Immune dysregulation is among the main adverse outcomes of spaceflight. Despite the crucial role of the antibody repertoire in host protection, the effects of spaceflight on the human antibody repertoire are unknown. Consequently, using high-throughput sequencing, we examined the IgM repertoire of five cosmonauts 25 days before launch, after 64 ± 11 and 129 ± 20 days spent on the International Space Station (ISS), and at 1, 7, and 30 days after landing. This is the first study of this kind in humans. Our data revealed that the IgM repertoire of the cosmonauts was different from that of control subjects (n = 4) prior to launch and that two out the five analyzed cosmonauts presented significant changes in their IgM repertoire during the mission. These modifications persisted up to 30 days after landing, likely affected the specificities of IgM binding sites, correlated with changes in the V(D)J recombination process responsible for creating antibody genes, and coincided with a higher stress response. These data confirm that the immune system of approximately half of the astronauts who spent 6 months on the ISS is sensitive to spaceflight conditions, and 2 | BUCHHEIM Et al. F I G U R E 4 The cosmonaut IgM repertoire is different from that of the controls. A, Dot blots show individual dispersion indexes for unique VDJ associations in controls (n = 4) and cosmonauts (n = 5) at the beginning of the study (left panel) and 8 months later for controls or 7 days after landing for cosmonauts (right panel). B, Dot blots show the individual frequency of IGHV replacement footprints at the same time points. Statistically significant differences were found using unpaired t tests (A) and Mann-Whitney U tests (B). *P ≤ .