STEM TODAY August 2017, No.23
STEM TODAY August 2017 , No. 23
CONTENTS Physiological Analysis of Skin in Space
Editorial Editor: Mr. Abhishek Kumar Sinha Editor / Technical Advisor: Mr. Martin Cabaniss
STEM Today, August 2017, No.23
Disclaimer ( Non-Commercial Publications ) STEM Today is dedicated for STEM Education and Human Spaceflight. This newsletter is designed for Teachers and Students with interests in Human Spaceflight and learning about NASA’s Human Research Roadmap. The opinion expressed in this newsletter is the opinion based on fact or knowledge gathered from various research articles. Appropriate credit is given to its original authors. The results or information included in this newsletter are from various research articles and appropriate credits are added. The citation of articles are included in Reference Section. The newsletter is not sold for a profit or included in another media or publication that is sold for a profit. Cover Page Moon Rise From the Space Station From his vantage point in low Earth orbit aboard the International Space Station, NASA astronaut Randy Bresnik pointed his camera toward the rising Moon and captured this beautiful image on August 3, 2017. Looking forward to the August 21 total solar eclipse, Bresnik wrote, "Gorgeous moon rise! Such great detail when seen from space. Next full moon marks #Eclipse2017. We’ll be watching from @Space_Station." Image Credit: NASA
Back Cover Space Station Flight Over the Bahamas One of the most recognizable points on the Earth for astronauts to photograph is the Bahamas, captured in striking images many times from the vantage point of the International Space Station. Expedition 52 Flight Engineer Randy Bresnik of NASA took this photo on Aug. 13, 2017, and shared it with his followers on social media. Bresnik said, "The stunning Bahamas were a real treat for us. The vivid turquoise of the water over the reef was absolutely captivating." Image Credit: NASA
STEM Today , August 2017
Editorial Dear Reader
STEM Today, August 2017, No.23
All young people should be prepared to think deeply and to think well so that they have the chance to become the innovators, educators, researchers, and leaders who can solve the most pressing challenges facing our world, both today and tomorrow. But, right now, not enough of our youth have access to quality STEM learning opportunities and too few students see these disciplines as springboards for their careers. According to Marillyn Hewson, "Our children - the elementary, middle and high school students of today - make up a generation that will change our universe forever. This is the generation that will walk on Mars, explore deep space and unlock mysteries that we can’t yet imagine". "They won’t get there alone. It is our job to prepare, inspire and equip them to build the future - and that’s exactly what Generation Beyond is designed to do." STEM Today will inspire and educate people about Spaceflight and effects of Spaceflight on Astronauts. Editor Mr. Abhishek Kumar Sinha
Editorial Dear Reader The Science, Technology, Engineering and Math (STEM) program is designed to inspire the next generation of innovators, explorers, inventors and pioneers to pursue STEM careers. According to former President Barack Obama, " Science is more than a school subject, or the periodic table, or the properties of waves. It is an approach to the world, a critical way to understand and explore and engage with the world, and then have the capacity to change that world..." STEM Today addresses the inadequate number of teachers skilled to educate in Human Spaceflight. It will prepare , inspire and educate teachers about Spaceflight. STEM Today will focus on NASA’S Human Research Roadmap. It will research on long duration spaceflight and put together latest research in Human Spaceflight in its monthly newsletter. Editor / Technical Advisor Mr. Martin Cabaniss
STEM Today, August 2017, No.23
Human Physiology Physiological Analysis of Skin in Space Until 2005 there were no information available concerning the long-term impact of weightlessness on living skin. Apart from itching and dryness of the skin (possibly partly due to the special skin care being used in the ISS), a thinning of the skin and increased sensitivity combined with delayed healing of wounds and also an increased tendency to skin infections have been reported after a long stay in space.
R
Skin Problem in Space
Skin impairments are one of the most frequent health problems that occur during space missions. For example, skin rashes are common on spaceflights. During spaceflight, rashes were observed to occur in the following locations: scalp, face, neck, chest, back, trunk, abdomen, arms, and hands. The appearance of the rashes generally consisted of bumps/nodules and/or small brown scaly patches, with or without petechiae, redness/hyperemia, and itching.
STEM Today, August 2017, No.23
Clinical characterization of rashes onboard ISS [ Crucian et. al.] To generally characterize the rashes occurring on board the ISS from a clinical perspective, a more detailed evaluation of crew medical records documenting in-flight rash occurrence was performed by a NASA flight surgeon. This additional analysis was performed on all crew members who had rash events. This represented a 16-astronaut subset of the overall 46 participating crew members. For each subject, all available information (which could vary between subjects) was used for the evaluation. Rash appearance and location were recorded. In some cases, photographs of the rashes were available. Specific incidence data for reported symptoms from 46 long-duration missions onboard ISS is summarized in Table 1. Spanning all event categories, 70 reports of symptoms potentially related to immune dysregulation were tabulated during flight, including both notable and non-notable events. The accumulated incidence rate for these events was found to be 3.40 events per flight year, or averaging approximately 1.7 events per 6-month ISS expedition crew member. By far, the majority of the adverse events observed on board the ISS were skin rashes (23 events), followed by upper respiratory symptoms, including congestion, rhinitis and/or sneezing (20 events). Tabulating the various types of infectious disease observed during spaceflight (including pharyngitis, skin infection, etc.) indicates at least 13 infectious disease events occurred during the reporting period. A more detailed evaluation of the 70 reported medical events further classified 42 events as "notable". Notable events included such characteristics as prolonged duration, repeated or recurring and/or, being unresponsive to treatment. These 42 notable events were observed in 46% of the crew members, whereas the remaining 54% either experienced no notable events or only events that were not classified as "notable" (Figure 1).
The most likely diagnosis breakdown of these 42 noteworthy events, based on the reported symptoms, is presented in Figure 2. Almost one-half were found to be prolonged rashes, followed by infectious disease, atypical
Page 4
allergies, and cold sores. An evaluation of the 42 notable events in the context of mission kinetics (month) is presented in Table 2. The highest concentration of notable adverse medical events occurred during the first month of flight (18 events); however, beyond the first month, there was a generally even spread of events between months 2 and 6 of flight.
STEM Today, August 2017, No.23
An evaluation of the distribution of the 42 notable medical events among the 46 crew members is presented in Figure 3. Eleven crew members experienced a single notable in-flight medical event, whereas 10 individual crew members experienced 2 or more events. One unique crew member experienced 9 inflight notable medical events.
During spaceflight, rashes were observed to occur in the following locations: scalp, face, neck, chest, back, trunk, abdomen, arms, and hands. The appearance of the rashes generally consisted of bumps/nodules and/or small brown scaly patches, with or without petechiae, redness/hyperemia, and itching. For the disease/symptom categories used in this evaluation, the ISS incidence rate was 3.40 events per flight year. Skin rashes were the most reported event (1.12/flight year) followed by upper respiratory symptoms (0.97/flight year) and various other (non-respiratory) infectious processes. During flight, 46% of crew members reported an event deemed "notable". Among the notable events, 40% were classified as rashes/hypersensitivities. Characterization of on-orbit rashes manifested as redness with irritation, and could present on a variety of body locations.
Page 5
STEM Today, August 2017, No.23
R
A case of persistent skin rash and rhinitis with immune system dysregulation onboard the ISS
For this case report, authors track symptomology, medication use, and research immunology findings for an ISS astronaut during a typical 6-month flight onboard ISS. This particular crewmember experienced a chronic rash, which occurred early and never fully resolved during the course of the mission. Authors overlay observed symptoms with major mission events, to highlight a potential relationship between clinical outcomes and mission stress. This article describes the findings from a single US astronaut during a long-duration 191-day mission onboard the International Space Station (ISS). The subject was participating in a larger in-flight immune study comprising 22 astronauts. Institutional review board approval for the parent investigation was obtained from the Committee for the Protection of Human Subjects at the Johnson Space Center (JSC), Houston, Texas. This ISS mission consisted of 191 flight days from launch to landing. Occurring during this ISS deployment were the dockings of 3 Space Shuttle missions, 2 Soyuz vehicles, 2 Russian "Progress" cargo vehicles, and 1 European Space Agency "ATV" cargo vehicle. The crewmember participated in 5 EVAs (extravehicular activitiesspacewalks). There were also 12 additional EVAs or spacewalks that occurred during Shuttle docked operations. These additional EVAs were performed by Shuttle crewmembers, but required support and guidance by ISS crewmembers. The crewmember also supported other significant on-orbit operations such as relocation of modules and hardware installation. All major mission events, including vehicle docking and/or undocking, and EVAs are represented in Figure 1. Crewmember on-orbit blood, saliva, and urine sample collections are also indicated, as are crewmember circadian rhythm shifts. Generally, these rhythm shifts are purposeful and preplanned by ground control to support mission operations. Other relevant medical data such as symptomatic incidents or periods of relevant medication usage are also represented. Using this information, clinical findings and research data may be interpreted in the context of the mission schedule and on-orbit events.
Page 6
STEM Today, August 2017, No.23
The case study crewmember experienced no unusual symptoms, other than those associated with normal adaptation to microgravity, before flight day 17. The crewmember then developed a rash, possibly dermatitis, on flight day 17. This corresponded to the first period of notable stress in the mission, coinciding with a Shuttle docking and an extremely high workload (Figure 1). The rash presented red, bumpy, and very itchy areas on the back and neck (Figure 2). Coinciding with the rash development was the appearance of eye and upper respiratory rhinitis symptoms, primarily sneezing and itchy, watery eyes. It is noteworthy that the crewmember does not experience terrestrial allergies of any kind and had never previously required any antihistamine medication. The occurrence of symptoms and rash severity over the general mission timeline is presented in Figure 1. Rash severity was tracked on a relative 1-10 scale between the crewmember and flight surgeon, with guidance having been provided to the crewmember to grade based on discomfort and operational impact. The crewmember treated the rash with hydrocortisone cream as needed at the crewmembers’ discretion. The use of this medication was not recorded daily, but per the crewmember, it was used heavily for the duration of the mission. The crewmember was also prescribed fluconazole on mission day 22, on the possibility that the rash could have fungal component. The antifungal had no beneficial effect on the rash. Near to the Shuttle undocking on
Page 7
flight day 27, there was general improvement in the rash severity, and the rhinitis symptoms were treated with, and responded to, an oral antihistamine.
STEM Today, August 2017, No.23
A worsening of rash symptoms occurred around mission day 33, immediately after an EVA, and coinciding with a period of notable on-orbit operations. Terbinafine cream was prescribed for use as needed on flight day 34. The severity of the rash generally diminished to 1-2+ by mission day 48, after 2 more EVAs. On flight day 69, the most challenging EVA (per the crewmember description) occurred. On mission day 71, a crewmate received some distressing personal news regarding a death in the family. This event was a psychological stressor for the entire crew. On mission day 73, the rash flared to its worst point in the 6-month mission, described by the crewmember as 10+.
Authors retrospectively anticipate, based on rash locations, appearance, and discomfort and/or itch, that this level of severity would correspond to approximately 30-37 on the Scoring Atopic Dermatitis scale. At this point, the hydrocortisone cream was exhausted. Triamcinolone acetonide cream was used and was found to be ineffective. A methylprednisolone steroid dosepack was prescribed, and the rash improved during the initial period of the 6-day treatment, with return of symptoms on the fifth day of the tapering. A 30 mg prednisone dose was initiated with a much slower "taper" employed over the following two and a half weeks with excellent control of symptoms. By mission day 88, the subject reported that the rash was again controlled to a 1+/2+ grade. Medications were resupplied during the flight day 119 Shuttle docking, and the crewmember was placed on histamine H1 and H2 blockers for the duration of the mission. The rash was generally well controlled for the duration of the mission, although some notations of the rash persisting were made in the flight surgeon log during the subsequent Shuttle dockings, specifically on flight days 119 and 152. An oral herpesviral reactivation occurred on mission day 146, which was treated with antiviral medication valacyclovir hydrochloride. After landing, both the itch and rash completely resolved within days to 1 week. Fortunately, this crewmember was participating in an immunological research activity, which surveyed various immune parameters at 3 timepoints during the 6-month mission. Compared with preflight baseline data, specific in-flight research findings for this subject include an altered leukocyte distribution (Figure E1), reductions in T-cell function (Figure E2), and altered cytokine production profiles (Figure E4). Also, the subject demonstrated the reactivation and shedding of latent Epstein-Barr virus (EBV) and varicella-zoster virus (VZV) during the mission (Figure E3). Viral reactivation generally occurs concurrently with immune dysregulation. An increase in salivary cortisol was observed, as well as a misalignment in the circadian rhythm of cortisol (Figure E5). This pattern of dysregulation is relatively typical for an ISS astronaut. Authors suggest that during spaceflight, the synergy of stressors affecting the human (microgravity, radiation, psychological and physiological stress, altered atmosphere) may create a dysregulated immune system. Although specific incidence numbers for the ISS are not publicly available, authors are aware of at least 1 other crewmember experiencing a rash phenomenon of similar magnitude, and others with less severity. Other crewmembers have remained completely asymptomatic during ISS missions. Internal NASA incidence numbers reveal that rashes and hypersensitivity reactions are the most reported adverse clinical events. Antihistamines are the second most used medication on the ISS. Unfortunately for this case, it was not possible to perform a standard clinical evaluation. There is no diagnostic laboratory equipment available on the ISS, and NASA flight surgeons are generally constrained to the
Page 8
STEM Today, August 2017, No.23
use of telemedicine and treatment of symptoms. Authors suggest that general immune changes in astronauts represent a dysregulation that may predispose some crewmembers to adverse clinical responses resulting in symptomology.
In the current case, the rash symptomology is consistent with atopic dermatitis, but alternative diagnoses such as a viral exanthema or contact dermatitis cannot be ruled out. Onboard ISS, astronauts use wet wipes for personal hygiene. At any time, there may be several different types of dry wipes, wet wipes, or wet towels (either US or Russian), available on the ISS. Some of these wipes may contain methylisothiazolinone, a known sensitizing allergen, which could promote a contact response. The crewmember recalls most frequently using the Russian-provided wet wipes, of which the specific ingredient formula is unfortunately not known. However, in this case the personal impression of the crewmember is that, based on rash locations, the rash was not likely to be associated with the use of any personal care product. Patch testing, which may have facilitated specific diagnosis, was unfortunately not possible during the mission, and not performed after the mission based on resolution of the symptoms. It is noteworthy, however, that the crewmember continues to report no terrestrial symptoms associated with the use of any similar products. Authors believe that this study onboard the ISS represents the first assessment of immunity, stress, symptomology, and latent herpesvirus reactivation during long-duration spaceflight. Specific clinical risks for deep space exploration missions, consisting of elevated radiation exposure, stress, and no rapid return option, may be increased. The purpose for the current ISS study was to ascertain the in-flight status of the immune system, so that a proper determination of clinical risk (if any) specifically related to immune dysregulation may occur
Page 9
STEM Today, August 2017, No.23
before the initiation of these deep space missions.
This case study provides evidence, albeit in a single subject, that immune dysregulation persists during flight. Moreover, although previously thought to be a largely subclinical phenomenon or a clinical risk only for deep space missions, authors now show that immune-mediated adverse medical events may occur even during prolonged orbital spaceflight. In this subject, the clinical care was well managed and the rash was successfully reduced in magnitude as to not significantly influence mission objectives.
Page 10
Page 11
STEM Today, August 2017, No.23
Although the necessary medications were available, the persistent nature of the symptoms utilized all assets of specific on-orbit medications and drove changes in resupply plans. These issues must be considered as we go forward to ensure that crews are adequately supplied with medications relevant to likely adverse clinical events.
R
Skin fungal Microbiota of Astronauts during a half-year stay at the ISS
This study analyzed the temporal changes in the skin fungal microbiota of 10 astronauts using pyrosequencing and quantitative PCR assay before, during, and after their stay in the ISS. Ten astronauts were involved in this study. They were transported to the ISS by a space shuttle or Soyuz rocket and stayed approximately 5 to 6 months. Samples were collected once prior to the astronauts’ trip to the ISS, twice during their stay at the ISS (at 2 and 4 months during), and once after their return to Earth.
STEM Today, August 2017, No.23
The study protocol was approved by institutional review board, and written informed consent was obtained from each participant. Since there were only a small number of astronauts on each ISS expedition, authors chose not to describe the ISS Expedition number or gender and age of the crew members in this study to prevent easy identification of individuals. Therefore, instead of publishing the actual ISS Expedition number, authors sequentially numbered the Expeditions (1-6) and the astronauts (A-J) (Table 1). For example, astronauts A and B (Expedition 1) were early participants and I and J participated later (Expedition 6) in this study.
Results Characterization of the fungal taxa Taxonomic assignment of each sequence read identified a total of 230 taxa from the 80 samples (from both cheeks and the chest at the 4 sampling times) of the 10 astronauts. The taxonomic assignment of skin fungal community members is shown in Supplementary Table S1. Of the 230 taxa, 178 were filamentous fungi and 52 were yeasts. Nine Malassezia species were detected from the skin samples. The relative abundances of the taxa are shown in Table 1 for M. restricta, M.globosa, M. sympodialis, Cyberlindnera jadinii, and Cladosporium phylotype 4. Malassezia accounted for >90% of the total of most samples regardless of when the skin sample was collected, the sampled body site, or the astronaut. The samples in which Malassezia accounted for <90% of the total contained other microorganisms with rel-
Page 12
STEM Today, August 2017, No.23
atively high abundances. For example, the samples I, C, E, G, and H contained Trichosporon asahii (22.4%), Aspergillus phylotype 1 (30.6%), Acaromyces (20.4%), Trichosporon asahii (52.4%), and M. slooffiae (65.3%), respectively (Table S1).
The Shannon diversity indexwas calculated to determine the diversity at each sampling time: preflight, inflight 1, inflight 2, and post-flight. In both cheek and chest samples, the fungal diversity of the skin samples obtained during the crews’ stay at the ISS was lower than that of the preflight samples; however, in the postflight samples, diversity recovered to the pre-flight level (Fig. 1). Overall, there were no major changes in the colonization levels of the various microorganisms during the crew’s residence at the ISS. Malassezia As a lipophilic fungi, Malassezia is found in humans of all races and both sexes and at all body sites. However, Malassezia colonization decreases as a proportion of total fungal colonization if another microorganism is present in abundance. Therefore, authors measured the level of Malassezia colonization using qPCR with the TaqMan probe. Colonization by Malassezia increased in the cheek and chest samples during the crew’s stay at the ISS and decreased upon their return to Earth (Fig. 2). With the level of colonization in the pre-flight sample set at 1, fold changes of 5.2 ± 6.5, 7.6 ± 7.5, and 2.4 ± 2.6 (mean ± standard deviation) were determined in the cheek samples from the in-flight 1, in-flight 2, and post-flight samples, respectively. In the chest samples, the corresponding fold changes were 9.5 ± 24.2, 9.3 ± 17.2, and 1.4 ± 1.0. Because the ascomycetous yeast Cyberlindnera jadinii was highly abundant in the skin samples of 5 of the 10 astronauts, authors recalculated the abundance of Malassezia determined in the pyrosequencing on a species level. M.restricta, M. globosa, and M. sympodialis were the most abundant, although 9 Malassezia species (M. dermatis, M.furfur, M. globosa, M. japonica, M. nana, M. obtusa, M.restricta, M. slooffiae, and M. sympodialis) were identified in the skin samples of the 10 astronauts. Figure 3 shows the temporal changes in the proportion (%) of M. restricta and eight other Malassezia species. The results showed that despite individual variation, there were no major changes in the proportion (%) of M. restricta in the cheek samples collected pre-flight, in-flight, and post-flight (mean ± standard deviation: 83.4% ± 28.0%, 89.6% ± 18.1%, 84.2% ± 28.0%, and 83.8% ± 26.6%, respectively). A similar analysis of the chest samples showed a higher proportion of M. restricta in the two in-flight samples and a decrease in the post-flight sample. The largest contributor to this decrease was M. sympodialis, which accounted for 23.4% ± 25.3%, 10.9% ± 15.7%, 7.6% ± 11.8%, and 30.1% ± 25.9% of the Malassezia species in the pre-flight, in-flight, and post-flight samples, respectively. The pre-flight sample from the chest of astronaut H contained M. sloffiae at an abundance of 65.3%, whereas the abundances of the other Malassezia species (M. globosa, M. restricta, and M. sympodialis) were 32.1%.
Page 13
STEM Today, August 2017, No.23
Detection of Cyberlindnera jadinii in the astronautsâ&#x20AC;&#x2122; skin samples The ascomycetous yeast Cyberlindnera jadinii was abundantly (>1.0%) detected in the skin samples of 5 (A, B, C, D, and E) of the 10 astronauts. In three of the five astronauts, the yeast was already detected in the preflight samples from the cheek and/or chest at abundances of 1.6% in astronaut B, 4.2% and 41.3% in astronaut C, and 45.2% in astronaut D. In the samples from astronauts A and E, C. jadinii was detected only in the in-flight samples. The microorganism was particularly abundant in the skin (cheek and/or chest) samples obtained during the two in-flight samples from the same three astronauts as above: 40.6% (cheek) and 64.9% (chest) of astro-
Page 14
STEM Today, August 2017, No.23
naut B, 23.1% and 35.5% (cheek) and 28.8% and 41.3% (chest) in astronaut C, and 23.7% and 45.2% (chest) in astronaut D. However, C. jadiniii was not detected in any of the postflight samples of these five astronauts. These astronauts participated in Expeditions 1, 2 and 3. For one astronaut on Expedition 4, the microorganism was present at very low levels (0.1% and 0.4%) in both in-flight samples. C. jadinii was not detected in any of the skin samples of astronauts H, I, or J.
The human body is covered by a wide variety of bacteria and fungi. Among the latter, members of the genus Malassezia are found in abundance at all anatomic sites. Because this yeast requires sebum for its growth, it occurs exclusively in mammals. The fatty acids and glycerin decomposed by the lipase produced by Malassezia are utilized not only by the yeast itself but also by other skin microorganisms. Expression of the Malassezia lipase gene is not sensitive to microgravity. Nonetheless, because the host skin serves as a culture medium for skin microorganisms, changes in its chemical composition, sebum production, the synthesis of antimicrobial peptides, and the skin environment (dry vs. oily skin) will impact the interactions of the skin microbiota. Astronauts who develop oily skin during their stay at the ISS should have higher than baseline (preflight) levels of Malassezia. In fact, in the two in-flight cheek and chest samples, Malassezia colonization increased by 7.6- ± 7.5-fold (mean ± standard deviation) and 9.5- ± 24.2- fold, respectively. This may have been due to stress or to the body-washing method necessitated by space flight, in which astronauts dry-wash their body and hair. In the study of members of an Antarctica geological investigation, who during their 3-month stay were only able to bathe once using a wet tissue but were unable to wash their hair, Malassezia colonization increased from 3.0- ± 1.9-fold to 5.3- ± 7.5-fold in cheek samples, from 8.9- ± 10.6-fold to 22.2- ± 40.0-fold in chest samples, and from 96.7- ± 113.8-fold to 916.9- ± 1251.5-fold in scalp samples. The fold changes in Malassezia colonization were similar in samples from the cheek and chest collected from the ISS crew and Antarctica investigation team members. Malassezia species are responsible for the development of seborrheic dermatitis, in which oleic acid, an unsaturated fatty acid that is hydrolyzed from sebum by Malassezia lipase, causes skin inflammation. The ratio of M. restricta vs. all Malassezia species was higher in the in-flight chest samples of the astronauts and suggests that they are more likely to develop seborrheic dermatitis during space flight. Malassezia and C. jadinii together accounted for >90% of the fungi in the skin samples obtained during the crew’s stay at the ISS: 99.1% ± 1.3% and 97.6% ± 5.2% in cheek samples, and 98.7% ± 1.7% and 91.3% ± 18.4% in chest samples. Whereas the increased percentage of Malassezia during spaceflight was expected, the higher abundance of C. jadinii in the skin samples of the astronauts was not. C. jadinii is an environmental fungus, not a skin fungus. C. jadinii may have incidentally adhered to the skin during the pre-flight period and persisted on the astronauts’ skin thereafter. Because C. jadinii was detected in the in-flight samples from Expedition 1, it likely arrived there during an earlier mission. Cyberlindnera jadinii was present in large amounts in the
Page 15
preflight samples of ISS Expedition 2 but was virtually nonexistent in the samples collected after ISS Expedition 4. The opportunistic yeast pathogen Trichosporon asahii was found in samples from eight astronauts (A, C, D, E, F, G, H, and I); samples from astronauts G and I exhibited a high level of colonization (52.3% and 22.4% from the chest of astronaut G and the cheek of astronaut I, respectively). T. asahii is a resident of the skin and intestinal tract of healthy individuals, but it can cause lifethreatening infection in neutropenic patients. T. asahii is also responsible for the development of summer-type hypersensitivity pneumonia (SHP). SHP develops subsequent to type III or IV allergies by repeated inhalation of environmental Trichosporon arthroconidia. The tinea-causing fungus Trichophyton was present in the in-flight chest sample of astronaut B, albeit at a low level (0.06%). As mentioned above, pathogens such as Cyberlindnera jadini, Trichosporon asahi, and Candida albicans cause opportunistic fungal infection only in the immunocompromised host.
STEM Today, August 2017, No.23
Top 6 microbes found at ISS (Skin)
Page 16
STEM Today, August 2017, No.23
Maximum number of Microbes found at Node 3 Module of ISS
Microbial Analysis of International Space Station (ISS) Air, Surfaces and Water (ISS_Micro_Analysis) NASA Life Sciences Data Archive (http://lsda.jsc.nasa.gov) Investigator Name: Mark Ott Mission (Payload): Expeditions 13, 19 - 43, 45 Experiment Title (ID): Microbial Analysis of International Space Station (ISS) Air, Surfaces and Water (ISS_Micro_Analysis) File name/Inventory ID: ISS_Micro_Analysis_Isolates/ ISS_Micro_Analysis_2010311581 Overview • Bacteria from surface and air samples are isolated on Tryptic Soy Agar for identification • Bacteria are isolated from water samples on ISS using a filtration unit, the Microbial Capture Device (MCD) that contains an R3A medium • Bacteria are also isolated from water samples returned from ISS to the Johnson Space Center in an archive water bag. Samples are processed using an R2A medium • Identification of bacteria was performed using either a VITEK identification system (bioMérieux) or 16S genetic analysis. Sample Locations include: U.S. Modules - Node 1, Node 2, Node 3, U.S. Laboratory, PMM Data Source: NASA Life Sciences Data Archive
Page 17
STEM Today, August 2017, No.23
In Space Skin Falls Off Your Feet (Literally) Video
After 2 1/2 months in Space, astronautsâ&#x20AC;&#x2122; calluses start peeling off. NASA astronauts Mike Massimino and Don Pettit explain why and how in this episode of the ISS Science Garage. NOTE:Staphylococcus epidermidis , Staphylococcus hominis and Staphylococcus capitis microbes are part of the normal human flora, typically the skin flora.
R
Change in Skin Physiological Parameters in Space
Until 2005 there were no information available concerning the long-term impact of weightlessness on living skin. Apart from itching and dryness of the skin (possibly partly due to the special skin care being used in the ISS), a thinning of the skin and increased sensitivity combined with delayed healing of wounds and also an increased tendency to skin infections have been reported after a long stay in space. A pilot study applying noninvasive dermatological test methods before, during and after a longterm mission of an astronaut, single measuring parameters of the skin have been recorded and at the same time possibly positive effects of skin care were examined. For this purpose, a test program was developed which had to be coordinated with the European Space Agency (ESA) with regard to content and time schedule. The measuring devices to be used for the tests in the ISS had to be miniaturized by the manufacturer and subsequently tested as to their suitability for space travel as well as their permissibility. The same went for the selected skin care emulsion. Results Epidermal Measurements Measuring the Hydration of the Stratum Corneum (Corneometer MSC 100) The results of skin physiological measurements of the epidermis are known to depend to a large extent on the conditions of the respective environment and skin adaptation to these conditions. While these measuring conditions in the ISS were more or less stable throughout the measuring period ( table 2 ), the environmental conditions for the measurements before and after the mission - the astronaut stayed in Florida, Cologne, and Moscow,respectively - had an extreme influence on the results, as can be seen from the Corneometer values ( table 3 ). This is why for the analysis of the results, mean values were calculated and those were then (in individual depictions) compared to the mean values of the ISS measurements.
Page 18
STEM Today, August 2017, No.23
Comparison of the mean values of the hydration measurements before, during and after the mission showed that there were only minor differences between the sides (right 1 left). However, there is a clear hydration effect of the applied skin care emulsion ( fig. 1 ). When it comes to the individual values for the measurements in space, both measuring fields on the forearm show an increase in the Corneometer values over time, although the prevailing conditions ( table 2 ) remained unchanged. In addition, there was no clear connection to the TEWL values. An increase in hydration values of this kind is also found in the aging skin. This phenomenon is, however, not a real hydration increase of the aged skin, which is dry, but it is due to a change in measuring area (i.e. the dielectric of the condenser) in favor of epidermis parts containing more water due to a thinning of the stratum corneum ( fig. 2 ).
Measuring TEWL (Tewameter MSC 100) With the measurement of TEWL the capacity of the epidermal barrier can be assessed quantitatively. Low values, which occur in the case of dermatitis atopica or other dermatoses, indicate a barrier disorder. With this method, the mean values also show the stabilizing effect of the skin care treatment carried out during the mission ( fig. 3 ). Furthermore, there is a continuous increase in TEWL values in the untreated measuring field. Whether this tendency is really relevant seems questionable in view of the different conditions for the terrestrial measurements. The individual values determined during the mission show some variation, probably related to the measurement, but no tendency to increase ( fig. 4 ).
Measuring the Surface Structure of the Skin (Surface Evaluation of Living Skin, SELS, SkinVisiometer Version 7/2000, S. Challois-M. Vergeau) With this method, the skin surface structure is recorded with a CCD camera under controlled lighting and its surface parameters [roughness, scaling, smoothness (volume), and wrinkling] are determined via lightness values and the order of the pixels. Constant short-wave lighting and the analysis of the recorded skin field adjusted to it are decisive for the evaluation of skin surface parameters. As a result of the different climatic conditions the test personâ&#x20AC;&#x2122;s skin was subjected to, there was a certain variation in the individual parameters (e.g. as a result of strong scaling) in the terrestrial measurements before the mission ( fig. 5 ). When the photographs of the skin before and after the mission were compared, coarser skin surface fields were noticed ( fig. 6 ). Such an increased coarsening of the skin fields is also found in aging skin ( fig. 7 ), probably as a result of a slowed-down turnover of epidermal cells from the basal layer to the stratum corneum. These findings correlate with the measuring results of the Corneometer, which indicated decreased thickness of the stratum corneum, and they also explain the dermatological complaints of astronauts mentioned earlier.
Page 19
Page 20
STEM Today, August 2017, No.23
Page 21
STEM Today, August 2017, No.23
Page 22
STEM Today, August 2017, No.23
STEM Today, August 2017, No.23
Unfortunately, the Visiometer measurements in space were registered with a deviating recording mode so that a direct quantitative comparison with the terrestrial measurements is not possible ( fig. 8 ). However, when it comes to the determination of the roughness values, skin treated with the emulsion during the mission is evidently smoother. The untreated measuring field shows a tendency toward an increase in roughness over the same period of time ( fig. 9 ).
Measuring Skin Elasticity (Cutometer SEM 575 Version 9.0.2.0) For space technological reasons these measurements, which were, above all, aimed at identifying possible influences at the level of the cutis (elasticity and 20-MHz ultrasound), could only be carried out terrestrially before and after the completion of the mission. During measurements, the skin is sucked into the measuring probe by means of below-atmospheric pressure. Here, the impression depth is recorded by an optical measuring system without contact. It is possible to carry out measurements at constant below-atmospheric pressure and also at linearly decreasing below-atmospheric pressure. Prior to each measurement, maximum pressure, measuring time, the time of pressure rise and fall as well as the number of measuring cycles are set. After the measurement, the respective measuring curve in a coordinate system appears on the monitor. It shows the impression depth of the skin into the measuring probe during action time and its regression afterwards. The characteristic pixels are approached with the cursor and the individual data are recorded.
For the determination of suction elasticity, the skin is sucked into a standardized probe by means of a fixed level of negative pressure. During this suction process and the subsequent release after the negative pressure is no longer there, a typical elasticity curve develops ( fig. 10 ). The total stretching/dilation of the skin (R0 ) as well as the viscoelastic properties in the initial suction phase (R6 ) (Uv/Ue) and the relaxation phase R7 (Ur/Uf)
Page 23
are termed biological elasticity. The combination of the two parts of curve R5 (Ur/Ue) characterizes the elastic properties of the skin ( table 4 ). After the stay in the ISS, all elasticity parameters increased ( table 5 ), different to normal ageing of the skin, which indicates a clear loss of elasticity of the cutis. Morphology of the Cutis Ultrasound B-Scan 20 MHz (DermaScan CV3, Version 1.6.5.0, Cortex Technology, Denmark) The loss of skin elasticity after the stay in space is confirmed by changes in the ultrasound picture of the skin. While before the mission only slight subepidermal photo-aging was visible as a low-echo zone ( fig. 11 ), after the mission there were large low-echo zones in the entire cutis ( fig. 12 ). In other places there were inversions of subcutaneous adipose tissue into the basal cutis as they occur in case of the so-called cellulite in women ( fig. 13 ). These low-echo zones are obviously not the result of an inclusion of liquid in the sense of edema - in that case one would expect decreased values for R0 and increased values for R6 - but are caused by a rarification of the fiber structure in the cutis.
STEM Today, August 2017, No.23
The epidermal measurements provided evidence of a thinning of the stratum corneum and a prolonged molting time of the cells from the stratum basale toward the stratum corneum. These results ( table 6 ) correlate with the reports of the astronauts about the state of the skin during their stay in space. A one-sided treatment with a skin care emulsion during the mission ( table 7 ) led to an improvement in the hydration of the stratum corneum as well as an improvement in the barrier function of the epidermis. Elasticity measurements and especially the ultrasound images of the skin showed signs of a rarification of the cutaneous fiber system. The observed low-echo zones were not due to liquid inclusion in the sense of an edema, which was shown by comparative elasticity tests. The changes in elasticity values (R0 and R6 ) that are typically seen in an edema do not exist. Atrophy due to inactivity, as it occurs in paraplegia, shows clearly smaller and more defined low-echo areas.
Skin Care - Physiological analysis of skin in space (ESA)
The experiment aims at the systematic characterisation of the effects of space on human skin. In the light of previously reported effects of the space environment on skin it is expected that weightlessness and the environment on board the ISS will result in an acceleration of skin ageing. This may lead to the idenfication of corresponding countermeasures in a much shorter time than on Earth. An apparently slight increase of hydration could be shown; it is also a common phenomenon in aging skin. This can be interpreted in relation to the thinning of corneal layers in aging skin and the measuring principle of Corneometry by means of the condensator method. Due to the thinning, deeper parts of the epidermis with more water are measured, which leads to higher hydration values. But overall pre-flight values compared to postflight values showed a slight decrease in skin hydration. The transepidermal water loss increased during the space mission, which shows an impairment of the barrier function of the skin and implies a loss of integrity of the basal lamina. With respect to the Surface Structure of the skin, an increased coarsening of the skin fields has been found. This is also found in aging skin. This could be due to a decreased turnover of epidermal cells from the basal layer up to the stratum corneum and would also explain why the epidermis gets thinner. An explanation of these phenomena might be the flattening of the interface between dermis and epidermis which causes less surface area for proliferative stem cells in the stratum basale. In contrast to the epidermal effects which are reminiscent of aging effects both the biological elasticity and the elastic properties of the dermis increased. This might be due to fluid shifts in weightlessness. However the far more important change observed after the mission was a severe degradation of the dermal connective tissue. This gets apparent through large amorphous low-echo zones on ultrasound images of the skin obtained two weeks after the end of the mission. This is considered not to be due to inactivity like in paraplegia, since corresponding ultrasound images would happen to look different.
Page 24
References Crucian B, Babiak-Vazquez A, Johnston S, Pierson DL, Ott CM, Sams C. Incidence of clinical symptoms during long-duration orbital spaceflight. International Journal of General Medicine. 2016;9:383-391. doi:10.2147 / IJGM.S114188.
Crucian B, Johnston S, Mehta S, Stowe R, Uchakin P, Quiriarte H, Pierson D, Laudenslager ML, Sams C. A case of persistent skin rash and rhinitis with immune system dysregulation onboard the International Space Station. J Allergy Clin Immunol Pract. 2016 Jul-Aug;4(4):759-762.e8. doi: 10.1016/j.jaip.2015.12.021. Epub 2016 Mar 29. PubMed PMID: 27036643.
Oranje AP, Glazenburg EJ, Wolkerstorfer A, de Waard-van der Spek FB. Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. Br J Dermatol. 2007 Oct;157(4):645-8. Epub 2007 Aug 21. Review. PubMed PMID: 17714568.
STEM Today, August 2017, No.23
Sugita, T., Yamazaki, T., Makimura, K., Cho, O., Yamada, S., Ohshima, H., Mukai, C. (2016). Comprehensive analysis of the skin fungal microbiota of astronauts during a half-year stay at the International Space Station. Sabouraudia, 54(3), 232-239.
Bacterial Monitoring in the International Space Station-"Kibo", JAXA.
Bacterial community structure in the International Space Station-"Kibo", JAXA.
Sugita T, Suto H, Unno T et al. Molecular analysis of Malassezia microflora on the skin of atopic dermatitis patients and healthy subjects. J Clin Microbiol 2001; 39: 3486-3490.
Tronnier H, Wiebusch M, Heinrich U. Change in skin physiological parameters in spaceâ&#x20AC;&#x201C;report on and results of the first study on man. Skin Pharmacol Physiol. 2008;21(5):283-92. doi: 10.1159/000148045. Epub 2008 Jul 28. PubMed PMID: 18663342.
Rashes and Exanthems on Long Duration Space Flights,NTRS,NASA.
Eric L Kerstman,Rashes on Space Flights,NASA.
D. Risin, (2008), "Evidence Report on: Risk of Inability to Adequately Treat an Ill or Injured Crewmember", Human Research Evidence Book 2008, Exploration Medical Capability (ExMC) Element, NASA, Johnson Space Center, Houston, Texas, http://humanresearchroadmap.nasa.gov/Evidence/reports/ExMC.pdf.
H. Tronnier, M. Wiebusch, U. Heinrich, (2008), "First Skin Physiological Tests in Weightlessness in the ISS Space Station", International Federation of the Societies of Cosmetic Chemists, 11, 3, pp. 231-238.
S. Mine, N.O. Fortunel, H. Pageon, D. Asselineau, (2008), "Aging alters functionally human dermal papillary fibroblasts but not reticular fibroblasts: a new view of skin morphogenesis and aging", Public Library of Science ONE, 3, 12, pp. e4066.