The Future of Personalized Medicine in Space: From Observations to Countermeasures

Abstract

The aim of personalized medicine is to detach from a “one-size fits all approach” and improve patient health by individualization to achieve the best outcomes in disease prevention, diagnosis and treatment. Technological advances in sequencing, improved knowledge of omics, integration with bioinformatics and new in vitro testing formats, have enabled personalized medicine to become a reality. Individual variation in response to environmental factors can affect susceptibility to disease and response to treatments. Space travel exposes humans to environmental stressors that lead to physiological adaptations, from altered cell behavior to abnormal tissue responses, including immune system impairment. In the context of human space flight research, human health studies have shown a significant inter-individual variability in response to space analogue conditions. A substantial degree of variability has been noticed in response to medications (from both an efficacy and toxicity perspective) as well as in susceptibility to damage from radiation exposure and in physiological changes such as loss of bone mineral density and muscle mass in response to deconditioning. At present, personalized medicine for astronauts is limited. With the advent of longer duration missions beyond low Earth orbit, it is imperative that space agencies adopt a personalized strategy for each astronaut, starting from pre-emptive personalized pre-clinical approaches through to individualized countermeasures to minimize harmful physiological changes and find targeted treatment for disease. Advances in space medicine can also be translated to terrestrial applications, and vice versa. This review places the astronaut at the center of personalized medicine, will appraise existing evidence and future preclinical tools as well as clinical, ethical and legal considerations for future space travel.

Physiological adaptations affecting drug pharmacokinetics in space: what do we really know? A critical review of the literature

“…Another important gap concerns the changes in haematological parameters, including the plasma protein levels, which can influence the free drug concentration and could precipitate unwanted adverse reactions. An extensive and complete study on the liver enzymatic pattern is still lacking, including also the polymorphic character of metabolic pathways (Pavez Loriè et al, 2021). Drug excretion is a further parameter that merits further detailed study in light of now dated studies and their controversial results.…”

“…Common medical conditions observed during the short‐duration Space Shuttle flights and longer space missions on the International Space Station (ISS) are space motion sickness (SMS), sleep problems, pain (such as headache, back pain, joint and muscle pain), allergies, skin rashes and dermatitis, sinus congestion, and infectious diseases (Kast et al, 2017; Pavez Loriè et al, 2021; Wotring, 2015). These conditions often require pharmacotherapy and, accordingly, drugs are prescribed and used in space under the assumption that they act in a similar manner as on Earth.…”

“…The highly demanding and stressful work, isolation and confinement, forced interpersonal relationships, circadian rhythm misalignments, and exposure to artificial light as well as to onboard noises can profoundly affect astronauts’ mood and central nervous system well‐being, with attendant consequences on all the organs and physiological systems. Reduced sanitation as well as exposure to radiation can alter human microbial balance, can increase the risk of DNA damage, and may compromise immune system function (Pavez Loriè et al, 2021; Williams et al, 2009). Relatively mild, yet chronic, hypoxia also can be a further stressor.…”

3D bioprinting and Rigenera® micrografting technology: A possible countermeasure for wound healing in spaceflight

“…This could be more easily achieved by recreating 3D skin in vitro models. The development of a three-dimensional construct would mimic a suitable microenvironment so that each type of cell (associated with the scaffold and with the micrografts) can express its own phenotype and perform its own functions ( Yannas, 2018 ; Negut et al, 2020 ; Pavez Loriè et al, 2021 ; Botchkareva and Westgate Editors, 2022 ). Furthermore, the bioprinting technology provides the design and the manufacturing of bioconstructs that are personalized based on the shape and size of the astronauts’ wounds and are biocompatible, biodegradable, and induce angiogenesis ( Yu et al, 2019 ).…”

Synthetic torpor protects rats from exposure to accelerated heavy ions

“…The energy of these particles is so high that shielding of the spacecraft cannot stop them and lead to exposure rates over 200 times higher than the radiation background on Earth 3 . For these very reasons, radiation countermeasures for future missions, including drugs, dietary supplements, and novel shielding, are being investigated [4][5][6][7] .…”