Personalized medicine in human space flight: using Omics based analyses to develop individualized countermeasures that enhance astronaut safety and performance

Abstract

Space flight is one of the most extreme conditions encountered by humans. Advances in Omics methodologies (genomics, transcriptomics, proteomics, and metabolomics) have revealed that unique differences exist between individuals. These differences can be amplified in extreme conditions, such as space flight. A better understanding of individual differences may allow us to develop personalized countermeasure packages that optimize the safety and performance of each astronaut. In this review, we explore the role of “Omics” in advancing our ability to: (1) more thoroughly describe the biological response of humans in space; (2) describe molecular attributes of individual astronauts that alter the risk profile prior to entering the space environment; (3) deploy Omics techniques in the development of personalized countermeasures; and (4) develop a comprehensive Omics-based assessment and countermeasure platform that will guide human space flight in the future. In this review, we advance the concept of personalized medicine in human space flight, with the goal of enhancing astronaut safety and performance. Because the field is vast, we explore selected examples where biochemical individuality might significantly impact countermeasure development. These include gene and small molecule variants associated with: (1) metabolism of therapeutic drugs used in space; (2) one carbon metabolism and DNA stability; (3) iron metabolism, oxidative stress and damage, and DNA stability; and (4) essential input (Mg and Zn) effects on DNA repair. From these examples, we advance the case that widespread Omics profiling should serve as the foundation for aerospace medicine and research, explore methodological considerations to advance the field, and suggest why personalized medicine may become the standard of care for humans in space.

Ergonomic Challenges for Astronauts during Space Travel and the Need for Space Medicine

“…We will have capitalized on the potential of a commercial return on the development of medicines in space not solely for space travel but for mankind on Earth [75,133]. We will have used the battery of 'omics' technologies [63,64,71,72,74,134] to pre-screen and select astronauts whose health status and predisposition to disease is exquisitely understood [90,134] and for whom the best possible survival outcome is predicted.…”

“…Moreover, the very small number of humans travelling in space may necessitate a detailed understanding of an astronauts genetics and offer both the opportunity for better treatment and the potential to predict response to countermeasures [71,72,74], which may benefit some aspects of personalised healthcare development on Earth [75].…”

“…This allows mission planners to propose and agree mitigation risks, some of which will include the development and refinement of countermeasures. There are many reviews which summarise the potential and actual countermeasures which are in put in place and a representative set is cited for further interest [2, 7,10,34,50,53,57,71,72,74,[76][77][78][79][80][81]. In Table 2, countermeasures in operation today are described for each of the physiological and psychological effects of spaceflight described in the preceding sections.…”

“…Vaccination, screening, pre-mission isolation, diet maintenance [77] Immunological, microbiome and genomic profiling before mission, monitoring during mission [64,71,74] Hard tissue loss Regular resistance training, resistive vibration, nutrition, pharmacological intervention [7,8,10,117] Optimisation of exercise (e.g. vertical treadmills, nutrition and pharmacological regimes.…”

Textbook of Personalized Medicine

“…A better understanding of individual differences may enable development of personalized countermeasure packages that optimize the safety and performance of each astronaut. "Omics" will enhance our ability to: (1) more thoroughly describe the biological response of humans in space; (2) describe molecular attributes of individual astronauts that alter the risk profi le prior to entering the space environment; (3) deploy Omics techniques in the development of personalized countermeasures; and (4) develop a comprehensive Omics-based assessment and countermeasure platform that will guide human space fl ight in the future (Schmidt and Goodwin 2013 ). Selected examples where biochemical individuality might signifi cantly impact countermeasure development include gene and small molecule variants associated with: (1) metabolism of therapeutic drugs used in space; (2) one carbon metabolism and DNA stability; (3) iron metabolism, oxidative stress and damage, and DNA stability; and (4) essential input (Mg and Zn) effects on DNA repair.…”