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Han X, Qu L, Yu M, Ye L, Shi L, Ye G, Yang J, Wang Y, Fan H, Wang Y, Tan Y, Wang C, Li Q, Lei W, Chen J, Liu Z, Shen Z, Li Y, Hu S. Thiamine-modified metabolic reprogramming of human pluripotent stem cell-derived cardiomyocyte under space microgravity. Signal Transduct Target Ther 2024; 9:86. [PMID: 38584163 PMCID: PMC10999445 DOI: 10.1038/s41392-024-01791-7] [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: 06/08/2023] [Revised: 02/08/2024] [Accepted: 03/12/2024] [Indexed: 04/09/2024] Open
Abstract
During spaceflight, the cardiovascular system undergoes remarkable adaptation to microgravity and faces the risk of cardiac remodeling. Therefore, the effects and mechanisms of microgravity on cardiac morphology, physiology, metabolism, and cellular biology need to be further investigated. Since China started constructing the China Space Station (CSS) in 2021, we have taken advantage of the Shenzhou-13 capsule to send human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) to the Tianhe core module of the CSS. In this study, hPSC-CMs subjected to space microgravity showed decreased beating rate and abnormal intracellular calcium cycling. Metabolomic and transcriptomic analyses revealed a battery of metabolic remodeling of hPSC-CMs in spaceflight, especially thiamine metabolism. The microgravity condition blocked the thiamine intake in hPSC-CMs. The decline of thiamine utilization under microgravity or by its antagonistic analog amprolium affected the process of the tricarboxylic acid cycle. It decreased ATP production, which led to cytoskeletal remodeling and calcium homeostasis imbalance in hPSC-CMs. More importantly, in vitro and in vivo studies suggest that thiamine supplementation could reverse the adaptive changes induced by simulated microgravity. This study represents the first astrobiological study on the China Space Station and lays a solid foundation for further aerospace biomedical research. These data indicate that intervention of thiamine-modified metabolic reprogramming in human cardiomyocytes during spaceflight might be a feasible countermeasure against microgravity.
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Affiliation(s)
- Xinglong Han
- Department of Cardiovascular Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College, Soochow University, Suzhou, China
| | - Lina Qu
- State Key Laboratory of Space Medicine, China Astronaut Research and Training Center, Beijing, China
| | - Miao Yu
- Department of Cardiovascular Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College, Soochow University, Suzhou, China
| | - Lingqun Ye
- Department of Cardiovascular Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College, Soochow University, Suzhou, China
| | - Liujia Shi
- State Key Laboratory of Space Medicine, China Astronaut Research and Training Center, Beijing, China
| | - Guangfu Ye
- State Key Laboratory of Space Medicine, China Astronaut Research and Training Center, Beijing, China
| | - Jingsi Yang
- Department of Cardiovascular Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College, Soochow University, Suzhou, China
| | - Yaning Wang
- Department of Cardiovascular Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College, Soochow University, Suzhou, China
| | - Hao Fan
- Department of Cardiovascular Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College, Soochow University, Suzhou, China
| | - Yong Wang
- Department of Cardiovascular Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College, Soochow University, Suzhou, China
| | - Yingjun Tan
- State Key Laboratory of Space Medicine, China Astronaut Research and Training Center, Beijing, China
| | - Chunyan Wang
- State Key Laboratory of Space Medicine, China Astronaut Research and Training Center, Beijing, China
| | - Qi Li
- State Key Laboratory of Space Medicine, China Astronaut Research and Training Center, Beijing, China
| | - Wei Lei
- Department of Cardiovascular Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College, Soochow University, Suzhou, China
| | - Jianghai Chen
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhaoxia Liu
- State Key Laboratory of Space Medicine, China Astronaut Research and Training Center, Beijing, China
| | - Zhenya Shen
- Department of Cardiovascular Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College, Soochow University, Suzhou, China.
| | - Yinghui Li
- State Key Laboratory of Space Medicine, China Astronaut Research and Training Center, Beijing, China.
| | - Shijun Hu
- Department of Cardiovascular Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College, Soochow University, Suzhou, China.
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Pastushkova LH, Goncharova AG, Rusanov VB, Nosovsky AM, Kashirina DN, Popova OV, Larina IM. Correlation between proteome changes and synchrony of cardiac electrical excitation under 3-day «dry immersion» conditions. Front Physiol 2023; 14:1285802. [PMID: 38107479 PMCID: PMC10722197 DOI: 10.3389/fphys.2023.1285802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/24/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
| | | | | | | | | | - O. V. Popova
- State Scientific Center of the Russian Federation, Institute of Medical and Biological Problems Russian Academy of Sciences, Moscow, Russia
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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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Krittanawong C, Scheuring RA. Space and precision cardiovascular health: future perspectives of space travel. Eur Heart J 2023; 44:3498-3500. [PMID: 37264547 DOI: 10.1093/eurheartj/ehad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Chayakrit Krittanawong
- Cardiology Division, NYU Langone Health and NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
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Shibata S, Wakeham DJ, Thomas JD, Abdullah SM, Platts S, Bungo MW, Levine BD. Cardiac Effects of Long-Duration Space Flight. J Am Coll Cardiol 2023; 82:674-684. [PMID: 37587578 DOI: 10.1016/j.jacc.2023.05.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Ventricular mass responds to changes in physical activity and loading, with cardiac hypertrophy after exercise training, and cardiac atrophy after sustained inactivity. Ventricular wall stress (ie, loading) decreases during microgravity. Cardiac atrophy does not plateau during 12 weeks of simulated microgravity but is mitigated by concurrent exercise training. OBJECTIVES The goal of this study was to determine whether the current exercise countermeasures on the International Space Station (ISS) offset cardiac atrophy during prolonged space flight. METHODS We measured left ventricular (LV) and right ventricular (RV) mass and volumes (via magnetic resonance imaging) in 13 astronauts (4 females; age 49 ± 4 years), between 75 and 60 days before and 3 days after 155 ± 31 days aboard the ISS. Furthermore, we assessed total cardiac work between 21 and 7 days before space flight and 15 days before the end of the mission. Data were compared via paired-samples t-tests. RESULTS Total cardiac work was lower during space flight (P = 0.008); however, we observed no meaningful difference in LV mass postflight (pre: 115 ± 30 g vs post: 118 ± 29 g; P = 0.053), with marginally higher LV stroke volume (P = 0.074) and ejection fraction postflight (P = 0.075). RV mass (P = 0.999), RV ejection fraction (P = 0.147), and ventricular end-diastolic (P = 0.934) and end-systolic volumes (P = 0.145) were not different postflight. There were strong positive correlations between the relative change in LV mass with the relative changes in total cardiac output (r = 0.73; P = 0.015) and total cardiac work (r = 0.53; P = 0.112). CONCLUSIONS The current exercise countermeasures used on the ISS appear effective in offsetting reductions in cardiac mass and volume, despite overall reductions in total cardiac work, during prolonged space flight.
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Affiliation(s)
- Shigeki Shibata
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Denis J Wakeham
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Michael W Bungo
- University of Texas Health Science Center, Houston, Texas, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Sharma SN, Meller LLT, Sharma AN, Amsterdam EA. Cardiovascular Adaptations of Space Travel: A Systematic Review. Cardiology 2023; 148:434-440. [PMID: 37302388 PMCID: PMC10614241 DOI: 10.1159/000531466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Space travel imposes significant gravitational and radiation stress on both cellular and systemic physiology, resulting in myriad cardiovascular changes that have not been fully characterized. METHODS We conducted a systematic review of the cellular and clinical adaptations of the cardiovascular system after exposure to real or simulated space travel in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed and Cochrane databases were searched in June 2021 for all peer-reviewed articles published since 1950 related to the following search terms entered in separate pairs: "cardiology and space" and "cardiology and astronaut." Only cellular and clinical studies in English concerning the investigation of cardiology and space were included. RESULTS Eighteen studies were identified, comprising 14 clinical and 4 cellular investigations. On the genetic level, pluripotent stem cells in humans and cardiomyocytes in mice displayed increased beat irregularity, with clinical studies revealing a persistent increase in heart rate after space travel. Further cardiovascular adaptations included a higher frequency of orthostatic tachycardia but no evidence of orthostatic hypotension, after return to sea level. Hemoglobin concentration was also consistently decreased after return to Earth. No consistent change in systolic or diastolic blood pressure or any clinically significant arrhythmias were observed during or after space travel. CONCLUSION Changes in oxygen carrying capacity, blood pressure, and post-flight orthostatic tachycardia may serve as reasons to further screen for pre-existing anemic and hypotensive conditions among astronauts.
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Affiliation(s)
| | - Leo L T Meller
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Ajay Nair Sharma
- School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Ezra A Amsterdam
- Division of Cardiology, Department of Internal Medicine, University of California, Davis, California, USA
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Popova OV, Rusanov VB. Is space flight arrhythmogenic? Front Physiol 2023; 14:1162355. [PMID: 37250132 PMCID: PMC10213435 DOI: 10.3389/fphys.2023.1162355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/17/2023] [Indexed: 05/31/2023] Open
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Veliz AL, Mamoun L, Hughes L, Vega R, Holmes B, Monteon A, Bray J, Pecaut MJ, Kearns-Jonker M. Transcriptomic Effects on the Mouse Heart Following 30 Days on the International Space Station. Biomolecules 2023; 13:biom13020371. [PMID: 36830740 PMCID: PMC9953463 DOI: 10.3390/biom13020371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
Efforts to understand the impact of spaceflight on the human body stem from growing interest in long-term space travel. Multiple organ systems are affected by microgravity and radiation, including the cardiovascular system. Previous transcriptomic studies have sought to reveal the changes in gene expression after spaceflight. However, little is known about the impact of long-term spaceflight on the mouse heart in vivo. This study focuses on the transcriptomic changes in the hearts of female C57BL/6J mice flown on the International Space Station (ISS) for 30 days. RNA was isolated from the hearts of three flight and three comparable ground control mice and RNA sequencing was performed. Our analyses showed that 1147 transcripts were significantly regulated after spaceflight. The MAPK, PI3K-Akt, and GPCR signaling pathways were predicted to be activated. Transcripts related to cytoskeleton breakdown and organization were upregulated, but no significant change in the expression of extracellular matrix (ECM) components or oxidative stress pathway-associated transcripts occurred. Our results indicate an absence of cellular senescence, and a significant upregulation of transcripts associated with the cell cycle. Transcripts related to cellular maintenance and survival were most affected by spaceflight, suggesting that cardiovascular transcriptome initiates an adaptive response to long-term spaceflight.
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Affiliation(s)
- Alicia L. Veliz
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
| | - Lana Mamoun
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
| | - Lorelei Hughes
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
| | - Richard Vega
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
| | - Bailey Holmes
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
| | - Andrea Monteon
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
| | - Jillian Bray
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
| | - Michael J. Pecaut
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
| | - Mary Kearns-Jonker
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
- Correspondence:
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Sy MR, Keefe JA, Sutton JP, Wehrens XHT. Cardiac function, structural, and electrical remodeling by microgravity exposure. Am J Physiol Heart Circ Physiol 2023; 324:H1-H13. [PMID: 36399385 PMCID: PMC9762974 DOI: 10.1152/ajpheart.00611.2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022]
Abstract
Space medicine is key to the human exploration of outer space and pushes the boundaries of science, technology, and medicine. Because of harsh environmental conditions related to microgravity and other factors and hazards in outer space, astronauts and spaceflight participants face unique health and medical challenges, including those related to the heart. In this review, we summarize the literature regarding the effects of spaceflight on cardiac structure and function. We also provide an in-depth review of the literature regarding the effects of microgravity on cardiac calcium handling. Our review can inform future mechanistic and therapeutic studies and is applicable to other physiological states similar to microgravity such as prolonged horizontal bed rest and immobilization.
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Affiliation(s)
- Mary R Sy
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas
- Department of Integrative Physiology, Baylor College of Medicine, Houston, Texas
| | - Joshua A Keefe
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas
- Department of Integrative Physiology, Baylor College of Medicine, Houston, Texas
| | - Jeffrey P Sutton
- Center for Space Medicine, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Xander H T Wehrens
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas
- Department of Integrative Physiology, Baylor College of Medicine, Houston, Texas
- Center for Space Medicine, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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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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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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12
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Mian A, Aamir Mian M. Space Medicine: Inspiring a new generation of physicians. Postgrad Med J 2022:7150864. [PMID: 37137531 DOI: 10.1136/pmj-2022-141875] [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: 04/27/2022] [Accepted: 06/18/2022] [Indexed: 11/03/2022]
Abstract
Space medicine is critical in enabling safe human exploration of space. The discipline focuses on supporting human survival, health, and performance in the austere environment of space. It is set to grow ever more important as significant transitions in the standard of space operations in the suborbital, low earth orbit (LEO) and beyond LEO domains will take place in the coming years. NASA along with their international and commercial partners have committed to returning to the Moon through the Artemis missions in this decade with the aim of achieving a permanent sustainable human presence on the lunar surface. Additionally, the development of reusable rockets is set to increase the number and frequency of humans going to space by making space travel more accessible. Commercial spaceflight and missions beyond LEO present many new challenges which space medicine physicians and researchers will need to address. Space medicine operates at the frontier of exploration, engineering, science and medicine. Aviation and Space Medicine (ASM) is the latest specialty to be recognised by the Royal College of Physicians and the General Medical Council in the UK. In this paper, we provide an introduction to space medicine, review the effects of spaceflight on human physiology and health along with countermeasures, medical and surgical issues in space, the varied roles of the ASM physician, challenges to UK space medicine practice and related research, and finally we explore the current representation of space medicine within the undergraduate curriculum.
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Affiliation(s)
- Areeb Mian
- Department of Surgery, University of Cambridge, Cambridge, UK
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13
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Levine BD, Nicol ED, Davos CH. Space: The Final Frontier? Eur J Prev Cardiol 2022; 29:1396-1398. [PMID: 35711101 DOI: 10.1093/eurjpc/zwac125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas and The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Edward D Nicol
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
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14
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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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Jirak P, Mirna M, Rezar R, Motloch LJ, Lichtenauer M, Jordan J, Binneboessel S, Tank J, Limper U, Jung C. How spaceflight challenges human cardiovascular health. Eur J Prev Cardiol 2022; 29:1399-1411. [PMID: 35148376 DOI: 10.1093/eurjpc/zwac029] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/08/2022] [Accepted: 02/06/2022] [Indexed: 11/14/2022]
Abstract
The harsh environmental conditions in space, particularly weightlessness and radiation exposure, can negatively affect cardiovascular function and structure. In the future, preventive cardiology will be crucial in enabling safe space travel. Indeed, future space missions destined to the Moon and from there to Mars will create new challenges to cardiovascular health while limiting medical management. Moreover, commercial spaceflight evolves rapidly such that older persons with cardiovascular risk factors will be exposed to space conditions. This review provides an overview on studies conducted in space and in terrestrial models, particularly head-down bedrest studies. These studies showed that weightlessness elicits a fluid shift towards the head, which likely predisposes to the spaceflight-associated neuro-ocular syndrome, neck vein thrombosis, and orthostatic intolerance after return to Earth. Moreover, cardiovascular unloading produces cardiopulmonary deconditioning which may be associated with cardiac atrophy. In addition to limiting physical performance, the mechanism further worsens orthostatic tolerance after return to Earth. Finally, space conditions may directly affect vascular health, however, the clinical relevance of these findings in terms of morbidity and mortality is unknown. Targeted preventive measures, which are referred to as countermeasures in aerospace medicine, and technologies to identify vascular risks early on will be required to maintain cardiovascular performance and health during future space missions.
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Affiliation(s)
- Peter Jirak
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Moritz Mirna
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Richard Rezar
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas J Motloch
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Michael Lichtenauer
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany.,Medical Faculty, University of Cologne, Germany
| | - Stephan Binneboessel
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Germany
| | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Ulrich Limper
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany.,Department of Anaesthesiology and Critical Care Medicine, Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Germany
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Zilli Vieira CL, Link MS, Garshick E, Peralta AA, Luttmann-Gibson H, Laden F, Liu M, Gold DR, Koutrakis P. Solar and geomagnetic activity enhance the effects of air pollutants on atrial fibrillation. Europace 2021; 24:713-720. [PMID: 34791174 DOI: 10.1093/europace/euab269] [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: 08/17/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Cardiac arrhythmias have been associated with intense solar and geomagnetic activity (SGA) and exposures to air pollution. METHODS We examined whether oscillations of SGA can modify the effect of hourly exposures to air pollutants on atrial fibrillation ≥30 s (AF) risk in patients with dual-chamber implantable cardioverter-defibrillators. The effects of SGA on ambient particulate matter <2.5 µm (PM2.5), black carbon (BC), ultrafine particles (PN), and associations with AF were assessed. Measures of SGA included solar wind proton density (SW), total interplanetary magnetic field strength (IMF), and Kp index, a measure of global geomagnetic activity. RESULTS Overall time lags between 0 and 24 h, periods of increased SGA (>50th percentile in IMF, SW, and Kp index) enhanced the effects of all three air pollutants on AF, while during periods of reduced SGA the associations were considerably weaker or absent. During periods of intense SW 6 h prior to an AF event, the odds ratio (OR) for PM2.5 exposure per interquartile range (IQR) of 5.6 µg/m3 was 1.7 [95% confident interval (CI) 1.3-2.3, P = 0.0001]. For periods of reduced SW, the OR for PM2.5 exposure per IQR was 1.2 (95% CI 0.9-1.5; P = 0.27). There were similar effects for PN and BC exposures. In patients with multiple AF events per hour, the associations with air pollutants during intense SGA were even greater. CONCLUSION The effects of air pollutants up to 24 h before AF events were enhanced during periods of increased SGA. Our results suggest that these effects may account for variation in AF risk.
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Affiliation(s)
- Carolina L Zilli Vieira
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Boston, MA, 02215, USA
| | - Mark S Link
- Department of Medicine, Division of Cardiology, UT Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX, 75390, USA
| | - Eric Garshick
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section, VA Boston Healthcare System, 150S Huntington Ave, Boston, MA, 02130, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Adjani A Peralta
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Boston, MA, 02215, USA
| | - Heike Luttmann-Gibson
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Boston, MA, 02215, USA
| | - Francine Laden
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Boston, MA, 02215, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Epidemiology, Harvard School of Public Health, 401 Park Drive, Boston, MA, USA
| | - Man Liu
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Boston, MA, 02215, USA
| | - Diane R Gold
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Boston, MA, 02215, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Boston, MA, 02215, USA
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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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18
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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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19
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Tissue Chips in Space: Modeling Human Diseases in Microgravity. Pharm Res 2019; 37:8. [PMID: 31848830 DOI: 10.1007/s11095-019-2742-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Microphysiological systems (MPS), also known as "organs-on-chips" or "tissue chips," leverage recent advances in cell biology, tissue engineering, and microfabrication to create in vitro models of human organs and tissues. These systems offer promising solutions for modeling human physiology and disease in vitro and have multiple applications in areas where traditional cell culture and animal models fall short. Recently, the National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health (NIH) and the International Space Station (ISS) U.S. National Laboratory have coordinated efforts to facilitate the launch and use of these MPS platforms onboard the ISS. Here, we provide an introduction to the NIH Tissue Chips in Space initiative and an overview of the coordinated efforts between NIH and the ISS National Laboratory. We also highlight the current progress in addressing the scientific and technical challenges encountered in the development of these ambitious projects. Finally, we describe the potential impact of the Tissue Chips in Space program for the MPS field as well as the wider biomedical and health research communities.
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