight programs and especially to upcoming commercial flights in which time spent in space (as on a suborbital flight) will be minor compared to the time spent in associated preparation, ascent, and return.

Historical Review of Lower Body Negative Pressure Research in Space Medicine.

Cephalad redistribution of intravascular and extravascular fluid occurs as a result of weightlessness during spaceflight. This provokes cardiovascular, cardiopulmonary, and autonomic nervous system responses. The resulting altered functional state can result in orthostatic hypotension and intolerance upon landing and return to a gravity environment. In-flight lower body negative pressure (LBNP) transiently restores normal body fluid distribution. Early in the U.S. space program, LBNP was devised as a way to test for orthostatic intolerance. With the development of the Skylab Program and longer duration spaceflight, it was realized that it could provide a method of monitoring orthostatic intolerance in flight and predicting the post-landing orthostatic response. LBNP was also investigated not only as an in-flight cardiovascular orthostatic stress test, but also as a countermeasure to cardiovascular deconditioning on Soviet space stations, Skylab, and the Shuttle. It is still being used by the Russian program on the International Space Station as an end-of-flight countermeasure.

Practicing for space underwater: inventing neutral buoyancy training, 1963-1968.

Neutral buoyancy's value was far from obvious when human spaceflight began in 1961. Starting in 1964, Environmental Research Associates, a tiny company in the suburbs of Baltimore, developed the key innovations in an obscure research project funded by NASA's Langley Research Center. The new Houston center dismissed it until a mid-1966 EVA crisis, after which it rapidly took over. In parallel, NASA Marshall Space Flight Center developed many of the same techniques, as did many large aerospace corporations, yet the long-run technological impact of corporate activity was near zero. Because ERA and Marshall's pioneering activities led to the two long-running NASA training centers at Houston and Huntsville, those two organizations deserve primary credit for the construction of the neutral buoyancy technological system.

Cardiovascular effects of anti-G suit and cooling garment during space shuttle re-entry and landing.

BACKGROUND: Many cardiovascular changes associated with spaceflight reduce the ability of the cardiovascular system to oppose gravity on return to Earth, leaving astronauts susceptible to orthostatic hypotension during re-entry and landing. Consequently, an anti-G suit was developed to protect arterial pressure during re-entry. A liquid cooling garment (LCG) was then needed to alleviate the thermal stress resulting from use of the launch and entry suit. METHODS: We studied 34 astronauts on 22 flights (4-16 d). Subjects were studied 10 d before launch and on landing day. Preflight, crewmembers were suited with their anti-G suits set to the intended inflation for re-entry. Three consecutive measurements of heart rate and arterial pressure were obtained while seated and then again while standing. Three subjects who inflated the anti-G suits also donned the LCG for landing. Arterial pressure and heart rate were measured every 5 min during the de-orbit maneuver, through maximum G-loading (max-G) and touch down (TD). After TD, crew-members again initiated three seated measurements followed by three standing measurements. RESULTS: Astronauts with inflated anti-G suits had higher arterial pressure than those who did not have inflated anti-G suits during re-entry and landing (133.1 +/- 2.5/76.1 +/- 2.1 vs. 128.3 +/- 4.2/79.3 +/- 2.9, de-orbit; 157.3 +/- 4.5/102.1 +/- 3.6 vs. 145.2 +/- 10.5/95.7 + 5.5, max-G; 159.6 +/- 3.9/103.7 +/- 3.3 vs. 134.1 +/- 5.1/85.7 +/- 3.1, TD). In the group with inflated anti-G suits, those who also wore the LCG exhibited significantly lower heart rates than those who did not (75.7 +/- 11.5 vs. 86.5 +/- 6.2, de-orbit; 79.5 +/- 24.8 vs. 112.1 +/- 8.7, max-G; 84.7 +/- 8.0 vs. 110.5 +/- 7.9, TD). CONCLUSIONS: The anti-G suit is effective in supporting arterial pressure. The addition of the LCG lowers heart rate during re-entry.

The impact of sex and gender on adaptation to space: executive summary.

This review article is a compendium of six individual manuscripts, a Commentary, and an Executive Summary. This body of work is entitled "The Impact of Sex and Gender on Adaptation to Space" and was developed in response to a recommendation from the 2011 National Academy of Sciences Decadal Survey, "Recapturing a Future for Space Exploration: Life and Physical Sciences for a New Era," which emphasized the need to fully understand sex and gender differences in space. To ensure the health and safety of male and female astronauts during long-duration space missions, it is imperative to examine and understand the influences that sex and gender have on physiological and psychological changes that occur during spaceflight. In this collection of manuscripts, six workgroups investigated and summarized the current body of published and unpublished human and animal research performed to date related to sex- and gender-based differences in the areas of cardiovascular, immunological, sensorimotor, musculoskeletal, reproductive, and behavioral adaptations to human spaceflight. Each workgroup consisted of scientists and clinicians from academia, the National Aeronautics and Space Administration (NASA), and other federal agencies and was co-chaired by one representative from NASA and one from the external scientific community. The workgroups met via telephone and e-mail over 6 months to review literature and data from space- and ground-based studies to identify sex and gender factors affecting crew health. In particular, the Life Sciences Data Archive and the Lifetime Surveillance of Astronaut Health were extensively mined. The groups identified certain sex-related differences that impact the risks and the optimal medical care required by space-faring women and men. It represents innovative research in sex and gender-based biology that impacts those individuals that are at the forefront of space exploration.