Inside health research from outer space

Bette Browne looks at the benefits that are being accrued from health research in space

The International Space Station (ISS), the brightest object in the night sky over Ireland during these summer months, is a unique laboratory for groundbreaking health research and innovation. Take the NeuroArm, the world’s first robot that is as dexterous as the human hand, but even more precise and tremor-free and can perform surgeries inside an MRI machine that would otherwise be impossible.

This device was developed by Canadian technology and research aboard the ISS in 2008 and has since been used to treat 70 patients who were otherwise inoperable. Then there is the Image-guided Autonomous Robot (IGAR), a digital innovation that is expected to increase access to critical surgical techniques to fight breast cancer. Another breakthrough was Modus V, a robotic digital microscope that helps in the treatment of patients with a range of brain and spine conditions, which is being used in 30 hospitals across North America.

ISS

“Canada’s main focus is on health research,” Ms Isabelle Tremblay, Director, Astronauts, Life Sciences and Space Medicine at the Canadian Space Agency (CSA), told the Medical Independent (MI) in a telephone interview.
The CSA is one-of-five international space agencies participating in innovative work aboard the modular ISS as it orbits the planet. The others are NASA (United States), Roscosmos State Corporation for Space Activities (Russia), JAXA (Japan Aerospace Exploration Agency), and the ESA (European Space Agency) of which Ireland is a member. The ISS, now 21 years old, will operate until at least 2024 and discussions are underway to extend that to 2028.

The Americans, Russians, and Europeans contribute most of the funding, but Japan and Canada are also key members. Canada is proud of its contribution.

“Although we have a small share allocation (on the ISS), Canada punches above its weight,” said Ms Tremblay.
Space is continually improving our understanding of medical conditions on Earth, she told MI. “Canadian scientists use space to study our bones, heart, blood vessels and brain. Their experiments have produced findings that can help people suffering from cardiovascular disorders, type 2 diabetes, osteoporosis, and balance problems. Living in weightless conditions changes the human body in many ways.

“The effects observed in astronauts are similar to accelerated aging and health problems caused by a sedentary lifestyle. Studying the human body in space for six months gives us data that would take 10 to 20 years to gather on Earth. All the knowledge is applicable here on Earth to better understand the effects of inactivity and what we can do efficiently to stay healthy.”

NASA

NASA also publicises the benefits of research aboard the space station, where astronauts have conducted nearly 3,000 scientific experiments over the last 20 years.

“The International Space Station is a unique laboratory for performing investigations that affect human health both in space and on Earth,” the US agency says on its website. “During its time in orbit, the space station has enabled research that is providing a better understanding of many aspects of human health including aging, trauma, disease and environmental impacts.”

The results of its research have provided new ways to mitigate bone loss, insights into bacterial behaviour, and innovative wound-healing techniques. “Advances in telemedicine, disease models, psychological stress response systems, nutrition, and cell behaviour are just a few more examples of the benefits that have been gained from applying studies in orbit to human health back on Earth.”

It cites insights into a range of diseases and conditions including Alzheimer’s disease, Parkinson’s disease, cancer, asthma, and heart disease. “Microgravity research has provided new insights to scientists studying these diseases. Without the interference of Earth’s gravity, Alzheimer’s researchers have studied protein clusters that can cause neurodegenerative diseases.

“Cancer researchers studied the growth of endothelial cells on the space station. Endothelial cells help supply blood in the body, and tumors need that blood to form. Space station-grown cells grow better than those on Earth and can help test new cancer treatments.”

Protein crystal growth experiments conducted aboard the space station have provided insights into numerous diseases, from cancer to gum disease, NASA says.

“One of the most promising results of these station experiments has come from the study of a protein associated with Duchenne muscular dystrophy (DMD). A treatment for DMD based on this research is in clinical trials.”

Twins study

Research from NASA’s landmark ‘twins study’ was published in 2019 in the journal Science. The study brought 10 research teams together to observe what physiological, molecular, and cognitive changes could happen to a human from exposure to spaceflight hazards. This was accomplished by comparing retired US astronaut Scott Kelly while he was in space, to his identical twin brother, retired astronaut Mark Kelly who remained on Earth. Because identical twins share the same genetic makeup, twin studies provide a way for scientists to explore how health is impacted by the environment. Scott provided a test case to measure in space, and Mark provided a baseline test case to compare those measurements on Earth.

“Findings from the twins study may be used to develop new treatments and preventative measures for stress-related health risks on Earth.” For example, NASA said telomere research may improve efforts to mitigate the effects of aging and disease.

“The proteomic research could have implications for research on traumatic brain injury. Research in astronauts could give new insights into how changes in the body are related to risk factors for diseases. These are just a few of
many ways spaceflight research can help humankind.”

Tissue chips

Tissue chips have also been tested. Tissue chips are roughly USB drive-size devices that contain human cells in a 3D matrix, representing functions of an organ. They help scientists to test how those cells respond to stresses, drugs, and genetic changes. The Tissue Chips in Space initiative aims to use these devices in microgravity to better understand and improve human health and disease treatment on Earth. Chips simulating lung, kidney, brain, and intestine behaviour have been sent to the space station by a branch of the US National Institutes of Health.

Many of the changes in the body caused by microgravity resemble the effects of diseases associated with aging on Earth but occur much faster in space. This means scientists may be able to use tissue chips in space to model changes that might take months or years to happen on Earth, according to NASA. Protein crystals grown on Earth are affected by gravity, which may alter the way the molecules align on the crystal, but researchers have discovered that growing crystals aboard the space station allows for slower growth and higher quality crystals. This high-quality crystallisation allows scientists to identify the structures of disease-causing proteins to develop new medications and treatments, according to NASA.

Ongoing research

June was a particularly busy month for research work aboard the ISS. On 5 June, Flight Engineer Thomas Pesquet of the ESA installed the Molecular Muscle Experiment-2 in the space station’s Columbus laboratory module. “MME-2 will test a series of drugs to see if they can improve health in space possibly leading to new therapeutic targets for examination on Earth,” stated NASA.

On 7 June, NASA astronaut Megan McArthur installed a new research device known as the ADSEP-2, or Advanced Space Experiment Processor-2, which will support observations of biological or physical samples. On the same day, fellow astronaut Shane Kimbrough put in place sample packs for an experiment to observe how bacteria is affected by microgravity and investigate ways to counteract any potential harmful changes. NASA suggests that results could also have a positive influence for oral health.

The ESA also describes the ISS as humankind’s laboratory in space. “Its unique microgravity environment enables researchers to study phenomena and carry out experiments that would not be possible on Earth,” according to the ESA’s website. “Scientific discoveries made are applied widely from health to metallurgy, while the increased knowledge we gain about our solar system helps build a deeper understanding of Earth and life itself.”

ESA’s human spaceflight research coordinator Jennifer Ngo-Anh explains the benefits of research aboard the ISS. “We typically run three types of experiments, research that cannot be done on Earth, research to understand and improve astronaut health and research that exploits the unique aspect of sending perfectly healthy and fit humans into a new and stressful environment,” she told the ESA website.

This work has included research into endothelial cells that line blood vessels. It is helping understand how and why they contract and expand, and why they have reduced functionality in old age on Earth. Scientists are also exploring whether new blood vessels can be grown in space by exploiting weightlessness. Meanwhile, in November, the ESA announced that Irish tech companies were using space technologies to help remotely monitor the health of patients with Covid-19.

The ESA-backed projects involve monitoring technologies, which were to be trialed in Ireland and other ESA member states. An early trial at Beaumont Hospital, Dublin, demonstrated that the system deployed could identify patients at risk of suffering respiratory failure 12 hours earlier than normally possible.

Remote healthcare

Keeping an astronaut healthy from a distance is the flight surgeon’s task on Earth. Small, easy-to-use machines are required for diagnosis, but also for research into human health. “Great strides have been made over the last two decades in ultrasound machines, heart-rate monitors, thermometers as well as in operating and sending the data to medical professionals many thousands of kilometres away,” according to the ESA.

Such advances help remote communities in very practical ways, Ms Tremblay told MI. “In Canada, we want to generate benefits and improve equity, especially for communities in the north of Canada. Remote presence robotic technologies provide the sense that physicians are present, enabling them to provide real-time clinical services at a distance.
“In Mars missions, a signal will take 20 minutes to go there and 20 minutes to come back so if there is an emergency, astronauts need to be able to make the decisions that matter in the short-term. So we need to improve their autonomy when it comes to health and improve systems that will allow us to monitor their health to prevent issues arising. Empowering people to take care of their health in space is very similar to what we need [to achieve] on Earth.”

Indeed, Ms Tremblay believed that major medical innovations and benefits may emerge from research during deep space missions. The health impact of a six-month stint on the ISS will be far different to several years on Mars.
“We don’t know [health effects] beyond six months,” Ms Tremblay emphasised. “We need to know that before we send people to Mars and how it’s going to affect their health over two years. We are involved in an initiative called Health Beyond or Deep Space Healthcare. That’s where major medical developments can be expected.”

Much of this evaluation of astronauts’ health and wellbeing will be done on a planned Lunar Gateway, a small space station that will be built over the course of this decade and will serve as a multi-purpose outpost orbiting the Moon.
Last year, four of the five space agencies working on the ISS reached agreement to back the Lunar Gateway. The CSA, ESA, and JAXA announced plans to participate in the NASA-led Lunar Gateway project.

However, Roscosmos said that the project was too “US-centric” and in January 2021, it announced it would not be participating. However, two months later, the Russian space agency signed an agreement with the Chinese National Space Administration to build what they called an International Scientific Lunar Station – a base on or around the Moon. Canada has been laying the foundations for its participation in Mars missions and focusing on the health aspects of such exploration.

According to an expert group report on the Potential Canadian Healthcare and Biomedical Roles for Deep-Space Human Spaceflight, published in 2018, “Medical processes during past flights have been Earth-centric, as the overall health of astronauts and cosmonauts has been supervised by a medical team on the ground. Expected and routine disorders could be diagnosed and treated by onboard crew medical officers.

“For more complicated issues or medical contingencies that could not be readily resolved in space, a flight surgeon has managed the medical situation from the ground until the ill crewmember could be returned to Earth for further treatment. This stabilisation and transportation was possible with abundant real-time voice communication between the medical team on Earth and the onboard crew, as well as with the electronic transmission of health data.” However, while this concept has worked well, it won’t be realistic once astronauts venture beyond Earth’s orbit.

“A round-trip journey to Mars takes almost three years. During that time, the expedition crew and spacecraft must operate with little or no resupply of air, water, food, medical supplies or spare parts. Astronauts will endure the harmful effects of weightlessness and space radiation for longer periods than ever before. Limited communication and speed-of-light delays will greatly reduce the role of mission control in helping the expedition succeed. Aborting a mission to return early, for example in the case of system failure or crew illness, will be impossible.”

The report stressed that “different approaches to complex medical operations in space and the functionality of spacecraft themselves” must be validated prior to the first Mars exploration mission.

“The practice of clinical medicine on Earth also happens to be evolving to become a more patient-centric and point-of-care model, similar to what is envisaged for the care of deep-space astronauts. Thus, this new autonomous model could potentially be evaluated by health-practitioners working in northern communities on Earth and by geriatric patients being remotely monitored at home.”

Innovation

It seems that everything translates back to enhancing healthcare on Earth. “Absolutely,” Ms Tremblay responded. “When we tackle a very challenging problem like space exploration it’s a powerful driver of innovation and we can apply that on Earth. If we look at deep space healthcare, we can see how we can also drive innovation in that area, working with partners, and that has the potential to transform the way our healthcare systems work and how we provide healthcare here on Earth.

“What inspired me to work on space exploration is that power to project us into the future and to have those advanced technologies that will transform our lives here on Earth. So, for me, space exploration has a key role in advancing our societies and our technologies when we work together. The ISS is a powerful example of that collaboration.”

It is also an example of the kind of collaboration that has worked well during the Covid-19 pandemic, believed Ms Tremblay. “We’ve just lived through a major pandemic and all the countries worked together and shared information so we had a vaccine very quickly. Scientists worked together internationally to solve the problem. We’ve been doing this in space for over 20 years on the ISS. When the world works together, we can solve the most challenging problems.
“Space is a unique environment to study health from a new perspective and accelerate research on medical and other issues so we can stay healthy and age healthily.

We’re living longer and therefore many people get diseases – cancers of course are a big issue. So on the ISS and other platforms, eventually we will be able to do more research like that – more breakthrough research on these issues.”
While such possibilities are tantalising, space exploration is an expensive business and funding will be critical, Ms Tremblay emphasised. She cited space tourism as a vehicle that could help finance missions and research.

“There are so many ways in which the ISS is being used for health research now, but the capacity to do this research is limited. If we can reduce the cost of access to space by generating revenue from space tourism, for example, we can make more potential breakthroughs because health is always a big focus.”