Hormonal, water balance, and electrolyte changes during sixty-day confinement

Social Isolation: A Narrative Review on the Dangerous Liaison between the Autonomic Nervous System and Inflammation

Social isolation and feelings of loneliness are related to higher mortality and morbidity. Evidence from studies conducted during space missions, in space analogs, and during the COVID-19 pandemic underline the possible role of the autonomic nervous system in mediating this relation. Indeed, the activation of the sympathetic branch of the autonomic nervous system enhances the cardiovascular response and activates the transcription of pro-inflammatory genes, which leads to a stimulation of inflammatory activation. This response is adaptive in the short term, in that it allows one to cope with a situation perceived as a threat, but in the long term it has detrimental effects on mental and physical health, leading to mood deflection and an increased risk of cardiovascular disease, as well as imbalances in immune system activation. The aim of this narrative review is to present the contributions from space studies and insights from the lockdown period on the relationship between social isolation and autonomic nervous system activation, focusing on cardiovascular impairment and immune imbalance. Knowing the pathophysiological mechanisms underlying this relationship is important as it enables us to structure effective countermeasures for the new challenges that lie ahead: the lengthening of space missions and Mars exploration, the specter of future pandemics, and the aging of the population.

Hormonal changes during long-term isolation

Confinement and inactivity induce considerable psychological and physiological modifications through social and sensory deprivation. The aim of the SFINCSS-99 experiment was to determine the cardiovascular and hormonal pattern of blood volume regulation during long-term isolation and confinement. Simulation experiments were performed in pressurized chambers similar in size to the volumes of modern space vehicles. Group I consisted of four Russian male volunteers, who spent 240 days in a 100-m(3 )chamber. Group II included four males (one German and three Russians) who spent 110 days in isolation (200-m(3) module). The blood samples, taken before, during and after the isolation period, were used to determine haematocrit (Ht), growth hormone (GH), active renin, aldosterone, and osmolality levels. From the urine samples, electrolytes, osmolality, nitrites, nitrates, cortisol, antidiuretic hormone (ADH), aldosterone, normetanephrine and metanephrine levels were determined. The increase in plasma volume (PV) that is associated with a tendency for a decrease in plasma active renin is likely to be due to decreased sympathetic activity, and concords with the changes in urinary catecholamine levels during confinement. Urinary catecholamine levels were significantly higher during the recovery period than during confinement. This suggests that the sympathoadrenal system was activated, and concords with the increase in heart rate. Vascular resistance is determined by not only the vasoconstrictor but also vasodilator systems. The ratio of nitrite/nitrate in urine, as an indicator of nitric oxide release, did not reveal any significant changes. Analysis of data suggests that the duration of the isolation was a main factor involved in the regulation of hormones.

Cardiovascular and hormonal changes induced by isolation and confinement

The cardiovascular changes induced by microgravity are in general described as the result of the loss of hydrostatic pressure. Other factors are also important: restricted environment with 1) elimination of mobility, action and 2) isolation always found in space environment or during simulation studies. Several studies indicate an analogy between microgravity and confinement. The results of simulation studies could be misinterpreted without a control confinement study present in the protocol.

Body weight and body composition during sixty days of isolation

The aim of this study was to find the mechanisms leading to the weight changes that have frequently been observed during isolation and in spaceflight. Isolation studies with small groups impose limitations on the measurements that can be performed to simple, noninvasive methods. In this study the simple parameters of body weight and body composition, along with sodium and potassium excretion, were determined in three males and one female subject before, during and after 60 days of isolation. Our assumption was that application of these simple methods might provide valuable information, when measurements are done on a daily basis and when the pre- and post-isolation periods are taken into account. Three subjects gained weight before isolation, while one lost weight. All four subjects gradually lost weight during isolation, 1-4% of their weight on the first day of isolation. During the first post-isolation week weight remained stable. During isolation one subject lost body fat, whereas another lost body water and lean body mass, but gained body fat. The urinary electrolyte excretion pattern reflected the changes in body composition: sodium loss coincided with a decrease of total body water, and potassium loss with a decrease of lean body mass. The Bioelectrical Impedance Analysis method, used in defining changes in body composition, provided data in good agreement with those obtained with the double-labeled water method. The results reported here are in agreement with observations reported by other investigators with respect to the body weight changes and the body composition. However, it is still not understood why some subjects lose fat and others gain fat under identical conditions. Psychological factors may be involved in these individual differences. Two further points have become clear from these studies: (1) the pre- and post-isolation periods should be taken into account, (2) urinary electrolyte excretion must be seen in the context of changes in body composition, not only in the context of kidney function.