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Ahmed SS, Goswami N, Sirek A, Green DA, Winnard A, Fiebig L, Weber T. Systematic review of the effectiveness of standalone passive countermeasures on microgravity-induced physiologic deconditioning. NPJ Microgravity 2024; 10:48. [PMID: 38664498 PMCID: PMC11045828 DOI: 10.1038/s41526-024-00389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
A systematic review of literature was conducted to evaluate the effectiveness of passive countermeasures in ameliorating the cardiopulmonary and musculoskeletal effects of gravitational unloading on humans during spaceflight. This systematic review is the third of a series being conducted by the European Space Agency to evaluate the effectiveness of countermeasures to physiologic deconditioning during spaceflight. With future long-duration space missions on the horizon, it is critical to understand the effectiveness of existing countermeasures to promote astronaut health and improve the probability of future mission success. An updated search for studies examining passive countermeasures was conducted in 2021 to supplement results from a broader search conducted in 2017 for all countermeasures. Ground-based analogue and spaceflight studies were included in the search. A total of 647 articles were screened following removal of duplicates, of which 16 were included in this review. Data extraction and analysis, quality assessment of studies, and transferability of reviewed studies to actual spaceflight based on their bed-rest protocol were conducted using dedicated tools created by the Aerospace Medicine Systematic Review Group. Of the 180 examined outcomes across the reviewed studies, only 20 were shown to have a significant positive effect in favour of the intervention group. Lower body negative pressure was seen to significantly maintain orthostatic tolerance (OT) closer to baseline as comparted to control groups. It also was seen to have mixed efficacy with regards to maintaining resting heart rate close to pre-bed rest values. Whole body vibration significantly maintained many balance-related outcome measures close to pre-bed rest values as compared to control. Skin surface cooling and centrifugation both showed efficacy in maintaining OT. Centrifugation also was seen to have mixed efficacy with regards to maintaining VO2max close to pre-bed rest values. Overall, standalone passive countermeasures showed no significant effect in maintaining 159 unique outcome measures close to their pre-bed rest values as compared to control groups. Risk of bias was rated high or unclear in all studies due to poorly detailed methodologies, poor control of confounding variables, and other sources of bias (i.e. inequitable recruitment of participants leading to a higher male:female ratios). The bed-rest transferability (BR) score varied from 2-7, with a median score of 5. Generally, most studies had good BR transferability but underreported on factors such as control of sunlight or radiation exposure, diet, level of exercise and sleep-cycles. We conclude that: (1) Lack of standardisation of outcome measurement and methodologies has led to large heterogeneity amongst studies; (2) Scarcity of literature and high risk of bias amongst existing studies limits the statistical power of results; and (3) Passive countermeasures have little or no efficacy as standalone measures against cardiopulmonary and musculoskeletal deconditioning induced by spaceflight related to physiologic deterioration due to gravity un-loading.
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Affiliation(s)
- Syed Shozab Ahmed
- Department of Family Medicine, Postgraduate Medical Education, Queen's University School of Medicine, Kingston, ON, Canada
| | - Nandu Goswami
- Division of Physiology, Otto Löwi Research Center for Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria.
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
- Integrative Health Department, Alma Mater Europaea Maribor, Maribor, Slovenia.
| | - Adam Sirek
- Faculty of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Institute for Earth and Space Exploration, Western University, London, ON, Canada
| | - David Andrew Green
- King's College London, Centre of Human & Applied Physiological Sciences, London, UK
- Space Medicine Team, HRE-OM, European Astronaut Centre, European Space Agency, Cologne, Germany
- KBRwyle Laboratories GmbH, Cologne, Germany
| | | | - Leonie Fiebig
- Space Biomedicine Systematic Review Methods, Wylam, UK
| | - Tobias Weber
- Space Medicine Team, HRE-OM, European Astronaut Centre, European Space Agency, Cologne, Germany
- KBRwyle Laboratories GmbH, Cologne, Germany
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2
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Munster DW, Lewandowski BE, Nelson ES, Prabhu RK, Myers JG. Modeling the impact of thoracic pressure on intracranial pressure. NPJ Microgravity 2024; 10:46. [PMID: 38600142 PMCID: PMC11006658 DOI: 10.1038/s41526-024-00385-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
A potential contribution to the progression of Spaceflight Associated Neuro-ocular Syndrome is the thoracic-to-spinal dural sac transmural pressure relationship. In this study, we utilize a lumped-parameter computational model of human cerebrospinal fluid (CSF) systems to investigate mechanisms of CSF redistribution. We present two analyses to illustrate potential mechanisms for CSF pressure alterations similar to those observed in microgravity conditions. Our numerical evidence suggests that the compliant relationship between thoracic and CSF compartments is insufficient to solely explain the observed decrease in CSF pressure with respect to the supine position. Our analyses suggest that the interaction between thoracic pressure and the cardiovascular system, particularly the central veins, has greater influence on CSF pressure. These results indicate that future studies should focus on the holistic system, with the impact of cardiovascular changes to the CSF pressure emphasized over the sequestration of fluid in the spine.
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Affiliation(s)
- Drayton W Munster
- NASA Glenn Research Center, 21000 Brookpark Road, Cleveland, OH, 44135, USA.
| | - Beth E Lewandowski
- NASA Glenn Research Center, 21000 Brookpark Road, Cleveland, OH, 44135, USA
| | - Emily S Nelson
- NASA Glenn Research Center, 21000 Brookpark Road, Cleveland, OH, 44135, USA
| | - R K Prabhu
- Universities Space Research Association, 21000 Brookpark Road, Cleveland, OH, 44135, USA
| | - Jerry G Myers
- NASA Glenn Research Center, 21000 Brookpark Road, Cleveland, OH, 44135, USA
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Lyonga Ngonge A, Nyange C, Ghali JK. Novel pharmacotherapeutic options for the treatment of postural orthostatic tachycardia syndrome. Expert Opin Pharmacother 2024; 25:181-188. [PMID: 38465412 DOI: 10.1080/14656566.2024.2319224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Postural tachycardia syndrome (POTS) is a disorder characterized by a constellation of symptoms including lightheadedness, fatigue, and palpitations when upright, associated with an increase in the heart rate (HR) of > 30 beats per minute when changing from a lying down to standing position or head-up tilt position and not associated with orthostatic hypotension. The causes as well as the management of POTS are not quite fully understood. AREAS COVERED We performed a literature review on the diagnosis and management of POTS, and this article includes an overview of novel pharmacotherapeutic options for the treatment of (POTS), although an effective treatment has not been established. EXPERT OPINION POTS is a clinical syndrome characterized by a constellation of symptoms that are nonspecific. No single etiology or unified hypothesis could be identified. In fact, multiple pathophysiological mechanisms have been proposed, and none of the suggested medications have been approved by the FDA for this indication. Further understanding of the autonomic nervous system and its adjustment to standing position is needed to provide better management strategies.
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Affiliation(s)
| | - Christabel Nyange
- Division of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA, USA
| | - Jalal K Ghali
- Division of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA, USA
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4
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Mastrandrea CJ, Greaves DK, Shoemaker JK, Blaber AP, Arbeille P, Hughson RL. Lower body negative pressure identifies altered central vein characteristics without accompanying changes to baroreflexes in astronauts within hours of landing. Sci Rep 2024; 14:1215. [PMID: 38216637 PMCID: PMC10786840 DOI: 10.1038/s41598-024-51643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024] Open
Abstract
Cardiovascular deconditioning and altered baroreflexes predispose returning astronauts to Orthostatic Intolerance. We assessed 7 astronauts (1 female) before and following long-duration spaceflight (146 ± 43 days) with minimal upright posture prior to testing. We applied lower body negative pressure (LBNP) of up to - 30 mmHg to supine astronauts instrumented for continual synchronous measurements of cardiovascular variables, and intermittent imaging the Portal Vein (PV) and Inferior Vena Cava (IVC). During supine rest without LBNP, postflight elevations to total peripheral resistance (TPR; 15.8 ± 4.6 vs. 20.8 ± 7.1 mmHg min/l, p < 0.05) and reductions in stroke volume (SV; 104.4 ± 16.7 vs. 87.4 ± 11.5 ml, p < 0.05) were unaccompanied by changes to heart rate (HR) or estimated central venous pressure (CVP). Small increases to systolic blood pressure (SBP) and diastolic blood pressure (DBP) were not statistically significant. Autoregressive moving average modelling (ARMA) during LBNP did not identify differences to either arterial (DBP → TPR and SBP → HR) or cardiopulmonary (CVP → TPR) baroreflexes consistent with intact cardiovascular control. On the other hand, IVC and PV diameter-CVP relationships during LBNP revealed smaller diameter for a given CVP postflight consistent with altered postflight venous wall dynamics.
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Affiliation(s)
- C J Mastrandrea
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada.
- University of Waterloo, Waterloo, ON, Canada.
| | - D K Greaves
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - J K Shoemaker
- School of Kinesiology and Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada
| | - A P Blaber
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - P Arbeille
- Unite Médecine Physiologie Spatiale, CERCOM, Faculté de Médecine-Université de Tours, Tours, France
| | - R L Hughson
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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5
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Li Y, Zhao Y, Zhong G, Xu Q, Tan Y, Xing W, Cao D, Wang Y, Liu C, Li J, Du R, Sun W, Yuan X, Li Y, Liu Z, Jin X, Zhao D, Song J, Wang Y, Kan G, Han X, Liu S, Yuan M, Gao F, Shu J, Li Y, Ling S. Vascular smooth muscle cell-specific miRNA-214 deficiency alleviates simulated microgravity-induced vascular remodeling. FASEB J 2024; 38:e23369. [PMID: 38100642 DOI: 10.1096/fj.202300727r] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 11/08/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
The human cardiovascular system has evolved to accommodate the gravity of Earth. Microgravity during spaceflight has been shown to induce vascular remodeling, leading to a decline in vascular function. The underlying mechanisms are not yet fully understood. Our previous study demonstrated that miR-214 plays a critical role in angiotensin II-induced vascular remodeling by reducing the levels of Smad7 and increasing the phosphorylation of Smad3. However, its role in vascular remodeling evoked by microgravity is not yet known. This study aimed to determine the contribution of miR-214 to the regulation of microgravity-induced vascular remodeling. The results of our study revealed that miR-214 expression was increased in the forebody arteries of both mice and monkeys after simulated microgravity treatment. In vitro, rotation-simulated microgravity-induced VSMC migration, hypertrophy, fibrosis, and inflammation were repressed by miR-214 knockout (KO) in VSMCs. Additionally, miR-214 KO increased the level of Smad7 and decreased the phosphorylation of Smad3, leading to a decrease in downstream gene expression. Furthermore, miR-214 cKO protected against simulated microgravity induced the decline in aorta function and the increase in stiffness. Histological analysis showed that miR-214 cKO inhibited the increases in vascular medial thickness that occurred after simulated microgravity treatment. Altogether, these results demonstrate that miR-214 has potential as a therapeutic target for the treatment of vascular remodeling caused by simulated microgravity.
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Affiliation(s)
- Youyou Li
- Department of Physical Education, China Agricultural University, Beijing, China
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Yunzhang Zhao
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
- Department of Cardiology & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Guohui Zhong
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
- School of Aerospace Medicine, The Fourth Military Medical University, Xi'an, China
| | - Qing Xu
- Core Facilities Center, Capital Medical University, Beijing, China
| | - Yingjun Tan
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Wenjuan Xing
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
- School of Aerospace Medicine, The Fourth Military Medical University, Xi'an, China
| | - Dengchao Cao
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Yinbo Wang
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Caizhi Liu
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Jianwei Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Ruikai Du
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Weijia Sun
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Xinxin Yuan
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Yeheng Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Zizhong Liu
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Xiaoyan Jin
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Dingsheng Zhao
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Jinping Song
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Yanqing Wang
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Guanghan Kan
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Xuan Han
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Shujuan Liu
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Min Yuan
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Feng Gao
- School of Aerospace Medicine, The Fourth Military Medical University, Xi'an, China
| | - Jingdan Shu
- Department of Physical Education, China Agricultural University, Beijing, China
| | - Yingxian Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Shukuan Ling
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou, China
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6
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Andrade MR, Azeez TA, Montgomery MM, Caldwell JT, Park H, Kwok AT, Borg AM, Narayanan SA, Willey JS, Delp MD, La Favor JD. Neurovascular dysfunction associated with erectile dysfunction persists after long-term recovery from simulations of weightlessness and deep space irradiation. FASEB J 2023; 37:e23246. [PMID: 37990646 DOI: 10.1096/fj.202300506rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 11/23/2023]
Abstract
There has been growing interest within the space industry for long-duration manned expeditions to the Moon and Mars. During deep space missions, astronauts are exposed to high levels of galactic cosmic radiation (GCR) and microgravity which are associated with increased risk of oxidative stress and endothelial dysfunction. Oxidative stress and endothelial dysfunction are causative factors in the pathogenesis of erectile dysfunction, although the effects of spaceflight on erectile function have been unexplored. Therefore, the purpose of this study was to investigate the effects of simulated spaceflight and long-term recovery on tissues critical for erectile function, the distal internal pudendal artery (dIPA), and the corpus cavernosum (CC). Eighty-six adult male Fisher-344 rats were randomized into six groups and exposed to 4-weeks of hindlimb unloading (HLU) or weight-bearing control, and sham (0Gy), 0.75 Gy, or 1.5 Gy of simulated GCR at the ground-based GCR simulator at the NASA Space Radiation Laboratory. Following a 12-13-month recovery, ex vivo physiological analysis of the dIPA and CC tissue segments revealed differential impacts of HLU and GCR on endothelium-dependent and -independent relaxation that was tissue type specific. GCR impaired non-adrenergic non-cholinergic (NANC) nerve-mediated relaxation in the dIPA and CC, while follow-up experiments of the CC showed restoration of NANC-mediated relaxation of GCR tissues following acute incubation with the antioxidants mito-TEMPO and TEMPOL, as well as inhibitors of xanthine oxidase and arginase. These findings indicate that simulated spaceflight exerts a long-term impairment of neurovascular erectile function, which exposes a new health risk to consider with deep space exploration.
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Affiliation(s)
- Manuella R Andrade
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, USA
| | - Tooyib A Azeez
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, USA
| | - McLane M Montgomery
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, USA
| | - Jacob T Caldwell
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, USA
| | - Hyerim Park
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, USA
| | - Andy T Kwok
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Alexander M Borg
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - S Anand Narayanan
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, USA
| | - Jeffrey S Willey
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael D Delp
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, USA
| | - Justin D La Favor
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, USA
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Krittanawong C, Isath A, Kaplin S, Virk HUH, Fogg S, Wang Z, Shepanek M, Scheuring RA, Lavie CJ. Cardiovascular disease in space: A systematic review. Prog Cardiovasc Dis 2023; 81:33-41. [PMID: 37531984 DOI: 10.1016/j.pcad.2023.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 07/29/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND With expanding commercial space programs, uncertainty remains about the cardiovascular effects of space environmental exposures including microgravity, confinement, isolation, space radiation, and altered bacterial virulence. Current limited data suggests additional health threats compared to Earth. METHODS We systematically reviewed PubMed, CENTRAL, Web of Science, EMBASE and Cochrane databases for prospective studies on spaceflight and cardiovascular outcomes. Search terms combined cardiovascular disease topics with spaceflight concepts. No date or language restrictions were imposed. RESULTS 35 studies representing 2696 space travelers met inclusion criteria. Studies were grouped into spaceflight associations with: atherosclerosis, mortality, cardiac function, orthostatic intolerance, and arrhythmias. Atherosclerosis evidence was limited, with animal studies linking space radiation to endothelial damage, oxidative stress, and inflammation. However, human data showed no significantly increased atherosclerotic disease in astronauts. Mortality studies demonstrated lower cardiovascular mortality in astronauts compared to the general population however there was conflicting data. Cardiac function studies revealed physiologic ventricular atrophy, increased arterial stiffness, and altered blood flow distribution attributed to microgravity exposure. Effects appeared transient and reversible post-flight. Orthostatic intolerance studies found astronauts experienced altered heart rate variability, baroreflex response, and blood pressure changes post-flight. Arrhythmia studies showed increased ventricular ectopy during spaceflight, but limited data on long term flights. CONCLUSIONS Environmental space hazards impact the cardiovascular system through multiple mechanisms. Microgravity causes cardiac atrophy and orthostatic intolerance while space radiation may potentially accelerate atherosclerosis. Further research is needed, especially regarding long-term spaceflights.
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Affiliation(s)
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Centre and New York Medical College, Valhalla, NY, USA
| | - Scott Kaplin
- Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY, USA
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH, USA
| | - Sonya Fogg
- Library and Learning Resource Center, Texas Heart Institute, Houston, USA
| | - Zhen Wang
- Mayo Clinic Evidence-based Practice Center, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Marc Shepanek
- Office of the Chief Health and Medical Officer, NASA, Washington, DC 20546, USA
| | | | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
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Edward JA, Peruri A, Rudofker E, Shamapant N, Parker H, Cotter R, Sabin K, Lawley J, Cornwell WK. Characteristics and Treatment of Exercise Intolerance in Patients With Long COVID. J Cardiopulm Rehabil Prev 2023; 43:400-406. [PMID: 37646620 DOI: 10.1097/hcr.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The post-acute sequalae of SARS-CoV-2, also known as "Long COVID," is characterized by profound fatigue, impaired functional capacity with post-exertional malaise, orthostatic intolerance, and tachycardia. At least 25-30% of individuals impacted by SARS-CoV-2 will go on to experience the Long COVID syndrome, underscoring the detrimental impact this condition has on society. Although efforts are underway to further understand risk factors for Long COVID and identify strategies to prevent disease development entirely, implementation of treatment strategies is warranted to alleviate symptom burden among those affected. This review provides a rationale for exercise prescriptions tailored to the Long COVID patient based on the pathophysiology underlying this syndrome, as well as the previously demonstrated benefits of exercise training in other similar populations whose clinical manifestations result from cardiac deconditioning. Herein, we discuss methods to tailor exercise protocols, accommodating exercise intolerance and post-exertional malaise that may otherwise limit the ability to participate in a training protocol, as well as data demonstrating that a focused exercise prescription may effectively alleviate symptom burden in these patients. Long COVID results, in large part, from deconditioning, which may result from as little as 20 hr of inactivity. Exercise prescriptions tailored to patients with Long COVID may effectively alleviate symptom burden associated with this condition and in the absence of overt contraindications should be considered in management.
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Affiliation(s)
- Justin A Edward
- Department of Medicine-Cardiology (Drs Edward, Rudofker, Shamapant, Parker, Cotter, and Cornwell and Ms Sabin) and Clinical Translational Research Center (Dr Cornwell), University of Colorado Anschutz Medical Campus, Aurora; Department of Medicine, Division of Cardiology, Parkview Medical Center, Pueblo, Colorado (Dr Peruri); and Department of Sport Science, Division of Physiology, University of Innsbruck, Innsbruck, Austria (Dr Lawley)
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9
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Hoenemann JN, Moestl S, van Herwaarden AE, Diedrich A, Mulder E, Frett T, Petrat G, Pustowalow W, Arz M, Heusser K, Lee S, Jordan J, Tank J, Hoffmann F. Effects of daily artificial gravity training on orthostatic tolerance following 60-day strict head-down tilt bedrest. Clin Auton Res 2023; 33:401-410. [PMID: 37347452 PMCID: PMC10439060 DOI: 10.1007/s10286-023-00959-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/26/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Orthostatic intolerance commonly occurs following immobilization or space flight. We hypothesized that daily artificial gravity training through short-arm centrifugation could help to maintain orthostatic tolerance following head-down tilt bedrest, which is an established terrestrial model for weightlessness. METHODS We studied 24 healthy persons (eight women; age 33.3 ± 9.0 years; BMI 24.3 ± 2.1 kg/m2) who participated in the 60-days head-down tilt bedrest (AGBRESA) study. They were assigned to 30 min/day continuous or 6 × 5 min intermittent short-arm centrifugation with 1Gz at the center of mass or a control group. We performed head-up tilt testing with incremental lower-body negative pressure until presyncope before and after bedrest. We recorded an electrocardiogram, beat-to-beat finger blood pressure, and brachial blood pressure and obtained blood samples from an antecubital venous catheter. Orthostatic tolerance was defined as time to presyncope. We related changes in orthostatic tolerance to changes in plasma volume determined by carbon dioxide rebreathing. RESULTS Compared with baseline measurements, supine and upright heart rate increased in all three groups following head-down tilt bedrest. Compared with baseline measurements, time to presyncope decreased by 323 ± 235 s with continuous centrifugation, by 296 ± 508 s with intermittent centrifugation, and by 801 ± 354 s in the control group (p = 0.0249 between interventions). The change in orthostatic tolerance was not correlated with changes in plasma volume. CONCLUSIONS Daily artificial gravity training on a short-arm centrifuge attenuated the reduction in orthostatic tolerance after 60 days of head-down tilt bedrest.
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Affiliation(s)
- J-N Hoenemann
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology, and Intensive Care, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - S Moestl
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - A E van Herwaarden
- Laboratory Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands
| | - A Diedrich
- Department of Medicine, Division of Clinical Pharmacology, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN, USA
| | - E Mulder
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - T Frett
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - G Petrat
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - W Pustowalow
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - M Arz
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - K Heusser
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - S Lee
- NASA JSC KBR Wyle, Houston, TX, USA
| | - J Jordan
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
- Head of Aerospace Medicine, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany
| | - J Tank
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany.
| | - F Hoffmann
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology, and Intensive Care, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Jagtap S, Kumar A, Mahale B, Dixit J, Kalange AE, Kanawade R, Gangal S, Vidyasagar P. Response of cardiac pulse parameters in humans at various inclinations via 360° rotating platform for simulated microgravity perspective. NPJ Microgravity 2023; 9:54. [PMID: 37463938 DOI: 10.1038/s41526-023-00301-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 07/02/2023] [Indexed: 07/20/2023] Open
Abstract
On the Earth, the human body is designed and adapted to function under uniform gravitational acceleration. However, exposure to microgravity or weightlessness as experienced by astronauts in space causes significant alterations in the functioning of the human cardiovascular system. Due to limitations in using real microgravity platforms, researchers opted for various ground-based microgravity analogs including head-down tilt (HDT) at fixed inclination. However, in the present study, an investigation of response of various cardiac parameters and their circulatory adaptation in 18 healthy male subjects was undertaken by using an indigenously developed 360° rotating platform. Cardiac pulse was recorded from 0° to 360° in steps of 30° inclination using piezoelectric pulse sensor (MLT1010) and associated cardiac parameters were analyzed. The results showed significant changes in the pulse shape while an interesting oscillating pattern was observed in associated cardiac parameters when rotated from 0° to 360°. The response of cardiac parameters became normal after returning to supine posture indicating the ability of the cardiovascular system to reversibly adapt to the postural changes. The observed changes in cardiac parameters at an inclination of 270°, in particular, were found to be comparable with spaceflight studies. Based on the obtained results and the proposed extended version of fluid redistribution mechanism, we herewith hypothesize that the rotation of a subject to head down tilt inclination (270°) along with other inclinations could represent a better microgravity analog for understanding the cumulative cardiac response of astronauts in space, particularly for short duration space missions.
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Affiliation(s)
- Sagar Jagtap
- Department of Physics, Haribhai V. Desai College, Pune, MS, 411002, India.
| | - Ajay Kumar
- Physical and Materials Chemistry Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune, MS, 411008, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
| | - Bhoopesh Mahale
- Department of Electronics, Savitribai Phule Pune University, Pune, MS, 411007, India
| | - Jyotsana Dixit
- Department of Microbiology, Savitribai Phule Pune University, Pune, MS, 411007, India
| | - Ashok E Kalange
- Department of Physics, Tuljaram Chaturchand College, Baramati, Dist., Pune, 413102, MS, India
| | - Rajesh Kanawade
- Physical and Materials Chemistry Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune, MS, 411008, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Shashikala Gangal
- Department of Electronics, Savitribai Phule Pune University, Pune, MS, 411007, India
| | - Pandit Vidyasagar
- Department of Physics, Savitribai Phule Pune University, Pune, MS, 411007, India.
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11
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Abstract
Gravity is a fundamental interaction that permeates throughout our Universe. On Earth, gravity gives weight to physical objects, and has been a constant presence throughout terrestrial biological evolution. Thus, gravity has shaped all biological functions, some examples include the growth of plants (e.g., gravitropism), the structure and morphology of biological parts in multicellular organisms, to its effects on our physiological function when humans travel into space. Moreover, from an evolutionary perspective, gravity has been a constant force on biology, and life, to our understanding, should have no reason to not experience the effects of gravity. Interestingly, there appear to be specific biological mechanisms that activate in the absence of gravity, with the space environment the only location to study the effects of a lack of gravity on biological systems. Thus, in this perspective piece, biological adaptations from the cellular to the whole organism levels to the presence and absence of gravity will be organized and described, as well as outlining future areas of research for gravitational biological investigations to address. Up to now, we have observed and shown how gravity effects biology at different levels, with a few examples including genetic (e.g., cell cycle, metabolism, signal transduction associated pathways, etc.), biochemically (e.g., cytoskeleton, NADPH oxidase, Yes-associated protein, etc.), and functionally (e.g., astronauts experiencing musculoskeletal and cardiovascular deconditioning, immune dysfunction, etc., when traveling into space). Based from these observations, there appear to be gravity-sensitive and specific pathways across biological organisms, though knowledge gaps of the effects of gravity on biology remain, such as similarities and differences across species, reproduction, development, and evolutionary adaptations, sex-differences, etc. Thus, here an overview of the literature is provided for context of gravitational biology research to-date and consideration for future studies, as we prepare for long-term occupation of low-Earth Orbit and cis-Lunar space, and missions to the Moon and Mars, experiencing the effects of Lunar and Martian gravity on biology, respectively, through our Artemis program.
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Karemaker JM. A Network approach to find poor orthostatic tolerance by simple tilt maneuvers. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1125023. [PMID: 36926547 PMCID: PMC10012999 DOI: 10.3389/fnetp.2023.1125023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023]
Abstract
The approach introduced by Network Physiology intends to find and quantify connectedness between close- and far related aspects of a person's Physiome. In this study I applied a Network-inspired analysis to a set of measurement data that had been assembled to detect prospective orthostatic intolerant subjects among people who were destined to go into Space for a two weeks mission. The advantage of this approach being that it is essentially model-free: no complex physiological model is required to interpret the data. This type of analysis is essentially applicable to many datasets where individuals must be found that "stand out from the crowd". The dataset consists of physiological variables measured in 22 participants (4f/18 m; 12 prospective astronauts/cosmonauts, 10 healthy controls), in supine, + 30° and + 70° upright tilted positions. Steady state values of finger blood pressure and derived thereof: mean arterial pressure, heart rate, stroke volume, cardiac output, systemic vascular resistance; middle cerebral artery blood flow velocity and end-tidal pCO2 in tilted position were (%)-normalized for each participant to the supine position. This yielded averaged responses for each variable, with statistical spread. All variables i.e., the "average person's response" and a set of %-values defining each participant are presented as radar plots to make each ensemble transparent. Multivariate analysis for all values resulted in obvious dependencies and some unexpected ones. Most interesting is how individual participants maintained their blood pressure and brain blood flow. In fact, 13/22 participants had all normalized Δ-values (i.e., the deviation from the group average, normalized for the standard deviation), both for +30° and +70°, within the 95% range. The remaining group demonstrated miscellaneous response patterns, with one or more larger Δ-values, however of no consequence for orthostasis. The values from one prospective cosmonaut stood out as suspect. However, early morning standing blood pressure within 12 h after return to Earth (without volume repletion) demonstrated no syncope. This study demonstrates an integrative way to model-free assess a large dataset, applying multivariate analysis and common sense derived from textbook physiology.
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Affiliation(s)
- John M Karemaker
- Department of Medical Biology, Section Systems Physiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
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13
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Krittanawong C, Singh NK, Scheuring RA, Urquieta E, Bershad EM, Macaulay TR, Kaplin S, Dunn C, Kry SF, Russomano T, Shepanek M, Stowe RP, Kirkpatrick AW, Broderick TJ, Sibonga JD, Lee AG, Crucian BE. Human Health during Space Travel: State-of-the-Art Review. Cells 2022; 12:cells12010040. [PMID: 36611835 PMCID: PMC9818606 DOI: 10.3390/cells12010040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
The field of human space travel is in the midst of a dramatic revolution. Upcoming missions are looking to push the boundaries of space travel, with plans to travel for longer distances and durations than ever before. Both the National Aeronautics and Space Administration (NASA) and several commercial space companies (e.g., Blue Origin, SpaceX, Virgin Galactic) have already started the process of preparing for long-distance, long-duration space exploration and currently plan to explore inner solar planets (e.g., Mars) by the 2030s. With the emergence of space tourism, space travel has materialized as a potential new, exciting frontier of business, hospitality, medicine, and technology in the coming years. However, current evidence regarding human health in space is very limited, particularly pertaining to short-term and long-term space travel. This review synthesizes developments across the continuum of space health including prior studies and unpublished data from NASA related to each individual organ system, and medical screening prior to space travel. We categorized the extraterrestrial environment into exogenous (e.g., space radiation and microgravity) and endogenous processes (e.g., alteration of humans' natural circadian rhythm and mental health due to confinement, isolation, immobilization, and lack of social interaction) and their various effects on human health. The aim of this review is to explore the potential health challenges associated with space travel and how they may be overcome in order to enable new paradigms for space health, as well as the use of emerging Artificial Intelligence based (AI) technology to propel future space health research.
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Affiliation(s)
- Chayakrit Krittanawong
- Department of Medicine and Center for Space Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
- Translational Research Institute for Space Health, Houston, TX 77030, USA
- Department of Cardiovascular Diseases, New York University School of Medicine, New York, NY 10016, USA
- Correspondence: or (C.K.); (B.E.C.); Tel.: +1-713-798-4951 (C.K.); +1-281-483-0123 (B.E.C.)
| | - Nitin Kumar Singh
- Biotechnology and Planetary Protection Group, Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | | | - Emmanuel Urquieta
- Translational Research Institute for Space Health, Houston, TX 77030, USA
- Department of Emergency Medicine and Center for Space Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Eric M. Bershad
- Department of Neurology, Center for Space Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Scott Kaplin
- Department of Cardiovascular Diseases, New York University School of Medicine, New York, NY 10016, USA
| | - Carly Dunn
- Department of Dermatology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Stephen F. Kry
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Marc Shepanek
- Office of the Chief Health and Medical Officer, NASA, Washington, DC 20546, USA
| | | | - Andrew W. Kirkpatrick
- Department of Surgery and Critical Care Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | | | - Jean D. Sibonga
- Division of Biomedical Research and Environmental Sciences, NASA Lyndon B. Johnson Space Center, Houston, TX 77058, USA
| | - Andrew G. Lee
- Department of Ophthalmology, University of Texas Medical Branch School of Medicine, Galveston, TX 77555, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX 77030, USA
- Department of Ophthalmology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Ophthalmology, Texas A and M College of Medicine, College Station, TX 77807, USA
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Brian E. Crucian
- National Aeronautics and Space Administration (NASA) Johnson Space Center, Human Health and Performance Directorate, Houston, TX 77058, USA
- Correspondence: or (C.K.); (B.E.C.); Tel.: +1-713-798-4951 (C.K.); +1-281-483-0123 (B.E.C.)
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14
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Rahmouni K. Energy metabolism and syncope. Clin Auton Res 2022; 32:391-393. [PMID: 36326945 DOI: 10.1007/s10286-022-00906-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Kamal Rahmouni
- Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA. .,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA. .,Fraternal Order of Eagles Diabetes Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA. .,Obesity Research and Education Initiative, University of Iowa Carver College of Medicine, Iowa City, IA, USA. .,Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, IA, USA. .,Veterans Affairs Health Care System, Iowa City, IA, USA.
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15
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Bennett AJ, Levine BD. Reply to Galizia and Abete. J Am Geriatr Soc 2022; 70:3300-3301. [PMID: 36254347 DOI: 10.1111/jgs.18051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ari J Bennett
- Cardiology Division, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Cardiology Division, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Benjamin D Levine
- Cardiology Division, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Exercise Physiology, Institute for Exercise and Environmental Medicine, Dallas, Texas, USA
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16
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Hedge ET, Patterson CA, Mastrandrea CJ, Sonjak V, Hajj-Boutros G, Faust A, Morais JA, Hughson RL. Implementation of exercise countermeasures during spaceflight and microgravity analogue studies: Developing countermeasure protocols for bedrest in older adults (BROA). Front Physiol 2022; 13:928313. [PMID: 36017336 PMCID: PMC9395735 DOI: 10.3389/fphys.2022.928313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/27/2022] [Indexed: 12/18/2022] Open
Abstract
Significant progress has been made in the development of countermeasures to attenuate the negative consequences of prolonged exposure to microgravity on astronauts’ bodies. Deconditioning of several organ systems during flight includes losses to cardiorespiratory fitness, muscle mass, bone density and strength. Similar deconditioning also occurs during prolonged bedrest; any protracted time immobile or inactive, especially for unwell older adults (e.g., confined to hospital beds), can lead to similar detrimental health consequences. Due to limitations in physiological research in space, the six-degree head-down tilt bedrest protocol was developed as ground-based analogue to spaceflight. A variety of exercise countermeasures have been tested as interventions to limit detrimental changes and physiological deconditioning of the musculoskeletal and cardiovascular systems. The Canadian Institutes of Health Research and the Canadian Space Agency recently provided funding for research focused on Understanding the Health Impact of Inactivity to study the efficacy of exercise countermeasures in a 14-day randomized clinical trial of six-degree head-down tilt bedrest study in older adults aged 55–65 years old (BROA). Here we will describe the development of a multi-modality countermeasure protocol for the BROA campaign that includes upper- and lower-body resistance exercise and head-down tilt cycle ergometry (high-intensity interval and continuous aerobic exercise training). We provide reasoning for the choice of these modalities following review of the latest available information on exercise as a countermeasure for inactivity and spaceflight-related deconditioning. In summary, this paper sets out to review up-to-date exercise countermeasure research from spaceflight and head-down bedrest studies, whilst providing support for the proposed research countermeasure protocols developed for the bedrest study in older adults.
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Affiliation(s)
- Eric T. Hedge
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Vita Sonjak
- Research Institute of McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Guy Hajj-Boutros
- Research Institute of McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Andréa Faust
- Research Institute of McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - José A. Morais
- Research Institute of McGill University Health Centre, McGill University, Montréal, QC, Canada
- Division of Geriatric Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Richard L. Hughson
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada
- *Correspondence: Richard L. Hughson,
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17
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Computational modeling of orthostatic intolerance for travel to Mars. NPJ Microgravity 2022; 8:34. [PMID: 35945233 PMCID: PMC9363491 DOI: 10.1038/s41526-022-00219-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/15/2022] [Indexed: 11/12/2022] Open
Abstract
Astronauts in a microgravity environment will experience significant changes in their cardiopulmonary system. Up until now, there has always been the reassurance that they have real-time contact with experts on Earth. Mars crew however will have gaps in their communication of 20 min or more. In silico experiments are therefore needed to assess fitness to fly for those on future space flights to Mars. In this study, we present an open-source controlled lumped mathematical model of the cardiopulmonary system that is able simulate the short-term adaptations of key hemodynamic parameters to an active stand test after being exposed to microgravity. The presented model is capable of adequately simulating key cardiovascular hemodynamic changes—over a short time frame—during a stand test after prolonged spaceflight under different gravitational conditions and fluid loading conditions. This model can form the basis for further exploration of the ability of the human cardiovascular system to withstand long-duration space flight and life on Mars.
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18
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Saehle T. Cerebral Hemodynamics During Exposure to Hypergravity (+G z) or Microgravity (0 G). Aerosp Med Hum Perform 2022; 93:581-592. [DOI: 10.3357/amhp.6008.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Optimal human performance and health is dependent on steady blood supply to the brain. Hypergravity (+Gz) may impair cerebral blood flow (CBF), and several investigators have also reported that microgravity (0 G) may influence cerebral hemodynamics. This
has led to concerns for safe performance during acceleration maneuvers in aviation or the impact long-duration spaceflights may have on astronaut health.METHODS: A systematic PEO (Population, Exposure, Outcome) search was done in PubMed and Web of Science, addressing studies on
how elevated +Gz forces or absence of such may impact cerebral hemodynamics. All primary research containing anatomical or physiological data on relevant intracranial parameters were included. Quality of the evidence was analyzed using the GRADE tool.RESULTS: The search
revealed 92 eligible articles. It is evident that impaired CBF during +Gz acceleration remains an important challenge in aviation, but there are significant variations in individual tolerance. The reports on cerebral hemodynamics during weightlessness are inconsistent, but published
data indicate that adaptation to sustained microgravity is also characterized by significant variations among individuals.DISCUSSION: Despite a high number of publications, the quality of evidence is limited due to observational study design, too few included subjects, and methodological
challenges. Clinical consequences of high +Gz exposure are well described, but there are significant gaps in knowledge regarding the intracranial pathophysiology and individual hemodynamic tolerance to both hypergravity and microgravity environments.Saehle T. Cerebral
hemodynamics during exposure to hypergravity (+Gz) or microgravity (0 G). Aerosp Med Hum Perform. 2022; 93(7):581–592.
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19
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Jordan J, Limper U, Tank J. Cardiovascular autonomic nervous system responses and orthostatic intolerance in astronauts and their relevance in daily medicine. Neurol Sci 2022; 43:3039-3051. [PMID: 35194757 PMCID: PMC9018660 DOI: 10.1007/s10072-022-05963-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/17/2022] [Indexed: 11/12/2022]
Abstract
Background The harsh environmental conditions during space travel, particularly weightlessness, impose a major burden on the human body including the cardiovascular system. Given its importance in adjusting the cardiovascular system to environmental challenges, the autonomic nervous system has been in the focus of scientists and clinicians involved in human space flight. This review provides an overview on human autonomic research under real and simulated space conditions with a focus on orthostatic intolerance. Methods The authors conducted a targeted literature search using Pubmed. Results Overall, 120 articles were identified and included in the review. Conclusions Postflight orthostatic intolerance is commonly observed in astronauts and could pose major risks when landing on another celestial body. The phenomenon likely results from changes in volume status and adaptation of the autonomic nervous system to weightlessness. Over the years, various non-pharmacological and pharmacological countermeasures have been investigated. In addition to enabling safe human space flight, this research may have implications for patients with disorders affecting cardiovascular autonomic control on Earth.
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Affiliation(s)
- Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center DLR, Linder Hoehe, 51147, Cologne, Germany. .,Aerospace Medicine, Medical Faculty, University of Cologne, Cologne, Germany.
| | - Ulrich Limper
- Institute of Aerospace Medicine, German Aerospace Center DLR, Linder Hoehe, 51147, Cologne, Germany.,Department of Anesthesiology and Intensive Care Medicine, Merheim Medical Center, Hospitals of Cologne, University of Witten/Herdecke, Cologne, Germany
| | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center DLR, Linder Hoehe, 51147, Cologne, Germany
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20
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Abstract
The direct (eg, radiation, microgravity) and indirect (eg, lifestyle perturbations) effects of spaceflight extend across multiple systems resulting in whole-organism cardiovascular deconditioning. For over 50 years, National Aeronautics and Space Administration has continually enhanced a countermeasures program designed to characterize and offset the adverse cardiovascular consequences of spaceflight. In this review, we provide a historical overview of research evaluating the effects of spaceflight on cardiovascular health in astronauts and outline mechanisms underpinning spaceflight-related cardiovascular alterations. We also discuss how spaceflight could be leveraged for aging, industry, and model systems such as human induced pluripotent stem cell-derived cardiomyocytes, organoid, and organ-on-a-chip technologies. Finally, we outline the increasing opportunities for scientists and clinicians to engage in cardiovascular research in space and on Earth.
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Affiliation(s)
- Jessica M Scott
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (J.M.S.).,Weill Cornell Medical College, New York, NY (J.M.S.)
| | | | - Lianne Dolan
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada (L.D.)
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21
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Wong V, Bell ZW, Sptiz RW, Song JS, Yamada Y, Abe T, Loenneke JP. Blood flow restriction maintains blood pressure upon head-up tilt. Physiol Int 2022; 109:106-118. [PMID: 35238796 DOI: 10.1556/2060.2022.00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/15/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Orthostatic intolerance occurs in some astronauts following space flight. Although orthostatic blood pressure responses should normalize in the weeks following the return to Earth, there may be situations where an immediate short-term solution is necessary (e.g., emergency evacuation). PURPOSE The purpose of this study was to examine different levels of blood flow restriction on changes in blood pressure and heart rate when transitioning from supine to a head-up tilt and determine whether this change differs based on sex. METHODS Eighty-nine participants (45 men, 44 women) completed the three visits with different pressures (Sham, Moderate, and High) in a randomized order. Cuffs were placed on the most proximal area of the thighs. Brachial blood pressure was measured at baseline, upon inflation of the cuffs in a supine position, immediately after tilt (70°), and eight more times separated by 45 seconds. RESULTS Data are presented as mean (SD). The change in systolic (High > Moderate > Sham) [High vs Sham: 5.5 (7.4) mmHg, High vs Moderate: 3 (7.4) mmHg, and Moderate vs Sham: 2.4 (8.4) mmHg] and diastolic pressure (High > Moderate = Sham) [High vs Sham: 2.4 (5.3) mmHg, High vs Moderate: 1.9 (6.3) mmHg] differed across applied pressures. The change in heart rate was initially greatest in the sham-pressure but increased the greatest in the high-pressure condition by the end of the head-up tilt period. Additionally, there was no influence of sex. CONCLUSION Blood flow restriction applied in this study increased blood pressure in a pressure-dependent manner upon head-up tilt.
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Affiliation(s)
- Vickie Wong
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Zachary W Bell
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Robert W Sptiz
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Jun Seob Song
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Yujiro Yamada
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Takashi Abe
- 2 Institute of Health and Sports Science and Medicine, Juntendo University, Inzai, Chiba 270-1695, Japan
| | - Jeremy P Loenneke
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
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22
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Tays GD, McGregor HR, Lee JK, Beltran N, Kofman IS, De Dios YE, Mulder E, Bloomberg JJ, Mulavara AP, Wood SJ, Seidler RD. The Effects of 30 Minutes of Artificial Gravity on Cognitive and Sensorimotor Performance in a Spaceflight Analog Environment. Front Neural Circuits 2022; 16:784280. [PMID: 35310547 PMCID: PMC8924040 DOI: 10.3389/fncir.2022.784280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
The altered vestibular signaling and somatosensory unloading of microgravity result in sensory reweighting and adaptation to conflicting sensory inputs. Aftereffects of these adaptive changes are evident postflight as impairments in behaviors such as balance and gait. Microgravity also induces fluid shifts toward the head and an upward shift of the brain within the skull; these changes are well-replicated in strict head-down tilt bed rest (HDBR), a spaceflight analog environment. Artificial gravity (AG) is a potential countermeasure to mitigate these effects of microgravity. A previous study demonstrated that intermittent (six, 5-mins bouts per day) daily AG sessions were more efficacious at counteracting orthostatic intolerance in a 5 day HDBR study than continuous daily AG. Here we examined whether intermittent daily AG was also more effective than continuous dosing for mitigating brain and behavioral changes in response to 60 days of HDBR. Participants (n = 24) were split evenly between three groups. The first received 30 mins of continuous AG daily (cAG). The second received 30 mins of intermittent AG daily (6 bouts of 5 mins; iAG). The third received no AG (Ctrl). We collected a broad range of sensorimotor, cognitive, and brain structural and functional assessments before, during, and after the 60 days of HDBR. We observed no significant differences between the three groups in terms of HDBR-associated changes in cognition, balance, and functional mobility. Interestingly, the intermittent AG group reported less severe motion sickness symptoms than the continuous group during centrifugation; iAG motion sickness levels were not elevated above those of controls who did not undergo AG. They also had a shorter duration of post-AG illusory motion than cAG. Moreover, the two AG groups performed the paced auditory serial addition test weekly while undergoing AG; their performance was more accurate than that of controls, who performed the test while in HDBR. Although AG did not counteract HDBR-induced gait and balance declines, iAG did not cause motion sickness and was associated with better self-motion perception during AG ramp-down. Additionally, both AG groups had superior cognitive performance while undergoing AG relative to controls; this may reflect attention or motivation differences between the groups.
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Affiliation(s)
- Grant D. Tays
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Heather R. McGregor
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | | | | | | | | | | | | | | | - Scott J. Wood
- NASA Johnson Space Center, Houston, TX, United States
| | - Rachael D. Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- *Correspondence: Rachael D. Seidler,
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Harris KM, Weber T, Greaves D, Green DA, Goswami N, Petersen LG. Going against the flow: are venous thromboembolism and impaired cerebral drainage critical risks for spaceflight? J Appl Physiol (1985) 2022; 132:270-273. [PMID: 34672768 PMCID: PMC8759966 DOI: 10.1152/japplphysiol.00425.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Katie M. Harris
- 1Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Tobias Weber
- 2European Astronaut Centre, European Space Agency, Space Medicine Team (HRE-OM), Cologne, Germany,3KBR GmbH, Cologne, Germany
| | - Danielle Greaves
- 4Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - David Andrew Green
- 2European Astronaut Centre, European Space Agency, Space Medicine Team (HRE-OM), Cologne, Germany,3KBR GmbH, Cologne, Germany,5Centre of Human & Applied Physiological Sciences, King’s College London, London, United Kingdom
| | - Nandu Goswami
- 6Division of Physiology, Otto Löwi Research Center for Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria
| | - Lonnie G. Petersen
- 7Department of Mechanical and Aerospace Engineering, University of California, San Diego, California,8Department of Radiology, University of California, San Diego, California
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24
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Baran R, Marchal S, Garcia Campos S, Rehnberg E, Tabury K, Baselet B, Wehland M, Grimm D, Baatout S. The Cardiovascular System in Space: Focus on In Vivo and In Vitro Studies. Biomedicines 2021; 10:59. [PMID: 35052739 PMCID: PMC8773383 DOI: 10.3390/biomedicines10010059] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/24/2021] [Accepted: 12/25/2021] [Indexed: 12/13/2022] Open
Abstract
On Earth, humans are subjected to a gravitational force that has been an important determinant in human evolution and function. During spaceflight, astronauts are subjected to several hazards including a prolonged state of microgravity that induces a myriad of physiological adaptations leading to orthostatic intolerance. This review summarises all known cardiovascular diseases related to human spaceflight and focusses on the cardiovascular changes related to human spaceflight (in vivo) as well as cellular and molecular changes (in vitro). Upon entering microgravity, cephalad fluid shift occurs and increases the stroke volume (35-46%) and cardiac output (18-41%). Despite this increase, astronauts enter a state of hypovolemia (10-15% decrease in blood volume). The absence of orthostatic pressure and a decrease in arterial pressures reduces the workload of the heart and is believed to be the underlying mechanism for the development of cardiac atrophy in space. Cellular and molecular changes include altered cell shape and endothelial dysfunction through suppressed cellular proliferation as well as increased cell apoptosis and oxidative stress. Human spaceflight is associated with several cardiovascular risk factors. Through the use of microgravity platforms, multiple physiological changes can be studied and stimulate the development of appropriate tools and countermeasures for future human spaceflight missions in low Earth orbit and beyond.
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Affiliation(s)
- Ronni Baran
- Department of Biomedicine, Aarhus University, Ole Worms Allé 4, 8000 Aarhus, Denmark; (R.B.); (D.G.)
| | - Shannon Marchal
- Department of Astronomy, Catholic University of Leuven, 3000 Leuven, Belgium;
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK CEN), Boeretang 200, 2400 Mol, Belgium; (E.R.); (K.T.); (B.B.)
| | - Sebastian Garcia Campos
- Department of Microgravity and Translational Regenerative Medicine, Otto von Guericke University, Universitätsplatz 2, 39106 Magdeburg, Germany; (S.G.C.); (M.W.)
- Research Group ‘Magdeburger Arbeitsgemeinschaft für Forschung unter Raumfahrt- und Schwerelosigkeitsbedingungen’ (MARS), Otto von Guericke University, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Emil Rehnberg
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK CEN), Boeretang 200, 2400 Mol, Belgium; (E.R.); (K.T.); (B.B.)
- Department of Molecular Biotechnology, Ghent University, 9000 Ghent, Belgium
| | - Kevin Tabury
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK CEN), Boeretang 200, 2400 Mol, Belgium; (E.R.); (K.T.); (B.B.)
- Department of Biomedical Engineering, University of South Carolina, Columbia, SC 29208, USA
| | - Bjorn Baselet
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK CEN), Boeretang 200, 2400 Mol, Belgium; (E.R.); (K.T.); (B.B.)
| | - Markus Wehland
- Department of Microgravity and Translational Regenerative Medicine, Otto von Guericke University, Universitätsplatz 2, 39106 Magdeburg, Germany; (S.G.C.); (M.W.)
- Research Group ‘Magdeburger Arbeitsgemeinschaft für Forschung unter Raumfahrt- und Schwerelosigkeitsbedingungen’ (MARS), Otto von Guericke University, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Daniela Grimm
- Department of Biomedicine, Aarhus University, Ole Worms Allé 4, 8000 Aarhus, Denmark; (R.B.); (D.G.)
- Department of Microgravity and Translational Regenerative Medicine, Otto von Guericke University, Universitätsplatz 2, 39106 Magdeburg, Germany; (S.G.C.); (M.W.)
- Research Group ‘Magdeburger Arbeitsgemeinschaft für Forschung unter Raumfahrt- und Schwerelosigkeitsbedingungen’ (MARS), Otto von Guericke University, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Sarah Baatout
- Department of Astronomy, Catholic University of Leuven, 3000 Leuven, Belgium;
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK CEN), Boeretang 200, 2400 Mol, Belgium; (E.R.); (K.T.); (B.B.)
- Department of Molecular Biotechnology, Ghent University, 9000 Ghent, Belgium
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25
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Pollock RD, Hodkinson PD, Smith TG. Oh G: The x, y and z of human physiological responses to acceleration. Exp Physiol 2021; 106:2367-2384. [PMID: 34730860 DOI: 10.1113/ep089712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/18/2021] [Indexed: 01/06/2023]
Abstract
NEW FINDINGS What is the topic of this review? This review focuses on the main physiological challenges associated with exposure to acceleration in the Gx, Gy and Gz directions and to microgravity. What advances does it highlight? Our current understanding of the physiology of these environments and latest strategies to protect against them are discussed in light of the limited knowledge we have in some of these areas. ABSTRACT The desire to go higher, faster and further has taken us to environments where the accelerations placed on our bodies far exceed or are much lower than that attributable to Earth's gravity. While on the ground, racing drivers of the fastest cars are exposed to high degrees of lateral acceleration (Gy) during cornering. In the air, while within the confines of the lower reaches of Earth's atmosphere, fast jet pilots are routinely exposed to high levels of acceleration in the head-foot direction (Gz). During launch and re-entry of suborbital and orbital spacecraft, astronauts and spaceflight participants are exposed to high levels of chest-back acceleration (Gx), whereas once in space the effects of gravity are all but removed (termed microgravity, μG). Each of these environments has profound effects on the homeostatic mechanisms within the body and can have a serious impact, not only for those with underlying pathology but also for healthy individuals. This review provides an overview of the main challenges associated with these environments and our current understanding of the physiological and pathophysiological adaptations to them. Where relevant, protection strategies are discussed, with the implications of our future exposure to these environments also being considered.
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Affiliation(s)
- Ross D Pollock
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Peter D Hodkinson
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Thomas G Smith
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK.,Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
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26
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Afshinnekoo E, Scott RT, MacKay MJ, Pariset E, Cekanaviciute E, Barker R, Gilroy S, Hassane D, Smith SM, Zwart SR, Nelman-Gonzalez M, Crucian BE, Ponomarev SA, Orlov OI, Shiba D, Muratani M, Yamamoto M, Richards SE, Vaishampayan PA, Meydan C, Foox J, Myrrhe J, Istasse E, Singh N, Venkateswaran K, Keune JA, Ray HE, Basner M, Miller J, Vitaterna MH, Taylor DM, Wallace D, Rubins K, Bailey SM, Grabham P, Costes SV, Mason CE, Beheshti A. Fundamental Biological Features of Spaceflight: Advancing the Field to Enable Deep-Space Exploration. Cell 2021; 183:1162-1184. [PMID: 33242416 DOI: 10.1016/j.cell.2020.10.050] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022]
Abstract
Research on astronaut health and model organisms have revealed six features of spaceflight biology that guide our current understanding of fundamental molecular changes that occur during space travel. The features include oxidative stress, DNA damage, mitochondrial dysregulation, epigenetic changes (including gene regulation), telomere length alterations, and microbiome shifts. Here we review the known hazards of human spaceflight, how spaceflight affects living systems through these six fundamental features, and the associated health risks of space exploration. We also discuss the essential issues related to the health and safety of astronauts involved in future missions, especially planned long-duration and Martian missions.
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Affiliation(s)
- Ebrahim Afshinnekoo
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10021, USA; The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10021, USA; WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, NY 10021, USA
| | - Ryan T Scott
- KBR, Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA
| | - Matthew J MacKay
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10021, USA; The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10021, USA; WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, NY 10021, USA
| | - Eloise Pariset
- Universities Space Research Association (USRA), Mountain View, CA 94043, USA; Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA
| | - Egle Cekanaviciute
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA
| | - Richard Barker
- Department of Botany, University of Wisconsin, Madison, WI 53706, USA
| | - Simon Gilroy
- Department of Botany, University of Wisconsin, Madison, WI 53706, USA
| | | | - Scott M Smith
- Human Health and Performance Directorate, NASA Johnson Space Center, Houston, TX 77058, USA
| | - Sara R Zwart
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Mayra Nelman-Gonzalez
- KBR, Human Health and Performance Directorate, NASA Johnson Space Center, Houston, TX 77058, USA
| | - Brian E Crucian
- Human Health and Performance Directorate, NASA Johnson Space Center, Houston, TX 77058, USA
| | - Sergey A Ponomarev
- Institute for the Biomedical Problems, Russian Academy of Sciences, 123007 Moscow, Russia
| | - Oleg I Orlov
- Institute for the Biomedical Problems, Russian Academy of Sciences, 123007 Moscow, Russia
| | - Dai Shiba
- JEM Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency (JAXA), Ibaraki 305-8505, Japan
| | - Masafumi Muratani
- Transborder Medical Research Center, and Department of Genome Biology, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
| | - Masayuki Yamamoto
- Department of Medical Biochemistry, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan; Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Stephanie E Richards
- Bionetics, NASA Kennedy Space Center, Kennedy Space Center, Merritt Island, FL 32899, USA
| | - Parag A Vaishampayan
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA
| | - Cem Meydan
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10021, USA; The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10021, USA; WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, NY 10021, USA
| | - Jonathan Foox
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10021, USA; The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10021, USA; WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, NY 10021, USA
| | - Jacqueline Myrrhe
- European Space Agency, Research and Payloads Group, Data Exploitation and Utilisation Strategy Office, 2200 AG Noordwijk, the Netherlands
| | - Eric Istasse
- European Space Agency, Research and Payloads Group, Data Exploitation and Utilisation Strategy Office, 2200 AG Noordwijk, the Netherlands
| | - Nitin Singh
- Biotechnology and Planetary Protection Group, Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - Kasthuri Venkateswaran
- Biotechnology and Planetary Protection Group, Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - Jessica A Keune
- Space Medicine Operations Division, NASA Johnson Space Center, Houston, TX 77058, USA
| | - Hami E Ray
- ASRC Federal Space and Defense, Inc., Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA
| | - Mathias Basner
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Jack Miller
- KBR, Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA; Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Martha Hotz Vitaterna
- Center for Sleep and Circadian Biology, Northwestern University, Evanston, IL 60208, USA; Department of Neurobiology, Northwestern University, Evanston, IL 60208, USA
| | - Deanne M Taylor
- Department of Biomedical Informatics, The Children's Hospital of Philadelphia, PA 19104, USA; Center for Mitochondrial and Epigenomic Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; The Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Douglas Wallace
- Center for Mitochondrial and Epigenomic Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; The Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kathleen Rubins
- Astronaut Office, NASA Johnson Space Center, Houston, TX 77058, USA
| | - Susan M Bailey
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA.
| | - Peter Grabham
- Center for Radiological Research, Department of Oncology, College of Physicians and Surgeons, Columbia University, New York, NY 10027, USA.
| | - Sylvain V Costes
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA.
| | - Christopher E Mason
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10021, USA; The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10021, USA; WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, NY 10021, USA; The Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, NY 10021, USA.
| | - Afshin Beheshti
- KBR, Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.
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Kourtidou-Papadeli C, Frantzidis CA, Gilou S, Plomariti CE, Nday CM, Karnaras D, Bakas L, Bamidis PD, Vernikos J. Gravity Threshold and Dose Response Relationships: Health Benefits Using a Short Arm Human Centrifuge. Front Physiol 2021; 12:644661. [PMID: 34045973 PMCID: PMC8144521 DOI: 10.3389/fphys.2021.644661] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/12/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose Increasing the level of gravity passively on a centrifuge, should be equal to or even more beneficial not only to astronauts living in a microgravity environment but also to patients confined to bed. Gravity therapy (GT) may have beneficial effects on numerous conditions, such as immobility due to neuromuscular disorders, balance disorders, stroke, sports injuries. However, the appropriate configuration for administering the Gz load remains to be determined. Methods To address these issues, we studied graded G-loads from 0.5 to 2.0g in 24 young healthy, male and female participants, trained on a short arm human centrifuge (SAHC) combined with mild activity exercise within 40–59% MHR, provided by an onboard bicycle ergometer. Hemodynamic parameters, as cardiac output (CO), stroke volume (SV), mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were analyzed, as well as blood gas analysis. A one-way repeated measures ANOVA and pairwise comparisons were conducted with a level of significance p < 0.05. Results Significant changes in heart rate variability (HRV) and its spectral components (Class, Fmax, and VHF) were found in all g loads when compared to standing (p < 0.001), except in 1.7 and 2.0g. There were significant changes in CO, cardiac index (CI), and cardiac power (CP) (p < 0.001), and in MAP (p = 0.003) at different artificial gravity (AG) levels. Dose-response curves were determined based on statistically significant changes in cardiovascular parameters, as well as in identifying the optimal G level for training, as well as the optimal G level for training. There were statistically significant gender differences in Cardiac Output/CO (p = 0.002) and Cardiac Power/CP (p = 0.016) during the AG training as compared to standing. More specifically, these cardiovascular parameters were significantly higher for male than female participants. Also, there was a statistically significant (p = 0.022) gender by experimental condition interaction, since the high-frequency parameter of the heart rate variability was attenuated during AG training as compared to standing but only for the female participants (p = 0.004). Conclusion The comprehensive cardiovascular evaluation of the response to a range of graded AG loads, as compared to standing, in male and female subjects provides the dose-response framework that enables us to explore and validate the usefulness of the centrifuge as a medical device. It further allows its use in precisely selecting personalized gravity therapy (GT) as needed for treatment or rehabilitation of individuals confined to bed.
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Affiliation(s)
- Chrysoula Kourtidou-Papadeli
- Biomedical Engineering & Aerospace Neuroscience, Laboratory of Medical Physics, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Greek Aerospace Medical Association and Space Research, Thessaloniki, Greece.,Aeromedical Center of Thessaloniki, Thessaloniki, Greece
| | - Christos A Frantzidis
- Biomedical Engineering & Aerospace Neuroscience, Laboratory of Medical Physics, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Greek Aerospace Medical Association and Space Research, Thessaloniki, Greece
| | - Sotiria Gilou
- Biomedical Engineering & Aerospace Neuroscience, Laboratory of Medical Physics, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina E Plomariti
- Biomedical Engineering & Aerospace Neuroscience, Laboratory of Medical Physics, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christiane M Nday
- Biomedical Engineering & Aerospace Neuroscience, Laboratory of Medical Physics, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Lefteris Bakas
- Laboratory of Aerospace and Rehabilitation Applications "Joan Vernikos" Arogi Rehabilitation Center, Thessaloniki, Greece
| | - Panagiotis D Bamidis
- Biomedical Engineering & Aerospace Neuroscience, Laboratory of Medical Physics, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Greek Aerospace Medical Association and Space Research, Thessaloniki, Greece
| | - Joan Vernikos
- Greek Aerospace Medical Association and Space Research, Thessaloniki, Greece.,Thirdage llc, Culpeper, VA, United States
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Yilmaz K, Burnley M, Böcker J, Müller K, Jones AM, Rittweger J. Influence of simulated hypogravity on oxygen uptake during treadmill running. Physiol Rep 2021; 9:e14787. [PMID: 33955197 PMCID: PMC8100405 DOI: 10.14814/phy2.14787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/14/2021] [Indexed: 11/24/2022] Open
Abstract
Prolonged exposure to microgravity during spaceflights leads to severe deterioration in the physical performance of astronauts. To understand the effectiveness of existing in‐flight daily countermeasures and to plan exercise onboard the International Space Station, we compared supine treadmill running to traditional upright treadmill running on earth. Specifically, we assessed the cardiorespiratory responses to conventional upright running to the responses to supine treadmill running under 0.3 g, 0.6 g, and 1 g of body weight in younger (20–30 years, n = 14, 8 females) and older healthy adults (50–60 years, n = 12, 6 females). Maximal cardiorespiratory capacity was additionally evaluated by performing an incremental running protocol on each treadmill. Maximum speed was greater for 0.3 g and 0.6 g in supine than for upright running (18.5 km/h (1.1) and 15.9 (3.1) vs 13.2 (2.4) p < 0.001). In contrast, maximum oxygen uptake (V˙O2max) and maximum heart rate (HRmax) were greater in upright running than in all supine conditions (Upright treadmill running vs S1.0G vs S0.6G vs S0.3G, 41.7 ml kg−1 min−1 (7.2) vs 30.5 (6.6) vs 32.9 (7.0) vs 30.9 (5.2), p < 0.001 and 171 beats min−1 (14) vs 152 (24) vs 155 (20) vs 152 (18), p < 0.001, respectively). The reduction in V˙O2max was remarkably similar across all three supine conditions, could not be increased by higher running speeds and can be well explained by reduced ground reaction forces (GRF). Thus, although a gravity‐related restriction of pulmonary gas exchange or perfusion of the legs when exercising in the supine position can be suspected, findings are also explicable on grounds of the vertical treadmill mechanics. Reduced loading will constitute a substantial limitation to V˙O2 in space with implications for crew health and the physical deterioration of astronauts.
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Affiliation(s)
- Kenan Yilmaz
- Department of Muscle and Bone Metabolism, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Mark Burnley
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, United Kingdom
| | - Jonas Böcker
- Department of Muscle and Bone Metabolism, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Klaus Müller
- Department of Muscle and Bone Metabolism, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Andrew M Jones
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter St Luke's Campus, Exeter, United Kingdom
| | - Jörn Rittweger
- Department of Muscle and Bone Metabolism, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany.,Department of Pediatrics and Adolescent, Medicine, University of Cologne, Cologne, Germany
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29
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Whittle RS, Diaz-Artiles A. Modeling individual differences in cardiovascular response to gravitational stress using a sensitivity analysis. J Appl Physiol (1985) 2021; 130:1983-2001. [PMID: 33914657 DOI: 10.1152/japplphysiol.00727.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The human cardiovascular (CV) system elicits a physiological response to gravitational environments, with significant variation between different individuals. Computational modeling can predict CV response, however model complexity and variation of physiological parameters in a normal population makes it challenging to capture individual responses. We conducted a sensitivity analysis on an existing 21-compartment lumped-parameter hemodynamic model in a range of gravitational conditions to 1) investigate the influence of model parameters on a tilt test CV response and 2) to determine the subset of those parameters with the most influence on systemic physiological outcomes. A supine virtual subject was tilted to upright under the influence of a constant gravitational field ranging from 0 g to 1 g. The sensitivity analysis was conducted using a Latin hypercube sampling/partial rank correlation coefficient methodology with subsets of model parameters varied across a normal physiological range. Sensitivity was determined by variation in outcome measures including heart rate, stroke volume, central venous pressure, systemic blood pressures, and cardiac output. Results showed that model parameters related to the length, resistance, and compliance of the large veins and parameters related to right ventricular function have the most influence on model outcomes. For most outcome measures considered, parameters related to the heart are dominant. Results highlight which model parameters to accurately value in simulations of individual subjects' CV response to gravitational stress, improving the accuracy of predictions. Influential parameters remain largely similar across gravity levels, highlighting that accurate model fitting in 1 g can increase the accuracy of predictive responses in reduced gravity.NEW & NOTEWORTHY Computational modeling is used to predict cardiovascular responses to altered gravitational environments. However, considerable variation between subjects and model complexity makes accurate parameter assignment for individuals challenging. This computational effort studies sensitivity in cardiovascular model outcomes due to varying parameters across a normal physiological range. This allows determination of which parameters have the largest influence on outcomes, i.e., which parameters must be most carefully selected to give accurate predictions of individual responses.
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Affiliation(s)
- Richard S Whittle
- Department of Aerospace Engineering, Texas A&M University, College Station, Texas
| | - Ana Diaz-Artiles
- Department of Aerospace Engineering, Texas A&M University, College Station, Texas.,Department of Health and Kinesiology, Texas A&M University, College Station, Texas
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Hupfeld KE, McGregor HR, Reuter-Lorenz PA, Seidler RD. Microgravity effects on the human brain and behavior: Dysfunction and adaptive plasticity. Neurosci Biobehav Rev 2021; 122:176-189. [PMID: 33454290 DOI: 10.1016/j.neubiorev.2020.11.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 09/01/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
Emerging plans for travel to Mars and other deep space destinations make it critical for us to understand how spaceflight affects the human brain and behavior. Research over the past decade has demonstrated two co-occurring patterns of spaceflight effects on the brain and behavior: dysfunction and adaptive plasticity. Evidence indicates the spaceflight environment induces adverse effects on the brain, including intracranial fluid shifts, gray matter changes, and white matter declines. Past work also suggests that the spaceflight environment induces adaptive neural effects such as sensory reweighting and neural compensation. Here, we introduce a new conceptual framework to synthesize spaceflight effects on the brain, Spaceflight Perturbation Adaptation Coupled with Dysfunction (SPACeD). We review the literature implicating neurobehavioral dysfunction and adaptation in response to spaceflight and microgravity analogues, and we consider pre-, during-, and post-flight factors that may interact with these processes. We draw several instructive parallels with the aging literature which also suggests co-occurring neurobehavioral dysfunction and adaptive processes. We close with recommendations for future spaceflight research, including: 1) increased efforts to distinguish between dysfunctional versus adaptive effects by testing brain-behavioral correlations, and 2) greater focus on tracking recovery time courses.
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Affiliation(s)
- K E Hupfeld
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - H R McGregor
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - P A Reuter-Lorenz
- Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - R D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States; Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States.
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Approaching Gravity as a Continuum Using the Rat Partial Weight-Bearing Model. Life (Basel) 2020; 10:life10100235. [PMID: 33049988 PMCID: PMC7599661 DOI: 10.3390/life10100235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 12/12/2022] Open
Abstract
For decades, scientists have relied on animals to understand the risks and consequences of space travel. Animals remain key to study the physiological alterations during spaceflight and provide crucial information about microgravity-induced changes. While spaceflights may appear common, they remain costly and, coupled with limited cargo areas, do not allow for large sample sizes onboard. In 1979, a model of hindlimb unloading (HU) was successfully created to mimic microgravity and has been used extensively since its creation. Four decades later, the first model of mouse partial weight-bearing (PWB) was developed, aiming at mimicking partial gravity environments. Return to the Lunar surface for astronauts is now imminent and prompted the need for an animal model closer to human physiology; hence in 2018, our laboratory created a new model of PWB for adult rats. In this review, we will focus on the rat model of PWB, from its conception to the current state of knowledge. Additionally, we will address how this new model, used in conjunction with HU, will help implement new paradigms allowing scientists to anticipate the physiological alterations and needs of astronauts. Finally, we will discuss the outstanding questions and future perspectives in space research and propose potential solutions using the rat PWB model.
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Frett T, Green DA, Mulder E, Noppe A, Arz M, Pustowalow W, Petrat G, Tegtbur U, Jordan J. Tolerability of daily intermittent or continuous short-arm centrifugation during 60-day 6o head down bed rest (AGBRESA study). PLoS One 2020; 15:e0239228. [PMID: 32946482 PMCID: PMC7500599 DOI: 10.1371/journal.pone.0239228] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Artificial gravity through short-arm centrifugation has potential as a multi-system countermeasure for deconditioning and cranial fluid shifts that may underlie ocular issues in microgravity. However, the optimal short-arm centrifugation protocol that is effective whilst remaining tolerable has yet to be determined. Given that exposure to centrifugation is associated with presyncope and syncope and in addition motion sickness an intermittent protocol has been suggested to be more tolerable. Therefore, we assessed cardiovascular loading and subjective tolerability of daily short arm centrifugation with either an intermittent or a continuous protocol during long-term head-down bed rest as model for microgravity exposure in a mixed sex cohort. During the Artificial Gravity Bed Rest with European Space Agency (AGBRESA) 60 day 6° head down tilt bed rest study we compared the tolerability of daily +1 Gz exposure at the center of mass centrifugation, either performed continuously for 30 minutes, or intermittedly (6 x 5 minutes). Heart rate and blood pressure were assessed daily during centrifugation along with post motion sickness scoring and rate of perceived exertion. During bed rest, 16 subjects (6 women, 10 men), underwent 960 centrifuge runs in total. Ten centrifuge runs had to be terminated prematurely, 8 continuous runs and 2 intermittent runs, mostly due to pre-syncopal symptoms and not motion sickness. All subjects were, however, able to resume centrifuge training on subsequent days. We conclude that both continuous and intermittent short-arm centrifugation protocols providing artificial gravity equivalent to +1 Gz at the center of mass is tolerable in terms of cardiovascular loading and motion sickness during long-term head down tilt bed rest. However, intermittent centrifugation appears marginally better tolerated, albeit differences appear minor.
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Affiliation(s)
- Timo Frett
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
- * E-mail:
| | - David Andrew Green
- Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany
- KBRwyle GmbH, Cologne, Germany
- King’s College London, London, United Kingdom
| | - Edwin Mulder
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Alexandra Noppe
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Michael Arz
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Willi Pustowalow
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Guido Petrat
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Uwe Tegtbur
- Institutes of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
- Chair of Aerospace Medicine, University of Cologne, Cologne, Germany
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Bimpong-Buta NY, Muessig JM, Knost T, Masyuk M, Binneboessel S, Nia AM, Kelm M, Jung C. Comprehensive Analysis of Macrocirculation and Microcirculation in Microgravity During Parabolic Flights. Front Physiol 2020; 11:960. [PMID: 32903511 PMCID: PMC7438475 DOI: 10.3389/fphys.2020.00960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/15/2020] [Indexed: 12/02/2022] Open
Abstract
Background Profound knowledge about cardiovascular physiology in the setting of microgravity can help in the course of preparations for human space missions. So far, influences of microgravity on the cardiovascular system have been demonstrated, particularly pertaining to venous fluid shifts. Yet, little is known about the mechanisms of these adaptations on continuous macrocirculatory level and regarding the microcirculation. Methods Twelve healthy volunteers were subjected to alternating microgravity and hypergravity in the course of parabolic flight maneuvers. Under these conditions, as well as in normal gravity, the sublingual microcirculation was assessed by intravital sidestream dark field microscopy. Furthermore, hemodynamic parameters such as heart rate, blood pressure, and cardiac output were recorded by beat-to-beat analysis. In these settings, data acquisition was performed in seated and in supine postures. Results Systolic [median 116 mmHg (102; 129) interquartile range (IQR) vs. 125 mmHg (109; 136) IQR, p = 0.01] as well as diastolic [median 72 mmHg (61; 79) IQR vs. 80 mmHg (69; 89) IQR, p = 0.003] blood pressure was reduced, and cardiac output [median 6.9 l/min (6.5; 8.8) IQR vs. 6.8 l/min (6.2; 8.5) IQR, p = 0.0002] increased in weightlessness compared to normal gravitation phases in the seated but not in the supine posture. However, microcirculation represented by perfused proportion of vessels and by total vessel density was unaffected in acute weightlessness. Conclusion Profound changes of the macrocirculation were found in seated postures, but not in supine postures. However, microcirculation remained stable in all postures.
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Affiliation(s)
- Nana-Yaw Bimpong-Buta
- Medical Faculty, Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Johanna M Muessig
- Medical Faculty, Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Thorben Knost
- Medical Faculty, Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Maryna Masyuk
- Medical Faculty, Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Stephan Binneboessel
- Medical Faculty, Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Amir M Nia
- Medical Faculty, Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Malte Kelm
- Medical Faculty, Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.,CARID, Cardiovascular Research Institute Düsseldorf, Düsseldorf, Germany
| | - Christian Jung
- Medical Faculty, Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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Laing C, Green DA, Mulder E, Hinghofer-Szalkay H, Blaber AP, Rittweger J, Goswami N. Effect of novel short-arm human centrifugation-induced gravitational gradients upon cardiovascular responses, cerebral perfusion and g-tolerance. J Physiol 2020; 598:4237-4249. [PMID: 32715482 PMCID: PMC7589294 DOI: 10.1113/jp273615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/08/2020] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS The aim of this study was to determine the effect of rotational axis position (RAP and thus g-gradient) during short-arm human centrifugation (SAHC) upon cardiovascular responses, cerebral perfusion and g-tolerance. In 10 male and 10 female participants, 10 min passive SAHC runs were performed with the RAP above the head (P1), at the apex of the head (P2), or at heart level (P3), with foot-level Gz at 1.0 g, 1.7 g and 2.4 g. We hypothesized that movement of the RAP from above the head (the conventional position) towards the heart might reduce central hypovolaemia, limit cardiovascular responses, aid cerebral perfusion, and thus promote g-tolerance. Moving the RAP footward towards the heart decreased the cerebral tissue saturation index, calf circumference and heart rate responses to SAHC, thereby promoting g-tolerance. Our results also suggest that RAP, and thus g-gradient, warrants further investigation as it may support use as a holistic spaceflight countermeasure. ABSTRACT Artificial gravity (AG) through short-arm human centrifugation (SAHC) has been proposed as a holistic spaceflight countermeasure. Movement of the rotational axis position (RAP) from above the head towards the heart may reduce central hypovolaemia, aid cerebral perfusion, and thus promote g-tolerance. This study determined the effect of RAP upon cardiovascular responses, peripheral blood displacement (i.e. central hypovolaemia), cerebral perfusion and g-tolerance, and their inter-relationships. Twenty (10 male) healthy participants (26.2 ± 4.0 years) underwent nine (following a familiarization run) randomized 10 min passive SAHC runs with RAP set above the head (P1), at the apex of the head (P2), or at heart level (P3) with foot-level Gz at 1.0 g, 1.7 g and 2.4 g. Cerebral tissue saturation index (cTSI, cerebral perfusion surrogate), calf circumference (CC, central hypovolaemia), heart rate (HR) and digital heart-level mean arterial blood pressure (MAP) were continuously recorded, in addition to incidence of pre-syncopal symptoms (PSS). ΔCC and ΔHR increases were attenuated from P1 to P3 (ΔCC: 5.46 ± 0.54 mm to 2.23 ± 0.42 mm; ΔHR: 50 ± 4 bpm to 8 ± 2 bpm, P < 0.05). In addition, ΔcTSI decrements were also attenuated (ΔcTSI: -2.85 ± 0.48% to -0.95 ± 0.34%, P < 0.05) and PSS incidence lower in P3 than P1 (P < 0.05). A positive linear relationship was observed between ΔCC and ΔHR with increasing +Gz, and a negative relationship between ΔCC and ΔcTSI, both independent of RAP. Our data suggest that movement of RAP towards the heart (reduced g-gradient), independent of foot-level Gz, leads to improved g-tolerance. Further investigations are required to assess the effect of differential baroreceptor feedback (i.e. aortic-carotid g-gradient).
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Affiliation(s)
- Charles Laing
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany.,King's College London, Centre for Human and Applied Physiological Sciences (CHAPS), London, UK
| | - David A Green
- King's College London, Centre for Human and Applied Physiological Sciences (CHAPS), London, UK.,Space Medicine Team, HRE-OM, European Astronaut Centre, European Space Agency, Cologne, Germany.,KBR, Wyle Laboratories GmbH, Cologne, Germany
| | - Edwin Mulder
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Helmut Hinghofer-Szalkay
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Medical University of Graz, Austria
| | - Andrew P Blaber
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Joern Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany.,Department of Paediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Nandu Goswami
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Medical University of Graz, Austria
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Patel S. The effects of microgravity and space radiation on cardiovascular health: From low-Earth orbit and beyond. IJC HEART & VASCULATURE 2020; 30:100595. [PMID: 32775602 PMCID: PMC7399104 DOI: 10.1016/j.ijcha.2020.100595] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 10/26/2022]
Abstract
The unique conditions of space harbor considerable challenges for astronauts to overcome. Namely, the ionizing content of space radiation and the effects of microgravity have been implicated in the pathogenesis of cardiovascular disease. Post-flight carotid arterial stiffness was demonstrated in astronaut studies while early arteriosclerosis has been linked with microgravity-induced oxidative stress in cellular studies. Similarly, radiation has been shown to disrupt molecular pathways, enhance reactive oxygen species and increase risk of cardiovascular disease in exposed populations. These results may bear even more significance in space owing to the propensity for microgravity and space radiation to yield synergistic and/or additive interactions. Potential countermeasures such as α-tocopherol and captopril target these oxidative pathways and may help to protect against the effects of microgravity and radiation-induced cardiac damage. However, more research needs to be conducted in this area to facilitate a safe passage for humans to the Moon, Mars and beyond.
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Affiliation(s)
- Smit Patel
- Vascular Biology, Cardiovascular Science, National Heart & Lung Institute (NHLI), Faculty of Medicine, Imperial College London, Dovehouse Street, London SW3 6LY, UK
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36
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Kermorgant M, Nasr N, Czosnyka M, Arvanitis DN, Hélissen O, Senard JM, Pavy-Le Traon A. Impacts of Microgravity Analogs to Spaceflight on Cerebral Autoregulation. Front Physiol 2020; 11:778. [PMID: 32719617 PMCID: PMC7350784 DOI: 10.3389/fphys.2020.00778] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022] Open
Abstract
It is well known that exposure to microgravity in astronauts leads to a plethora physiological responses such as headward fluid shift, body unloading, and cardiovascular deconditioning. When astronauts return to Earth, some encounter problems related to orthostatic intolerance. An impaired cerebral autoregulation (CA), which could be compromised by the effects of microgravity, has been proposed as one of the mechanisms responsible for orthostatic intolerance. CA is a homeostatic mechanism that maintains cerebral blood flow for any variations in cerebral perfusion pressure by adapting the vascular tone and cerebral vessel diameter. The ground-based models of microgravity are useful tools for determining the gravitational impact of spaceflight on human body. The head-down tilt bed rest (HDTBR), where the subject remains in supine position at −6 degrees for periods ranging from few days to several weeks is the most commonly used ground-based model of microgravity for cardiovascular deconditioning. head-down bed rest (HDBR) is able to replicate cephalic fluid shift, immobilization, confinement, and inactivity. Dry immersion (DI) model is another approach where the subject remains immersed in thermoneutral water covered with an elastic waterproof fabric separating the subject from the water. Regarding DI, this analog imitates absence of any supporting structure for the body, centralization of body fluids, immobilization and hypokinesia observed during spaceflight. However, little is known about the impact of microgravity on CA. Here, we review the fundamental principles and the different mechanisms involved in CA. We also consider the different approaches in order to assess CA. Finally, we focus on the effects of short- and long-term spaceflight on CA and compare these findings with two specific analogs to microgravity: HDBR and DI.
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Affiliation(s)
- Marc Kermorgant
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
| | - Nathalie Nasr
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France.,Department of Neurology, Institute for Neurosciences, Toulouse University Hospital, Toulouse, France
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital, Cambridge, United Kingdom.,Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland
| | - Dina N Arvanitis
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
| | - Ophélie Hélissen
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
| | - Jean-Michel Senard
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France.,Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Anne Pavy-Le Traon
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France.,Department of Neurology, Institute for Neurosciences, Toulouse University Hospital, Toulouse, France
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Borovik AS, Orlova EA, Tomilovskaya ES, Tarasova OS, Vinogradova OL. Phase Coupling Between Baroreflex Oscillations of Blood Pressure and Heart Rate Changes in 21-Day Dry Immersion. Front Physiol 2020; 11:455. [PMID: 32508675 PMCID: PMC7253653 DOI: 10.3389/fphys.2020.00455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/09/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Dry immersion (DI) is a ground-based experimental model which reproduces the effects of microgravity on the cardiovascular system and, therefore, can be used to study the mechanisms of post-flight orthostatic intolerance in cosmonauts. However, the effects of long-duration DI on cardiovascular system have not been studied yet. The aim of this work was to study the effects of 21-day DI on systemic hemodynamics and its baroreflex control at rest and during head-up tilt test (HUTT). Methods Ten healthy young men were exposed to DI for 21 days. The day before, on the 7th, 14th, and 19th day of DI, as well as on the 1st and 5th days of recovery they were subjected to HUTT: 15 min in supine position and then 15 min of orthostasis (60°). ECG, arterial pressure, stroke volume and respiration rate were continuously recorded during the test. Phase synchronization index (PSI) of beat-to-beat mean arterial pressure (MAP) and heart rate (HR) in the frequency band of baroreflex waves (∼0.1 Hz) was used as a quantitative measure of baroreflex activity. Results During DI, strong tachycardia and the reduction of stroke volume were observed both in supine position and during HUTT, these indicators did not recover on post-immersion day 5. In contrast, systolic arterial pressure and MAP decreased during HUTT on 14th day of DI, but then restored to pre-immersion values. Before DI and on day 5 of recovery, a transition from supine position to orthostasis was accompanied by an increase in PSI at the baroreflex frequency. However, PSI did not change in HUTT performed during DI and on post-immersion day 1. The amplitude of MAP oscillations at this frequency were increased by HUTT at all time points, while an increase of respective HR oscillations was absent during DI. Conclusion 21-day DI drastically changed the hemodynamic response to HUTT, while its effect on blood pressure was reduced between days 14 and 19, which speaks in favor of the adaptation to the conditions of DI. The lack of increase in phase synchronization of baroreflex MAP and HR oscillations during HUTT indicates disorders of baroreflex cardiac control during DI.
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Affiliation(s)
- Anatoly S Borovik
- State Research Center of the Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Evgeniya A Orlova
- State Research Center of the Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Elena S Tomilovskaya
- State Research Center of the Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Olga S Tarasova
- State Research Center of the Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia.,Faculty of Biology, M.V. Lomonosov Moscow State University, Moscow, Russia
| | - Olga L Vinogradova
- State Research Center of the Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia.,Faculty of Basic Medicine, M.V. Lomonosov Moscow State University, Moscow, Russia
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Amirova L, Navasiolava N, Rukavishvikov I, Gauquelin-Koch G, Gharib C, Kozlovskaya I, Custaud MA, Tomilovskaya E. Cardiovascular System Under Simulated Weightlessness: Head-Down Bed Rest vs. Dry Immersion. Front Physiol 2020; 11:395. [PMID: 32508663 PMCID: PMC7248392 DOI: 10.3389/fphys.2020.00395] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background The most applicable human models of weightlessness are −6° head-down bed rest (HDBR) and head-out dry immersion (DI). A detailed experimental comparison of cardiovascular responses in both models has not yet been carried out, in spite of numerous studies having been performed in each of the models separately. Objectives We compared changes in central hemodynamics, autonomic regulation, plasma volume, and water balance induced by −6° HDBR and DI. Methods Eleven subjects participated in a 21-day HDBR and 12 subjects in a 3-day DI. During exposure, measurements of the water balance, blood pressure, and heart rate were performed daily. Plasma volume evolution was assessed by the Dill–Costill method. In order to assess orthostatic tolerance time (OTT), central hemodynamic responses to orthostatic stimuli, and autonomous regulation, the 80° lower body negative pressure–tilt test was conducted before and right after both exposures. Results For most of the studied parameters, the changes were co-directional, although they differed in their extent. The changes in systolic blood pressure and total peripheral resistance after HDBR were more pronounced than those after DI. The OTT was decreased in both groups: to 14.2 ± 3.1 min (vs. 27.9 ± 2.5 min before exposure) in the group of 21-day HDBR and to 8.7 ± 2.1 min (vs. 27.7 ± 1.2 min before exposure) in the group of 3-day DI. Conclusions In general, cardiovascular changes during the 21-day HDBR and 3-day DI were co-directional. In some cases, changes in the parameters after 3-day DI exceeded changes after the 21-day HDBR, while in other cases the opposite was true. Significantly stronger effects of DI on cardiovascular function may be due to hypovolemia and support unloading (supportlessness).
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Affiliation(s)
- Liubov Amirova
- Laboratory of Gravitational Physiology of the Sensorimotor System, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia.,Laboratoire MITOVASC, UMR Institut National de la Santé et de la Recherche Médicale 1083, Centre National de la Recherche Scientifique 6015, Université d'Angers, Angers, France
| | - Nastassia Navasiolava
- Laboratoire MITOVASC, UMR Institut National de la Santé et de la Recherche Médicale 1083, Centre National de la Recherche Scientifique 6015, Université d'Angers, Angers, France
| | - Ilya Rukavishvikov
- Laboratory of Gravitational Physiology of the Sensorimotor System, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | | | - Claude Gharib
- Institut NeuroMyogène, Université Claude Bernard Lyon 1, Lyon, France
| | - Inessa Kozlovskaya
- Laboratory of Gravitational Physiology of the Sensorimotor System, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Marc-Antoine Custaud
- Laboratoire MITOVASC, UMR Institut National de la Santé et de la Recherche Médicale 1083, Centre National de la Recherche Scientifique 6015, Université d'Angers, Angers, France.,Centre de Recherche Clinique, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Elena Tomilovskaya
- Laboratory of Gravitational Physiology of the Sensorimotor System, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
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Noh W, Lee M, Kim HJ, Kim KS, Yang S. Hypergravity induced disruption of cerebellar motor coordination. Sci Rep 2020; 10:4452. [PMID: 32157179 PMCID: PMC7064588 DOI: 10.1038/s41598-020-61453-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/21/2020] [Indexed: 01/23/2023] Open
Abstract
The cerebellum coordinates voluntary movements for balanced motor activity in a normal gravity condition. It remains unknown how hypergravity is associated with cerebellum-dependent motor behaviors and Purkinje cell’s activities. In order to investigate the relationship between gravity and cerebellar physiology, we measured AMPA-mediated fast currents and mGluR1-mediated slow currents of cerebellar Purkinje cells along with cerebellum-dependent behaviors such as the footprint and irregular ladder under a hypergravity condition. We found abnormal animal behaviors in the footprint and irregular ladder tests under hypergravity. They are correlated with decreased AMPA and mGluR1-mediated synaptic currents of Purkinje cells. These results indicate that gravity regulates the activity of Purkinje cells, thereby modulating cerebellum-dependent motor outputs.
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Affiliation(s)
- Wonjun Noh
- Department of Nano-Bioengineering, Incheon National University, Incheon, Korea
| | - Minseok Lee
- Department of Nano-Bioengineering, Incheon National University, Incheon, Korea
| | - Hyun Ji Kim
- Department of Otorhinolaryngology-Head & Neck surgery, Inha University, College of medicine, Incheon, Korea
| | - Kyu-Sung Kim
- Department of Otorhinolaryngology-Head & Neck surgery, Inha University, College of medicine, Incheon, Korea.
| | - Sunggu Yang
- Department of Nano-Bioengineering, Incheon National University, Incheon, Korea.
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Norsk P. Adaptation of the cardiovascular system to weightlessness: Surprises, paradoxes and implications for deep space missions. Acta Physiol (Oxf) 2020; 228:e13434. [PMID: 31872965 DOI: 10.1111/apha.13434] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 01/02/2023]
Abstract
Weightlessness in space induces a fluid shift from the dependent to the cephalad parts of the body leading to distension of the cardiac chambers and an accumulation of blood in the veins of the head and neck. Surprisingly, central venous pressure (CVP) during the initial hours of spaceflight decreases compared to being horizontal supine on the ground. The explanation is that the thorax is expanded by weightlessness leading to a decrease in inter-pleural pressure (IPP), which exceeds the measured decrease in CVP. Thus, transmural CVP (TCVP = CVP - IPP) is increased indicating an augmented cardiac preload. Simultaneously, stroke volume and cardiac output (CO) are increased by 18%-26% within the initial weeks and more so by 35%-56% during the subsequent months of flight relative to in the upright posture on the ground. Mean arterial pressure (MAP) is decreased indicating a lower systemic vascular resistance (MAP/CO). It is therefore a surprise that sympathetic nerve activity is not suppressed in space and thus cannot be a mechanism for the systemic vasodilation, which still needs to be explored. Recent observations indicate that the fluid shift during long duration (months) flights is associated with increased retinal thickness that sometimes leads to optical disc oedema. Ocular and cerebral structural changes, increases in left atrial size and decreased flows with thrombi formation in the left internal jugular vein have also been observed. This is of concern for future long duration deep space missions because the health implications are unknown.
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Affiliation(s)
- Peter Norsk
- Center for Space Medicine & Department of Molecular Physiology and Biophysics Baylor College of Medicine Houston TX USA
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Wood KN, Murray KR, Greaves DK, Hughson RL. Inflight leg cuff test does not identify the risk for orthostatic hypotension after long-duration spaceflight. NPJ Microgravity 2019; 5:22. [PMID: 31633009 PMCID: PMC6789148 DOI: 10.1038/s41526-019-0082-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 09/18/2019] [Indexed: 11/09/2022] Open
Abstract
Landing day symptoms from orthostatic hypotension after prolonged spaceflight can be debilitating, but severity of these symptoms can be unpredictable and highly individual. We tested the hypothesis that an impaired baroreflex response to an inflight leg cuff test could predict orthostatic intolerance on return to Earth. Eight male astronauts (44 ± 7 years of age (mean ± SD); mean mission length: 167 ± 12 days) participated in a standardized supine-to-sit-to-stand test (5 min-30s-3 min) pre- and postflight, and a 3 min thigh cuff occlusion test pre- and inflight with continuous monitoring of heart rate and arterial blood pressure. The arterial baroreflex was not changed inflight as shown by similar reductions in mean arterial pressure (MAP) response to leg cuff deflation (preflight -19 ± 2 mmHg vs. inflight -18 ± 5 mmHg). With the sit/stand test, the nadir of MAP was lower postflight (-17 ± 9 mmHg) than preflight (-11 ± 6 mmHg, p < 0.05). A greater increase in heart rate (25 ± 7; 16 ± 3 bpm) and decrease in stroke volume (-24 ± 11; -6 ± 4 mL) occurred with sit/stand postflight than leg cuffs inflight (p < 0.001). Inflight testing was influenced by elevated cardiac output resulting in a smaller drop in total peripheral resistance. Two of eight subjects exhibited orthostatic hypotension during the postflight stand test; their responses were not predicted by the inflight leg cuff deflation test. These results suggest that the baroreflex response examined by inflight leg cuff deflation was not a reliable indicator of postflight stand responses.
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Affiliation(s)
- Katelyn N Wood
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON Canada
| | - Kevin R Murray
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON Canada
| | - Danielle K Greaves
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON Canada
| | - Richard L Hughson
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON Canada
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Tahimic CGT, Paul AM, Schreurs AS, Torres SM, Rubinstein L, Steczina S, Lowe M, Bhattacharya S, Alwood JS, Ronca AE, Globus RK. Influence of Social Isolation During Prolonged Simulated Weightlessness by Hindlimb Unloading. Front Physiol 2019; 10:1147. [PMID: 31572207 PMCID: PMC6753329 DOI: 10.3389/fphys.2019.01147] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/22/2019] [Indexed: 12/15/2022] Open
Abstract
The hindlimb unloading (HU) model has been used extensively to simulate the cephalad fluid shift and musculoskeletal disuse observed in spaceflight with its application expanding to study immune, cardiovascular and central nervous system responses, among others. Most HU studies are performed with singly housed animals, although social isolation also can substantially impact behavior and physiology, and therefore may confound HU experimental results. Other HU variants that allow for paired housing have been developed although no systematic assessment has been made to understand the effects of social isolation on HU outcomes. Hence, we aimed to determine the contribution of social isolation to tissue responses to HU. To accomplish this, we developed a refinement to the traditional NASA Ames single housing HU system to accommodate social housing in pairs, retaining desirable features of the original design. We conducted a 30-day HU experiment with adult, female mice that were either singly or socially housed. HU animals in both single and social housing displayed expected musculoskeletal deficits versus housing matched, normally loaded (NL) controls. However, select immune and hypothalamic-pituitary-adrenal (HPA) axis responses were differentially impacted by the HU social environment relative to matched NL controls. HU led to a reduction in % CD4+ T cells in singly housed, but not in socially housed mice. Unexpectedly, HU increased adrenal gland mass in socially housed but not singly housed mice, while social isolation increased adrenal gland mass in NL controls. HU also led to elevated plasma corticosterone levels at day 30 in both singly and socially housed mice. Thus, musculoskeletal responses to simulated weightlessness are similar regardless of social environment with a few differences in adrenal and immune responses. Our findings show that combined stressors can mask, not only exacerbate, select responses to HU. These findings further expand the utility of the HU model for studying possible combined effects of spaceflight stressors.
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Affiliation(s)
- Candice G T Tahimic
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, United States.,KBR, Houston, TX, United States
| | - Amber M Paul
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, United States.,Universities Space Research Association, Columbia, MD, United States
| | - Ann-Sofie Schreurs
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, United States.,KBR, Houston, TX, United States
| | - Samantha M Torres
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, United States.,Blue Marble Space Institute of Science, Seattle, WA, United States
| | - Linda Rubinstein
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, United States.,Universities Space Research Association, Columbia, MD, United States
| | - Sonette Steczina
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, United States.,Blue Marble Space Institute of Science, Seattle, WA, United States
| | - Moniece Lowe
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, United States.,Blue Marble Space Institute of Science, Seattle, WA, United States
| | - Sharmila Bhattacharya
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, United States
| | - Joshua S Alwood
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, United States
| | - April E Ronca
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, United States.,Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Ruth K Globus
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, United States
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Wood KN, Greaves DK, Hughson RL. Interrelationships between pulse arrival time and arterial blood pressure during postural transitions before and after spaceflight. J Appl Physiol (1985) 2019; 127:1050-1057. [PMID: 31414954 DOI: 10.1152/japplphysiol.00317.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We tested the hypothesis that acute changes in arterial blood pressure (BP) when astronauts moved between supine and standing posture before and after spaceflight can be tracked by beat-to-beat changes in pulse arrival time (PAT). Nine male crewmembers (45 ± 7 yr of age; mean mission length: 165 ± 13 days) participated in a standardized supine-to-sit-to-stand test (5 min-30 s-3 min) before flight and 1 day following return to Earth with continuous monitoring of ECG and finger arterial BP. PAT was determined from the R-wave of the ECG to the foot of the BP waveform. On average, modest cardiovascular deconditioning was detected by ~10 beats/min increase in heart rate in supine and standing posture after spaceflight (P < 0.05). When looking across the full data collection period, the r2 values between inverse of PAT (1/PAT) and systolic (SBP) and diastolic BP (DBP) varied considerably between individuals (SBP preflight 0.142 ± 0.186, postflight 0.262 ± 0.243). Individual variability was consistent during periods of transition (SBP preflight 0.284 ± 0.324, postflight 0.297 ± 0.269); however, when SBP dropped >20 mmHg, r2 was significant in 5 of 5 preflight tests and 5 of 7 postflight tests. The standard error of the estimate based on a simple linear model during both pre- and postflight testing was 9-11 mmHg for SBP and 6-7 mmHg for DBP. Overall, the results support the hypothesis that PAT tracked dynamic changes in BP. PAT as a noninvasive, nonintrusive surrogate for changes in BP could be developed as an indicator of risk for syncope on return from spaceflight or other Earth-based applications.NEW & NOTEWORTHY Astronauts returning to Earth's gravity are at increased risk of low blood pressure on standing. Arterial pulse arrival time tracked the decrease in arterial blood pressure on moving from supine to upright posture. Nonintrusive technology providing indicators sensitive to acute changes in blood pressure could act as an early warning system to identify risk for hypotension that place astronauts, or people on Earth, at risk of impaired cognitive performance, fainting, and falls.
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Affiliation(s)
- Katelyn N Wood
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - Danielle K Greaves
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - Richard L Hughson
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
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Diaz-Artiles A, Heldt T, Young LR. Computational model of cardiovascular response to centrifugation and lower body cycling exercise. J Appl Physiol (1985) 2019; 127:1453-1468. [PMID: 31343946 DOI: 10.1152/japplphysiol.00314.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Short-radius centrifugation combined with exercise has been suggested as a potential countermeasure against spaceflight deconditioning. Both the long-term and acute physiological responses to such a combination are incompletely understood. We developed and validated a computational model to study the acute cardiovascular response to centrifugation combined with lower body ergometer exercise. The model consisted of 21 compartments, including the upper body, renal, splanchnic, and leg circulation, as well as a four-chamber heart and pulmonary circulation. It also included the effects of gravity gradient and ergometer exercise. Centrifugation and exercise profiles were simulated and compared with experimental data gathered on 12 subjects exposed to a range of gravitational levels (1 and 1.4G measured at the feet) and workload intensities (25-100 W). The model was capable of reproducing cardiovascular changes (within ± 1 SD from the group-averaged behavior) due to both centrifugation and exercise, including dynamic responses during transitions between the different phases of the protocol. The model was then used to simulate the hemodynamic response of hypovolemic subjects (blood volume reduced by 5-15%) subjected to similar gravitational stress and exercise profiles, providing insights into the physiological responses of experimental conditions not tested before. Hypovolemic results are in agreement with the limited available data and the expected responses based on physiological principles, although additional experimental data are warranted to further validate our predictions, especially during the exercise phases. The model captures the cardiovascular response for a range of centrifugation and exercise profiles, and it shows promise in simulating additional conditions where data collection is difficult, expensive, or infeasible.NEW & NOTEWORTHY Artificial gravity combined with exercise is a potential countermeasure for spaceflight deconditioning, but the long-term and acute cardiovascular response to such gravitational stress is still largely unknown. We provide a novel mathematical model of the cardiovascular system that incorporates gravitational stress generated by centrifugation and lower body cycling exercise, and we validate it with experimental measurements from human subjects. Simulations of experimental conditions not used for model development corroborate the model's predictive capabilities.
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Affiliation(s)
- Ana Diaz-Artiles
- Department of Aerospace Engineering, Texas A & M University, College Station, Texas
| | - Thomas Heldt
- Institute for Medical Engineering and Science, Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Laurence R Young
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, Massachusetts
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Convertino VA. Mechanisms of inspiration that modulate cardiovascular control: the other side of breathing. J Appl Physiol (1985) 2019; 127:1187-1196. [PMID: 31225967 DOI: 10.1152/japplphysiol.00050.2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective of this minireview is to describe the physiology and potential clinical benefits derived from inspiration. Recent animal and clinical studies demonstrate that one of the body's natural mechanisms associated with inspiration is to harness the respiratory pump to enhance circulation to vital organs. There is evidence that large reductions in intrathoracic pressure (>20 cmH2O) caused by some inspiration maneuvers (e.g., Mueller maneuver) or pathophysiology (e.g., heart failure, chronic obstructive lung disease) can result in adverse hemodynamic effects. However, the respiratory pump can improve cardiovascular functions when a "sweet spot" for generation of negative intrathoracic pressure during inspiration can be maintained at or less than 10 cmH2O below normal inspiration. These beneficial physiological effects include greater cardiac filling and output, lower intracranial pressure, cardiac baroreflex resetting, greater cerebral blood flow oscillatory patterns, increased vascular pressure gradients, and promoting sustained feedback between sympathetic nerve activity and arterial pressure. In addition to promoting gas exchange, data obtained from numerous animal and human experiments have provided new insights into "the other side of breathing": the modulation of circulation by reduced intrathoracic pressure generated during inspiration. The translation of these physiological relationships form the basis for the development and application of technologies designed to optimize the intrathoracic pump for treatment of clinical conditions associated with hypovolemia including cardiac arrest, orthostatic hypotension, hemorrhagic shock, and traumatic brain injury. Harnessing these fundamental mechanisms that control cardiopulmonary physiology provides opportunities to use inspiration as a potential tool to help treat significant and often life-threatening circulatory disorders.
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Affiliation(s)
- Victor A Convertino
- Battlefield Health & Trauma Center for Human Integrative Physiology, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
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Diaz-Artiles A, Navarro Tichell P, Perez F. Cardiopulmonary Responses to Sub-Maximal Ergometer Exercise in a Hypo-Gravity Analog Using Head-Down Tilt and Head-Up Tilt. Front Physiol 2019; 10:720. [PMID: 31263424 PMCID: PMC6590066 DOI: 10.3389/fphys.2019.00720] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022] Open
Abstract
After more than 50 years of spaceflight, we still do not know what is the appropriate range of gravity levels that are required to maintain normal physiological function in humans. This research effort aimed to investigate musculoskeletal, cardiovascular, and pulmonary responses between 0 and 1 g. A human experiment was conducted to investigate acute physiological outcomes to simulated altered-gravity with and without ergometer exercise using a head-down tilt (HDT)/head-up tilt (HUT) paradigm. A custom tilting platform was built to simulate multiple gravitational loads in the head-to-toe direction (Gz) by tilting the bed to the appropriate angle. Gravity levels included: Microgravity (-6°HDT), Moon (0.17g-Gz at +9.5°HUT), Mars (0.38g-Gz at +22.3°HUT), and Earth (1g-Gz at +90° upright). Fourteen healthy subjects performed an exercise protocol at each simulated gravity level that consisted of three work rates (50W, 75W, 100W) while maintaining a constant cycling rate of 90 rpm. Multiple cardiopulmonary variables were gathered, including volume of oxygen uptake (VO2), volume of carbon dioxide output (VCO2), pulmonary ventilation (VE), tidal volume (VT), respiratory rate (Rf), blood pressure, and heart rate (HR) using a portable metabolic system and a brachial blood pressure cuff. Foot forces were also measured continuously during the protocol. Exercise data were analyzed with repeated-measures ANOVA with Bonferroni correction for multiple comparisons, and regression models were fitted to the experimental data to generate dose-response curves as a function of simulated AG-levels and exercise intensity. Posture showed a main effect in all variables except for systolic blood pressure. In particular, VO2, VCO2, VE, VT, Rf, and HR showed average changes across exercise conditions between Microgravity and 1 g (i.e., per unit of simulated AG) of -97.88 mL/min/g, -95.10 mL/min/g, -3.95 L/min/g, 0.165 L/g, -5.33 breaths/min/g, and 5.05 bpm/g, respectively. In the case of VO2, further pairwise comparisons did not show significant differences between conditions, which was consistent with previous studies using supine and HDT postures. For all variables (except HR), comparisons between Mars and Earth conditions were not statistically different, suggesting that ergometer exercise at a gravitational stress comparable to Mars gravity (∼3/8 g) could provide similar physiological stimuli as cycling under 1 g on Earth.
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Affiliation(s)
- Ana Diaz-Artiles
- Department of Aerospace Engineering, Texas A&M University, College Station, TX, United States
| | - Patricia Navarro Tichell
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, United States
| | - Francisca Perez
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, United States
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47
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Mulavara AP, Peters BT, Miller CA, Kofman IS, Reschke MF, Taylor LC, Lawrence EL, Wood SJ, Laurie SS, Lee SMC, Buxton RE, May-Phillips TR, Stenger MB, Ploutz-Snyder LL, Ryder JW, Feiveson AH, Bloomberg JJ. Physiological and Functional Alterations after Spaceflight and Bed Rest. Med Sci Sports Exerc 2019; 50:1961-1980. [PMID: 29620686 PMCID: PMC6133205 DOI: 10.1249/mss.0000000000001615] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Supplemental digital content is available in the text. Introduction Exposure to microgravity causes alterations in multiple physiological systems, potentially impacting the ability of astronauts to perform critical mission tasks. The goal of this study was to determine the effects of spaceflight on functional task performance and to identify the key physiological factors contributing to their deficits. Methods A test battery comprised of seven functional tests and 15 physiological measures was used to investigate the sensorimotor, cardiovascular, and neuromuscular adaptations to spaceflight. Astronauts were tested before and after 6-month spaceflights. Subjects were also tested before and after 70 d of 6° head-down bed rest, a spaceflight analog, to examine the role of axial body unloading on the spaceflight results. These subjects included control and exercise groups to examine the effects of exercise during bed rest. Results Spaceflight subjects showed the greatest decrement in performance during functional tasks that required the greatest demand for dynamic control of postural equilibrium which was paralleled by similar decrements in sensorimotor tests that assessed postural and dynamic gait control. Other changes included reduced lower limb muscle performance and increased HR to maintain blood pressure. Exercise performed during bed rest prevented detrimental change in neuromuscular and cardiovascular function; however, both bed rest groups experienced functional and balance deficits similar to spaceflight subjects. Conclusion Bed rest data indicate that body support unloading experienced during spaceflight contributes to postflight postural control dysfunction. Further, the bed rest results in the exercise group of subjects confirm that resistance and aerobic exercises performed during spaceflight can play an integral role in maintaining neuromuscular and cardiovascular functions, which can help in reducing decrements in functional performance. These results indicate that a countermeasure to mitigate postflight postural control dysfunction is required to maintain functional performance.
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Affiliation(s)
| | | | | | | | | | | | | | - Scott J Wood
- Neurosciences Laboratory, NASA-Johnson Space Center, Houston, TX
| | | | - Stuart M C Lee
- Cardiovascular and Vision Laboratory, KBRwyle, Houston, TX
| | - Roxanne E Buxton
- Exercise Physiology and Countermeasures Laboratory, KBRwyle, Houston, TX
| | | | - Michael B Stenger
- Cardiovascular and Vision Laboratory, NASA-Johnson Space Center, Houston, TX
| | | | - Jeffrey W Ryder
- Exercise Physiology and Countermeasures Laboratory, KBRwyle, Houston, TX
| | - Alan H Feiveson
- Biostatistics Laboratory, NASA-Johnson Space Center, Houston, TX
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Kashirina DN, Percy AJ, Pastushkova LK, Borchers CH, Kireev KS, Ivanisenko VA, Kononikhin AS, Nikolaev EN, Larina IM. The molecular mechanisms driving physiological changes after long duration space flights revealed by quantitative analysis of human blood proteins. BMC Med Genomics 2019; 12:45. [PMID: 30871558 PMCID: PMC6416832 DOI: 10.1186/s12920-019-0490-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background The conditions of space flight have a significant effect on the physiological processes in the human body, yet the molecular mechanisms driving physiological changes remain unknown. Methods Blood samples of 18 Russian cosmonauts who had conducted long-duration missions to the International Space Station were collected 30 days before launch and on the first and seventh days after landing. Results A panel of 125 proteins in the blood plasma was quantitated by a well-established and highly regarded targeted mass spectrometry approach. This method involves the monitoring of multiple reactions in conjunction with stable isotope-labeled standards at the University of Victoria - Genome BC Proteomics Centre. Conclusions Reduction of circulating plasma volume during space flight and activation of fluid retention at the final stage of the flight affect the changes in plasma protein concentrations present in the first days after landing. Using an ANOVA approach, it was revealed that only 1 protein (S100A9) reliably responded to space flight conditions. This protein plays an important role in the functioning of the endothelium and can serve as a marker for activation of inflammatory reactions. Concentrations of the proteins of complement, coagulation cascades, and acute phase reactants increase in the blood of cosmonauts as measured the first day after landing. Most of these proteins’ concentrations continue to increase by the 7th day after space flight. Similar dynamics are observed for proteases and their inhibitors. Thus, there is a shift in proteolytic blood systems, which is necessary for the restoration of muscle tissue and maintenance of oncotic homeostasis. Electronic supplementary material The online version of this article (10.1186/s12920-019-0490-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daria N Kashirina
- Institute for Biomedical Problems - Russian Federation State Scientific Research Center of RAS, Moscow, Russia.
| | - Andrew J Percy
- Genome British Columbia Proteomics Centre, University of Victoria, Victoria, BC, Canada
| | - Liudmila Kh Pastushkova
- Institute for Biomedical Problems - Russian Federation State Scientific Research Center of RAS, Moscow, Russia
| | - Christoph H Borchers
- Genome British Columbia Proteomics Centre, University of Victoria, Victoria, BC, Canada
| | - Kirill S Kireev
- Yu.A.Gagarin Research and Test Cosmonaut Training Center, Star City, Moscow Region, Russia
| | - Vladimir A Ivanisenko
- Institute of Cytology and Genetics of SB RAS, Novosibirsk, Russia.,Novosibirsk State University, Novosibirsk, Russia
| | - Alexey S Kononikhin
- Institute for Biomedical Problems - Russian Federation State Scientific Research Center of RAS, Moscow, Russia.,V.L. Talrose Institute for Energy Problems of Chemical Physics, Russian Academy of Sciences, Moscow, Russia.,Moscow Institute of Physics and Technology, Dolgoprudny, Moscow region, Russia
| | - Eugene N Nikolaev
- V.L. Talrose Institute for Energy Problems of Chemical Physics, Russian Academy of Sciences, Moscow, Russia.,Moscow Institute of Physics and Technology, Dolgoprudny, Moscow region, Russia.,Skolkovo Institute of Science and Technology, Skoltech, Moscow region, Russia
| | - Irina M Larina
- Institute for Biomedical Problems - Russian Federation State Scientific Research Center of RAS, Moscow, Russia
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Bryarly M, Phillips LT, Fu Q, Vernino S, Levine BD. Postural Orthostatic Tachycardia Syndrome. J Am Coll Cardiol 2019; 73:1207-1228. [DOI: 10.1016/j.jacc.2018.11.059] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 12/26/2022]
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50
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Goswami N, Blaber AP, Hinghofer-Szalkay H, Convertino VA. Lower Body Negative Pressure: Physiological Effects, Applications, and Implementation. Physiol Rev 2019; 99:807-851. [PMID: 30540225 DOI: 10.1152/physrev.00006.2018] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This review presents lower body negative pressure (LBNP) as a unique tool to investigate the physiology of integrated systemic compensatory responses to altered hemodynamic patterns during conditions of central hypovolemia in humans. An early review published in Physiological Reviews over 40 yr ago (Wolthuis et al. Physiol Rev 54: 566-595, 1974) focused on the use of LBNP as a tool to study effects of central hypovolemia, while more than a decade ago a review appeared that focused on LBNP as a model of hemorrhagic shock (Cooke et al. J Appl Physiol (1985) 96: 1249-1261, 2004). Since then there has been a great deal of new research that has applied LBNP to investigate complex physiological responses to a variety of challenges including orthostasis, hemorrhage, and other important stressors seen in humans such as microgravity encountered during spaceflight. The LBNP stimulus has provided novel insights into the physiology underlying areas such as intolerance to reduced central blood volume, sex differences concerning blood pressure regulation, autonomic dysfunctions, adaptations to exercise training, and effects of space flight. Furthermore, approaching cardiovascular assessment using prediction models for orthostatic capacity in healthy populations, derived from LBNP tolerance protocols, has provided important insights into the mechanisms of orthostatic hypotension and central hypovolemia, especially in some patient populations as well as in healthy subjects. This review also presents a concise discussion of mathematical modeling regarding compensatory responses induced by LBNP. Given the diverse applications of LBNP, it is to be expected that new and innovative applications of LBNP will be developed to explore the complex physiological mechanisms that underline health and disease.
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Affiliation(s)
- Nandu Goswami
- Physiology Section, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz , Graz , Austria ; Department of Biomedical Physiology and Kinesiology, Simon Fraser University , Burnaby, British Columbia , Canada ; Battlefield Health & Trauma Center for Human Integrative Physiology, Combat Casualty Care Research Program, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Andrew Philip Blaber
- Physiology Section, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz , Graz , Austria ; Department of Biomedical Physiology and Kinesiology, Simon Fraser University , Burnaby, British Columbia , Canada ; Battlefield Health & Trauma Center for Human Integrative Physiology, Combat Casualty Care Research Program, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Helmut Hinghofer-Szalkay
- Physiology Section, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz , Graz , Austria ; Department of Biomedical Physiology and Kinesiology, Simon Fraser University , Burnaby, British Columbia , Canada ; Battlefield Health & Trauma Center for Human Integrative Physiology, Combat Casualty Care Research Program, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Victor A Convertino
- Physiology Section, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz , Graz , Austria ; Department of Biomedical Physiology and Kinesiology, Simon Fraser University , Burnaby, British Columbia , Canada ; Battlefield Health & Trauma Center for Human Integrative Physiology, Combat Casualty Care Research Program, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
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