Healthcare from Space, Down to Earth

The Sky is the limit. This 20th century cliché is no longer true! With scores of millions on earth malnourished and having major health problems it may appear outlandish to invest in space science and encourage space tourism for the super, super rich. Be that as it may there are many, many bye products which are a direct offshoot of technology customised initially for space exploration, resulting in better healthcare to earthlings on Terra Firma. This article gives a glimpse as to how trillions spent in space exploration may eventually be justified after all – a peep into the fascinating world of space technology enabled healthcare on earth.

K Ganapathy, Director, Apollo Telemedicine Networking Foundation

NASA to send humans to the moon once again – but this time we will stay. This media release says it all. This will be a forerunner to the manned mission to Mars. With 600 individuals already having gone into space in the last 55 years and space tourism having started, extra-terrestrial healthcare is now a reality. Sceptics question mega funding for space projects. It is seldom realised, that phenomenal technological advances in healthcare during the last two decades, is a direct spinoff of technology, primarily developed for space exploration. Cynics argue that proving technology transfer is exceptionally complex. Nevertheless these snapshots illustrate some of the 2000 products identified by NASA as a by-product of space exploration. Bringing space, down to Earth is not a pun. Representing almost one per cent of global economic activity, the multiplier effect and stimulus to health and economic growth is real. There is considerable similarity between probing the emptiness of space on distant galaxies and getting into millimetre sized capillaries in the heart and brain of the unborn – to paraphrase Star Trek, to go “where no man has ever gone before”.

Innovation often originates from technology transfer or spinoffs where the original technology was developed with extremely high standards, with failure not an option. Healthcare designed for extreme environments of space, has improved care on earth. Quarantine during lockdowns is a crude naïve simplistic illustration. Astronauts on the International Space Station (ISS) live and work in an isolated and confined environment under stressful conditions and in a hostile environment. High-level performance is expected throughout.

Space provides a unique environment conducive to studying effectiveness of drugs and to test new drug therapies. There is a potential to decrease drug development and medicinal costs. Economic models suggest that a 10 per cent improvement in failure prediction rates prior to enacting clinical trials could save US$100 million in development costs per drug. An ISS National Lab project from 490 Biotech, Inc., is studying a bioluminescent assay tool kit to reduce failure rate of current drug discovery efforts. If confirmed the tool kit could have a high impact on the estimated US$12 billion market for this technology Deploying wearable sensors and software in the ISS represents the ultimate remote patient monitoring scenario. A wearable tech, called Astroskin, collects scientific data on activity levels, sleep quality and

Global navigation satellite systems developed for space exploration have proved a panacea for disaster responses, telemedicine, tele-education and for safe and efficient transportation.

vital signs, including blood oxygen levels, blood pressure, heart rate and electrical activity, and breathing rate. These products, designed to track the health of astronauts, will eventually make healthcare system on earth more accessible.

As many as 235 astronauts from 18 countries have participated in various healthcare projects in the last 23 years at the ISS located 400 km above the earth. Every one of the remaining 365 who have left earth has also been part of healthcare studies. Following outbreak of Covid-19, in 37 days NASA and the Jet Propulsion Laboratory in Houston developed the VITAL ventilator. 31 licenses were awarded to 100 applicants making it the most licensed NASA technology. When the Perseverance rover made a successful landing on Mars it used ultraviolet laser to look for invisible organic materials. Preliminary work for this resulted in similar devices being used by the pharmaceutical industry and waste water treatment plants offering considerable cost savings. Invisible dental braces, tracking sensors, nutraceuticals, battery-powered surgical instruments, Emergency blankets (survival/anti-shock) and appliances to develop fine motor skills are illustrations of deployment of space technology. 3D printing of living tissue could address shortage of cadaveric organs for transplant. Bio-print facilities to produce functional complex human tissues in a microgravity milieu during Low Earth Orbit flights are in the offing. Techshot has already signed an agreement with a space station company Axiom space to install the first commercial bio-printer on the International space Station (ISS). space station Research platforms paves way for manufacturing in zero gravity. Cultivating clinical-grade stem cells for therapeutic applications in humans—the aim of an ISS National Lab investigation by the Mayo Clinic—may improve understanding of cancer resistance to chemotherapy. Protein crystallisation studies on earth are being extended to the ISS National Lab. Larger and more uniform crystals grown in microgravity help better interpretation of their molecular structures. This may result in new drugs to control cancer growth, improving drug discovery and delivery methods and reducing side effects. A programme through the National Cancer Institute’s Chemical Biology Consortium will conduct multiple protein crystallisation experiments. Cancer-related projects have improved 3D cell culturing methods for higheraccuracy drug testing. The ISS National Lab is a unique research platform available to US researchers from small companies, Fortune 500 companies, research institutions and government agencies, all interested in leveraging microgravity

Merck & Co. utilised the ISS National Lab to grow millions of highly ordered, uniform crystalline particles of the therapeutic monoclonal antibody Keytruda® with the potential to improve drug delivery for patients. The research team’s preliminary results were successful, with crystals grown in microgravity clearly showing more uniform size and distribution. A protein crystal growth project from the Frederick National Laboratory for Cancer Research aims to reveal the structure of RAS proteins produced by three of the most common oncogenes in human cancer. Mutations in RAS proteins are implicated in one fourth of all cancer cases and are involved in early onset and progression of 90 per cent of the deadliest cancers, including lung, colon, and pancreatic cancers. A project from Hauptman Woodward Medical Research Institute, Inc., looks to grow crystals of four proteins associated with human disease. Larger, better-organised crystals of these specific proteins could have a significant impact on drug development for Parkinson’s disease, bovine spongiform encephalopathy, ethyl malonic aciduria, and cutaneous squamous cell carcinoma.

Global navigation satellite systems developed for space exploration have proved a panacea for disaster responses, telemedicine, tele-education and for safe and efficient transportation. Space products include portable broadband telecommunication systems using satellite video phones. These are particularly useful for providing remote healthcare in disaster management.

Charge-coupled devices (CCDs) used on the Hubble Space Telescope to convert a distant star’s light directly into digital images was modified for better imaging of breast tissue. This resulted in new digital mammography biopsy techniques. Reducing light scatter in cameras on spaceships resulted in tiny cameras stationed in malleable fibre optic tubes, negotiating through mm sized blood vessels Miniature cameras for study of the GI tract can be swallowed. Capsules swallowed can be converted into balloons in the stomach reducing gastric capacity. This assisted weight reduction method will compete with invasive bariatric surgery.

Ventricular Assist Device, a life-saving heart pump for patients awaiting heart transplants was designed by combining supercomputer simulation of fluid flow through rocket engines. Programmable pacemakers, micro-transmitters used in foetal monitoring, laser angioplasty and light-emitting diodes (LEDs) used in neurosurgery are all modifications from space technology. Advances in

AUTHOR BIO

K Ganapathy is a Former Secretary and Past President Neurological Society of India, Telemedicine Society of India & Indian Society for Stereotactic & Functional Neurosurgery Hon Distinguished Professor The Tamil Nadu Dr. MGR Medical University. Member Roster of experts Digital Health WHO. Director, Apollo Telemedicine Networking Foundation & Apollo Tele Health Services, India.

Website : www.drkganapathy.com E Mail : drganapathy@apollohospitals.com treatment of osteoporosis and muscle wasting diseases are secondary to study of mechanical loading and tissue remodelling in microgravity environments, a problem encountered in space. Detailed studies in microgravity of cells and microbes have resulted in better understanding of diseases on earth. POCD (Point of Care Diagnostics) where a drop of blood analyses 50 blood parameters and handheld ultrasound smartphone applications are other by-products. Smart watches measuring heart rate, blood pressure, temperature, oxygen saturation are entirely fallout of technology used for space exploration. Wearables include smart vests which will record and transmit temperature and blood sugar.

Admonitions not to float in Cloud Nine but to come down to earth and have one’s feet firmly on the ground may not be really relevant in the years to come. The sky will no longer be the limit for terrestrial problems.