Space Medicine

Challenges and Achievements

Gravity on Earth has shaped the anatomy and physiology of human beings. Exposure to microgravity has been shown to affect the entire body, causing numerous changes, such as a reduction in heart size and blood volume, disturbances of the neurological system, and decreases in bone density and muscle mass. This paper aims to increase the awareness and understanding of humankind’s final frontier.

Thais Russomano, InnovaSpace.

The presence of gravity on Earth has had an integral effect on the development of life over billions of years and shaped the anatomy and physiology of human beings. Exposure to microgravity has been shown to affect the entire body, causing numerous changes, such as a reduction in heart size and blood volume, disturbances of the neurological system, and decreases in bone density and muscle mass. These physiological changes can lead to undesirable health consequences and to operational difficulties, especially in emergency situations.

The growth in private space corporations, the imminent increase in numbers of space tourists, and intentions to prolong the duration and distance of space travel necessitates a greater awareness and understanding of humankind’s final frontier and its potential effects on space travellers. It is vitally important to know more about the characteristics of the space environment and how these affect our health and wellbeing, and anatomy and physiology during spaceflight, including the cardiopulmonary, neuropsychological and muscle-skeleton systems.

A discussion follows of some of the most notable alterations that take place in the body of astronauts when exposed to the environment of space.

The cardiovascular system in space

The removal of all hydrostatic gradients when entering space (microgravity) causes a headward shift of blood and body fluids, resulting in facial oedema and decreased leg volume. This shift is believed to be the primary stimulus for many of the physiological effects of spaceflight, including a reduction in plasma volume, increase in central fluid volume, enlargement of the heart, and an increase in cardiac output on initial exposure to microgravity. However, this is subsequently followed by a decrease in heart size and cardiac output, with a drop in the circulating blood volume as part of the cardiovascular adaptation to microgravity. More recently, neurovascular changes (Spaceflight Associated NeuroOcular Syndrome - SANS) and decreased venous blood flow in veins in the upper body have been identified.

The symptoms of post-flight cardiovascular de-conditioning include low arterial blood pressure, inappropriate increase in resting heart rate and decreased exercise tolerance. This condition exists when there is either an excessive postural decrease in cardiac filling and stroke volume and/or an inadequate compensatory neurohumoral response, resulting in a failure to maintain adequate brain perfusion in an upright position. Post-flight orthostatic intolerance has been reported widely by astronauts and cosmonauts, especially after long-term space missions.

Lung function in space

The effects of short and long-term microgravity exposure on lung volumes, capacities and function have been studied on the ground, in parabolic fights and during space missions.

Parabolic flights have shown that the sternum bone is displaced in the cranial direction in microgravity and is accompanied by an increase in diameter of the lower rib cage. This change in the gravitational gradient also affects the distribution of ventilation and perfusion in the upright human lung. This uneven distribution of ventilation and blood flow within the lungs leads to variations in ventilation-perfusion ratios. Microgravity was expected to abolish completely apicobasal differences in perfusion and its persistence is possibly related to other mechanisms not affected by gravity, such as centralperipheral differences in blood flow and interregional differences in conductance. The diffusion capacity of the lung increased by 62 per cent in a parabolic flight study and by 28 per cent in sustained microgravity, when values were compared with pre-flight standing values.

position of the chest wall was predicted to cause the volume-pressure curve to lie between the standing upright and the supine position curves, with a net result of a reduction in lung volumes.

During the 9-day flight of the Space Life Sciences-1 mission, lung volumes were able to be measured in sustained microgravity and showed a reduction in static and dynamic volumes. The

Humans are terrestrial beings. We have been shaped by Earth’s gravity and atmosphere. Every single cell in our body is affected when exposed to extraterrestrial environments.

Neuropsychology in space

The vestibular system, located within the inner ear, is used by the body to give us our spatial orientation and balance. It is one of the first organs to react to microgravity exposure, with a quick and sometimes intense response to the lack

of gravity. This is known as space motion sickness.

The psychosocial aspects faced by astronauts during space missions are also considered, addressing the coping mechanisms used to deal with confinement, monotony and isolation from family and friends. This important topic affecting humans and their interactions in space, including psychiatric, interpersonal and cultural aspects, becomes even more relevant with the imminent increase in space tourism and longer-term plans for crewed Moon and Mars missions. Astronauts on the International Space Station (ISS), for example, live in an isolated, confined and extreme environment, initiating natural pathophysiological processes of psychosocial adaptation. Although isolated, crews maintain continuous communication with the ground control Mission Support, who provide in-flight guidance and assistance at any time during the flight.

The human muscle-skeleton system

Our muscle-skeleton system is greatly affected by time spent in space and countermeasures are applied to minimise the changes that occur in bones and muscles. It is well known that the amount of weight that bones must support while in space is reduced to almost zero. At the same time, many bones that aid in movement are no longer under the same stresses that they are subjected to on Earth. Bone loss begins within the first few days in space and astronauts are able to regain most, but not all of their bone mass in the months following their return to Earth.

The lack of gravity also has the same detrimental effect on skeletal muscles, especially those that normally act against the force of gravity, such as the calf and quadricep muscles, which become weaker and atrophic. The best way of decreasing the effects of microgravity on the muscle-skeletal system is through the adoption of a routine of daily exercise during a space mission. It is a hard task to keep astronauts healthy in space missions. Countermeasures for the body and mind are needed, together with the use of digital health.

Exercise countermeasures require the adaptation of exercise devices and the use of restraint systems to keep the astronaut in place when performing exercises. A healthy and balanced diet plus supplementary substances, such as vitamin D, are also important for the maintenance of muscles and bones in space.

The importance of an adequate understanding of these and other physiological responses to microgravity, with a view to assuring the good health and wellbeing of astronauts in space, has grown since the beginning of human space exploration and has motivated a series of biomedical experiments in several space missions, such as the Skylab, Space Shuttle, Mir Space Station and ISS programmes. However, many factors associated with spaceflight activities complicate attempts to delineate the time course of physiological responses to microgravity, including:

Sample Size - crew sizes have ranged from 5 to 8 astronauts, with only 2 or 3 of these being allowed to participate in biomedical experiments. Any attempt to extrapolate from this small number to a larger population is unsatisfactory;

Limited Capabilities for Scientific Observations - biomedical experiments are restricted by operational limitations and the time available during a space mission;

Extensive Use of Countermeasures - the prophylactic and therapeutic use of a variety of countermeasures has masked the direct effects attributable to microgravity alone on human adaptation to the space environment;

Different Mission Types - frequent changes of mission profiles make direct comparisons between flights difficult.

Therefore, space analogues on Earth, water and air have been developed, ranging from placing a volunteer on a tilt-table, immersion in a pool (neutral buoyancy facility) or studying the effects of gravitational changes in a parabolic flight. Some analogues can be established in Universities or Research Institutes, with the involvement of professors and grad/undergraduate students. The best scenario would be to have academics from different areas, creating a very inter- and multidisciplinary environment in which to study the human body and mind reactions and adaptations to some simulated aspects of a space mission.

Given the current rise in number of commercial spaceflight organisations, such as SpaceX, Virgin Galactic and Blue Origin, and predicted exponential growth in this space sector, it is vital to better understand some aspects regarding Space Tourism, particularly the medical challenges involved, and also contemplating the next steps for this developing area. The profile of the civilian space traveller, for example, is likely to be very different from that of the well selected and trained professional astronauts, which will impose a range of medical and health challenges to doctors and scientists on the ground. In the evolving spaceflight arena that will increasingly consider longer-duration spaceflights and the potential for Moon bases and Mars exploration, the human factor becomes increasingly important to long-term mission success and to the possibility of humankind living in off-Earth communities.

Besides the use of countermeasures in a space mission, a very important way to medically support astronauts and space tourists is the use of digital health, and in particular, telemedicine.

Telemedicine has been applied to space missions since the first manned spaceflight in 1961, when the ECG of Yuri Gagarin was transmitted to the mission control centre on Earth. The continuous development of digital and communication technologies has progressively improved the way these systems can help monitor the wellbeing of astronauts during space missions and treat clinical conditions.

This technology applied at the ISS has provided some inputs for the provision of healthcare in rural and remote areas of the globe. Groundbased telemedicine and digital health studies have also been conducted to evaluate how these systems could provide health assistance in the management of physical and mental issues through the evaluation of medical procedures and care of different health conditions. However, the great distances in planetary exploration, such as a trip to Mars, leads to time delays in communication with medical personnel on Earth, which can range from three minutes to 24 minutes each way, affecting the application of telehealth in space missions. In terms of telesurgery, for example, a useful tool when there is the need to invasively treat patients who are geographically separated from their physicians, it would be impossible to apply it for a medical situation on Mars, however, it is still a viable technique for missions to low-Earth orbit or the Moon.

It is in this context of the current human space exploration era that InnovaSpace, founded by myself and Administrative Director Mary Upritchard, was born!

InnovaSpace believes in a Space Without Borders and this is our driving ethos. It is a limited company, established and registered in England & Wales in April 2018, with activities in the areas of aerospace medicine, space physiology and telehealth.

A strong Advisory Board, consisting of world-leading researchers and scientists, provides further support in the space life sciences and related areas, covering a wide diversity of fields, such as space pharmacy, nutrition, psychiatry, physiology, biomechanics, aerospace medicine, human factors, parabolic flights and Space/Earth technology transfer, among others.

InnovaSpace is focused across the spectrum of society, from a governmental level through to universities and the industry, whilst also conducting outreach projects with the general public and the young, using the subject of Space and Space Exploration to inspire interest in the STEAM subjects. InnovaSpace also endeavours to assist nations in harnessing the human side of short- and long-term space program goals, as well as developing access to space knowledge and TeleHealth potential in educational institutions.

InnovaSpace has identified Six Factors that are necessary for Space Leadership and Distinction: (1) the Global Bridging of institutes, experts and talent; (2) the enablement of a Space Identity through initiatives, which form a rate of global participation; (3) the empowerment of Innovation through research that is transferable to other sectors; (4) the Facilitation of New Knowledge; (5) the Cultivation of young minds for aerospace and space science through engagement with schools and the development of aligned curricula - For example, our Kids2Mars outreach program, with a model of global participation, has introduced Space and Space Sciences in a motivational manner to children worldwide; (6) Building skilled capacity in highly-complex yet necessary areas for Space Preparedness.

In summary, InnovaSpace is a Think Tank, global and inclusive, multicultural and multidisciplinary in nature, and operating in space, aeronautics and telehealth. Through its work, InnovaSpace establishes collaborations and partnerships with governments, the business sector, academic world, research institutions, non-profit organizations and society as a whole. Its actions aim to conduct innovative activities in teaching and research, provide technical and scientific consultancy and establish a network of professionals, researchers, entrepreneurs, and students, linked by the common theme of the human presence in extreme environments, such as astronauts on orbital missions/ interplanetary trips and aviators/crew members in aeronautical activities.

AUTHOR BIO

Thais Russomano has 30+ yr of experience in Aerospace Med, Space Phys, Telemed & Digital Health. She is an MD with an MSc in Aerospace Med/USA, a PhD in Space Phys- KCL/UK, and was a researcher for 3 yr at DLR/Germany. Founded and coordinated for 18 yr the MicroGPUCRS, BR, is academically linked to many Universities (KCL-UK, Univ of Lisbon-PT, UFCSPA-BR), CEO-InnovaSpace UK, member of IAA Board of Trustees, and was a volunteer Space4Women Mentor-UNOOSA, UN.

Executive Interview with the Guerbet CEO David Hale on ‘innovation4MRI’

How is Guerbet innovating in MRI contrast media and associated technologies?

David: Guerbet is a pioneer with a long history – over 100 years in the field of contrast agents, particularly in MRI, having invented the 1st macrocyclic GBCA, which has been on the market for more than 30 years and in more than 70 countries. This really gives us the opportunity to build very strong relationships with the radiology community and through that better understand their medical needs.

We’re a company with a long-term growth strategy supported by shareholders from the Guerbet family and we invest a significant part of our revenues 10% in R&D (Research & Development). With more than 200 of our employees are dedicated to innovation in 5 R&D centers around the world. They’re actively collaborate with a broad network of academic partners, centers of excellence to strengthen and accelerate our innovation capabilities.

Guerbet’s innovation in MRI is not restricted to the development of contrast agents and injection systems. We’re also actively exploring new approaches in MRI, including the integration of artificial intelligence (AI), this is a way to the future of clinical imaging.

What were Guerbet’s guiding principles over the decades to foster relationships with clients and partners?

At the basis our guiding principle (and this is also our purpose) has really been – can we build a lasting relationship to do something together that enables people to live better. At Guerbet we relentless in our commitment to go further and to help build the future of medical imaging.

Collaborating closely with radiological community, observing and listening, sharing knowledge through multiple educational resources – that allows us to better anticipate what their needs are for patients. And I would add that what makes us unique ‘Guerbet touch’ is with nearly a century of passion and dedication to innovation. This is the commitment that drives our R&D teams to create innovations that serve both radiologists and patients.

How do you see Guerbet’s contribution to the future of medical imaging?

Guerbet will obviously continue to invest in R&D specifically focused on helping our radiologists, delivering on their expectations in their daily practice and help them improve on patient outcomes.

If you think about it, given the ever-increasing volume of information that radiologists are expected to be aware of, about best practices and new techniques in the field of MRI.

For us it seems fairly obvious for us to provide what help we can in this area. Guerbet is committed to staying at the forefront of innovation in MRI and as a leader in the field we believe by sharing information and building new solutions, we can really add value.

About Guerbet

At Guerbet, we build lasting relationships so that we enable people to live better. That is our purpose. A world leader in medical imaging, Guerbet is a publicly traded company on the Euronext Paris Stock Exchange, headquartered in France with offices and production facilities in Europe, the Americas and Asia-Pacific. It has a long-standing reputation as a pioneer in the research and development of contrast media for radiology.

Today, Guerbet contributes to progress made in the diagnosis of major disease areas including cancer, cardiovascular, inflammatory and neurodegenerative diseases. The company’s novel and effective imaging solutions help to improve patient management throughout the world. Guerbet offers a comprehensive range of imaging products, solutions, and services for Diagnostic Imaging –MRI, X Ray, Digital Solutions / AI– and Interventional Imaging, to enhance clinical decision-making, from diagnosis to treatment and follow-up, and improve patients’ quality of life.

For more information, please visit www.guerbet.com.

We’re specifically focused on working on innovation that will improve the radiology practice and benefit patients. One area of innovation is ‘how do we find solutions to reduce gadolinium retention in both in patients and in the environment’. The is an emerging unmet need and in this are Guerbet primarily position to help

David Hale was appointed Chief Executive Officer of Guerbet on January 1, 2020. He joined Guerbet Executive Committee as Chief Commercial Officer in February 2018. David has almost twenty years’ experience in the field of radiology. His international career is characterised by strong geographical mobility, particularly in the United States, France, Germany and Switzerland, contributing to his ability to adapt and succeed in different cultures.

About Innovation4mri

Innovation4MRI.com has been created to provide a source of relevant news about innovation in MRI. The information published on the site has been selected and reviewed for relevance, interest, and outstanding scientific value. The site provides information about 3 pillars of innovation in MRI: scanners (hardware) and image analysis and digital capabilities (software), image-enhancement approaches (including contrast agents), and sustainability (packaging).

Innovation4MRI.com provides summaries and links to research articles, recent reviews, public presentations, and video or podcast interviews with experts. These include interviews with academics and clinicians with expertise in radiology, as well as experts working in private industry. All the resources on the site have been carefully selected because they are particularly relevant to MRI enthusiasts.